An eight-month-old male child presented with fever, diarrhoea, and difficulty in breathing was admitted to the paediatric ward of the Amirou Boubacar Diallo national hospital (HNABD) of Niamey. The mother of the child had fever and shortness of breath approximately four weeks prior to admission and subsequently died. Upon clinical examination, the child was lethargic with dehydration but without shock or cyanosis, and he weighed 5 kg and was 78 cm in height. The weight-for-height index was less than three Z-score, which corresponds to those with severe acute malnutrition. He had tachypnoea with a respiratory rate of 56 cycles/min, tachycardia at 148 heartbeats per minute, and temperature of 38.5 C. Oxygen saturation, measured with a pulse oximeter (SpO2), was 90% in ambient air.
The pulmonary examination revealed moderate respiratory distress with chest indrawing. Auscultation showed bronchial rales in the right pulmonary system, and the abdomen was flexible with moderate hepatomegaly.
Based on clinical findings, the epidemic context of COVID-19, and the circumstances of the mother's death, there was a high probability of SARS-CoV-2 infection, as a result of which a nasal swab was taken immediately and sent to the Centre de Recherche Medicale et Sanitaire (CERMES), a National Reference Laboratory for respiratory viruses. Virological analysis was conducted using real-time reverse transcriptase polymerase chain reaction (rRT-PCR). The blood count was normal, the plasma test was negative, and blood glucose was 1.42 g/L. The renal function and blood ion gram were normal. The chest X-ray showed features of pneumonic consolidation in the right lung (Figure 1).
Treatment started immediately with oxygen therapy at 1 l/min, and a combination of ceftriaxone (75 mg/kg/day) and gentamycin (3 mg/kg/day) was instituted. Finally, dietary support was provided with therapeutic milk using a feeding tube. The clinical course was marked by severe respiratory distress and the gradual decrease of SpO2, despite oxygen therapy. Unfortunately, the child died 48 hours following admission. The laboratory diagnosis confirmed an infection by SARS-CoV-2 a few hours after the child's death.