Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU)

Significant research achievements at LOMWRU 2009-2014

lomwru-achievements
LOWMRU team members in the IDC laboratory, Vientiane, Lao PDR
  1. Conducted the first investigation of the aetiology of non-malarial fevers in rural mainland Asia, demonstrating that scrub typhus, dengue, leptospirosis and Japanese encephalitis virus infection are major causes of non-malaria fever across Laos, and that there are important differences in infectious disease epidemiology between northern and southern Laos
  2. Rediscovered sennetsu (Neorickettsia sennetsu) in Asia, describing the first patients from Laos and gave the first description of the pathogen in fish, supporting the Japanese hypothesis that the disease is contracted from eating raw fish
  3. Demonstrated that clinical infantile beriberi and cryptic biochemical thiamin deficiency are common in Vientiane, precipitating important discussions about prevention and post-partum dietary behaviour. Showed that basal red cell transketolase activity, rather than the activation coefficient, is the best predictor of clinical infantile beriberi and the utility of markers of cardiac dysfunction, such as troponin T, as accessible surrogate markers
  4. Developed a novel LAMP assay for detection of Rickettsia typhi in blood, but demonstrated that it has low sensitivity, probably because of very low blood bacterial densities in murine typhus
  5. Described for the first time the pneumococcal serotypes causing invasive diseases in Laos and the importance of Japanese encephalitis virus – this evidence led to the introduction of vaccination programmes against both pathogens in Laos
  6. Demonstrated that typhoid bacteraemia can be accurately, quickly and relatively inexpensively identified in blood culture fluid using typhoid antigen detecting rapid diagnostic tests (RDTs) and that fluoroquinolone resistance markers can be determined by PCR of the RDT sample
  7. Showed that scrub typhus, murine typhus and leptospirosis are important causes of central nervous system infections in Vientiane (with a higher frequency than ‘conventional’ bacterial pathogens) and probably elsewhere in Asia
  8. Demonstrated that Staphylococcus aureus is the leading cause of bacteraemia in Lao infants, probably because of maternal hot bed use, suggesting that cloxacillin use should be considered as empirical treatment for late onset sepsis in neonates
  9. Built, with WWARN, the English and French language online Antimalarial Quality Surveyor and analysed the resulting comprehensive database. Devised the first guidelines for conducting and reporting medicine quality surveys and revised these for WHO and wrote the first ever section on antimalarial quality for the WHO malaria treatment guidelines
  10. Conducted extensive work on quality of medicines globally – used innovative forensics to demonstrate likely origin of falsified medicines, built collaborations across regulators, police, chemists, pharmacists and public health physicians, performing the first repeated random survey of medicine quality to test for change, evaluated new diagnostic tests for medicine quality, participating in investigations of medicine quality problems in Peru, Angola, Laos and many other countries, advised the Joint Inter-agency Task Force on public health aspects of medicine quality, advocated for public health orientated definitions of different types of poor quality medicines and that the CONSORT guidelines should include requirement for checking medicine quality used in clinical trials