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Parra Barrera EL, Reales-González J, Salas D, Reyes Santamaría E, Bello S, Rico A, Pardo L, Parra E, Rodriguez K, Alarcon Z, Guerra Vega AP, Porras MA, Gomez-Rangel SY, Duarte C, Moreno J. Fatal acute undifferentiated febrile illness among clinically suspected leptospirosis cases in Colombia, 2016-2019. PLoS Negl Trop Dis 2023; 17:e0011683. [PMID: 37844106 PMCID: PMC10602388 DOI: 10.1371/journal.pntd.0011683] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 10/26/2023] [Accepted: 09/26/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Acute undifferentiated febrile illness is a common challenge for clinicians, especially in tropical and subtropical countries. Incorrect or delayed diagnosis of febrile patients may result in medical complications or preventable deaths. Common causes of acute undifferentiated febrile illness in Colombia include leptospirosis, rickettsioses, dengue fever, malaria, chikungunya, and Zika virus infection. In this study, we described the acute undifferentiated febrile illness in postmortem patients reported as suspected cases of leptospirosis through the national leptospirosis surveillance in Colombia, 2016-2019. METHODOLOGY/PRINCIPAL FINDINGS We retrospectively analyze human fresh and formalin-fixed tissue samples from fatal suspected leptospirosis cases reported by the Public Health Laboratories in Colombia. Leptospirosis confirmation was made by immunohistochemistry, real-time polymerase chain reaction (PCR) in the tissue samples. In some cases, the serum sample was used for confirmation by Microagglutination test (MAT). Simultaneously, tissue samples were tested by PCR for the most common viral (dengue, Zika, and chikungunya), bacterial (Brucella spp., and Rickettsia spp.), and parasitic (malaria). Fresh tissue samples from 92 fatal suspected leptospirosis cases were reported to the National Reference Laboratory from 22/32 departments in Colombia. We confirmed leptospirosis in 27% (25/92) of cases. Other pathogens identified by real-time PCR were Brucella spp. (10.9%), Rickettsia spp. (14.1%), and dengue (2.2%). Dengue (6.9%), hepatitis (3.5%), and Yellow Fever cases (2.2%) were detected by the pathology. All patients were negative for chikungunya and Plasmodium spp. Most cases were classified as undifferentiated febrile illnesses (45.7%; 42/92). CONCLUSIONS/SIGNIFICANCE This study underscores the importance of early and accurate recognition of leptospirosis to prevent mortalities. Moreover, it draws attention to the existence of other febrile syndromes in Colombia, including rickettsiosis and brucellosis, that currently lack sufficient human surveillance and regular reporting. Expanding laboratory surveillance to include viruses such as Hantavirus, Mayaro virus, Oropouche virus, and West Nile virus is crucial.
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Affiliation(s)
- Eliana L Parra Barrera
- Grupo de Microbiología, Subdirección Laboratorio Nacional de Referencia. Dirección de Redes en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
- Grupo de Virología, Subdirección Laboratorio Nacional de Referencia. Dirección de Redes en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
| | - Jhonatan Reales-González
- Grupo de Microbiología, Subdirección de Investigación en Salud Pública. Instituto Nacional de Salud, Bogotá, Colombia
| | - Daniela Salas
- Grupo de Enfermedades Transmitidas por Vectores y Zoonosis, Instituto Nacional de Salud, Bogotá, Colombia
| | - Elizabeth Reyes Santamaría
- Departamento de Medicina interna y Departamento de Medicina crítica y cuidados intensivos. Hospital Universitario Fundación Santa Fe de Bogotá, Colombia
| | - Solmara Bello
- Grupo de Microbiología, Subdirección Laboratorio Nacional de Referencia. Dirección de Redes en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
| | - Angélica Rico
- Grupo de Virología, Subdirección Laboratorio Nacional de Referencia. Dirección de Redes en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
- Grupo de Enfermedades Transmisibles Prevenibles por Vacunación en Salud, Dirección de Vigilancia y Análisis del Riesgo en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
| | - Lissethe Pardo
- Grupo de Virología, Subdirección Laboratorio Nacional de Referencia. Dirección de Redes en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
| | - Edgar Parra
- Grupo de Patología, Subdirección Laboratorio Nacional de Referencia. Dirección de Redes en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
| | - Karina Rodriguez
- Grupo de Microbiología, Subdirección Laboratorio Nacional de Referencia. Dirección de Redes en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
| | - Zonía Alarcon
- Grupo de Microbiología, Subdirección de Investigación en Salud Pública. Instituto Nacional de Salud, Bogotá, Colombia
