title: The infective causes of hepatitis and jaundice amongst hospitalised patients in Vientiane, Laos.
abstract: There is little information on the diverse infectious causes of jaundice and hepatitis in the Asiatic tropics. Serology (hepatitis A, B, C and E, leptospirosis, dengue, rickettsia), antigen tests (dengue), PCR assays (hepatitis A, C and E) and blood cultures (septicaemia) were performed on samples from 392 patients admitted with jaundice or raised transaminases (> or =x3) to Mahosot Hospital, Vientiane, Laos over 3 years. Conservative definitions suggested diagnoses of dengue (8.4%), rickettsioses (7.3%), leptospirosis (6.8%), hepatitis B (4.9%), hepatitis C (4.9%), community-acquired septicaemia (3.3%) and hepatitis E (1.6%). Although anti-hepatitis A virus (HAV) IgM antibody results suggested that 35.8% of patients had acute HAV infections, anti-HAV IgG antibody avidity and HAV PCR suggested that 82% had polyclonal activation and not acute HAV infections. Scrub typhus, murine typhus or leptospirosis were present in 12.8% of patients and were associated with meningism and relatively low AST and ALT elevation. These patients would be expected to respond to empirical doxycycline therapy which, in the absence of virological diagnosis and treatment, may be an appropriate cost-effective intervention in Lao patients with jaundice/hepatitis.
authors.affiliation: Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR.
authors.forename: Bounkong
authors.initials: B
authors.lastname: Syhavong
authors.forename: Bouachanh
authors.initials: B
authors.lastname: Rasachack
authors.forename: Lee
authors.initials: L
authors.lastname: Smythe
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Rolain
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Roque-Afonso
authors.forename: Kemajittra
authors.initials: K
authors.lastname: Jenjaroen
authors.forename: Vimone
authors.initials: V
authors.lastname: Soukkhaserm
authors.forename: Simmaly
authors.initials: S
authors.lastname: Phongmany
authors.forename: Rattanaphone
authors.initials: R
authors.lastname: Phetsouvanh
authors.forename: Sune
authors.initials: S
authors.lastname: Soukkhaserm
authors.forename: Te
authors.initials: T
authors.lastname: Thammavong
authors.forename: Mayfong
authors.initials: M
authors.lastname: Mayxay
authors.forename: Stuart D
authors.initials: SD
authors.lastname: Blacksell
authors.forename: Eleanor
authors.initials: E
authors.lastname: Barnes
authors.forename: Philippe
authors.initials: P
authors.lastname: Parola
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Dussaix
authors.forename: Didier
authors.initials: D
authors.lastname: Raoult
authors.forename: Isla
authors.initials: I
authors.lastname: Humphreys
authors.forename: Paul
authors.initials: P
authors.lastname: Klenerman
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: White
authors.forename: Paul N
authors.initials: PN
authors.lastname: Newton
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000175:diagnosis; D003715:Dengue / Q000175:diagnosis; D005260:Female; D005334:Fever / Q000382:microbiology; D006525:Hepatitis, Viral, Human / Q000175:diagnosis / Q000209:etiology*; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007565:Jaundice / Q000382:microbiology* / Q000821:virology; D007812:Laos; D007922:Leptospirosis / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000302:isolation & purification; D012282:Rickettsia Infections / Q000175:diagnosis; D012612:Scrub Typhus / Q000175:diagnosis; D012698:Serologic Tests / Q000379:methods; D014437:Typhus, Endemic Flea-Borne / Q000175:diagnosis; D055815:Young Adult
chemical_list: D012367:RNA, Viral