The infective causes of hepatitis and jaundice amongst hospitalised patients in Vientiane, Laos
Identifieur interne : 001F33 ( PascalFrancis/Checkpoint ); précédent : 001F32; suivant : 001F34The infective causes of hepatitis and jaundice amongst hospitalised patients in Vientiane, Laos
Auteurs : Bounkong Syhavong [Laos] ; Bouachanh Rasachack [Laos] ; Lee Smythe [Australie] ; Jean-Marc Rolain [France] ; Anne-Marie Roque-Afonso [France] ; Kemajittra Jenjaroen [Thaïlande] ; Vimone Soukkhaserm [Laos] ; Simmaly Phongmany [Laos] ; Rattanaphone Phetsouvanh [Laos, Royaume-Uni] ; Sune Soukkhaserm [Laos] ; Te Thammavong [Laos] ; Mayfong Mayxay [Laos, Royaume-Uni] ; Stuart D. Blacksell [Laos, 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 [Laos, Thaïlande, Royaume-Uni] ; Paul N. Newton [Laos, Royaume-Uni]Source :
- Transactions of the Royal Society of Tropical Medicine and Hygiene [ 0035-9203 ] ; 2010.
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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 (≥ x 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.
Affiliations:
- Australie, France, Laos, Royaume-Uni, Thaïlande
- Angleterre, Oxfordshire, Provence-Alpes-Côte d'Azur, Île-de-France
- Marseille, Oxford
- Université d'Oxford, Université de la Méditerranée
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<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>
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<author><name sortKey="Soukkhaserm, Vimone" sort="Soukkhaserm, Vimone" uniqKey="Soukkhaserm V" first="Vimone" last="Soukkhaserm">Vimone Soukkhaserm</name>
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<author><name sortKey="Phongmany, Simmaly" sort="Phongmany, Simmaly" uniqKey="Phongmany S" first="Simmaly" last="Phongmany">Simmaly Phongmany</name>
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<author><name sortKey="Soukkhaserm, Sune" sort="Soukkhaserm, Sune" uniqKey="Soukkhaserm S" first="Sune" last="Soukkhaserm">Sune Soukkhaserm</name>
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<affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Rd.</s1>
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<author><name sortKey="Barnes, Eleanor" sort="Barnes, Eleanor" uniqKey="Barnes E" first="Eleanor" last="Barnes">Eleanor Barnes</name>
<affiliation wicri:level="4"><inist:fA14 i1="09"><s1>The Peter Medawar Building for Pathogen Research, University of Oxford</s1>
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<author><name sortKey="Parola, Philippe" sort="Parola, Philippe" uniqKey="Parola P" first="Philippe" last="Parola">Philippe Parola</name>
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<author><name sortKey="Dussaix, Elisabeth" sort="Dussaix, Elisabeth" uniqKey="Dussaix E" first="Elisabeth" last="Dussaix">Elisabeth Dussaix</name>
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<placeName><region type="region" nuts="2">Île-de-France</region>
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<author><name sortKey="Raoult, Didier" sort="Raoult, Didier" uniqKey="Raoult D" first="Didier" last="Raoult">Didier Raoult</name>
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<settlement type="city">Marseille</settlement>
<settlement type="city">Marseille</settlement>
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<orgName type="university">Université de la Méditerranée</orgName>
