The infective causes of hepatitis and jaundice amongst hospitalised patients in Vientiane, Laos
Identifieur interne : 000762 ( Ncbi/Merge ); précédent : 000761; suivant : 000763The infective causes of hepatitis and jaundice amongst hospitalised patients in Vientiane, Laos
Auteurs : Bounkong Syhavong ; Bouachanh Rasachack ; Lee Smythe [Australie] ; Jean-Marc Rolain [France] ; Anne-Marie Roque-Afonso [France] ; Kemajittra Jenjaroen [Thaïlande] ; Vimone Soukkhaserm ; Simmaly Phongmany ; Rattanaphone Phetsouvanh [Royaume-Uni] ; Sune Soukkhaserm ; Te Thammavong ; Mayfong Mayxay [Royaume-Uni] ; Stuart D. Blacksell [Thaïlande, Royaume-Uni] ; Eleanor Barnes [Royaume-Uni] ; Philippe Parola [France] ; Elisabeth Dussaix [France] ; Didier Raoult [France] ; Isla Humphreys [Royaume-Uni] ; Paul Klenerman [Royaume-Uni] ; Nicholas J. White [Thaïlande, Royaume-Uni] ; Paul N. Newton [Royaume-Uni]Source :
- Transactions of the Royal Society of Tropical Medicine and Hygiene [ 0035-9203 ] ; 2010.
Abstract
There is little information on the diverse infectious causes of jaundice and hepatitis in the Asiatic tropics. Serology (hepatitis A, B, C and E, leptospirosis, dengue, rickettsia), antigen tests (dengue), PCR assays (hepatitis A, C and E) and blood cultures (septicaemia) were performed on samples from 392 patients admitted with jaundice or raised transaminases (≥ × 3) to Mahosot Hospital, Vientiane, Laos over 3 years. Conservative definitions suggested diagnoses of dengue (8.4%), rickettsioses (7.3%), leptospirosis (6.8%), hepatitis B (4.9%), hepatitis C (4.9%), community-acquired septicaemia (3.3%) and hepatitis E (1.6%). Although anti-hepatitis A virus (HAV) IgM antibody results suggested that 35.8% of patients had acute HAV infections, anti-HAV IgG antibody avidity and HAV PCR suggested that 82% had polyclonal activation and not acute HAV infections. Scrub typhus, murine typhus or leptospirosis were present in 12.8% of patients and were associated with meningism and relatively low AST and ALT elevation. These patients would be expected to respond to empirical doxycycline therapy which, in the absence of virological diagnosis and treatment, may be an appropriate cost-effective intervention in Lao patients with jaundice/hepatitis.
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DOI: 10.1016/j.trstmh.2010.03.002
PubMed: 20378138
PubMed Central: 2896487
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for Clinical Vaccinology and Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Churchill Hospital, 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></author><author><name sortKey="Soukkhaserm, Sune" sort="Soukkhaserm, Sune" uniqKey="Soukkhaserm S" first="Sune" last="Soukkhaserm">Sune Soukkhaserm</name><affiliation><nlm:aff id="aff1">Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR</nlm:aff><wicri:noCountry code="subfield">Lao PDR</wicri:noCountry></affiliation></author><author><name sortKey="Thammavong, Te" sort="Thammavong, Te" uniqKey="Thammavong T" first="Te" last="Thammavong">Te Thammavong</name><affiliation><nlm:aff id="aff7">National Blood Transfusion Centre, Lao Red Cross, Vientiane, Lao PDR</nlm:aff><wicri:noCountry code="subfield">Lao PDR</wicri:noCountry></affiliation></author><author><name sortKey="Mayxay, Mayfong" sort="Mayxay, Mayfong" uniqKey="Mayxay M" first="Mayfong" last="Mayxay">Mayfong Mayxay</name><affiliation><nlm:aff id="aff1">Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, 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="aff6">Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Centre for Clinical Vaccinology and Tropical Medicine, University of 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d'Oxford</orgName></affiliation></author><author><name sortKey="Parola, Philippe" sort="Parola, Philippe" uniqKey="Parola P" first="Philippe" last="Parola">Philippe Parola</name><affiliation wicri:level="4"><nlm:aff id="aff3">URMITE CNRS-IRD UMR 6236, Faculté de Médecine et de Pharmacie, Université de la Méditerranée, Marseille, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>URMITE CNRS-IRD UMR 6236, Faculté de Médecine et de Pharmacie, Université de la Méditerranée, 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><settlement type="city">Marseille</settlement></placeName><orgName type="university">Université de la Méditerranée</orgName></affiliation></author><author><name sortKey="Dussaix, Elisabeth" sort="Dussaix, Elisabeth" uniqKey="Dussaix E" first="Elisabeth" last="Dussaix">Elisabeth Dussaix</name><affiliation wicri:level="1"><nlm:aff id="aff4">AP-HP, National Reference Centre for HAV, Hôpital Paul Brousse, Villejuif, 94804 France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>AP-HP, National Reference Centre for HAV, Hôpital Paul Brousse, Villejuif</wicri:regionArea><wicri:noRegion>Villejuif</wicri:noRegion><wicri:noRegion>Villejuif</wicri:noRegion></affiliation></author><author><name sortKey="Raoult, Didier" sort="Raoult, Didier" uniqKey="Raoult D" first="Didier" last="Raoult">Didier Raoult</name><affiliation wicri:level="4"><nlm:aff id="aff3">URMITE CNRS-IRD UMR 6236, Faculté de Médecine et de Pharmacie, Université de la Méditerranée, Marseille, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>URMITE