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Al Hariri YK, Sulaiman SAS, Khan AH, Adnan AS, Al-Ebrahem SQ. Determinants of prolonged hospitalization and mortality among leptospirosis patients attending tertiary care hospitals in northeastern state in peninsular Malaysia: A cross sectional retrospective analysis. Front Med (Lausanne) 2022; 9:887292. [PMID: 36160172 PMCID: PMC9500579 DOI: 10.3389/fmed.2022.887292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundLeptospirosis is the most common anthropozoonosis worldwide and imposes a major public health problem in many tropical countries. It is a leading cause of disease burden in form of mortality, morbidity and hospital admission. Identifying patients at high risk for mortality or for prolonged hospitalization may save lives and preserve economy. The aim of the current study is to identify significant factors associated with disease mortality and prolonged hospitalization.DesignCress-sectional retrospective study.SettingsTertiary care teaching hospitals in Kelantan, Peninsular Malaysia.ParticipantsAdult patients proven to have leptospirosis depending on IgM ELISA were classified into two classes depending on prolonged hospitalization (>7 days or ≤ 7 days) and mortality (fatal cases or non-fatal cases). Patients' clinico-laboratory data were compared according to these two outcomes using the appropriate statistical test.ResultsOf the 525 patients enrolled, 136 (25.9%) had prolonged hospitalization. The mean length of stay was 6.77 ± 5.68 days. Logistic regression analysis identified acute kidney injury (AKI) (OR 2.3), Jaundice (OR 2.7), elevated alanine aminotransferase (ALT) (OR 2), and prolonged prothrombin time (PT) (OR 1.9) independently associated with prolonged hospitalization. Case fatality rate was 6.48% and around one third of fatal cases had prolonged hospitalization of more than seven days. Factors associated with leptospirosis mortality included age >40 years (p < 0.001), patients presented with tachypnea (p = 0.002), pulmonary infiltrate (p < 0.001), T-wave changes (p < 0.001), atrial fibrillation (p = 0.013), conducting abnormality (p < 0.001), chronic kidney diseases (p < 0.001), multiple organ dysfunctions (p < 0.0010), respiratory failure (p < 0.001), pneumonia (p < 0.001), sepsis (p = 0.004), low venous PH (p = 0.042), AKI (P < 0.001), elevated AST (p < 0.001) or ALT (p = 0.004), hypoalbuminemia (p < 0.001), rhabdomyolysis (p < 0.001), severe thrombocytopenia (p = 0.042), prolonged PT (p < 0.001) or prolonged aPTT (p < 0.017).ConclusionsSignificant proportion of leptospirosis patients (25.9%) had prolonged hospital stay and less proportion died (6.48%). Early identifying patients with factors associated with prolonged hospitalization and death will positively impact practitioners' decisions regarding the proper and fast course of management including ICU admission.
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Affiliation(s)
- Yassin K. Al Hariri
- Department of Clinical Sciences, Ajman University, Ajman, United Arab Emirates
- *Correspondence: Yassin K. Al Hariri
| | - Syed A. S. Sulaiman
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
- Advanced Medical and Dental Institute, Universiti Sains Malaysia (USM), Penang, Malaysia
| | - Amer H. Khan
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
- Amer H. Khan
| | - Azreen S. Adnan
- Management Science University (MSU) Medical Centre, Shah Alam, Selangor, Malaysia
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Das P, Rahman MZ, Banu S, Rahman M, Chisti MJ, Chowdhury F, Akhtar Z, Palit A, Martin DW, Anwar MU, Namwase AS, Angra P, Kato CY, Ramos CJ, Singleton J, Stewart-Juba J, Patel N, Condit M, Chung IH, Galloway R, Friedman M, Cohen AL. Acute febrile illness among outpatients seeking health care in Bangladeshi hospitals prior to the COVID-19 pandemic. PLoS One 2022; 17:e0273902. [PMID: 36048788 PMCID: PMC9436081 DOI: 10.1371/journal.pone.0273902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 08/18/2022] [Indexed: 11/19/2022] Open
Abstract
Understanding the distribution of pathogens causing acute febrile illness (AFI) is important for clinical management of patients in resource-poor settings. We evaluated the proportion of AFI caused by specific pathogens among outpatients in Bangladesh. During May 2019-March 2020, physicians screened patients aged ≥2 years in outpatient departments of four tertiary level public hospitals. We randomly enrolled patients having measured fever (≥100.4°F) during assessment with onset within the past 14 days. Blood and urine samples were tested at icddr,b through rapid diagnostic tests, bacterial culture, and polymerase chain reaction (PCR). Acute and convalescent samples were sent to the Centers for Disease Control and Prevention (USA) for Rickettsia and Orientia (R/O) and Leptospira tests. Among 690 patients, 69 (10%) had enteric fever (Salmonella enterica serotype Typhi orSalmonella enterica serotype Paratyphi), 51 (7.4%) Escherichia coli, and 28 (4.1%) dengue detected. Of the 441 patients tested for R/O, 39 (8.8%) had rickettsioses. We found 7 (2%) Leptospira cases among the 403 AFI patients tested. Nine patients (1%) were hospitalized, and none died. The highest proportion of enteric fever (15%, 36/231) and rickettsioses (14%, 25/182) was in Rajshahi. Dhaka had the most dengue cases (68%, 19/28). R/O affected older children and young adults (IQR 8-23 years) and was detected more frequently in the 21-25 years age-group (17%, 12/70). R/O was more likely to be found in patients in Rajshahi region than in Sylhet (aOR 2.49, 95% CI 0.85-7.32) between July and December (aOR 2.01, 1.01-5.23), and who had a history of recent animal entry inside their house than not (aOR 2.0, 0.93-4.3). Gram-negative Enterobacteriaceae were the most common bacterial infections, and dengue was the most common viral infection among AFI patients in Bangladeshi hospitals, though there was geographic variability. These results can help guide empiric outpatient AFI management.
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Affiliation(s)
- Pritimoy Das
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - M. Ziaur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sayera Banu
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mahmudur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammod Jobayer Chisti
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Fahmida Chowdhury
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Zubair Akhtar
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Anik Palit
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Daniel W. Martin
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Mahabub Ul Anwar
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Angella Sandra Namwase
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Pawan Angra
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Cecilia Y. Kato
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Carmen J. Ramos
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Joseph Singleton
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Jeri Stewart-Juba
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Nikita Patel
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Marah Condit
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Ida H. Chung
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Renee Galloway
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Michael Friedman
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Adam L. Cohen
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
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Gupta N, Wilson W, Ravindra P, Joylin S, Bhat R, Saravu K. Clinical profile, management and outcome of patients with leptospirosis during the times of COVID-19 pandemic: A prospective study from a tertiary care centre in South India. LE INFEZIONI IN MEDICINA 2022; 29:393-401. [PMID: 35146344 DOI: 10.53854/liim-2903-10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 06/28/2021] [Indexed: 12/26/2022]
Abstract
Leptospirosis is a rodent-borne acute febrile illness, classically seen after heavy rainfall and floods. This study aimed to describe the clinical profile, management strategies and outcome of patients with leptospirosis amidst the Coronavirus disease-2019 outbreak. A prospective study of adult patients with undifferentiated fever (5-15 days) was conducted in South India between October 2020 and February 2021. The demographic, clinical details, laboratory details, treatment and outcome of leptospirosis positive (based on serology) and negative patients were compared. A chisquare test was used for qualitative variables, while an independent t-test or Mann Whitney U test was used for continuous variables. Of the 206 patients with suspected acute febrile illness, a total of 63 patients were diagnosed with leptospirosis based on serology results. The median sequential organ failure assessment score was higher in those with leptospirosis (p<0.001). Myalgia, abdominal pain, jaundice, decreased urine output, myocarditis, and dialysis requirement were more common in patients with leptospirosis. Leucocytosis and raised procalcitonin/C-reactive protein were more common in patients with leptospirosis. The duration of stay and antibiotic consumption was higher in patients with leptospirosis. Acute febrile illness such as leptospirosis should be suspected in tropical areas with significant risk factors. The presence of conjunctival suffusion, hepatic and renal dysfunction should warrant a serology test for leptospirosis.
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Affiliation(s)
- Nitin Gupta
- Department of Infectious Diseases, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.,Manipal Center for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - William Wilson
- Department of Emergency Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Prithvishree Ravindra
- Department of Emergency Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sowmya Joylin
- Department of Infectious Diseases, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Rachana Bhat
- Department of Emergency Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Kavitha Saravu
- Department of Infectious Diseases, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.,Manipal Center for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Moradi G, Masoumi Asl H, Bahmani N, Vahabi A, Shirzadi S, Zare Z, Goodarzi E, Naemi H, Khazaei Z, Karimi A. Epidemiology incidence and geographical distribution of leptospirosis using GIS and its incidence prediction in Iran in 2021. Med J Islam Repub Iran 2021; 35:109. [PMID: 34956955 PMCID: PMC8683794 DOI: 10.47176/mjiri.35.109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Leptospirosis is known as a public health problem in developing and developed countries. The aim of this study was to investigate the incidence and geographical distribution of leptospirosis using the Geographic Information System (GIS) and to predict its incidence in Iran in 2021.
Methods: This was a descriptive analytical study. Information on leptospirosis was obtained from the Center for Communicable Diseases Control during 2009-2015. In the next step, The ArcGIS 9.3 was used to prepare geographic maps of the disease incidence and frequency. Therefore, using the Raster Calculator tool, the disease prediction map was drawn.
Results: The results showed that the highest incidence of leptospirosis during 2009-2015 was observed in Gilan, Mazandaran, and Golestan provinces, respectively. The incidence of the disease had an increasing trend from 2013 to 2015. Based on the results of the modeling in Iran, the provinces of Gilan, Mazandaran, and Golestan, with 72.18%, 8.54%, and 4.95% of their area, respectively, have the largest areas at a high-risk for leptospirosis in the coming years.
Conclusion: The prevalence of leptospirosis is affected by geographical and climatic conditions of every region; thus, the incidence of the disease is higher in the provinces located at the Caspian coastal side and in some regions in Semnan province. Hence, if health authorities pay more attention to developing health plans to prevent the disease, the risk of disease in these areas will be reduced in the future.
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Affiliation(s)
- Ghobad Moradi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Hossein Masoumi Asl
- Center for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran
| | - Nasrin Bahmani
- Zoonoses Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Ahmad Vahabi
- Zoonoses Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | | | - Zahra Zare
- Zoonosis Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Goodarzi
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Hasan Naemi
- Cellular and Molecular Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Zaher Khazaei
- Department of Public Health, School of Medicine, Dezful University of Medical Sciences, Dezful, Iran
| | - Asrin Karimi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
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LEPTOSPIRA, PARVOVIRUS, AND TOXOPLASMA IN THE NORTH AMERICAN RIVER OTTER (LONTRA CANADENSIS) IN NORTH CAROLINA, USA. J Wildl Dis 2021; 56:791-802. [PMID: 32320341 DOI: 10.7589/2019-05-129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 11/07/2019] [Indexed: 11/20/2022]
Abstract
The North American river otter (Lontra canadensis) is the largest mustelid in North Carolina, US, and was once extirpated from the central and western portions of the state. Over time and after a successful reintroduction project, otters are now abundant and occur throughout North Carolina. However, there is a concern that diseases may have an impact on the otter population, as well as on other aquatic mammals, either through exposure to emerging diseases, contact with domestic animals such as domestic cats (Felis catus), or less robust condition of individuals through declines in water quality. We tested brain and kidney tissue from harvested otters for the pathogens that cause leptospirosis, parvovirus, and toxoplasmosis. Leptospirosis and toxoplasmosis are priority zoonoses and are maintained by domestic and wild mammals. Although parvovirus is not zoonotic, it does affect pets, causing mild to fatal symptoms. Across the 2014-15 and 2015-16 trapping seasons, we tested 220 otters (76 females, 144 males) using real-time PCR for Leptospira interrogans, parvovirus, and Toxoplasma gondii. Of the otters tested, 1% (3/220) were positive for L. interrogans, 19% (41/220) were positive for parvovirus, and 24% (53/220) were positive for T. gondii. Although the pathogens for parvovirus and toxoplasmosis are relatively common in North Carolina otters, the otter harvest has remained steady and the population appears to be abundant and self-sustaining. Therefore, parvovirus and toxoplasmosis do not currently appear to be negatively impacting the population. However, subsequent research should examine transmission parameters between domestic and wild species and the sublethal effects of infection.
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Benavidez KM, Guerra T, Torres M, Rodriguez D, Veech JA, Hahn D, Miller RJ, Soltero FV, Ramírez AEP, Perez de León A, Castro-Arellano I. The prevalence of Leptospira among invasive small mammals on Puerto Rican cattle farms. PLoS Negl Trop Dis 2019; 13:e0007236. [PMID: 31107872 PMCID: PMC6544380 DOI: 10.1371/journal.pntd.0007236] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 05/31/2019] [Accepted: 02/12/2019] [Indexed: 12/17/2022] Open
Abstract
Leptospirosis, an emerging infectious disease caused by bacteria of the genus Leptospira, is thought to be the most widespread zoonotic disease in the world. A first step in preventing the spread of Leptospira is delineating the animal reservoirs that maintain and disperse the bacteria. Quantitative PCR (qPCR) methods targeting the LipL32 gene were used to analyze kidney samples from 124 House mice (Mus musculus), 94 Black rats (Rattus rattus), 5 Norway rats (R. norvegicus), and 89 small Indian mongooses (Herpestes auropunctatus) from five cattle farms in Puerto Rico. Renal carriage of Leptospira was found in 38% of the sampled individuals, with 59% of the sampled mice, 34% of Black rats, 20% of Norway rats, and 13% of the mongooses. A heterogeneous distribution of prevalence was also found among sites, with the highest prevalence of Leptospira-positive samples at 52% and the lowest at 30%. Comparative sequence analysis of the LipL32 gene from positive samples revealed the presence of two species of Leptospira, L. borgpetersenii and L. interrogans in mice, detected in similar percentages in samples from four farms, while samples from the fifth farm almost exclusively harbored L. interrogans. In rats, both Leptospira species were found, while mongooses only harbored L. interrogans. Numbers tested for both animals, however, were too small (n = 7 each) to relate prevalence of Leptospira species to location. Significant associations of Leptospira prevalence with anthropogenic landscape features were observed at farms in Naguabo and Sabana Grande, where infected individuals were closer to human dwellings, milking barns, and ponds than were uninfected individuals. These results show that rural areas of Puerto Rico are in need of management and longitudinal surveillance of Leptospira in order to prevent continued infection of focal susceptible species (i.e. humans and cattle).
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Affiliation(s)
- Kathryn M. Benavidez
- Department of Biology, Texas State University, San Marcos, Texas, United States of America
| | - Trina Guerra
- Department of Biology, Texas State University, San Marcos, Texas, United States of America
| | - Madison Torres
- Department of Biology, Texas State University, San Marcos, Texas, United States of America
| | - David Rodriguez
- Department of Biology, Texas State University, San Marcos, Texas, United States of America
| | - Joseph A. Veech
- Department of Biology, Texas State University, San Marcos, Texas, United States of America
| | - Dittmar Hahn
- Department of Biology, Texas State University, San Marcos, Texas, United States of America
| | - Robert J. Miller
- Cattle Fever Tick Research Laboratory, United States Department of Agriculture–Agricultural Research Service, MAB 6419, Edinburg, Texas, United States of America
| | - Fred V. Soltero
- Animal and Plant Health Inspection Service PR and USVI SPRS District 2, United States Department of Agriculture, Hato Rey, Puerto Rico
| | - Alejandro E. Pérez Ramírez
- Agrological Laboratory Analysis & Registration of Agricultural Materials PR Dept. of Agriculture 7 Carr. 693 Dorado, PR
| | - Adalberto Perez de León
- Knippling-Bushland U.S. Livestock Insects Research Laboratory, United States Department of Agriculture–Agricultural Research Service, Kerrville, Texas, United States of America
- Veterinary Pest Genomics Center, United States Department of Agriculture–Agricultural Research Service, Kerrville, TX, United States of America
| | - Iván Castro-Arellano
- Department of Biology, Texas State University, San Marcos, Texas, United States of America
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LEPTOSPIROSIS IN URBAN AND SUBURBAN AMERICAN BLACK BEARS (URSUS AMERICANUS) IN WESTERN NORTH CAROLINA, USA. J Wildl Dis 2019; 55:74-83. [DOI: 10.7589/2017-10-263] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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De Francesco Daher E, de Carvalho GSG, de Sousa Soares D, Mendes MH, Parente Filho SLA, Rocha HAL, da Silva Junior GB. Changing patterns in leptospirosis: a three-decade study in Brazil. Int J Infect Dis 2017; 60:4-10. [PMID: 28483723 DOI: 10.1016/j.ijid.2017.04.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 04/25/2017] [Accepted: 04/28/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND This study was conducted to investigate changes in the clinical pattern of leptospirosis over time, analyzing its clinical and laboratory presentations in a metropolitan city of Brazil. METHOD This was a retrospective study including all patients with leptospirosis admitted to tertiary care hospitals in Fortaleza in the northeast of Brazil, between 1985 and 2015. Patients were divided into three groups according to the year of hospital admission: group I for the years 1985-1995, group II for 1996-2005, and group III for 2006-2015. Demographic, clinical, and laboratory data were compared between the groups. RESULTS A total of 507 patients were included. Their mean age was 37.3±15.9years and 82.4% were male. The mean time between symptom onset and admission was 7±4 days. There was a linear decrease in the levels of serum urea (190.1±92.7, 135±79.5, and 95.6±73.3mg/dl, respectively, p <0.0001) and creatinine (5.8±2.9, 3.8±2.6, and 3.0±2.5mg/dl, respectively, p <0.0001) in each decade, while levels of hemoglobin (10.31±1.9, 10.8±2.0, and 11.5±2.1g/dl, respectively, p <0.0001) and platelets (57.900±52.650, 80.130±68.836, and 107.101±99.699×109/l, respectively, p<0.0001) increased. There was a tendency towards a linear decrease in mortality (22%, 14%, and 11.6%, respectively, p=0.060). CONCLUSIONS Leptospirosis showed significant changes over time in this region. The main changes point to a decrease in disease severity and complications, such as acute kidney injury. Mortality has decreased, being close to 11%.
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Affiliation(s)
- Elizabeth De Francesco Daher
- Department of Internal Medicine, School of Medicine, Walter Cantídio University Hospital, Federal University of Ceará, Fortaleza, Ceará, Brazil.
| | | | - Douglas de Sousa Soares
- Department of Internal Medicine, School of Medicine, Walter Cantídio University Hospital, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Matheus Henrique Mendes
- Department of Internal Medicine, School of Medicine, Walter Cantídio University Hospital, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Sérgio Luiz Arruda Parente Filho
- Department of Internal Medicine, School of Medicine, Walter Cantídio University Hospital, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | | | - Geraldo Bezerra da Silva Junior
- School of Medicine, Public Health Graduate Program, Health Sciences Center, University of Fortaleza, Fortaleza, Ceará, Brazil
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Sharp TM, Rivera García B, Pérez-Padilla J, Galloway RL, Guerra M, Ryff KR, Haberling D, Ramakrishnan S, Shadomy S, Blau D, Tomashek KM, Bower WA. Early Indicators of Fatal Leptospirosis during the 2010 Epidemic in Puerto Rico. PLoS Negl Trop Dis 2016; 10:e0004482. [PMID: 26914210 PMCID: PMC4767218 DOI: 10.1371/journal.pntd.0004482] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 02/01/2016] [Indexed: 12/12/2022] Open
Abstract
Background Leptospirosis is a potentially fatal bacterial zoonosis that is endemic throughout the tropics and may be misdiagnosed as dengue. Delayed hospital admission of leptospirosis patients is associated with increased mortality. Methodology/Principal Findings During a concurrent dengue/leptospirosis epidemic in Puerto Rico in 2010, suspected dengue patients that tested dengue-negative were tested for leptospirosis. Fatal and non-fatal hospitalized leptospirosis patients were matched 1:1–3 by age. Records from all medical visits were evaluated for factors associated with fatal outcome. Among 175 leptospirosis patients identified (4.7 per 100,000 residents), 26 (15%) were fatal. Most patients were older males and had illness onset during the rainy season. Fatal case patients first sought medical care earlier than non-fatal control patients (2.5 vs. 5 days post-illness onset [DPO], p < 0.01), but less frequently first sought care at a hospital (52.4% vs. 92.2%, p < 0.01). Although fatal cases were more often diagnosed with leptospirosis at first medical visit (43.9% vs. 9.6%, p = 0.01), they were admitted to the hospital no earlier than non-fatal controls (4.5 vs. 6 DPO, p = 0.31). Cases less often developed fever (p = 0.03), but more often developed jaundice, edema, leg pain, hemoptysis, and had a seizure (p ≤ 0.03). Multivariable analysis of laboratory values from first medical visit associated with fatal outcome included increased white blood cell (WBC) count with increased creatinine (p = 0.001), and decreased bicarbonate with either increased WBC count, increased creatinine, or decreased platelet count (p < 0.001). Conclusions/Significance Patients with fatal leptospirosis sought care earlier, but were not admitted for care any earlier than non-fatal patients. Combinations of routine laboratory values predictive of fatal outcome should be considered in admission decision-making for patients with suspected leptospirosis. Leptospirosis is a common tropical illness that results from exposure to the urine of animals infected with Leptospira bacteria. Because leptospirosis shares signs and symptoms with other common tropical illnesses such as dengue, identification of patients with leptospirosis can be challenging. Early identification of patients with leptospirosis is necessary to initiate antibiotic therapy and in some cases provide in-hospital management. During an epidemic of leptospirosis in Puerto Rico that occurred during a concomitant dengue epidemic, we identified leptospirosis patients by screening specimens from suspected dengue patients. Of 175 leptospirosis patients identified, 26 (15%) died. After comparing leptospirosis patients that died to patients of a similar age that were hospitalized but survived, we observed that fatal cases were more often sent home after their first medical visit. We next identified several routinely available laboratory values from patients’ first medical visit that were associated with patients that died. Clinicians can use such laboratory values to diagnose and hospitalize leptospirosis patients at increased risk for fatal outcome.
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Affiliation(s)
- Tyler M. Sharp
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
- * E-mail:
| | | | - Janice Pérez-Padilla
- Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Renee L. Galloway
- Bacterial Special Pathogens Branch, Division of High Consequence Pathogens, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Marta Guerra
- Bacterial Special Pathogens Branch, Division of High Consequence Pathogens, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kyle R. Ryff
- Puerto Rico Department of Health, San Juan, Puerto Rico
| | - Dana Haberling
- Bacterial Special Pathogens Branch, Division of High Consequence Pathogens, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sharada Ramakrishnan
- Bacterial Special Pathogens Branch, Division of High Consequence Pathogens, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sean Shadomy
- Bacterial Special Pathogens Branch, Division of High Consequence Pathogens, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Dianna Blau
- Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kay M. Tomashek
- Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - William A. Bower
- Bacterial Special Pathogens Branch, Division of High Consequence Pathogens, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Sánchez-Montes S, Espinosa-Martínez DV, Ríos-Muñoz CA, Berzunza-Cruz M, Becker I. Leptospirosis in Mexico: Epidemiology and Potential Distribution of Human Cases. PLoS One 2015. [PMID: 26207827 PMCID: PMC4514770 DOI: 10.1371/journal.pone.0133720] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Leptospirosis is widespread in Mexico, yet the potential distribution and risk of the disease remain unknown. METHODOLOGY/PRINCIPAL FINDINGS We analysed morbidity and mortality according to age and gender based on three sources of data reported by the Ministry of Health and the National Institute of Geography and Statics of Mexico, for the decade 2000-2010. A total of 1,547 cases were reported in 27 states, the majority of which were registered during the rainy season, and the most affected age group was 25-44 years old. Although leptospirosis has been reported as an occupational disease of males, analysis of morbidity in Mexico showed no male preference. A total number of 198 deaths were registered in 21 states, mainly in urban settings. Mortality was higher in males (61.1%) as compared to females (38.9%), and the case fatality ratio was also increased in males. The overall case fatality ratio in Mexico was elevated (12.8%), as compared to other countries. We additionally determined the potential disease distribution by examining the spatial epidemiology combined with spatial modeling using ecological niche modeling techniques. We identified regions where leptospirosis could be present and created a potential distribution map using bioclimatic variables derived from temperature and precipitation. Our data show that the distribution of the cases was more related to temperature (75%) than to precipitation variables. Ecological niche modeling showed predictive areas that were widely distributed in central and southern Mexico, excluding areas characterized by extreme climates. CONCLUSIONS/SIGNIFICANCE In conclusion, an epidemiological surveillance of leptospirosis is recommended in Mexico, since 55.7% of the country has environmental conditions fulfilling the criteria that favor the presence of the disease.
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Affiliation(s)
- Sokani Sánchez-Montes
- Unidad de Investigación en Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
- Centro de Medicina Tropical, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Deborah V. Espinosa-Martínez
- Museo de Zoología “Alfonso L. Herrera”, Departamento de Biología Evolutiva, Facultad de Ciencias, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - César A. Ríos-Muñoz
- Unidad de Investigación en Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
- Centro de Medicina Tropical, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
- Museo de Zoología “Alfonso L. Herrera”, Departamento de Biología Evolutiva, Facultad de Ciencias, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Miriam Berzunza-Cruz
- Unidad de Investigación en Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
- Centro de Medicina Tropical, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Ingeborg Becker
- Unidad de Investigación en Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
- Centro de Medicina Tropical, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
- * E-mail:
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Hantavirus infection among children hospitalized for febrile illness suspected to be dengue in Barbados. J Infect Public Health 2015; 9:81-7. [PMID: 26153080 DOI: 10.1016/j.jiph.2015.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 05/27/2015] [Accepted: 06/12/2015] [Indexed: 01/29/2023] Open
Abstract
Emerging picture of hantavirus infection in the South America is characterized by greater proportion of childhood infection and wider spectrum of disease from mild asymptomatic to lethal cardiopulmonary disease. Barbados is endemic for dengue and leptospirosis, both of which share clinical features with hantavirus infection and in many cases neither of these diagnosis could be confirmed. We investigate whether some of the children hospitalized with suspected dengue could indeed have been hantavirus infections. In this prospective study children hospitalized with suspected dengue were tested for hantavirus infection using ELISA for the IgM antibodies. Thirty-eight children tested positive for hantavirus infection. They presented with fever, headache and mild respiratory and gastrointestinal symptoms and signs. None of them had features suggestive of hantavirus cardiopulmonary syndrome. Blood count values ranged from low to normal to high for their age. There were no deaths. Hantavirus infection is prevalent in this Caribbean country. It predominantly presents with milder disease and is responsible for some of the nonspecific febrile illnesses in children.
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Bourhy P, Herrmann Storck C, Theodose R, Olive C, Nicolas M, Hochedez P, Lamaury I, Zinini F, Brémont S, Landier A, Cassadou S, Rosine J, Picardeau M. Serovar diversity of pathogenic Leptospira circulating in the French West Indies. PLoS Negl Trop Dis 2013; 7:e2114. [PMID: 23516654 PMCID: PMC3597474 DOI: 10.1371/journal.pntd.0002114] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 01/30/2013] [Indexed: 12/04/2022] Open
Abstract
Background Leptospirosis is one of the most important neglected tropical bacterial diseases in Latin America and the Caribbean. However, very little is known about the circulating etiological agents of leptospirosis in this region. In this study, we describe the serological and molecular features of leptospires isolated from 104 leptospirosis patients in Guadeloupe (n = 85) and Martinique (n = 19) and six rats captured in Guadeloupe, between 2004 and 2012. Methods and Findings Strains were studied by serogrouping, PFGE, MLVA, and sequencing 16SrRNA and secY. DNA extracts from blood samples collected from 36 patients in Martinique were also used for molecular typing of leptospires via PCR. Phylogenetic analyses revealed thirteen different genotypes clustered into five main clades that corresponded to the species: L. interrogans, L. kirschneri, L. borgpetersenii, L. noguchi, and L. santarosai. We also identified L. kmetyi in at least two patients with acute leptospirosis. This is the first time, to our knowledge, that this species has been identified in humans. The most prevalent genotypes were associated with L. interrogans serovars Icterohaemorrhagiae and Copenhageni, L. kirschneri serovar Bogvere, and L. borgpetersenii serovar Arborea. We were unable to identify nine strains at the serovar level and comparison of genotyping results to the MLST database revealed new secY alleles. Conclusions The overall serovar distribution in the French West Indies was unique compared to the neighboring islands. Typing of leptospiral isolates also suggested the existence of previously undescribed serovars. Leptospirosis is an emerging zoonotic disease caused by infection with pathogenic strains of Leptospira. Isolation of Leptospira strains is rare, making it difficult to assess their distribution worldwide. In this study, we characterized cultures of Leptospira obtained from more than one hundred leptospirosis patients from the French West Indies by serology and various molecular typing methods to identify the strains circulating in this endemic region. Typing of leptospiral isolates showed that causative agents of leptospirosis in the French West Indies are mainly from the serogroups Icterohaemorrhagiae and Ballum, but we also identified new genotypes. We also found that the distribution of the predominant pathogenic leptospiral serovars differed between the Caribbean islands. A better understanding of the epidemiology of leptospirosis will improve our knowledge in the distribution of this emerging neglected tropical disease worldwide. The identification of the circulating etiological agents of leptospirosis in the French West Indies will also help establish appropriate control and prevention measures in this area where the disease is endemic.
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Affiliation(s)
- Pascale Bourhy
- Institut Pasteur, Unité de Biologie des Spirochètes, National Reference Center and WHO Collaborating Center for Leptospirosis, Paris, France
| | - Cécile Herrmann Storck
- University Hospital of Pointe à Pitre, Department of Bacteriology and Infectious and Tropical Diseases, Guadeloupe, French West Indies
| | - Rafaelle Theodose
- University Hospital of Fort de France, Department of Bacteriology and Infectious and Tropical Diseases, Martinique, French West Indies
| | - Claude Olive
- University Hospital of Fort de France, Department of Bacteriology and Infectious and Tropical Diseases, Martinique, French West Indies
| | - Muriel Nicolas
- University Hospital of Pointe à Pitre, Department of Bacteriology and Infectious and Tropical Diseases, Guadeloupe, French West Indies
| | - Patrick Hochedez
- University Hospital of Fort de France, Department of Bacteriology and Infectious and Tropical Diseases, Martinique, French West Indies
| | - Isabelle Lamaury
- University Hospital of Pointe à Pitre, Department of Bacteriology and Infectious and Tropical Diseases, Guadeloupe, French West Indies
| | - Farida Zinini
- Institut Pasteur, Unité de Biologie des Spirochètes, National Reference Center and WHO Collaborating Center for Leptospirosis, Paris, France
| | - Sylvie Brémont
- Institut Pasteur, Unité de Biologie des Spirochètes, National Reference Center and WHO Collaborating Center for Leptospirosis, Paris, France
| | - Annie Landier
- Institut Pasteur, Unité de Biologie des Spirochètes, National Reference Center and WHO Collaborating Center for Leptospirosis, Paris, France
| | - Sylvie Cassadou
- French Institute for Public Health Surveillance (InVS), Interregional epidemiology unit of French West Indies (Cire Antilles-Guyane), Fort-de-France, Martinique, French West Indies
| | - Jacques Rosine
- French Institute for Public Health Surveillance (InVS), Interregional epidemiology unit of French West Indies (Cire Antilles-Guyane), Fort-de-France, Martinique, French West Indies
| | - Mathieu Picardeau
- Institut Pasteur, Unité de Biologie des Spirochètes, National Reference Center and WHO Collaborating Center for Leptospirosis, Paris, France
- * E-mail:
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Schneider MC, Nájera P, Aldighieri S, Bacallao J, Soto A, Marquiño W, Altamirano L, Saenz C, Marin J, Jimenez E, Moynihan M, Espinal M. Leptospirosis outbreaks in Nicaragua: identifying critical areas and exploring drivers for evidence-based planning. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2012; 9:3883-910. [PMID: 23202822 PMCID: PMC3524603 DOI: 10.3390/ijerph9113883] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 09/21/2012] [Accepted: 09/24/2012] [Indexed: 11/16/2022]
Abstract
Leptospirosis is an epidemic-prone zoonotic disease that occurs worldwide. In Central America, leptospirosis outbreaks have been reported in almost all countries; Nicaragua in particular has faced several outbreaks. The objective of this study was to stratify the risk and identify "critical areas" for leptospirosis outbreaks in Nicaragua, and to perform an exploratory analysis of potential "drivers". This ecological study includes the entire country (153 municipalities). Cases from 2004 to 2010 were obtained from the country's health information system, demographic and socioeconomic variables from its Census, and environmental data from external sources. Criteria for risk stratification of leptospirosis were defined. Nicaragua reported 1,980 cases of leptospirosis during this period, with the highest percentage of cases (26.36%) in León, followed by Chinandega (15.35%). Among the 153 municipalities, 48 were considered critical areas, 85 were endemic and 20 silent. Using spatial and statistical analysis, the variable presenting the most evident pattern of association with critical areas defined by top quintile of incidence rate is the percentage of municipal surface occupied by the soil combination of cambisol (over pyroclastic and lava bedrock) and andosol (over a volcanic ashes foundation). Precipitation and percentage of rural population are also associated with critical areas. This methodology and findings could be used for Nicaragua's Leptospirosis Intersectoral Plan, and to identify possible risk areas in other countries with similar drivers.
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Affiliation(s)
- Maria Cristina Schneider
- Pan American Health Organization, Health Surveillance and Disease Prevention and Control,525 23rd. St. NW, Washington, DC 20037, USA; (P.N.); (S.A.); (M.M.); (M.E.)
| | - Patricia Nájera
- Pan American Health Organization, Health Surveillance and Disease Prevention and Control,525 23rd. St. NW, Washington, DC 20037, USA; (P.N.); (S.A.); (M.M.); (M.E.)
| | - Sylvain Aldighieri
- Pan American Health Organization, Health Surveillance and Disease Prevention and Control,525 23rd. St. NW, Washington, DC 20037, USA; (P.N.); (S.A.); (M.M.); (M.E.)
| | - Jorge Bacallao
- University of Medical Sciences ofHabana, Research and Reference Center of Atherosclerosis of Havana, Universidad de Ciencias Médicas de La Habana, Tulipán y Panorama, Plaza, La Habana, Cuba;
| | - Aida Soto
- University of Medical Sciences ofHabana, Research and Reference Center of Atherosclerosis of Havana, Universidad de Ciencias Médicas de La Habana, Tulipán y Panorama, Plaza, La Habana, Cuba;
| | - Wilmer Marquiño
- Pan American Health Organization Nicaragua, PO Box 1309, Managua, Nicaragua; (A.S.); (W.M.); (L.A.)
| | - Lesbia Altamirano
- Pan American Health Organization Nicaragua, PO Box 1309, Managua, Nicaragua; (A.S.); (W.M.); (L.A.)
| | - Carlos Saenz
- Ministry of Health of Nicaragua, Costado Oeste Colonia Primero de Mayo, PO Box 107, Managua, Nicaragua; (C.S.); (J.M.); (E.J.)
| | - Jesus Marin
- Ministry of Health of Nicaragua, Costado Oeste Colonia Primero de Mayo, PO Box 107, Managua, Nicaragua; (C.S.); (J.M.); (E.J.)
| | - Eduardo Jimenez
- Ministry of Health of Nicaragua, Costado Oeste Colonia Primero de Mayo, PO Box 107, Managua, Nicaragua; (C.S.); (J.M.); (E.J.)
| | - Matthew Moynihan
- Pan American Health Organization, Health Surveillance and Disease Prevention and Control,525 23rd. St. NW, Washington, DC 20037, USA; (P.N.); (S.A.); (M.M.); (M.E.)
| | - Marcos Espinal
- Pan American Health Organization, Health Surveillance and Disease Prevention and Control,525 23rd. St. NW, Washington, DC 20037, USA; (P.N.); (S.A.); (M.M.); (M.E.)
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Characterization of LIC11207, a novel leptospiral protein that is recognized by human convalescent sera and prevents apoptosis of polymorphonuclear leukocytes. Microb Pathog 2012; 56:21-8. [PMID: 23092690 DOI: 10.1016/j.micpath.2012.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 10/09/2012] [Accepted: 10/15/2012] [Indexed: 01/01/2023]
Abstract
We report the study of a predicted outer-membrane leptospiral protein encoded by the gene lic11207. This protein is conserved in several pathogenic leptospiral strains but is absent in the saprophyte Leptospira biflexa. This putative outer-membrane protein has a domain of unknown function (DUF) 1565 found in several phylogenetically diverse bacteria and in the archaeon Methanosarcina acetivorans. The gene was cloned and expressed in Escherichia coli BL21 (SI) strain using the expression vector pDEST17. The 34 kDa recombinant protein was tagged with N-terminal hexahistidine and purified by metal-charged chromatography. The purified protein was used to assess: reactivity with human convalescent sera; in vivo expression; ability to activate endothelial cells (EC); and ability to modulate the apoptosis of polymorphonuclear cells (PMNs). The LIC11207 coding sequence was identified in vivo in the hamster renal tubules during experimental infection with Leptospira interrogans. The rLIC11207 showed significant antigenicity against human convalescent sera when compared with sera from healthy donors. The recombinant protein did not alter the surface expression of E-selectin or intercellular adhesion molecule 1 (ICAM-1) in EC and failed to induce the release of von Willebrand factor (vWF). Interestingly, rLIC11207 delayed apoptosis of PMNs suggesting a possible role of this protein during the infection.
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Goeijenbier M, Wagenaar J, Goris M, Martina B, Henttonen H, Vaheri A, Reusken C, Hartskeerl R, Osterhaus A, Van Gorp E. Rodent-borne hemorrhagic fevers: under-recognized, widely spread and preventable – epidemiology, diagnostics and treatment. Crit Rev Microbiol 2012; 39:26-42. [DOI: 10.3109/1040841x.2012.686481] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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16
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Long-term trends in the epidemiology of human leptospirosis (Slovak Republic, 1954-2006). Eur J Clin Microbiol Infect Dis 2012; 31:2167-76. [PMID: 22354522 DOI: 10.1007/s10096-012-1551-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 01/06/2012] [Indexed: 10/28/2022]
Abstract
The purpose of this study was the observation of eventual shifts in some basic epidemiological features of human leptospirosis in Slovakia over a long period of time. Epidemiological traits of human leptospirosis were evaluated in three decades: 1954-1963 (822 cases), 1976-1985 (477 cases) and 1997-2006 (310 cases). The evaluation encompassed the aetiologic structure of cases, the incidence rate of diseases, men-to-women ratio of patients, as well as the professional and seasonal distribution of patients. The most affected feature was the incidence rate, which decreased by more than 70% over time. Another considerable change was the proportion of different major serological types of leptospirosis. The initially prevailing Sejroe infections fell to 4th place in the percentage rank, while Grippotyphosa disease, which was ranked 2nd place at the beginning of the observations, became dominating. Icterohaemorrhagiae disease climbed from 4th place to 2nd place. Third place was reserved by the Pomona + Tarassovi infections during the whole study period. A distinct tendency of age- and gender-specific incidence rate compared to the proportion of leptospirosis by age and gender was noticed; only minor alterations of the values of both parameters were registered over time. The overall value of the men-to-women ratio (MWR) of diseased persons was virtually within the same range in all three time periods but varied according to different age groups. The MWRs relative to the causal Leptospira serovars were stable over time but markedly differed among distinct serovars. Incidence rates related to age and aetiology showed different trends for the major serological types of leptospirosis. Changes were observed in the professional distribution of leptospirosis: there was an important proportional decrease of cases among farmers and field workers, an increase among house-wives + pensioners, but only some slight changes in abattoir workers/butchers, pupils + students and workers. The seasonal distribution of patients did not show any remarkable changes; the maximum percentage of cases occurred during the period extending from July to November during the whole period of observation. The epidemiological features of human leptospirosis underwent important shifts in the Slovak Republic over a 50-year period of time. They were very closely related to economical, social and political changes, which are discussed in this paper. The results may be useful for specialists in other European countries.
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Forde M, Morrison K, Dewailly E, Badrie N, Robertson L. Strengthening integrated research and capacity development within the Caribbean region. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2011; 11 Suppl 2:S7. [PMID: 22166013 PMCID: PMC3247838 DOI: 10.1186/1472-698x-11-s2-s7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The Caribbean region, like other developing regions of the world, faces significant challenges in conducting research, especially in the context of limited resource capacities and capabilities. Further, due to its diverse and multiple island states, research capacity is scattered and unevenly spread within the region. The Caribbean EcoHealth Programme (CEHP) is a research program that is structured to improve the capacity and capability of health professionals in the Caribbean region to respond in integrative and innovative ways to on-going and emerging environmental health challenges by means of multi-sectoral interventions. METHODS Core parts of the CEHP's mission are to (1) conduct collaborative research in areas that the region has identified as critical; (2) build and strengthening integrated approaches to research; and (3) develop and enhance basic research capacity within the Caribbean region.Fundamental to the success of the CEHP's human and resource development mission has been its use of the Atlantis Mobile Laboratory (AML). The AML has allowed the CEHP program to move throughout the Caribbean and be able to respond to calls for specific research and capacity building opportunities. RESULTS The CEHP's five main research projects have generated the following results: (1) the Persistent Organic Pollutants (POPs) study has evaluated human exposures to POPs, heavy metals, pesticides, and zoonotic infections; (2) the Burden of Illness (BOI) studies have developed protocols for the testing of foodborne microorganisms, strengthen laboratory analytical capabilities, and determined the prevalence and incidence of food-borne illness; (3) the Rainwater Harvesting (RWH) study has evaluated the microbial and chemical quality of rainwater harvesting systems; (4) the Ecotoxicology Water (ETW) studies have provided much needed data on the quality of recreational and drinking water supplies, and (5) the Food Safety Training Program has developed Diploma and M.Sc Agri-Food Safety and Quality Assurance programmes. CONCLUSIONS The CEHP program provides a successful example of how a collaborative instead of researcher driven research agenda can lead to not only the generation of needed information, but also leave within the region where the research has been carried out the capacity and capabilities to continue to do so independent of outside interventions.
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Knowledge, attitudes and practices of Trinidadian households regarding leptospirosis and related matters. Int Health 2011; 3:131-7. [DOI: 10.1016/j.inhe.2011.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Katz AR, Buchholz AE, Hinson K, Park SY, Effler PV. Leptospirosis in Hawaii, USA, 1999-2008. Emerg Infect Dis 2011; 17:221-6. [PMID: 21291592 PMCID: PMC3204774 DOI: 10.3201/eid1702.101109] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Although infrequently diagnosed in the United States, leptospirosis is a notable reemerging infectious disease throughout developing countries. Until 1995, when the disease was eliminated from the US list of nationally notifiable diseases, Hawaii led the nation in reported annual incidence rates. Leptospirosis remains a notifiable disease in Hawaii. To ascertain the status of leptospirosis in Hawaii since the most recent US report in 2002, we reviewed 1999–2008 data obtained from case investigation reports by the Hawaii State Department of Health. Of the 345 case reports related to in-state exposures, 198 (57%) were laboratory confirmed. Our findings indicate a change in seasonal disease occurrence from summer to winter and in the infective serogroup from Icterohemorrhagiae to Australis. Also, during the past 20 years, recreational exposures have plateaued, while occupational exposures have increased. Ongoing surveillance is needed to clarify and track the dynamic epidemiology of this widespread zoonosis.
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Affiliation(s)
- Alan R Katz
- Department of Public Health Sciences, John A. Burns School of Medicine, University of Hawaii, Biomedical Sciences Building, Rm D104M, 1960 East-West Rd, Honolulu, HI 96822, USA.
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Abstract
Leptospirosis is the most widespread zoonosis in the world. Humans become infected through contact with the urine of carrier animals, directly or via contaminated environments. This review reports available data on animal leptospirosis in ten tropical islands: Barbados, Martinique, Guadeloupe, Grenada, Trinidad, New Caledonia, Hawaii, French Polynesia, La Réunion and Mayotte. Leptospirosis is endemic in these insular wild and domestic fauna. Each island presents a specific panel of circulating serovars, closely linked with animal and environmental biodiversity, making it epidemiologically different from the mainland. Rats, mongooses and mice are proven major renal carriers of leptospires in these areas but dogs also constitute a significant potential reservoir. In some islands seroprevalence of leptospirosis in animals evolves with time, inducing changes in the epidemiology of the human disease. Consequently more investigations on animal leptospirosis in these ecosystems and use of molecular tools are essential for prevention and control of the human disease.
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Mohan ARM, Cumberbatch A, Adesiyun AA, Chadee DD. Epidemiology of human leptospirosis in Trinidad and Tobago, 1996-2007: a retrospective study. Acta Trop 2009; 112:260-5. [PMID: 19679092 DOI: 10.1016/j.actatropica.2009.08.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Revised: 08/02/2009] [Accepted: 08/05/2009] [Indexed: 11/29/2022]
Abstract
A retrospective study to describe the epidemiology of human leptospirosis in Trinidad and Tobago during 1996-2007 was conducted. All confirmed cases of leptospirosis was analyzed according to age, sex, seasonality and geographic distribution. A total of 278 cases were recorded, with an average annual incidence rate of 1.84 per 100,000 population. Seventy-five percent of the cases occurred during the wet season, with the highest number of cases recorded in November. A positive correlation was found between number of cases and rainfall. Males constituted 80% of all cases, and the overall male:female ratio was 4.6:1. The total case fatality rate was 5.8%, with deaths among males four times more common than in females. Clinical leptospirosis was greatest in the 10-19 age group and lowest in the 0-9 age group. The total prevalence was 22 per 100,000 population, with the highest prevalence 41 per 100,000 recorded in the regional corporation of Sangre Grande and the lowest (6 per 100,000) in the city of Port of Spain. The lack of important information and active surveillance showed that the level of awareness of the disease is low in the country. The disease is still under-reported, and is considered to be of significant public health importance.
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Affiliation(s)
- Andrea R M Mohan
- Department of Life Sciences, The University of The West Indies, St. Augustine, Trinidad and Tobago
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Liverpool J, Francis S, Liverpool CE, Dean GT, Mendez DD. Leptospirosis: case reports of an outbreak in Guyana. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2008; 102:239-45. [PMID: 18348778 DOI: 10.1179/136485908x278784] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Although leptospirosis is a globally important zoonotic disease that affects humans on all continents, in both urban and rural areas, it often goes undiagnosed because its clinical manifestations are frequently non-specific. Even when leptospirosis is suspected, confirmation is made difficult by problems in isolating the causative organism in culture and by the low sensitivity of the available serological tests. Following torrential rains and flooding in January-February 2005, an outbreak of leptospirosis was suspected in Guyana, South America. Overall, 108 suspected cases presented at a medical post in the East Coast area of Guyana, and some of these cases are described in detail here. A better understanding of the clinical and paraclinical characteristics of leptospirosis should improve the recognition and appropriate treatment of the disease. Health education could reduce exposure, and physicians and primary healthcare workers could be made more aware of the signs and symptoms of leptospirosis.
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Affiliation(s)
- J Liverpool
- Morehouse School of Medicine, Stone Mountain, GA 30087, USA.
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Tassinari WS, Pellegrini DCP, Sá CBP, Reis RB, Ko AI, Carvalho MS. Detection and modelling of case clusters for urban leptospirosis. Trop Med Int Health 2008; 13:503-12. [DOI: 10.1111/j.1365-3156.2008.02028.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Changes in epidemiology of leptospirosis in 2003--2004, a two El Niño Southern Oscillation period, Guadeloupe archipelago, French West Indies. Epidemiol Infect 2007; 136:1407-15. [PMID: 18096102 DOI: 10.1017/s0950268807000052] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Our study aimed at analysing the changes in epidemiological features of leptospirosis cases from the hospital of Pointe à Pitre in Guadeloupe in 2003--2004 compared to reliable data in 1994--2001. Leptospirosis incidence increased fourfold during 2002--2004, a period with two El Niño events. Whereas the main risk factors were unchanged (male gender, occupational exposure, contact with cattle or pigs) a major role of rodent exposure emerged (52%, P=0.02, multivariate analysis). Interestingly, mean age of cases shifted to the older population (51.7 years vs. 43 years, P<0.05). Moreover, the Ballum serogroup rose dramatically (36% of incidence) competing with the Icterohaemorragiae serogroup (62%). However, severe forms were less recorded. Our data suggest that the changes in leptospirosis features could be related to exceptional meteorological events and their consequences on rodent populations. We propose the monitoring of rodent population and climatic data as a tool of management of leptospirosis in Guadeloupe.
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Slack AT, Symonds ML, Dohnt MF, Smythe LD. The epidemiology of leptospirosis and the emergence of Leptospira borgpetersenii serovar Arborea in Queensland, Australia, 1998-2004. Epidemiol Infect 2006; 134:1217-25. [PMID: 16690001 PMCID: PMC2870520 DOI: 10.1017/s0950268806006352] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2006] [Indexed: 11/07/2022] Open
Abstract
Leptospirosis is one of the most commonly encountered zoonoses in both Australia and the rest of the world. The incidence of leptospirosis in Queensland over the 7-year study period (1998-2004) was 3.1/100000 population. Enhanced surveillance questionnaires were used to collect patient data and facilitate an epidemiological investigation of leptospirosis in Queensland. Farming occupations comprised the majority of occupational exposure cases, however, recreational exposure accounted for 18% of the 883 cases. Rainfall and the presence of animal hosts had the most influence on the incidence of leptospirosis. Several trends in serovar numbers over this period are noted, in particular the emergence of L. borgpetersenii serovar Arborea, which accounted for 22% of all leptospirosis cases in Australia and 68% of South-East Queensland cases in 2004. Assessment of epidemiological trends in leptospirosis is important to obtain directed public health intervention and outcomes in the reduction of leptospirosis cases.
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Affiliation(s)
- A T Slack
- WHO/FAO/OIE Collaborating Centre for Reference & Research on Leptospirosis, Western Pacific Region, Centre for Public Health Sciences, Queensland Health Scientific Services, Brisbane, Australia.
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Vieira ML, Gama-Simões MJ, Collares-Pereira M. Human leptospirosis in Portugal: a retrospective study of eighteen years. Int J Infect Dis 2006; 10:378-86. [PMID: 16600656 DOI: 10.1016/j.ijid.2005.07.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2005] [Revised: 07/14/2005] [Accepted: 07/22/2005] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Leptospirosis, an under-recognized public health problem, needs to be confirmed through specific laboratory diagnosis. DESIGN We describe herein a series of 4618 symptomatic patients for whom a microagglutination test (MAT) serology was available, representing a unique picture of human leptospirosis in central mainland Portugal and the Azores islands of São Miguel and Terceira, over eighteen- and twelve-year periods, respectively. RESULTS The distribution of the 1024 (22%) cases identified was an average 57 cases per year, with higher frequency in males (67%). These represent the majority of leptospirosis notifications in Portugal, with a higher annual incidence rate in the islands, compared to the central mainland (11.1 and 1.7/100,000 population, respectively). Middle-aged adults (25-54 years) were most frequently infected (45%). Cases occurred mainly in December and January. Serovars from nine presumptive serogroups caused infection, with a predominance of Icterohaemorrhagiae, Pomona, and Ballum, accounting for 66% of cases. CONCLUSIONS Seropositivity was associated with both anicteric and icteric leptospirosis. Several risk factors and a higher transmission risk in certain areas were emphasized. Leptospirosis was confirmed as a steadily increasing public health problem; good surveillance, communication, and laboratory support are thus necessary to reduce the impact of leptospirosis in areas at risk.
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Affiliation(s)
- Maria Luisa Vieira
- Unidade de Leptospirose e Borreliose de Lyme, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
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Abstract
PURPOSE OF REVIEW Leptospirosis, a spirochaetal zoonotic disease, has been recognized as an important emerging infectious disease in the last 10 years. This review addresses the issues in the epidemiology, diagnosis and clinical management which confront public health responses, and highlights the progress made towards understanding the Leptospira genome, biology and pathogenesis. RECENT FINDINGS Leptospirosis has spread from its traditional rural base to become the cause of epidemics in poor urban slum communities in developing countries. Mortality from severe disease forms, Weil's disease and severe pulmonary haemorrhage syndrome, is high (>10% and >50%, respectively) even when optimal treatment is provided. Moreover, the overall disease burden is underestimated, since leptospirosis is a significant cause of undifferentiated fever and frequently not recognized. Barriers to addressing this problem have been the lack of an adequate diagnostic test and effective control measures. China and Brazil, countries in which leptospirosis is a major health problem, have completed the sequence of the Leptospira interrogans genome. Together with new genetic tools and proteomics, new insights have been made into the biology of Leptospira and the mechanisms used to adapt to host and external environments. Surface-exposed proteins and putative virulence determinants have been identified which may serve as sub-unit vaccine candidates. SUMMARY Major progress has been made in the basic research of leptospirosis. Future challenges will be to translate these advances into public health measures for developing countries. Yet the most effective responses may be interventions that directly address the determinants of poverty, such as poor sanitation, which are often responsible for transmission.
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Affiliation(s)
- Alan J A McBride
- Gonçalo Moniz Research Centre, Oswaldo Cruz Foundation, Ministry of Health, Rua Waldemar Falcão 121, 40295-001 Salvador, Bahia, Brazil
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Bruce MG, Sanders EJ, Leake JAD, Zaidel O, Bragg SL, Aye T, Shutt KA, Deseda CC, Rigau-Perez JG, Tappero JW, Perkins BA, Spiegel RA, Ashford DA. Leptospirosis among patients presenting with dengue-like illness in Puerto Rico. Acta Trop 2005; 96:36-46. [PMID: 16083836 DOI: 10.1016/j.actatropica.2005.07.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2005] [Revised: 06/22/2005] [Accepted: 07/04/2005] [Indexed: 11/30/2022]
Abstract
Leptospirosis is difficult to distinguish from dengue fever without laboratory confirmation. Sporadic cases/clusters of leptospirosis occur in Puerto Rico, but surveillance is passive and laboratory confirmation is rare. We tested for leptospirosis using an IgM ELISA on sera testing negative for dengue virus IgM antibody and conducted a case-control study assessing risk factors for leptospirosis, comparing clinical/laboratory findings between leptospirosis (case-patients) and dengue patients (controls). Among 730 dengue-negative sera, 36 (5%) were positive for leptospirosis. We performed post mortem testing for leptospirosis on 12 available specimens from suspected dengue-related fatalities; 10 (83%) tested positive. Among these 10 fatal cases, pulmonary hemorrhage and renal failure were the most common causes of death. We enrolled 42 case-patients and 84 controls. Jaundice, elevated BUN, hyperbilirubinemia, anemia, and leukocytosis were associated with leptospirosis (p < .01 for all). Male sex, walking in puddles, rural habitation, and owning horses were independently associated with leptospirosis. Epidemiological, clinical, and laboratory criteria may help distinguish leptospirosis from dengue and identify patients who would benefit from early antibiotic treatment.
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Affiliation(s)
- Michael G Bruce
- Arctic Investigations Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention (CDC), Anchorage, Alaska 99508, USA.
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Levett PN. Usefulness of serologic analysis as a predictor of the infecting serovar in patients with severe leptospirosis. Clin Infect Dis 2003; 36:447-52. [PMID: 12567302 DOI: 10.1086/346208] [Citation(s) in RCA: 172] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2002] [Accepted: 11/07/2002] [Indexed: 11/03/2022] Open
Abstract
The diagnosis of leptospirosis is often made using the microscopic agglutination test (MAT), in which live antigens representing >20 serogroups undergo reaction with patient serum samples to detect agglutinating antibodies. Data derived from this assay are often used to infer the identity of the infecting leptospiral serovar or serogroup; however, paradoxical reactions and cross-reactions between serogroups are common. To evaluate the usefulness of this approach, data on culture-proven cases of leptospirosis that occurred in Barbados from January 1980 through December 1998 were reviewed. A total of 151 isolates of 4 serovars were identified. The sensitivity of MAT for the prediction of the infecting serovar was determined. Overall, the predominant serogroup at a titer of >or=100 correctly predicted 46.4% of all serovars isolated. If a titer of >or=800 was used as the cutoff, sensitivity decreased slightly to 44.4%. The overall specificity for all serogroups was 64.8%. Serologic analysis appeared to be of little value for the identification of the infecting serovar in individual cases of leptospirosis in humans. Presumptive serogroup reactivity data should be used only to gain a broad idea of the serogroups present at the population level.
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Affiliation(s)
- Paul N Levett
- School of Clinical Medicine and Research, University of the West Indies, and Leptospira Laboratory, Ministry of Health, Bridgetown, Barbados.
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Abdulkader RCRM, Daher EF, Camargo ED, Spinosa C, da Silva MV. Leptospirosis severity may be associated with the intensity of humoral immune response. Rev Inst Med Trop Sao Paulo 2002; 44:79-83. [PMID: 12048544 DOI: 10.1590/s0036-46652002000200005] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Leptospirosis severity may be increasing, with pulmonary involvement becoming more frequent. Does this increase result from an intense immune response to leptospire? Notice that renal failure, thrombocytopenia and pulmonary complications are found during the immune phase. Thirty-five hospitalized patients with Weil's disease had 5 blood samples drawn, from the 15th day to the 12th month of symptoms, for ELISA-IgM, -IgG and -IgA specific antibody detection. According their 1st IgG titer, the patients were divided into: group 1 (n = 13) titer > 1:400 (positive) and group 2 (n = 22) titer < or =1:400 (negative). Early IgG antibodies in group 1 showed high avidity which may indicate reinfection. Group 1 was older, had worse pulmonary and renal function, and fever for a longer period than group 2. Throughout the study, IgG and IgA titers remained higher in group 1. In conclusion, the severity of Weil's disease may be associated with the intensity of the humoral immune response to leptospire.
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Affiliation(s)
- Regina C R M Abdulkader
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
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Katz AR, Ansdell VE, Effler PV, Middleton CR, Sasaki DM. Assessment of the clinical presentation and treatment of 353 cases of laboratory-confirmed leptospirosis in Hawaii, 1974-1998. Clin Infect Dis 2001; 33:1834-41. [PMID: 11692294 DOI: 10.1086/324084] [Citation(s) in RCA: 134] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2001] [Revised: 06/25/2001] [Indexed: 12/12/2022] Open
Abstract
Leptospirosis is frequently misdiagnosed as a result of its protean and nonspecific presentation. Leptospirosis, a zoonosis with global distribution, commonly occurs in tropical and subtropical regions; most reported cases in the United States occur in Hawaii. All laboratory-confirmed leptospirosis cases in the State of Hawaii from 1974 through 1998 (n=353) were clinically evaluated. The most common presentation involved nonspecific signs or symptoms, including fever, myalgia, and headache. Jaundice occurred in 39% of cases; conjunctival suffusion was described in 28% of these cases. Initiation of antibiotics before the seventh day of symptoms was associated with a significantly shortened duration of illness. Because early recognition and initiation of antibiotic therapy are important, clinicians should familiarize themselves with the clinical presentation of leptospirosis, and when evaluating a patient with a febrile illness, they should obtain exposure and travel histories and entertain the possibility of leptospirosis in the differential diagnosis.
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Affiliation(s)
- A R Katz
- Department of Public Health Sciences and Epidemiology, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI 96822, USA.
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Abstract
Leptospirosis is a globally important zoonotic disease that affects humans on all continents, in both urban and rural contexts, and in temperate and tropical climes. Leptospirosis is a disease of the environment; transmission depends on interactions between humans and mammalian reservoir hosts. A variety of infectious diseases that present as undifferentiated febrile syndromes, such as malaria, dengue and influenza, as well as viral hemorrhagic fevers can mimic leptospirosis. The importance of pulmonary hemorrhage as a lethal complication of leptospirosis has become more widely recognized. In contrast to textbook dogma, population-based studies indicate that there is a poor correlation between infecting leptospiral strain and clinical expression of disease. Genetic transformation of a Leptospira sp. has now been reported, which should allow for detailed analysis of a variety of leptospiral genes. Publication of the whole Leptospira genome is eagerly awaited. Following recent reports of a new, highly effective conjugate typhoid vaccine, new efforts to find leptospirosis vaccines should include the manufacture and testing of conjugate leptospiral lipopolysaccharide vaccines. Recent advances, particularly in epidemiology, molecular genetics and pathogenesis, are placing leptospirosis at the cutting edge of biomedical science.
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Affiliation(s)
- J M Vinetz
- World Health Organization Collaborating Center for Tropical Diseases, University of Texas Medical Branch, Galveston, Texas 77555-0609, USA.
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Flannery B, Costa D, Carvalho FP, Guerreiro H, Matsunaga J, Da Silva ED, Ferreira AG, Riley LW, Reis MG, Haake DA, Ko AI. Evaluation of recombinant Leptospira antigen-based enzyme-linked immunosorbent assays for the serodiagnosis of leptospirosis. J Clin Microbiol 2001; 39:3303-10. [PMID: 11526167 PMCID: PMC88335 DOI: 10.1128/jcm.39.9.3303-3310.2001] [Citation(s) in RCA: 117] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2001] [Accepted: 07/01/2001] [Indexed: 11/20/2022] Open
Abstract
There is an urgent need for development of new serodiagnostic strategies for leptospirosis, an emerging zoonosis with worldwide distribution. We have evaluated the diagnostic utility of five recombinant antigens in enzyme-linked immunosorbent assays (ELISAs) for serodiagnosis of leptospirosis. Sera from 50 healthy residents of a high-incidence region were used to determine cutoff values for 96% specificity. In paired sera from 50 cases of leptospirosis confirmed by the microscopic agglutination test, immunoglobulin G (IgG) but not IgM reacted with the recombinant leptospiral proteins. The recombinant LipL32 IgG ELISA had the highest sensitivities in the acute (56%) and convalescent (94%) phases of leptospirosis. ELISAs based on recombinant OmpL1, LipL41, and Hsp58 had sensitivities of 16, 24, and 18% during the acute phase and 72, 44, and 32% during convalescence, respectively. Compared to sera from healthy individuals, patient sera did not react significantly with recombinant LipL36 (P > 0.05). Recombinant LipL32 IgG ELISA demonstrated 95% specificity among 100 healthy individuals, and specificities ranging from 90 to 97% among 30 dengue patients, 30 hepatitis patients, and 16 patients with diseases initially thought to be leptospirosis. Among 39 Venereal Disease Research Laboratory test-positive individuals and 30 Lyme disease patients, 13 and 23% of sera, respectively, reacted positively with the rLipL32 antigen. These findings indicate that rLipL32 may be an useful antigen for the serodiagnosis of leptospirosis.
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Affiliation(s)
- B Flannery
- School of Public Health, University of California, Berkeley, California 94720, USA
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Levett PN, Branch SL, Whittington CU, Edwards CN, Paxton H. Two methods for rapid serological diagnosis of acute leptospirosis. CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY 2001; 8:349-51. [PMID: 11238220 PMCID: PMC96061 DOI: 10.1128/cdli.8.2.349-351.2001] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Leptospirosis is a common and underdiagnosed zoonosis. Two rapid assays for serological diagnosis of acute leptospirosis in diagnostic laboratories, the immunoglobulin M (IgM)-dipstick assay and the indirect hemagglutination assay (IHA), were evaluated and compared with standard assays. Sera were examined from 104 patients admitted to a hospital for investigation in a leptospirosis diagnostic protocol. Specimens for serology were taken on days 1 and 4 of the patients' hospital stay. Antibodies were detected using an IgM-enzyme-linked immunosorbent assay (ELISA), microscopic agglutination test (MAT), an IgM-dipstick assay, and an IHA. Fifty-one patients were found to have leptospirosis. The sensitivity of the IgM-dipstick assay was 98%, its specificity was 90.6%, its positive predictive value was 90.9%, and its negative predictive value was 98%. The sensitivity of the IHA was 92.2%, its specificity was 94.4%, its positive predictive value was 95.9%, and its negative predictive value was 92.7%. The standard IgM-ELISA and MAT, were positive in the first samples tested from 67 and 55% of the cases, respectively, and the rapid IgM-dipstick assay and IHA were positive in 71 and 49%, respectively, in the first sample tested. Both rapid assays are highly sensitive and specific. Neither requires specialized equipment, and both are suitable for use in diagnostic laboratories.
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Affiliation(s)
- P N Levett
- School of Clinical Medicine & Research, University of the West Indies, Bridgetown, Barbados.
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Plank R, Dean D. Overview of the epidemiology, microbiology, and pathogenesis of Leptospira spp. in humans. Microbes Infect 2000; 2:1265-76. [PMID: 11008116 DOI: 10.1016/s1286-4579(00)01280-6] [Citation(s) in RCA: 191] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Leptospirosis is probably the world's most widespread zoonosis. It remains underdiagnosed largely due to the broad spectrum of signs and symptoms attributable to this spirochetal pathogen. Leptospira spp. cause a diversity of diseases from flu-like illness to Weil's syndrome with multi-organ failure. Recent epidemics may herald a change in virulence or an alteration in the balance between humans and their interactions with other host species and the environment.
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Affiliation(s)
- R Plank
- Division of Infectious Disease, University of California at San Francisco School of Medicine, Box 0811, CA 94143, USA
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Yersin C, Bovet P, Mérien F, Clément J, Laille M, Van Ranst M, Perolat P. Pulmonary haemorrhage as a predominant cause of death in leptospirosis in Seychelles. Trans R Soc Trop Med Hyg 2000; 94:71-6. [PMID: 10748905 DOI: 10.1016/s0035-9203(00)90445-0] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We examined the cause of death during a 12-month period (1995/96) in all consecutive patients admitted to hospital with leptospiral infection in Seychelles (Indian Ocean), where the disease is endemic. Leptospirosis was diagnosed by use of the microscopic agglutination test and a specific polymerase chain reaction assay on serum samples. Seventy-five cases were diagnosed and 6 patients died, a case fatality of 8%. All 6 patients died within 9 days of onset of symptoms and within 2 days of admission for 5 of them (5 days for the 6th). On autopsy, diffuse bilateral pulmonary haemorrhage (PH) was found in all fatalities. Renal, cardiac, digestive and cerebral haemorrhages were also found in 5, 3, 3 and 1 case(s), respectively. Incidentally, haemoptysis and lung infiltrate on chest radiographs, which suggest PH, were found in 8 of the 69 non-fatal cases. Dengue and hantavirus infections were ruled out. In conclusion, PH appeared to be a main cause of death in leptospirosis in this population, although haemorrhage in other organs may also have contributed to fatal outcomes. This cause of death contrasts with the findings generally reported in endemic settings.
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Weekes CC, Everard CO, Levett PN. Seroepidemiology of canine leptospirosis on the island of Barbados. Vet Microbiol 1997; 57:215-22. [PMID: 9355256 DOI: 10.1016/s0378-1135(97)00127-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Previous surveillance in Barbados documented the absence of infection with Leptospira serogroup Canicola in dogs. The aim of this study was to survey the current state of canine leptospirosis in Barbados, 10 years after the last survey. Sera from 78 unwanted dogs scheduled for euthanasia and 61 dogs suspected of having acute leptospirosis were tested by microscopic agglutination (MAT) and by an ELISA method adapted for canine IgM and IgG antibodies. The seroprevalence in unwanted dogs was 62% (48/78), at an MAT titre of > or = 100. The majority of animals had low titres, suggestive of previous infection. Serogroup Autumnalis was the most common reactor (45%), followed by serogroups Icterohaemorrhagiae and Australis (each 16%) and Pomona (13%). Serogroup Ballum was uncommon in this group. The seroprevalence determined by MAT in acutely-ill dogs was 75% (46/61). The most common predominant serogroup was Icterohaemorrhagiae (36%) followed by serogroup Australis (13%), while serogroups Autumnalis and Ballum were also of little significance. Paired specimens were available from eight acutely-ill dogs. One animal was seronegative while five dogs showed evidence of seroconversion. An IgM-ELISA titre of > or = 320 was used to confirm current infection in eight of these nine animals. Previous studies in Barbados showed a higher prevalence of serogroup Icterohaemorrhagiae than of Autumnalis, but the relative frequency of these two serogroups may be changing. The high seroprevalence in dogs is of public health concern because the close contact between dogs and man may provide the link between a reservoir in the environment and susceptible humans.
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Affiliation(s)
- C C Weekes
- Leptospira Laboratory, St. Michael, Barbados
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