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Vijayachari P, Awaradi S, Siddaraju HM, Nithin K, Veerendra S, Babu US, Chander MP, Kartick C, Anwesh M, Sugunan AP. Survey of the present health & nutritional status of Shompen tribe of Great Nicobar Island. Indian J Med Res 2024; 159:35-42. [PMID: 38439124 PMCID: PMC10954110 DOI: 10.4103/ijmr.ijmr_3193_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND OBJECTIVES Shompens are one of the two mongoloid tribes of Nicobar district. There is little information about their recent health status since the last survey which was conducted in 1998. Hence, a comprehensive health and nutritional survey was conducted in March 2017 to assess the changes. The survey was carried out by a joint team of various organizations including the ICMR-Regional Medical Research Centre and Tribal Welfare and Health Department both located in Port Blair. METHODS A detailed health and nutrition survey of the Shompen community was planned by deputing a field research team. The survey included demographic data, anthropometric data, clinical examination, screening for the markers of infectious diseases, respiratory pathogens, tuberculosis and haemoglobinopathies. RESULTS About half of the Shompen adults (both males and females) had a body mass index (BMI) of ≥23. However, Shompen children had a good nutritional status with no child suffering from undernutrition. As per BMI for age, none of the children <5 yr were under-nourished, while in the 5-17 yr group, 12 per cent of children were undernourished. Anaemia prevalence was about 48.3 per cent, with 54 per cent prevalence in females and 43.8 per cent in males. Fungal infection of the skin, acute respiratory infection and abdominal pain were the common morbidities observed. None had active pulmonary tuberculosis. Of 38 Shompens screened for IgG (immunoglobulin G) antibodies, 42.1 and 18.4 per cent were positive for measles and rubella, respectively. Seroprevalence of Leptospira was 35.5 per cent. The prevalence of hypertension was 13.2 per cent, whereas another 28.9 per cent were pre-hypertensive. INTERPRETATION CONCLUSIONS The population structure of the Shompen is not skewed and under nutrition was not widely prevalent among the children of <5 yr. The other positive observations were the absence of malaria, filariasis and dengue. However, there was natural infection of measles and rubella. Fungal skin infection and intestinal parasitic infestations were widely prevalent. Although cardiovascular risk profile was low, there were signs of emerging risk of over-weight, hypertension and dyslipidaemia. These together with the high prevalence of smokeless tobacco use may have a serious effect on the cardiovascular disease susceptibility of the Shompen population in the future.
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Affiliation(s)
| | - S. Awaradi
- Andaman Nicobar Tribal Research Institute, Port Blair, India
| | | | - K. Nithin
- Department of Panchakarma, Jammu Institute of Ayurveda and Research, NARDNI Raipur, Jammu, Jammu & Kashmir, India
| | - S.S. Veerendra
- Campbell Bay PHC, Great Nicobar, Andaman & Nicobar Islands, India
| | - U. Suresh Babu
- ICMR-Regional Medical Research Centre, Port Blair, India
| | | | - C. Kartick
- ICMR-Regional Medical Research Centre, Port Blair, India
| | - M. Anwesh
- ICMR-Regional Medical Research Centre, Port Blair, India
| | - A. P. Sugunan
- ICMR-Regional Medical Research Centre, Port Blair, India
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Vimal Raj R, Vinod Kumar K, Lall C, Vedhagiri K, Sugunan AP, Sunish IP, Sharma S, Vijayachari P. Changing trend in the seroprevalence and risk factors of human leptospirosis in the South Andaman Island, India. Zoonoses Public Health 2018; 65:683-689. [PMID: 29873192 DOI: 10.1111/zph.12478] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 01/22/2018] [Accepted: 03/20/2018] [Indexed: 11/30/2022]
Abstract
Seroprevalence of leptospirosis among a healthy population of the South Andaman Island was assessed through random sampling. Previous studies have high seroprevalences of up to 55% in general population and 65% in agricultural labourers. The study subjects (1,181 in total, 781 rural and 400 urban) were interviewed and tested for antibodies against Leptospira. Multivariate models were developed to determine the risk factors in the rural and the urban population. The overall seroprevalence was 10.9%, with rural (12.9%) being higher than the urban subjects (7.0%). The commonest infecting serogroup was Icterohaemorrhagiae (53.5%), followed by Grippotyphosa (13.2%). Compared to the earlier observation, seroprevalence was lower and an apparent shift in the infecting serogroup was found. This shift was in concordance with the changing trend in animal population. Significant difference in risk factors, both in rural and urban areas, was also observed. Similar trends in seroprevalence are being observed around the world. Therefore, time to time prevalence studies are needed for the development of effective control measure.
