1
|
Valente M, Bramugy J, Keddie SH, Hopkins H, Bassat Q, Baerenbold O, Bradley J, Falconer J, Keogh RH, Newton PN, Picardeau M, Crump JA. Diagnosis of human leptospirosis: systematic review and meta-analysis of the diagnostic accuracy of the Leptospira microscopic agglutination test, PCR targeting Lfb1, and IgM ELISA to Leptospira fainei serovar Hurstbridge. BMC Infect Dis 2024; 24:168. [PMID: 38326762 PMCID: PMC10848445 DOI: 10.1186/s12879-023-08935-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/19/2023] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Leptospirosis is an underdiagnosed infectious disease with non-specific clinical presentation that requires laboratory confirmation for diagnosis. The serologic reference standard remains the microscopic agglutination test (MAT) on paired serum samples. However, reported estimates of MAT's sensitivity vary. We evaluated the accuracy of four index tests, MAT on paired samples as well as alternative standards for leptospirosis diagnosis: MAT on single acute-phase samples, polymerase chain reaction (PCR) with the target gene Lfb1, and ELISA IgM with Leptospira fainei serovar Hurstbridge as an antigen. METHODS We performed a systematic review of studies reporting results of leptospirosis diagnostic tests. We searched eight electronic databases and selected studies that tested human blood samples and compared index tests with blood culture and/or PCR and/or MAT (comparator tests). For MAT selection criteria we defined a threshold for single acute-phase samples according to a national classification of leptospirosis endemicity. We used a Bayesian random-effect meta-analysis to estimate the sensitivity and specificity of MAT in single acute-phase and paired samples separately, and assessed risk of bias using the Quality Assessment of Studies of Diagnostic Accuracy Approach- 2 (QUADAS-2) tool. RESULTS For the MAT accuracy evaluation, 15 studies were included, 11 with single acute-phase serum, and 12 with paired sera. Two included studies used PCR targeting the Lfb1 gene, and one included study used IgM ELISA with Leptospira fainei serovar Hurstbridge as antigen. For MAT in single acute-phase samples, the pooled sensitivity and specificity were 14% (95% credible interval [CrI] 3-38%) and 86% (95% CrI 59-96%), respectively, and the predicted sensitivity and specificity were 14% (95% CrI 0-90%) and 86% (95% CrI 9-100%). Among paired MAT samples, the pooled sensitivity and specificity were 68% (95% CrI 32-92%) and 75% (95% CrI 45-93%) respectively, and the predicted sensitivity and specificity were 69% (95% CrI 2-100%) and 75% (2-100%). CONCLUSIONS Based on our analysis, the accuracy of MAT in paired samples was not high, but it remains the reference standard until a more accurate diagnostic test is developed. Future studies that include larger numbers of participants with paired samples will improve the certainty of accuracy estimates.
Collapse
Affiliation(s)
- Marta Valente
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Calle Rosselló, 171, Entresol, Barcelona, 08036, Spain.
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.
| | - Justina Bramugy
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | | | - Heidi Hopkins
- London School of Hygiene & Tropical Medicine, London, UK
| | - Quique Bassat
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Calle Rosselló, 171, Entresol, Barcelona, 08036, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ICREA, Pg. Lluís Companys 23, Barcelona, 08010, Spain
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - John Bradley
- London School of Hygiene & Tropical Medicine, London, UK
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Jane Falconer
- London School of Hygiene & Tropical Medicine, London, UK
| | - Ruth H Keogh
- London School of Hygiene & Tropical Medicine, London, UK
| | - Paul N Newton
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Lao-Oxford-Mahosot Hospital Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | - Mathieu Picardeau
- Biology of Spirochetes Unit, French National Reference Centre for Leptospirosis, Institut Pasteur, Université Paris Cité, Paris, F-75015, France
| | - John A Crump
- Centre for International Health, University of Otago, Dunedin, New Zealand
| |
Collapse
|
2
|
Zhang Y, Zheng Y. Leptospirosis-associated meningitis in a patient with sjögren's syndrome: a case report. BMC Infect Dis 2023; 23:778. [PMID: 37946137 PMCID: PMC10636908 DOI: 10.1186/s12879-023-08794-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/06/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Leptospirosis is a zoonotic disease that afflicts both humans and animals. It progresses from flu-like symptoms to more severe hepatic and renal failure, and may also lead to aseptic meningitis. Individuals with autoimmune diseases (ADs) are potentially more susceptible to Leptospirosis. Thus far, limited data has documented the association between Leptospirosis and autoimmune disorders. CASE PRESENTATION The patient had a definitive pathological diagnosis of Sjögren's syndrome (SS). Due to recurrent headaches, the patient sought consultation with a neurologist. Lumbar puncture revealed elevated white blood cells and protein levels in the cerebrospinal fluid, along with decreased glucose. Tuberculous meningitis was suspected. Radiographic imaging exhibited meningeal enhancement, ventricular enlargement, and hydrocephalus. The patient commenced treatment with anti-tuberculosis therapy and corticosteroids. Subsequently, high-throughput sequencing (HTS) of cerebrospinal fluid identified the presence of Leptospira interrogans. The patient was ultimately diagnosed with Leptospiral meningitis, and underwent antimicrobial and immunosuppressive therapy, resulting in stabilization of the condition and gradual symptom recovery. CONCLUSIONS The case highlights the challenges in diagnosing and managing leptospirosis-related meningitis in the presence of ADs and emphasizes the importance of utilizing HTS for accurate pathogen detection. The potential correlation between leptospirosis and SS warrants further investigation, as does the need for multidisciplinary involvement in treatment strategies for such complex cases.
