Undiagnosed AIDS in a 13-year-old boy in rural Gabon
Saskia Dede Davi,
Ayodele Alabi,
Lillian Rene Endamne,
Teite Rebecca Hildebrandt,
Anita Lumeka,
Dearie Glory Okwu,
Rella Zoleko-Manego,
Ghyslain Mombo-Ngoma,
Selidji Todagbe Agnandji,
Michael Ramharter
Affiliations
Saskia Dede Davi
Center for Tropical Medicine, Bernhard-Nocht Institute for Tropical Medicine & I. Dept. of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; German Centre for Infection Research, Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg-Lübeck-Borstel-Riems, Germany; Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon; Corresponding author at: Bernhard-Nocht-Straße-74, 20359 Hamburg, Germany.
Ayodele Alabi
Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon; Leiden University Center for Infectious Diseases (LU-CID), Leiden University Medical Center, Leiden, the Netherlands; Institute of Tropical Medicine, Travel Medicine and Human Parasitology, Competence Centre for Tropical Medicine Baden-Württemberg, Universitätsklinikum Tübingen, Tübingen, Germany; German Center for Infectious Diseases Research (DZIF), Tübingen, Germany
Lillian Rene Endamne
Center for Tropical Medicine, Bernhard-Nocht Institute for Tropical Medicine & I. Dept. of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
Teite Rebecca Hildebrandt
Center for Tropical Medicine, Bernhard-Nocht Institute for Tropical Medicine & I. Dept. of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; German Centre for Infection Research, Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg-Lübeck-Borstel-Riems, Germany
Anita Lumeka
Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
Dearie Glory Okwu
Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
Rella Zoleko-Manego
Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
Ghyslain Mombo-Ngoma
German Centre for Infection Research, Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg-Lübeck-Borstel-Riems, Germany; Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon; Department of Implementation Research, Bernhard-Nocht Institute for Tropical Medicine, Hamburg, Germany
Selidji Todagbe Agnandji
Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon; Institute of Tropical Medicine, Travel Medicine and Human Parasitology, Competence Centre for Tropical Medicine Baden-Württemberg, Universitätsklinikum Tübingen, Tübingen, Germany; German Center for Infectious Diseases Research (DZIF), Tübingen, Germany
Michael Ramharter
Center for Tropical Medicine, Bernhard-Nocht Institute for Tropical Medicine & I. Dept. of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; German Centre for Infection Research, Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg-Lübeck-Borstel-Riems, Germany; Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
Introduction: To date, 38.4 million people live with the Human Immunodeficiency virus (HIV) amongst whom 1.7 million are children below fourteen years of age. The highest burden of HIV is in sub-Saharan Africa. Children living with HIV acquired the infection mostly by mother-to-child transmission (MTCT), however the diagnosis is often delayed.In malaria-endemic countries, fever is one of the most frequent symptoms for seeking medical care and it is often primarily suspected as the onset of malaria or respiratory bacterial infections. Here, we report a case of late-onset undiagnosed AIDS in a 13-year-old boy living in rural Gabon in the Gabonese tropical rainforest in the province of Ngounié. Case: A 13-year-old orphan child presented at our routine consultation for fever screening at the Institut de Santé de Sindara (ISSA) in 2021 due to remittent fever episodes, paleness, chronic fatigue and cough. His medical history documented repeated consultations and hospitalisations over the past years, establishing various diagnoses and treatments without significantly improving his condition. Serologic testing established the diagnosis of HIV-1 infection, classifying it as CDC stage 3 AIDS. Given the family history, late-onset symptomatic HIV infection 13 years after mother-to-child transmission was the most likely transmission mode. Discussion: HIV infection may occur in older children and young adolescents and should be considered as an important differential diagnosis of reappearing fevers in regions of malaria transmission. Early diagnosis of HIV, particularly in children and adolescents, improves health outcomes. highlighting the need for HIV testing in children and adolescents.