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Vibert M, Guimard T, Brochard J, Takoudju EM, Larrose C, Boutoille D, Le Turnier P. Leptospirosis in retirees living in rural areas: a poorly recognized emerging problem in mainland France? Open Forum Infect Dis 2022; 9:ofac269. [PMID: 35854997 PMCID: PMC9290540 DOI: 10.1093/ofid/ofac269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 05/27/2022] [Indexed: 11/15/2022] Open
Abstract
Abstract
Among 40 patients diagnosed with leptospirosis in 3 hospitals of western mainland France between 2014 and 2018 half were at least 60 years old and retired. Their exposure factors were mainly rural residential environment with limited remarkable risk factors. Better awareness and information on leptospirosis appear necessary in this population.
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Affiliation(s)
| | - Thomas Guimard
- Post Emergency and Infectious Diseases department, La Roche sur Yon Hospital , La Roche sur Yon, France
| | - Julia Brochard
- Polyvalent Medicine department, Saint Nazaire Hospital , Saint Nazaire, France
| | - Eve-Marie Takoudju
- Microbiology department, La Roche sur Yon Hospital , La Roche sur Yon, France
| | - Catherine Larrose
- Medical biology department, Nantes University Hospital , Nantes, France
| | - David Boutoille
- Nantes University Hospital Infectious Diseases department, Nantes University Hospital, Nantes, France and INSERM CIC 1413, , Nantes, France
| | - Paul Le Turnier
- Nantes University Hospital Infectious Diseases department, Nantes University Hospital, Nantes, France and INSERM CIC 1413, , Nantes, France
- Infectious Diseases department, Cayenne Hospital , Cayenne, French Guiana
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Philip N, Priya SP, Jumah Badawi AH, Mohd Izhar MH, Mohtarrudin N, Tengku Ibrahim TA, Sekawi Z, Neela VK. Pulmonary haemorrhage as the earliest sign of severe leptospirosis in hamster model challenged with Leptospira interrogans strain HP358. PLoS Negl Trop Dis 2022; 16:e0010409. [PMID: 35584087 PMCID: PMC9116642 DOI: 10.1371/journal.pntd.0010409] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/10/2022] [Indexed: 11/18/2022] Open
Abstract
Background Severe leptospirosis is challenging as it could evolve rapidly and potentially fatal if appropriate management is not performed. An understanding of the progression and pathophysiology of Leptospira infection is important to determine the early changes that could be potentially used to predict the severe occurrence of leptospirosis. This study aimed to understand the kinetics pathogenesis of Leptospira interrogans strain HP358 in the hamster model and identify the early parameters that could be used as biomarkers to predict severe leptospirosis. Methodology/Principal findings Male Syrian hamsters were infected with Leptospira interrogans strain HP358 and euthanized after 24 hours, 3, 4, 5, 6 and 7 days post-infection. Blood, lungs, liver and kidneys were collected for leptospiral detection, haematology, serum biochemistry and differential expression of pro- and anti-inflammatory markers. Macroscopic and microscopic organ damages were investigated. Leptospira interrogans strain HP358 was highly pathogenic and killed hamsters within 6–7 days post-infection. Pulmonary haemorrhage and blood vessel congestion in organs were noticed as the earliest pathological changes. The damages in organs and changes in biochemistry value were preceded by changes in haematology and immune gene expression. Conclusion/Significance This study deciphered haemorrhage as the earliest manifestation of severe leptospirosis and high levels of IL-1β, CXCL10/IP-10, CCL3/MIP-α, neutrophils and low levels of lymphocytes and platelets serve as a cumulative panel of biomarkers in severe leptospirosis. As the severe form of leptospirosis could progress rapidly and be potentially fatal if not treated earlier, deciphering the pathophysiology kinetics of infection is crucial to determine the parameters of disease severity. To understand this, we challenged hamsters with the highly virulent Leptospira interrogans strain HP358. Pulmonary haemorrhage was observed as the earliest pathological change followed by liver and kidneys damages. The increased expression of IL-1β, CXCL10/IP-10, CCL3/MIP-α, high neutrophils and low lymphocytes and platelets production observed in the present study indicate that these parameters could serve as a cumulative panel of biomarkers in severe leptospirosis.
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Affiliation(s)
- Noraini Philip
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Sivan Padma Priya
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- RAK College of Dental Sciences, Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah, United Arab Emirates
| | - Ahmad Hussein Jumah Badawi
- Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Mohd Hafidz Mohd Izhar
- Comparative Medicine and Technology Unit, Institute of Bioscience, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Norhafizah Mohtarrudin
- Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Tengku Azmi Tengku Ibrahim
- Department of Veterinary Preclinical Sciences, Faculty of Veterinary Medicine, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Zamberi Sekawi
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Vasantha Kumari Neela
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- * E-mail:
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Kakita T, Okano S, Kyan H, Miyahira M, Taira K, Kitashoji E, Koizumi N. Laboratory diagnostic, epidemiological, and clinical characteristics of human leptospirosis in Okinawa Prefecture, Japan, 2003-2020. PLoS Negl Trop Dis 2021; 15:e0009993. [PMID: 34905535 PMCID: PMC8670671 DOI: 10.1371/journal.pntd.0009993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/12/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Leptospirosis is considered an endemic disease among agricultural workers in Okinawa Prefecture, which is the southernmost part of Japan and has a subtropical climate, but data on the current status and trend of this disease are scarce. METHODOLOGY/PRINCIPAL FINDINGS We conducted a retrospective study of clinically suspected leptospirosis patients whose sample and information were sent to the Okinawa Prefectural Institute of Health and Environment from November 2003 to December 2020. Laboratory diagnosis was established using culture, nested polymerase chain reaction (PCR), and/or microscopic agglutination test (MAT) with blood, cerebrospinal fluid, and/or urine samples. Statistical analyses were performed to compare the epidemiological information, clinical features, and sensitivities of diagnostic methods among laboratory-confirmed cases. Serogroups and the species of Leptospira isolates were determined by MAT using 13 antisera and flaB sequencing. A total of 531 clinically suspected patients were recruited, among whom 246 (46.3%) were laboratory confirmed to have leptospirosis. Among the confirmed cases, patients aged 20-29 years (22.4%) and male patients (85.7%) were the most common. The most common estimated sources of infection were recreation (44.5%) and labor (27.8%) in rivers. Approximately half of the isolates were of the L. interrogans serogroup Hebdomadis. The main clinical symptoms were fever (97.1%), myalgia (56.3%), and conjunctival hyperemia (52.2%). Headache occurred significantly more often in patients with Hebdomadis serogroup infections than those with other serogroup infections. The sensitivities of culture and PCR exceeded 65% during the first 6 days, while the sensitivity of MAT surpassed that of culture and PCR in the second week after onset. PCR using blood samples was a preferable method for the early diagnosis of leptospirosis. CONCLUSIONS/SIGNIFICANCE The results of this study will support clinicians in the diagnosis and treatment of undifferentiated febrile patients in Okinawa Prefecture as well as patients returning from Okinawa Prefecture.