Collapse
Affiliation(s)
- Yifan Zhang
- Neurological Center, Shenzhen Baoan People's Hospital, Shenzhen, China
| | - Yong Zheng
- Neurological Center, Shenzhen Baoan People's Hospital, Shenzhen, China.
| |
Collapse
|
3
|
Mišić-Majerus L, Kišek TC, Ružić-Sabljić E. Leptospirosis and characterization of Leptospira isolates from patients in Koprivnica-Križevci County, Croatia from 2000-2004. Access Microbiol 2023; 5:acmi000431. [PMID: 37223056 PMCID: PMC10202403 DOI: 10.1099/acmi.0.000431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 02/28/2023] [Indexed: 05/25/2023] Open
Abstract
Introduction Leptospirosis, caused by spirochetes of the genus Leptospira , is present in the Koprivnica-Križevci County area, Croatia. Clinical manifestation can range from asymptomatic, short-term mild, non-specific febrile disease, to severe forms with high mortality rates. Aim The aim of the study was to valuate culture in front of microscopic agglutination test (MAT) for diagnosis of infection, and to evaluate clinical and laboratory features of the disease. Moreover, we want to characterize Leptospira strains involved in infection in Koprivnica-Križevci County, Croatia. Methods We included 68 patients with clinical presentation consistent with leptospirosis collected in a 5-year period (2000-2004). Clinical samples (blood, urine and cerebrospinal fluid, CSF) were inoculated in Kolthoff's medium; species of isolated Leptospira strains was determined with Tm of real-time PCR, serogroup/serovar with MAT and NotI-RFLP analysis. Demonstration of specific antibodies in patients' sera was done using microscopic agglutination test. Results Leptospira was isolated from the blood of 14/51(27.5 %) patients and the most often identified serogroup/serovar was Icterohaemorrhagiae (8/10, 80%) followed by Grippotyphosa (10%). Regarding to species level, 8/10 isolated belonged to L. interrogans sensu stricto and one to L. kirschneri species. MAT was carried out on 51 patients with suspected leptospirosis, and was positive in 11/51(21.5 %) patients. Most of our patients presented with moderate severe symptoms, were hospitalized from August to October, and were infected mainly during the work or recreation in our county. The frequency of particular clinical features and pathological laboratory findings correlated with the severity of the clinical condition. Conclusions Leptospirosis can be confirmed microbiologically, culture and MAT contributed almost equally to the diagnosis of infection. Serovar Icterohaemorrhagiae was found as the dominant one, and L. interrogans sensu stricto as dominant species in our county. Epidemiological data shown that leptospirosis occurs seasonally, affects the rural population, and most commonly is presented with moderate severe clinical course.
Collapse
Affiliation(s)
- Ljiljana Mišić-Majerus
- Department of Infectious Diseases, General Hospital "Dr. Tomislav Bardek", Željka Selingera 1, Koprivnica, Croatia
| | - Tjaša Cerar Kišek
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Ljubljana, Zaloška 4, Ljubljana, Slovenia
| | - Eva Ružić-Sabljić
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Ljubljana, Zaloška 4, Ljubljana, Slovenia
| |
Collapse
|
4
|
Zhu Z, Feng J, Dong Y, Jiang B, Wang X, Li F. Cerebral infarct induced by severe leptospirosis-a case report and literature review. BMC Neurol 2022; 22:506. [PMID: 36581810 PMCID: PMC9798630 DOI: 10.1186/s12883-022-03021-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 12/09/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Although most leptospirosis is mild, the severe form can cause multiple complications, with a fatality rate of over 50% even with ICU support. The clinical manifestations of leptospirosis vary depending on organs and tissues involved. Both cerebral artery and coronary artery can be damaged by leptospirosis. Although cerebral arteritis induced by leptospirosis has been reported, cerebral infarction caused by leptospirosis is rarely reported. CASE PRESENTATION We report the case of a 79-year-old man admitted to intensive care unit (ICU) because of 3 days duration of fever, bloody sputum and dyspnea. Five days before he was admitted to hospital, he had harvested rice in flooded fields. After admission, leptospira interrogans DNA sequence was identified in bronchoalveolar lavage fluid (BALF) by next-generation sequencing (NGS). Microscopic agglutination test (MAT) showed the serum antibody of Mini serovars was 1,600 and Hebdomadis serovars was 800. On the eighth day of admission, the patient noted left hemiplegia. Cranial CT scan revealed low-density shadow in the right basal ganglia, so cerebral infarction was diagnosed. The patient's condition rapidly deteriorated and he died on the eleventh day of admission despite penicillin treatment, invasive mechanical ventilation and continuous renal replacement support. CONCLUSION Neurologic leptospirosis manifested as cerebral occlusion, although rare, might be deadly and should not be ignored.