| | - Angela Patricia Guerra Vega
- Grupo de Parasitología, Subdirección Laboratorio Nacional de Referencia. Dirección de Redes en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
| | - Mayra A Porras
- Grupo de Virología, Subdirección Laboratorio Nacional de Referencia. Dirección de Redes en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
| | - Sergio Yebrail Gomez-Rangel
- Grupo de Virología, Subdirección Laboratorio Nacional de Referencia. Dirección de Redes en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
| | - Carolina Duarte
- Grupo de Microbiología, Subdirección Laboratorio Nacional de Referencia. Dirección de Redes en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
| | - Jaime Moreno
- Grupo de Microbiología, Subdirección de Investigación en Salud Pública. Instituto Nacional de Salud, Bogotá, Colombia
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Parra Barrera EL, Bello S, Gallego-Lopez GM, Atero N, Reyes Santamaría E, Bautista A. Distribution, frequency and clinical presentation of leptospirosis and coinfections: a systematic review protocol. BMJ Open 2022; 12:e055187. [PMID: 36526310 PMCID: PMC9764663 DOI: 10.1136/bmjopen-2021-055187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Leptospirosis is a zoonotic disease with high prevalence in low-income and middle-income countries and tropical and subtropical regions. The clinical symptoms of the disease are similar to symptoms presented by other endemic infectious diseases that could be present simultaneously. Thus, leptospirosis could be masked by similar infections like dengue, malaria, hantavirus, melioidosis and borreliosis, among others. Therefore, leptospirosis could present itself as an under-reported infection or as a coinfection with another pathogen, as has been reported in the literature. However, there is a lack of documented evidence about the specific risk factors of leptospirosis infection, the symptoms, the coinfection's mortality and the frequency of coinfection. Additionally, leptospirosis coinfections have not been considered a neglected public health concern. Therefore, this systematic review aims to evaluate published articles that show the risk factors associated with leptospirosis infection and coinfection with other pathogens. METHODS AND ANALYSIS The search process to identify eligible studies will be conducted including the LILACS, ProQuest, PubMed and Scopus databases with no restriction in terms of publication date. Also, grey literature will be included in the research. Authors will independently screen the title and abstracts of the articles identified from the search using Rayyan free software. Eligibility criteria include peer-reviewed research articles written in English or Spanish, including observational studies, cohorts, case-control, cross-sectional, ecological studies and report cases. The systematic review will include studies that report descriptions of leptospirosis cases with coinfection or co-occurrence. The search will be accomplished by articles from 1950 to May 2022. The data will be extracted in a standard extraction form using an Excel format. ETHICS AND DISSEMINATION Results will be published in a peer-reviewed journal. Also, findings will be disseminated through scientific meetings. Ethical approval will not be required as this is a systematic review and primary data will be not collected or included. PROSPERO REGISTRATION NUMBER CRD42021234754.
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Affiliation(s)
- Eliana L Parra Barrera
- Grupo de Salud Ambiental y Laboral, Instituto Nacional de Salud, Bogotá, Colombia
- Subdirección de Estudios Clínicos y Epidemiología clínica, Fundacion Santa Fe de Bogota, Bogota, Colombia
- Multidisciplinary Initiative for Collaborative Research in Bacterial Resistance (MICROB-R), Santiago, RM, Chile
| | - Solmara Bello
- Subdirección de Estudios Clínicos y Epidemiología clínica, Fundacion Santa Fe de Bogota, Bogota, Colombia
- Grupo de Microbiología, Instituto Nacional de Salud, Bogotá, Colombia
| | - Gina M Gallego-Lopez
- Morgridge Institute for Research, Madison, WI, 53706, United States of America, Madison, Wisconsin, USA
- Department of Medical Microbiology and Immunology, University of Wisconsin, Madison, Wisconsin, USA
| | - Nicolhole Atero
- Escuela de Medicina Veterinaria, Facultad de Agronomía e Ingeniería Forestal, Facultad de Ciencias Biológicas y Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Elízabeth Reyes Santamaría
- Departamento de Medicina interna, Fundación Santa Fe de Bogotá, Bogotá, Colombia
- Departamento de Medicina critica y cuidado intensivo, Fundación Santa Fe de Bogotá, Bogotá, Colombia
