AustralieFrV1, Main, Exploration, bibRecord, 002A51

Orientia, rickettsia, and leptospira pathogens as causes of CNS infections in Laos: a prospective study

Identifieur interne : 002A51 ( Main/Exploration ); précédent : 002A50; suivant : 002A52

Orientia, rickettsia, and leptospira pathogens as causes of CNS infections in Laos: a prospective study

Auteurs : Sabine Dittrich [Royaume-Uni] ; Sayaphet Rattanavong ; Sue J. Lee [Royaume-Uni, Thaïlande] ; Phonepasith Panyanivong ; Scott B. Craig [Australie] ; Suhella M. Tulsiani [Australie, Danemark] ; Stuart D. Blacksell [Royaume-Uni, Thaïlande] ; David A B. Dance [Royaume-Uni] ; Audrey Dubot-Pérès [Royaume-Uni, France] ; Amphone Sengduangphachanh ; Phonelavanh Phoumin ; Daniel H. Paris [Royaume-Uni, Thaïlande] ; Paul N. Newton [Royaume-Uni]

Source :

The Lancet. Global Health [ 2214-109X ] ; 2015.

RBID : PMC:4547322

Descripteurs français

KwdFr :
- Adolescent, Adulte, Adulte d'âge moyen, Encéphalite (microbiologie), Encéphalite (épidémiologie), Enfant, Enfant d'âge préscolaire, Femelle, Humains, Jeune adulte, Laos (épidémiologie), Leptospira (isolement et purification), Mâle, Méningite (microbiologie), Méningite (épidémiologie), Nourrisson, Nouveau-né, Orientia tsutsugamushi (isolement et purification), Rickettsia (isolement et purification), Sujet âgé, Sujet âgé de 80 ans ou plus, Études prospectives.
MESH :
- isolement et purification : Leptospira, Orientia tsutsugamushi, Rickettsia.
- microbiologie : Encéphalite, Méningite.
- épidémiologie : Encéphalite, Laos, Méningite.
- Adolescent, Adulte, Adulte d'âge moyen, Enfant, Enfant d'âge préscolaire, Femelle, Humains, Jeune adulte, Mâle, Nourrisson, Nouveau-né, Sujet âgé, Sujet âgé de 80 ans ou plus, Études prospectives.

English descriptors

KwdEn :
- Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Encephalitis (epidemiology), Encephalitis (microbiology), Female, Humans, Infant, Infant, Newborn, Laos (epidemiology), Leptospira (isolation & purification), Male, Meningitis (epidemiology), Meningitis (microbiology), Middle Aged, Orientia tsutsugamushi (isolation & purification), Prospective Studies, Rickettsia (isolation & purification), Young Adult.
MESH :
- geographic , epidemiology : Laos.
- epidemiology : Encephalitis, Meningitis.
- isolation & purification : Leptospira, Orientia tsutsugamushi, Rickettsia.
- microbiology : Encephalitis, Meningitis.
- Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Female, Humans, Infant, Infant, Newborn, Male, Middle Aged, Prospective Studies, Young Adult.

Abstract

SummaryBackground

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.

Funding

Wellcome Trust UK.

Url:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4547322

DOI: 10.1016/S2214-109X(14)70289-X
PubMed: 25617190
PubMed Central: 4547322

Affiliations:

