The Aetiologies and Impact of Fever in Pregnant Inpatients in Vientiane, Laos
Identifieur interne : 000577 ( Pmc/Checkpoint ); précédent : 000576; suivant : 000578The Aetiologies and Impact of Fever in Pregnant Inpatients in Vientiane, Laos
Auteurs : Vilada Chansamouth ; Syvilay Thammasack ; Rattanaphone Phetsouvanh ; Valy Keoluangkot ; Catrin E. Moore [Royaume-Uni] ; Stuart D. Blacksell [Royaume-Uni, Thaïlande] ; Josee Castonguay-Vanier ; Audrey Dubot-Pérès [Royaume-Uni, France] ; Jarasporn Tangkhabuanbutra ; Narongchai Tongyoo [Thaïlande] ; Phooksavanh Souphaphonh ; Onanong Sengvilaipaseuth ; Manivanh Vongsouvath ; Koukeo Phommasone ; Davanh Sengdethka ; Amphayvanh Seurbsanith ; Scott B. Craig [Australie] ; Laura Hermann [Thaïlande] ; Michel Strobel ; Paul N. Newton [Royaume-Uni]Source :
- PLoS Neglected Tropical Diseases [ 1935-2727 ] ; 2016.
Abstract
Laos has the highest maternal mortality ratio in mainland Southeast Asia and a high incidence of infectious diseases. Globally, malaria has been the pathogen most intensively investigated in relation to impact on pregnancy, but there has been relatively little research on the aetiology and impact of other diseases. We therefore aimed to determine the causes and impact of fever in pregnant women admitted to two central hospitals in Vientiane City, Lao PDR (Laos).
This hospital-based prospective study was conducted in Mahosot Hospital and the Mother and Child Hospital, Vientiane, between 2006 and 2010, with the aim to recruit 250 consenting pregnant women admitted with tympanic temperature ≥37.5°C. Primary outcome was the cause of fever and secondary outcomes were pregnancy outcomes. Specific investigations (culture, antigen, molecular and serological tests) were performed to investigate causes of fever. After discharge, all pregnant women were asked to return for review and convalescence serum on day 10–14 and were monitored until delivery.
250 pregnant women were recruited to this study between February 2006 and November 2010. Fifty percent were pregnant for the first time. Their median (range) gestational age on admission was 24 (4–43) weeks. The median (range) tympanic admission temperature was 38.5°C (37.5–40.5°C). Fifteen percent of patients stated that they had taken antibiotics before admission. Headache, myalgia, back pain and arthralgia were described by >60% of patients and 149 (60%) were given a laboratory diagnosis. Of those with confirmed diagnoses, 132 (53%) had a single disease and 17 (7%) had apparent mixed diseases. Among those who had a single disease, dengue fever was the most common diagnosis, followed by pyelonephritis, scrub typhus, murine typhus and typhoid. Patients were also diagnosed with tuberculosis, appendicitis,
Fevers other than malaria, such as dengue, pyelonephritis, rickettsioses and typhoid are common causes of fever during pregnancy in the Asian tropics. Further investigations of their impact in the community on maternal death, fetal loss, vertical transmission, low birth weight and preterm birth are needed.
Url:
DOI: 10.1371/journal.pntd.0004577
PubMed: 27050192
PubMed Central: 4822858
Affiliations:
- Australie, France, Royaume-Uni, Thaïlande
- Angleterre, Oxfordshire, Provence-Alpes-Côte d'Azur
- Marseille, Oxford
- Université d'Oxford
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<author><name sortKey="Tongyoo, Narongchai" sort="Tongyoo, Narongchai" uniqKey="Tongyoo N" first="Narongchai" last="Tongyoo">Narongchai Tongyoo</name>
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<author><name sortKey="Vongsouvath, Manivanh" sort="Vongsouvath, Manivanh" uniqKey="Vongsouvath M" first="Manivanh" last="Vongsouvath">Manivanh Vongsouvath</name>
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<author><name sortKey="Sengdethka, Davanh" sort="Sengdethka, Davanh" uniqKey="Sengdethka D" first="Davanh" last="Sengdethka">Davanh Sengdethka</name>
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<author><name sortKey="Craig, Scott B" sort="Craig, Scott B" uniqKey="Craig S" first="Scott B." last="Craig">Scott B. Craig</name>
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<author><name sortKey="Strobel, Michel" sort="Strobel, Michel" uniqKey="Strobel M" first="Michel" last="Strobel">Michel Strobel</name>
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<author><name sortKey="Newton, Paul N" sort="Newton, Paul N" uniqKey="Newton P" first="Paul N." last="Newton">Paul N. Newton</name>
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<affiliation wicri:level="4"><nlm:aff id="aff004"><addr-line>Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, United Kingdom</addr-line>
</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford</wicri:regionArea>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">The Aetiologies and Impact of Fever in Pregnant Inpatients in Vientiane, Laos</title>
<author><name sortKey="Chansamouth, Vilada" sort="Chansamouth, Vilada" uniqKey="Chansamouth V" first="Vilada" last="Chansamouth">Vilada Chansamouth</name>
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<author><name sortKey="Thammasack, Syvilay" sort="Thammasack, Syvilay" uniqKey="Thammasack S" first="Syvilay" last="Thammasack">Syvilay Thammasack</name>
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<author><name sortKey="Moore, Catrin E" sort="Moore, Catrin E" uniqKey="Moore C" first="Catrin E." last="Moore">Catrin E. Moore</name>
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<author><name sortKey="Castonguay Vanier, Josee" sort="Castonguay Vanier, Josee" uniqKey="Castonguay Vanier J" first="Josee" last="Castonguay-Vanier">Josee Castonguay-Vanier</name>
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</nlm:aff>
<wicri:noCountry code="subfield">Lao PDR</wicri:noCountry>
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<author><name sortKey="Dubot Peres, Audrey" sort="Dubot Peres, Audrey" uniqKey="Dubot Peres A" first="Audrey" last="Dubot-Pérès">Audrey Dubot-Pérès</name>
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</nlm:aff>
<wicri:noCountry code="subfield">Lao PDR</wicri:noCountry>
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</nlm:aff>
<country xml:lang="fr">France</country>
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<region type="old region">Provence-Alpes-Côte d'Azur</region>
<settlement type="city">Marseille</settlement>
</placeName>
</affiliation>
</author>
<author><name sortKey="Tangkhabuanbutra, Jarasporn" sort="Tangkhabuanbutra, Jarasporn" uniqKey="Tangkhabuanbutra J" first="Jarasporn" last="Tangkhabuanbutra">Jarasporn Tangkhabuanbutra</name>
<affiliation><nlm:aff id="aff001"><addr-line>Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR</addr-line>
</nlm:aff>
<wicri:noCountry code="subfield">Lao PDR</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Tongyoo, Narongchai" sort="Tongyoo, Narongchai" uniqKey="Tongyoo N" first="Narongchai" last="Tongyoo">Narongchai Tongyoo</name>
<affiliation wicri:level="1"><nlm:aff id="aff005"><addr-line>Mahidol–Oxford Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand</addr-line>
</nlm:aff>
<country xml:lang="fr">Thaïlande</country>
<wicri:regionArea>Mahidol–Oxford Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok</wicri:regionArea>
