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    • The study also points out some other important

    2019-04-29

    The study also points out some other important aspects of the pneumonia burden. Increasingly, the major pneumonia burden is in the first 2 years of life (rather than the international focus on children aged younger than 5 years). Additionally, severe pneumonia accounting for most pneumonia deaths occurs in the first 6 months of life (in this study 26 of 32 of severe episodes had occurred by age 2 months), which might need increasing attention in programme-priority setting. As part of an epidemiological transition accompanying the trends reported here, wheeze is an increasingly important presentation in children presenting with cough and difficulty breathing (reported in 65% of cases in this study), which merits further research to reduce antibiotic over-treatment and promote correct treatment of wheeze in these children. The male to female incidence ratio of 2:1 is substantially larger than the established (slight) increased pneumonia risk due to so-called biological frailty in boys and points to the need to explore possible gender discrimination in care-seeking. Although the study reports an active surveillance system, this system is in fact an active case ascertainment within an essentially passive surveillance system, which could have led to missed cases (when care was not sought) and differential care-seeking by gender. Alarming levels of differential hospital admissions of children with pneumonia by gender have been reported in some LMICs. If the full effect of effective interventions against childhood pneumonia is to be realised, then gender discrimination in some countries needs to be recognised as a major source of inequity in child health. Reporting of child health data by sex, as in this study, needs to be seen as an essential order BLZ945 of good practice in the reporting of child health data so that attention can be drawn to sex discrimination, where it exists.
    In , Sabine Dittrich and colleagues report that scrub typhus caused by , murine typhus caused by , and leptospirosis caused by various species account for more than a third of CNS infections diagnosed over 8 years in Vientiane Hospital in Laos. The study is one more great contribution from this team in their investigation of undocumented syndromes, as well as in the public health challenge of rickettsial diseases in southeast Asia. The same investigators have previously reported that scrub typhus was the second most common microbial cause of fever of unknown origin in rural Laos (122 [15%] of 799 diagnosed cases). In 2006, rickettsial infection was detected in 115 (27%) of 427 adults admitted to Vientiane Hospital for fever with negative blood culture. The most common rickettsial agent was followed by . Fewer data are available about the prevalence of these diseases in other southeast Asian countries. In Thailand, scrub and murine typhus has been reported in 16% and 2%, respectively, of fever of unknown origin, with mortality of 3–17% for scrub typhus. Even if epidemiological data for the whole region are unavailable, the substantial presence of rickettsial infections is shown by frequent reports in travellers returning from this area. Because ecotourism and adventure travel are increasingly popular, the incidence of tick-borne rickettsioses among travellers is likely to continue to increase. All patients with rickettsial infections reported by Dittrich and colleagues presented with fever at admission, and few patients presented with typical eschars of inoculation (only 3·6% of patients with murine typhus and 6·7% with scrub typhus). This finding might be a result of poor awareness about pathognomonic signs of rickettsioses among clinicians rather than an absence of such disease. Rickettsioses are treatable but remain underestimated. Besides murine typhus and scrub typhus, tick-borne spotted fever group rickettsioses cause much fever of unknown origin in tropical countries. is one such rickettsia; it has been detected worldwide in arthropod hosts (mainly fleas), with the cat flea the only confirmed biological vector. A growing number of reports implicate in human disease, particularly in the tropics. It has been detected in 3–4% of cases of fever of unknown origin in rural Mali and Kenya, and 6% of cases in rural Senegal. has also been detected in mosquitoes and it is common in countries in Africa with high prevalences of malaria. Cases of infection in Thailand have also been reported.
    In recent months, the International Monetary Fund (IMF) has announced US$430 million of funding to fight Ebola in Sierra Leone, Guinea, and Liberia. By making these funds available, the IMF aims to become part of the solution to the crisis, even if this involves a departure from its usual approach. As IMF Director Christine Lagarde said at a meeting on the outbreak, “It is good to increase the fiscal deficit when it\'s a matter of curing the people, of taking the precautions to actually try to contain the disease. The IMF doesn\'t say that very often.”