Infections in Children Admitted with Complicated Severe Acute Malnutrition in Niger

Abstract

BackgroundAlthough malnutrition affects thousands of children throughout the Sahel each year and predisposes them to infections, there is little data on the etiology of infections in these populations. We present a clinical and biological characterization of infections in hospitalized children with complicated severe acute malnutrition (SAM) in Maradi, Niger.MethodsChildren with complicated SAM hospitalized in the intensive care unit of a therapeutic feeding center, with no antibiotics in the previous 7 days, were included. A clinical examination, blood, urine and stool cultures, and chest radiography were performed systematically on admission.ResultsAmong the 311 children included in the study, gastroenteritis was the most frequent clinical diagnosis on admission, followed by respiratory tract infections and malaria. Blood or urine culture was positive in 17% and 16% of cases, respectively, and 36% had abnormal chest radiography. Enterobacteria were sensitive to most antibiotics, except amoxicillin and cotrimoxazole. Twenty-nine (9%) children died, most frequently from sepsis. Clinical signs were poor indicators of infection and initial diagnoses correlated poorly with biologically or radiography-confirmed diagnoses.ConclusionsThese data confirm the high level of infections and poor correlation with clinical signs in children with complicated SAM, and provide antibiotic resistance profiles from an area with limited microbiological data. These results contribute unique data to the ongoing debate on the use and choice of broad-spectrum antibiotics as first-line treatment in children with complicated SAM and reinforce the call for an update of international guidelines on management of complicated SAM based on more recent data.

Routine Amoxicillin for Uncomplicated Severe Acute Malnutrition in Children

“…Samples were transported to the Epicenter laboratory in Maradi, Niger, and plated on culture medium for incubation on the day of collection. 17 Pathogenic bacteria were identified with the use of standard biochemical techniques, and antimicrobial susceptibility was assessed by means of disk diffusion. 18 Bacteremia and bacteriuria were defined as positive blood and urine cultures, respectively.…”

Diagnostic and Prognostic Value of Procalcitonin and C-Reactive Protein in Malnourished Children

“…1,2 In children hospitalized with SAM plus a medical complication, clinical diagnosis of infection is complicated by the paucity of clinical signs; classic symptoms of infection (eg, fever in response to bacteremia, or respiratory symptoms in children with pneumonia) are not always present in children with SAM, who instead often present with unspecific apathy. 3,4 Furthermore, laboratory diagnostic capacity is often limited in regions with the highest burdens of malnutrition. Consequently, treatment is empirical, and broad-spectrum antibiotics are recommended for all hospitalized children with complicated SAM.…”

“…SAM was defined as weightfor-height ,3 z-score below the median, by using the World Health 4 Urine was collected using a Foley catheter. Lumbar puncture was performed when at least 1 clinical sign of involvement of the central nervous system was present.…”

Pengaruh Home Visit Terhadap Penurunan Episode Penyakit Infeksi dan Peningkatan Angka Kecukupan Gizi pada Balita Malnutrisi Akut Berat

“…Zat-zat mikronutrien yang sangat mempengaruhi respon imun meliputi zinc, selenium, zat besi, vitamin A, vitamin C, vitamin B-6, dan asam folat (12). Beberapa penelitian menyebutkan bahwa diare merupakan penyakit infeksi yang paling banyak diderita oleh balita malnutrisi, kemudian diikuti oleh infeksi saluran pernafasan (25,26).…”