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Affiliation(s)
- Ratchagadasse Vimal Raj
- Regional Medical Research Centre (ICMR), WHO Collaborating Centre for Diagnosis, Reference, Research and Training in Leptospirosis, Port Blair, Andaman and Nicobar Islands, India
| | - Kirubakaran Vinod Kumar
- Regional Medical Research Centre (ICMR), WHO Collaborating Centre for Diagnosis, Reference, Research and Training in Leptospirosis, Port Blair, Andaman and Nicobar Islands, India
| | - Chandan Lall
- Regional Medical Research Centre (ICMR), WHO Collaborating Centre for Diagnosis, Reference, Research and Training in Leptospirosis, Port Blair, Andaman and Nicobar Islands, India
| | | | - Attayur Purushothaman Sugunan
- Regional Medical Research Centre (ICMR), WHO Collaborating Centre for Diagnosis, Reference, Research and Training in Leptospirosis, Port Blair, Andaman and Nicobar Islands, India
| | - Ittoop Pulikkottil Sunish
- Regional Medical Research Centre (ICMR), WHO Collaborating Centre for Diagnosis, Reference, Research and Training in Leptospirosis, Port Blair, Andaman and Nicobar Islands, India
| | - Sameer Sharma
- Regional Medical Research Centre (ICMR), WHO Collaborating Centre for Diagnosis, Reference, Research and Training in Leptospirosis, Port Blair, Andaman and Nicobar Islands, India
| | - Paluru Vijayachari
- Regional Medical Research Centre (ICMR), WHO Collaborating Centre for Diagnosis, Reference, Research and Training in Leptospirosis, Port Blair, Andaman and Nicobar Islands, India
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Abstract
Leptospirosis is a widespread bacterial zoonosis with highest burden in low-income populations living in tropical and subtropical regions, both in urban and in rural environments. Rodents are known as the main reservoir animals, but other mammals may also significantly contribute to human infections in some settings. Clinical presentation of leptospirosis is nonspecific and variable, and most of the early signs and symptoms point to the so-called “acute fever of unknown origin”, a major diagnostic challenge in tropical and subtropical areas. However, leptospirosis can rapidly evolve to life-threatening complications, especially if left untreated. There is a need for good awareness of leptospirosis and rapid antibiotic treatment based on clinical and epidemiological suspicion. Severe leptospirosis cases include renal and/or respiratory failure and shock, necessitating intensive care, also seldom available or with limited capacity. Confirmation of leptospirosis relies on biological diagnosis, which unfortunately uses tricky methods seldom available. This biological confirmation, however, is essential for surveillance and public health purpose. A good knowledge of leptospirosis epidemiology (eg, the reservoir animals involved, the Leptospira strains circulating, the seasonal and geographical patterns, and specific populations at risk) can be achieved through adequate surveillance and diagnosis. This can pave the way to prevention and intervention strategies and in turn alleviate the toll leptospirosis takes on affected populations. Over the past few years, leptospirosis has been increasingly recognized, as the need for multidisciplinary approaches in a One-Health perspective has been acknowledged, raising hope to successfully tackle the challenges of this zoonosis.
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Affiliation(s)
- Cyrille Goarant
- Institut Pasteur International Network, Institut Pasteur in New Caledonia, Leptospirosis Research and Expertise Unit, Nouméa, New Caledonia
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Hem S, Ly S, Votsi I, Vogt F, Asgari N, Buchy P, Heng S, Picardeau M, Sok T, Ly S, Huy R, Guillard B, Cauchemez S, Tarantola A. Estimating the Burden of Leptospirosis among Febrile Subjects Aged below 20 Years in Kampong Cham Communities, Cambodia, 2007-2009. PLoS One 2016; 11:e0151555. [PMID: 27043016 PMCID: PMC4820258 DOI: 10.1371/journal.pone.0151555] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 03/01/2016] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Leptospirosis is an emerging but neglected public health challenge in the Asia/Pacific Region with an annual incidence estimated at 10-100 per 100,000 population. No accurate data, however, are available for at-risk rural Cambodian communities. METHOD We conducted anonymous, unlinked testing for IgM antibodies to Leptospira spp. on paired sera of Cambodian patients <20 years of age between 2007-2009 collected through active, community-based surveillance for febrile illnesses in a convenience sample of 27 rural and semi-rural villages in four districts of Kampong Cham province, Cambodia. Leptospirosis testing was done on paired serological samples negative for Dengue, Japanese encephalitis and Chikungunya viruses after random selection. Convalescent samples found positive while initial samples were negative were considered as proof of acute infection. We then applied a mathematical model to estimate the risk of fever caused by leptospirosis, dengue or other causes in rural Cambodia. RESULTS A total of 630 samples are coming from a randomly selected subset of 2358 samples. IgM positive were found on the convalescent serum sample, among which 100 (15.8%) samples were IgM negative on an earlier sample. Seventeen of these 100 seroconversions were confirmed using a Microagglutination Test. We estimated the probability of having a fever due to leptospirosis at 1. 03% (95% Credible Interval CI: 0. 95%-1. 22%) per semester. In comparison, this probability was 2. 61% (95% CI: 2. 55%, 2. 83%) for dengue and 17. 65% (95% CI: 17. 49%, 18. 08%) for other causes. CONCLUSION Our data from febrile cases aged below 20 years suggest that the burden of leptospirosis is high in rural Cambodian communities. This is especially true during the rainy season, even in the absence of identified epidemics.
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Affiliation(s)
- Sopheak Hem
- Institut Pasteur in Cambodia, Phnom Penh, Cambodia
| | - Sowath Ly
- Institut Pasteur in Cambodia, Phnom Penh, Cambodia
| | - Irene Votsi
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Paris, France
| | - Florian Vogt
- Masters of Science in Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nima Asgari
- World Health Organization, Phnom Penh, Cambodia
| | | | - Seiha Heng
- Institut Pasteur in Cambodia, Phnom Penh, Cambodia
| | - Mathieu Picardeau
- Institut Pasteur, National Reference Center and WHO Collaborating Center for Leptospirosis, Paris, France
| | - Touch Sok
- Communicable Diseases Control Department of the Ministry of Health, Phnom Penh, Cambodia
| | - Sovann Ly
- Communicable Diseases Control Department of the Ministry of Health, Phnom Penh, Cambodia
| | - Rekol Huy
- National Dengue Control Program, National Center for Entomology, Parasitology, and Malaria Control, Phnom Penh, Cambodia
| | | | - Simon Cauchemez
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Paris, France
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Lall C, Kumar KV, Raj RV, Vedhagiri K, Vijayachari P. Prevalence and Diversity of Leptospires in Different Ecological Niches of Urban and Rural Areas of South Andaman Island. Microbes Environ 2016; 31:79-82. [PMID: 26936796 PMCID: PMC4791121 DOI: 10.1264/jsme2.me15149] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 12/19/2015] [Indexed: 11/12/2022] Open
Abstract
Leptospirosis is an emerging disease around the globe. South Andaman Island is an endemic region for leptospirosis. We herein compared the prevalence of leptospires in urban and rural areas of South Andaman Island. The PCR detection and isolation of Leptospira revealed that pathogenic leptospires were prevalent in sewage water and household drainage water in urban areas and in paddy fields, vegetable field water, and stream water in rural areas. These results demonstrate that intermediates are ubiquitously present in the environment and may be responsible for asymptomatic infections, and also provide an insight into disease ecology.
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Affiliation(s)
- Chandan Lall
- Regional Medical Research Centre (ICMR), WHO Collaborating Centre for Diagnosis, Reference, Research and Training in LeptospirosisPort Blair-744101, Andaman and Nicobar IslandsIndia
| | - K. Vinod Kumar
- Regional Medical Research Centre (ICMR), WHO Collaborating Centre for Diagnosis, Reference, Research and Training in LeptospirosisPort Blair-744101, Andaman and Nicobar IslandsIndia
| | - R. Vimal Raj
- Regional Medical Research Centre (ICMR), WHO Collaborating Centre for Diagnosis, Reference, Research and Training in LeptospirosisPort Blair-744101, Andaman and Nicobar IslandsIndia
| | - K. Vedhagiri
- National Hub for Healthcare Instrumentation Development (NHHID), Centre for Biotechnology, Anna UniversityChennai—600 025India
| | - P. Vijayachari
- Regional Medical Research Centre (ICMR), WHO Collaborating Centre for Diagnosis, Reference, Research and Training in LeptospirosisPort Blair-744101, Andaman and Nicobar IslandsIndia
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Vijayachari P, Sugunan AP, Sharma S, Roy S, Natarajaseenivasan K, Sehgal SC. Leptospirosis in the Andaman Islands, India. Trans R Soc Trop Med Hyg 2007; 102:117-22. [PMID: 17991499 DOI: 10.1016/j.trstmh.2007.08.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2007] [Revised: 08/30/2007] [Accepted: 08/30/2007] [Indexed: 11/19/2022] Open
Abstract
Leptospirosis is an emerging zoonosis. In the Andaman Islands during the early twentieth century, it occurred in the penal settlements of the British India Administration, mostly as Weil's disease, an acute febrile illness with hepato-renal complications. It was caused by leptospires belonging to groups Akiamy A and Andamans A. After the 1930s nothing further is known regarding the disease until the late 1980s, when Andaman haemorrhagic fever (AHF), a mysterious illness with the majority of cases presenting pulmonary involvement, appeared. AHF was later identified as leptospirosis and severe pulmonary haemorrhage was shown for the first time as a complication of leptospirosis from India. Leptospirosis continues to occur in the Islands annually. It generally presents as two separate clinical syndromes: the hepato-renal form, and the pulmonary form, which is associated with high case fatality rates ranging from 10 to 15%. Infections are due to a variety of serovars, Valbuzzi being the commonest. Leptospira interrogans sensu stricto has been the predominant infecting species. Doxycycline has been shown to confer a beneficial effect in reducing the clinical illness and mortality during outbreaks. The history of leptospirosis in the Islands, its epidemiology, clinical spectrum, characteristics of the isolates and control are reviewed and discussed in this article.
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Affiliation(s)
- P Vijayachari
- Regional Medical Research Centre (Indian Council of Medical Research), WHO Collaborating Centre for Diagnosis, Reference, Research & Training in Leptospirosis, Port Blair 744 101, Andaman & Nicobar Islands.
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Croda J, Ramos JGR, Matsunaga J, Queiroz A, Homma A, Riley LW, Haake DA, Reis MG, Ko AI. Leptospira immunoglobulin-like proteins as a serodiagnostic marker for acute leptospirosis. J Clin Microbiol 2007; 45:1528-34. [PMID: 17360842 PMCID: PMC1865864 DOI: 10.1128/jcm.02344-06] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
There is an urgent need for improved diagnosis of leptospirosis, an emerging infectious disease which imparts a large disease burden in developing countries. We evaluated the use of Leptospira immunoglobulin (Ig)-like (Lig) proteins as a serodiagnostic marker for leptospirosis. Lig proteins have bacterial immunoglobulin-like (Big) tandem repeat domains, a moiety found in virulence factors in other pathogens. Sera from patients identified during urban outbreaks in Brazil reacted strongly with immunoblots of a recombinant fragment comprised of the second to sixth Big domains of LigB from L. interrogans serovar Copenhageni, the principal agent for transmission in this setting. Furthermore, the sera recognized an analogous LigB fragment derived from L. kirschneri serovar Grippotyphosa, a pathogenic serovar which is not endemic to the study area. The immunoblot assay detected anti-LigB IgM antibodies in sera from 92% (95% confidence interval, 85 to 96%) of patients during acute-phase leptospirosis. The assay had a sensitivity of 81% for sera from patients with less than 7 days of illness. Anti-LigB antibodies were found in sera from 57% of the patients who did not have detectable anti-whole-Leptospira responses as detected by IgM enzyme-linked immunosorbent assay and microagglutination test. The specificities of the assay were 93 to 100% and 90 to 97% among sera from healthy individuals and patients with diseases that have clinical presentations that overlap with those of leptospirosis, respectively. These findings indicate that the antibody response to this putative virulence determinant is a sensitive and specific marker for acute infection. The use of this marker may aid the prompt and timely diagnosis required to reduce the high mortality associated with severe forms of the disease.
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Affiliation(s)
- Julio Croda
- Gonçalo Moniz Research Center, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador, Brazil
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Abstract
Leptospirosis, caused by spirochetes of the genus Leptospira, has increasingly been recognized to affect travelers and residents in tropical settings. A zoonotic disease, leptospirosis is transmitted to humans through environmental surface waters contaminated by the urine of chronically infected mammals. Outcome of infection varies, ranging from acute febrile illness (including self-resolving undifferentiated fever) to aseptic meningitis to a fulminant syndrome of jaundice, oliguric renal failure, pulmonary hemorrhage, and refractory shock. Hospitalized cases have mortality rates as high as 25%. A recent clinical trial showed that third-generation cephalosporin is as effective as doxycycline and penicillin in the treatment of acute disease. Doxycycline is effective in preventing leptospirosis in travelers. No protective vaccine is currently available.
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Affiliation(s)
- Jessica N Ricaldi
- Division of Infectious Diseases, Department of Medicine, University of California San Diego School of Medicine, 9500 Gilman Drive, 0640, Cellular and Molecular Medicine-East, Room 2052, La Jolla, CA 92093-0640, USA
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Cachay ER, Vinetz JM. A global research agenda for leptospirosis. J Postgrad Med 2005; 51:174-8. [PMID: 16333188 PMCID: PMC2270399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
Leptospirosis is a zoonotic spirochetal disease of global importance. This disease continues to have a major impact on people living in urban and rural areas of developing countries with inestimable morbidity and mortality. Funding for research and control efforts is currently haphazard, not organized and not effective for public health efforts, primarily because there are no concerted, ongoing international efforts to assess the impact of leptospirosis on human health. Major issues in the field need to be addressed to develop strategies of control, amelioration and treatment. These include the following: mechanisms of naturally acquired and vaccine-induced protective immunity against clinical leptospirosis; mechanisms of severe leptospirosis pathogenesis; standardized, precise and simplified taxonomy of Leptospira relevant to disease manifestations, transmission and control; effective adjunct treatments in addition to antimicrobials; and environmental assessment for risk of leptospirosis transmission and relevant mammalian reservoirs. Once effective ongoing, collaborative international efforts to assess the impact of leptospirosis on human and veterinary health are underway, appropriate mobilization of clinical and public health research funding will follow.
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Affiliation(s)
- E R Cachay
- Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, USA
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Segura ER, Ganoza CA, Campos K, Ricaldi JN, Torres S, Silva H, Céspedes MJ, Matthias MA, Swancutt MA, Liñán RL, Gotuzzo E, Guerra H, Gilman RH, Vinetz JM. Clinical spectrum of pulmonary involvement in leptospirosis in a region of endemicity, with quantification of leptospiral burden. Clin Infect Dis 2005; 40:343-51. [PMID: 15668855 PMCID: PMC2366057 DOI: 10.1086/427110] [Citation(s) in RCA: 149] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2004] [Accepted: 09/08/2004] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Pulmonary involvement in leptospirosis remains poorly recognized in regions where it is endemic, despite reports of recent outbreaks and epidemic disease. METHODS A prospective, population-based study was carried out to identify febrile patients exposed to Leptospira in urban and rural contexts in Iquitos, Peru. Evidence of exposure to Leptospira was obtained by serologic testing, and diagnosis of leptospirosis was confirmed in pulmonary cases by culture or quantitative real-time PCR assay. RESULTS Of 633 consecutively enrolled febrile patients, 321 (50.7%) had antileptospiral IgM antibodies or high titers of antileptospiral antibodies. Seven patients with histories of only urban exposure to leptospires had severe pulmonary manifestations; of these, 5 patients died; 4 of the deaths were caused by pulmonary hemorrhage, and 1 was caused by acute respiratory distress syndrome and multiorgan failure. Real-time, quantitative PCR assay showed high levels of leptospiremia (>or=10(4) leptospires/mL) in most fatal cases; 1 patient, from whom tissue specimens were obtained at autopsy, had >or=10(5) leptospires/g of lung, kidney, and muscle tissue. DISCUSSION. This study demonstrates the underdiagnosis of leptospirosis in a region of high endemicity and the underrecognition of grave pulmonary complications. Pulmonary involvement in leptospirosis was present in urban but not rural areas. Presumptive treatment for leptospirosis should be initiated immediately in the appropriate epidemiological and clinical context.
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Affiliation(s)
- Eddy R. Segura
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Instituto Nacional de Salud, Lima
| | - Christian A. Ganoza
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Instituto Nacional de Salud, Lima
| | - Kalina Campos
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Instituto Nacional de Salud, Lima
- Asociación Benéfica PRISMA, Instituto Nacional de Salud, Lima
| | - Jessica N. Ricaldi
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Instituto Nacional de Salud, Lima
- Division of Infectious Diseases, Department of Medicine, University of California, San Diego School of Medicine, La Jolla, California
| | - Sonia Torres
- Asociación Benéfica PRISMA, Instituto Nacional de Salud, Lima
| | - Hermann Silva
- Unidad de Epidemiología, Hospital de Apoyo Iquitos, Iquitos, Peru
| | | | - Michael A. Matthias
- Division of Infectious Diseases, Department of Medicine, University of California, San Diego School of Medicine, La Jolla, California
| | - Mark A. Swancutt
- Division of Infectious Diseases, Department of Medicine, University of California, San Diego School of Medicine, La Jolla, California
| | | | - Eduardo Gotuzzo
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Instituto Nacional de Salud, Lima
| | - Humberto Guerra
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Instituto Nacional de Salud, Lima
| | - Robert H. Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Joseph M. Vinetz
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Instituto Nacional de Salud, Lima
- Asociación Benéfica PRISMA, Instituto Nacional de Salud, Lima
- Division of Infectious Diseases, Department of Medicine, University of California, San Diego School of Medicine, La Jolla, California
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Roy S, Biswas D, Vijayachari P, Sugunan AP, Sehgal SC. A 22-mer primer enhances discriminatory power of AP-PCR fingerprinting technique in characterization of leptospires. Trop Med Int Health 2004; 9:1203-9. [PMID: 15548317 DOI: 10.1111/j.1365-3156.2004.01322.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate the discriminatory power and usefulness of arbitrarily primed-polymerase chain reaction (AP-PCR) characterization of leptospires with M16 primer. METHODS AP-PCR fingerprints of 20 reference strains of Leptospira representing 20 different serovars belonging to seven genospecies (Leptospira interrogans, 11; L. noguchii, 2; L. borgpetersenii, 1; L. santarosai, 2; L. biflexa, 2; L. kirschneri, 1; L. weilii, 1) were generated by employing M16 primer. Fingerprints generated with this primer were compared with those generated with two other commonly used primers PB1, and L10. An attempt was also made to type 20 leptospiral isolates with the M16 primer. RESULTS AND CONCLUSION Fingerprints with M16 primer could not only differentiate between strains of different genospecies, but also between strains of the same genospecies belonging to different serovars. While two commonly used primers (PB1 and L10) failed to discriminate between some of the different serovars belonging to the same genospecies, this primer was able to generate discriminatory fingerprints for all strains tested. All 20 Leptospira isolates, recovered from patients in Andaman Islands, could also be typed by fingerprints generated with the M16 primer. The discriminatory power of M16 primer adds more specificity to the rapidity of this system of characterization and can be used as an excellent tool in epidemiological studies on Leptospira.
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Affiliation(s)
- Subarna Roy
- WHO Collaborating Center for Diagnosis, Research, Training and Reference in Leptospirosis, Regional Medical Research Center (ICMR) Port Blair, India
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12
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Johnson MA, Smith H, Joseph P, Gilman RH, Bautista CT, Campos KJ, Cespedes M, Klatsky P, Vidal C, Terry H, Calderon MM, Coral C, Cabrera L, Parmar PS, Vinetz JM. Environmental exposure and leptospirosis, Peru. Emerg Infect Dis 2004; 10:1016-22. [PMID: 15207052 PMCID: PMC3323149 DOI: 10.3201/eid1006.030660] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Human infection by leptospires has highly variable clinical manifestations, which range from subclinical infection to fulminant disease. We conducted a population-based, cross-sectional seroepidemiologic study in Peru to determine potential relationships of environmental context to human exposure to Leptospira and disease associated with seroconversion. Three areas were studied: a flooded, urban slum in the Peruvian Amazon city of Iquitos; rural, peri-Iquitos villages; and a desert shantytown near Lima. Seroprevalence in Belen was 28% (182/650); in rural areas, 17% (52/316); and in a desert shantytown, 0.7% (1/150). Leptospira-infected peridomestic rats were found in all locales. In Belen, 20 (12.4%) of 161 patients seroconverted between dry and wet seasons (an incidence rate of 288/1,000). Seroconversion was associated with history of febrile illness; severe leptospirosis was not seen. Human exposure to Leptospira in the Iquitos region is high, likely related both to the ubiquity of leptospires in the environment and human behavior conducive to transmission from infected zoonotic sources.
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Affiliation(s)
- Michael A.S. Johnson
- Asociación Benéfica Prisma, Lima, Peru
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Hannah Smith
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Priya Joseph
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Robert H. Gilman
- Asociación Benéfica Prisma, Lima, Peru
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Christian T. Bautista
- Asociación Benéfica Prisma, Lima, Peru
- U.S. Naval Medical Center Research Detachment, Lima, Peru
| | - Kalina J. Campos
- Asociación Benéfica Prisma, Lima, Peru
- Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Michelle Cespedes
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Peter Klatsky
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Hilja Terry
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Maritza M. Calderon
- Asociación Benéfica Prisma, Lima, Peru
- Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Carlos Coral
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lilia Cabrera
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Paminder S. Parmar
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joseph M. Vinetz
- University of California San Diego School of Medicine, La Jolla, California, USA
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Karande S, Bhatt M, Kelkar A, Kulkarni M, De A, Varaiya A. An observational study to detect leptospirosis in Mumbai, India, 2000. Arch Dis Child 2003; 88:1070-5. [PMID: 14670771 PMCID: PMC1719391 DOI: 10.1136/adc.88.12.1070] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Leptospirosis is relatively uncommon in children. Following torrential rains and flooding an outbreak of leptospirosis was suspected in Mumbai. AIMS To investigate the possibility of an outbreak of leptospirosis and describe the clinical illness. METHODS From 24 July to 14 September 2000, children with a history of abrupt onset of high fever (>39 degrees C), who presented to our hospital, were admitted and tested serologically for anti-Leptospira antibodies by a quantitative enzyme linked immunosorbent assay (ELISA) test. An IgM titre of more than 20U/ml confirmed the diagnosis of leptospirosis. Clinical features