<wicri:noRegion>Bangkok</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Souphaphonh, Phooksavanh" sort="Souphaphonh, Phooksavanh" uniqKey="Souphaphonh P" first="Phooksavanh" last="Souphaphonh">Phooksavanh Souphaphonh</name>
<affiliation><nlm:aff id="aff007"><addr-line>Department of Gynecology and Obstetrics, Mahosot Hospital, Vientiane, Lao PDR</addr-line>
</nlm:aff>
<wicri:noCountry code="subfield">Lao PDR</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Sengvilaipaseuth, Onanong" sort="Sengvilaipaseuth, Onanong" uniqKey="Sengvilaipaseuth O" first="Onanong" last="Sengvilaipaseuth">Onanong Sengvilaipaseuth</name>
<affiliation><nlm:aff id="aff001"><addr-line>Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR</addr-line>
</nlm:aff>
<wicri:noCountry code="subfield">Lao PDR</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Vongsouvath, Manivanh" sort="Vongsouvath, Manivanh" uniqKey="Vongsouvath M" first="Manivanh" last="Vongsouvath">Manivanh Vongsouvath</name>
<affiliation><nlm:aff id="aff001"><addr-line>Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR</addr-line>
</nlm:aff>
<wicri:noCountry code="subfield">Lao PDR</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Phommasone, Koukeo" sort="Phommasone, Koukeo" uniqKey="Phommasone K" first="Koukeo" last="Phommasone">Koukeo Phommasone</name>
<affiliation><nlm:aff id="aff001"><addr-line>Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR</addr-line>
</nlm:aff>
<wicri:noCountry code="subfield">Lao PDR</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Sengdethka, Davanh" sort="Sengdethka, Davanh" uniqKey="Sengdethka D" first="Davanh" last="Sengdethka">Davanh Sengdethka</name>
<affiliation><nlm:aff id="aff001"><addr-line>Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR</addr-line>
</nlm:aff>
<wicri:noCountry code="subfield">Lao PDR</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Seurbsanith, Amphayvanh" sort="Seurbsanith, Amphayvanh" uniqKey="Seurbsanith A" first="Amphayvanh" last="Seurbsanith">Amphayvanh Seurbsanith</name>
<affiliation><nlm:aff id="aff001"><addr-line>Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR</addr-line>
</nlm:aff>
<wicri:noCountry code="subfield">Lao PDR</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Craig, Scott B" sort="Craig, Scott B" uniqKey="Craig S" first="Scott B." last="Craig">Scott B. Craig</name>
<affiliation wicri:level="1"><nlm:aff id="aff008"><addr-line>WHO/FAO/OIE Collaborating Centre for Reference and Research on Leptospirosis, Queensland Health Forensic and Scientific Services, Australia</addr-line>
</nlm:aff>
<country xml:lang="fr">Australie</country>
<wicri:regionArea>WHO/FAO/OIE Collaborating Centre for Reference and Research on Leptospirosis, Queensland Health Forensic and Scientific Services</wicri:regionArea>
<wicri:noRegion>Queensland Health Forensic and Scientific Services</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Hermann, Laura" sort="Hermann, Laura" uniqKey="Hermann L" first="Laura" last="Hermann">Laura Hermann</name>
<affiliation wicri:level="1"><nlm:aff id="aff009"><addr-line>Department of Virology, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand</addr-line>
</nlm:aff>
<country xml:lang="fr">Thaïlande</country>
<wicri:regionArea>Department of Virology, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok</wicri:regionArea>
<wicri:noRegion>Bangkok</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Strobel, Michel" sort="Strobel, Michel" uniqKey="Strobel M" first="Michel" last="Strobel">Michel Strobel</name>
<affiliation><nlm:aff id="aff002"><addr-line>Institut de la Francophonie pour la Medecine Tropicale (IFMT), Vientiane, Lao PDR</addr-line>
</nlm:aff>
<wicri:noCountry code="subfield">Lao PDR</wicri:noCountry>
</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="aff001"><addr-line>Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR</addr-line>
</nlm:aff>
<wicri:noCountry code="subfield">Lao PDR</wicri:noCountry>
</affiliation>
<affiliation wicri:level="4"><nlm:aff id="aff004"><addr-line>Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, United Kingdom</addr-line>
</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford</wicri:regionArea>
<placeName><settlement type="city">Oxford</settlement>
<region type="nation">Angleterre</region>
