The Aetiologies and Impact of Fever in Pregnant Inpatients in Vientiane, Laos

Abstract

IntroductionLaos 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).Materials and MethodsThis 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.Principle findings250 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.ConclusionFevers 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.

Etiologies of Acute Undifferentiated Febrile Illness in Bangkok, Thailand

“…Malaria smears by Giemsa staining and chest radiography were performed in all cases on the day of enrollment at HTD. Rapid diagnostic tests included QuickProfile ™ Dengue Duo Panel for dengue non-structural protein 1 (NS1) antigen (Ag) and immunoglobulin (Ig) G/IgM (LumiQuick Diagnostics, Inc., Santa Clara, CA), QuickView ™ Rickettsia IgG/IgM Combo Test (LumiQuick Diagnostics, Inc.), 18 ImmunoDOT ™ test for Rickettsia typhi (GenBio, San Diego, CA), 19 QuickProfile ™ Salmonella typhi/paratyphi Antigen Duo Test (LumiQuick Diagnostics, Inc.), QuickView ™ S. Typhi IgG/IgM Duo Test Card (LumiQuick Diagnostics, Inc.), and Leptorapide ® for leptospirosis (Linnodee, Doagh, Northern Ireland). 20 All RDTs were performed according to manufacturers' instruction.…”

Maternal and perinatal complications in pregnant women with urinary tract infection caused by Escherichia coli

“…There is evidence that eradication of AB prevents around 80% of pyelonephritis episodes in pregnant women. The most common clinical manifestations of UTI in pregnant patients are generalized malaise, dysuria, increase urinary frequency, low back pain and fever in up to 30% of the cases …”

Febrile illness in Asia: gaps in epidemiology, diagnosis and management for informing health policy

“…Because of concerns about conducting clinical research in the latter two groups, the evidence base is poor, although understanding is especially needed. There has been increasing interest in the aetiology of fevers in pregnancy and the impact that these have for the high maternal and newborn mortality in rural Asia [48,51]. The evidence that infection with dengue is associated with increased foetal death rates in Brazil [52] has great implications for dengue endemic areas across South and South-East Asia.…”