in the confirmed leptospirosis and leptospirosis negative groups were analysed. RESULTS Of 53 children screened, 18 (34%) had leptospirosis. In all 18, the disease was anicteric and responded well to intravenous penicillin. Four clinical features present at the time of admission were significantly associated with leptospirosis: a history of contact with flood water (18/18 v 16/35), conjunctival suffusion (5/18 v 1/35), abdominal pain (9/18 v 5/35), and skin rash (5/18 v 1/35). As the number of these four features concomitantly present increased, the chances of the child having leptospirosis also increased significantly. A history of contact with flood water had a sensitivity of 100%, and the presence of conjunctival suffusion, abdominal pain, and skin rash had a specificity of 97%, 86%, and 97%, respectively, for identifying children with leptospirosis. CONCLUSION Leptospirosis should be suspected in febrile children with contact with flood water.
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Affiliation(s)
- S Karande
- Department of Paediatrics, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, Bombay, 400 022, India
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14
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Abstract
OBJECTIVE There is limited data available on symptomatic leptospirosis in Indian children. We report an outbreak of leptospirosis that occurred in children living in slums following heavy rainfall and flooding. This hospital-based prospective study was conducted from July to August 2001. METHODS Diagnosis of acute leptospirosis was suspected by following the Indian Leptospirosis Society working definition for leptospirosis. Diagnosis was confirmed by detecting anti-Leptospira antibodies, using either a Leptospira genus-specific latex agglutination assay or a dipstick assay or by a macroscopic slide agglutination test. RESULT Thirty (32%) out of 93 children admitted had acute leptospirosis. Fever, bodyache, chills, abdominal pain, headache, vomiting, cough, hepatosplenomegaly, edema and crepitations were the common presenting signs and symptoms. Twenty - two children had anicteric leptospirosis and 8 had Weil disease. Response to penicillin treatment was good in all except in one child with Weil disease who died of renal failure within 3 hours of admission. CONCLUSION Leptospirosis has emerged as an infectious disease in Mumbai. During monsoon, parents should ensure that their child does not have contact with the contaminated flood water.
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Affiliation(s)
- Sunil Karande
- Department of Pediatrics, Lokmanya Tilak Municipal Medical College and Lokmanya Tilak Municipal General Hospital, Sion, Mumbai, India.
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Smits HL, Eapen CK, Sugathan S, Kuriakose M, Gasem MH, Yersin C, Sasaki D, Pujianto B, Vestering M, Abdoel TH, Gussenhoven GC. Lateral-flow assay for rapid serodiagnosis of human leptospirosis. CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY 2001; 8:166-9. [PMID: 11139212 PMCID: PMC96027 DOI: 10.1128/cdli.8.1.166-169.2001] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
An assay device for the rapid detection of Leptospira-specific immunoglobulin M (IgM) antibodies in human sera is presented. The sensitivity (85.8%) and specificity (93.6%) of the assay compared well (91.9% agreement) with those of an IgM enzyme-linked immunosorbent assay routinely used in the serodiagnosis of leptospirosis. The sensitivity of the assay varied with the stage of the disease. The assay uses stabilized components and is simply performed by the addition of serum and sample fluid to the sample well of the assay device. The assay is read after 10 min, and a positive result is obtained when staining of the test line is observed.
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Affiliation(s)
- H L Smits
- Department of Biomedical Research, Royal Tropical Institute, Amsterdam, The Netherlands.
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