Causes of non-malarial fever in Laos: a prospective study

被引：185

作者：

Mayxay, Mayfong ^{[1
,2
,3
]}

Castonguay-Vanier, Josee ^{[1
]}

Chansamouth, Vilada ^{[1
]}

Dubot-Peres, Audrey ^{[1
,3
,4
]}

Paris, Daniel H. ^{[3
,5
]}

Phetsouvanh, Rattanaphone ^{[1
,3
]}

Tangkhabuanbutra, Jarasporn ^{[5
]}

Douangdala, Phouvieng ^{[6
]}

Inthalath, Saythong ^{[6
]}

Souvannasing, Phoutthalavanh ^{[7
]}

Slesak, Guenther ^{[8
]}

Tongyoo, Narongchai ^{[5
]}

Chanthongthip, Anisone ^{[1
]}

Panyanouvong, Phonepasith ^{[1
]}

Sibounheuang, Bountoy ^{[1
]}

Phommasone, Koukeo ^{[1
]}

Dohnt, Michael ^{[9
,10
]}

Phonekeo, Darouny ^{[11
]}

Hongvanthong, Bouasy ^{[12
]}

Xayadeth, Sinakhone ^{[11
]}

Ketmayoon, Pakapak ^{[13
]}

Blacksell, Stuart D. ^{[3
,5
]}

Moore, Catrin E. ^{[1
,3
]}

Craig, Scott B. ^{[9
,10
]}

Burns, Mary-Anne ^{[9
,10
]}

von Sonnenburg, Frank ^{[14
]}

Corwin, Andrew ^{[15
]}

de Lamballerie, Xavier ^{[4
]}

Gonzalez, Iveth J. ^{[16
]}

Christophel, Eva Maria ^{[17
]}

Cawthorne, Amy ^{[17
]}

Bell, David ^{[16
]}

Newton, Paul N. ^{[1
,3
]}

机构：

[1] Mahosot Hosp, Lao Oxford Mahosot Hosp Wellcome Trust Res Unit L, Microbiol Lab, Viangchan, Laos

[2] Univ Hlth Sci, Fac Postgrad Studies, Viangchan, Laos

[3] Univ Oxford, Nuffield Dept Clin Med, Ctr Trop Med, Oxford, England

[4] Aix Marseille Univ, IRD French Inst Res Dev, EHESP French Sch Publ Hlth, UMR D Emergence Pathol Virales 190, Marseille, France

[5] Mahidol Univ, Fac Trop Med, MORU, Bangkok, Thailand

[6] Luang Namtha Prov Hosp, Luang Namtha, Luang Namtha Pr, Laos

[7] Salavan Prov Hosp, Salavan, Salavan Provinc, Laos

[8] Trop Hosp Paul Lechler Krankenhaus, Tubingen, Germany

[9] WHO FAO OIE Collaborating Ctr Leptospirosis Refer, Brisbane, Qld, Australia

[10] Queensland Univ Technol, Sch Biomed Sci, Brisbane, Qld 4001, Australia

[11] Natl Ctr Lab & Epidemiol, Viangchan, Laos

[12] Ctr Malariol Parasitol & Entomol, Viangchan, Laos

[13] WHO, Viangchan, Laos

[14] Univ Munich, Dept Infect Dis & Trop Med, Munich, Germany

[15] US Embassy, Ctr Dis Control & Prevent, Viangchan, Laos

[16] FIND, Geneva, Switzerland

[17] WHO Reg Off Western Pacific, Manila, Philippines

来源：

LANCET GLOBAL HEALTH | 2013年 / 1卷 / 01期

基金：

英国惠康基金;

关键词：

CANDIDATUS RICKETTSIA ANDEANAE; JAPANESE ENCEPHALITIS-VIRUS; ACUTE FEBRILE ILLNESS; SCRUB TYPHUS; ORIENTIA-TSUTSUGAMUSHI; MURINE TYPHUS; CEREBROSPINAL-FLUID; SPOTTED-FEVER; DIAGNOSIS; PDR;

D O I：

10.1016/S2214-109X(13)70008-1

中图分类号：

R1 [预防医学、卫生学];

学科分类号：

1004 ; 120402 ;

摘要：

Background Because of reductions in the incidence of Plasmodium falciparum malaria in Laos, identification of the causes of fever in people without malaria, and discussion of the best empirical treatment options, are urgently needed. We aimed to identify the causes of non-malarial acute fever in patients in rural Laos. Methods For this prospective study, we recruited 1938 febrile patients, between May, 2008, and December, 2010, at Luang Namtha provincial hospital in northwest Laos (n=1390), and between September, 2008, and December, 2010, at Salavan provincial hospital in southern Laos (n=548). Eligible participants were aged 5-49 years with fever (>= 38 degrees C) lasting 8 days or less and were eligible for malaria testing by national guidelines. Findings With conservative definitions of cause, we assigned 799 (41%) patients a diagnosis. With exclusion of influenza, the top five diagnoses when only one aetiological agent per patient was identified were dengue (156 [8%] of 1927 patients), scrub typhus (122 [7%] of 1871), Japanese encephalitis virus (112 [6%] of 1924), leptospirosis (109 [6%] of 1934), and bacteraemia (43 [2%] of 1938). 115 (32%) of 358 patients at Luang Namtha hospital tested influenza PCR-positive between June and December, 2010, of which influenza B was the most frequently detected strain (n=121 [87%]). Disease frequency differed significantly between the two sites: Japanese encephalitis virus infection (p=0.04), typhoid (p=0.006), and leptospirosis (p=0.001) were more common at Luang Namtha, whereas dengue and malaria were more common at Salavan (all p<0.0001). With use of evidence from southeast Asia when possible, we estimated that azithromycin, doxycycline, ceftriaxone, and ofloxacin would have had significant efficacy for 258 (13%), 240 (12%), 154 (8%), and 41 (2%) of patients, respectively. Interpretation Our findings suggest that a wide range of treatable or preventable pathogens are implicated in non-malarial febrile illness in Laos. Empirical treatment with doxycycline for patients with undifferentiated fever and negative rapid diagnostic tests for malaria and dengue could be an appropriate strategy for rural health workers in Laos.

引用

页码：E46 / E54

页数：9

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