Publication: A prospective study of the causes of febrile illness requiring hospitalization in children in Cambodia
Accepted Date
2013-03-01
Issued Date
2013-04-09
Resource Type
Language
eng
ISSN
1932-6203 (electronic)
Rights
Mahidol University
Rights Holder(s)
PLoS ONE
Bibliographic Citation
Chheng K, Carter MJ, Emary K, Chanpheaktra N, Moore CE, Stoesser N, et al. A prospective study of the causes of febrile illness requiring hospitalization in children in Cambodia. PLoS One. 2013 Apr 9;8(4):e60634.
Suggested Citation
Chheng, Kheng, Carter, Michael J., Emary, Kate, Chanpheaktra, Ngoun, Moore, Catrin E., Stoesser, Nicole, Putchhat, Hor, Sona, Soeng, Reaksmey, Sin, Kitsutani, Paul, Sar, Borann, van Doorn, H. Rogier, Uyen, Nguyen Hanh, Tan, Le Van, Paris, Daniel, Blacksell, Stuart D., Premjit Amornchai, เปรมจิตร อมรชัย, Vanaporn Wuthiekanun, วรรณพร วุฒิเอกอนันต์, Parry, Christopher M., Day, Nicholas P. J., Kumar, Varun A prospective study of the causes of febrile illness requiring hospitalization in children in Cambodia. Chheng K, Carter MJ, Emary K, Chanpheaktra N, Moore CE, Stoesser N, et al. A prospective study of the causes of febrile illness requiring hospitalization in children in Cambodia. PLoS One. 2013 Apr 9;8(4):e60634.. doi:10.1371/journal.pone.0060634. Print 2013 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/693
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Title
A prospective study of the causes of febrile illness requiring hospitalization in children in Cambodia
Author(s)
Chheng, Kheng
Carter, Michael J.
Emary, Kate
Chanpheaktra, Ngoun
Moore, Catrin E.
Stoesser, Nicole
Putchhat, Hor
Sona, Soeng
Reaksmey, Sin
Kitsutani, Paul
Sar, Borann
van Doorn, H. Rogier
Uyen, Nguyen Hanh
Tan, Le Van
Paris, Daniel
Blacksell, Stuart D.
Premjit Amornchai
เปรมจิตร อมรชัย
Vanaporn Wuthiekanun
วรรณพร วุฒิเอกอนันต์
Parry, Christopher M.
Day, Nicholas P. J.
Kumar, Varun
Carter, Michael J.
Emary, Kate
Chanpheaktra, Ngoun
Moore, Catrin E.
Stoesser, Nicole
Putchhat, Hor
Sona, Soeng
Reaksmey, Sin
Kitsutani, Paul
Sar, Borann
van Doorn, H. Rogier
Uyen, Nguyen Hanh
Tan, Le Van
Paris, Daniel
Blacksell, Stuart D.
Premjit Amornchai
เปรมจิตร อมรชัย
Vanaporn Wuthiekanun
วรรณพร วุฒิเอกอนันต์
Parry, Christopher M.
Day, Nicholas P. J.
Kumar, Varun
Corresponding Author(s)
Abstract
BACKGROUND: Febrile illnesses are pre-eminent contributors to morbidity and
mortality among children in South-East Asia but the causes are poorly understood.
We determined the causes of fever in children hospitalised in Siem Reap province,
Cambodia.
METHODS AND FINDINGS: A one-year prospective study of febrile children admitted
to Angkor Hospital for Children, Siem Reap. Demographic, clinical, laboratory and
outcome data were comprehensively analysed. Between October 12(th) 2009 and
October 12(th) 2010 there were 1225 episodes of febrile illness in 1180 children.
Median (IQR) age was 2.0 (0.8-6.4) years, with 850 (69%) episodes in children <5
years. Common microbiological diagnoses were dengue virus (16.2%), scrub typhus
(7.8%), and Japanese encephalitis virus (5.8%). 76 (6.3%) episodes had
culture-proven bloodstream infection, including Salmonella enterica serovar Typhi
(22 isolates, 1.8%), Streptococcus pneumoniae (13, 1.1%), Escherichia coli (8,
0.7%), Haemophilus influenzae (7, 0.6%), Staphylococcus aureus (6, 0.5%) and
Burkholderia pseudomallei (6, 0.5%). There were 69 deaths (5.6%), including those
due to clinically diagnosed pneumonia (19), dengue virus (5), and melioidosis
(4). 10 of 69 (14.5%) deaths were associated with culture-proven bloodstream
infection in logistic regression analyses (odds ratio for mortality 3.4, 95% CI
1.6-6.9). Antimicrobial resistance was prevalent, particularly in S. enterica
Typhi, (where 90% of isolates were resistant to ciprofloxacin, and 86% were
multi-drug resistant). Comorbid undernutrition was present in 44% of episodes and
a major risk factor for acute mortality (OR 2.1, 95% CI 1.1-4.2), as were HIV
infection and cardiac disease.
CONCLUSION: We identified a microbiological cause of fever in almost 50% of
episodes in this large study of community-acquired febrile illness in
hospitalized children in Cambodia. The range of pathogens, antimicrobial
susceptibility, and co-morbidities associated with mortality described will be of
use in the development of rational guidelines for infectious disease treatment
and control in Cambodia and South-East Asia.