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Causes of non-malarial fever in Laos: a prospective study.
[scrub typhus]
Because
of
reductions
in
the
incidence
of
Plasmodium
falciparum
malaria
in
Laos
,
identification
of
the
causes
of
fever
in
people
without
malaria
,
and
discussion
of
the
best
empirical
treatment
options
,
are
urgently
needed
.
We
aimed
to
identify
the
causes
of
non-malarial
acute
fever
in
patients
in
rural
Laos
.
For
this
prospective
study
,
we
recruited
1938
febrile
patients
,
between
May
,
2008
,
and
December
,
2010
,
at
Luang
Namtha
provincial
hospital
in
northwest
Laos
(
n
=
1390
)
,
and
between
September
,
2008
,
and
December
,
2010
,
at
Salavan
provincial
hospital
in
southern
Laos
(
n
=
548
)
.
Eligible
participants
were
aged
5
-
49
years
with
fever
(
≥
38
°
C
)
lasting
8
days
or
less
and
were
eligible
for
malaria
testing
by
national
guidelines
.
With
conservative
definitions
of
cause
,
we
assigned
799
(
41
%
)
patients
a
diagnosis
.
With
exclusion
of
influenza
,
the
top
five
diagnoses
when
only
one
aetiological
agent
per
patient
was
identified
were
dengue
(
156
[
8
%
]
of
1927
patients
)
,
scrub
typhus
(
122
[
7
%
]
of
1871
)
,
Japanese
encephalitis
virus
(
112
[
6
%
]
of
1924
)
,
leptospirosis
(
109
[
6
%
]
of
1934
)
,
and
bacteraemia
(
43
[
2
%
]
of
1938
)
.
115
(
32
%
)
of
358
patients
at
Luang
Namtha
hospital
tested
influenza
PCR-
positive
between
June
and
December
,
2010
,
of
which
influenza
B
was
the
most
frequently
detected
strain
(
n
=
121
[
87
%
]
)
.
Disease
frequency
differed
significantly
between
the
two
sites
:
Japanese
encephalitis
virus
infection
(
p
=
0
·
04
)
,
typhoid
(
p
=
0
·
006
)
,
and
leptospirosis
(
p
=
0
·
001
)
were
more
common
at
Luang
Namtha
,
whereas
dengue
and
malaria
were
more
common
at
Salavan
(
all
p
<
0
·
0001
)
.
With
use
of
evidence
from
southeast
Asia
when
possible
,
we
estimated
that
azithromycin
,
doxycycline
,
ceftriaxone
,
and
ofloxacin
would
have
had
significant
efficacy
for
258
(
13
%
)
,
240
(
12
%
)
,
154
(
8
%
)
,
and
41
(
2
%
)
of
patients
,
respectively
.
Our
findings
suggest
that
a
wide
range
of
treatable
or
preventable
pathogens
are
implicated
in
non-malarial
febrile
illness
in
Laos
.
Empirical
treatment
with
doxycycline
for
patients
with
undifferentiated
fever
and
negative
rapid
diagnostic
tests
for
malaria
and
dengue
could
be
an
appropriate
strategy
for
rural
health
workers
in
Laos
.
Wellcome
Trust
,
WHO-
Western
Pacific
Region
,
Foundation
for
Innovative
New
Diagnostics
,
US
Centers
for
Disease
Control
and
Prevention
Diseases
Validation
Diseases presenting
"had significant efficacy for 258 (13%"
symptom
scrub typhus
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