Causes of non-malarial fever in Laos: a prospective study
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 pat...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
Elsevier
2013
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| _version_ | 1797073554175426560 |
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| author | Mayxay, M Castonguay-Vanier, J Chansamouth, V Dubot-Pérès, A Paris, DH Phetsouvanh, R Tangkhabuanbutra, J Douangdala, P Inthalath, S Souvannasing, P Slesak, G Tongyoo, N Chanthongthip, A Panyanouvong, P Sibounheuang, B Phommasone, K Dohnt, M Phonekeo, D Hongvanthong, B Xayadeth, S Ketmayoon, P Blacksell, SD Moore, CE Craig, SB Burns, M-A von Sonnenburg, F Corwin, A de Lamballerie, X González, IJ Christophel, EM Cawthorne, A Bell, D Newton, PN |
| author_facet | Mayxay, M Castonguay-Vanier, J Chansamouth, V Dubot-Pérès, A Paris, DH Phetsouvanh, R Tangkhabuanbutra, J Douangdala, P Inthalath, S Souvannasing, P Slesak, G Tongyoo, N Chanthongthip, A Panyanouvong, P Sibounheuang, B Phommasone, K Dohnt, M Phonekeo, D Hongvanthong, B Xayadeth, S Ketmayoon, P Blacksell, SD Moore, CE Craig, SB Burns, M-A von Sonnenburg, F Corwin, A de Lamballerie, X González, IJ Christophel, EM Cawthorne, A Bell, D Newton, PN |
| author_sort | Mayxay, M |
| collection | OXFORD |
| description | 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°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.
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| first_indexed | 2024-03-06T23:23:49Z |
| format | Journal article |
| id | oxford-uuid:69b0b723-5459-4158-8593-cab04d4a1034 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T23:23:49Z |
| publishDate | 2013 |
| publisher | Elsevier |
| record_format | dspace |
| spelling | oxford-uuid:69b0b723-5459-4158-8593-cab04d4a10342022-03-26T18:52:40ZCauses of non-malarial fever in Laos: a prospective studyJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:69b0b723-5459-4158-8593-cab04d4a1034EnglishSymplectic ElementsElsevier 2013Mayxay, MCastonguay-Vanier, JChansamouth, VDubot-Pérès, AParis, DHPhetsouvanh, RTangkhabuanbutra, JDouangdala, PInthalath, SSouvannasing, PSlesak, GTongyoo, NChanthongthip, APanyanouvong, PSibounheuang, BPhommasone, KDohnt, MPhonekeo, DHongvanthong, BXayadeth, SKetmayoon, PBlacksell, SDMoore, CECraig, SBBurns, M-Avon Sonnenburg, FCorwin, Ade Lamballerie, XGonzález, IJChristophel, EMCawthorne, ABell, DNewton, PNBackground 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°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. |
| spellingShingle | Mayxay, M Castonguay-Vanier, J Chansamouth, V Dubot-Pérès, A Paris, DH Phetsouvanh, R Tangkhabuanbutra, J Douangdala, P Inthalath, S Souvannasing, P Slesak, G Tongyoo, N Chanthongthip, A Panyanouvong, P Sibounheuang, B Phommasone, K Dohnt, M Phonekeo, D Hongvanthong, B Xayadeth, S Ketmayoon, P Blacksell, SD Moore, CE Craig, SB Burns, M-A von Sonnenburg, F Corwin, A de Lamballerie, X González, IJ Christophel, EM Cawthorne, A Bell, D Newton, PN Causes of non-malarial fever in Laos: a prospective study |
| title | Causes of non-malarial fever in Laos: a prospective study |
| title_full | Causes of non-malarial fever in Laos: a prospective study |
| title_fullStr | Causes of non-malarial fever in Laos: a prospective study |
| title_full_unstemmed | Causes of non-malarial fever in Laos: a prospective study |
| title_short | Causes of non-malarial fever in Laos: a prospective study |
| title_sort | causes of non malarial fever in laos a prospective study |
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