CNRS-IRD UMR 6236, Faculté de Médecine et de Pharmacie, Université de la Méditerranée, 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><settlement type="city">Marseille</settlement></placeName><orgName type="university">Université de la Méditerranée</orgName></affiliation></author><author><name sortKey="Humphreys, Isla" sort="Humphreys, Isla" uniqKey="Humphreys I" first="Isla" last="Humphreys">Isla Humphreys</name><affiliation wicri:level="4"><nlm:aff id="aff9">The Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>The Peter Medawar Building for Pathogen Research, 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></author><author><name sortKey="Klenerman, Paul" sort="Klenerman, Paul" uniqKey="Klenerman P" first="Paul" last="Klenerman">Paul Klenerman</name><affiliation wicri:level="4"><nlm:aff id="aff9">The Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>The Peter Medawar Building for Pathogen Research, 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></author><author><name sortKey="White, Nicholas J" sort="White, Nicholas J" uniqKey="White N" first="Nicholas J." last="White">Nicholas J. White</name><affiliation><nlm:aff id="aff1">Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR</nlm:aff><wicri:noCountry code="subfield">Lao PDR</wicri:noCountry></affiliation><affiliation wicri:level="1"><nlm:aff id="aff5">Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Rd., Bangkok 10400, Thailand</nlm:aff><country xml:lang="fr">Thaïlande</country><wicri:regionArea>Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Rd., Bangkok 10400</wicri:regionArea><wicri:noRegion>Bangkok 10400</wicri:noRegion></affiliation><affiliation wicri:level="4"><nlm:aff id="aff6">Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Churchill Hospital, 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></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">Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, 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="aff6">Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Churchill Hospital, 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></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno 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B" first="Bounkong" last="Syhavong">Bounkong Syhavong</name><affiliation><nlm:aff id="aff1">Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR</nlm:aff><wicri:noCountry code="subfield">Lao PDR</wicri:noCountry></affiliation></author><author><name sortKey="Rasachack, Bouachanh" sort="Rasachack, Bouachanh" uniqKey="Rasachack B" first="Bouachanh" last="Rasachack">Bouachanh Rasachack</name><affiliation><nlm:aff id="aff1">Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR</nlm:aff><wicri:noCountry code="subfield">Lao PDR</wicri:noCountry></affiliation></author><author><name sortKey="Smythe, Lee" sort="Smythe, Lee" uniqKey="Smythe L" first="Lee" last="Smythe">Lee Smythe</name><affiliation wicri:level="1"><nlm:aff id="aff2">WHO/AO/OIE Collaborating Centre for Reference & Research on Leptospirosis, Queensland Health Forensic and Scientific Services, Coopers Plains, Queensland, 4108, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>WHO/AO/OIE Collaborating Centre for Reference & Research on Leptospirosis, Queensland Health Forensic and Scientific Services, Coopers Plains, Queensland, 4108</wicri:regionArea><wicri:noRegion>4108</wicri:noRegion></affiliation></author><author><name sortKey="Rolain, Jean Marc" sort="Rolain, Jean Marc" uniqKey="Rolain J" first="Jean-Marc" last="Rolain">Jean-Marc Rolain</name><affiliation wicri:level="4"><nlm:aff id="aff3">URMITE CNRS-IRD UMR 6236, Faculté de Médecine et de Pharmacie, Université de la Méditerranée, Marseille, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>URMITE CNRS-IRD UMR 6236, Faculté de Médecine et de Pharmacie, Université de la Méditerranée, 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><settlement type="city">Marseille</settlement></placeName><orgName type="university">Université de la Méditerranée</orgName></affiliation></author><author><name sortKey="Roque Afonso, Anne Marie" sort="Roque Afonso, Anne Marie" uniqKey="Roque Afonso A" first="Anne-Marie" last="Roque-Afonso">Anne-Marie Roque-Afonso</name><affiliation wicri:level="1"><nlm:aff id="aff4">AP-HP, National Reference Centre for HAV, Hôpital Paul Brousse, Villejuif, 94804 France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>AP-HP, National Reference Centre for HAV, Hôpital Paul Brousse, Villejuif</wicri:regionArea><wicri:noRegion>Villejuif</wicri:noRegion><wicri:noRegion>Villejuif</wicri:noRegion></affiliation></author><author><name sortKey="Jenjaroen, Kemajittra" sort="Jenjaroen, Kemajittra" uniqKey="Jenjaroen K" first="Kemajittra" last="Jenjaroen">Kemajittra Jenjaroen</name><affiliation wicri:level="1"><nlm:aff id="aff5">Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Rd., Bangkok 10400, Thailand</nlm:aff><country xml:lang="fr">Thaïlande</country><wicri:regionArea>Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Rd., Bangkok 10400</wicri:regionArea><wicri:noRegion>Bangkok 10400</wicri:noRegion></affiliation></author><author><name