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<author><name sortKey="Humphreys, Isla" sort="Humphreys, Isla" uniqKey="Humphreys I" first="Isla" last="Humphreys">Isla Humphreys</name>
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<settlement type="city">Oxford</settlement>
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<orgName type="university">Université d'Oxford</orgName>
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<author><name sortKey="Klenerman, Paul" sort="Klenerman, Paul" uniqKey="Klenerman P" first="Paul" last="Klenerman">Paul Klenerman</name>
<affiliation wicri:level="4"><inist:fA14 i1="09"><s1>The Peter Medawar Building for Pathogen Research, University of Oxford</s1>
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<settlement type="city">Oxford</settlement>
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<orgName type="university">Université d'Oxford</orgName>
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<author><name sortKey="White, Nicholas J" sort="White, Nicholas J" uniqKey="White N" first="Nicholas J." last="White">Nicholas J. White</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital</s1>
<s2>Vientiane</s2>
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<country>Laos</country>
<wicri:noRegion>Vientiane</wicri:noRegion>
</affiliation>
<affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Rd.</s1>
<s2>Bangkok 10400</s2>
<s3>THA</s3>
<sZ>6 aut.</sZ>
<sZ>13 aut.</sZ>
<sZ>20 aut.</sZ>
</inist:fA14>
<country>Thaïlande</country>
<wicri:noRegion>Bangkok 10400</wicri:noRegion>
</affiliation>
<affiliation wicri:level="4"><inist:fA14 i1="06"><s1>Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Churchill Hospital</s1>
<s2>Oxford</s2>
<s3>GBR</s3>
<sZ>9 aut.</sZ>
<sZ>12 aut.</sZ>
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<country>Royaume-Uni</country>
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<settlement type="city">Oxford</settlement>
</placeName>
<orgName type="university">Université d'Oxford</orgName>
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</author>
<author><name sortKey="Newton, Paul N" sort="Newton, Paul N" uniqKey="Newton P" first="Paul N." last="Newton">Paul N. Newton</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital</s1>
<s2>Vientiane</s2>
<s3>LAO</s3>
<sZ>1 aut.</sZ>
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<sZ>12 aut.</sZ>
<sZ>13 aut.</sZ>
<sZ>20 aut.</sZ>
<sZ>21 aut.</sZ>
</inist:fA14>
<country>Laos</country>
<wicri:noRegion>Vientiane</wicri:noRegion>
</affiliation>
<affiliation wicri:level="4"><inist:fA14 i1="06"><s1>Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Churchill Hospital</s1>
<s2>Oxford</s2>
<s3>GBR</s3>
<sZ>9 aut.</sZ>
<sZ>12 aut.</sZ>
<sZ>13 aut.</sZ>
<sZ>20 aut.</sZ>
<sZ>21 aut.</sZ>
</inist:fA14>
<country>Royaume-Uni</country>
<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">INIST</idno>
<idno type="inist">10-0331519</idno>
<date when="2010">2010</date>
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<idno type="RBID">Pascal:10-0331519</idno>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">The infective causes of hepatitis and jaundice amongst hospitalised patients in Vientiane, Laos</title>
<author><name sortKey="Syhavong, Bounkong" sort="Syhavong, Bounkong" uniqKey="Syhavong B" first="Bounkong" last="Syhavong">Bounkong Syhavong</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital</s1>
<s2>Vientiane</s2>
<s3>LAO</s3>
<sZ>1 aut.</sZ>
<sZ>2 aut.</sZ>
<sZ>7 aut.</sZ>
<sZ>8 aut.</sZ>
<sZ>9 aut.</sZ>
<sZ>10 aut.</sZ>
