Viral CNS infections in children from a malaria-endemic area of Malawi: a prospective cohort study
Viral CNS infections in children from a malaria-endemic area of Malawi: a prospective cohort study
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DOI：
10.1016/s2214-109x(13)70060-3
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发表时间：
2013-09-01
影响因子：
34.3
通讯作者：
Solomon, Tom
中科院分区：
文献类型：
--
作者：
Mallewa, Macpherson;Vallely, Pam;Solomon, Tom
发热伴意识减退是撒哈拉以南非洲地区儿童入院的重要原因，死亡率高。脑型疟疾是一个重要的病因，当急性恶性疟原虫感染和昏迷被记录下来而没有其他明显的原因时，就被诊断为脑型疟疾。我们调查了病毒是否也可能是中枢神经系统感染的一个重要原因，在这样的病人，并检查病毒病原体和疟疾parasitaemia.Methods的相对贡献，我们做了一个前瞻性队列研究，在马拉维的布兰太尔。从2002年3月1日至2004年8月31日，我们招募了年龄在2个月至15岁之间的儿童，他们因疑似非细菌性CNS感染而入院。脑脊液（CSF）白色细胞计数低于1000个细胞/μ L且细菌显微镜检查和培养阴性的儿童被认为疑似病毒CNS感染。检查血液中的无性型恶性疟原虫。对脑脊液或死后脑活检标本进行PCR检测15种已知引起CNS infection.Findings的病毒，完整的结果数据可用于513名儿童疑似病毒性CNS感染，其中94人（18%）死亡。163名儿童（32%）患有恶性疟原虫寄生虫血症，其中34名（21%）死亡。在133名儿童（26%）的中枢神经系统中检测到至少一种病毒，其中43名（33%）死亡。检测到12种不同的病毒;腺病毒是最常见的，影响42名儿童;腮腺炎，人类疱疹病毒6，狂犬病，巨细胞病毒，单纯疱疹病毒1和肠道病毒也很重要。513名儿童中有45名（9%）同时患有寄生虫血症和病毒感染，其中78名临床诊断为脑型疟疾的儿童中有27名（35%）。双重感染的儿童比单纯寄生虫病、单纯病毒感染或两者都没有的儿童更容易癫痫发作（p
Background Fever with reduced consciousness is an important cause of hospital admission of children in sub-Saharan Africa, with high mortality. Cerebral malaria, diagnosed when acute Plasmodium falciparum infection and coma are recorded with no other apparent reason, is one important cause. We investigated whether viruses could also be an important cause of CNS infection in such patients, and examined the relative contribution of viral pathogens and malaria parasitaemia.Methods We did a prospective cohort study in Blantyre, Malawi. From March 1, 2002, to Aug 31, 2004, we enrolled children aged between 2 months and 15 years who were admitted to hospital with suspected non-bacterial CNS infections. Children with a cerebrospinal fluid (CSF) white cell count of less than 1000 cells per mu L and negative bacterial microscopy and culture were deemed to have suspected viral CNS infection. Blood was examined for asexual forms of P falciparum. PCR was done on CSF or on post-mortem brain biopsy specimens to detect 15 viruses known to cause CNS infection.Findings Full outcome data were available for 513 children with suspected viral CNS infection, of whom 94 (18%) died. 163 children (32%) had P falciparum parasitaemia, of whom 34 (21%) died. At least one virus was detected in the CNS in 133 children (26%), of whom 43 (33%) died. 12 different viruses were detected; adenovirus was the most common, affecting 42 children; mumps, human herpes virus 6, rabies, cytomegalovirus, herpes simplex virus 1, and enterovirus were also important. 45 (9%) of the 513 children had both parasitaemia and viral infection, including 27 (35%) of 78 diagnosed clinically with cerebral malaria. Children with dual infection were more likely to have seizures than were those with parasitaemia alone, viral infection only, or neither (p