sortKey="Soukkhaserm, Vimone" sort="Soukkhaserm, Vimone" uniqKey="Soukkhaserm V" first="Vimone" last="Soukkhaserm">Vimone Soukkhaserm</name><affiliation><nlm:aff id="aff1">Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR</nlm:aff><wicri:noCountry code="subfield">Lao PDR</wicri:noCountry></affiliation></author><author><name sortKey="Phongmany, Simmaly" sort="Phongmany, Simmaly" uniqKey="Phongmany S" first="Simmaly" last="Phongmany">Simmaly Phongmany</name><affiliation><nlm:aff id="aff1">Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR</nlm:aff><wicri:noCountry code="subfield">Lao PDR</wicri:noCountry></affiliation></author><author><name sortKey="Phetsouvanh, Rattanaphone" sort="Phetsouvanh, Rattanaphone" uniqKey="Phetsouvanh R" first="Rattanaphone" last="Phetsouvanh">Rattanaphone Phetsouvanh</name><affiliation><nlm:aff id="aff1">Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, 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="aff6">Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Churchill Hospital, 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></author><author><name sortKey="Soukkhaserm, Sune" sort="Soukkhaserm, Sune" uniqKey="Soukkhaserm S" first="Sune" last="Soukkhaserm">Sune Soukkhaserm</name><affiliation><nlm:aff id="aff1">Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR</nlm:aff><wicri:noCountry code="subfield">Lao PDR</wicri:noCountry></affiliation></author><author><name sortKey="Thammavong, Te" sort="Thammavong, Te" uniqKey="Thammavong T" first="Te" last="Thammavong">Te Thammavong</name><affiliation><nlm:aff id="aff7">National Blood Transfusion Centre, Lao Red Cross, Vientiane, Lao PDR</nlm:aff><wicri:noCountry code="subfield">Lao PDR</wicri:noCountry></affiliation></author><author><name sortKey="Mayxay, Mayfong" sort="Mayxay, Mayfong" uniqKey="Mayxay M" first="Mayfong" last="Mayxay">Mayfong Mayxay</name><affiliation><nlm:aff id="aff1">Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, 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="aff6">Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Churchill Hospital, 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><nlm:aff id="aff8">Faculty of Post Graduate Studies, University of Health Sciences, Vientiane, Lao PDR</nlm:aff><wicri:noCountry code="subfield">Lao PDR</wicri:noCountry></affiliation></author><author><name sortKey="Blacksell, Stuart D" sort="Blacksell, Stuart D" uniqKey="Blacksell S" first="Stuart D." last="Blacksell">Stuart D. Blacksell</name><affiliation><nlm:aff id="aff1">Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR</nlm:aff><wicri:noCountry code="subfield">Lao PDR</wicri:noCountry></affiliation><affiliation wicri:level="1"><nlm:aff id="aff5">Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Rd., Bangkok 10400, Thailand</nlm:aff><country xml:lang="fr">Thaïlande</country><wicri:regionArea>Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Rd., Bangkok 10400</wicri:regionArea><wicri:noRegion>Bangkok 10400</wicri:noRegion></affiliation><affiliation wicri:level="4"><nlm:aff id="aff6">Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Churchill Hospital, 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></author><author><name sortKey="Barnes, Eleanor" sort="Barnes, Eleanor" uniqKey="Barnes E" first="Eleanor" last="Barnes">Eleanor Barnes</name><affiliation wicri:level="4"><nlm:aff id="aff9">The Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>The Peter Medawar Building for Pathogen Research, 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></author><author><name sortKey="Parola, Philippe" sort="Parola, Philippe" uniqKey="Parola P" first="Philippe" last="Parola">Philippe Parola</name><affiliation wicri:level="4"><nlm:aff id="aff3">URMITE CNRS-IRD UMR 6236, Faculté de Médecine et de Pharmacie, Université de la Méditerranée, Marseille, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>URMITE CNRS-IRD UMR 6236, Faculté de Médecine et de Pharmacie, Université de la Méditerranée, 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><settlement type="city">Marseille</settlement></placeName><orgName type="university">Université de la Méditerranée</orgName></affiliation></author><author><name sortKey="Dussaix, Elisabeth" sort="Dussaix, Elisabeth" uniqKey="Dussaix E" first="Elisabeth" last="Dussaix">Elisabeth Dussaix</name><affiliation wicri:level="1"><nlm:aff id="aff4">AP-HP, National Reference Centre for HAV, Hôpital Paul Brousse, Villejuif, 94804 France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>AP-HP, National Reference Centre for HAV, Hôpital Paul Brousse, Villejuif</wicri:regionArea><wicri:noRegion>Villejuif</wicri:noRegion><wicri:noRegion>Villejuif</wicri:noRegion></affiliation></author><author><name sortKey="Raoult, Didier" sort="Raoult, Didier" uniqKey="Raoult D" first="Didier" last="Raoult">Didier Raoult</name><affiliation wicri:level="4"><nlm:aff id="aff3">URMITE CNRS-IRD UMR 6236, Faculté de Médecine et de Pharmacie, Université de la Méditerranée, Marseille, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>URMITE CNRS-IRD UMR 6236, Faculté de Médecine et de Pharmacie, Université de la Méditerranée, 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><settlement