ArticleThe Lancet. Global health2015
Orientia, rickettsia, and leptospira pathogens as causes of CNS infections in Laos: a prospective study.
Article in The Lancet. Global health, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 86 papers, 8 of them syntheses that pooled it.
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Who cites it
86 citing papers in PubMed, 8 syntheses or guidelines pooled it, 123 citations in OpenAlex.
- Review of the aetiologies of central nervous system infections in Vietnam.Frontiers in public health · 2024Pooled it
- Neurological manifestations of scrub typhus infection: A systematic review and meta-analysis of clinical features and case fatality.PLoS neglected tropical diseases · 2022Pooled it
- A systematic review of the untreated mortality of murine typhus.PLoS neglected tropical diseases · 2020Pooled it
- Association between reported aetiology of central nervous system infections and the speciality of study investigators-a bias compartmental syndrome?Transactions of the Royal Society of Tropical Medicine and Hygiene · 2017Pooled it
- Estimating the burden of scrub typhus: A systematic review.PLoS neglected tropical diseases · 2017Pooled it
- Revisiting doxycycline in pregnancy and early childhood--time to rebuild its reputation?Expert opinion on drug safety · 2016Pooled it
- A Systematic Review of Mortality from Untreated Scrub Typhus (Orientia tsutsugamushi).PLoS neglected tropical diseases · 2015Pooled it
- A Systematic Review of the Mortality from Untreated Leptospirosis.PLoS neglected tropical diseases · 2015Pooled it
- A Prospective, Open-label, Randomized Trial of Doxycycline Versus Azithromycin for the Treatment of Uncomplicated Murine Typhus.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2019Trial
- Clinical features and outcomes of neuroleptospirosis in French Guiana: Insights from a retrospective study (2015-2021).PLoS neglected tropical diseases · 2026Article
- Clinical and Laboratory Features of Scrub Typhus among Adult Patients with Acute Febrile Illness in Tak and Nakhon Phanom Provinces, Thailand, 2017-2020.The American journal of tropical medicine and hygiene · 2026Article
- Clinical features and risk factors for severe pediatric scrub typhus in Liangshan Prefecture, China: A retrospective cohort study.BMC pediatrics · 2026Article
- Zoonotic neglected tropical diseases at the animal-human interface in the Greater Mekong Subregion: Two decades of surveillance in Laos and Cambodia.PLoS neglected tropical diseases · 2026Review
- Meningoencephalitis in Flea-Borne Typhus: A Report of Two Cases and a Review of CNS Complications.Pathogens (Basel, Switzerland) · 2026Review
- Neglected rickettsial diseases in Southeast Asia: Twenty-five years of progress in surveillance, diagnostics, and clinical research.PLoS neglected tropical diseases · 2026Review
- Leptospirosis-associated meningitis in an urban tropical endemic setting in northeastern Brazil: Three New cases and a meta-summary of 176 reported cases.PLoS neglected tropical diseases · 2026Article
- A repetitive nucleotide insertion in the rplV gene is associated with in vitro resistance to azithromycin in Rickettsia typhi.PLoS neglected tropical diseases · 2026Article
- Neuroleptospirosis in patients presenting with primary central nervous system infection: A multicentre study.PLoS neglected tropical diseases · 2026Observational
- Scrub and murine typhus seroprevalence among blood donors in Laos.PLoS neglected tropical diseases · 2026Article
- HIV infection complicated with talaromyces marneffei, tuberculosis, hemophagocytic lymphohistiocytosis and non-Hodgkin lymphoma: a complex case report.BMC infectious diseases · 2025Article
26 more citing papers are in PubMed but not listed here.
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Authors and funding
13 authors at 8 institutions in 6 countries.
Funding
Abstract
backgroundScrub typhus (caused by Orientia tsutsugamushi), murine typhus (caused by Rickettsia typhi), and leptospirosis are common causes of febrile illness in Asia; meningitis and meningoencephalitis are severe complications. However, scarce data exist for the burden of these pathogens in patients with CNS disease in endemic countries. Laos is representative of vast economically poor rural areas in Asia with little medical information to guide public health policy. We assessed whether these pathogens are important causes of CNS infections in Laos.
methodsBetween Jan 10, 2003, and Nov 25, 2011, we enrolled 1112 consecutive patients of all ages admitted with CNS symptoms or signs requiring a lumbar puncture at Mahosot Hospital, Vientiane, Laos. Microbiological examinations (culture, PCR, and serology) targeted so-called conventional bacterial infections (Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, S suis) and O tsutsugamushi, Rickettsia typhi/Rickettsia spp, and Leptospira spp infections in blood or cerebrospinal fluid (CSF). We analysed and compared causes and clinical and CSF characteristics between patient groups.
findings1051 (95%) of 1112 patients who presented had CSF available for analysis, of whom 254 (24%) had a CNS infection attributable to a bacterial or fungal pathogen. 90 (35%) of these 254 infections were caused by O tsutsugamushi, R typhi/Rickettsia spp, or Leptospira spp. These pathogens were significantly more frequent than conventional bacterial infections (90/1051 [9%] vs 42/1051 [4%]; p<0·0001) by use of conservative diagnostic definitions. CNS infections had a high mortality (236/876 [27%]), with 18% (13/71) for R typhi/Rickettsia spp, O tsutsugamushi, and Leptospira spp combined, and 33% (13/39) for conventional bacterial infections (p=0·076).
interpretationOur data suggest that R typhi/Rickettsia spp, O tsutsugamushi, and Leptospira spp infections are important causes of CNS infections in Laos. Antibiotics, such as tetracyclines, needed for the treatment of murine typhus and scrub typhus, are not routinely advised for empirical treatment of CNS infections. These severely neglected infections represent a potentially large proportion of treatable CNS disease burden across vast endemic areas and need more attention.
fundingWellcome Trust UK.
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