<region type="région" nuts="1">Oxfordshire</region>
</placeName>
<orgName type="university">Université d'Oxford</orgName>
</affiliation>
</author>
</analytic>
<series><title level="j">PLoS Neglected Tropical Diseases</title>
<idno type="ISSN">1935-2727</idno>
<idno type="eISSN">1935-2735</idno>
<imprint><date when="2016">2016</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc><textClass></textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en"><sec id="sec001"><title>Introduction</title>
<p>Laos has the highest maternal mortality ratio in mainland Southeast Asia and a high incidence of infectious diseases. Globally, malaria has been the pathogen most intensively investigated in relation to impact on pregnancy, but there has been relatively little research on the aetiology and impact of other diseases. We therefore aimed to determine the causes and impact of fever in pregnant women admitted to two central hospitals in Vientiane City, Lao PDR (Laos).</p>
</sec>
<sec id="sec002"><title>Materials and Methods</title>
<p>This hospital-based prospective study was conducted in Mahosot Hospital and the Mother and Child Hospital, Vientiane, between 2006 and 2010, with the aim to recruit 250 consenting pregnant women admitted with tympanic temperature ≥37.5°C. Primary outcome was the cause of fever and secondary outcomes were pregnancy outcomes. Specific investigations (culture, antigen, molecular and serological tests) were performed to investigate causes of fever. After discharge, all pregnant women were asked to return for review and convalescence serum on day 10–14 and were monitored until delivery.</p>
</sec>
<sec id="sec003"><title>Principle findings</title>
<p>250 pregnant women were recruited to this study between February 2006 and November 2010. Fifty percent were pregnant for the first time. Their median (range) gestational age on admission was 24 (4–43) weeks. The median (range) tympanic admission temperature was 38.5°C (37.5–40.5°C). Fifteen percent of patients stated that they had taken antibiotics before admission. Headache, myalgia, back pain and arthralgia were described by >60% of patients and 149 (60%) were given a laboratory diagnosis. Of those with confirmed diagnoses, 132 (53%) had a single disease and 17 (7%) had apparent mixed diseases. Among those who had a single disease, dengue fever was the most common diagnosis, followed by pyelonephritis, scrub typhus, murine typhus and typhoid. Patients were also diagnosed with tuberculosis, appendicitis, <italic>Staphylococcus aureus</italic>
septicemia, leptospirosis, Japanese encephalitis virus infection and <italic>Plasmodium falciparum</italic>
malaria. Severe consequences, including maternal death, miscarriage, stillbirth, low birth weight and preterm birth, were found among 28 (78%) mothers with dengue fever, rickettsioses and typhoid.</p>
</sec>
<sec id="sec004"><title>Conclusion</title>
<p>Fevers other than malaria, such as dengue, pyelonephritis, rickettsioses and typhoid are common causes of fever during pregnancy in the Asian tropics. Further investigations of their impact in the community on maternal death, fetal loss, vertical transmission, low birth weight and preterm birth are needed.</p>
</sec>
</div>
</front>
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</TEI>
<pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS Negl Trop Dis</journal-id>
<journal-id journal-id-type="iso-abbrev">PLoS Negl Trop Dis</journal-id>
<journal-id journal-id-type="publisher-id">plos</journal-id>
<journal-id journal-id-type="pmc">plosntds</journal-id>
<journal-title-group><journal-title>PLoS Neglected Tropical Diseases</journal-title>
</journal-title-group>
<issn pub-type="ppub">1935-2727</issn>
<issn pub-type="epub">1935-2735</issn>
<publisher><publisher-name>Public Library of Science</publisher-name>
<publisher-loc>San Francisco, CA USA</publisher-loc>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">27050192</article-id>
<article-id pub-id-type="pmc">4822858</article-id>
<article-id pub-id-type="doi">10.1371/journal.pntd.0004577</article-id>
<article-id pub-id-type="publisher-id">PNTD-D-15-02048</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject>
<subj-group><subject>Diagnostic Medicine</subject>
<subj-group><subject>Signs and Symptoms</subject>