type="city">Marseille</settlement></placeName><orgName type="university">Université de la Méditerranée</orgName></affiliation></author><author><name sortKey="Humphreys, Isla" sort="Humphreys, Isla" uniqKey="Humphreys I" first="Isla" last="Humphreys">Isla Humphreys</name><affiliation wicri:level="4"><nlm:aff id="aff9">The Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>The Peter Medawar Building for Pathogen Research, 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></author><author><name sortKey="Klenerman, Paul" sort="Klenerman, Paul" uniqKey="Klenerman P" first="Paul" last="Klenerman">Paul Klenerman</name><affiliation wicri:level="4"><nlm:aff id="aff9">The Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>The Peter Medawar Building for Pathogen Research, 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></author><author><name sortKey="White, Nicholas J" sort="White, Nicholas J" uniqKey="White N" first="Nicholas J." last="White">Nicholas J. White</name><affiliation><nlm:aff id="aff1">Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR</nlm:aff><wicri:noCountry code="subfield">Lao PDR</wicri:noCountry></affiliation><affiliation wicri:level="1"><nlm:aff id="aff5">Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Rd., Bangkok 10400, Thailand</nlm:aff><country xml:lang="fr">Thaïlande</country><wicri:regionArea>Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Rd., Bangkok 10400</wicri:regionArea><wicri:noRegion>Bangkok 10400</wicri:noRegion></affiliation><affiliation wicri:level="4"><nlm:aff id="aff6">Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Churchill Hospital, 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></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">Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, 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="aff6">Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Churchill Hospital, 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></author></analytic><series><title level="j">Transactions of the Royal Society of Tropical Medicine and Hygiene</title><idno type="ISSN">0035-9203</idno><idno type="eISSN">1878-3503</idno><imprint><date when="2010">2010</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><title>Summary</title><p>There is little information on the diverse infectious causes of jaundice and hepatitis in the Asiatic tropics. Serology (hepatitis A, B, C and E, leptospirosis, dengue, rickettsia), antigen tests (dengue), PCR assays (hepatitis A, C and E) and blood cultures (septicaemia) were performed on samples from 392 patients admitted with jaundice or raised transaminases (≥ × 3) to Mahosot Hospital, Vientiane, Laos over 3 years. Conservative definitions suggested diagnoses of dengue (8.4%), rickettsioses (7.3%), leptospirosis (6.8%), hepatitis B (4.9%), hepatitis C (4.9%), community-acquired septicaemia (3.3%) and hepatitis E (1.6%). Although anti-hepatitis A virus (HAV) IgM antibody results suggested that 35.8% of patients had acute HAV infections, anti-HAV IgG antibody avidity and HAV PCR suggested that 82% had polyclonal activation and not acute HAV infections. Scrub typhus, murine typhus or leptospirosis were present in 12.8% of patients and were associated with meningism and relatively low AST and ALT elevation. These patients would be expected to respond to empirical doxycycline therapy which, in the absence of virological diagnosis and treatment, may be an appropriate cost-effective intervention in Lao patients with jaundice/hepatitis.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Bounlu, K" uniqKey="Bounlu K">K. Bounlu</name></author><author><name sortKey="Insisiengmay, S" uniqKey="Insisiengmay S">S. Insisiengmay</name></author><author><name sortKey="Vanthanouvong, K" uniqKey="Vanthanouvong K">K. Vanthanouvong</name></author><author><name sortKey="Saykham" uniqKey="Saykham">Saykham</name></author><author><name sortKey="Widjaja, S" uniqKey="Widjaja S">S. Widjaja</name></author><author><name sortKey="Iinuma, K" uniqKey="Iinuma K">K. Iinuma</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Laras, K" uniqKey="Laras K">K. Laras</name></author><author><name sortKey="Cao, B V" uniqKey="Cao B">B.V. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Trans R Soc Trop Med Hyg</journal-id><journal-id journal-id-type="iso-abbrev">Trans. R. Soc. Trop. Med. Hyg</journal-id><journal-title-group><journal-title>Transactions of the Royal Society of Tropical Medicine and Hygiene</journal-title></journal-title-group><issn pub-type="ppub">0035-9203</issn><issn pub-type="epub">1878-3503</issn><publisher><publisher-name>Elsevier</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">20378138</article-id><article-id pub-id-type="pmc">2896487</article-id><article-id pub-id-type="publisher-id">TRSTMH1355</article-id><article-id pub-id-type="doi">10.1016/j.trstmh.2010.03.002</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>The infective causes of hepatitis and jaundice amongst hospitalised patients in Vientiane, Laos</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Syhavong</surname><given-names>Bounkong</given-names></name><xref rid="aff1" ref-type="aff">a</xref></contrib><contrib