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Viral, Bacterial, Metabolic, and Autoimmune Causes of Severe Acute Encephalopathy in Sub-Saharan Africa: A Multicenter Cohort Study.
Edridge, Arthur; Namazzi, Ruth; Tebulo, Andrew; Mfizi, Anan; Deijs, Martin; Koekkoek, Sylvie; de Wever, Bob; van der Ende, Arie; Umiwana, Jeanine; de Jong, Menno D; Jans, Judith; Verhoeven-Duif, Nanda; Titulaer, Maarten; van Karnebeek, Clara; Seydel, Karl; Taylor, Terrie; Asiimwe-Kateera, Brenda; van der Hoek, Lia; Kabayiza, Jean-Claude; Mallewa, Macpherson; Idro, Richard; Boele van Hensbroek, Michael; van Woensel, Job B M.
Afiliação
  • Edridge A; Amsterdam Centre for Global Child Health, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Department of Medical Microbiology & Infection Prevention, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. Electronic address: a.w.edridge@a
  • Namazzi R; Department of Paediatrics, Makerere University, Kampala, Uganda.
  • Tebulo A; Blantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi.
  • Mfizi A; Department of Paediatrics, University Teaching Hospital of Kigali, Kigali, Rwanda.
  • Deijs M; Department of Medical Microbiology & Infection Prevention, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
  • Koekkoek S; Department of Medical Microbiology & Infection Prevention, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
  • de Wever B; Department of Medical Microbiology & Infection Prevention, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
  • van der Ende A; Department of Medical Microbiology & Infection Prevention, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
  • Umiwana J; Department of Paediatrics, University Teaching Hospital of Kigali, Kigali, Rwanda.
  • de Jong MD; Department of Medical Microbiology & Infection Prevention, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
  • Jans J; Laboratory of Metabolic Diseases, UMC Utrecht, Utrecht, The Netherlands.
  • Verhoeven-Duif N; Laboratory of Metabolic Diseases, UMC Utrecht, Utrecht, The Netherlands.
  • Titulaer M; Department of Neurology, ErasmusMC, Rotterdam, The Netherlands.
  • van Karnebeek C; Departments of Pediatrics and Human Genetics, Emma Center for Personalized Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
  • Seydel K; Blantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi; Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, MI.
  • Taylor T; Blantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi; Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, MI.
  • Asiimwe-Kateera B; College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
  • van der Hoek L; Department of Medical Microbiology & Infection Prevention, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
  • Kabayiza JC; Department of Paediatrics, University Teaching Hospital of Kigali, Kigali, Rwanda.
  • Mallewa M; Blantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi.
  • Idro R; Department of Paediatrics, Makerere University, Kampala, Uganda.
  • Boele van Hensbroek M; Amsterdam Centre for Global Child Health, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
  • van Woensel JBM; Amsterdam Centre for Global Child Health, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Paediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands.
J Pediatr ; 258: 113360, 2023 07.
Article em En | MEDLINE | ID: mdl-36828342
OBJECTIVES: To assess whether viral, bacterial, metabolic, and autoimmune diseases are missed by conventional diagnostics among children with severe acute encephalopathy in sub-Saharan Africa. STUDY DESIGN: One hundred thirty-four children (6 months to 18 years) presenting with nontraumatic coma or convulsive status epilepticus to 1 of 4 medical referral centers in Uganda, Malawi, and Rwanda were enrolled between 2015 and 2016. Locally available diagnostic tests could be supplemented in 117 patients by viral, bacterial, and 16s quantitative polymerase chain reaction testing, metagenomics, untargeted metabolomics, and autoimmune immunohistochemistry screening. RESULTS: Fourteen (12%) cases of viral encephalopathies, 8 (7%) cases of bacterial central nervous system (CNS) infections, and 4 (4%) cases of inherited metabolic disorders (IMDs) were newly identified by additional diagnostic testing as the most likely cause of encephalopathy. No confirmed cases of autoimmune encephalitis were found. Patients for whom additional diagnostic testing aided causal evaluation (aOR 3.59, 90% CI 1.57-8.36), patients with a viral CNS infection (aOR 7.91, 90% CI 2.49-30.07), and patients with an IMD (aOR 9.10, 90% CI 1.37-110.45) were at increased risk for poor outcome of disease. CONCLUSIONS: Viral and bacterial CNS infections and IMDs are prevalent causes of severe acute encephalopathy in children in Uganda, Malawi, and Rwanda that are missed by conventional diagnostics and are associated with poor outcome of disease. Improved diagnostic capacity may increase diagnostic yield and might improve outcome of disease.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Encefalopatias / Encefalite / Doenças Metabólicas Tipo de estudo: Clinical_trials / Diagnostic_studies / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Child / Humans País/Região como assunto: Africa Idioma: En Revista: J Pediatr Ano de publicação: 2023 Tipo de documento: Article País de publicação: Estados Unidos
Texto completo
Adicionar na Minha BVS
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Encefalopatias / Encefalite / Doenças Metabólicas Tipo de estudo: Clinical_trials / Diagnostic_studies / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Child / Humans País/Região como assunto: Africa Idioma: En Revista: J Pediatr Ano de publicação: 2023 Tipo de documento: Article País de publicação: Estados Unidos