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Affiliation(s)
- Tetsuya Kakita
- Department of Biological Sciences, Okinawa Prefectural Institute of Health and Environment, Uruma, Okinawa, Japan
| | - Sho Okano
- Department of Biological Sciences, Okinawa Prefectural Institute of Health and Environment, Uruma, Okinawa, Japan
| | - Hisako Kyan
- Department of Biological Sciences, Okinawa Prefectural Institute of Health and Environment, Uruma, Okinawa, Japan
| | - Masato Miyahira
- Department of Biological Sciences, Okinawa Prefectural Institute of Health and Environment, Uruma, Okinawa, Japan
| | - Katsuya Taira
- Department of Biological Sciences, Okinawa Prefectural Institute of Health and Environment, Uruma, Okinawa, Japan
| | - Emi Kitashoji
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Nagasaki, Japan
| | - Nobuo Koizumi
- Department of Bacteriology I, National Institute of Infectious Disease, Shinjuku, Tokyo, Japan
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Schattner A, Dubin I, Glick Y, Nissim E. Acute painless pancreatitis as an unusual presentation of leptospirosis in a low-incidence country. BMJ Case Rep 2020; 13:13/8/e234988. [PMID: 32843404 DOI: 10.1136/bcr-2020-234988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
A healthy, urban-dwelling man presented with lassitude, jaundice without increased liver enzymes or obstructive features on imaging, brief acute kidney injury, leucocytosis with near-normal C reactive protein and markedly increased serum amylase and lipase. Leptospirosis was not considered for 10 days because of the low incidence of the disease in the country, absent animal contact and physicians' low index of suspicion. Presentation without fever and without the commonly associated abdominal pain, myalgia, headache, thrombocytopaenia or elevated serum creatine kinase added to the diagnostic challenge. Once an infectious cause of acute pancreatitis was contemplated, leptospirosis was immediately sought and diagnosed by PCR of urine and microscopic agglutination test, and he fully recovered on ceftriaxone. Physicians in countries with a low incidence of leptospirosis should be more aware of the possibility of the disease even when several key features such as fever or pain are missing and the patient has a rare infectious acute pancreatitis.
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Affiliation(s)
- Ami Schattner
- Faculty of Medicine, Hebrew University Hadassah Medical School, Jerusalem, Israel .,Laniado Hospital, Sanz Medical Centre, Netanya, Israel
| | - Ina Dubin
- Laniado Hospital, Sanz Medical Centre, Netanya, Israel
| | - Yair Glick
- Laniado Hospital, Sanz Medical Centre, Netanya, Israel
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Philip N, Bahtiar Affendy N, Ramli SNA, Arif M, Raja P, Nagandran E, Renganathan P, Taib NM, Masri SN, Yuhana MY, Than LTL, Seganathirajah M, Goarant C, Goris MGA, Sekawi Z, Neela VK. Leptospira interrogans and Leptospira kirschneri are the dominant Leptospira species causing human leptospirosis in Central Malaysia. PLoS Negl Trop Dis 2020; 14:e0008197. [PMID: 32203511 PMCID: PMC7117766 DOI: 10.1371/journal.pntd.0008197] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 04/02/2020] [Accepted: 03/03/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Leptospirosis, commonly known as rat-urine disease, is a global but endemic zoonotic disease in the tropics. Despite the historical report of leptospirosis in Malaysia, the information on human-infecting species is limited. Determining the circulating species is important to understand its epidemiology, thereby to strategize appropriate control measures through public health interventions, diagnostics, therapeutics and vaccine development. METHODOLOGY/PRINCIPLE FINDINGS We investigated the human-infecting Leptospira species in blood and serum samples collected from clinically suspected leptospirosis patients admitted to three tertiary care hospitals in Malaysia. From a total of 165 patients, 92 (56%) were confirmed cases of leptospirosis through Microscopic Agglutination Test (MAT) (n = 43; 47%), Polymerase Chain Reaction (PCR) (n = 63; 68%) or both MAT and PCR (n = 14; 15%). The infecting Leptospira spp., determined by partial 16S rDNA (rrs) gene sequencing revealed two pathogenic species namely Leptospira interrogans (n = 44, 70%) and Leptospira kirschneri (n = 17, 27%) and one intermediate species Leptospira wolffii (n = 2, 3%). Multilocus sequence typing (MLST) identified an isolate of L. interrogans as a novel sequence type (ST 265), suggesting that this human-infecting strain has a unique genetic profile different from similar species isolated from rodents so far. CONCLUSIONS/SIGNIFICANCE Leptospira interrogans and Leptospira kirschneri were identified as the dominant Leptospira species causing human leptospirosis in Central Malaysia. The existence of novel clinically important ST 265 (infecting human), that is different from rodent L. interrogans strains cautions reservoir(s) of these Leptospira lineages are yet to be identified.