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Artus A, Schafer IJ, Cossaboom CM, Haberling DL, Galloway R, Sutherland G, Browne AS, Roth J, France V, Cranford HM, Kines KJ, Pompey J, Ellis BR, Walke H, Ellis EM. Seroprevalence, distribution, and risk factors for human leptospirosis in the United States Virgin Islands. PLoS Negl Trop Dis 2022; 16:e0010880. [PMCID: PMC9665390 DOI: 10.1371/journal.pntd.0010880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/10/2022] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Aileen Artus
- Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ilana J. Schafer
- Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail: (IJS); (EME)
| | - Caitlin M. Cossaboom
- Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Epidemic Intelligence Service, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Dana L. Haberling
- Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Renee Galloway
- Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Graham Sutherland
- Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - A. Springer Browne
- Epidemic Intelligence Service, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- U.S. Virgin Islands Department of Health, U.S. Virgin Islands, United States of America
| | - Joseph Roth
- U.S. Virgin Islands Department of Health, U.S. Virgin Islands, United States of America
- Division of Local and State Readiness, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Valicia France
- U.S. Virgin Islands Department of Health, U.S. Virgin Islands, United States of America
| | - Hannah M. Cranford
- U.S. Virgin Islands Department of Health, U.S. Virgin Islands, United States of America
| | - Kristine J. Kines
- Division of Preparedness and Emerging Infections, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Justine Pompey
- Division of Preparedness and Emerging Infections, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Brett R. Ellis
- U.S. Virgin Islands Department of Health, U.S. Virgin Islands, United States of America
| | - Henry Walke
- Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Esther M. Ellis
- U.S. Virgin Islands Department of Health, U.S. Virgin Islands, United States of America
- * E-mail: (IJS); (EME)
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Samrot AV, Sean TC, Bhavya KS, Sahithya CS, Chan-drasekaran S, Palanisamy R, Robinson ER, Subbiah SK, Mok PL. Leptospiral Infection, Pathogenesis and Its Diagnosis-A Review. Pathogens 2021; 10:pathogens10020145. [PMID: 33535649 PMCID: PMC7912936 DOI: 10.3390/pathogens10020145] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/05/2020] [Accepted: 12/09/2020] [Indexed: 12/22/2022] Open
Abstract
Leptospirosis is a perplexing conundrum for many. In the existing literature, the pathophysiological mechanisms pertaining to leptospirosis is still not understood in full. Considered as a neglected tropical zoonotic disease, leptospirosis is culminating as a serious problem worldwide, seemingly existing as co-infections with various other unrelated diseases, including dengue and malaria. Misdiagnosis is also common as non-specific symptoms are documented extensively in the literature. This can easily lead to death, as the severe form of leptospirosis (Weil's disease) manifests as a complex of systemic complications, especially renal failure. The virulence of Leptospira sp. is usually attributed to the outer membrane proteins, including LipL32. With an armament of virulence factors at their disposal, their ability to easily adhere, invade and replicate within cells calls for a swift refinement in research progress to establish their exact pathophysiological framework. As an effort to reconstitute the current knowledge on leptospirosis, the basis of leptospiral infection, including its risk factors, classification, morphology, transmission, pathogenesis, co-infections and clinical manifestations are highlighted in this review. The various diagnostic techniques are also outlined with emphasis on their respective pros and cons.
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Affiliation(s)
- Antony V. Samrot
- School of Bioscience, Faculty of Medicine, Bioscience and Nursing, MAHSA University, Jenjarom, Selangor 42610, Malaysia;
- Correspondence: (A.V.S.); (P.L.M.)
| | - Tan Chuan Sean
- School of Bioscience, Faculty of Medicine, Bioscience and Nursing, MAHSA University, Jenjarom, Selangor 42610, Malaysia;
| | - Karanam Sai Bhavya
- Department of Biotechnology, School of Bio and Chemical Engineering, Sathyabama Institute of Science and Technology, Jeppiaar Nagar, Chennai, Tamil Nadu 627 011, India; (K.S.B.); (C.S.S.); (S.C.); (R.P.)
| | - Chamarthy Sai Sahithya
- Department of Biotechnology, School of Bio and Chemical Engineering, Sathyabama Institute of Science and Technology, Jeppiaar Nagar, Chennai, Tamil Nadu 627 011, India; (K.S.B.); (C.S.S.); (S.C.); (R.P.)
