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Title: Causes of non-malarial fever in Laos: A prospective study
Authors: Mayfong Mayxay
Josée Castonguay-Vanier
Vilada Chansamouth
Audrey Dubot-Pérès
Daniel H. Paris
Rattanaphone Phetsouvanh
Jarasporn Tangkhabuanbutra
Phouvieng Douangdala
Saythong Inthalath
Phoutthalavanh Souvannasing
Günther Slesak
Narongchai Tongyoo
Anisone Chanthongthip
Phonepasith Panyanouvong
Bountoy Sibounheuang
Koukeo Phommasone
Michael Dohnt
Darouny Phonekeo
Bouasy Hongvanthong
Sinakhone Xayadeth
Pakapak Ketmayoon
Stuart D. Blacksell
Catrin E. Moore
Scott B. Craig
Mary Anne Burns
Frank von Sonnenburg
Andrew Corwin
Xavier de Lamballerie
Iveth J. González
Eva Maria Christophel
Amy Cawthorne
David Bell
Paul N. Newton
Mahosot Hospital
University of Health Sciences
Nuffield Department of Clinical Medicine
Emergence des Pathologies Virales
Mahidol University
Luang Namtha Provincial Hospital
Salavan Provincial Hospital
WHO/FAO/OIE Collaborating Centre for Leptospirosis Reference and Research
Queensland University of Technology QUT
National Centre for Laboratory and Epidemiology
Institute of Malariology, Parasitology and Entomology
Ludwig-Maximilians-Universitat Munchen
Centers for Disease Control and Prevention
Foundation for Innovative New Diagnostics, Switzerland
The World Health Organization Regional Office for the Western Pacific philippines
Keywords: Medicine
Issue Date: 1-Sep-2013
Citation: The Lancet Global Health. Vol.1, No.1 (2013)
Abstract: 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. Funding: Wellcome Trust, WHO-Western Pacific Region, Foundation for Innovative New Diagnostics, US Centers for Disease Control and Prevention. © 2013 Mayxay et al.
ISSN: 2214109X
Appears in Collections:Scopus 2011-2015

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