<sZ>12 aut.</sZ>
<sZ>13 aut.</sZ>
<sZ>20 aut.</sZ>
<sZ>21 aut.</sZ>
</inist:fA14>
<country>Laos</country>
<wicri:noRegion>Vientiane</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Rasachack, Bouachanh" sort="Rasachack, Bouachanh" uniqKey="Rasachack B" first="Bouachanh" last="Rasachack">Bouachanh Rasachack</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital</s1>
<s2>Vientiane</s2>
<s3>LAO</s3>
<sZ>1 aut.</sZ>
<sZ>2 aut.</sZ>
<sZ>7 aut.</sZ>
<sZ>8 aut.</sZ>
<sZ>9 aut.</sZ>
<sZ>10 aut.</sZ>
<sZ>12 aut.</sZ>
<sZ>13 aut.</sZ>
<sZ>20 aut.</sZ>
<sZ>21 aut.</sZ>
</inist:fA14>
<country>Laos</country>
<wicri:noRegion>Vientiane</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Smythe, Lee" sort="Smythe, Lee" uniqKey="Smythe L" first="Lee" last="Smythe">Lee Smythe</name>
<affiliation wicri:level="1"><inist:fA14 i1="02"><s1>WHO/AO/OIE Collaborating Centre for Reference & Research on Leptospirosis, Queensland Health Forensic and Scientific Services</s1>
<s2>Coopers Plains, Queensland, 4108</s2>
<s3>AUS</s3>
<sZ>3 aut.</sZ>
</inist:fA14>
<country>Australie</country>
<wicri:noRegion>Coopers Plains, Queensland, 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"><inist:fA14 i1="03"><s1>URMITE CNRS-IRD UMR 6236, Faculté de Médecine et de Pharmacie, Université de la Méditerranée</s1>
<s2>Marseille</s2>
<s3>FRA</s3>
<sZ>4 aut.</sZ>
<sZ>15 aut.</sZ>
<sZ>17 aut.</sZ>
</inist:fA14>
<country>France</country>
<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"><inist:fA14 i1="04"><s1>AP-HP, National Reference Centre for HAV, Hôpital Paul Brousse</s1>
<s2>Villejuif, 94804</s2>
<s3>FRA</s3>
<sZ>5 aut.</sZ>
<sZ>16 aut.</sZ>
</inist:fA14>
<country>France</country>
<wicri:noRegion>94804</wicri:noRegion>
<wicri:noRegion>Hôpital Paul Brousse</wicri:noRegion>
<wicri:noRegion>Villejuif, 94804</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"><inist:fA14 i1="05"><s1>Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Rd.</s1>
<s2>Bangkok 10400</s2>
<s3>THA</s3>
<sZ>6 aut.</sZ>
<sZ>13 aut.</sZ>
<sZ>20 aut.</sZ>
</inist:fA14>
<country>Thaïlande</country>
<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 wicri:level="1"><inist:fA14 i1="01"><s1>Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital</s1>
<s2>Vientiane</s2>
<s3>LAO</s3>
<sZ>1 aut.</sZ>
<sZ>2 aut.</sZ>
<sZ>7 aut.</sZ>
<sZ>8 aut.</sZ>
<sZ>9 aut.</sZ>
<sZ>10 aut.</sZ>
<sZ>12 aut.</sZ>
<sZ>13 aut.</sZ>
<sZ>20 aut.</sZ>
<sZ>21 aut.</sZ>
</inist:fA14>
<country>Laos</country>
<wicri:noRegion>Vientiane</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Phongmany, Simmaly" sort="Phongmany, Simmaly" uniqKey="Phongmany S" first="Simmaly" last="Phongmany">Simmaly Phongmany</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital</s1>
<s2>Vientiane</s2>
<s3>LAO</s3>
<sZ>1 aut.</sZ>
<sZ>2 aut.</sZ>
<sZ>7 aut.</sZ>
<sZ>8 aut.</sZ>
<sZ>9 aut.</sZ>
<sZ>10 aut.</sZ>
<sZ>12 aut.</sZ>
<sZ>13 aut.</sZ>
<sZ>20 aut.</sZ>
<sZ>21 aut.</sZ>
</inist:fA14>
<country>Laos</country>
<wicri:noRegion>Vientiane</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Phetsouvanh, Rattanaphone" sort="Phetsouvanh, Rattanaphone" uniqKey="Phetsouvanh R" first="Rattanaphone" last="Phetsouvanh">Rattanaphone Phetsouvanh</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital</s1>
<s2>Vientiane</s2>
<s3>LAO</s3>
<sZ>1 aut.</sZ>
<sZ>2 aut.</sZ>
<sZ>7 aut.</sZ>
<sZ>8 aut.</sZ>
<sZ>9 aut.</sZ>
<sZ>10 aut.</sZ>
<sZ>12 aut.</sZ>
<sZ>13 aut.</sZ>
<sZ>20 aut.</sZ>
<sZ>21 aut.</sZ>
</inist:fA14>