Collapse
Affiliation(s)
- Zhongli Zhu
- Department of critical care medicine, The General Hospital of Western Theater Command, 270 Tianhui Road, Chengdu, Sichuan 610083 China
| | - Jian Feng
- Department of critical care medicine, The General Hospital of Western Theater Command, 270 Tianhui Road, Chengdu, Sichuan 610083 China
| | - Yong Dong
- Department of critical care medicine, Dazhu County People’s Hospital, 99 Qingnian Road, Sichuan Dazhou, 635199 China
| | - Bin Jiang
- Department of critical care medicine, Dazhu County People’s Hospital, 99 Qingnian Road, Sichuan Dazhou, 635199 China
| | - Xiong Wang
- Department of cardiovascular medicine, The General Hospital of Western Theater Command, 270 Tianhui Road, Chengdu, Sichuan 610083 China
| | - Fuxiang Li
- Department of critical care medicine, The General Hospital of Western Theater Command, 270 Tianhui Road, Chengdu, Sichuan 610083 China
| |
Collapse
|
5
|
Comia IR, Miambo RD, Noormahomed EV, Mahoche M, Pondja A, Schooley RT, Benson C, Sacarlal J. A systematic review and meta-analysis of the epidemiology of Leptospirosis in HIV uninfected and in people living with HIV from the Southern African Development Community. PLoS Negl Trop Dis 2022; 16:e0010823. [PMID: 36508469 PMCID: PMC9744292 DOI: 10.1371/journal.pntd.0010823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 09/16/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Leptospirosis is an occupational, neglected febrile disease of bacterial origin transmitted between humans and animals. In this manuscript we summarize available data on Leptospira infection in HIV uninfected and in people living with HIV from the Southern African Development Community (SADC) countries, identifying gaps in knowledge and recommend future research priorities. METHODOLOGY Articles published between 1990 and 2021 were accessed by an online search of Google Scholar and Medline/PubMed performed between February 2020 and July 2022. The STATA program was used for the Meta-analysis. Pooled prevalence values with 95% confidence intervals and heterogeneity were determined. RESULTS Thirty studies from eight SADC countries, reporting the prevalence on Leptospira were reviewed. A pooled prevalence of 19% (CI: 13-25%), a heterogeneity level of 96% and index score ranging from 2 to 9 was determined. Only four (4) studies reported HIV co-infection status. Three species of Leptospira (Leptospira interrogans (4), L. kirschneri (3), Leptospira borgpetersenii (1) and 23 serogroups were identified. The most frequently reported serogroups were Icterohaemorrhagiae (13), Grippotyphosa and Australis (10) followed by Sejroe (8). CONCLUSION Studies on human leptospirosis in the SADC region are scarce, especially in people living with HIV. Additional studies aimed at determining the prevalence and the role of the pathogen in people living with HIV, including detailed clinical, molecular and demographic data are recommended.
Collapse
Affiliation(s)
- Isac Rodrigues Comia
- Faculty of Health Sciences, Lúrio University, Nampula, Mozambique
- Department of Microbiology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Regina Daniel Miambo
- Department of Para-Clinics, Faculty of Veterinary, Eduardo Mondlane University, Maputo, Mozambique
- Mozambique Institute for Health Education and Research (MIHER), Maputo, Mozambique
- * E-mail:
| | - Emília Virgínia Noormahomed
- Department of Microbiology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- Mozambique Institute for Health Education and Research (MIHER), Maputo, Mozambique
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, California, United States of America
| | - Manuel Mahoche
- Faculty of Health Sciences, Lúrio University, Nampula, Mozambique
- Mozambique Institute for Health Education and Research (MIHER), Maputo, Mozambique
| | - Alberto Pondja
- Department of Para-Clinics, Faculty of Veterinary, Eduardo Mondlane University, Maputo, Mozambique
| | - Robert Turner Schooley
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, California, United States of America
| | - Constance Benson
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, California, United States of America
| | - Jahit Sacarlal
- Mozambique Institute for Health Education and Research (MIHER), Maputo, Mozambique
| |
Collapse
|
6
|
Rodrigues TC, Santos AL, Pinheiro ES, Piatti RM, Castro V, Buiatte AB, Lima AM, Marmontel M. Survey for Leptospira and Brucella in Amazonian manatees, Amazon river dolphins, and a tucuxi in the Brazilian Amazon. DISEASES OF AQUATIC ORGANISMS 2022; 150:17-29. [PMID: 35796508 DOI: 10.3354/dao03667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Leptospirosis and brucellosis are zoonotic diseases with global distributions that represent severe hazards to humans and animals. We investigated exposure to Leptospira spp. and Brucella spp. in samples from Amazonian manatees Trichechus inunguis, Amazon river dolphins Inia geoffrensis, and a tucuxi Sotalia fluviatilis. The animals were free-ranging or undergoing in situ rehabilitation in the mid-Solimões River region, Brazilian Amazon. Serum samples from 19 Amazonian manatees were tested by microscopic agglutination test, Rose Bengal test, and 2-mercaptoethanol Brucella agglutination test. Antibodies against Leptospira spp. were detected in 63% of the manatees tested and serovar Patoc was considered the infecting serovar in all positive samples. Titers were generally low, indicating chronic exposure, but higher titers indicative of an active infection were detected in 3 animals. Anti-Brucella spp. antibodies were not detected. Tissue and/or body fluid samples from 12 Amazon river dolphins, a tucuxi, and 2 Amazonian manatees were investigated by multiplex PCR and bacteriology for Leptospira spp. and Brucella spp. All samples were negative. However, Enterococcus faecalis was isolated from uterine fluid, lymph node, and lung of 3 Amazon river dolphins. Bacillus spp. were isolated from milk and synovial fluid from 2 Amazon river dolphins and from a milk sample from 1 Amazonian manatee. Knowledge of the pathogens present in Amazonian manatees, Amazon river dolphins, and tucuxis is of great relevance to species conservation and environmental health. Although no clinical signs were noted, further research is needed to elucidate the clinical relevance of infection by Leptospira sp. serovar Patoc in Amazonian aquatic mammals.
Collapse
|
7
|
Molecular Diagnostic Methods For The Detection of Leptospirosis. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2022. [DOI: 10.22207/jpam.16.2.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Leptospirosis is a widespread infectious disease caused by the spirochete Leptospira. The clinical features of leptospirosis are fever, headache, vomiting, jaundice, and the acute form of the disease is commonly called Weil’s disease. The microscopic agglutination test (MAT) is a gold standard method used to detect leptospirosis. However, it requires 14 days of time and skilled personnel to detect leptospirosis. Various molecular methods were developed for the rapid detection process, including polymerase chain reaction (PCR), multiplex PCR, nested PCR, real-time PCR, and Loop-mediated isothermal amplification (LAMP). Other immuno-based biosensor kits are readily available for the diagnosis of leptospirosis. Though these methods claim to be highly sensitive and specific, each method has its drawbacks. This review discusses the different molecular diagnostic techniques applied for the diagnosis of leptospirosis; elaborating on each method’s sensitivity, specificity, and detection time and the different samples of water, blood, and urine used.
Collapse
|
8
|
Role of Diagnostics in Epidemiology, Management, Surveillance, and Control of Leptospirosis. Pathogens 2022; 11:pathogens11040395. [PMID: 35456070 PMCID: PMC9032781 DOI: 10.3390/pathogens11040395] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/22/2022] [Accepted: 03/22/2022] [Indexed: 12/12/2022] Open
Abstract
A One Health approach to the epidemiology, management, surveillance, and control of leptospirosis relies on accessible and accurate diagnostics that can be applied to humans and companion animals and livestock. Diagnosis should be multifaceted and take into account exposure risk, clinical presentation, and multiple direct and/or indirect diagnostic approaches. Methods of direct detection of Leptospira spp. include culture, histopathology and immunostaining of tissues or clinical specimens, and nucleic acid amplification tests (NAATs). Indirect serologic methods to detect leptospiral antibodies include the microscopic agglutination test (MAT), the enzyme-linked immunosorbent assay (ELISA), and lateral flow methods. Rapid diagnostics that can be applied at the point-of-care; NAAT and lateral flow serologic tests are essential for management of acute infection and control of outbreaks. Culture is essential to an understanding of regional knowledge of circulating strains, and we discuss recent improvements in methods for cultivation, genomic sequencing, and serotyping. We review the limitations of NAATs, MAT, and other diagnostic approaches in the context of our expanding understanding of the diversity of pathogenic Leptospira spp. Novel approaches are needed, such as loop mediated isothermal amplification (LAMP) and clustered regularly interspaced short palindromic repeats (CRISPR)-based approaches to leptospiral nucleic acid detection.
Collapse
|
9
|
Evaluation of a genus-specific rGroEL 1-524 IgM-ELISA and commercial ELISA kits during the course of leptospirosis in Thailand. Sci Rep 2021; 11:19785. [PMID: 34611273 PMCID: PMC8492722 DOI: 10.1038/s41598-021-99377-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 09/23/2021] [Indexed: 01/29/2023] Open
Abstract
In the present study, we developed a genus-specific rGroEL1-524 IgM-ELISA assay for use in screening diagnosis of suspected leptospirosis among acute undifferentiated febrile illness patients during acute fever. The diagnostic accuracies of the rGroEL1–524 IgM-ELISA, commercial Panbio IgM-ELISA, and Virion-Serion Classic IgG-ELISA were evaluated using 133 Thai leptospirosis sera and 210 controls. Sensitivities were 91.7%, 59.6%, and 17.7% for acute infection, and the specificities were 92.6%, 90.2%, and 88.3% for the non-leptospirosis control, respectively. The rGroEL1-524 IgM-ELISA had high sensitivity, at 92.3% and 91.7%, among culture-positive and MAT-negative cases at 1–3 days post-onset of symptoms (DPO1–3), respectively. Impaired specificity on scrub typhus was found, possibly from antibody cross-reaction to ortholog GroEL. Commercial Panbio IgM-ELISA had sensitivities at DPO1–3 of 30.8% and 41.7% for culture-positive and MAT-negative cases whereas Virion-Serion IgG-ELISA showed sensitivities of 5.9% and 13.3%, respectively. The rGroEL1-524 IgM-ELISA could be useful as a screening test for early diagnosis. The performance of the commercial ELISA suggests the applicability of IgM-ELISA for diagnosis, while IgG-ELISA is useful for seroprevalence surveys. However, confirmation by reference tests is recommended.
Collapse
|
10
|
Jayasundara D, Gamage C, Senavirathna I, Warnasekara J, Matthias MA, Vinetz JM, Agampodi S. Optimizing the microscopic agglutination test (MAT) panel for the diagnosis of Leptospirosis in a low resource, hyper-endemic setting with varied microgeographic variation in reactivity. PLoS Negl Trop Dis 2021; 15:e0009565. [PMID: 34197457 PMCID: PMC8279374 DOI: 10.1371/journal.pntd.0009565] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/14/2021] [Accepted: 06/15/2021] [Indexed: 11/19/2022] Open
Abstract
The microscopic agglutination test (MAT) is the standard serological reference test for the diagnosis of leptospirosis, despite being a technically demanding and laborious procedure. The use of a locally optimised MAT panel is considered essential for proper performance and interpretation of results. This paper describes the procedure of selecting such an optimised panel for Sri Lanka, a country hyper-endemic for leptospirosis. MAT was performed using 24 strains on 1132 serum samples collected from patients presenting with acute undifferentiated fever. Of 24 strains, 15 were selected as the optimised panel, while only 11% of serum samples showed positivity. A geographical variation in predominantly reactive serovars was observed, whereas reactivity was low with the saprophytic strain Patoc. Testing with paired sera yielded a higher sensitivity but provided only a retrospective diagnosis. Serological tests based on ELISA with complementary molecular diagnosis using PCR are a feasible and robust alternative approach to diagnose leptospirosis in countries having a higher burden of the disease.
