Publication:
Causes of non-malarial fever in Laos: A prospective study

Issued Date

2013-09-01

Resource Type

Article

ISSN

2214109X

DOI

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

Other identifier(s)

2-s2.0-84883399109

Rights

Mahidol University

Rights Holder(s)

SCOPUS

Bibliographic Citation

The Lancet Global Health. Vol.1, No.1 (2013)

Suggested Citation

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 Causes of non-malarial fever in Laos: A prospective study. The Lancet Global Health. Vol.1, No.1 (2013). doi:10.1016/S2214-109X(13)70008-1 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/32197

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Title

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

Author(s)

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

Other Contributor(s)

Mahosot Hospital
 University of Health Sciences
 Nuffield Department of Clinical Medicine
 Emergence des Pathologies Virales
 Mahidol University
 Luang Namtha Provincial Hospital
 Salavan Provincial Hospital
 Paul-Lechler-Krankenhaus
 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
 WHO
 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

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.

Keyword(s)

Medicine

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URI

https://repository.li.mahidol.ac.th/handle/20.500.14594/32197

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