<country>Laos</country>
<wicri:noRegion>Vientiane</wicri:noRegion>
</affiliation>
<affiliation wicri:level="4"><inist:fA14 i1="06"><s1>Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Churchill Hospital</s1>
<s2>Oxford</s2>
<s3>GBR</s3>
<sZ>9 aut.</sZ>
<sZ>12 aut.</sZ>
<sZ>13 aut.</sZ>
<sZ>20 aut.</sZ>
<sZ>21 aut.</sZ>
</inist:fA14>
<country>Royaume-Uni</country>
<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 wicri:level="1"><inist:fA14 i1="01"><s1>Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital</s1>
<s2>Vientiane</s2>
<s3>LAO</s3>
<sZ>1 aut.</sZ>
<sZ>2 aut.</sZ>
<sZ>7 aut.</sZ>
<sZ>8 aut.</sZ>
<sZ>9 aut.</sZ>
<sZ>10 aut.</sZ>
<sZ>12 aut.</sZ>
<sZ>13 aut.</sZ>
<sZ>20 aut.</sZ>
<sZ>21 aut.</sZ>
</inist:fA14>
<country>Laos</country>
<wicri:noRegion>Vientiane</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Thammavong, Te" sort="Thammavong, Te" uniqKey="Thammavong T" first="Te" last="Thammavong">Te Thammavong</name>
<affiliation wicri:level="1"><inist:fA14 i1="07"><s1>National Blood Transfusion Centre, Lao Red Cross</s1>
<s2>Vientiane</s2>
<s3>LAO</s3>
<sZ>11 aut.</sZ>
</inist:fA14>
<country>Laos</country>
<wicri:noRegion>Vientiane</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Mayxay, Mayfong" sort="Mayxay, Mayfong" uniqKey="Mayxay M" first="Mayfong" last="Mayxay">Mayfong Mayxay</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital</s1>
<s2>Vientiane</s2>
<s3>LAO</s3>
<sZ>1 aut.</sZ>
<sZ>2 aut.</sZ>
<sZ>7 aut.</sZ>
<sZ>8 aut.</sZ>
<sZ>9 aut.</sZ>
<sZ>10 aut.</sZ>
<sZ>12 aut.</sZ>
<sZ>13 aut.</sZ>
<sZ>20 aut.</sZ>
<sZ>21 aut.</sZ>
</inist:fA14>
<country>Laos</country>
<wicri:noRegion>Vientiane</wicri:noRegion>
</affiliation>
<affiliation wicri:level="4"><inist:fA14 i1="06"><s1>Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Churchill Hospital</s1>
<s2>Oxford</s2>
<s3>GBR</s3>
<sZ>9 aut.</sZ>
<sZ>12 aut.</sZ>
<sZ>13 aut.</sZ>
<sZ>20 aut.</sZ>
<sZ>21 aut.</sZ>
</inist:fA14>
<country>Royaume-Uni</country>
<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"><inist:fA14 i1="08"><s1>Faculty of Post Graduate Studies, University of Health Sciences</s1>
<s2>Vientiane</s2>
<s3>LAO</s3>
<sZ>12 aut.</sZ>
</inist:fA14>
<country>Laos</country>
<wicri:noRegion>Vientiane</wicri:noRegion>
</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 wicri:level="1"><inist:fA14 i1="01"><s1>Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital</s1>
<s2>Vientiane</s2>
<s3>LAO</s3>
<sZ>1 aut.</sZ>
<sZ>2 aut.</sZ>
<sZ>7 aut.</sZ>
<sZ>8 aut.</sZ>
<sZ>9 aut.</sZ>
<sZ>10 aut.</sZ>
<sZ>12 aut.</sZ>
<sZ>13 aut.</sZ>
<sZ>20 aut.</sZ>
<sZ>21 aut.</sZ>
</inist:fA14>
<country>Laos</country>
<wicri:noRegion>Vientiane</wicri:noRegion>
</affiliation>
<affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Rd.</s1>
<s2>Bangkok 10400</s2>
<s3>THA</s3>
<sZ>6 aut.</sZ>
<sZ>13 aut.</sZ>
<sZ>20 aut.</sZ>
</inist:fA14>
<country>Thaïlande</country>
<wicri:noRegion>Bangkok 10400</wicri:noRegion>
</affiliation>
<affiliation wicri:level="4"><inist:fA14 i1="06"><s1>Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Churchill Hospital</s1>
<s2>Oxford</s2>
<s3>GBR</s3>
<sZ>9 aut.</sZ>
<sZ>12 aut.</sZ>
<sZ>13 aut.</sZ>
<sZ>20 aut.</sZ>
<sZ>21 aut.</sZ>
</inist:fA14>
<country>Royaume-Uni</country>
<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"><inist:fA14 i1="09"><s1>The Peter Medawar Building for Pathogen Research, University of Oxford</s1>
<s2>Oxford</s2>
<s3>GBR</s3>
<sZ>14 aut.</sZ>
<sZ>18 aut.</sZ>
<sZ>19 aut.</sZ>