Collapse
Affiliation(s)
- Dinesha Jayasundara
- Leptospirosis Research Laboratory, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
- Department of Microbiology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Chandika Gamage
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Indika Senavirathna
- Leptospirosis Research Laboratory, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
- Department of Biochemistry, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Janith Warnasekara
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Michael A. Matthias
- School of Medicine, Yale University, New Haven, Connecticut, United States of America
| | - Joseph M. Vinetz
- School of Medicine, Yale University, New Haven, Connecticut, United States of America
| | - Suneth Agampodi
- Leptospirosis Research Laboratory, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
- School of Medicine, Yale University, New Haven, Connecticut, United States of America
| |
Collapse
|
11
|
Correlation between renal distribution of leptospires during the acute phase and chronic renal dysfunction in a hamster model of infection with Leptospira interrogans. PLoS Negl Trop Dis 2021; 15:e0009410. [PMID: 34143778 PMCID: PMC8213162 DOI: 10.1371/journal.pntd.0009410] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 04/26/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Leptospirosis has been described as a biphasic disease consisting of hematogenous dissemination to major organs in the acute phase and asymptomatic renal colonization in the chronic phase. Several observational studies have suggested an association between leptospirosis and chronic kidney disease (CKD). We investigated the dynamics of leptospires and histopathological changes in the kidney to understand the relationship between them, and also investigated the extent of renal dysfunction in the acute and chronic phases of leptospirosis using a hamster model. FINDINGS Hamsters (n = 68) were subcutaneously infected with 1 × 104 cells of the Leptospira interrogans serovar Manilae strain UP-MMC-SM. A total of 53 infected hamsters developed fatal acute leptospirosis, and the remaining 15 hamsters recovered from the acute phase, 13 of which showed Leptospira colonization in the kidneys in the chronic phase. Five asymptomatic hamsters also had renal colonization in the chronic phase. Immunofluorescence staining showed that leptospires were locally distributed in the renal interstitium in the early acute phase and then spread continuously into the surrounding interstitium. The kidneys of the surviving hamsters in the chronic phase showed patchy lesions of atrophic tubules, a finding of chronic tubulointerstitial nephritis, which were substantially consistent with the distribution of leptospires in the renal interstitium. The degree of atrophic tubules in kidney sections correlated statistically with the serum creatinine level in the chronic phase (rs = 0.78, p = 0.01). CONCLUSION Subcutaneous infection with pathogenic leptospires could cause acute death or chronic leptospirosis in hamsters after surviving the acute phase. We suggest that the renal distribution of leptospires during the acute phase probably affected the extent of tubular atrophy, leading to CKD.
Collapse
|
12
|
Dhawan S, Althaus T, Lubell Y, Suwancharoen D, Blacksell SD. Evaluation of the Panbio Leptospira IgM ELISA among Outpatients Attending Primary Care in Southeast Asia. Am J Trop Med Hyg 2021; 104:1777-1781. [PMID: 33724923 PMCID: PMC8103482 DOI: 10.4269/ajtmh.20-0818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 01/12/2021] [Indexed: 01/12/2023] Open
Abstract
Despite estimates suggesting Leptospira spp. being endemic in Southeast Asia, evidence remains limited. Diagnostic accuracy evaluations based on Leptospira ELISA mainly rely on hospitalized and severe patients; therefore, studies measuring the pathogen burden may be inaccurate in the community. We evaluated the Panbio Leptospira ELISA IgM among 656 febrile outpatients attending primary care in Chiangrai, Thailand, and Hlaing Tha Yar, Yangon, Myanmar. ELISA demonstrated limited diagnostic accuracy for the detection of acute leptospiral infection using the manufacturer recommended cutoff, with a sensitivity of 71.4% and specificity of 36.4%, and an area under the receiver operator characteristic curve value of 0.65 (95% CI: 0.41-0.89), compared with our reference test, the PCR assay. ELISA also performed poorly as a screening tool for detecting recent exposure to Leptospira spp. compared with the "gold-standard" microscopic agglutination test, with a specificity of 42.7%. We conclude that the utility of the Leptospira IgM ELISA for both serodiagnosis and seroprevalence is limited in our setting.