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Affiliation(s)
- Noraini Philip
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Norliza Bahtiar Affendy
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Siti Nur Alia Ramli
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Muhamad Arif
- Center of Excellence in Life Sciences, Bharathidasan University, Tiruchirappalli, India
| | - Pappitha Raja
- School of Medicine, Dentistry and Biomedical Sciences, Queens University, Belfast, Northern Ireland, United Kingdom
| | - Elanngovan Nagandran
- Clinical Research Centre Unit, Tengku Ampuan Rahimah Hospital, Ministry of Health Malaysia, Klang, Selangor, Malaysia
| | - Pukunan Renganathan
- Clinical Research Centre Unit, Tengku Ampuan Rahimah Hospital, Ministry of Health Malaysia, Klang, Selangor, Malaysia
| | - Niazlin Mohd Taib
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Siti Norbaya Masri
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Muhamad Yazli Yuhana
- Infectious Diseases Unit, Internal Medicine Department, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Leslie Thian Lung Than
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Mithra Seganathirajah
- General Medicine, Hospital Serdang, Ministry of Health Malaysia, Jalan Puchong, Kajang, Selangor, Malaysia
| | - Cyrille Goarant
- Institut Pasteur de Noume´a, Leptospirosis Research and Expertise Unit, Noume´a, New Caledonia
| | - Marga G. A. Goris
- OIE and National Collaborating Centre for Reference and Research on Leptospirosis Academic Medical Center, Department of Medical Microbiology, University of Amsterdam, Amsterdam, the Netherlands
| | - Zamberi Sekawi
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Vasantha Kumari Neela
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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Gasem MH, Hadi U, Alisjahbana B, Tjitra E, Hapsari MMDEAH, Lestari ES, Aman AT, Lokida D, Salim G, Kosasih H, Merati KTP, Laras K, Arif M, Lukman N, Sudarmono P, Lisdawati V, Lau CY, Neal A, Karyana M. Leptospirosis in Indonesia: diagnostic challenges associated with atypical clinical manifestations and limited laboratory capacity. BMC Infect Dis 2020; 20:179. [PMID: 32103771 PMCID: PMC7045408 DOI: 10.1186/s12879-020-4903-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 02/18/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The burden of leptospirosis in Indonesia is poorly understood. Data from an observational study conducted from 2013 to 2016 in seven cities across Indonesia was used to estimate the incidence of leptospirosis and document its clinical manifestations in patients requiring hospitalization. METHODS Specimens from patients hospitalized with acute fever were collected at enrollment, 14-28 days, and 3 months. Demographic and clinical information were collected during study visits and/or retrieved from medical records and double-entered into clinical report forms. After initially screening for dengue virus and other pathogens, specimens were tested at a central Reference Laboratory for anti-Leptospira IgM using commercial ELISA kits and for Leptospira DNA using an in-house quantitative real-time PCR assay. RESULTS Of 1464 patients enrolled, 45 (3.1%) confirmed cases (by PCR and/or sero-coversion or four-fold increase of IgM) and 6 (0.4%) probable cases (by high titer IgM) of leptospirosis were identified by the Reference Laboratory. Disease incidence at sites ranged from 0 (0%) cases in Denpasar to 17 (8.9%) cases in Semarang. The median age of patients was 41.2 years (range of 5.3 to 85.0 years), and 67% of patients were male. Twenty-two patients (43.1%) were accurately diagnosed at sites, and 29 patients (56.9%) were clinically misdiagnosed as having another infection, most commonly dengue fever (11, 37.9%). Clinically, 20 patients (39.2%) did not present with hyperbilirubinemia or increased creatinine levels. Two patients (3.9%) died, both from respiratory failure. Fifteen patients (29.4%) clinically diagnosed with leptospirosis at sites were negative based on IgM ELISA and/or PCR at the Reference Laboratory. CONCLUSIONS Leptospirosis remains an important cause of hospitalization in Indonesia. It can have diverse clinical presentations, making it difficult to differentiate from other common tropical infections. PCR combined with ELISA is a powerful alternative to the cumbersome gold-standard microscopic agglutination test, particularly in resource-limited settings.
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Affiliation(s)
| | - Usman Hadi
- Dr. Soetomo Academic General Hospital, Faculty of Medicine Airlangga University, Surabaya, Indonesia
| | - Bachti Alisjahbana
- Hasan Sadikin Hospital - Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - Emiliana Tjitra
- National Institute of Health Research and Development (NIHRD), Ministry of Health Republic of Indonesia, Jakarta, Indonesia
| | - M M D E A H Hapsari
- Dr. Kariadi Hospital - Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Endang Sri Lestari
- Dr. Kariadi Hospital - Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Abu Tholib Aman
- Dr. Sardjito Hospital - Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Yogyakarta, Indonesia
| | - Dewi Lokida
- Tangerang District Hospital, Tangerang, Indonesia
| | - Gustiani Salim
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Badan Litbangkes, Building 4, 5th floor, Jl Percetakan Negara no 29, Jakarta, 10560, Indonesia
| | - Herman Kosasih
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Badan Litbangkes, Building 4, 5th floor, Jl Percetakan Negara no 29, Jakarta, 10560, Indonesia.