</inist:fA14>
<country>Royaume-Uni</country>
<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"><inist:fA14 i1="03"><s1>URMITE CNRS-IRD UMR 6236, Faculté de Médecine et de Pharmacie, Université de la Méditerranée</s1>
<s2>Marseille</s2>
<s3>FRA</s3>
<sZ>4 aut.</sZ>
<sZ>15 aut.</sZ>
<sZ>17 aut.</sZ>
</inist:fA14>
<country>France</country>
<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="3"><inist:fA14 i1="04"><s1>AP-HP, National Reference Centre for HAV, Hôpital Paul Brousse</s1>
<s2>Villejuif, 94804</s2>
<s3>FRA</s3>
<sZ>5 aut.</sZ>
<sZ>16 aut.</sZ>
</inist:fA14>
<country>France</country>
<placeName><region type="region" nuts="2">Île-de-France</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Raoult, Didier" sort="Raoult, Didier" uniqKey="Raoult D" first="Didier" last="Raoult">Didier Raoult</name>
<affiliation wicri:level="4"><inist:fA14 i1="03"><s1>URMITE CNRS-IRD UMR 6236, Faculté de Médecine et de Pharmacie, Université de la Méditerranée</s1>
<s2>Marseille</s2>
<s3>FRA</s3>
<sZ>4 aut.</sZ>
<sZ>15 aut.</sZ>
<sZ>17 aut.</sZ>
</inist:fA14>
<country>France</country>
<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"><inist:fA14 i1="09"><s1>The Peter Medawar Building for Pathogen Research, University of Oxford</s1>
<s2>Oxford</s2>
<s3>GBR</s3>
<sZ>14 aut.</sZ>
<sZ>18 aut.</sZ>
<sZ>19 aut.</sZ>
</inist:fA14>
<country>Royaume-Uni</country>
<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"><inist:fA14 i1="09"><s1>The Peter Medawar Building for Pathogen Research, University of Oxford</s1>
<s2>Oxford</s2>
<s3>GBR</s3>
<sZ>14 aut.</sZ>
<sZ>18 aut.</sZ>
<sZ>19 aut.</sZ>
</inist:fA14>
<country>Royaume-Uni</country>
<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 wicri:level="1"><inist:fA14 i1="01"><s1>Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital</s1>
<s2>Vientiane</s2>
<s3>LAO</s3>
<sZ>1 aut.</sZ>
<sZ>2 aut.</sZ>
<sZ>7 aut.</sZ>
<sZ>8 aut.</sZ>
<sZ>9 aut.</sZ>
<sZ>10 aut.</sZ>
<sZ>12 aut.</sZ>
<sZ>13 aut.</sZ>
<sZ>20 aut.</sZ>
<sZ>21 aut.</sZ>
</inist:fA14>
<country>Laos</country>
<wicri:noRegion>Vientiane</wicri:noRegion>
</affiliation>
<affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Rd.</s1>
<s2>Bangkok 10400</s2>
<s3>THA</s3>
<sZ>6 aut.</sZ>
<sZ>13 aut.</sZ>
<sZ>20 aut.</sZ>
</inist:fA14>
<country>Thaïlande</country>
<wicri:noRegion>Bangkok 10400</wicri:noRegion>
</affiliation>
<affiliation wicri:level="4"><inist:fA14 i1="06"><s1>Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Churchill Hospital</s1>
<s2>Oxford</s2>
<s3>GBR</s3>
<sZ>9 aut.</sZ>
<sZ>12 aut.</sZ>
<sZ>13 aut.</sZ>
<sZ>20 aut.</sZ>
<sZ>21 aut.</sZ>
</inist:fA14>
<country>Royaume-Uni</country>
<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 wicri:level="1"><inist:fA14 i1="01"><s1>Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital</s1>
<s2>Vientiane</s2>
<s3>LAO</s3>
<sZ>1 aut.</sZ>
<sZ>2 aut.</sZ>
<sZ>7 aut.</sZ>
<sZ>8 aut.</sZ>
<sZ>9 aut.</sZ>
<sZ>10 aut.</sZ>
<sZ>12 aut.</sZ>
<sZ>13 aut.</sZ>
<sZ>20 aut.</sZ>
<sZ>21 aut.</sZ>
</inist:fA14>
<country>Laos</country>
<wicri:noRegion>Vientiane</wicri:noRegion>
</affiliation>
<affiliation wicri:level="4"><inist:fA14 i1="06"><s1>Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Churchill Hospital</s1>
<s2>Oxford</s2>
<s3>GBR</s3>
<sZ>9 aut.</sZ>
<sZ>12 aut.</sZ>
<sZ>13 aut.</sZ>
<sZ>20 aut.</sZ>
<sZ>21 aut.</sZ>
</inist:fA14>
<country>Royaume-Uni</country>
<placeName><settlement type="city">Oxford</settlement>
<region type="country">Angleterre</region>