Collapse
Affiliation(s)
- Sandhya Dhawan
- Mahidol-Oxford Tropical Research Medicine Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Thomas Althaus
- Mahidol-Oxford Tropical Research Medicine Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;,Nuffield Department of Medicine, Nuffield Department of Medicine Research Building, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Yoel Lubell
- Mahidol-Oxford Tropical Research Medicine Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;,Nuffield Department of Medicine, Nuffield Department of Medicine Research Building, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Duangjai Suwancharoen
- Department of Livestock Development, National Institute of Animal Health, Ministry of Agriculture and Cooperatives, Bangkok, Thailand
| | - Stuart D. Blacksell
- Mahidol-Oxford Tropical Research Medicine Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;,Nuffield Department of Medicine, Nuffield Department of Medicine Research Building, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom;,Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic,Address correspondence to Stuart D. Blacksell, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand. E-mail:
| |
Collapse
|
13
|
Fabian E, Wenisch C, Eisner F, Muhr T, Bauer PK, Prein K, Maierhofer U, Lax SF, Krause R, Zollner G, Weihs W, Krejs GJ. Clinical-Pathological Conference Series from the Medical University of Graz : Case No 164: A 46-year-old man with abdominal pain, dyspnea and rapidly progressing multiorgan failure. Wien Klin Wochenschr 2021; 133:731-740. [PMID: 33871688 PMCID: PMC8053743 DOI: 10.1007/s00508-021-01841-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2021] [Indexed: 12/22/2022]
Affiliation(s)
- Elisabeth Fabian
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Christoph Wenisch
- 4th Department of Internal Medicine with Infectious and Tropical Medicine, State Hospital Klinik Favoriten, Vienna, Austria
| | - Florian Eisner
- Division of Emergency Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Tina Muhr
- Division of Cardiology, Department of Internal Medicine, State Hospital (LKH) Graz II, Graz, Austria
| | - Philipp K Bauer
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Kurt Prein
- Department of Pathology, State Hospital (LKH) Graz II, Graz, Austria
| | - Urša Maierhofer
- Department of Pathology, State Hospital (LKH) Graz II, Graz, Austria
| | - Sigurd F Lax
- Department of Pathology, State Hospital (LKH) Graz II, Graz, Austria
| | - Robert Krause
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Gernot Zollner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Wolfgang Weihs
- Division of Cardiology, Department of Internal Medicine, State Hospital (LKH) Graz II, Graz, Austria
| | - Guenter J Krejs
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
| |
Collapse
|
14
|
Niloofa R, Karunanayake L, de Silva HJ, Premawansa S, Rajapakse S, Handunnetti S. Development of in-house ELISAs as an alternative method for the serodiagnosis of leptospirosis. Int J Infect Dis 2021; 105:135-140. [PMID: 33556609 DOI: 10.1016/j.ijid.2021.01.074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/23/2021] [Accepted: 01/25/2021] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Leptospirosis is most often diagnosed clinically, and a laboratory test with high diagnostic accuracy is required. METHODS IgM and IgG ELISAs using Leptospira antigens were established and evaluated in relation to the microscopic agglutination test (MAT). Antigen preparation consisted of saprophytic Leptospira biflexa to detect genus-specific antibodies (genus-specific ELISA) and a pool of the five most prevalent Leptospira interrogans serovars in Sri Lanka to detect serovar-specific antibodies (serovar-specific ELISA). IgM and IgG immune responses were studied in severe and mild leptospirosis patients (n = 100 in each group). RESULTS The ELISAs showed high repeatability and reproducibility. The serovar-specific IgM-ELISA showed a sensitivity of 80.2% and specificity of 89%; the genus-specific IgM-ELISA showed a sensitivity of 83.3% and specificity of 91%. The serovar- and genus-specific IgG-ELISAs showed sensitivities of 73.3% and 81.7%, respectively, and specificities of 83.3% and 83.3%, respectively. The commercial IgM-ELISA showed a sensitivity of 79.2% and specificity of 93%. The commercial IgG-ELISA showed a sensitivity of 50% and specificity of 96.7%. IgM levels observed in mild and severe leptospirosis patients were significantly higher than in the healthy control group, with mean absorbance values of 0.770, 0.778, and 0.163, respectively. Severe leptospirosis patients had significantly higher mean anti-leptospiral IgG levels compared to both mild leptospirosis patients and healthy control group subjects (0.643, 0.358, and 0.116, respectively; ANOVA, p < 0.001). The presence of anti-leptospiral IgG above an optical density of 0.643 at 1:100 could predict a high risk of severe disease. CONCLUSION The serovar-specific in-house ELISA could be used for the laboratory diagnosis of leptospirosis in endemic settings. The high levels of anti-leptospiral IgG observed suggest its value as a predictor of disease severity.
Collapse
Affiliation(s)
- Roshan Niloofa
- Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo, Colombo, Sri Lanka.
| | | | | | | | - Senaka Rajapakse
- Tropical Medicine Research Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Shiroma Handunnetti
- Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo, Colombo, Sri Lanka
| |
Collapse
|
15
|
Rajput D, Gupta A, Verma SS, Barabari GS, Wani AA, Kumar N. Jaundice and Thrombocytopenia in an acute abdomen with concurrent Appendicitis and spontaneous Rectal perforation: An unusual presentation of human leptospirosis. Trop Doct 2021; 51:427-431. [PMID: 33530876 DOI: 10.1177/0049475520981298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Leptospirosis, a bacterial infection attributed to the group leptospira, remains a globally emerging public-health issue in many endemic tropical, subtropical and temperate zones of the world. The burden is expected to inflate with population shifts related to violent storms and urban floods leading to poor housing and inadequate sanitation. Leptospirosis may mimic other illnesses such as influenza, dengue fever, typhoid and malaria due to its myriad presentation ranging from a mild, self-limiting febrile illness to hepatorenal dysfunction, myocarditis, pulmonary haemorrhage, meningitis, optic neuritis and rhabdomyolysis. The classical gastrointestinal manifestation of leptospirosis without hepatorenal dysfunction (Weil's disease) is a rare entity. We report a rare presentation of concurrent appendicitis and rectal perforation in a patient, whose jaundice and thrombocytopenia led to a suspicion of leptospirosis, confirmed by serology and fulfilment of parameters under the modified Faine's criteria. The patient was managed successfully and discharged in a stable condition.