Le document en format XML

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<author><name sortKey="Tulsiani, Suhella M" sort="Tulsiani, Suhella M" uniqKey="Tulsiani S" first="Suhella M" last="Tulsiani">Suhella M. Tulsiani</name>
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</affiliation>
</author>
<author><name sortKey="Dance, David A B" sort="Dance, David A B" uniqKey="Dance D" first="David A B" last="Dance">David A B. Dance</name>
<affiliation><nlm:aff id="aff1">Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR</nlm:aff>
<wicri:noCountry code="subfield">Lao PDR</wicri:noCountry>
</affiliation>
<affiliation wicri:level="4"><nlm:aff id="aff2">Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, University of Oxford, Oxford, UK</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, University of Oxford, Oxford</wicri:regionArea>
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</author>
<author><name sortKey="Dubot Peres, Audrey" sort="Dubot Peres, Audrey" uniqKey="Dubot Peres A" first="Audrey" last="Dubot-Pérès">Audrey Dubot-Pérès</name>
<affiliation><nlm:aff id="aff1">Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR</nlm:aff>
<wicri:noCountry code="subfield">Lao PDR</wicri:noCountry>
</affiliation>
<affiliation wicri:level="4"><nlm:aff id="aff2">Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, University of Oxford, Oxford, UK</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, University of Oxford, Oxford</wicri:regionArea>
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<region type="comté" nuts="2">Oxfordshire</region>
<settlement type="city">Oxford</settlement>
</placeName>
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<affiliation wicri:level="3"><nlm:aff id="aff7">UMR_D 190 “Emergence des Pathologies Virales”, Aix-Marseille University, IRD French Institute of Research for Development, EHESP French School of Public Health, Marseille, France</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>UMR_D 190 “Emergence des Pathologies Virales”, Aix-Marseille University, IRD French Institute of Research for Development, EHESP French School of Public Health, Marseille</wicri:regionArea>
<placeName><region type="region">Provence-Alpes-Côte d'Azur</region>
<region type="old region">Provence-Alpes-Côte d'Azur</region>
<settlement type="city">Marseille</settlement>
</placeName>
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<author><name sortKey="Sengduangphachanh, Amphone" sort="Sengduangphachanh, Amphone" uniqKey="Sengduangphachanh A" first="Amphone" last="Sengduangphachanh">Amphone Sengduangphachanh</name>
<affiliation><nlm:aff id="aff1">Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR</nlm:aff>
<wicri:noCountry code="subfield">Lao PDR</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Phoumin, Phonelavanh" sort="Phoumin, Phonelavanh" uniqKey="Phoumin P" first="Phonelavanh" last="Phoumin">Phonelavanh Phoumin</name>
<affiliation><nlm:aff id="aff1">Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR</nlm:aff>
<wicri:noCountry code="subfield">Lao PDR</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Paris, Daniel H" sort="Paris, Daniel H" uniqKey="Paris D" first="Daniel H" last="Paris">Daniel H. Paris</name>
<affiliation wicri:level="4"><nlm:aff id="aff2">Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, University of Oxford, Oxford, UK</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, University of Oxford, Oxford</wicri:regionArea>
<placeName><settlement type="city">Oxford</settlement>
<region type="country">Angleterre</region>
<region type="comté" nuts="2">Oxfordshire</region>
<settlement type="city">Oxford</settlement>
</placeName>
<orgName type="university">Université d'Oxford</orgName>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff3">Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand</nlm:aff>
<country xml:lang="fr">Thaïlande</country>
<wicri:regionArea>Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok</wicri:regionArea>
<wicri:noRegion>Bangkok</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Newton, Paul N" sort="Newton, Paul N" uniqKey="Newton P" first="Paul N" last="Newton">Paul N. Newton</name>
<affiliation><nlm:aff id="aff1">Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR</nlm:aff>
<wicri:noCountry code="subfield">Lao PDR</wicri:noCountry>
</affiliation>
<affiliation wicri:level="4"><nlm:aff id="aff2">Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, University of Oxford, Oxford, UK</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, University of Oxford, Oxford</wicri:regionArea>
<placeName><settlement type="city">Oxford</settlement>
<region type="country">Angleterre</region>
<region type="comté" nuts="2">Oxfordshire</region>
<settlement type="city">Oxford</settlement>
</placeName>
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</affiliation>
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<series><title level="j">The Lancet. Global Health</title>
<idno type="eISSN">2214-109X</idno>
<imprint><date when="2015">2015</date>
</imprint>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adolescent</term>
<term>Adult</term>
<term>Aged</term>
<term>Aged, 80 and over</term>
<term>Child</term>