<region type="comté" nuts="2">Oxfordshire</region>
<settlement type="city">Oxford</settlement>
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<orgName type="university">Université d'Oxford</orgName>
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<series><title level="j" type="main">Transactions of the Royal Society of Tropical Medicine and Hygiene</title>
<title level="j" type="abbreviated">Trans. r. soc. trop. med. hyg.</title>
<idno type="ISSN">0035-9203</idno>
<imprint><date when="2010">2010</date>
</imprint>
</series>
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<seriesStmt><title level="j" type="main">Transactions of the Royal Society of Tropical Medicine and Hygiene</title>
<title level="j" type="abbreviated">Trans. r. soc. trop. med. hyg.</title>
<idno type="ISSN">0035-9203</idno>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Hepatitis</term>
<term>Hepatitis E virus</term>
<term>Human</term>
<term>Jaundice</term>
<term>Laos</term>
<term>Leptospirosis</term>
<term>Rickettsia typhi</term>
<term>Tropical medicine</term>
</keywords>
<keywords scheme="Pascal" xml:lang="fr"><term>Hépatite</term>
<term>Leptospirose</term>
<term>Ictère</term>
<term>Laos</term>
<term>Médecine tropicale</term>
<term>Homme</term>
<term>Virus hépatite E</term>
<term>Rickettsia typhi</term>
</keywords>
<keywords scheme="Wicri" type="geographic" xml:lang="fr"><term>Laos</term>
</keywords>
<keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Homme</term>
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<front><div type="abstract" xml:lang="en">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 (≥ x 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.</div>
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<fA08 i1="01" i2="1" l="ENG"><s1>The infective causes of hepatitis and jaundice amongst hospitalised patients in Vientiane, Laos</s1>
</fA08>
<fA11 i1="01" i2="1"><s1>SYHAVONG (Bounkong)</s1>
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<fA11 i1="09" i2="1"><s1>PHETSOUVANH (Rattanaphone)</s1>
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<fA11 i1="10" i2="1"><s1>SOUKKHASERM (Sune)</s1>
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<fA11 i1="11" i2="1"><s1>THAMMAVONG (Te)</s1>
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<fA11 i1="12" i2="1"><s1>MAYXAY (Mayfong)</s1>
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<fA11 i1="13" i2="1"><s1>BLACKSELL (Stuart D.)</s1>
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<fA11 i1="14" i2="1"><s1>BARNES (Eleanor)</s1>
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<fA11 i1="15" i2="1"><s1>PAROLA (Philippe)</s1>
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<fA11 i1="16" i2="1"><s1>DUSSAIX (Elisabeth)</s1>
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<fA11 i1="17" i2="1"><s1>RAOULT (Didier)</s1>
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<fA11 i1="18" i2="1"><s1>HUMPHREYS (Isla)</s1>
</fA11>
<fA11 i1="19" i2="1"><s1>KLENERMAN (Paul)</s1>
</fA11>
<fA11 i1="20" i2="1"><s1>WHITE (Nicholas J.)</s1>
</fA11>
<fA11 i1="21" i2="1"><s1>NEWTON (Paul N.)</s1>
</fA11>
<fA14 i1="01"><s1>Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital</s1>
<s2>Vientiane</s2>
<s3>LAO</s3>
<sZ>1 aut.</sZ>
<sZ>2 aut.</sZ>
<sZ>7 aut.</sZ>
<sZ>8 aut.</sZ>
<sZ>9 aut.</sZ>
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<sZ>12 aut.</sZ>
<sZ>13 aut.</sZ>
<sZ>20 aut.</sZ>
<sZ>21 aut.</sZ>
