Dataset Information

Causes of non-malarial fever in Laos: a prospective study.

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

SUBMITTER: Mayxay M

PROVIDER: S-EPMC3986032 | biostudies-literature | 2013 Jul

REPOSITORIES: biostudies-literature

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Publications

Causes of non-malarial fever in Laos: a prospective study.

Mayxay Mayfong M Castonguay-Vanier Josée J Chansamouth Vilada V Dubot-Pérès Audrey A Paris Daniel H DH Phetsouvanh Rattanaphone R Tangkhabuanbutra Jarasporn J Douangdala Phouvieng P Inthalath Saythong S Souvannasing Phoutthalavanh P Slesak Günther G Tongyoo Narongchai N Chanthongthip Anisone A Panyanouvong Phonepasith P Sibounheuang Bountoy B Phommasone Koukeo K Dohnt Michael M Phonekeo Darouny D Hongvanthong Bouasy B Xayadeth Sinakhone S Ketmayoon Pakapak P Blacksell Stuart D SD Moore Catrin E CE Craig Scott B SB Burns Mary-Anne MA von Sonnenburg Frank F Corwin Andrew A de Lamballerie Xavier X González Iveth J IJ Christophel Eva Maria EM Cawthorne Amy A Bell David D Newton Paul N PN

The Lancet. Global health 20130701 1

<h4>Background</h4>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.<h4>Methods</h4>For this prospective study, we recruited 1938 febrile patients, between May, 2008, and December, 2010, at Luang Namtha provincial hospital in northwest Laos ...[more]

PMID: 24748368

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Dataset Information

Causes of non-malarial fever in Laos: a prospective study.

Background

Methods

Findings

Interpretation

Funding

Publications

Causes of non-malarial fever in Laos: a prospective study.

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