contrib-type="author"><name><surname>Rasachack</surname><given-names>Bouachanh</given-names></name><xref rid="aff1" ref-type="aff">a</xref></contrib><contrib contrib-type="author"><name><surname>Smythe</surname><given-names>Lee</given-names></name><xref rid="aff2" ref-type="aff">b</xref></contrib><contrib contrib-type="author"><name><surname>Rolain</surname><given-names>Jean-Marc</given-names></name><xref rid="aff3" ref-type="aff">c</xref></contrib><contrib contrib-type="author"><name><surname>Roque-Afonso</surname><given-names>Anne-Marie</given-names></name><xref rid="aff4" ref-type="aff">d</xref></contrib><contrib contrib-type="author"><name><surname>Jenjaroen</surname><given-names>Kemajittra</given-names></name><xref rid="aff5" ref-type="aff">e</xref></contrib><contrib contrib-type="author"><name><surname>Soukkhaserm</surname><given-names>Vimone</given-names></name><xref rid="aff1" ref-type="aff">a</xref></contrib><contrib contrib-type="author"><name><surname>Phongmany</surname><given-names>Simmaly</given-names></name><xref rid="aff1" ref-type="aff">a</xref></contrib><contrib contrib-type="author"><name><surname>Phetsouvanh</surname><given-names>Rattanaphone</given-names></name><xref rid="aff1" ref-type="aff">a</xref><xref rid="aff6" ref-type="aff">f</xref></contrib><contrib contrib-type="author"><name><surname>Soukkhaserm</surname><given-names>Sune</given-names></name><xref rid="aff1" ref-type="aff">a</xref></contrib><contrib contrib-type="author"><name><surname>Thammavong</surname><given-names>Te</given-names></name><xref rid="aff7" ref-type="aff">g</xref></contrib><contrib contrib-type="author"><name><surname>Mayxay</surname><given-names>Mayfong</given-names></name><xref rid="aff1" ref-type="aff">a</xref><xref rid="aff6" ref-type="aff">f</xref><xref rid="aff8" ref-type="aff">h</xref></contrib><contrib contrib-type="author"><name><surname>Blacksell</surname><given-names>Stuart D.</given-names></name><xref rid="aff1" ref-type="aff">a</xref><xref rid="aff5" ref-type="aff">e</xref><xref rid="aff6" ref-type="aff">f</xref></contrib><contrib contrib-type="author"><name><surname>Barnes</surname><given-names>Eleanor</given-names></name><xref rid="aff9" ref-type="aff">i</xref></contrib><contrib contrib-type="author"><name><surname>Parola</surname><given-names>Philippe</given-names></name><xref rid="aff3" ref-type="aff">c</xref></contrib><contrib contrib-type="author"><name><surname>Dussaix</surname><given-names>Elisabeth</given-names></name><xref rid="aff4" ref-type="aff">d</xref></contrib><contrib contrib-type="author"><name><surname>Raoult</surname><given-names>Didier</given-names></name><xref rid="aff3" ref-type="aff">c</xref></contrib><contrib contrib-type="author"><name><surname>Humphreys</surname><given-names>Isla</given-names></name><xref rid="aff9" ref-type="aff">i</xref></contrib><contrib contrib-type="author"><name><surname>Klenerman</surname><given-names>Paul</given-names></name><xref rid="aff9" ref-type="aff">i</xref></contrib><contrib contrib-type="author"><name><surname>White</surname><given-names>Nicholas J.</given-names></name><xref rid="aff1" ref-type="aff">a</xref><xref rid="aff5" ref-type="aff">e</xref><xref rid="aff6" ref-type="aff">f</xref></contrib><contrib contrib-type="author"><name><surname>Newton</surname><given-names>Paul N.</given-names></name><email>paul@tropmedres.ac</email><xref rid="aff1" ref-type="aff">a</xref><xref rid="aff6" ref-type="aff">f</xref><xref rid="cor1" ref-type="corresp">⁎</xref></contrib></contrib-group><aff id="aff1"><label>a</label>Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR</aff><aff id="aff2"><label>b</label>WHO/AO/OIE Collaborating Centre for Reference & Research on Leptospirosis, Queensland Health Forensic and Scientific Services, Coopers Plains, Queensland, 4108, Australia</aff><aff id="aff3"><label>c</label>URMITE CNRS-IRD UMR 6236, Faculté de Médecine et de Pharmacie, Université de la Méditerranée, Marseille, France</aff><aff id="aff4"><label>d</label>AP-HP, National Reference Centre for HAV, Hôpital Paul Brousse, Villejuif, 94804 France</aff><aff id="aff5"><label>e</label>Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Rd., Bangkok 10400, Thailand</aff><aff id="aff6"><label>f</label>Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, UK</aff><aff id="aff7"><label>g</label>National Blood Transfusion Centre, Lao Red Cross, Vientiane, Lao PDR</aff><aff id="aff8"><label>h</label>Faculty of Post Graduate Studies, University of Health Sciences, Vientiane, Lao PDR</aff><aff id="aff9"><label>i</label>The Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, UK</aff><author-notes><corresp id="cor1"><label>⁎</label>Corresponding author. Tel.: +856 21 242168; fax: +856 21 242168. <email>paul@tropmedres.ac</email></corresp></author-notes><pub-date pub-type="pmc-release"><month>7</month><year>2010</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on the