| | | | - Kanti Laras
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Badan Litbangkes, Building 4, 5th floor, Jl Percetakan Negara no 29, Jakarta, 10560, Indonesia
| | - Mansyur Arif
- Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia
| | - Nurhayati Lukman
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Badan Litbangkes, Building 4, 5th floor, Jl Percetakan Negara no 29, Jakarta, 10560, Indonesia
| | | | | | - Chuen-Yen Lau
- National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health, Bethesda, MD, USA
| | - Aaron Neal
- National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health, Bethesda, MD, USA
| | - Muhammad Karyana
- National Institute of Health Research and Development (NIHRD), Ministry of Health Republic of Indonesia, Jakarta, Indonesia
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Badan Litbangkes, Building 4, 5th floor, Jl Percetakan Negara no 29, Jakarta, 10560, Indonesia
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Durfort C, Bourée P, Salmon D. Répartition des secteurs professionnels à risque d’exposition chez les cas de leptospirose diagnostiqués en France entre 2007 et 2017. ARCH MAL PROF ENVIRO 2020. [DOI: 10.1016/j.admp.2019.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Miailhe AF, Mercier E, Maamar A, Lacherade JC, Le Thuaut A, Gaultier A, Asfar P, Argaud L, Ausseur A, Ben Salah A, Botoc V, Chaoui K, Charpentier J, Cracco C, De Prost N, Eustache ML, Ferré A, Gauvin E, Goursaud S, Grall M, Guiot P, Jonas M, Lambiotte F, Landais M, Lemarié J, Lesieur O, Lhommet C, Michel P, Monseau Y, Moschietto S, Nseir S, Osman D, Pillot J, Piton G, Sedillot N, Sirodot M, Thevenin D, Zafrani L, Zerbib Y, Bourhy P, Lascarrou JB, Reignier J. Severe leptospirosis in non-tropical areas: a nationwide, multicentre, retrospective study in French ICUs. Intensive Care Med 2019; 45:1763-1773. [PMID: 31654079 DOI: 10.1007/s00134-019-05808-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 09/26/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE To report the incidence, risk factors, clinical presentation, and outcome predictors of severe leptospirosis requiring intensive care unit (ICU) admission in a temperate zone. METHODS LEPTOREA was a retrospective multicentre study conducted in 79 ICUs in metropolitan France. Consecutive adults admitted to the ICU for proven severe leptospirosis from January 2012 to September 2016 were included. Multiple correspondence analysis (MCA) and hierarchical classification on principal components (HCPC) were performed to distinguish different clinical phenotypes. RESULTS The 160 included patients (0.04% of all ICU admissions) had median values of 54 years [38-65] for age, 40 [28-58] for the SAPSII, and 11 [8-14] for the SOFA score. Hospital mortality was 9% and was associated with older age; worse SOFA score and early need for endotracheal ventilation and/or renal replacement therapy; chronic alcohol abuse and worse hepatic dysfunction; confusion; and higher leucocyte count. Four phenotypes were identified: moderately severe leptospirosis (n = 34, 21%) with less organ failure and better outcomes; hepato-renal leptospirosis (n = 101, 63%) with prominent liver and kidney dysfunction; neurological leptospirosis (n = 8, 5%) with the most severe organ failures and highest mortality; and respiratory leptospirosis (n = 17, 11%) with pulmonary haemorrhage. The main risk factors for leptospirosis contamination were contact with animals, contact with river or lake water, and specific occupations. CONCLUSIONS Severe leptospirosis was an uncommon reason for ICU admission in metropolitan France and carried a lower mortality rate than expected based on the high severity and organ-failure scores. The identification in our population of several clinical presentations may help clinicians establish an appropriate index of suspicion for severe leptospirosis.
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Affiliation(s)
- Arnaud-Félix Miailhe
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Emmanuelle Mercier
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Bretonneau, CRICS-TRIGGERSEP network, Tours, France
| | - Adel Maamar
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Jean-Claude Lacherade
- Service de Médecine Intensive Réanimation, Centre Hospitalier Départemental de la Vendée, La Roche sur Yon, France
| | - Aurélie Le Thuaut
- Direction de la recherche, Plateforme de Méthodologie et Biostatistique, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Aurélie Gaultier
- Direction de la recherche, Plateforme de Méthodologie et Biostatistique, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Pierre Asfar
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Angers, Angers, France
| | - Laurent Argaud
- Service de Réanimation médicale, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Antoine Ausseur
- Service de Réanimation polyvalente, Centre Hospitalier de Cholet, Cholet, France
| | - Adel Ben Salah
- Service de Réanimation polyvalente, Centre Hospitalier de Chartres, Chartres, France
| | - Vlad Botoc
- Service de Réanimation et surveillance continue, Centre Hospitalier de Saint Malo, Saint-Malo, France
| | - Karim Chaoui
- Service de Réanimation polyvalente, Centre Hospitalier de Cahors, Cahors, France
| | - Julien Charpentier
- Service de Médecine Intensive Réanimation, Hôpital Cochin, Groupe Hospitalier Centre-Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Christophe Cracco
- Service de réanimation polyvalente et surveillance continue, Centre Hospitalier d'Angoulême, Angoulême, France
| | - Nicolas De Prost
- Service de Réanimation Médicale, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Marie-Line Eustache
- Service de Réanimation polyvalente, Centre Hospitalier Bretagne-Atlantique, Vannes, France
| | - Alexis Ferré
- Service de Réanimation médico-chirurgicale, Centre hospitalier de Versailles, site André Mignot, Le Chesnay, France
| | - Elena Gauvin
- Service de Réanimation polyvalente, Centre Hospitalier de Niort, Niort, France
| | - Suzanne Goursaud
- Service de Réanimation médicale, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Maximilien Grall
- Service de Réanimation médicale, Hôpital Charles Nicolle, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | - Philippe Guiot
- Service de réanimation médicale, GHRMSA, Mulhouse, France
| | - Maud Jonas
- Service de Réanimation polyvalente et USC, Centre Hospitalier de Saint Nazaire, Saint Nazaire, France
| | - Fabien Lambiotte
- Service de Réanimation polyvalente, Centre Hospitalier de Valenciennes, Valenciennes, France
| | - Mickael Landais
- Service de Réanimation polyvalente, Centre Hospitalier du Mans, Le Mans, France
| | - Jérémie Lemarié
- MD, INSERM, U1116, 54500, Vandoeuvre-lès-Nancy, France.,Université de Lorraine, Nancy, France.,Service de Réanimation Médicale, Centre Hospitalier Universitaire de Nancy, Hôpital Central, Nancy, France
| | - Olivier Lesieur
- Service de Réanimation et surveillance continue, Hôpital Saint-Louis, La Rochelle, France
| | - Claire Lhommet
- Service de Réanimation polyvalente, Centre Hospitalier de Saint Brieuc, Saint Brieuc, France
| | - Philippe Michel
- Service de réanimation médico-chirurgicale, Centre Hospitalier René-Dubos, Pontoise, France
| | - Yannick Monseau
- Service de Réanimation polyvalente, Centre Hospitalier de Périgueux, Périgueux, France
| | - Sébastien Moschietto
- Service de Médecine Intensive Réanimation, Centre Hospitalier Henri Duffaut, Avignon, France
| | - Saad Nseir
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Lille, Lille, France.,Faculté de Médecine, Université de Lille, Lille, France
| | - David Osman
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jérome Pillot
- Service de réanimation polyvalente, Hôpital Saint-Léon, Centre hospitalier de la Côte Basque, Bayonne, France
| | - Gaël Piton
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Nicholas Sedillot
- Service de réanimation polyvalente, Centre Hospitalier Fleyriat, Bourg-en-Bresse, France
| | - Michel Sirodot
- Service de Médecine Intensive Réanimation, Centre Hospitalier Annecy, Annecy, France
| | - Didier Thevenin
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Lens, Lens, France
| | - Lara Zafrani
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Yoann Zerbib
- Service de Réanimation médicale, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
| | - Pascale Bourhy
- Unité de Biologie des Spirochètes, Institut Pasteur, Paris, France
| | - Jean-Baptiste Lascarrou
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Jean Reignier
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France. .,Université de Nantes, Nantes, France. .,Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Hotel-Dieu, 30 Bd. Jean Monnet, 44093, Nantes Cedex 1, France.
