Leptospira serology in small ruminants on St. Croix, U.S. Virgin Islands

Seroprevalence, distribution, and risk factors for human leptospirosis in the United States Virgin Islands

Background

The first documented human leptospirosis cases in the U.S. Virgin Islands (USVI) occurred following 2017 Hurricanes Irma and Maria. We conducted a representative serosurvey in USVI to estimate the seroprevalence and distribution of human leptospirosis and evaluate local risk factors associated with seropositivity.

Methodology/Principal findings

A stratified, two-stage cluster sampling design was used and consisted of three island strata and random selection of census blocks and then households. All eligible members of selected households were invited to participate (≥5 years old, resided in USVI ≥6 months and ≥6 months/year). Household and individual-level questionnaires were completed, and serum collected from each enrolled individual. Microscopic agglutination test serology was conducted, and bivariate and logistic regression analyses completed to identify risk factors for seropositivity.

In March 2019, 1,161 individuals were enrolled from 918 households in St. Croix, St. Thomas, and St. John. The territory-wide weighted seroprevalence was 4.0% (95% CI:2.3–5.7). Characteristics/exposures independently associated with seropositivity using logistic regression included contact with cows (OR: 39.5; 95% CI: 9.0–172.7), seeing rodents/rodent evidence or contact with rodents (OR: 2.6; 95% CI: 1.1–5.9), and increasing age (OR: 1.02; 95% CI: 1.002–1.04); full or partial Caucasian/White race was negatively correlated with seropositivity (OR: 0.02, 95% CI: 0.04–0.7). Bivariate analysis showed self-reported jaundice since the 2017 hurricanes (pRR: 5.7; 95% CI: 1.0–33.4) was associated with seropositivity and using a cover/lid on cisterns/rainwater collection containers (pRR: 0.3; 95% CI: 0.08–0.8) was protective against seropositivity.

Conclusions/Significance

Leptospirosis seropositivity of 4% across USVI demonstrates an important human disease that was previously unrecognized and emphasizes the importance of continued leptospirosis surveillance and investigation. Local risk factors identified may help guide future human and animal leptospirosis studies in USVI, strengthen leptospirosis public health surveillance and treatment timeliness, and inform targeted education, prevention, and control efforts.

Assessing rodents as carriers of pathogenic Leptospira species in the U.S. Virgin Islands and their risk to animal and public health

Leptospirosis is a global zoonotic disease caused by pathogenic bacteria of the genus Leptospira. We sought to determine if rodents in U.S. Virgin Islands (USVI) are carriers of Leptospira. In total, 140 rodents were sampled, including 112 Mus musculus and 28 Rattus rattus. A positive carrier status was identified for 64/140 (45.7%); 49 (35.0%) were positive by dark-field microscopy, 60 (42.9%) by culture, 63 (45.0%) by fluorescent antibody testing, and 61 (43.6%) by real-time polymerase chain reaction (rtPCR). Molecular typing indicated that 48 isolates were L. borgpetersenii and 3 were L. kirschneri; the remaining nine comprised mixed species. In the single culture-negative sample that was rtPCR positive, genotyping directly from the kidney identified L. interrogans. Serotyping of L. borgpetersenii isolates identified serogroup Ballum and L. kirschneri isolates as serogroup Icterohaemorrhagiae. These results demonstrate that rodents are significant Leptospira carriers and adds to understanding the ecoepidemiology of leptospirosis in USVI.

Mongooses (Urva auropunctata) as reservoir hosts of Leptospira species in the United States Virgin Islands, 2019-2020

During 2019-2020, the Virgin Islands Department of Health investigated potential animal reservoirs of Leptospira spp., the bacteria that cause leptospirosis. In this cross-sectional study, we investigated Leptospira spp. exposure and carriage in the small Indian mongoose (Urva auropunctata, syn: Herpestes auropunctatus), an invasive animal species. This study was conducted across the three main islands of the U.S. Virgin Islands (USVI), which are St. Croix, St. Thomas, and St. John. We used the microscopic agglutination test (MAT), fluorescent antibody test (FAT), real-time polymerase chain reaction (lipl32 rt-PCR), and bacterial culture to evaluate serum and kidney specimens and compared the sensitivity, specificity, positive predictive value, and negative predictive value of these laboratory methods. Mongooses (n = 274) were live-trapped at 31 field sites in ten regions across USVI and humanely euthanized for Leptospira spp. testing. Bacterial isolates were sequenced and evaluated for species and phylogenetic analysis using the ppk gene. Anti-Leptospira spp. antibodies were detected in 34% (87/256) of mongooses. Reactions were observed with the following serogroups: Sejroe, Icterohaemorrhagiae, Pyrogenes, Mini, Cynopteri, Australis, Hebdomadis, Autumnalis, Mankarso, Pomona, and Ballum. Of the kidney specimens examined, 5.8% (16/270) were FAT-positive, 10% (27/274) were culture-positive, and 12.4% (34/274) were positive by rt-PCR. Of the Leptospira spp. isolated from mongooses, 25 were L. borgpetersenii, one was L. interrogans, and one was L. kirschneri. Positive predictive values of FAT and rt-PCR testing for predicting successful isolation of Leptospira by culture were 88% and 65%, respectively. The isolation and identification of Leptospira spp. in mongooses highlights the potential role of mongooses as a wildlife reservoir of leptospirosis; mongooses could be a source of Leptospira spp. infections for other wildlife, domestic animals, and humans.

