The infective causes of hepatitis and jaundice amongst hospitalised patients in Vientiane, Laos
The infective causes of hepatitis and jaundice amongst hospitalised patients in Vientiane, Laos
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DOI：
10.1016/j.trstmh.2010.03.002
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发表时间：
2010-07-01
影响因子：
2.2
通讯作者：
Newton, Paul N.
中科院分区：
文献类型：
--
作者：
Syhavong, Bounkong;Rasachack, Bouachanh;Newton, Paul N.
关于亚洲热带地区黄疸和肝炎的各种传染性原因的资料很少。血清学（甲型肝炎。B、C和E、钩端螺旋体病、登革热、立克次体）、抗原检测（登革热）、PCR检测（甲型、丙型和戊型肝炎）和血培养（败血症），这些样本来自老挝万象Mahosot医院3年来收治的392名黄疸或转氨酶升高（>= x 3）患者。保守的定义建议诊断为登革热（8.4%）、立克次体病（7.3%）、钩端螺旋体病（6.8%）、B肝炎（4.9%）、丙型肝炎（4.9%）、社区获得性败血症（3.3%）和戊型肝炎（1.6%）。虽然抗甲型肝炎病毒（HAV）IgM抗体结果表明，35.8%的患者有急性HAV感染，抗HAV IgG抗体亲和力和HAV PCR表明，82%的患者有多克隆活化，而不是急性HAV感染。12.8%的患者存在恙虫病、鼠斑疹伤寒或钩端螺旋体病，并与脑膜炎和相对较低的AST和ALT升高相关。预计这些患者将对经验性强力霉素治疗作出反应，在缺乏病毒学诊断和治疗的情况下，强力霉素治疗可能是老挝黄疸/肝炎患者的适当的具有成本效益的干预措施。(C)2010年皇家热带医学和卫生学会。由爱思唯尔有限公司出版。保留所有权利。
There is little information on the diverse infectious causes of jaundice and hepatitis in the Asiatic tropics. Serology (hepatitis A. B, C and E, leptospirosis, dengue, rickettsia), antigen tests (dengue), PCR assays (hepatitis A, C and E) and blood cultures (septicaemia) were performed on samples from 392 patients admitted with jaundice or raised transaminases (>= x 3) to Mahosot Hospital, Vientiane, Laos over 3 years. Conservative definitions suggested diagnoses of dengue (8.4%), rickettsioses (7.3%), leptospirosis (6.8%), hepatitis B (4.9%), hepatitis C (4.9%), community-acquired septicaemia (3.3%) and hepatitis E (1.6%). Although anti-hepatitis A virus (HAV) IgM antibody results suggested that 35.8% of patients had acute HAV infections, anti-HAV IgG antibody avidity and HAV PCR suggested that 82% had polyclonal activation and not acute HAV infections. Scrub typhus, murine typhus or leptospirosis were present in 12.8% of patients and were associated with meningism and relatively low AST and ALT elevation. These patients would be expected to respond to empirical doxycycline therapy which, in the absence of virological diagnosis and treatment, may be an appropriate cost-effective intervention in Lao patients with jaundice/hepatitis. (C) 2010 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved.