e-Article
Causes of non-malarial fever in Laos: a prospective study
Document Type
article
Author
Mayfong Mayxay, MD; Josée Castonguay-Vanier, MSc; Vilada Chansamouth, MD; Audrey Dubot-Pérès, PhD; Daniel H Paris, MD; Rattanaphone Phetsouvanh, MD; Jarasporn Tangkhabuanbutra, MSc; Phouvieng Douangdala, MD; Saythong Inthalath, MD; Phoutthalavanh Souvannasing, MD; Günther Slesak, MD; Narongchai Tongyoo, MPhil; Anisone Chanthongthip; Phonepasith Panyanouvong; Bountoy Sibounheuang; Koukeo Phommasone, MD; Michael Dohnt; Darouny Phonekeo, MD; Bouasy Hongvanthong, MD; Sinakhone Xayadeth; Pakapak Ketmayoon, MSc; Stuart D Blacksell, PhD; Catrin E Moore, PhD; Scott B Craig, PhD; Mary-Anne Burns; Prof. Frank von Sonnenburg, MD; Andrew Corwin, PhD; Prof. Xavier de Lamballerie, MD; Iveth J González, MD; Eva Maria Christophel, MD; Amy Cawthorne, MSc; David Bell, MRCP; Dr. Paul N Newton, MRCP
Source
The Lancet Global Health, Vol 1, Iss 1, Pp e46-e54 (2013)
Subject
Language
English
ISSN
2214-109X
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