Publication: Orientia, rickettsia, and leptospira pathogens as causes of CNS infections in Laos: a prospective study.
Issued Date
2015-02
Copyright Date
2015
Resource Type
Language
eng
ISSN
2214-109X (electronic)
Rights
Mahidol University
Rights Holder(s)
Elsevier Science
Bibliographic Citation
Dittrich S, Rattanavong S, Lee SJ, Panyanivong P, Craig SB, Tulsiani SM, et al. Orientia, rickettsia, and leptospira pathogens as causes of CNS infections in Laos: a prospective study. Lancet Glob Health. 2015 Feb;3(2):e104-12.
Suggested Citation
Dittrich, Sabine, Rattanavong, Sayaphet, Lee, Sue J., Panyanivong, Phonepasith, Craig, Scott B., Tulsiani, Suhella M., Blacksell, Stuart D., Dance, David A. B., Dubot-Pérès, Audre, Amphone Sengduangphachan, Phoumin, Phonelavanh, Paris, Daniel H., Newton, Paul N. Orientia, rickettsia, and leptospira pathogens as causes of CNS infections in Laos: a prospective study.. Dittrich S, Rattanavong S, Lee SJ, Panyanivong P, Craig SB, Tulsiani SM, et al. Orientia, rickettsia, and leptospira pathogens as causes of CNS infections in Laos: a prospective study. Lancet Glob Health. 2015 Feb;3(2):e104-12.. doi:10.1016/S2214-109X(14)70289-X. Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/793
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Title
Orientia, rickettsia, and leptospira pathogens as causes of CNS infections in Laos: a prospective study.
Corresponding Author(s)
Abstract
BACKGROUND: Scrub typhus (caused by Orientia tsutsugamushi), murine typhus
(caused by Rickettsia typhi), and leptospirosis are common causes of febrile
illness in Asia; meningitis and meningoencephalitis are severe complications.
However, scarce data exist for the burden of these pathogens in patients with CNS
disease in endemic countries. Laos is representative of vast economically poor
rural areas in Asia with little medical information to guide public health
policy. We assessed whether these pathogens are important causes of CNS
infections in Laos.
METHODS: Between Jan 10, 2003, and Nov 25, 2011, we enrolled 1112 consecutive
patients of all ages admitted with CNS symptoms or signs requiring a lumbar
puncture at Mahosot Hospital, Vientiane, Laos. Microbiological examinations
(culture, PCR, and serology) targeted so-called conventional bacterial infections
(Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, S
suis) and O tsutsugamushi, Rickettsia typhi/Rickettsia spp, and Leptospira spp
infections in blood or cerebrospinal fluid (CSF). We analysed and compared causes
and clinical and CSF characteristics between patient groups.
FINDINGS: 1051 (95%) of 1112 patients who presented had CSF available for
analysis, of whom 254 (24%) had a CNS infection attributable to a bacterial or
fungal pathogen. 90 (35%) of these 254 infections were caused by O tsutsugamushi,
R typhi/Rickettsia spp, or Leptospira spp. These pathogens were significantly
more frequent than conventional bacterial infections (90/1051 [9%] vs 42/1051
[4%]; p<0·0001) by use of conservative diagnostic definitions. CNS infections had
a high mortality (236/876 [27%]), with 18% (13/71) for R typhi/Rickettsia spp, O
tsutsugamushi, and Leptospira spp combined, and 33% (13/39) for conventional
bacterial infections (p=0·076).
INTERPRETATION: Our data suggest that R typhi/Rickettsia spp, O tsutsugamushi,
and Leptospira spp infections are important causes of CNS infections in Laos.
Antibiotics, such as tetracyclines, needed for the treatment of murine typhus and
scrub typhus, are not routinely advised for empirical treatment of CNS
infections. These severely neglected infections represent a potentially large
proportion of treatable CNS disease burden across vast endemic areas and need
more attention.