Exposure and Carriage of Pathogenic Leptospira in Livestock in St. Croix, U.S. Virgin Islands

From 2019–2020, the Virgin Islands Department of Health (VIDOH) investigated potential animal reservoirs of Leptospira spp., the pathogenic bacteria that cause leptospirosis. We examined Leptospira exposure and carriage in livestock on the island of St. Croix, United States Virgin Islands (USVI). We utilized the microscopic agglutination test (MAT) to evaluate the sera, and the fluorescent antibody test (FAT), real time polymerase chain reaction (rt-PCR), and bacterial culture to evaluate urine specimens from livestock (n = 126): 28 cattle, 19 goats, 46 pigs, and 33 sheep. Seropositivity was 37.6% (47/125) with agglutinating antibodies to the following serogroups identified: Australis, Djasiman, Icterohaemorrhagiae, Ballum, Sejroe, Cynopteri, Autumnalis, Hebdomadis, Pomona, Canicola, Grippotyphosa, and Pyrogenes. Urine from 4 animals (4.0%, 4/101) was positive by rt-PCR for lipL32: 2 sheep, 1 goat, and 1 bull. Sequencing of secY amplicons identified L. interrogans in 1 sheep and 1 bull. Livestock in USVI harbor pathogenic Leptospira bacteria and could play a role in the zoonotic cycle of leptospirosis.

Histopathology of the kidney and seroprevalence of leptospirosis in wild rats in Baghdad Province, Iraq

Background and Aim: Leptospirosis, caused by pathogenic leptospires, is a globally emerging infectious disease affecting both humans and animals, which act as reservoirs, with large outbreaks worldwide. The role of rats in dispersing leptospirosis was never investigated in Iraq. Because of the seriousness of the disease and the scarce data regarding this disease in Iraq, this study determines the incidence of leptospirosis in rats and its renal histopathological profile. Materials and Methods: Of 211 captured rats, 82 apparently healthy rats were included in this study. After euthanatizing, 3-5-ml blood was collected by cardiac puncture. Approximately 0.5 cm3 of the kidney was collected for routine histopathology and stained using hematoxylin and eosin (H&E) and Warthin–Starry (WS) stains. Blood smears were prepared and stained with the WS stain. Results: All rats (100%) with different age groups were immunoglobulin G (IgG)-positive, and 90.24% of them had the IgG against leptospiral antigens in kidney tissues. The juvenile age group had higher IgG levels than other age groups. Considering sex, no significant differences in the overall results were observed. Serum concentrations of blood urea nitrogen and creatinine showed significant increments in the sub-adult and adult IgG- positive groups compared with the IgG-negative groups. No significant alterations were observed in the juvenile group. Using WS stains, 13 and 1 blood smears and 0 and 8 kidney tissues were positive for leptospires in the sub-adult and adult groups, respectively. Microscopical findings of the renal cortex and medulla in the sub-adult IgG-positive group showed hemorrhage, glomerular deterioration, tubular cell degeneration and necrosis with cast formation, periarterial edema, and focal hemorrhage with congestion of peritubular arteries. The adult IgG-positive group revealed deterioration similar to that in the sub-adult group and tended to be chronic. No leptospires were observed using H&E staining. Conclusion: IgG-positive carrier rats refer to previously exposed or infected rats. Understanding the risk of transmitting the disease to human and animals through a carrier rat's urine is highly predicted and possible mitigation of zoonotic transmission.

First Reported Human Cases of Leptospirosis in the United States Virgin Islands in the Aftermath of Hurricanes Irma and Maria, September-November 2017

Objective

Following Hurricanes Irma and Maria, the first case of human leptospirosis ever identified in the US Virgin Islands (USVI) was reported to the Virgin Islands Department of Health. Leptospirosis is a potentially fatal bacterial disease caused by Leptospira species found in animal urine and urine-contaminated water and soil. Outbreaks can occur following extreme weather events.

Method

Additional cases of leptospirosis were identified in the 2.5 months post-hurricanes by reviewing emergency department (ED) records from territorial hospitals for patients demonstrating leptospirosis-consistent symptoms, testing symptomatic patients previously enrolled in the USVI arbovirus surveillance system (VIASS), and adding leptospirosis testing prospectively to VIASS. Available patient sera underwent local rapid diagnostic testing for anti-Leptospira IgM followed by confirmatory microscopic agglutination testing at the US Centers for Disease Control and Prevention. Water was collected from cisterns with epidemiologic links to confirmed cases and tested by real-time PCR (qPCR) for pathogenic Leptospira spp.