| | - SaiPriya Chan-drasekaran
- Department of Biotechnology, School of Bio and Chemical Engineering, Sathyabama Institute of Science and Technology, Jeppiaar Nagar, Chennai, Tamil Nadu 627 011, India; (K.S.B.); (C.S.S.); (S.C.); (R.P.)
| | - Raji Palanisamy
- Department of Biotechnology, School of Bio and Chemical Engineering, Sathyabama Institute of Science and Technology, Jeppiaar Nagar, Chennai, Tamil Nadu 627 011, India; (K.S.B.); (C.S.S.); (S.C.); (R.P.)
| | - Emilin Renitta Robinson
- Department of Food Processing Technology, Karunya Institute of Technology and Science, Coimbatore, Tamil Nadu 641 114, India;
| | - Suresh Kumar Subbiah
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM Serdang, Selangor 43400, Malaysia;
- Department of Biotechnology, Bharath Institute of Higher Education and Research (BIHER), Selaiyur, Tamil Nadu 600 073, India
- Genetics and Regenerative Medicine Research Centre, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM Serdang, Selangor 43400, Malaysia
| | - Pooi Ling Mok
- Department of Biotechnology, Bharath Institute of Higher Education and Research (BIHER), Selaiyur, Tamil Nadu 600 073, India
- Genetics and Regenerative Medicine Research Centre, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM Serdang, Selangor 43400, Malaysia
- Department of Biomedical Science, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM Serdang, Selangor 43400, Malaysia
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Jouf University, Sakaka P.O. Box 2014, Aljouf Province, Saudi Arabia
- Correspondence: (A.V.S.); (P.L.M.)
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Sharp TM, Quandelacy TM, Adams LE, Aponte JT, Lozier MJ, Ryff K, Flores M, Rivera A, Santiago GA, Muñoz-Jordán JL, Alvarado LI, Rivera-Amill V, Garcia-Negrón M, Waterman SH, Paz-Bailey G, Johansson MA, Rivera-Garcia B. Epidemiologic and spatiotemporal trends of Zika Virus disease during the 2016 epidemic in Puerto Rico. PLoS Negl Trop Dis 2020; 14:e0008532. [PMID: 32956416 PMCID: PMC7529257 DOI: 10.1371/journal.pntd.0008532] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 10/01/2020] [Accepted: 06/28/2020] [Indexed: 12/16/2022] Open
Abstract
Background After Zika virus (ZIKV) emerged in the Americas, laboratory-based surveillance for arboviral diseases in Puerto Rico was adapted to include ZIKV disease. Methods and findings Suspected cases of arboviral disease reported to Puerto Rico Department of Health were tested for evidence of infection with Zika, dengue, and chikungunya viruses by RT-PCR and IgM ELISA. To describe spatiotemporal trends among confirmed ZIKV disease cases, we analyzed the relationship between municipality-level socio-demographic, climatic, and spatial factors, and both time to detection of the first ZIKV disease case and the midpoint of the outbreak. During November 2015–December 2016, a total of 71,618 suspected arboviral disease cases were reported, of which 39,717 (55.5%; 1.1 cases per 100 residents) tested positive for ZIKV infection. The epidemic peaked in August 2016, when 71.5% of arboviral disease cases reported weekly tested positive for ZIKV infection. Incidence of ZIKV disease was highest among 20–29-year-olds (1.6 cases per 100 residents), and most (62.3%) cases were female. The most frequently reported symptoms were rash (83.0%), headache (64.6%), and myalgia (63.3%). Few patients were hospitalized (1.2%), and 13 (<0.1%) died. Early detection of ZIKV disease cases was associated with increased population size (log hazard ratio [HR]: -0.22 [95% confidence interval -0.29, -0.14]), eastern longitude (log HR: -1.04 [-1.17, -0.91]), and proximity to a city (spline estimated degrees of freedom [edf] = 2.0). Earlier midpoints of the outbreak were associated with northern latitude (log HR: -0.30 [-0.32, -0.29]), eastern longitude (spline edf = 6.5), and higher mean monthly temperature (log HR: -0.04 [-0.05, -0.03]). Higher incidence of ZIKV disease was associated with lower mean precipitation, but not socioeconomic factors. Conclusions During the ZIKV epidemic in Puerto Rico, 1% of residents were reported to public health authorities and had laboratory evidence of ZIKV disease. Transmission was first detected in urban areas of eastern Puerto Rico, where transmission also peaked earlier. These trends suggest that ZIKV was first introduced to Puerto Rico in the east before disseminating throughout the island. During epidemics of Zika virus disease in the Americas in 2015 and 2016, assessment of transmission dynamics was limited by inconsistent laboratory testing of patients with suspected Zika virus disease. This limitation was further complicated by co-circulation of dengue and chikungunya viruses, which cause illnesses clinically similar to Zika virus disease. In Puerto Rico, all reported suspect cases of arboviral disease were tested for Zika, dengue, and chikungunya virus infection throughout the epidemic, which allowed for fine-scale analysis of epidemiologic and spatiotemporal trends. In total, 39,717 cases of Zika virus disease were detected, or roughly 1% of all residents of Puerto Rico. Young adults and females were most affected. Disease was mostly mild, as only 1% of cases were hospitalized. Thirteen patients with Zika virus disease died, most of whom had Guillain-Barré syndrome or severe underlying illnesses. Early detection of Zika virus disease cases was associated with more populated areas of eastern Puerto Rico, where early detection of peak case numbers also occurred, particularly in warmer areas. These trends suggest that, in contrast to prior epidemics of dengue and chikungunya that started in the San Juan metropolitan region, the Zika virus epidemic appears to have begun in eastern Puerto Rico.
