title: A prospective study of the causes of febrile illness requiring hospitalization in children in Cambodia.
abstract: BACKGROUND
  Febrile illnesses are pre-eminent contributors to morbidity and mortality among children in South-East Asia but the causes are poorly understood. We determined the causes of fever in children hospitalised in Siem Reap province, Cambodia.
  
  
  RESULTS
  A one-year prospective study of febrile children admitted to Angkor Hospital for Children, Siem Reap. Demographic, clinical, laboratory and outcome data were comprehensively analysed. Between October 12(th) 2009 and October 12(th) 2010 there were 1225 episodes of febrile illness in 1180 children. Median (IQR) age was 2.0 (0.8-6.4) years, with 850 (69%) episodes in children <5 years. Common microbiological diagnoses were dengue virus (16.2%), scrub typhus (7.8%), and Japanese encephalitis virus (5.8%). 76 (6.3%) episodes had culture-proven bloodstream infection, including Salmonella enterica serovar Typhi (22 isolates, 1.8%), Streptococcus pneumoniae (13, 1.1%), Escherichia coli (8, 0.7%), Haemophilus influenzae (7, 0.6%), Staphylococcus aureus (6, 0.5%) and Burkholderia pseudomallei (6, 0.5%). There were 69 deaths (5.6%), including those due to clinically diagnosed pneumonia (19), dengue virus (5), and melioidosis (4). 10 of 69 (14.5%) deaths were associated with culture-proven bloodstream infection in logistic regression analyses (odds ratio for mortality 3.4, 95% CI 1.6-6.9). Antimicrobial resistance was prevalent, particularly in S. enterica Typhi, (where 90% of isolates were resistant to ciprofloxacin, and 86% were multi-drug resistant). Comorbid undernutrition was present in 44% of episodes and a major risk factor for acute mortality (OR 2.1, 95% CI 1.1-4.2), as were HIV infection and cardiac disease.
  
  
  CONCLUSIONS
  We identified a microbiological cause of fever in almost 50% of episodes in this large study of community-acquired febrile illness in hospitalized children in Cambodia. The range of pathogens, antimicrobial susceptibility, and co-morbidities associated with mortality described will be of use in the development of rational guidelines for infectious disease treatment and control in Cambodia and South-East Asia.
authors.affiliation: Angkor Hospital for Children, Siem Reap, Kingdom of Cambodia.
authors.forename: Kheng
authors.initials: K
authors.lastname: Chheng
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Carter
authors.forename: Kate
authors.initials: K
authors.lastname: Emary
authors.forename: Ngoun
authors.initials: N
authors.lastname: Chanpheaktra
authors.forename: Catrin E
authors.initials: CE
authors.lastname: Moore
authors.forename: Nicole
authors.initials: N
authors.lastname: Stoesser
authors.forename: Hor
authors.initials: H
authors.lastname: Putchhat
authors.forename: Soeng
authors.initials: S
authors.lastname: Sona
authors.forename: Sin
authors.initials: S
authors.lastname: Reaksmey
authors.forename: Paul
authors.initials: P
authors.lastname: Kitsutani
authors.forename: Borann
authors.initials: B
authors.lastname: Sar
authors.forename: H Rogier
authors.initials: HR
authors.lastname: van Doorn
authors.forename: Nguyen Hanh
authors.initials: NH
authors.lastname: Uyen
authors.forename: Le
authors.initials: L
authors.lastname: Van Tan
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Paris
authors.forename: Daniel
authors.initials: D
authors.lastname: Paris
authors.forename: Stuart D
authors.initials: SD
authors.lastname: Blacksell
authors.forename: Premjit
authors.initials: P
authors.lastname: Amornchai
authors.forename: Vanaporn
authors.initials: V
authors.lastname: Wuthiekanun
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Parry
authors.forename: Nicholas P J
authors.initials: NP
authors.lastname: Day
authors.forename: Varun
authors.initials: V
authors.lastname: Kumar
mesh_terms: D000293:Adolescent; D001424:Bacterial Infections / Q000175:diagnosis / Q000453:epidemiology; D002160:Cambodia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D005334:Fever / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D005843:Geography; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D014777:Virus Diseases / Q000175:diagnosis / Q000453:epidemiology