The Aetiologies and Impact of Fever in Pregnant Inpatients in Vientiane, Laos
The Aetiologies and Impact of Fever in Pregnant Inpatients in Vientiane, Laos
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DOI：
10.1371/journal.pntd.0004577
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发表时间：
2016-04-01
影响因子：
3.8
通讯作者：
Newton, Paul N.
中科院分区：
文献类型：
--
作者：
Chansamouth, Vilada;Thammasack, Syvilay;Newton, Paul N.
老挝是东南亚大陆孕产妇死亡率最高的国家，传染病发病率也很高。在全球范围内，疟疾一直是就其对怀孕的影响进行最深入研究的病原体，但对其他疾病的病因和影响的研究相对较少。因此，我们的目的是确定在万象市的两个中心医院，老挝人民民主共和国（老挝）的孕妇发热的原因和影响材料和方法这是基于医院的前瞻性研究进行了Mahosot医院和妇幼医院，万象，2006年和2010年之间，目的是招募250名鼓膜温度>= 37.5 ℃的自愿孕妇。主要结局为发热原因，次要结局为妊娠结局。进行了特定调查（培养、抗原、分子和血清学检测），以调查发热原因。出院后，所有孕妇被要求返回审查和恢复血清在第10-14天，并进行监测，直到deliver.Principle findings 250名孕妇被招募到本研究之间的2006年2月和2010年11月。50%是第一次怀孕。他们入院时的中位（范围）胎龄为24（4-43）周。鼓膜入院温度的中位数（范围）为38.5摄氏度（37.5-40.5摄氏度）。15%的患者表示他们在入院前服用了抗生素。>60%的患者描述了头痛、肌痛、背痛和关节痛，149例（60%）患者得到了实验室诊断。在确诊的患者中，132人（53%）患有单一疾病，17人（7%）患有明显的混合疾病。在患有单一疾病的人中，登革热是最常见的诊断，其次是肾盂肾炎、恙虫病、鼠斑疹伤寒和伤寒。患者还被诊断患有肺结核、阑尾炎、金黄色葡萄球菌败血症、钩端螺旋体病、日本脑炎病毒感染和恶性疟原虫疟疾。严重的后果，包括产妇死亡，流产，死产，低出生体重和早产，被发现28（78%）的母亲与登革热，立克次体病和伤寒。ConclusionFever以外的疟疾，如登革热，肾盂肾炎，立克次体病和伤寒是常见的原因在亚洲热带地区怀孕期间发热。需要进一步调查它们在社区对孕产妇死亡、胎儿丢失、垂直传播、出生体重不足和早产的影响。
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 degrees 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 degrees C (37.5-40.5 degrees 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.