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Affiliation(s)
- Tyler M. Sharp
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
- US Public Health Service, Rockville, Maryland, United States of America
- * E-mail:
| | - Talia M. Quandelacy
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Laura E. Adams
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
- US Public Health Service, Rockville, Maryland, United States of America
| | - Jomil Torres Aponte
- Office of Epidemiology, Puerto Rico Department of Health, San Juan, Puerto Rico
| | - Matthew J. Lozier
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
- US Public Health Service, Rockville, Maryland, United States of America
| | - Kyle Ryff
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Mitchelle Flores
- Biological and Chemical Emergencies Laboratory, Puerto Rico Department of Health, San Juan, Puerto Rico
| | - Aidsa Rivera
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Gilberto A. Santiago
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | | | | | | | | | - Stephen H. Waterman
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
- US Public Health Service, Rockville, Maryland, United States of America
| | - Gabriela Paz-Bailey
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Michael A. Johansson
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Brenda Rivera-Garcia
- Biological and Chemical Emergencies Laboratory, Puerto Rico Department of Health, San Juan, Puerto Rico
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Lobkowicz L, Ramond A, Sanchez Clemente N, Ximenes RADA, Miranda-Filho DDB, Montarroyos UR, Martelli CMT, de Araújo TVB, Brickley EB. The frequency and clinical presentation of Zika virus coinfections: a systematic review. BMJ Glob Health 2020; 5:e002350. [PMID: 32381652 PMCID: PMC7228501 DOI: 10.1136/bmjgh-2020-002350] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/24/2020] [Accepted: 04/07/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND There is limited knowledge on the influence of concurrent coinfections on the clinical presentation of Zika virus (ZIKV) disease. METHODS To better understand the types, frequencies and clinical manifestations of ZIKV coinfections, we did a systematic review of four databases (PubMed, Embase, Web of Science, LILACS) without restrictions for studies on ZIKV coinfections confirmed by nucleic acid (quantitative real-time-PCR) testing of ZIKV and coinfecting pathogens. The review aimed to identify cohort, cross-sectional, case series and case report studies that described frequencies and/or clinical signs and symptoms of ZIKV coinfections. Conference abstracts, reviews, commentaries and studies with imprecise pathogen diagnoses and/or no clinical evaluations were excluded. RESULTS The search identified 34 articles from 10 countries, comprising 2 cohort, 10 cross-sectional, 8 case series and 14 case report studies. Coinfections were most frequently reported to have occurred with other arthropod-borne viruses (arboviruses); out of the 213 coinfections described, ZIKV infections co-occurred with chikungunya in 115 cases, with dengue in 68 cases and with both viruses in 19 cases. Other coinfecting agents included human immunodeficiency, Epstein-Barr, human herpes and Mayaro viruses, Leptospira spp, Toxoplasma gondii and Schistosoma mansoni. ZIKV-coinfected cases primarily presented with mild clinical features, typical of ZIKV monoinfection; however, 9% of cases in cohort and cross-sectional studies were reported to experience complications. CONCLUSION Based on the evidence collated in this review, coinfections do not appear to strongly influence the clinical manifestations of uncomplicated ZIKV infections. Further research is needed to confirm whether risk of severe complications is altered when ZIKV infection co-occurs with other infections. PROSPERO REGISTRATION NUMBER CRD42018111023.