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Russell CD, Jones ME, O'Shea DT, Simpson KJ, Mitchell A, Laurenson IF. Challenges in the diagnosis of leptospirosis outwith endemic settings: a Scottish single centre experience. J R Coll Physicians Edinb 2019; 48:9-15. [PMID: 29741518 DOI: 10.4997/jrcpe.2018.102] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Leptospirosis is a zoonotic infection occurring worldwide but endemic in tropical countries. This study describes diagnostic testing for leptospirosis at our institution in Scotland over a 10-year period. Method We identified patients with blood samples referred to the Public Health England reference laboratory for leptospirosis testing between 2006 and 2016. Results A total of 480 samples were sent for IgM ELISA testing with 26 positive results from 14 patients. Two patients met criteria for 'confirmed' leptospirosis (microscopic agglutination test > 1:320 in one case and a positive PCR in the other) and the remaining 12 were 'probable' on the basis of IgM ELISA positivity, though 9 did not have microscopic agglutination testing performed. Nine infections were imported, mostly from Asia and with a history of fresh water exposure. Three co-infections (respiratory syncytial virus, influenza B and Campylobacter sp.) were identified. Conclusions Practical issues with microscopic agglutination testing (insufficient blood sent to reference laboratory) and PCR (travellers returning > 7 days after illness onset) represent challenges to the laboratory confirmation of a clinical diagnosis of leptospirosis. Co-infection and infectious/auto-immune causes of false positive serology should be evaluated.
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Affiliation(s)
- C D Russell
- CD Russell, Regional Infectious, Diseases Unit, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK,
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Héry G, Letheulle J, Flécher E, Quentin C, Piau C, Le Tulzo Y, Tattevin P. Massive intra-alveolar hemorrhage caused by Leptospira serovar Djasiman in a traveler returning from Laos. J Travel Med 2015; 22:212-4. [PMID: 25728613 DOI: 10.1111/jtm.12189] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 11/25/2014] [Accepted: 12/01/2014] [Indexed: 12/19/2022]
Abstract
Leptospirosis is one of the most common pathogens responsible for life-threatening tropical disease in travelers. We report a case of massive intra-alveolar hemorrhage caused by Leptospira serovar Djasiman in a 38-year-old man returning from Laos, who was cured with antibiotics and salvage treatment with extra-corporeal membrane oxygenation.
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Affiliation(s)
- Guillaume Héry
- Department of Infectious Disease and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
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Bandara M, Ananda M, Wickramage K, Berger E, Agampodi S. Globalization of leptospirosis through travel and migration. Global Health 2014; 10:61. [PMID: 25112368 PMCID: PMC4131158 DOI: 10.1186/s12992-014-0061-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 07/23/2014] [Indexed: 11/10/2022] Open
Abstract
Leptospirosis remains the most widespread zoonotic disease in the world, commonly found in tropical or temperate climates. While previous studies have offered insight into intra-national and intra-regional transmission, few have analyzed transmission across international borders. Our review aimed at examining the impact of human travel and migration on the re-emergence of Leptospirosis. Results suggest that alongside regional environmental and occupational exposure, international travel now constitute a major independent risk factor for disease acquisition. Contribution of travel associated leptospirosis to total caseload is as high as 41.7% in some countries. In countries where longitudinal data is available, a clear increase of proportion of travel-associated leptospirosis over the time is noted. Reporting patterns is clearly showing a gross underestimation of this disease due to lack of diagnostic facilities. The rise in global travel and eco-tourism has led to dramatic changes in the epidemiology of Leptospirosis. We explore the obstacles to prevention, screening and diagnosis of Leptopirosis in health systems of endemic countries and of the returning migrant or traveler. We highlight the need for developing guidelines and preventive strategies of Leptospirosis related to travel and migration, including enhancing awareness of the disease among health professionals in high-income countries.
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Affiliation(s)
| | | | | | | | - Suneth Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka.
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Muñoz-Zanzi C, Mason MR, Encina C, Astroza A, Romero A. Leptospira contamination in household and environmental water in rural communities in southern Chile. Int J Environ Res Public Health 2014; 11:6666-80. [PMID: 24972030 DOI: 10.3390/ijerph110706666] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 06/03/2014] [Accepted: 06/18/2014] [Indexed: 12/28/2022]
Abstract
Leptospirosis is a zoonosis of global distribution that affects tropical and temperate areas. Under suitable conditions, Leptospira can survive in water and soil and contribute to human and animal infections. The objective of this study was to describe the presence of pathogenic Leptospira in peri-domestic water samples from rural households in southern Chile. Water samples, including puddles, containers, animal troughs, rivers, canals, and drinking water were collected from 236 households and tested for Leptospira using a PCR assay targeting the lipL32 gene. Evidence of Leptospira presence was detected in all sample types; overall, 13.5% (77/570) samples tested positive. A total of 10/22 (45.5%) open containers, 12/83 (14.5%) animal drinking sources, 9/47 (19.1%) human drinking sources, and 36/306 (19.3%) puddles tested positive. Lower income (OR = 4.35, p = 0.003), increased temperature (OR = 1.23, p < 0.001), and presence of dogs (OR = 15.9, p = 0.022) were positively associated with positive puddles. Increased number of rodent signs was associated with positive puddles in the household (OR = 3.22); however, only in the lower income households. There was no association between PCR positive rodents and puddles at the household level. Results revealed the ubiquity of Leptospira in the household environment and highlight the need to develop formal approaches for systematic monitoring.