Collapse
Affiliation(s)
- Deepak Rajput
- Assistant Professor, Department of Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Amit Gupta
- Additional Professor, Department of Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Siddharth Shankar Verma
- Junior Resident, Department of Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Geetha Sindhuri Barabari
- Junior Resident, Department of Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Ajaz A Wani
- Consultant GI Oncology and HPB Surgery, SMVD Narayana Super Speciality Hospital, Katra, India
| | - Navin Kumar
- Assistant Professor, Department of Surgery, All India Institute of Medical Sciences, Rishikesh, India
| |
Collapse
|
16
|
Benitez ADN, Monica TC, Miura AC, Romanelli MS, Giordano LGP, Freire RL, Mitsuka-Breganó R, Martins CM, Biondo AW, Serrano IM, Lopes THCR, Reis RB, Gomes JF, Costa F, Wunder E, Ko AI, Navarro IT. Spatial and Simultaneous Seroprevalence of Anti- Leptospira Antibodies in Owners and Their Domiciled Dogs in a Major City of Southern Brazil. Front Vet Sci 2021; 7:580400. [PMID: 33490126 PMCID: PMC7820180 DOI: 10.3389/fvets.2020.580400] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 11/19/2020] [Indexed: 11/13/2022] Open
Abstract
Although leptospirosis has been considered a major concern in urban areas, no study to date has spatially and simultaneously compared both owner and dog serology in households of major cities. Accordingly, the aim of the present study was to assess the seroprevalence of Leptospira antibodies, evaluate associated risk factors and conduct spatial analyses in 565 randomly selected households, which included 597 dog owners and 729 dogs in Londrina, Southern Brazil. Seropositivity by MAT were detected in in 11/597 (1.84%) owners and in 155/729 (21.26%) dogs. The risk factors were evaluated with logistic regression analysis and spatial factors and case distribution were evaluated with kernel density analyses. The sera of 14/155 (9.03%) dogs reacted for more than one serovar with the same titer. Canicola was the most frequent serogroup, detected in 3/11 (27.27%) owners and 76/155 (49.03%) dogs. The highest titer among the owners was 1:3,200 and was detected in the same household with a titer of 1:800 in the dog. Simultaneous owner-dog seropositivity was found in 7/565 (1.23%) households, with three reacted against serogroup Canicola. Positive owners were detected in 4/565 (0.70%) households and positive dogs were detected in 141/565 (24.95%) households. The associated risks of infection for dogs were different from those associated with infection in owners. Risk analyses for Canicola also identified specific factors of infection. Regardless of owner and dog cases were not statistically clustered, the kernel map has shown dog positivity occurrence in the same hot locations and near positive owners. The dependent variable analysis and logit model suggested a greater likelihood of peri-domiciliary contact with Leptospira. In conclusion, exposure to Leptospira infection was significantly higher in dogs than in their owners and human cases spatially overlapped dog cases, implicating dogs as potential environmental sentinels for this disease. In addition, the associated risk may vary according to serogroup, and the observed simultaneous Canicola seropositivity of owner and dog has suggested intradomicile-transmitted infection.
Collapse
Affiliation(s)
| | - Thais Cabral Monica
- Laboratory of Zoonoses and Public Health, Londrina State University, Londrina, Brazil
| | - Ana Carolina Miura
- Laboratory of Zoonoses and Public Health, Londrina State University, Londrina, Brazil
| | | | | | - Roberta Lemos Freire
- Department of Preventive Veterinary Medicine, Londrina State University, Londrina, Brazil
| | - Regina Mitsuka-Breganó
- Department of Preventive Veterinary Medicine, Londrina State University, Londrina, Brazil
| | - Camila Marinelli Martins
- Department of Nursing and Public Health, Ponta Grossa State University, Ponta Grossa, Brazil.,AAC&T, Consultoria em Pesquisa Ltda, Curitiba, Brazil
| | - Alexander Welker Biondo
- Department of Veterinary Medicine, Federal University of Parana, Curitiba, Brazil.,Department of Comparative Pathobiology, Purdue University, West Lafayette, IN, United States
| | | | | | | | - Jancarlo Ferreira Gomes
- School of Medical Sciences and Institute of Computing, University of Campinas, Campinas, Brazil
| | - Federico Costa
- Fiocruz, Gonçalo Moniz Research Institute, Brazilian Ministry of Health, Salvador, Brazil.,Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | - Elsio Wunder
- Fiocruz, Gonçalo Moniz Research Institute, Brazilian Ministry of Health, Salvador, Brazil.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States
| | - Albert Icksang Ko
- Fiocruz, Gonçalo Moniz Research Institute, Brazilian Ministry of Health, Salvador, Brazil.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States
| | | |
Collapse
|
17
|
Hubler A, Schibli A, Locher P. [Febrile episodes, headache and limb pain as well as generalized myalgia in a 27-year-old returning male traveller]. Internist (Berl) 2020; 62:315-319. [PMID: 33237440 PMCID: PMC7687202 DOI: 10.1007/s00108-020-00908-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Unspezifische grippale Symptome wie Fieber, Gliederschmerzen und Kopfschmerzen kommen in der Hausarztpraxis und Notfallstation sehr häufig vor. Beim septischen Patienten mit positiver Reiseanamnese für wärmere Breitengrade muss die Differenzialdiagnose neben banalen viralen Erkrankungen auf seltenere Ursachen erweitert werden. Ein 27-jähriger Schweizer präsentierte sich mit oben genannten Symptomen nach einem Ferienaufenthalt in Südfrankreich. Nach rascher Zustandsverschlechterung mit Lungen‑, Leber- und Nierenbeteiligung musste der Patient intensivmedizinisch behandelt werden. Die klinisch vermutete Diagnose einer Leptospirose ließ sich im Verlauf serologisch bestätigen.