Results

Sixteen retrospectively identified symptomatic patients were enrolled in VIASS; 15 with available samples tested negative. Based on review of 5226 ED charts, 6 patients were further investigated; of these, 5 were tested of which 1 was positive. Prospective leptospirosis surveillance tested 57 additional patients; of these, 1 was positive. Water from 1 of 5 tested cisterns was found positive by qPCR.

Conclusions

This investigation documents the first 3 cases of leptospirosis reported in the USVI and demonstrates how VIASS successfully was adapted to establish leptospirosis surveillance. Contaminated cistern water was identified as a potential source for Leptospira spp. transmission, highlighting the need for additional post-hurricane remediation and disinfection guidance.

Leptospira seroprevalence in animals in the Caribbean region: A systematic review

This systematic review summarises the data published on the Leptospira seroprevalence, serovar diversity and distribution among animal species in the Caribbean region. Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, and checklist, relevant articles were identified and data were extracted and recorded. The review provided Leptospira seroprevalence data from 16 Caribbean islands (Barbados, Trinidad, Grenada, Puerto Rico, Saint Croix, St. Kitts and Nevis, Jamaica, Antigua, Carriacou, Dominica, Guadalupe, Martinique, Monserrat, St. Lucia, St. Maarten, and St. Vincent) in a variety of animal species. Reviewing the literature highlighted the limited amount of data available from limited number of islands. Many of the studies conducted have recorded seroprevalences based on variable and small samples sizes. Besides, serovar panels used for MAT were not consistent between studies. The review indicates that the Leptospira exposure in a given geographic location may change with time and climatic and environmental conditions, and highlights the need to conduct continual surveillance in tropical countries where the climate supports the survival of Leptospira in the environment. Specific attention must be given to standardization of MAT panels and protocols and providing training across laboratories involved in testing. Further, animal and environment testing to isolate and identify circulating Leptospira spp. in a geographic region must actively be pursued. This knowledge is important to implement geographically specific control programs, as risk factors of Leptospira transmission is favoured by various factors such as change in climatic conditions, urbanization, encroachment of wildlife inhabitation, import/export of animals, increase in adventure travel, and water related recreational activities.

Leptospiral antibodies in the breeding goat population of Poland

In 2007, a survey was conducted on the prevalence of antibodies to 19 Leptospira serovars in goats in Poland . Sera were collected from adult females of all 49 breeding goat herds in Poland by applying simple random sampling. In total, 736 sera were tested by the microscopic agglutination test. A herd was considered seropositive if at least one goat with a titre of 100 or more was detected. Herd-level seroprevalence of Leptospira was 89.8 per cent and individual-level seroprevalence varied from less than 1.0 to 85.0 per cent among the herds. Antibodies to Leptospira serovars Zanoni, Bratislava, Autumnalis, Australis and Javanica were most frequently detected. Although 40.3 per cent of seropositive goats had high antibody titres (≥ 400), suggesting recent infection, no relationship with abortions or other clinical manifestation of leptospirosis in goats was detected.

Serological survey of leptospirosis in livestock animals in the Lesser Antilles

A serological survey was performed of 1788 cattle, goats and sheep on 13 islands in the Lesser Antilles. Sera were tested by microscopic agglutination (MAT) using a panel of 22 live antigens. Evidence of past exposure, at a titer of > or = 100, was found in 101 animals (5.6%). Antibodies were more common in cattle and goats (7.2% in each) than in sheep (1.7%). Seroprevalence was highest in cattle in Martinique (20%) and in goats in St. Vincent (23%). The predominant serogroups were Sejroe (largely confined to cattle in Martinique), Autumnalis, Icterohaemorrhagiae, Grippotyphosa, and Cynopteri. Eleven cattle from Martinique and 2 sheep with titers of > or = 800 showed evidence of recent infection.

Seroprevalence of leptospirosis in a rural flood prone district of Bangladesh

Leptospirosis is a worldwide zoonotic disease. In the present investigation, a total of 89 human sera from a flood prone district of Bangladesh was screened by a one-point microscapsule agglutination test (MCAT). MCAT-positive and -doubtful sera were further tested by microscopic agglutination test (MAT) against 16 reference serovars of Leptospira interrogans, and the antibody titres determined. In MCAT, 34 sera were positive and 22 were doubtful. Among those positive and doubtful sera, 33 and 20, respectively were tested by MAT. Thirty-four out of 53 MCAT-screened samples were MAT-positive. The titres ranged from 20 to 1600 with antibodies to serovars copenhageni, australis, cynopteri and icterohaemorrhagiae being the most prevalent. Eleven MCAT-positive samples failed to react with any strains used by MAT, suggesting the presence of new or untested serovars. Among the MAT-positive samples, the presence of antibody against two or more serovars was more common than that of a single serovar. The present study suggests that rural people in Bangladesh are at high risk to leptospiral infection.