@article{fdi:010063712,
  title = {{O}rientia, rickettsia, and leptospira pathogens as causes of {CNS} infections in {L}aos : a prospective study},
  author = {{D}ittrich, {S}. and {R}attanavong, {S}. and {L}ee, {S}. {J}. and {P}anyanivong, {P}. and {C}raig, {S}. {B}. and {T}ulsiani, {S}. {M}. and {B}lacksell, {S}. {D}. and {D}ance, {D}. {A}. {B}. and {D}ubot {P}{\'e}r{\`e}s, {A}udrey and {S}engduangphachanh, {A}. and {P}houmin, {P}. and {P}aris, {D}. {H}. and {N}ewton, {P}. {N}.},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground {S}crub typhus (caused by {O}rientia tsutsugamushi), murine typhus (caused by {R}ickettsia typhi), and leptospirosis are common causes of febrile illness in {A}sia; meningitis and meningoencephalitis are severe complications. {H}owever, scarce data exist for the burden of these pathogens in patients with {CNS} disease in endemic countries. {L}aos is representative of vast economically poor rural areas in {A}sia with little medical information to guide public health policy. {W}e assessed whether these pathogens are important causes of {CNS} infections in {L}aos. {M}ethods {B}etween {J}an 10, 2003, and {N}ov 25, 2011, we enrolled 1112 consecutive patients of all ages admitted with {CNS} symptoms or signs requiring a lumbar puncture at {M}ahosot {H}ospital, {V}ientiane, {L}aos. {M}icrobiological examinations (culture, {PCR}, and serology) targeted so-called conventional bacterial infections ({S}treptococcus pneumoniae, {N}eisseria meningitidis, {H}aemophilus influenzae, {S} suis) and {O} tsutsugamushi, {R}ickettsia typhi/{R}ickettsia spp, and {L}eptospira spp infections in blood or cerebrospinal fluid ({CSF}). {W}e analysed and compared causes and clinical and {CSF} characteristics between patient groups. {F}indings 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/{R}ickettsia spp, or {L}eptospira spp. {T}hese 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/{R}ickettsia spp, {O} tsutsugamushi, and {L}eptospira spp combined, and 33% (13/39) for conventional bacterial infections (p = 0.076). {I}nterpretation {O}ur data suggest that {R} typhi/{R}ickettsia spp, {O} tsutsugamushi, and {L}eptospira spp infections are important causes of {CNS} infections in {L}aos. {A}ntibiotics, such as tetracyclines, needed for the treatment of murine typhus and scrub typhus, are not routinely advised for empirical treatment of {CNS} infections. {T}hese severely neglected infections represent a potentially large proportion of treatable {CNS} disease burden across vast endemic areas and need more attention. {F}unding {W}ellcome {T}rust {UK}.},
  keywords = {{LAOS}},
  booktitle = {},
  journal = {{L}ancet {G}lobal {H}ealth},
  volume = {3},
  numero = {2},
  pages = {{E}104--{E}112},
  ISSN = {2214-109{X}},
  year = {2015},
  DOI = {10.1016/{S}2214-109{X}(14)70289-{X}},
  URL = {https://www.documentation.ird.fr/hor/fdi:010063712},
}