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Affiliation(s)
- Ludmila Lobkowicz
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Anna Ramond
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Nuria Sanchez Clemente
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | | | - Elizabeth B Brickley
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Rodríguez-Morales AJ, Ramírez-Vallejo E, Alvarado-Arnez LE, Paniz-Mondolfi A, Zambrano LI, Ko AI. Fatal Zika virus disease in adults: A critical reappraisal of an under-recognized clinical entity. Int J Infect Dis 2019; 83:160-162. [PMID: 30858118 DOI: 10.1016/j.ijid.2019.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 03/04/2019] [Indexed: 12/16/2022] Open
Affiliation(s)
- Alfonso J Rodríguez-Morales
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia; Colombian Collaborative Network of Zika (RECOLZIKA), Pereira, Risaralda, Colombia.
| | - Eduardo Ramírez-Vallejo
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia; Colombian Collaborative Network of Zika (RECOLZIKA), Pereira, Risaralda, Colombia; Eduardo Ramirez Vallejo Cardiologia SAS, Pereira, Risaralda, Colombia
| | | | - Alberto Paniz-Mondolfi
- Colombian Collaborative Network of Zika (RECOLZIKA), Pereira, Risaralda, Colombia; Department of Infectious Diseases and Tropical Medicine, Clínica IDB Cabudare, Instituto de Investigaciones Biomédicas IDB, Barquisimeto, 3023, Lara, Venezuela; Infectious Diseases Research Branch, Venezuelan Science Incubator and the Zoonosis and Emerging Pathogens Regional Collaborative Network, Cabudare, 3023, Lara, Venezuela; Laboratorio de Señalización Celular y Bioquímica de Parásitos, Instituto de Estudios Avanzados (IDEA), Caracas, Venezuela; Academia Nacional de Medicina, Caracas, Venezuela
| | - Lysien I Zambrano
- Colombian Collaborative Network of Zika (RECOLZIKA), Pereira, Risaralda, Colombia; Department of Morphological Sciences, School of Medical, Sciences, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras; Cardiovascular Division, Department of Physiology, Escola Paulista de Medicina (UNIFESP-EPM), Universidade Federal de São Paulo, São Paulo, Brazil
| | - Albert I Ko
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA; Instituto Gonçalo Moniz, Fundação Oswaldo Cruz/MS, Salvador, Bahia, Brazil
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Benavidez KM, Guerra T, Torres M, Rodriguez D, Veech JA, Hahn D, Miller RJ, Soltero FV, Ramírez AEP, Perez de León A, Castro-Arellano I. The prevalence of Leptospira among invasive small mammals on Puerto Rican cattle farms. PLoS Negl Trop Dis 2019; 13:e0007236. [PMID: 31107872 PMCID: PMC6544380 DOI: 10.1371/journal.pntd.0007236] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 05/31/2019] [Accepted: 02/12/2019] [Indexed: 12/17/2022] Open
Abstract
Leptospirosis, an emerging infectious disease caused by bacteria of the genus Leptospira, is thought to be the most widespread zoonotic disease in the world. A first step in preventing the spread of Leptospira is delineating the animal reservoirs that maintain and disperse the bacteria. Quantitative PCR (qPCR) methods targeting the LipL32 gene were used to analyze kidney samples from 124 House mice (Mus musculus), 94 Black rats (Rattus rattus), 5 Norway rats (R. norvegicus), and 89 small Indian mongooses (Herpestes auropunctatus) from five cattle farms in Puerto Rico. Renal carriage of Leptospira was found in 38% of the sampled individuals, with 59% of the sampled mice, 34% of Black rats, 20% of Norway rats, and 13% of the mongooses. A heterogeneous distribution of prevalence was also found among sites, with the highest prevalence of Leptospira-positive samples at 52% and the lowest at 30%. Comparative sequence analysis of the LipL32 gene from positive samples revealed the presence of two species of Leptospira, L. borgpetersenii and L. interrogans in mice, detected in similar percentages in samples from four farms, while samples from the fifth farm almost exclusively harbored L. interrogans. In rats, both Leptospira species were found, while mongooses only harbored L. interrogans. Numbers tested for both animals, however, were too small (n = 7 each) to relate prevalence of Leptospira species to location. Significant associations of Leptospira prevalence with anthropogenic landscape features were observed at farms in Naguabo and Sabana Grande, where infected individuals were closer to human dwellings, milking barns, and ponds than were uninfected individuals. These results show that rural areas of Puerto Rico are in need of management and longitudinal surveillance of Leptospira in order to prevent continued infection of focal susceptible species (i.e. humans and cattle).
