Febrile seizures in 1-5 aged infants in tropical practice: Frequency, etiology and outcome of hospitalization.

Dear Sir,

Assogba et al. mentioned that the etiologies of febrile seizures (FS) in their studied cohort included in a descending order of frequency the following: Falciparum malaria (FM) infection (52.3%), bacterial meningitis (14.9%), respiratory tract infection (10.4%), digestive tract (7.8%), isolated high pyretic (5.5%), measles (3.2%), urinate tract (2.6%), human immunodeficiency virus (HIV) infection (1.6%), and none determined (1.6%).[1] I presume that HIV infection as an etiology for FS (1.6%) was greatly underestimated compared to FM infection (52.3%). This is based on the following three points.

First, though no studies are yet present considering the exact prevalence of pediatric HIV infection in Togo, the available data pointed out to the alarmingly high prevalence of HIV infection in Sub-Saharan Africa (SSA). Many reasons could explain why the spread of HIV in SSA has not been declining over the years. These were found to include “poverty, famine, low status of women in society, corruption, naive risk taking perception, resistance to sexual behavior change, high prevalence of sexually transmitted infections, internal conflicts and refugee status, antiquated beliefs, lack of recreational facilities, ignorance of individual's HIV status, child and adult prostitution, uncertainty of safety of blood intended for transfusion, widow inheritance, circumcision, illiteracy, and female genital cutting and polygamy.”[2]

Second, Assogba et al.[1] didn't mention in the methodology the protocol of diagnosing HIV infection in their studied cohort. However, I presume that they employed serologic HIV rapid diagnostic tests (RDTs). It is obvious that there are many RDT in the routine clinical work with variations in their sensitivity and specificity. Interestingly, a recent evaluation of nine RDT, in Lomé, Togo has shown that the “sensitivity and specificity observed for seven tests were ≥ 99% and ≥ 98%, respectively:First response HIV 1–2-O PMC Medical, India, GENIE Fast HIV 1–2 and Genie™ III HIV (1/2) Bio-Rad, France, HIV TRI-DOT + Ag; J. Mitra, India; SD Bioline HIV (1/2) 3.0 and SD Bioline HIV/Syphilis DUO Standard Diagnostic, Korea; and VIKIA HIV (1/2); BioMérieux, France. Two tests had performances inferior to WHO recommendations: INSTI HIV1/2 Biolytical Canada; sensitivity = 97.8% and Hexagon HIV Human GmbH Germany; specificity = 94.8%.”[3]

Third, the distributions of malaria and HIV is widely overlapped in SSA. There is an interesting interaction between HIV infection and malaria. On one hand, “HIV-related immunosuppression is correlated with increased malaria infection, burden, and treatment failure, and with complicated malaria, irrespective of immune status.”[4] On the other hand, “the effect of malaria on HIV-infected individuals has also been explored, with the parasitic infection increasing the risk of HIV disease progression and mother-to-child transmission of HIV.”[5]

Finally, despite the aforementioned remarks, I presume that the campaigns for “roll back malaria” should run in parallel with HIV prevention programs to cut short the evolution of new cases of malaria and HIV infection and ultimately their neurological complications.

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