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Pommier JD, Gorman C, Crabol Y, Bleakley K, Sothy H, Santy K, Tran HTT, Nguyen LV, Bunnakea E, Hlaing CS, Aye AMM, Cappelle J, Herrant M, Piola P, Rosset B, Chevalier V, Tarantola A, Channa M, Honnorat J, Pinto AL, Rattanavong S, Vongsouvath M, Mayxay M, Phangmanixay S, Phongsavath K, Tin OS, Kyaw LL, Tin HH, Linn K, Tran TMH, Pérot P, Thuy NTT, Hien N, Phan PH, Buchy P, Dussart P, Laurent D, Eloit M, Dubot-Pérès A, Lortholary O, de Lamballerie X, Newton PN, Lecuit M. Childhood encephalitis in the Greater Mekong region (the SouthEast Asia Encephalitis Project): a multicentre prospective study. Lancet Glob Health 2022; 10:e989-e1002. [PMID: 35714649 PMCID: PMC9210261 DOI: 10.1016/s2214-109x(22)00174-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 03/09/2022] [Accepted: 03/23/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Encephalitis is a worldwide public health issue, with a substantially high burden among children in southeast Asia. We aimed to determine the causes of encephalitis in children admitted to hospitals across the Greater Mekong region by implementing a comprehensive state-of-the-art diagnostic procedure harmonised across all centres, and identifying clinical characteristics related to patients' conditions. METHODS In this multicentre, observational, prospective study of childhood encephalitis, four referral hospitals in Cambodia, Vietnam, Laos, and Myanmar recruited children (aged 28 days to 16 years) who presented with altered mental status lasting more than 24 h and two of the following minor criteria: fever (within the 72 h before or after presentation), one or more generalised or partial seizures (excluding febrile seizures), a new-onset focal neurological deficit, cerebrospinal fluid (CSF) white blood cell count of 5 per mL or higher, or brain imaging (CT or MRI) suggestive of lesions of encephalitis. Comprehensive diagnostic procedures were harmonised across all centres, with first-line testing was done on samples taken at inclusion and results delivered within 24 h of inclusion for main treatable causes of disease and second-line testing was done thereafter for mostly non-treatable causes. An independent expert medical panel reviewed the charts and attribution of causes of all the included children. Using multivariate analyses, we assessed risk factors associated with unfavourable outcomes (ie, severe neurological sequelae and death) at discharge using data from baseline and day 2 after inclusion. This study is registered with ClinicalTrials.gov, NCT04089436, and is now complete. FINDINGS Between July 28, 2014, and Dec 31, 2017, 664 children with encephalitis were enrolled. Median age was 4·3 years (1·8-8·8), 295 (44%) children were female, and 369 (56%) were male. A confirmed or probable cause of encephalitis was identified in 425 (64%) patients: 216 (33%) of 664 cases were due to Japanese encephalitis virus, 27 (4%) were due to dengue virus, 26 (4%) were due to influenza virus, 24 (4%) were due to herpes simplex virus 1, 18 (3%) were due to Mycobacterium tuberculosis, 17 (3%) were due to Streptococcus pneumoniae, 17 (3%) were due to enterovirus A71, 74 (9%) were due to other pathogens, and six (1%) were due to autoimmune encephalitis. Diagnosis was made within 24 h of admission to hospital for 83 (13%) of 664 children. 119 (18%) children had treatable conditions and 276 (42%) had conditions that could have been preventable by vaccination. At time of discharge, 153 (23%) of 664 children had severe neurological sequelae and 83 (13%) had died. In multivariate analyses, risk factors for unfavourable outcome were diagnosis of M tuberculosis infection upon admission (odds ratio 3·23 [95% CI 1·04-10·03]), coma on day 2 (2·90 [1·78-4·72]), supplementary oxygen requirement (1·89 [1·25-2·86]), and more than 1 week duration between symptom onset and admission to hospital (3·03 [1·68-5·48]). At 1 year after inclusion, of 432 children who were discharged alive from hospital with follow-up data, 24 (5%) had died, 129 (30%) had neurological sequelae, and 279 (65%) had completely recovered. INTERPRETATION In southeast Asia, most causes of childhood encephalitis are either preventable or treatable, with Japanese encephalitis virus being the most common cause. We provide crucial information that could guide public health policy to improve diagnostic, vaccination, and early therapeutic guidelines on childhood encephalitis in the Greater Mekong region. FUNDING Institut Pasteur, Institut Pasteur International Network, Fondation Merieux, Aviesan Sud, INSERM, Wellcome Trust, Institut de Recherche pour le Développement (IRD), and Fondation Total.
