Altered mental status among febrile hospitalized HIV-Infected children aged 0 - 59 months in Mozambique

Abstract

Background:Altered mental status (AMS) is a priority presenting sign that must be assessed inHIV-infected, febrile children, yet diagnosis is difficult in areas with limited diagnostic capacity.Malaria and bacterial meningitis have been reported as the most common causes of AMS in febrilechildren presenting to the hospital in sub-Saharan Africa. However, in an HIV-infected child, centralnervous system manifestations are diverse.Methods:We conducted a clinical observational study of HIV-infected febrile children, aged 0–59 months, hospitalized in Mozambique and prospectively followed. Within this cohort, a nested studywas designed to characterize children admitted with AMS and to assess factors associated with mortal-ity. Univariate and multivariable analysis were performed comparing characteristics of the cohort byAMS status and evaluated demographic and clinical factors by in-hospital mortality outcome.Results:In total, 727 children were enrolled between April 2016 and February 2019, 16% had AMSat admission. HIV-infected, febrile children, who presented with AMS and who had a diagnosis ofbacteremia, had a 4-fold increased relative odds of in-hospital mortality, and children who presentedwith neurologic symptoms on admission had a roughly 8-fold higher odds of in-hospital mortalityrelative to children without presenting neurologic findings.Conclusions:Mozambique has a pressing need to expand local diagnostic capacity. Our results highlightthe critical need for clinicians to incorporate a broader differential into their potential causes of AMS, andto develop a Ministry of Health approved diagnostic and management algorithm, which is standardlyused, to manage patients for whom reliable and relevant diagnostic services are not available.