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Estavoyer J, Chirouze C, Faucher J, Floret N, Couetdic G, Leroy J, Hoen B. Leptospirosis in Franche-Comté (FRANCE): Clinical, biological, and therapeutic data. Med Mal Infect 2013; 43:379-85. [DOI: 10.1016/j.medmal.2013.06.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 05/28/2013] [Accepted: 06/18/2013] [Indexed: 10/26/2022]
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Craig SB, Graham GC, Burns MA, Dohnt MF, Smythe LD, McKay DB. Lymphopenia in leptospirosis. Annals of Tropical Medicine & Parasitology 2013; 103:279-82. [DOI: 10.1179/136485909x398294] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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van de Werve C, Perignon A, Jauréguiberry S, Bricaire F, Bourhy P, Caumes E. Travel-related leptospirosis: a series of 15 imported cases. J Travel Med 2013; 20:228-31. [PMID: 23809072 DOI: 10.1111/jtm.12035] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 01/21/2013] [Accepted: 01/23/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Leptospirosis belongs to the spectrum of travel-related infections. METHODS We retrospectively studied all the consecutive cases of travel-related leptospirosis seen in our department between January 2008 and September 2011. Patients were included with a clinical picture compatible with the disease within 21 days after return, the presence of a thermoresistant antigen or IgM antibodies, Elisa ≥ 1 /400, and a positive microagglutination test (MAT) ≥ 1/100. RESULTS Fifteen leptospirosis cases were evaluated. Exposure occurred in Asia (47%), Africa (20%), the Caribbean (20%), and Indian Ocean (13%). Fourteen patients were infected during water-related activities. On admission the most frequent symptoms were fever (100%), headache (80%), and digestive disorders (67%). Relevant laboratory findings included impaired liver function tests (100%), lymphocytopenia (80%), thrombocytopenia (67%), and elevated C-reactive protein (CRP) (67%). Our cases were confirmed by MAT that found antibodies against nine different serovars. Seven patients were cured with amoxicillin, four with doxycycline, two with ceftriaxone, one with ceftriaxone, doxycycline, and spiramycin, whereas one recovered spontaneously (retrospective diagnosis). Eight patients were hospitalized. All patients recovered. CONCLUSION Our cases involved nine different serovars. They were related to travel in Asia, Africa, and the Caribbean. Bathing or other fresh-water leisure activities (canoeing, kayaking, rafting) are the most likely at-risk exposure. Any traveler with fever and at-risk exposure should be investigated for leptospirosis.
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Craig SB, Smythe LD, Graham GC, Burns MA, McMahon JL, Dohnt MF, Tulsiani SM, McKay DB. Haemoglobin and red cell counts in leptospirosis patients infected with different serovars. Rev Soc Bras Med Trop 2013; 46:237-40. [DOI: 10.1590/0037-8682-1013-2013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Accepted: 05/18/2011] [Indexed: 11/22/2022] Open
Affiliation(s)
- Scott Benjamin Craig
- WHO/OIE/FAO Collaborating Centre for Reference and Research on Leptospirosis, Australia; University of the Sunshine Coast, Australia
| | - Lee Douglas Smythe
- WHO/OIE/FAO Collaborating Centre for Reference and Research on Leptospirosis, Australia; University of the Sunshine Coast, Australia
| | - Glenn Charles Graham
- University of the Sunshine Coast, Australia; Queensland Health Forensic and Scientific Service, Australia
| | - Mary-Anne Burns
- WHO/OIE/FAO Collaborating Centre for Reference and Research on Leptospirosis, Australia
| | - Jamie Lee McMahon
- WHO/OIE/FAO Collaborating Centre for Reference and Research on Leptospirosis, Australia
| | - Michael Francis Dohnt
- WHO/OIE/FAO Collaborating Centre for Reference and Research on Leptospirosis, Australia
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Hicham S, ihsane M, Abderahim EB, Brahim B, Labib S, Mustapha H, Mohamed K, Adil I, Abdelilah M, Nabil K. Multivisceral organ failure related to leptospirosis in pregnant patient. Indian J Crit Care Med 2013; 17:43-5. [PMID: 23833476 PMCID: PMC3701397 DOI: 10.4103/0972-5229.112143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Leptospirosis is the most widespread zoonosis in the world. It is caused by pathogenic leptospira infection. This infection is also an uncommon cause of hepatorenal failure. Indeed, hemolysis, elevated liver enzyme levels and low platelet count syndrome, and acute fatty liver of pregnancy are specific to the pregnant state. Leptospirosis is rarely described in pregnancy; it might mimic puerperal sepsis or hepatorenal failure associated with pregnancy induced hypertension. We report a case of leptospirosis presenting as multiple organ failure during third trimester of pregnancy with a good outcome.
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Affiliation(s)
- Sbai Hicham
- From: Department of Anaesthesia and Reanimation, University Hospital Hassan II of Fez, Morocco
| | - Mellouki ihsane
- Department of Hepato-gastroenterology, University Hospital Hassan II of Fez, Morocco
| | - El Bouazzaoui Abderahim
- From: Department of Anaesthesia and Reanimation, University Hospital Hassan II of Fez, Morocco
| | - Boukatta Brahim
- From: Department of Anaesthesia and Reanimation, University Hospital Hassan II of Fez, Morocco
| | - Smail Labib
- From: Department of Anaesthesia and Reanimation, University Hospital Hassan II of Fez, Morocco
| | - Harrandou Mustapha
- From: Department of Anaesthesia and Reanimation, University Hospital Hassan II of Fez, Morocco
| | - Khatouf Mohamed
- From: Department of Anaesthesia and Reanimation, University Hospital Hassan II of Fez, Morocco
| | - Ibrahimi Adil
- Department of Hepato-gastroenterology, University Hospital Hassan II of Fez, Morocco
| | - Melhouf Abdelilah
- Department of Gynecology and Obstetrics, University Hospital Hassan II of Fez, Morocco
| | - Kanjaa Nabil
- From: Department of Anaesthesia and Reanimation, University Hospital Hassan II of Fez, Morocco
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Abstract
The recent high-profile death of a British Olympic rower from leptospirosis has raised awareness to this uncommon but potentially fatal disease. The re-emergence of the disease abroad is well documented in the literature, but less is known about cases in the UK. The increase in participation in water sports, foreign travel and often a combination of the two, has increased the exposure of tourists subsequently returning to the UK from areas of high prevalence. Leptospirosis is a zoonotic infection. The bacteria are shed in the urine of animals to the environment from where humans are infected by incidental hosts. There is a wide spectrum of severity of symptoms, from a self-limiting febrile illness to fatal pulmonary haemorrhage, renal or liver failure. It is thought that cases remain unrecognized every year in the UK, largely due to the mild nature of symptoms and the wide differential for febrile illness and partly due to lack of awareness among clinicians. This review examines the epidemiology of leptospirosis in the UK, over the period 2006-10, the clinical features, diagnostic techniques and treatment.
