Publications des scientifiques de l'IRD

Dittrich S., Rattanavong S., Lee S. J., Panyanivong P., Craig S. B., Tulsiani S. M., Blacksell S. D., Dance D. A. B., Dubot Pérès Audrey, Sengduangphachanh A., Phoumin P., Paris D. H., Newton P. N. (2015). Orientia, rickettsia, and leptospira pathogens as causes of CNS infections in Laos : a prospective study. Lancet Global Health, 3 (2), p. E104-E112. ISSN 2214-109X.

Titre du document
Orientia, rickettsia, and leptospira pathogens as causes of CNS infections in Laos : a prospective study
Année de publication
2015
Type de document
Article référencé dans le Web of Science WOS:000348199700016
Auteurs
Dittrich S., Rattanavong S., Lee S. J., Panyanivong P., Craig S. B., Tulsiani S. M., Blacksell S. D., Dance D. A. B., Dubot Pérès Audrey, Sengduangphachanh A., Phoumin P., Paris D. H., Newton P. N.
Source
Lancet Global Health, 2015, 3 (2), p. E104-E112 ISSN 2214-109X
Background Scrub typhus (caused by Orientia tsutsugamushi), murine typhus (caused by Rickettsia typhi), and leptospirosis are common causes of febrile illness in Asia; meningitis and meningoencephalitis are severe complications. However, scarce data exist for the burden of these pathogens in patients with CNS disease in endemic countries. Laos is representative of vast economically poor rural areas in Asia with little medical information to guide public health policy. We assessed whether these pathogens are important causes of CNS infections in Laos. Methods Between Jan 10, 2003, and Nov 25, 2011, we enrolled 1112 consecutive patients of all ages admitted with CNS symptoms or signs requiring a lumbar puncture at Mahosot Hospital, Vientiane, Laos. Microbiological examinations (culture, PCR, and serology) targeted so-called conventional bacterial infections (Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, S suis) and O tsutsugamushi, Rickettsia typhi/Rickettsia spp, and Leptospira spp infections in blood or cerebrospinal fluid (CSF). We analysed and compared causes and clinical and CSF characteristics between patient groups. Findings 1051 (95%) of 1112 patients who presented had CSF available for analysis, of whom 254 (24%) had a CNS infection attributable to a bacterial or fungal pathogen. 90 (35%) of these 254 infections were caused by O tsutsugamushi, R typhi/Rickettsia spp, or Leptospira spp. These pathogens were significantly more frequent than conventional bacterial infections (90/1051 [9%] vs 42/1051 [4%]; p < 0.0001) by use of conservative diagnostic definitions. CNS infections had a high mortality (236/876 [27%]), with 18% (13/71) for R typhi/Rickettsia spp, O tsutsugamushi, and Leptospira spp combined, and 33% (13/39) for conventional bacterial infections (p = 0.076). Interpretation Our data suggest that R typhi/Rickettsia spp, O tsutsugamushi, and Leptospira spp infections are important causes of CNS infections in Laos. Antibiotics, such as tetracyclines, needed for the treatment of murine typhus and scrub typhus, are not routinely advised for empirical treatment of CNS infections. These severely neglected infections represent a potentially large proportion of treatable CNS disease burden across vast endemic areas and need more attention. Funding Wellcome Trust UK.
Plan de classement
Entomologie médicale / Parasitologie / Virologie [052]
Description Géographique
LAOS
Localisation
Fonds IRD [F B010063712]
Identifiant IRD
fdi:010063712
Contact