P2B215: Practice Patterns in Pediatric Infectious Encephalopathy in Four Centers in Africa

Background:

Introduction: Infectious encephalopathy (IE) (e.g., meningitis, encephalitis, and cerebral abscess) carries high mortality and morbidity in children, especially in low and middle income countries (LMIC). There is no evidence- and resource-based diagnostic algorithm and a paucity of guidance for treatment strategies for pediatric IE patients in LMICs. This study aims to describe the usual care evaluation, management, and outcomes of pediatric IE in four hospitals in LMICs in sub-Saharan Africa.

Methods:

Methods: This is a secondary analysis of PANGEA-DC, which was a four-week prospective observational study in children ( < 18 years) with IE conducted in 2017. Study sites included public referral hospitals in Ethiopia, Kenya, Rwanda, and Ghana. Data collection included patient and center demographics, diagnostic testing, medical interventions, and patient outcomes (e.g., hospital mortality, change in Pediatric Cerebral Performance Category Score(PCPC)). Data were compared using Chi-square testing with Stata software (College Station, TX).

Results:

Results: Seventy-two children (range 0-17 years of age) with IE were analyzed. Sixty-four percent (n=46) of children had no pre-existing medical conditions. Most patients were reported to have IE without further etiologic distinction (78%, n=56).Specific IE etiologies included cerebral malaria (10%, n=7), encephalitis (4%, n=3), tuberculosis (4%, n=3), bacterial meningitis (3%, n=2), and cerebral abscess (1%, n=1). Fourteen (19%) patients had head computed tomography (CT) performed, while lumbar puncture with cerebrospinal fluid (CSF) collection was completed in thirty-two (44%) children. Sixty-two (86%) of patients were admitted to the hospital, four of whom were admitted to the intensive care unit. Four (6%, n=4/62) inpatients required invasive mechanical ventilation, while one (2%, n=1/62) was managed with vasopressors and a central venous catheter. Mortality was 13% (n=9). Of surviving children, 21% (n=13/62) had a worse PCPC score at hospital discharge compared to admission.

Conclusion:

Conclusions: Cerebral malaria was the most common cause of pediatric IE patients identified in this pilot study; however, etiologic testing, as is recommended the World Health Organization (WHO), was very limited. Further, management strategies varied significantly. Resource limitations and diagnostic constraints may have affected clinical decisions. Our cohort’s morbidity and mortality rates align with other studies in LMICs, strongly suggesting the critical need for prospective studies to inform LMIC-focused, evidence-based clinical guidelines.