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Affiliation(s)
- A E Forbes
- Department of Cardiology, Hillingdon Hospital, Pield Heath Road, Uxbridge, Middlesex, UB8 3NN, UK
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Silva Júnior GB, Abreu KLS, Mota RMS, Barreto AGC, Araújo SMHA, Rocha HAL, Libório AB, Daher EF. RIFLE and Acute Kidney Injury Network classifications predict mortality in leptospirosis-associated acute kidney injury. Nephrology (Carlton) 2011; 16:269-76. [PMID: 21342320 DOI: 10.1111/j.1440-1797.2010.01391.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
AIM Acute kidney injury (AKI) is a common complication in leptospirosis. The aim of this study is to investigate the association between RIFLE and AKIN classifications with mortality in leptospirosis-associated AKI. METHODS A retrospective study was conducted in patients with leptospirosis admitted to tertiary hospitals in Brazil. The association between RIFLE and AKIN classifications with mortality was investigated. Univariate and multivariate analysis was performed to investigate risk factors for death. RESULTS A total of 287 patients were included, with an average age of 37 ± 16 years, and 80.8% were male. Overall mortality was 13%. There was a significant association between these classifications and death. Among non-survivors, 86% were in the class 'failure' and AKIN 3. Increased mortality was observed according to the worse classifications: 'risk' (R; 2%), 'injury' (I; 8%) and 'failure' (F; 23%), as well as in AKIN 1 (2%), AKIN 2 (8%) and AKIN 3 (23%) (P < 0.0001). The worst classifications were significantly associated with death: RIFLE F (odds ratio = 11.6, P = 0.018) and AKIN 3 (odds ratio = 12.8, P = 0.013). Receiver-operator curve for patients with AKI showed high areas under the curve (0.71, 95% confidence interval = 0.67-0.74) for both RIFLE and AKIN classifications in determining the sensitivity for mortality. CONCLUSION There is a significant association between RIFLE and AKIN classifications with mortality in patients with leptospirosis. Initiation of dialysis in patients with RIFLE F and AKIN 3 should always be considered.
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Affiliation(s)
- Geraldo B Silva Júnior
- Post-Graduation Program in Medical Sciences Division of Nephrology, Department of Internal Medicine, Federal University of Ceará, Ceará, Brazil
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Guo Y, Wang K, Sun S. Identification of an HLA-A*0201-restricted CD8+ T-cell epitope encoded within Leptospiral immunoglobulin-like protein A. Microbes Infect 2010; 12:364-73. [DOI: 10.1016/j.micinf.2010.01.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2009] [Revised: 01/20/2010] [Accepted: 01/20/2010] [Indexed: 11/24/2022]
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Craig SB, Graham GC, Burns MA, Dohnt MF, Smythe LD, McKay DB. Haematological and clinical-chemistry markers in patients presenting with leptospirosis: a comparison of the findings from uncomplicated cases with those seen in the severe disease. Ann Trop Med Parasitol 2010; 103:333-41. [PMID: 19508751 DOI: 10.1179/136485909x435058] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In a retrospective study, the laboratory findings from the first blood samples taken following hospital presentation in patients with uncomplicated leptospirosis have been compared with the corresponding data for patients admitted, to a high-dependency medical ward or intensive-care unit, with severe leptospirosis. The aim was to identify those laboratory markers that differentiate the two clinical groups upon initial presentation. Marked differences were observed, in some of the haematological and clinical-chemistry markers, between the patients with severe leptospirosis and those with the uncomplicated disease. Statistically significant differences were found in haemoglobin concentrations, haematocrits, counts of erythrocytes, leucocytes, neutrophils and platelets, and serum concentrations of creatinine, urea, protein and albumin. These markers may therefore be useful in the assessment and early detection of disease severity in patients with suspected leptospirosis. Investigations into the use of albumin treatments, which might significantly improve the clinical care of patients with acute leptospirosis, appear to be justified.
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Affiliation(s)
- S B Craig
- WHO/FAO/OIE Collaborating Centre for Reference and Research on Leptospirosis, Communicable Diseases Unit, Queensland Health Forensic and Scientific Services, P.O. Box 594, Archerfield, Queensland, 4108, Australia.
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Daher EF, Lima RS, Silva Júnior GB, Silva EC, Karbage NN, Kataoka RS, Carvalho Júnior PC, Magalhães MM, Mota RM, Libório AB. Clinical presentation of leptospirosis: a retrospective study of 201 patients in a metropolitan city of Brazil. Braz J Infect Dis 2010. [DOI: 10.1016/s1413-8670(10)70002-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Craig SB, Graham GC, Burns MA, Dohnt MF, Smythe LD, McKay DB. Lymphopenia is observed regularly in the acute (leptospiraemic) phase but not the immune phase of leptospirosis. Trans R Soc Trop Med Hyg 2009; 103:958-60. [PMID: 19386339 DOI: 10.1016/j.trstmh.2009.03.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Revised: 03/16/2009] [Accepted: 03/17/2009] [Indexed: 11/29/2022] Open
Abstract
Lymphocyte counts in patients with leptospirosis have been shown to be variable. This study retrospectively compared lymphocyte counts from the first blood samples taken following hospital presentation in patients with leptospirosis who were either (i) IgM non-reactive, (ii) IgM reactive and microscopic agglutination test (MAT) non-reactive or (iii) IgM and MAT reactive in an effort to determine whether differences in lymphocyte counts are observed in the acute and immune phase of leptospirosis. Statistical differences in lymphocyte counts were observed between the three groups. In conclusion, this study has shown that the phase of leptospiral infection may affect patient lymphocyte counts.