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Affiliation(s)
- Jean David Pommier
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia; Institut Pasteur, Biology of Infection Unit, Paris, France; Inserm U1117, Paris, France; Intensive Care Department, University Hospital of Guadeloupe, Guadeloupe, France
| | - Chris Gorman
- Virology Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Yoann Crabol
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Kevin Bleakley
- Université Paris-Saclay, CNRS, Inria, Laboratoire de Mathématiques d'Orsay, Orsay, France
| | - Heng Sothy
- Kantha Bopha IV Children's Hospital, Phnom Penh, Cambodia
| | - Ky Santy
- Kantha Bopha IV Children's Hospital, Phnom Penh, Cambodia
| | | | | | - Em Bunnakea
- Kantha Bopha IV Children's Hospital, Phnom Penh, Cambodia
| | | | | | - Julien Cappelle
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia; French Agricultural Research Centre for International Development (CIRAD), Montpellier, France
| | - Magali Herrant
- International Department, Institut Pasteur, Paris, France
| | - Patrice Piola
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Bruno Rosset
- French Agricultural Research Centre for International Development (CIRAD), Montpellier, France
| | - Veronique Chevalier
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia; French Agricultural Research Centre for International Development (CIRAD), Montpellier, France
| | - Arnaud Tarantola
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Mey Channa
- Virology Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Jerome Honnorat
- French Reference Center for Paraneoplastic Neurological Syndromes and Autoi mmune Encephalitis, Hospices Civils de Lyon, Synatac Team, NeuroMyoGene Institute, Inserm U1217/CNRS UMR5310, Université de Lyon, Lyon, France
| | - Anne Laure Pinto
- French Reference Center for Paraneoplastic Neurological Syndromes and Autoi mmune Encephalitis, Hospices Civils de Lyon, Synatac Team, NeuroMyoGene Institute, Inserm U1217/CNRS UMR5310, Université de Lyon, Lyon, France
| | - Sayaphet Rattanavong
- Lao-Oxford-Mahosot Hospital, Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | - Manivanh Vongsouvath
- Lao-Oxford-Mahosot Hospital, Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | - Mayfong Mayxay
- Lao-Oxford-Mahosot Hospital, Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos; Unité des Virus Émergents, Marseille, France
| | | | | | | | | | | | - Kyaw Linn
- Yangon Children's Hospital, Yangon, Myanmar
| | | | - Philippe Pérot
- Laboratory for Pathogen Discovery, Institut Pasteur, Paris, France
| | | | - Nguyen Hien
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | | | - Philippe Buchy
- Virology Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Philippe Dussart
- Virology Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Denis Laurent
- Kantha Bopha IV Children's Hospital, Phnom Penh, Cambodia
| | - Marc Eloit
- Laboratory for Pathogen Discovery, Institut Pasteur, Paris, France; Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Audrey Dubot-Pérès
- Lao-Oxford-Mahosot Hospital, Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos; Unité des Virus Émergents, Marseille, France; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Churchill Hospital, Oxford, UK
| | - Olivier Lortholary
- Université Paris Cité, Department of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, Institut Imagine, Assistance Publique-Hôpitaux de Paris, Paris, France; Institut Pasteur, CNRS, Molecular Mycology Unit, National Reference Center for Mycoses and Antifungals, UMR 2000, Paris, France
| | | | - Paul N Newton
- Lao-Oxford-Mahosot Hospital, Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Churchill Hospital, Oxford, UK
| | - Marc Lecuit
- Institut Pasteur, Biology of Infection Unit, Paris, France; Inserm U1117, Paris, France; Université Paris Cité, Department of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, Institut Imagine, Assistance Publique-Hôpitaux de Paris, Paris, France.
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Park KD, Hong CR, Choi JY, Kim MS, Yi ES, Saysouliyo S, Phongsavath K, Shin HY. Foundation of pediatric cancer treatment in Lao People's Democratic Republic at the Lao-Korea National Children's Hospital. Pediatr Hematol Oncol 2018; 35:268-275. [PMID: 30595064 DOI: 10.1080/08880018.2018.1477888] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIM The Lao-Korea National Children's Hospital initiated and developed a pediatric cancer treatment program for the first time in September 2012, through education by the Lee Jong-Wook project, establishment of infrastructure by the Korea International Cooperation Agency, and cooperation of medical staff. MATERIAL AND METHODS we describe the experience of initiating and building this program by retrospectively reviewing the data from pediatric patients with cancer diagnosed at the Lao-Korea National Children's Hospital between September 2012 and December 2016. RESULTS A total of 78 patients diagnosed with acute lymphoblastic leukemia (ALL) (n = 44), acute myeloid leukemia (AML) (n = 12), chronic myeloid leukemia (n = 7), lymphoma (n = 6), retinoblastoma (n = 5), Wilms tumor (n = 3), and germ cell tumor (n = 1) were included. Of the 44 patients with ALL, 40 received induction chemotherapy, and 4 refused chemotherapy. Of these 40 patients, 29 (73.6%) achieved complete remission (CR) and 9 (22.5%) died during chemotherapy. Of the 29 patients with CR, 4 completed the chemotherapy, 19 were still on chemotherapy, 4 relapsed, and 2 were deceased. Treatment was unsuccessful for all 12 patients with AML. CONCLUSION We successfully initiated the pediatric cancer care program but faced challenges associated with high mortality because of insufficient resources. We should continue our efforts to find more abandoned patients, detect cancer earlier, and reduce the overall associated mortality.
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Affiliation(s)
- Kyung Duk Park
- a Department of Pediatrics , Chonbuk National University College of Medicine , Jeonju , Republic of Korea
| | - Che Ry Hong
- b Department of Pediatrics , Seoul National University College of Medicine , Seoul , Republic of Korea
| | - Jung Yoon Choi
- b Department of Pediatrics , Seoul National University College of Medicine , Seoul , Republic of Korea
| | - Min Sun Kim
- b Department of Pediatrics , Seoul National University College of Medicine , Seoul , Republic of Korea
| | - Eun Sang Yi
- c Korea International Cooperation Agency (KOICA) , Seoul , Republic of Korea
| | - Sonephet Saysouliyo
- d Department of Pediatrics , National Children's Hospital , Vientiane , Lao Democratic People's Republic
| | - Khounthavy Phongsavath
- d Department of Pediatrics , National Children's Hospital , Vientiane , Lao Democratic People's Republic
| | - Hee Young Shin
- b Department of Pediatrics , Seoul National University College of Medicine , Seoul , Republic of Korea
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