<subj-group><subject>Fevers</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject>
<subj-group><subject>Pathology and Laboratory Medicine</subject>
<subj-group><subject>Signs and Symptoms</subject>
<subj-group><subject>Fevers</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject>
<subj-group><subject>Infectious Diseases</subject>
<subj-group><subject>Bacterial Diseases</subject>
<subj-group><subject>Typhus</subject>
<subj-group><subject>Scrub Typhus</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject>
<subj-group><subject>Women's Health</subject>
<subj-group><subject>Maternal Health</subject>
<subj-group><subject>Pregnancy</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject>
<subj-group><subject>Women's Health</subject>
<subj-group><subject>Obstetrics and Gynecology</subject>
<subj-group><subject>Pregnancy</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject>
<subj-group><subject>Infectious Diseases</subject>
<subj-group><subject>Bacterial Diseases</subject>
<subj-group><subject>Typhus</subject>
<subj-group><subject>Murine Typhus</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject>
<subj-group><subject>Tropical Diseases</subject>
<subj-group><subject>Neglected Tropical Diseases</subject>
<subj-group><subject>Dengue Fever</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject>
<subj-group><subject>Infectious Diseases</subject>
<subj-group><subject>Viral Diseases</subject>
<subj-group><subject>Dengue Fever</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject>
<subj-group><subject>Parasitic Diseases</subject>
<subj-group><subject>Malaria</subject>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject>
<subj-group><subject>Tropical Diseases</subject>
<subj-group><subject>Malaria</subject>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject>
<subj-group><subject>Urology</subject>
<subj-group><subject>Urinary Tract Infections</subject>
<subj-group><subject>Pyelonephritis</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject>
<subj-group><subject>Pharmacology</subject>
<subj-group><subject>Drugs</subject>
<subj-group><subject>Antimicrobials</subject>
<subj-group><subject>Antibiotics</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject>
<subj-group><subject>Microbiology</subject>
<subj-group><subject>Microbial Control</subject>
<subj-group><subject>Antimicrobials</subject>
<subj-group><subject>Antibiotics</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
</article-categories>
<title-group><article-title>The Aetiologies and Impact of Fever in Pregnant Inpatients in Vientiane, Laos</article-title>
<alt-title alt-title-type="running-head">Fever during Pregnancy</alt-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Chansamouth</surname>
<given-names>Vilada</given-names>
</name>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff002"><sup>2</sup>
</xref>
<xref ref-type="corresp" rid="cor001">*</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Thammasack</surname>
<given-names>Syvilay</given-names>
</name>
<xref ref-type="aff" rid="aff003"><sup>3</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Phetsouvanh</surname>
<given-names>Rattanaphone</given-names>
</name>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Keoluangkot</surname>
<given-names>Valy</given-names>
</name>
<xref ref-type="aff" rid="aff002"><sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff003"><sup>3</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Moore</surname>
<given-names>Catrin E.</given-names>
</name>
<xref ref-type="aff" rid="aff004"><sup>4</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Blacksell</surname>
<given-names>Stuart D.</given-names>
</name>
<xref ref-type="aff" rid="aff004"><sup>4</sup>
</xref>
<xref ref-type="aff" rid="aff005"><sup>5</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Castonguay-Vanier</surname>
<given-names>Josee</given-names>
</name>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Dubot-Pérès</surname>
<given-names>Audrey</given-names>
</name>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff004"><sup>4</sup>
</xref>
<xref ref-type="aff" rid="aff006"><sup>6</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Tangkhabuanbutra</surname>
<given-names>Jarasporn</given-names>
