Acute Abdomen in Pediatric Patients With Lassa Fever: Prevalence and Response to Nonoperative Management

Abstract

Few reports on the prevalence of acute abdomen (AAbd) in pediatric patients with Lassa fever (LF) are available, and no firm policy on its management exists. Here, we report on its prevalence in and the response to treatment among a cohort of children with confirmed LF. Six (10.3%) of 58 children with LF had AAbd, whereas 6 (2.8%) of 215 children with AAbd had LF. Nonoperative treatment was successful in 5 of the 6 children with both AAbd and LF. We conclude that AAbd is not uncommon in pediatric patients with LF, and it could be responsive to nonoperative treatment. Testing for LF in all children with febrile AAbd might be justified in areas in which LF is endemic.

Caseload and Case Fatality of Lassa Fever in Nigeria, 2001–2018: A Specialist Center's Experience and Its Implications

“…Team leads, Medical, Pediatric, Obstetric, Nursing care, Laboratory services/IPC, and LF Diagnostic Services, supervise the management of patients in the LFW. Currently, the usual bundle of treatment includes intravenous fluids at maintenance rate, intravenous ribavirin given as a single dose daily (28, 29) or as divided doses daily (12, 13, 30), broad spectrum antibiotics usually intravenous ceftriaxone, intravenous antimalarial drugs usually artesunate, and supportive care. The latter include monitoring of vital signs, correction for fluid and electrolyte imbalance, cardiovascular support with bolus doses of intravenous fluids and treatment with inotropic drugs in patients with septic shock, maintenance of fluid balance and hemodialysis for patients with acute kidney injury (AKI), intravenous anticonvulsants for the control of convulsions, and monitoring of fluid and electrolyte balance.…”

“…The latter include monitoring of vital signs, correction for fluid and electrolyte imbalance, cardiovascular support with bolus doses of intravenous fluids and treatment with inotropic drugs in patients with septic shock, maintenance of fluid balance and hemodialysis for patients with acute kidney injury (AKI), intravenous anticonvulsants for the control of convulsions, and monitoring of fluid and electrolyte balance. Patients with suspected acute abdomen are co-managed with the surgical team (29, 30). Pregnant women are managed based on viability of the fetus as assessed clinically and with Ultrasound Scan (USS) examination; those with non-viable fetus undergo evacuation of the uterus while those with a viable fetus are placed on intravenous ribavirin (31).…”

Fatal case of newborn Lassa fever virus infection mimicking late onset neonatal sepsis: a case report from northern Nigeria

“…Available evidence suggests paediatric illness presents with an acute febrile illness, generalized edema, abdominal distension, and bleeding [13]. In other literature, paediatric patients with Lassa fever have also been shown to present with acute abdomen, convulsive episodes or in severe disease, clinical features of a swollen baby syndrome which is characterized by widespread edema, abdominal distention, and bleeding [14][15][16]. There is a dearth of knowledge of clinical course for neonates with Lassa fever virus infection because of an increased risk of adverse pregnancy outcomes in vertically acquired infection [17].…”

Acute kidney injury and mortality in pediatric Lassa fever versus question of access to dialysis

“…The diagnosis of LF was confirmed using reverse transcriptase polymerase chain reaction (RT-PCR) test as described previously (Asogun et al, 2012;Akpede et al, 2019). The clinical case management has also been described previously (Akhuemokhan et al, 2017;Akpede et al, 2018), and included supportive care and intravenous ribavirin. However, facilities for hemodialysis were not available for children with AKI until the last quarter of 2017, for which reason none of the patients reported in this paper benefited from its use.…”

“…AKI is associated with a high CFR of about 60% in hospitalized adults with LF (Okokhere et al, 2018). Its prevalence and impact have not been well documented in children with LF, but it might similarly be contributory to the high CFR in hospitalized children with LF (Akpede et al, 2018). If true, its early diagnosis and treatment could improve the survival of pediatric patients with LF.…”