Prof Paul Newton

Research Area: Clinical Epidemiology
Scientific Themes: Tropical Medicine & Global Health
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Laboratories at dusk, Laos

Laboratories at dusk, Laos

We are a small clinical tropical medicine research group, the Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, based at Mahosot Hospital, Vientiane in Laos. Vientiane is a small capital city, on the banks of the Mekong River, of a country of 6 million people, but of the size of the UK. We are embedded in the Microbiology Laboratory of the Hospital and linked to the Mahidol University Oxford University Research Unit (MORU) in Bangkok, Thailand. The research is funded by the Wellcome Trust (UK).

The main aim of our work is to provide Lao health workers and the Lao Government with key data that will help make evidence-based decisions for individual patients and for health policy. The conditions we concentrate on include malaria, scrub typhus, murine typhus, melioidosis, dengue, leptospirosis, the causes of central nervous system infections and hepatitis/jaundice. We are also investigating diseases of nutrition and poverty such as infantile beriberi and noma.

We are particularly interested in the public health importance of diseases such scrub typhus and murine typhus, which were previously unrecognised, and the causes of community-acquired bacteraemia. Early work demonstrated the importance of local knowledge in deciding policy and the heterogeneity of infectious epidemiology in rural Asia. We also perform clinical trials on malaria, typhoid, murine typhus and scrub typhus treatment and evaluate rapid diagnostic tests for key diseases. We coordinate and conduct research on a Cinderella of medical specialties – medicine quality - especially the severe public health problem of counterfeit antimalarials in Asia and Africa.

We build human medical research capacity in Laos and produce a Lao and English language medical journal – the Mahosot Microbiology Review.

There are no collaborations listed for this principal investigator.

Newton PN, Fernández FM, Plançon A, Mildenhall DC, Green MD, Ziyong L, Christophel EM, Phanouvong S et al. 2008. A collaborative epidemiological investigation into the criminal fake artesunate trade in South East Asia. PLoS Med, 5 (2), pp. e32. Read abstract | Read more

Since 1998 the serious public health problem in South East Asia of counterfeit artesunate, containing no or subtherapeutic amounts of the active antimalarial ingredient, has led to deaths from untreated malaria, reduced confidence in this vital drug, large economic losses for the legitimate manufacturers, and concerns that artemisinin resistance might be engendered. Hide abstract

Phetsouvanh R, Phongmany S, Soukaloun D, Rasachak B, Soukhaseum V, Soukhaseum S, Frichithavong K, Khounnorath S et al. 2006. Causes of community-acquired bacteremia and patterns of antimicrobial resistance in Vientiane, Laos. Am J Trop Med Hyg, 75 (5), pp. 978-985. Read abstract

There is no published information on the causes of bacteremia in the Lao PDR (Laos). Between 2000 and 2004, 4512 blood culture pairs were taken from patients admitted to Mahosot Hospital, Vientiane, Laos, with suspected community-acquired bacteremia; 483 (10.7%) cultures grew a clinically significant community-acquired organism, most commonly Salmonella enterica serovar typhi (50.9%), Staphylococcus aureus (19.0%), and Escherichia coli (12.4%). S. aureus bacteremia was common among infants (69.2%), while children 1-5 years had a high frequency of typhoid (44%). Multi-drug-resistant S. Typhi was rare (6%). On multiple logistic regression analysis, typhoid was associated with younger age, longer illness, diarrhea, higher admission temperature, and lower peripheral white blood cell count than non-typhoidal bacteremia. Empirical parenteral ampicillin and gentamicin would have some activity against approximately 88% of clinically significant isolates at a cost of US $1.4/day, an important exception being B. pseudomallei. Bacteremic infants in this setting require an anti-staphylococcal antibiotic. Hide abstract

Newton PN, Green MD, Fernández FM, Day NP, White NJ. 2006. Counterfeit anti-infective drugs. Lancet Infect Dis, 6 (9), pp. 602-613. Read abstract | Read more

The production of counterfeit or substandard anti-infective drugs is a widespread and under-recognised problem that contributes to morbidity, mortality, and drug resistance, and leads to spurious reporting of resistance and toxicity and loss of confidence in health-care systems. Counterfeit drugs particularly affect the most disadvantaged people in poor countries. Although advances in forensic chemical analysis and simple field tests will enhance drug quality monitoring, improved access to inexpensive genuine medicines, support of drug regulatory authorities, more open reporting, vigorous law enforcement, and more international cooperation with determined political leadership will be essential to counter this threat. Hide abstract

Phongmany S, Rolain JM, Phetsouvanh R, Blacksell SD, Soukkhaseum V, Rasachack B, Phiasakha K, Soukkhaseum S et al. 2006. Rickettsial infections and fever, Vientiane, Laos. Emerg Infect Dis, 12 (2), pp. 256-262. Read abstract | Read more

Rickettsial diseases have not been described previously from Laos, but in a prospective study, acute rickettsial infection was identified as the cause of fever in 115 (27%) of 427 adults with negative blood cultures admitted to Mahosot Hospital in Vientiane, Laos. The organisms identified by serologic analysis were Orientia tsutsugamushi (14.8%), Rickettsia typhi (9.6%), and spotted fever group rickettsia (2.6% [8 R. helvetica, 1 R. felis, 1 R. conorii subsp. indica, and 1 Rickettsia "AT1"]). Patients with murine typhus had a lower frequency of peripheral lymphadenopathy than those with scrub typhus (3% vs. 46%, p<0.001). Rickettsioses are an underrecognized cause of undifferentiated febrile illnesses among adults in Laos. This finding has implications for the local empiric treatment of fever. Hide abstract

Newton PN, McGready R, Fernandez F, Green MD, Sunjio M, Bruneton C, Phanouvong S, Millet P et al. 2006. Manslaughter by fake artesunate in Asia--will Africa be next? PLoS Med, 3 (6), pp. e197. | Read more

Newton PN, Angus BJ, Chierakul W, Dondorp A, Ruangveerayuth R, Silamut K, Teerapong P, Suputtamongkol Y, Looareesuwan S, White NJ. 2003. Randomized comparison of artesunate and quinine in the treatment of severe falciparum malaria. Clin Infect Dis, 37 (1), pp. 7-16. Read abstract | Read more

A randomized, open-label comparison of artesunate and quinine was conducted in 113 adults with clinically severe falciparum malaria in western Thailand. Mortality was 12% with artesunate and 22% with quinine treatment (relative risk, 0.53; 95% confidence interval, 0.23-1.26; P=.22). Multiple logistic regression analysis found admission plasma lactate level, Glasgow Coma Scale score, and total serum bilirubin level to be independent risk factors for death. Coma recovery and times to normalize plasma lactate levels were similar, but the parasite clearance time was much shorter among artesunate-treated patients (P=.019). Fewer patients became hypoglycemic during artesunate therapy (10%) than during quinine therapy (28%) (P=.03). Artesunate is at least as effective as quinine in the treatment of adults with severe malaria. Larger trials are required to determine whether mortality is reduced among patients treated with artesunate. Hide abstract

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