<pub-date pub-type="ppub"><month>7</month><year>2010</year></pub-date><volume>104</volume><issue>7-2</issue><fpage>475</fpage><lpage>483</lpage><history><date date-type="received"><day>12</day><month>7</month><year>2009</year></date><date date-type="rev-recd"><day>4</day><month>3</month><year>2010</year></date><date date-type="accepted"><day>5</day><month>3</month><year>2010</year></date></history><permissions><copyright-statement>© 2010 Elsevier Ltd.</copyright-statement><copyright-year>2010</copyright-year><copyright-holder>Royal Society of Tropical Medicine and Hygiene</copyright-holder><license><license-p>This document may be redistributed and reused, subject to <ext-link ext-link-type="uri" xlink:href="http://www.elsevier.com/wps/find/authorsview.authors/supplementalterms1.0">certain conditions</ext-link>.</license-p></license></permissions><abstract><title>Summary</title><p>There is little information on the diverse infectious causes of jaundice and hepatitis in the Asiatic tropics. Serology (hepatitis A, B, C and E, leptospirosis, dengue, rickettsia), antigen tests (dengue), PCR assays (hepatitis A, C and E) and blood cultures (septicaemia) were performed on samples from 392 patients admitted with jaundice or raised transaminases (≥ × 3) to Mahosot Hospital, Vientiane, Laos over 3 years. Conservative definitions suggested diagnoses of dengue (8.4%), rickettsioses (7.3%), leptospirosis (6.8%), hepatitis B (4.9%), hepatitis C (4.9%), community-acquired septicaemia (3.3%) and hepatitis E (1.6%). Although anti-hepatitis A virus (HAV) IgM antibody results suggested that 35.8% of patients had acute HAV infections, anti-HAV IgG antibody avidity and HAV PCR suggested that 82% had polyclonal activation and not acute HAV infections. Scrub typhus, murine typhus or leptospirosis were present in 12.8% of patients and were associated with meningism and relatively low AST and ALT elevation. These patients would be expected to respond to empirical doxycycline therapy which, in the absence of virological diagnosis and treatment, may be an appropriate cost-effective intervention in Lao patients with jaundice/hepatitis.</p></abstract><kwd-group><title>Keywords</title><kwd>Jaundice</kwd><kwd>Hepatitis E virus</kwd><kwd><italic>Orientia tsutsugamushi</italic></kwd><kwd><italic>Rickettsia typhi</italic></kwd><kwd>Leptospirosis</kwd><kwd>Laos</kwd></kwd-group></article-meta></front><floats-group><fig id="fig1"><label>Figure 1</label><caption><p>(A) Number of patients recruited per age category and percent age distribution of patients with anti-HAV IgM antibodies; (B) percent age distribution of patients with anti-HBV core IgM antibodies; (C) percent age distribution of patients HCV PCR positive; (D) percent age distribution of patients anti-leptospire MAT positive; (E) percent age distribution of patients dengue positive (IgM, IgG and/or NS1).</p></caption><graphic xlink:href="gr1"></graphic></fig><fig id="fig2"><label>Figure 2</label><caption><p>Box plots (median, 25th and 75th percentiles and whiskers to range) for serum AST (A), ALT (B), total bilirubin (C) concentrations and total bilirubin:AST (D) and total bilirubin:ALT (E) ratios for patients with laboratory evidence for leptospirosis, typhus (scrub typhus, murine typhus and spotted fever group combined), community-acquired septicaemia, dengue and viral hepatitis A,B,C and E. Patients with mixed infections have been excluded.</p></caption><graphic xlink:href="gr2"></graphic></fig><table-wrap id="tbl1" position="float"><label>Table 1</label><caption><p>Serology, antigen and gene detection markers of acute jaundice/hepatitis among 392 Lao patients at Mahosot Hospital 2001–2004</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left">Marker</th><th align="left">All patients</th><th align="left">Fever</th></tr><tr><th></th><th align="left">No. positive/tested (%)</th><th align="left">No. positive/tested (%)</th></tr></thead><tbody><tr><td colspan="3" align="left">Hepatitis A</td></tr><tr><td align="left"> IgM</td><td align="left">136/380 (35.8)</td><td align="left">115/300 (38.3)</td></tr><tr><td align="left"> IgM w/o other diagnosis</td><td align="left">110/380 (28.9)</td><td align="left">95/300 (31.7)</td></tr><tr><td colspan="3" align="left">
</td></tr><tr><td colspan="3" align="left">Hepatitis B</td></tr><tr><td align="left"> HBsAg</td><td align="left">70/389 (18.0)</td><td align="left">50/304 (16.5)</td></tr><tr><td align="left"> Anti-HBsAg</td><td align="left">61/388 (15.7)</td><td align="left">51/303 (16.8)</td></tr><tr><td align="left"> Anti-IgM core</td><td align="left">19/119 (16.0)</td><td align="left">11/93 (11.8)</td></tr><tr><td colspan="3" align="left">
</td></tr><tr><td colspan="3" align="left">Hepatitis C</td></tr><tr><td align="left"> Total Ig</td><td align="left">63/389 (16.2)</td><td align="left">46/304 (15.1)</td></tr><tr><td align="left"> PCR</td><td align="left">19/50 (38.0)</td><td align="left">13/36 (36.1)</td></tr><tr><td colspan="3" align="left">
</td></tr><tr><td colspan="3" align="left">Hepatitis E</td></tr><tr><td align="left"> IgM</td><td align="left">6/378 (1.6)</td><td align="left">5/298 (1.7)</td></tr><tr><td align="left"> PCR</td><td align="left">2/12 (17.0)</td><td align="left">2/11 (18.2)</td></tr><tr><td colspan="3" align="left">
</td></tr><tr><td colspan="3" align="left">Dengue</td></tr><tr><td align="left"> IgM, IgG and NS1</td><td align="left">33/189 (17.5)</td><td align="left">30/139 (21.6)</td></tr><tr><td align="left"> Primary</td><td align="left">14/189 (7.4)</td><td align="left">13/139 (9.4)</td></tr><tr><td align="left"> Secondary</td><td align="left">19/189 (10.0)</td><td align="left">17/139 (12.2)</td></tr><tr><td colspan="3" align="left">
