Facteurs associés aux formes sévères de choléra dans la population pédiatrique lors de l’épidémie à Mayotte en 2024

Introduction : Cholera is an acute gastrointestinal infection, potentially fatal due to dehydration, mainly affecting populations living in extreme poverty. Endemic in many countries, it spreads easily through contaminated water and human migration. Children, physiologically vulnerable and exposed to fecal contamination, accounted for a significant proportion of cases during the 2024 Mayotte outbreak. The aim of this study was to identify demographic, clinical, and/or biological factors associated with severe forms in the pediatric population. Methods : We conducted an ambispective, single-center study including all patients under 18 years of age with a positive V. cholerae PCR between March 18 and July 12, 2024. Clinical and biological data were collected to classify patients according to a severity score. Severe cases were defined by the presence of at least one of the following criteria: arterial hypotension, a Glasgow Coma Scale score less than 14, or evidence of metabolic acidosis with a pH below 7.20. Univariate and multivariate analyses were performed to identify factors associated with severe forms. Results : Of the 103 children studied, 37% had severe cases. These cases featured more vomiting, higher stool output, worse metabolic acidosis, acute kidney injury, hemoconcentration, and higher bacterial loads (lower Ct values). No hospitalized child died due to early and aggressive rehydration. Only bacterial load (V. cholerae PCR Ct) was linked to severity in multivariate analysis. Conclusion : This study details pediatric cholera in Mayotte and highlights that early identification of severe dehydration enables prompt, aggressive rehydration and reduces mortality. Rapid triage is crucial to optimize care in resource-limited settings.