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Affiliation(s)
- Kathryn M. Benavidez
- Department of Biology, Texas State University, San Marcos, Texas, United States of America
| | - Trina Guerra
- Department of Biology, Texas State University, San Marcos, Texas, United States of America
| | - Madison Torres
- Department of Biology, Texas State University, San Marcos, Texas, United States of America
| | - David Rodriguez
- Department of Biology, Texas State University, San Marcos, Texas, United States of America
| | - Joseph A. Veech
- Department of Biology, Texas State University, San Marcos, Texas, United States of America
| | - Dittmar Hahn
- Department of Biology, Texas State University, San Marcos, Texas, United States of America
| | - Robert J. Miller
- Cattle Fever Tick Research Laboratory, United States Department of Agriculture–Agricultural Research Service, MAB 6419, Edinburg, Texas, United States of America
| | - Fred V. Soltero
- Animal and Plant Health Inspection Service PR and USVI SPRS District 2, United States Department of Agriculture, Hato Rey, Puerto Rico
| | - Alejandro E. Pérez Ramírez
- Agrological Laboratory Analysis & Registration of Agricultural Materials PR Dept. of Agriculture 7 Carr. 693 Dorado, PR
| | - Adalberto Perez de León
- Knippling-Bushland U.S. Livestock Insects Research Laboratory, United States Department of Agriculture–Agricultural Research Service, Kerrville, Texas, United States of America
- Veterinary Pest Genomics Center, United States Department of Agriculture–Agricultural Research Service, Kerrville, TX, United States of America
| | - Iván Castro-Arellano
- Department of Biology, Texas State University, San Marcos, Texas, United States of America
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9
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Jayathilaka PGNS, Mendis ASV, Perera MHMTS, Damsiri HMT, Gunaratne AVC, Agampodi SB. An outbreak of leptospirosis with predominant cardiac involvement: a case series. BMC Infect Dis 2019; 19:265. [PMID: 30885170 PMCID: PMC6423826 DOI: 10.1186/s12879-019-3905-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 03/14/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Severe leptospirosis is known to cause multi organ dysfunction including cardiac involvement. In the clinical setting with limited resources, high degree of suspicion is needed to diagnose cardiac involvement including myocarditis. Although myocarditis is not reported as a common complication due to lack of diagnostic facilities, there are evidence to support myocarditis is more prevalent in post mortem studies of patients died due to leptospirosis. We present a case series of severe leptospirosis with cardiac involvement observed during a period of one month at Colombo-North Teaching Hospital, Sri Lanka. CASE PRESENTATION We report here five patients with severe leptospirosis complicated with cardiac involvement, admitted to a single medical ward, Colombo-North Teaching Hospital, Sri Lanka during a one-month period. Out of six suspected leptospirosis patients admitted during that period, five in a raw developed severe leptospirosis with cardiac involvement. In this case series, four patients were confirmed serologically or quantitative PCR and one patient had possible leptospirosis. All patients developed shock during their course of illness. Two patients developed rapid atrial fibrillation. One patient had dynamic T wave changes in ECG and the other two had sinus tachycardia. Two patients had evidence of myocarditis in 2D echocardiogram, whereas other two patients had nonspecific findings and one patient had normal 2D echocardiogram. All five patients had elevated cardiac troponin I titre and it was normalized with the recovery. All five patients developed acute kidney injury. Four patients needed inotropic/vasopressor support to maintain mean arterial pressure and one patient recovered from shock with fluid resuscitation. All patients were recovered from their illness and repeat 2D echocardiograms after recovery did not show residual complications. One patient had serologically proven dengue co-infection with leptospirosis. CONCLUSIONS Myocarditis and cardiac involvement in leptospirosis may be overlooked due to non-specific clinical findings and co-existing multi-organ dysfunction. Atypical presentation of this case series may be due to micro-geographic variation and unusual outbreak of leptospirosis. Co-infection of dengue with leptospirosis should be considered in managing patients especially in endemic areas.