<term>Child, Preschool</term>
<term>Encephalitis (epidemiology)</term>
<term>Encephalitis (microbiology)</term>
<term>Female</term>
<term>Humans</term>
<term>Infant</term>
<term>Infant, Newborn</term>
<term>Laos (epidemiology)</term>
<term>Leptospira (isolation & purification)</term>
<term>Male</term>
<term>Meningitis (epidemiology)</term>
<term>Meningitis (microbiology)</term>
<term>Middle Aged</term>
<term>Orientia tsutsugamushi (isolation & purification)</term>
<term>Prospective Studies</term>
<term>Rickettsia (isolation & purification)</term>
<term>Young Adult</term>
</keywords>
<keywords scheme="KwdFr" xml:lang="fr"><term>Adolescent</term>
<term>Adulte</term>
<term>Adulte d'âge moyen</term>
<term>Encéphalite (microbiologie)</term>
<term>Encéphalite (épidémiologie)</term>
<term>Enfant</term>
<term>Enfant d'âge préscolaire</term>
<term>Femelle</term>
<term>Humains</term>
<term>Jeune adulte</term>
<term>Laos (épidémiologie)</term>
<term>Leptospira (isolement et purification)</term>
<term>Mâle</term>
<term>Méningite (microbiologie)</term>
<term>Méningite (épidémiologie)</term>
<term>Nourrisson</term>
<term>Nouveau-né</term>
<term>Orientia tsutsugamushi (isolement et purification)</term>
<term>Rickettsia (isolement et purification)</term>
<term>Sujet âgé</term>
<term>Sujet âgé de 80 ans ou plus</term>
<term>Études prospectives</term>
</keywords>
<keywords scheme="MESH" type="geographic" qualifier="epidemiology" xml:lang="en"><term>Laos</term>
</keywords>
<keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Encephalitis</term>
<term>Meningitis</term>
</keywords>
<keywords scheme="MESH" qualifier="isolation & purification" xml:lang="en"><term>Leptospira</term>
<term>Orientia tsutsugamushi</term>
<term>Rickettsia</term>
</keywords>
<keywords scheme="MESH" qualifier="isolement et purification" xml:lang="fr"><term>Leptospira</term>
<term>Orientia tsutsugamushi</term>
<term>Rickettsia</term>
</keywords>
<keywords scheme="MESH" qualifier="microbiologie" xml:lang="fr"><term>Encéphalite</term>
<term>Méningite</term>
</keywords>
<keywords scheme="MESH" qualifier="microbiology" xml:lang="en"><term>Encephalitis</term>
<term>Meningitis</term>
</keywords>
<keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Encéphalite</term>
<term>Laos</term>
<term>Méningite</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Adolescent</term>
<term>Adult</term>
<term>Aged</term>
<term>Aged, 80 and over</term>
<term>Child</term>
<term>Child, Preschool</term>
<term>Female</term>
<term>Humans</term>
<term>Infant</term>
<term>Infant, Newborn</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Prospective Studies</term>
<term>Young Adult</term>
</keywords>
<keywords scheme="MESH" xml:lang="fr"><term>Adolescent</term>
<term>Adulte</term>
<term>Adulte d'âge moyen</term>
<term>Enfant</term>
<term>Enfant d'âge préscolaire</term>
<term>Femelle</term>
<term>Humains</term>
<term>Jeune adulte</term>
<term>Mâle</term>
<term>Nourrisson</term>
<term>Nouveau-né</term>
<term>Sujet âgé</term>
<term>Sujet âgé de 80 ans ou plus</term>
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<front><div type="abstract" xml:lang="en"><title>Summary</title>
<sec><title>Background</title>
<p>Scrub typhus (caused by <italic>Orientia tsutsugamushi</italic>
), murine typhus (caused by <italic>Rickettsia typhi</italic>
), 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.</p>
</sec>
<sec><title>Methods</title>
<p>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 (<italic>Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, S suis</italic>
) and <italic>O tsutsugamushi, Rickettsia typhi/Rickettsia</italic>
 spp, and <italic>Leptospira</italic>
 spp infections in blood or cerebrospinal fluid (CSF). We analysed and compared causes and clinical and CSF characteristics between patient groups.</p>
</sec>
<sec><title>Findings</title>
<p>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 <italic>O tsutsugamushi, R typhi/Rickettsia</italic>
 spp, or <italic>Leptospira</italic>
 spp. These pathogens were significantly more frequent than conventional bacterial infections (90/1051 [9%] <italic>vs</italic>
 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 <italic>R typhi/Rickettsia</italic>
 spp, <italic>O tsutsugamushi</italic>
, and <italic>Leptospira</italic>
 spp combined, and 33% (13/39) for conventional bacterial infections (p=0·076).</p>
</sec>
<sec><title>Interpretation</title>
<p>Our data suggest that <italic>R typhi/Rickettsia</italic>
 spp, <italic>O tsutsugamushi</italic>
, and <italic>Leptospira</italic>
 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.</p>
</sec>
<sec><title>Funding</title>
<p>Wellcome Trust UK.</p>
</sec>
</div>
</front>
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Serveur d'exploration sur les relations entre la France et l'Australie

Orientia, rickettsia, and leptospira pathogens as causes of CNS infections in Laos: a prospective study

Orientia, rickettsia, and leptospira pathogens as causes of CNS infections in Laos: a prospective study

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	Serveur d'exploration sur les relations entre la France et l'Australie
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