326. Malaria vs. Bacterial Meningitis in Children With Spinal Tap in the Luanda Children’s Hospital, Angola

Abstract

Background. In Sub-Saharan Africa, both malaria (M), and bacterial meningitis (BM) cause fever and central nervous system (CNS) disturbance. We studied their prevalence, characteristics, outcome, and risk factors for poor outcome to better understand the clinical impact of suspected CNS infection in children. Methods. We conducted a prospective study in the Children's Hospital (HPDB) in the capital of Angola which attends 300 new patients daily. Spinal tap (ST) was performed for children presenting with altered consciousness, convulsions, prostration, or meningism. The analysis included children aged 3 month to 15 years with confrmed discharge diagnosis in 2016-2017. Results. Of 941 children, the diagnosis was M in 56% (525), BM in 12% (116), epilepsy/convulsions in 9% (88), and other infections in 6% (60). Of all children, 16% (150/941) died, 6% (45/733) had severe, 14% (93/655) any neurological sequelae, and 27% (243/897) either died or had neurological sequelae. In children with M, the corresponding fgures were 7% (35/525), 1.5% (7/476), 4% (19/443), and 11% (54/514). In children with BM, the fgures were 41% (47/116), 15% (8/54), 33% (11/33), and 55% (58/105), respectively. Comparing with M, children with BM were younger (median age (IQR) 28 (61) vs. 60 (68) months, P < 0.0001), had an underlying illness (23/97 vs. 19/374, P < 0.0001), like sickle-cell disease (18/96 vs. 9/372, P < 0.0001), longer duration of illness (4 (4) vs. 3 (3) days, P < 0.0001, dyspnea (70/119 vs. 210/463, P = 0.009), were dehydrated (36/113 vs. 67/441, P < 0.0001), or malnourished (38/115 vs. 75/447, P = 0.0001). Multivariate analysis revealed as independent risk factors for death or neurological sequelae age <12 months (OR 1.71, 95% CI 1.02-2.88, P < 0.0001), duration of illness >3 days (2.48, 1.68-3.64, P < 0.0001), malnutrition (1.92, 1.20-3.05, P = 0.006), and dehydration (1.92, 1.16-3.14, P = 0.01). When BM vs. M was included in the analysis, BM appeared as the most important risk factor (OR 8.06, 4.44-14.65, P < 0.0001) and age lost its signifcance. Conclusion. In suspected CNS infection, M was the fnal diagnosis of most children. However, BM caused more deaths and neurological sequelae. Amendable factors, such as delay in treatment, dehydration, and malnutrition, appeared as risk factors for poor outcome.