title: The Aetiologies and Impact of Fever in Pregnant Inpatients in Vientiane, Laos.
abstract: BACKGROUND
  Laos has the highest maternal mortality ratio in mainland Southeast Asia and a high incidence of infectious diseases. Globally, malaria has been the pathogen most intensively investigated in relation to impact on pregnancy, but there has been relatively little research on the aetiology and impact of other diseases. We therefore aimed to determine the causes and impact of fever in pregnant women admitted to two central hospitals in Vientiane City, Lao PDR (Laos).
  
  
  METHODS
  This hospital-based prospective study was conducted in Mahosot Hospital and the Mother and Child Hospital, Vientiane, between 2006 and 2010, with the aim to recruit 250 consenting pregnant women admitted with tympanic temperature ≥37.5°C. Primary outcome was the cause of fever and secondary outcomes were pregnancy outcomes. Specific investigations (culture, antigen, molecular and serological tests) were performed to investigate causes of fever. After discharge, all pregnant women were asked to return for review and convalescence serum on day 10-14 and were monitored until delivery.
  
  
  RESULTS
  250 pregnant women were recruited to this study between February 2006 and November 2010. Fifty percent were pregnant for the first time. Their median (range) gestational age on admission was 24 (4-43) weeks. The median (range) tympanic admission temperature was 38.5°C (37.5-40.5°C). Fifteen percent of patients stated that they had taken antibiotics before admission. Headache, myalgia, back pain and arthralgia were described by >60% of patients and 149 (60%) were given a laboratory diagnosis. Of those with confirmed diagnoses, 132 (53%) had a single disease and 17 (7%) had apparent mixed diseases. Among those who had a single disease, dengue fever was the most common diagnosis, followed by pyelonephritis, scrub typhus, murine typhus and typhoid. Patients were also diagnosed with tuberculosis, appendicitis, Staphylococcus aureus septicemia, leptospirosis, Japanese encephalitis virus infection and Plasmodium falciparum malaria. Severe consequences, including maternal death, miscarriage, stillbirth, low birth weight and preterm birth, were found among 28 (78%) mothers with dengue fever, rickettsioses and typhoid.
  
  
  CONCLUSIONS
  Fevers other than malaria, such as dengue, pyelonephritis, rickettsioses and typhoid are common causes of fever during pregnancy in the Asian tropics. Further investigations of their impact in the community on maternal death, fetal loss, vertical transmission, low birth weight and preterm birth are needed.
authors.affiliation: Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR.|Institut de la Francophonie pour la Medecine Tropicale (IFMT), Vientiane, Lao PDR.
authors.forename: Vilada
authors.initials: V
authors.lastname: Chansamouth
authors.affiliation: Infectious Disease Center, Mahosot Hospital, Vientiane, Lao PDR.
authors.forename: Syvilay
authors.initials: S
authors.lastname: Thammasack
authors.affiliation: Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR.
authors.forename: Rattanaphone
authors.initials: R
authors.lastname: Phetsouvanh
authors.affiliation: Institut de la Francophonie pour la Medecine Tropicale (IFMT), Vientiane, Lao PDR.|Infectious Disease Center, Mahosot Hospital, Vientiane, Lao PDR.
authors.forename: Valy
authors.initials: V
authors.lastname: Keoluangkot
authors.affiliation: Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, United Kingdom.
authors.forename: Catrin E
authors.initials: CE
authors.lastname: Moore
authors.affiliation: Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, United Kingdom.|Mahidol-Oxford Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
authors.forename: Stuart D
authors.initials: SD
authors.lastname: Blacksell
authors.affiliation: Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR.
authors.forename: Josee
authors.initials: J
authors.lastname: Castonguay-Vanier
authors.affiliation: Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR.|Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, United Kingdom.|UMR_D 190 "Emergence des Pathologies Virales", Aix- Marseille University, IRD French Institute of Research for Development, EHESP French School of Public Health, Marseille, France.
authors.forename: Audrey
authors.initials: A
authors.lastname: Dubot-Pérès
authors.affiliation: Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR.
authors.forename: Jarasporn
authors.initials: J
authors.lastname: Tangkhabuanbutra
authors.affiliation: Mahidol-Oxford Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
authors.forename: Narongchai
authors.initials: N
authors.lastname: Tongyoo
authors.affiliation: Department of Gynecology and Obstetrics, Mahosot Hospital, Vientiane, Lao PDR.
authors.forename: Phooksavanh
authors.initials: P
authors.lastname: Souphaphonh
authors.affiliation: Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR.
authors.forename: Onanong
authors.initials: O
authors.lastname: Sengvilaipaseuth
authors.affiliation: Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR.
authors.forename: Manivanh
authors.initials: M
authors.lastname: Vongsouvath
authors.affiliation: Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR.
authors.forename: Koukeo
authors.initials: K
authors.lastname: Phommasone
authors.affiliation: Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR.
authors.forename: Davanh
authors.initials: D
authors.lastname: Sengdethka
authors.affiliation: Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR.
authors.forename: Amphayvanh
authors.initials: A
authors.lastname: Seurbsanith
authors.affiliation: WHO/FAO/OIE Collaborating Centre for Reference and Research on Leptospirosis, Queensland Health Forensic and Scientific Services, Australia.
authors.forename: Scott B
authors.initials: SB
authors.lastname: Craig
authors.affiliation: Department of Virology, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand.
authors.forename: Laura
authors.initials: L
authors.lastname: Hermann
authors.affiliation: Institut de la Francophonie pour la Medecine Tropicale (IFMT), Vientiane, Lao PDR.
authors.forename: Michel
authors.initials: M
authors.lastname: Strobel
authors.affiliation: Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR.|Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, United Kingdom.
authors.forename: Paul N
authors.initials: PN
authors.lastname: Newton
mesh_terms: D000328:Adult; D003141:Communicable Diseases / Q000209:etiology* / Q000382:microbiology / Q000469:parasitology / Q000821:virology; D003715:Dengue / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology; D005260:Female; D005334:Fever / Q000453:epidemiology* / Q000209:etiology* / Q000469:parasitology / Q000821:virology; D006760:Hospitalization; D006801:Humans; D007230:Infant, Low Birth Weight; D007297:Inpatients; D007812:Laos / Q000453:epidemiology; D063130:Maternal Death / Q000209:etiology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000209:etiology* / Q000382:microbiology / Q000469:parasitology / Q000821:virology; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000209:etiology; D011446:Prospective Studies; D011704:Pyelonephritis / Q000175:diagnosis / Q000453:epidemiology; D012282:Rickettsia Infections / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology / Q000382:microbiology; D012612:Scrub Typhus / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology; D012698:Serologic Tests; D014435:Typhoid Fever / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology; D014437:Typhus, Endemic Flea-Borne / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology