Orientia, rickettsia, and leptospira pathogens as causes of CNS infections in Laos: a prospective study

Sabine Dittrich; Sayaphet Rattanavong; Sue J Lee; Phonepasith Panyanivong; Scott B Craig; Suhella M Tulsiani; Stuart D Blacksell; David A B Dance; Audrey Dubot-Peres; Amphone Senguangphachanh; Phonelavanh Phoumin; Daniel H Paris; Paul N Newton

doi:10.1016/S2214-109X(14)70289-X

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Orientia, rickettsia, and leptospira pathogens as causes of CNS infections in Laos: a prospective study

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Orientia, rickettsia, and leptospira pathogens as causes of CNS infections in Laos: a prospective study

Sabine Dittrich, Sayaphet Rattanavong, Sue J Lee, Phonepasith Panyanivong, Scott B Craig, Suhella M Tulsiani, Stuart D Blacksell, David A B Dance, Audrey Dubot-Peres, Amphone Senguangphachanh, …

Lancet Global Health, Vol.3(2), pp.e104-e112

2015

DOI: https://doi.org/10.1016/S2214-109X(14)70289-X

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Abstract

CNS infections

Laos

orientia

rickettsia

leptospira

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.

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Title: Orientia, rickettsia, and leptospira pathogens as causes of CNS infections in Laos: a prospective study
Authors: Sabine Dittrich (Author) - University of Oxford, United Kingdom
Sayaphet Rattanavong (Author) - Mahosot Hospital, Laos
Sue J Lee (Author) - Mahidol University, Thailand
Phonepasith Panyanivong (Author) - Mahosot Hospital, Laos
Scott B Craig (Author) - University of the Sunshine Coast - Faculty of Science, Health, Education and Engineering
Suhella M Tulsiani (Author) - University of Copenhagen, Denmark
Stuart D Blacksell (Author) - University of Oxford, United Kingdom
David A B Dance (Author) - University of Oxford, United Kingdom
Audrey Dubot-Peres (Author) - University of Oxford, United Kingdom
Amphone Senguangphachanh (Author) - Mahosot Hospital, Laos
Phonelavanh Phoumin (Author) - Mahosot Hospital, Laos
Daniel H Paris (Author) - University of Oxford, United Kingdom
Paul N Newton (Author) - Mahosot Hospital, Laos
Publication details: Lancet Global Health, Vol.3(2), pp.e104-e112
Publisher: Lancet Publishing Group
Date published: 2015
DOI: 10.1016/S2214-109X(14)70289-X
ISSN: 2214-109X
Copyright note: Copyright © Dittrich et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.
Organisation Unit: School of Science and Engineering - Legacy; University of the Sunshine Coast, Queensland
Language: English
Record Identifier: 99449369902621
Output Type: Journal article

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