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Affiliation(s)
| | | | | | | | | | - Suneth Buddhika Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
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10
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Van Dyne EA, Neaterour P, Rivera A, Bello-Pagan M, Adams L, Munoz-Jordan J, Baez P, Garcia M, Waterman SH, Reyes N, Richardson LC, Rivera-Garcia B, Sharp TM. Incidence and Outcome of Severe and Nonsevere Thrombocytopenia Associated With Zika Virus Infection-Puerto Rico, 2016. Open Forum Infect Dis 2018; 6:ofy325. [PMID: 30631791 DOI: 10.1093/ofid/ofy325] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 11/29/2018] [Indexed: 12/28/2022] Open
Abstract
Background Zika virus (ZIKV) infection has been associated with severe thrombocytopenia. We describe the incidence, clinical manifestations, and outcomes of patients with ZIKV infection and thrombocytopenia. Methods We reviewed medical records of patients with ZIKV infection and thrombocytopenia (platelet count <100 ×109 cells/L) in Puerto Rico during 2016. Severe thrombocytopenia was defined by platelet count <20 ×109/L or a platelet count <50 ×109/L and treatment for immune thrombocytopenia (ITP). Results Of 37 878 patients with ZIKV infection, 47 (0.1%) had thrombocytopenia in the absence of an alternative etiology (1.4 cases/100 000 population), including 12 with severe thrombocytopenia. Most patients with thrombocytopenia were adult (77%) and male (53%). Platelet nadir occurred a median (range) of 6 (1-16) and 5 (0-34) days after symptom onset for patients with severe and nonsevere thrombocytopenia, respectively. Among patients with severe thrombocytopenia, all had bleeding, 33% were admitted to the intensive care unit, and 8% died; 50% were treated for ITP. Among 5 patients with severe thrombocytopenia who received intravenous immunoglobulin, the median platelet count increase (range) was 112 (65-202) ×109/L. In contrast, among 4 patients who received platelet transfusion, the median increase in platelet count (range) was 8.5 (-6 to 52) ×109/L. Conclusions Patients with severe thrombocytopenia and ZIKV infection experienced prominent acute morbidity. Consistent with recommended management, administration of ITP treatments to such patients may be more efficacious than platelet transfusion in resolving thrombocytopenia. Severe thrombocytopenia should be considered a rare outcome of ZIKV infection.
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Affiliation(s)
- Elizabeth A Van Dyne
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia.,United States Public Health Service, Silver Springs, Maryland
| | - Paige Neaterour
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Aidsa Rivera
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | | | - Laura Adams
- United States Public Health Service, Silver Springs, Maryland.,Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Jorge Munoz-Jordan
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | | | - Myriam Garcia
- Puerto Rico Department of Health, San Juan, Puerto Rico
| | - Stephen H Waterman
- United States Public Health Service, Silver Springs, Maryland.,Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Nimia Reyes
- Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lisa C Richardson
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Tyler M Sharp
- United States Public Health Service, Silver Springs, Maryland.,Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
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11
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Fatal Dengue, Chikungunya and Leptospirosis: The Importance of Assessing Co-infections in Febrile Patients in Tropical Areas. Trop Med Infect Dis 2018; 3:tropicalmed3040123. [PMID: 30486238 PMCID: PMC6306852 DOI: 10.3390/tropicalmed3040123] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 11/19/2018] [Accepted: 11/20/2018] [Indexed: 12/24/2022] Open
Abstract
The febrile patient from tropical areas, in which emerging arboviruses are endemic, represents a diagnostic challenge, and potential co-infections with other pathogens (i.e., bacteria or parasites) are usually overlooked. We present a case of an elderly woman diagnosed with dengue, chikungunya and Leptospira interrogans co-infection. Study Design: Case report. An 87-year old woman from Colombia complained of upper abdominal pain, arthralgia, myalgia, hyporexia, malaise and intermittent fever accompanied with progressive jaundice. She had a medical history of chronic heart failure (Stage C, New York Heart Association, NYHA III), without documented cardiac murmurs, right bundle branch block, non-valvular atrial fibrillation, hypertension, and chronic venous disease. Her cardiac and pulmonary status quickly deteriorated after 24 h of her admission without electrocardiographic changes and she required ventilatory and vasopressor support. In the next hours the patient evolved to pulseless electrical activity and then she died. Dengue immunoglobulin M (IgM), non-structural protein 1 (NS1) enzyme-linked immunosorbent assay (ELISA), microagglutination test (MAT) for Leptospira interrogans and reverse transcription polymerase chain reaction (RT-PCR) for chikungunya, were positive. This case illustrates a multiple co-infection in a febrile patient from a tropical area of Latin America that evolved to death.
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