The Aga Khan Hospital, Dar-es-salaam, Tanzania.
Muhimbili University of Health and Allied Sciences, Dar-es-salaam, Tanzania.
Pan Afr Med J. 2022 May 12;42:33. doi: 10.11604/pamj.2022.42.33.33018. eCollection 2022.
There is scanty data on overall pediatric presentations with COVID-19 in sub-Saharan Africa and none reported related to stroke. Management of acute stroke in children has been challenging due to delays in presentation and difficulties in deducing the exact etiology. This is the first such case of a stroke in a child with COVID-19 infection reported in Tanzania to the best of our knowledge. A six-and-a-half-year-old male child of Asian origin with no history of chronic illness presented to our facility with fever, rash, gastrointestinal symptoms and conjunctivitis. Subsequently, he developed headache, irritability, altered mentation, loss of speech, facial nerve palsy and hemiparesis. He was provisionally diagnosed with bacterial meningitis with a differential diagnosis of viral encephalitis and received standard treatment for the same. On further investigations, magnetic resonance imaging (MRI) of the brain showed ischemic infarct along the territory of left middle cerebral artery and given the history of the child´s exposure to a relative with COVID-19 infection, child underwent a nasopharyngeal swab for polymerase chain reaction testing which was negative but the serum IgG for COVID was positive. Despite the severe presentation initially, early detection and appropriate management resulted in survival, regained speech and motor function. Due to constraints in health care systems in sub-Saharan Africa, it is difficult to exhaust the diagnostics in order to narrow down the list of differentials in a child with stroke. This case is reported to further describe the diverse presentations of COVID-19 particularly in children which has been under-represented especially in sub-Saharan Africa. Attending physicians should have a high index of suspicion for SARS-CoV-2 as the etiology for exposed children presenting with neurological symptoms.
在撒哈拉以南非洲，关于儿童 COVID-19 整体表现的数据很少，并且没有报告与中风相关的数据。由于发病延迟和难以推断确切病因，儿童急性中风的治疗具有挑战性。据我们所知，这是坦桑尼亚首例 COVID-19 感染相关儿童中风病例。一名 6 岁半的亚裔男童，无慢性病史，因发热、皮疹、胃肠道症状和结膜炎就诊于我院。随后，他出现头痛、烦躁、意识改变、言语障碍、面神经瘫痪和偏瘫。他被初步诊断为细菌性脑膜炎，需与病毒性脑炎进行鉴别诊断，并接受了标准治疗。进一步检查发现，大脑磁共振成像（MRI）显示左侧大脑中动脉分布区的缺血性梗死。鉴于患儿接触过 COVID-19 感染者的病史，进行了鼻咽拭子聚合酶链反应（PCR）检测，但结果为阴性，但血清 IgG 对 COVID 呈阳性。尽管患儿最初表现严重，但早期发现和适当的治疗使患儿存活下来，恢复了言语和运动功能。由于撒哈拉以南非洲卫生保健系统的限制，很难进行全面的诊断检查以缩小中风患儿的鉴别诊断范围。本病例旨在进一步描述 COVID-19 的不同表现，特别是在儿童中，特别是在撒哈拉以南非洲，这方面的病例报道较少。对于出现神经系统症状的暴露儿童，主治医生应该高度怀疑 SARS-CoV-2 是病因。
