ABSTRACT
During 2003-2011, we recruited 1,065 patients of all ages admitted to Mahosot Hospital (Vientiane, Laos) with suspected central nervous system (CNS) infection. Etiologies were laboratory confirmed for 42.3% of patients, who mostly had infections with emerging pathogens: viruses in 16.2% (mainly Japanese encephalitis virus [8.8%]); bacteria in 16.4% (including Orientia tsutsugamushi [2.9%], Leptospira spp. [2.3%], and Rickettsia spp. [2.3%]); and Cryptococcus spp. fungi in 6.6%. We observed no significant differences in distribution of clinical encephalitis and meningitis by bacterial or viral etiology. However, patients with bacterial CNS infection were more likely to have a history of diabetes than others. Death (26.3%) was associated with low Glasgow Coma Scale score, and the mortality rate was higher for patients with bacterial than viral infections. No clinical or laboratory variables could guide antibiotic selection. We conclude that high-dependency units and first-line treatment with ceftriaxone and doxycycline for suspected CNS infections could improve patient survival in Laos.
Subject(s)
Central Nervous System Infections/etiology , Adolescent , Adult , Central Nervous System Infections/diagnosis , Central Nervous System Infections/drug therapy , Child , Child, Preschool , Cross Infection/drug therapy , Cross Infection/etiology , Female , Health Policy , Humans , Infant , Infectious Encephalitis/etiology , Infectious Encephalitis/microbiology , Infectious Encephalitis/virology , Laos , Male , Meningitis/etiology , Meningitis/microbiology , Meningitis/virology , Prospective Studies , Young AdultABSTRACT
As data about the causes of neonatal sepsis in low-income countries are inadequate, we reviewed the etiology and antibiotic susceptibilities of bacteremia in young infants in Laos. As Staphylococcus aureus is the leading cause of bacteremia in Lao infants, we also examined risk factors for this infection, in particular the local practice of warming mothers during the first weeks postpartum with hot coals under their beds (hot beds). Clinical and laboratory data regarding infants aged 0-60 days evaluated for sepsis within 72 h of admission to Mahosot Hospital in Vientiane, Laos, were reviewed, and 85 of 1438 (5.9%) infants' blood cultures grew a clinically significant organism. Most common were S. aureus, Escherichia coli and Klebsiella pneumoniae. Whereas no methicillin-resistant S. aureus was found, only 18% of E. coli isolates were susceptible to ampicillin. A history of sleeping on a hot bed with mother was associated with S. aureus bacteremia (odds ratio 4.8; 95% confidence interval 1.2-19.0).
Subject(s)
Bacteremia/epidemiology , Hospitalization/statistics & numerical data , Sepsis/epidemiology , Staphylococcal Infections/epidemiology , Staphylococcus aureus/isolation & purification , Anti-Bacterial Agents/therapeutic use , Bacteremia/drug therapy , Bacteremia/microbiology , Escherichia coli/drug effects , Escherichia coli/isolation & purification , Escherichia coli Infections/diagnosis , Escherichia coli Infections/drug therapy , Escherichia coli Infections/epidemiology , Female , Hospitals, Pediatric/statistics & numerical data , Humans , Infant , Infant, Newborn , Klebsiella Infections/diagnosis , Klebsiella Infections/drug therapy , Klebsiella Infections/epidemiology , Klebsiella pneumoniae/drug effects , Klebsiella pneumoniae/isolation & purification , Laos/epidemiology , Male , Microbial Sensitivity Tests , Risk Factors , Sepsis/drug therapy , Sepsis/microbiology , Staphylococcal Infections/diagnosis , Staphylococcal Infections/drug therapy , Staphylococcus aureus/drug effects , Treatment OutcomeABSTRACT
A 12-year-old Lao boy with obstructive biliary Ascaris infection is described and video of the gallbladder ultrasound presented. The patient developed severe complications of obstructive cholangitis, a large right pleural effusion and hepatic abscesses requiring prolonged antibiotic therapy. The differential diagnosis of worms in the gall-bladder is discussed.
Subject(s)
Ascariasis/complications , Cholangitis/etiology , Common Bile Duct Diseases/complications , Gallbladder/diagnostic imaging , Liver Abscess/etiology , Animals , Ascariasis/parasitology , Ascaris/isolation & purification , Child , Cholangitis/microbiology , Cholangitis/parasitology , Common Bile Duct/parasitology , Common Bile Duct Diseases/parasitology , Gallbladder/parasitology , Humans , Laos , Liver Abscess/parasitology , Male , UltrasonographyABSTRACT
There is no published information on the causes of bacteremia in the Lao PDR (Laos). Between 2000 and 2004, 4512 blood culture pairs were taken from patients admitted to Mahosot Hospital, Vientiane, Laos, with suspected community-acquired bacteremia; 483 (10.7%) cultures grew a clinically significant community-acquired organism, most commonly Salmonella enterica serovar typhi (50.9%), Staphylococcus aureus (19.0%), and Escherichia coli (12.4%). S. aureus bacteremia was common among infants (69.2%), while children 1-5 years had a high frequency of typhoid (44%). Multi-drug-resistant S. Typhi was rare (6%). On multiple logistic regression analysis, typhoid was associated with younger age, longer illness, diarrhea, higher admission temperature, and lower peripheral white blood cell count than non-typhoidal bacteremia. Empirical parenteral ampicillin and gentamicin would have some activity against approximately 88% of clinically significant isolates at a cost of US $1.4/day, an important exception being B. pseudomallei. Bacteremic infants in this setting require an anti-staphylococcal antibiotic.