</name>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Tongyoo</surname>
<given-names>Narongchai</given-names>
</name>
<xref ref-type="aff" rid="aff005"><sup>5</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Souphaphonh</surname>
<given-names>Phooksavanh</given-names>
</name>
<xref ref-type="aff" rid="aff007"><sup>7</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Sengvilaipaseuth</surname>
<given-names>Onanong</given-names>
</name>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Vongsouvath</surname>
<given-names>Manivanh</given-names>
</name>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Phommasone</surname>
<given-names>Koukeo</given-names>
</name>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Sengdethka</surname>
<given-names>Davanh</given-names>
</name>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Seurbsanith</surname>
<given-names>Amphayvanh</given-names>
</name>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Craig</surname>
<given-names>Scott B.</given-names>
</name>
<xref ref-type="aff" rid="aff008"><sup>8</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Hermann</surname>
<given-names>Laura</given-names>
</name>
<xref ref-type="aff" rid="aff009"><sup>9</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Strobel</surname>
<given-names>Michel</given-names>
</name>
<xref ref-type="aff" rid="aff002"><sup>2</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Newton</surname>
<given-names>Paul N.</given-names>
</name>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff004"><sup>4</sup>
</xref>
</contrib>
</contrib-group>
<aff id="aff001"><label>1</label>
<addr-line>Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR</addr-line>
</aff>
<aff id="aff002"><label>2</label>
<addr-line>Institut de la Francophonie pour la Medecine Tropicale (IFMT), Vientiane, Lao PDR</addr-line>
</aff>
<aff id="aff003"><label>3</label>
<addr-line>Infectious Disease Center, Mahosot Hospital, Vientiane, Lao PDR</addr-line>
</aff>
<aff id="aff004"><label>4</label>
<addr-line>Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, United Kingdom</addr-line>
</aff>
<aff id="aff005"><label>5</label>
<addr-line>Mahidol–Oxford Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand</addr-line>
</aff>
<aff id="aff006"><label>6</label>
<addr-line>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</addr-line>
</aff>
<aff id="aff007"><label>7</label>
<addr-line>Department of Gynecology and Obstetrics, Mahosot Hospital, Vientiane, Lao PDR</addr-line>
</aff>
<aff id="aff008"><label>8</label>
<addr-line>WHO/FAO/OIE Collaborating Centre for Reference and Research on Leptospirosis, Queensland Health Forensic and Scientific Services, Australia</addr-line>
</aff>
<aff id="aff009"><label>9</label>
<addr-line>Department of Virology, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand</addr-line>
</aff>
<contrib-group><contrib contrib-type="editor"><name><surname>Raoult</surname>
<given-names>Didier</given-names>
</name>
<role>Editor</role>
<xref ref-type="aff" rid="edit1"></xref>
</contrib>
</contrib-group>
<aff id="edit1"><addr-line>Faculté de Médecine,Aix-Marseille Université, FRANCE</addr-line>
</aff>
<author-notes><fn fn-type="conflict" id="coi001"><p>The authors have declared that no competing interests exist.</p>
</fn>
<fn fn-type="con" id="contrib001"><p>Conceived and designed the experiments: VC PNN RP MS. Performed the experiments: VC ST VK PS KP JT. Analyzed the data: VC PNN. Contributed reagents/materials/analysis tools: NT JT JCV OS SBC AS DS MV. Wrote the paper: VC PNN ADP JCV SDB LH CEM.</p>
</fn>
<corresp id="cor001">* E-mail: <email>vilada@tropmedres.ac</email>
</corresp>
</author-notes>
<pub-date pub-type="epub"><day>6</day>
<month>4</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="collection"><month>4</month>
<year>2016</year>
</pub-date>
<volume>10</volume>
<issue>4</issue>
<elocation-id>e0004577</elocation-id>
<history><date date-type="received"><day>10</day>
<month>12</month>
<year>2015</year>
</date>
<date date-type="accepted"><day>4</day>
<month>3</month>
<year>2016</year>
</date>
</history>
<permissions><copyright-statement>© 2016 Chansamouth et al</copyright-statement>
<copyright-year>2016</copyright-year>
<copyright-holder>Chansamouth et al</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>This is an open access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License</ext-link>
, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</license-p>
</license>
</permissions>
<self-uri content-type="pdf" xlink:type="simple" xlink:href="pntd.0004577.pdf"></self-uri>
<abstract><sec id="sec001"><title>Introduction</title>
<p>Laos has the highest maternal mortality ratio in mainland Southeast Asia and a high incidence of infectious diseases. Globally, malaria has been the pathogen most intensively investigated in relation to impact on pregnancy, but there has been relatively little research on the aetiology and impact of other diseases. We therefore aimed to determine the causes and impact of fever in pregnant women admitted to two central hospitals in Vientiane City, Lao PDR (Laos).</p>
</sec>
<sec id="sec002"><title>Materials and Methods</title>
<p>This hospital-based prospective study was conducted in Mahosot Hospital and the Mother and Child Hospital, Vientiane, between 2006 and 2010, with the aim to recruit 250 consenting pregnant women admitted with tympanic temperature ≥37.5°C. Primary outcome was the cause of fever and secondary outcomes were pregnancy outcomes. Specific investigations (culture, antigen, molecular and serological tests) were performed to investigate causes of fever. After discharge, all pregnant women were asked to return for review and convalescence serum on day 10–14 and were monitored until delivery.</p>
</sec>
<sec id="sec003"><title>Principle findings</title>
<p>250 pregnant women were recruited to this study between February 2006 and November 2010. Fifty percent were pregnant for the first time. Their median (range) gestational age on admission was 24 (4–43) weeks. The median (range) tympanic admission temperature was 38.5°C (37.5–40.5°C). Fifteen percent of patients stated that they had taken antibiotics before admission. Headache, myalgia, back pain and arthralgia were described by >60% of patients and 149 (60%) were given a laboratory diagnosis. Of those with confirmed diagnoses, 132 (53%) had a single disease and 17 (7%) had apparent mixed diseases. Among those who had a single disease, dengue fever was the most common diagnosis, followed by pyelonephritis, scrub typhus, murine typhus and typhoid. Patients were also diagnosed with tuberculosis, appendicitis, <italic>Staphylococcus aureus</italic>
septicemia, leptospirosis, Japanese encephalitis virus infection and <italic>Plasmodium falciparum</italic>
malaria. Severe consequences, including maternal death, miscarriage, stillbirth, low birth weight and preterm birth, were found among 28 (78%) mothers with dengue fever, rickettsioses and typhoid.</p>
</sec>
<sec id="sec004"><title>Conclusion</title>
<p>Fevers other than malaria, such as dengue, pyelonephritis, rickettsioses and typhoid are common causes of fever during pregnancy in the Asian tropics. Further investigations of their impact in the community on maternal death, fetal loss, vertical transmission, low birth weight and preterm birth are needed.</p>
</sec>
</abstract>
<abstract abstract-type="summary"><title>Author Summary</title>
<p>Laos has a high incidence of infectious diseases and high prevalence of poverty. Malaria in pregnancy if of great public health interest. However, malaria has not been reported in Vientiane City for decades, but others diseases such as dengue fever, rickettsioses, typhoid fever, leptospirosis and Japanese encephalitis, have. In this prospective hospital-based study of the causes of fever in pregnancy, dengue fever was the most common diagnosis, followed by pyelonephritis with <italic>Escherichia coli</italic>
, murine typhus, scrub typhus and typhoid fever. Severe consequences, including maternal death, miscarriage, stillbirth, low birth weight and preterm birth, were found among mothers with dengue fever, rickettsioses and typhoid. As a hospital-based study it has limitations and large community cohort studies will help us to learn more about fevers and their impact in pregnancy.</p>
</abstract>
<funding-group><funding-statement>This study was funded by the Wellcome Trust of Great Britain. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.</funding-statement>
</funding-group>
<counts><fig-count count="0"></fig-count>
<table-count count="4"></table-count>
<page-count count="16"></page-count>
</counts>
<custom-meta-group><custom-meta id="data-availability"><meta-name>Data Availability</meta-name>
<meta-value>All relevant data are within the paper and its Supporting Information files.</meta-value>
</custom-meta>
</custom-meta-group>
</article-meta>
<notes><title>Data Availability</title>
<p>All relevant data are within the paper and its Supporting Information files.</p>
</notes>
</front>
</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>
</orgName>
</list>
<tree><noCountry><name sortKey="Castonguay Vanier, Josee" sort="Castonguay Vanier, Josee" uniqKey="Castonguay Vanier J" first="Josee" last="Castonguay-Vanier">Josee Castonguay-Vanier</name>
<name sortKey="Chansamouth, Vilada" sort="Chansamouth, Vilada" uniqKey="Chansamouth V" first="Vilada" last="Chansamouth">Vilada Chansamouth</name>
<name sortKey="Keoluangkot, Valy" sort="Keoluangkot, Valy" uniqKey="Keoluangkot V" first="Valy" last="Keoluangkot">Valy Keoluangkot</name>
<name sortKey="Phetsouvanh, Rattanaphone" sort="Phetsouvanh, Rattanaphone" uniqKey="Phetsouvanh R" first="Rattanaphone" last="Phetsouvanh">Rattanaphone Phetsouvanh</name>
<name sortKey="Phommasone, Koukeo" sort="Phommasone, Koukeo" uniqKey="Phommasone K" first="Koukeo" last="Phommasone">Koukeo Phommasone</name>
<name sortKey="Sengdethka, Davanh" sort="Sengdethka, Davanh" uniqKey="Sengdethka D" first="Davanh" last="Sengdethka">Davanh Sengdethka</name>
<name sortKey="Sengvilaipaseuth, Onanong" sort="Sengvilaipaseuth, Onanong" uniqKey="Sengvilaipaseuth O" first="Onanong" last="Sengvilaipaseuth">Onanong Sengvilaipaseuth</name>
<name sortKey="Seurbsanith, Amphayvanh" sort="Seurbsanith, Amphayvanh" uniqKey="Seurbsanith A" first="Amphayvanh" last="Seurbsanith">Amphayvanh Seurbsanith</name>
<name sortKey="Souphaphonh, Phooksavanh" sort="Souphaphonh, Phooksavanh" uniqKey="Souphaphonh P" first="Phooksavanh" last="Souphaphonh">Phooksavanh Souphaphonh</name>
<name sortKey="Strobel, Michel" sort="Strobel, Michel" uniqKey="Strobel M" first="Michel" last="Strobel">Michel Strobel</name>
<name sortKey="Tangkhabuanbutra, Jarasporn" sort="Tangkhabuanbutra, Jarasporn" uniqKey="Tangkhabuanbutra J" first="Jarasporn" last="Tangkhabuanbutra">Jarasporn Tangkhabuanbutra</name>
<name sortKey="Thammasack, Syvilay" sort="Thammasack, Syvilay" uniqKey="Thammasack S" first="Syvilay" last="Thammasack">Syvilay Thammasack</name>
<name sortKey="Vongsouvath, Manivanh" sort="Vongsouvath, Manivanh" uniqKey="Vongsouvath M" first="Manivanh" last="Vongsouvath">Manivanh Vongsouvath</name>
</noCountry>
<country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Moore, Catrin E" sort="Moore, Catrin E" uniqKey="Moore C" first="Catrin E." last="Moore">Catrin E. Moore</name>
</region>
<name sortKey="Blacksell, Stuart D" sort="Blacksell, Stuart D" uniqKey="Blacksell S" first="Stuart D." last="Blacksell">Stuart D. Blacksell</name>
<name sortKey="Dubot Peres, Audrey" sort="Dubot Peres, Audrey" uniqKey="Dubot Peres A" first="Audrey" last="Dubot-Pérès">Audrey Dubot-Pérès</name>
<name sortKey="Newton, Paul N" sort="Newton, Paul N" uniqKey="Newton P" first="Paul N." last="Newton">Paul N. Newton</name>
</country>
<country name="Thaïlande"><noRegion><name sortKey="Blacksell, Stuart D" sort="Blacksell, Stuart D" uniqKey="Blacksell S" first="Stuart D." last="Blacksell">Stuart D. Blacksell</name>
</noRegion>
<name sortKey="Hermann, Laura" sort="Hermann, Laura" uniqKey="Hermann L" first="Laura" last="Hermann">Laura Hermann</name>
<name sortKey="Tongyoo, Narongchai" sort="Tongyoo, Narongchai" uniqKey="Tongyoo N" first="Narongchai" last="Tongyoo">Narongchai Tongyoo</name>
</country>
<country name="France"><region name="Provence-Alpes-Côte d'Azur"><name sortKey="Dubot Peres, Audrey" sort="Dubot Peres, Audrey" uniqKey="Dubot Peres A" first="Audrey" last="Dubot-Pérès">Audrey Dubot-Pérès</name>
</region>
</country>
<country name="Australie"><noRegion><name sortKey="Craig, Scott B" sort="Craig, Scott B" uniqKey="Craig S" first="Scott B." last="Craig">Scott B. Craig</name>
</noRegion>
</country>
</tree>
</affiliations>
</record>
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