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Affiliation(s)
- Scott B Craig
- WHO/OIE/FAO Collaborating Centre for Reference and Research on Leptospirosis, Communicable Diseases Unit, Queensland Health Forensic and Scientific Service, Archerfield, Queensland 4108, Australia. scott
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Strady C, Penalba C, Baumard S, Brodard V, Wynckel A, Auvray C, Jaussaud R, Andreoletti L. Nephropathia epidemica and leptospirosis in Champagne-Ardenne, France: comparison of clinical, biological and epidemiological profiles. Eur J Clin Microbiol Infect Dis 2009; 28:825-9. [DOI: 10.1007/s10096-009-0716-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2008] [Accepted: 02/03/2009] [Indexed: 10/21/2022]
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Tattevin P. Méningoencéphalites infectieuses de l’adulte non immunodéprimé. Rev Med Interne 2009; 30:125-34. [DOI: 10.1016/j.revmed.2008.05.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2007] [Revised: 05/09/2008] [Accepted: 05/14/2008] [Indexed: 10/21/2022]
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Affiliation(s)
- Androula Pavli
- Office for Travel Medicine, Hellenic Center for Disease Control and Preventation, Athens, Greece
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Abgueguen P, Delbos V, Blanvillain J, Chennebault JM, Cottin J, Fanello S, Pichard E. Clinical aspects and prognostic factors of leptospirosis in adults. Retrospective study in France. J Infect 2008; 57:171-8. [DOI: 10.1016/j.jinf.2008.06.010] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Revised: 06/11/2008] [Accepted: 06/12/2008] [Indexed: 11/18/2022]
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Roczek A, Forster C, Raschel H, Hörmansdorfer S, Bogner KH, Hafner-Marx A, Lepper H, Dobler G, Büttner M, Sing A. Severe course of rat bite-associated Weil's disease in a patient diagnosed with a new Leptospira-specific real-time quantitative LUX-PCR. J Med Microbiol 2008; 57:658-663. [DOI: 10.1099/jmm.0.47677-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Leptospirosis is a zoonotic disease with global distribution, caused by spirochaetes of the genus Leptospira. Transmission of Leptospira interrogans serovar Icterohaemorrhagiae, the causative agent of Weil's disease, to humans usually results from exposure to the urine of infected, but mostly asymptomatic, rodents, either by direct contact or indirectly through contaminated soil or water. Although regarded as a re-emerging infectious disease, human leptospirosis is probably underdiagnosed due to its often unspecific clinical appearance and difficulties in culturing leptospires. Therefore, more rapid and specific diagnostic procedures are needed. Here we describe a novel real-time quantitative PCR system developed for the accurate and fast diagnosis of pathogenic Leptospira spp. Its usefulness in the management of a patient with rat bite-associated multiorgan failure is demonstrated.
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Affiliation(s)
- Alexandra Roczek
- Bavarian Health and Food Safety Authority (LGL), Veterinärstraße 2, 85764 Oberschleißheim, Germany
| | - Christian Forster
- Universitätsklinikum Erlangen, Medizinische Klinik 4, Krankenhausstraße 12, 91054 Erlangen, Germany
| | - Heribert Raschel
- Bavarian Health and Food Safety Authority (LGL), Veterinärstraße 2, 85764 Oberschleißheim, Germany
| | - Stefan Hörmansdorfer
- Bavarian Health and Food Safety Authority (LGL), Veterinärstraße 2, 85764 Oberschleißheim, Germany
| | - Karl-Heinz Bogner
- Bavarian Health and Food Safety Authority (LGL), Veterinärstraße 2, 85764 Oberschleißheim, Germany
| | - Angela Hafner-Marx
- Bavarian Health and Food Safety Authority (LGL), Veterinärstraße 2, 85764 Oberschleißheim, Germany
| | - Hans Lepper
- Bavarian Health and Food Safety Authority (LGL), Veterinärstraße 2, 85764 Oberschleißheim, Germany
| | - Gerhard Dobler
- Institute of Microbiology of the Bundeswehr, Neuherbergstraße 11, 80937 München, Germany
| | - Mathias Büttner
- Bavarian Health and Food Safety Authority (LGL), Veterinärstraße 2, 85764 Oberschleißheim, Germany
| | - Andreas Sing
- Bavarian Health and Food Safety Authority (LGL), Veterinärstraße 2, 85764 Oberschleißheim, Germany
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Kitazawa T, Aoki T, Harada S, Hatakeyama S, Ota Y, Koike K, Kamiura N, Hasegawa M. [Leptospirosis with paraplegia and abnormal lung image]. ACTA ACUST UNITED AC 2008; 97:158-60. [PMID: 18283906 DOI: 10.2169/naika.97.158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Takatoshi Kitazawa
- Department of Infectious Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo
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Michot JM, Lidove O, Boutboul D, Aguilar C, Merle H, Olindo S, Cabre P, Papo T. La leptospirose: une cause inhabituelle d'uvéite antérieure. Rev Med Interne 2007; 28:566-7. [PMID: 17482723 DOI: 10.1016/j.revmed.2007.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2006] [Accepted: 03/15/2007] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Leptospirosis is an anthropozoonosis, which affect 100000 people by year worldwide. CASE REPORT Leptospirosis and IgA deficiency were revealed in a young man by acute anterior uveitis, after canyoning practice in the French West Indies. DISCUSSION Uveitis should be added to the ocular phenotype of leptospirosis.
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Affiliation(s)
- J-M Michot
- Service de médecine interne, hôpital Bichat, 46, rue Henri-Huchard, 75722 Paris cedex 18, France
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Abstract
Percentage of serological positivity examined in 4205 blood sera by serological method microscopic agglutination test (MAT) on the hinterland territory of our laboratory (East Bohemia; 1999-2003) was 0.38-4.7 %. By the PCR method for detection of DNA of pathogenic leptospires (L. interrogans, L. borgpetersenii and L. kirschneri) from 57 samples of different biological materials from patients with fever of unknown etiology positive results were obtained in 4 specimens (7 %; 3 samples of urine and 1 sample of blood). This method was shown to distinguish between pathogenic and nonpathogenic strains and can detect 2.5-10 cells per mL of biological material. As an important presumption of successful detection of pathogenic leptospires a correct collecting of blood, urine samples or liquor is required before starting antibody therapy. The PCR method possesses a clear advantage over other methods, such as MAT, which relies on the detection of antibodies the presence of which cannot be detected until days after infection.
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Affiliation(s)
- Z Cermáková
- Department of Clinical Microbiology, Faculty of Medicine and University Hospital in Hradec Králové, Charles University, 500 05 Hradec Králové, Czechia.
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