</td></tr><tr><td colspan="3" align="left">Leptospirosis<xref rid="tbl1fn1" ref-type="table-fn">a</xref></td></tr><tr><td align="left"> MAT</td><td align="left">26/385 (6.8)</td><td align="left">24/303 (7.9)</td></tr><tr><td colspan="3" align="left">
</td></tr><tr><td colspan="3" align="left">Murine typhus<xref rid="tbl1fn2" ref-type="table-fn">b</xref></td></tr><tr><td align="left"> IgM/IgG IFA</td><td align="left">14/382 (3.7)</td><td align="left">11/301 (3.7)</td></tr><tr><td colspan="3" align="left">
</td></tr><tr><td colspan="3" align="left">Scrub typhus<xref rid="tbl1fn3" ref-type="table-fn">c</xref></td></tr><tr><td align="left"> IgM/IgG IFA</td><td align="left">8/382 (2.1)</td><td align="left">8/301 (2.7)</td></tr><tr><td colspan="3" align="left">
</td></tr><tr><td colspan="3" align="left">Spotted fever group<xref rid="tbl1fn4" ref-type="table-fn">d</xref></td></tr><tr><td align="left"> IgM/IgG IFA</td><td align="left">6/382 (1.6)</td><td align="left">5/301 (1.7)</td></tr><tr><td colspan="3" align="left">
</td></tr><tr><td colspan="3" align="left">Septicaemia</td></tr><tr><td align="left"> Culture positive</td><td align="left">13/166 (7.8)</td><td align="left">12/146 (8.2)</td></tr></tbody></table><table-wrap-foot><fn><p>Ig: immunoglobulin.</p></fn></table-wrap-foot><table-wrap-foot><fn id="tbl1fn1"><label>a</label><p>The serovars tested were Pomona, Hardjo, Tarassovi, Grippotyphosa, Celledoni, Copenhageni, Australis, Pyrogenes, Canicola, Hebdomadis, Mini, Sarmin, Autumnalis, Cynopteri, Ballum, Bataviae, Djasiman, Javanica, Panama, Shermani and Mwalok. The serovars used in an MAT panel may not always represent the actual infecting serovar for the region but demonstrate reaction within the Serogroup housing the actual serovar.</p></fn></table-wrap-foot><table-wrap-foot><fn id="tbl1fn2"><label>b</label><p>Using whole-cell antigens of <italic>R. typhi</italic>.</p></fn></table-wrap-foot><table-wrap-foot><fn id="tbl1fn3"><label>c</label><p>Using whole-cell antigens of <italic>O. tsutsugamushi</italic> serotypes Karp, Kato, Gilliam, and Kawasaki.</p></fn></table-wrap-foot><table-wrap-foot><fn id="tbl1fn4"><label>d</label><p>Using whole-cell antigens <italic>R. conorii</italic> subsp. indica, <italic>R. felis, R. heilongjangensis, R. helvetica, R. honei, R. japonica, Rickettsia</italic> ‘ATI’, <italic>R. slovaca</italic>.<xref rid="bib4" ref-type="bibr"><sup>4</sup></xref></p></fn></table-wrap-foot></table-wrap><table-wrap id="tbl2" position="float" orientation="landscape"><label>Table 2</label><caption><p>Evidence for dual positivity among serology, antigen and gene detection markers of acute jaundice/hepatitis among 392 Lao patients at Mahosot Hospital, 2001–2004. SFG = spotted fever group.</p></caption><table frame="hsides" rules="groups"><thead><tr><th></th><th align="left">HAV</th><th align="left">HBV</th><th align="left">HCV</th><th align="left">HEV</th><th align="left">Dengue</th><th align="left">Leptospirosis</th><th align="left">Scrub typhus</th><th align="left">Murine typhus</th><th align="left">SFG</th><th align="left">Sepsis</th></tr></thead><tbody><tr><td align="left">HAV</td><td align="left"><bold>136</bold></td><td align="left">6</td><td align="left">1</td><td align="left">1</td><td align="left">0</td><td align="left">9</td><td align="left">2</td><td align="left">3</td><td align="left">2</td><td align="left">3</td></tr><tr><td align="left">HBV</td><td align="left">6</td><td align="left"><bold>19</bold></td><td align="left">0</td><td align="left">2</td><td align="left">0</td><td align="left">0</td><td align="left">0</td><td align="left">0</td><td align="left">0</td><td align="left">0</td></tr><tr><td align="left">HCV</td><td align="left">1</td><td align="left">0</td><td align="left"><bold>19</bold></td><td align="left">0</td><td align="left">0</td><td align="left">0</td><td align="left">0</td><td align="left">0</td><td align="left">1</td><td align="left">2</td></tr><tr><td align="left">HEV</td><td align="left">0</td><td align="left">0</td><td align="left">0</td><td align="left"><bold>6</bold></td><td align="left">0</td><td align="left">1</td><td align="left">0</td><td align="left">0</td><td align="left">0</td><td align="left">0</td></tr><tr><td align="left">Dengue</td><td align="left">0</td><td align="left">0</td><td align="left">0</td><td align="left">0</td><td align="left"><bold>33</bold></td><td align="left">0</td><td align="left">2</td><td align="left">1</td><td align="left">0</td><td align="left">1</td></tr><tr><td align="left">Leptospirosis</td><td align="left">9</td><td align="left">0</td><td align="left">0</td><td align="left">1</td><td align="left">0</td><td align="left"><bold>26</bold></td><td align="left">2</td><td align="left">0</td><td align="left">2</td><td align="left">1</td></tr><tr><td align="left">Scrub typhus</td><td align="left">2</td><td align="left">0</td><td align="left">0</td><td align="left">0</td><td align="left">2</td><td align="left">2</td><td align="left"><bold>8</bold></td><td