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<fA14 i1="02"><s1>WHO/AO/OIE Collaborating Centre for Reference & Research on Leptospirosis, Queensland Health Forensic and Scientific Services</s1>
<s2>Coopers Plains, Queensland, 4108</s2>
<s3>AUS</s3>
<sZ>3 aut.</sZ>
</fA14>
<fA14 i1="03"><s1>URMITE CNRS-IRD UMR 6236, Faculté de Médecine et de Pharmacie, Université de la Méditerranée</s1>
<s2>Marseille</s2>
<s3>FRA</s3>
<sZ>4 aut.</sZ>
<sZ>15 aut.</sZ>
<sZ>17 aut.</sZ>
</fA14>
<fA14 i1="04"><s1>AP-HP, National Reference Centre for HAV, Hôpital Paul Brousse</s1>
<s2>Villejuif, 94804</s2>
<s3>FRA</s3>
<sZ>5 aut.</sZ>
<sZ>16 aut.</sZ>
</fA14>
<fA14 i1="05"><s1>Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Rd.</s1>
<s2>Bangkok 10400</s2>
<s3>THA</s3>
<sZ>6 aut.</sZ>
<sZ>13 aut.</sZ>
<sZ>20 aut.</sZ>
</fA14>
<fA14 i1="06"><s1>Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Churchill Hospital</s1>
<s2>Oxford</s2>
<s3>GBR</s3>
<sZ>9 aut.</sZ>
<sZ>12 aut.</sZ>
<sZ>13 aut.</sZ>
<sZ>20 aut.</sZ>
<sZ>21 aut.</sZ>
</fA14>
<fA14 i1="07"><s1>National Blood Transfusion Centre, Lao Red Cross</s1>
<s2>Vientiane</s2>
<s3>LAO</s3>
<sZ>11 aut.</sZ>
</fA14>
<fA14 i1="08"><s1>Faculty of Post Graduate Studies, University of Health Sciences</s1>
<s2>Vientiane</s2>
<s3>LAO</s3>
<sZ>12 aut.</sZ>
</fA14>
<fA14 i1="09"><s1>The Peter Medawar Building for Pathogen Research, University of Oxford</s1>
<s2>Oxford</s2>
<s3>GBR</s3>
<sZ>14 aut.</sZ>
<sZ>18 aut.</sZ>
<sZ>19 aut.</sZ>
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<fA64 i1="01" i2="1"><s0>Transactions of the Royal Society of Tropical Medicine and Hygiene</s0>
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<fC01 i1="01" l="ENG"><s0>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 (≥ x 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.</s0>
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<s5>02</s5>
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<s5>07</s5>
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<s5>07</s5>
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<s5>07</s5>
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<s5>08</s5>
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<s2>NG</s2>
<s5>08</s5>
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<s5>11</s5>
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<affiliations><list><country><li>Australie</li>
<li>France</li>
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<li>Thaïlande</li>
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<tree><country name="Laos"><noRegion><name sortKey="Syhavong, Bounkong" sort="Syhavong, Bounkong" uniqKey="Syhavong B" first="Bounkong" last="Syhavong">Bounkong Syhavong</name>
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<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="Phetsouvanh, Rattanaphone" sort="Phetsouvanh, Rattanaphone" uniqKey="Phetsouvanh R" first="Rattanaphone" last="Phetsouvanh">Rattanaphone Phetsouvanh</name>
<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="Thammavong, Te" sort="Thammavong, Te" uniqKey="Thammavong T" first="Te" last="Thammavong">Te Thammavong</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="Australie"><noRegion><name sortKey="Smythe, Lee" sort="Smythe, Lee" uniqKey="Smythe L" first="Lee" last="Smythe">Lee Smythe</name>
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</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>
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