Global Health in the Global South Research Team-University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, French Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Research Centre, Bordeaux, France.
Department of Infectious Diseases and Tropical Medicine, Division of Tropical Medicine and Clinical International Health, CHU Bordeaux, Hôpital Pellegrin, Place Amélie Raba Léon, Bordeaux, France.
J Pediatric Infect Dis Soc. 2024 Nov 4;13(10):513-522. doi: 10.1093/jpids/piae083.
Data on the presentation, management, and outcomes of Lassa fever (LF) in children are limited.
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.
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.
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.
有关儿童拉沙热（LF）的临床表现、治疗和结局的数据有限。
描述 2018 年 4 月至 2023 年 2 月期间在尼日利亚参加逆转录酶和聚合酶链反应（RT-PCR）确诊 LF 的儿童队列研究（LASCOPE）前瞻性队列研究中年龄在 15 岁以下、经 RT-PCR 确诊的 LF 患儿的临床和生物学特征、治疗和结局。
124 名儿童（12 个月以下：19 名；12 个月以上：105 名）因 LF 住院并接受 RT-PCR 确诊。所有患儿均接受静脉注射利巴韦林治疗。在随访期间，99/124（80%）有发热；71/124（57%）有消化系统症状，呕吐（n=56/122，46%）和腹痛（n=34/78，年龄≥5 岁，44%）比腹泻（n=19/124，15%）更常见；17/124（14%）有出血迹象；112 名患儿中 44 名（39%）的血细胞比容低于 25%，其中 32/44（73%）接受了输血；44/88（50%）出现低血压；18/112（16.1%）发生肾脏疾病改善全球结局（KDIGO）≥2 级急性肾损伤；112 名患儿中 10 名（8.9%）KDIGO 3 级急性肾衰竭；4/124（3.2%）接受肾脏替代治疗。7 名患儿死亡，其中 4 名年龄在 12 个月以下（病死率：12 个月以下为 22%，95%置信区间（CI）为 7%-48%；12 个月以上为 2.9%，95%CI 为 0.7%-8.7%）。单变量分析显示，年龄（P=0.003）、意识障碍（P=0.026）和拉沙 RT-PCR Ct 值（P=0.006）与第 30 天死亡率相关。
与以往报道的成人 LF 住院患儿相比，12 个月以上患儿的病死率较低。低血压和急性肾损伤是最常见的器官功能障碍。出血相对少见。贫血和输血需求常见，利巴韦林诱导的溶血的相对贡献尚不清楚。