align="left">0</td><td align="left">0</td><td align="left">0</td></tr><tr><td align="left">Murine typhus</td><td align="left">3</td><td align="left">0</td><td align="left">0</td><td align="left">0</td><td align="left">1</td><td align="left">0</td><td align="left">0</td><td align="left"><bold>14</bold></td><td align="left">0</td><td align="left">0</td></tr><tr><td align="left">Spotted fever group</td><td align="left">2</td><td align="left">0</td><td align="left">1</td><td align="left">0</td><td align="left">0</td><td align="left">2</td><td align="left">0</td><td align="left">0</td><td align="left"><bold>6</bold></td><td align="left">0</td></tr><tr><td align="left">Sepsis</td><td align="left">3</td><td align="left">0</td><td align="left">2</td><td align="left">0</td><td align="left">1</td><td align="left">1</td><td align="left">0</td><td align="left">0</td><td align="left">0</td><td align="left"><bold>13</bold></td></tr><tr><td align="left">All (% dual)</td><td align="left">26/136 (19%)</td><td align="left">6/19 (32%)</td><td align="left">4/19 (21%)</td><td align="left">4/6 (67%)</td><td align="left">4/33 (12%)</td><td align="left">15/26 (58%)</td><td align="left">6/8 (75%)</td><td align="left">4/14 (29%)</td><td align="left">5/6 (83%)</td><td align="left">7/13 (54%)</td></tr></tbody></table></table-wrap></floats-group></pmc><affiliations><list><country><li>Australie</li><li>France</li><li>Royaume-Uni</li><li>Thaïlande</li></country><region><li>Angleterre</li><li>Oxfordshire</li><li>Provence-Alpes-Côte d'Azur</li></region><settlement><li>Marseille</li><li>Oxford</li></settlement><orgName><li>Université d'Oxford</li><li>Université de la Méditerranée</li></orgName></list><tree><noCountry><name sortKey="Phongmany, Simmaly" sort="Phongmany, Simmaly" uniqKey="Phongmany S" first="Simmaly" last="Phongmany">Simmaly Phongmany</name><name sortKey="Rasachack, Bouachanh" sort="Rasachack, Bouachanh" uniqKey="Rasachack B" first="Bouachanh" last="Rasachack">Bouachanh Rasachack</name><name sortKey="Soukkhaserm, Sune" sort="Soukkhaserm, Sune" uniqKey="Soukkhaserm S" first="Sune" last="Soukkhaserm">Sune Soukkhaserm</name><name sortKey="Soukkhaserm, Vimone" sort="Soukkhaserm, Vimone" uniqKey="Soukkhaserm V" first="Vimone" last="Soukkhaserm">Vimone Soukkhaserm</name><name sortKey="Syhavong, Bounkong" sort="Syhavong, Bounkong" uniqKey="Syhavong B" first="Bounkong" last="Syhavong">Bounkong Syhavong</name><name sortKey="Thammavong, Te" sort="Thammavong, Te" uniqKey="Thammavong T" first="Te" last="Thammavong">Te Thammavong</name></noCountry><country name="Australie"><noRegion><name sortKey="Smythe, Lee" sort="Smythe, Lee" uniqKey="Smythe L" first="Lee" last="Smythe">Lee Smythe</name></noRegion></country><country name="France"><region name="Provence-Alpes-Côte d'Azur"><name sortKey="Rolain, Jean Marc" sort="Rolain, Jean Marc" uniqKey="Rolain J" first="Jean-Marc" last="Rolain">Jean-Marc Rolain</name></region><name sortKey="Dussaix, Elisabeth" sort="Dussaix, Elisabeth" uniqKey="Dussaix E" first="Elisabeth" last="Dussaix">Elisabeth Dussaix</name><name sortKey="Parola, Philippe" sort="Parola, Philippe" uniqKey="Parola P" first="Philippe" last="Parola">Philippe Parola</name><name sortKey="Raoult, Didier" sort="Raoult, Didier" uniqKey="Raoult D" first="Didier" last="Raoult">Didier Raoult</name><name sortKey="Roque Afonso, Anne Marie" sort="Roque Afonso, Anne Marie" uniqKey="Roque Afonso A" first="Anne-Marie" last="Roque-Afonso">Anne-Marie Roque-Afonso</name></country><country name="Thaïlande"><noRegion><name sortKey="Jenjaroen, Kemajittra" sort="Jenjaroen, Kemajittra" uniqKey="Jenjaroen K" first="Kemajittra" last="Jenjaroen">Kemajittra Jenjaroen</name></noRegion><name sortKey="Blacksell, Stuart D" sort="Blacksell, Stuart D" uniqKey="Blacksell S" first="Stuart D." last="Blacksell">Stuart D. Blacksell</name><name sortKey="White, Nicholas J" sort="White, Nicholas J" uniqKey="White N" first="Nicholas J." last="White">Nicholas J. White</name></country><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Phetsouvanh, Rattanaphone" sort="Phetsouvanh, Rattanaphone" uniqKey="Phetsouvanh R" first="Rattanaphone" last="Phetsouvanh">Rattanaphone Phetsouvanh</name></region><name sortKey="Barnes, Eleanor" sort="Barnes, Eleanor" uniqKey="Barnes E" first="Eleanor" last="Barnes">Eleanor Barnes</name><name sortKey="Blacksell, Stuart D" sort="Blacksell, Stuart D" uniqKey="Blacksell S" first="Stuart D." last="Blacksell">Stuart D. Blacksell</name><name sortKey="Humphreys, Isla" sort="Humphreys, Isla" uniqKey="Humphreys I" first="Isla" last="Humphreys">Isla Humphreys</name><name sortKey="Klenerman, Paul" sort="Klenerman, Paul" uniqKey="Klenerman P" first="Paul" last="Klenerman">Paul Klenerman</name><name sortKey="Mayxay, Mayfong" sort="Mayxay, Mayfong" uniqKey="Mayxay M" first="Mayfong" last="Mayxay">Mayfong Mayxay</name><name sortKey="Newton, Paul N" sort="Newton, Paul N" uniqKey="Newton P" first="Paul N." last="Newton">Paul N. Newton</name><name sortKey="White, Nicholas J" sort="White, Nicholas J" uniqKey="White N" first="Nicholas J." last="White">Nicholas J. White</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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