Presentation and Outcomes of Lassa Fever in Children in Nigeria: A Prospective Cohort Study (LASCOPE)
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Titre
Presentation and Outcomes of Lassa Fever in Children in Nigeria: A Prospective Cohort Study (LASCOPE)
Sujet
Description
Data on the presentation, management, and outcomes of Lassa fever (LF) in children are limited.
Key Points
- Lassa fever fatality is lower in children over 12 months old than in adults.
- Upper gastrointestinal symptoms should prompt immediate testing in highly endemic areas.
- The frequent need for transfusion raises concern about the use of ribavirin.
Date
2024-08-21
Citer ce document
Alexandre Duvignaud, Ijeoma C Etafo, Marie Jaspard, Qasim Salau, Béatrice Serra, Abiodun J Kareem, Sylvain Juchet, Tolulope O Jegede, Delphine Gabillard, Abiodun T Abidoye, Camille Le Gal, Chukwuyem Abejegah, Sampson Owhin, Kevin Okwaraeke, Mahamadou Doutchi, Jackson Katembo Vihundira, Rene-M Besong-Lache, Benjamin Seri, Marion Bérerd-Camara, Alex P A Salam, Adebola Olayinka, Peter Horby, Ephraim Ogbaini-Emovon, Sophie Duraffour, Liasu A Ahmed, Stephan Günther, Akinola N Adedosu, Xavier Anglaret, Denis Malvy, Hans J Lang, Oladele O Ayodeji, Presentation and Outcomes of Lassa Fever in Children in Nigeria: A Prospective Cohort Study (LASCOPE), Journal of the Pediatric Infectious Diseases Society, Volume 13, Issue 10, October 2024, Pages 513–522, https://doi.org/10.1093/jpids/piae083
Résumé
Background
Data on the presentation, management, and outcomes of Lassa fever (LF) in children are limited.
Methods
Description of the clinical and biological features, treatment, and outcomes of reverse transcriptase and polymerase chain reaction (RT-PCR)-confirmed LF in children aged under 15, enrolled in the LASsa fever clinical COurse and Prognostic factors in an Epidemic context (LASCOPE) prospective cohort study in Nigeria between April 2018 and February 2023.
Results
One hundred twenty-four children (aged under 12 months: 19; over 12 months: 105) were hospitalized with RT-PCR-confirmed LF. All received intravenous ribavirin. During follow-up, 99/124 (80%) had fever; 71/124 (57%) had digestive symptoms, vomiting (n = 56/122, 46%) and abdominal pain (n = 34/78 aged ≥5 years, 44%) more often than diarrhea (n = 19/124, 15%); 17/124 (14%) had hemorrhagic signs; 44/112 (39%) had a hematocrit lower than 25%, of whom 32/44 (73%) received transfusions; 44/88 (50%) developed hypotension; 18/112 (16.1%) developed kidney disease improving global outcome (KDIGO) ≥2 acute kidney injury; 10/112 (8.9%) had KDIGO 3 acute kidney failure; 4/124 (3.2%) underwent renal replacement therapy. Seven children died, including 4 aged under 12 months (case fatality rate: under 12 months—22%, 95% confidence interval (CI): 7%–48%; over 12 months—2.9%, 95% CI: 0.7%–8.7%). In univariable analysis, age (P = .003), impaired consciousness (P = .026), and Lassa RT-PCR Ct value (P = .006) were associated with Day 30 mortality.
Conclusions
The fatality rate for children over 12 months hospitalized with LF was lower than that previously reported for adults. Hypotension and acute kidney injury were the most frequent organ dysfunctions. Bleeding was relatively infrequent. Anemia and the need for transfusion were common, the relative contribution of ribavirin-induced hemolysis being unknown.
Topics: anemia polymerase chain reaction hypotension abdominal pain hemorrhage consciousness disturbance renal failure, acute fever blood transfusion digestion gastrointestinal system lassa fever nigeria prospective studies reverse transcriptase polymerase chain reaction ribavirin vomiting hematocrit transfusion
Data on the presentation, management, and outcomes of Lassa fever (LF) in children are limited.
Methods
Description of the clinical and biological features, treatment, and outcomes of reverse transcriptase and polymerase chain reaction (RT-PCR)-confirmed LF in children aged under 15, enrolled in the LASsa fever clinical COurse and Prognostic factors in an Epidemic context (LASCOPE) prospective cohort study in Nigeria between April 2018 and February 2023.
Results
One hundred twenty-four children (aged under 12 months: 19; over 12 months: 105) were hospitalized with RT-PCR-confirmed LF. All received intravenous ribavirin. During follow-up, 99/124 (80%) had fever; 71/124 (57%) had digestive symptoms, vomiting (n = 56/122, 46%) and abdominal pain (n = 34/78 aged ≥5 years, 44%) more often than diarrhea (n = 19/124, 15%); 17/124 (14%) had hemorrhagic signs; 44/112 (39%) had a hematocrit lower than 25%, of whom 32/44 (73%) received transfusions; 44/88 (50%) developed hypotension; 18/112 (16.1%) developed kidney disease improving global outcome (KDIGO) ≥2 acute kidney injury; 10/112 (8.9%) had KDIGO 3 acute kidney failure; 4/124 (3.2%) underwent renal replacement therapy. Seven children died, including 4 aged under 12 months (case fatality rate: under 12 months—22%, 95% confidence interval (CI): 7%–48%; over 12 months—2.9%, 95% CI: 0.7%–8.7%). In univariable analysis, age (P = .003), impaired consciousness (P = .026), and Lassa RT-PCR Ct value (P = .006) were associated with Day 30 mortality.
Conclusions
The fatality rate for children over 12 months hospitalized with LF was lower than that previously reported for adults. Hypotension and acute kidney injury were the most frequent organ dysfunctions. Bleeding was relatively infrequent. Anemia and the need for transfusion were common, the relative contribution of ribavirin-induced hemolysis being unknown.
Topics: anemia polymerase chain reaction hypotension abdominal pain hemorrhage consciousness disturbance renal failure, acute fever blood transfusion digestion gastrointestinal system lassa fever nigeria prospective studies reverse transcriptase polymerase chain reaction ribavirin vomiting hematocrit transfusion
Accessibilité
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence. Available on journal website
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