Collapse
Affiliation(s)
- A Hubler
- Klinik für Innere Medizin Triemli, Departement Innere Medizin, Stadtspital Waid und Triemli, Birmensdorferstrasse 497, 8063, Zürich, Schweiz.
| | - A Schibli
- Departement Innere Medizin, Abteilung für Infektiologie, Spitalhygiene und Personalmedizin, Stadtspital Waid und Triemli, Zürich, Schweiz
| | - P Locher
- Klinik für Innere Medizin Triemli, Departement Innere Medizin, Stadtspital Waid und Triemli, Birmensdorferstrasse 497, 8063, Zürich, Schweiz
| |
Collapse
|
18
|
SEROLOGIC SURVEY OF LEPTOSPIRA SPP. IN CAPTIVE ANIMALS FROM VERACRUZ, MEXICO. J Zoo Wildl Med 2020; 51:222-227. [PMID: 32212567 DOI: 10.1638/2018-0120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2019] [Indexed: 11/21/2022] Open
Abstract
Leptospirosis is the most common zoonotic disease worldwide and is considered endemic in countries with tropical climates. It is caused by 10 species of the Leptospira genus and by more than 275 serovars which can affect a wide range of vertebrates. In the Americas, 122 species of four classes of vertebrates have been reported to be infected or exposed to many Leptospira species. Many of these reports are from zoos and rehabilitation centers. Mexico has one single study that reported antibody titers against Leptospira in zoo animals. The purpose of this research was to identify the degree of exposure of some captive mammals and reptiles in Veracruz, a Mexican state with endemic leptospirosis, through microagglutination using 14 live strains of five Leptospira species. Sera samples were collected from 55 animals of 11 species from two classes (Mammalia and Reptilia), four orders (Primates, Artiodactyla, Carnivora, Crocodilia), and nine genera. The more prevalent serovars were Icterohaemorrhagiae and Tarassovi and the highest titers were reactive to the serovar Icterohaemorrhagiae with a value of 1: 51,200.
Collapse
|
19
|
Fagre AC, Mayo CE, Pabilonia KL, Landolt GA. Seroprevalence of Leptospira spp. in Colorado equids and association with clinical disease. J Vet Diagn Invest 2020; 32:718-721. [PMID: 32715980 DOI: 10.1177/1040638720943155] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Detection of Leptospira interrogans is difficult as a result of intermittent leptospiruria and brief leptospiremia. Hence, diagnosis relies heavily on serologic testing, the reference method of which is the microscopic agglutination test (MAT). In horses, clinical leptospirosis has been associated with abortion, recurrent uveitis, and sporadic cases of hepatic and renal disease. Little information exists on the seroprevalence of antibodies to L. interrogans in equids in the United States; past nationwide studies suggest that the seroprevalence in some areas is as high as 77% (reciprocal titer ≥ 100). We tested sera from 124 apparently healthy horses previously submitted for equine infectious anemia (EIA) serology using MAT for 6 serovars-Bratislava, Canicola, Grippotyphosa, Hardjo, Icterohaemorrhagiae, and Pomona. When using a reciprocal MAT titer cutoff of ≥ 100, 102 of 124 (82%) of the samples were positive for at least one serovar. Seropositivity was significantly associated with increasing age. Query of specimens from clinical cases submitted to the Colorado State University Veterinary Diagnostic Laboratory for MAT since 2010 indicated significantly greater seroprevalence (p = 0.015) of pathogenic serovar Pomona in clinical cases compared to sera submitted from healthy equids for routine EIA testing. Information from our diagnostic laboratory submission forms also suggests a correlation between uveitis or other ophthalmic problems and serovar Pomona.
Collapse
Affiliation(s)
- Anna C Fagre
- Departments of Microbiology, Immunology, and Pathology (Fagre, Mayo, Pabilonia) and Clinical Sciences (Landolt), College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO
| | - Christie E Mayo
- Departments of Microbiology, Immunology, and Pathology (Fagre, Mayo, Pabilonia) and Clinical Sciences (Landolt), College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO
| | - Kristy L Pabilonia
- Departments of Microbiology, Immunology, and Pathology (Fagre, Mayo, Pabilonia) and Clinical Sciences (Landolt), College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO
| | - Gabriele A Landolt
- Departments of Microbiology, Immunology, and Pathology (Fagre, Mayo, Pabilonia) and Clinical Sciences (Landolt), College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO
| |
Collapse
|
20
|
Seroprevalence of Leptospirosis among High-Risk Individuals in Morocco. Interdiscip Perspect Infect Dis 2020; 2020:5236045. [PMID: 32565788 PMCID: PMC7256772 DOI: 10.1155/2020/5236045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 04/09/2020] [Indexed: 11/30/2022] Open
Abstract
Background Leptospirosis is an anthropozoonotic reemerging neglected infectious disease underreported in most developing countries. A cross-sectional study was performed between 17 and 23 February 2014 to estimate the seroprevalence of leptospirosis among high-risk populations in Casablanca (Morocco). Methods A total of 490 human serum samples (97.6% males) were collected in 3 high-risk occupational sites including the biggest meat slaughterhouse (n = 208), a poultry market (n = 121), and the fish market (n = 161). A total of 125 human blood samples were also collected from the general population and used in this study as a control group. To detect the presence of anti-Leptospira, sera were screened with in-house IgG and IgM enzyme-linked immunosorbent assay (ELISA). Positive samples were tested by Microscopic Agglutination Technique (MAT) using a panel of 24 serovar cultures and cut point of 1 : 25. Results Seroprevalence of leptospirosis among the control group was 10.4% (13/125). A high seropositivity among the overall seroprevalence of 24.1% (118/490) was observed in the high-risk groups of which 7.3% (36/490), 13.7% (67/490), and 3.1% (15/490) were for anti-Leptospira IgM, IgG, and both IgG and IgM antibodies, respectively. Most of the positive individuals were occupationally involved in poultry (37.2%), followed by the market fish (26.1%) and the meat slaughterhouse (14.9%) workers. Among all ELISA-positive serum samples, 20.3% (n = 24) had positive MAT responses, of which the Icterohaemorrhagiae (n = 7) is the most common infecting serogroup followed by Javanica (4), Australis (2), and Sejroe, Mini, and Panama (one in each). In the remaining 8 MAT-positive sera, MAT showed equal titers against more than one serogroup. Conclusion Individuals engaged in risk activities are often exposed to leptospiral infection. Therefore, control and prevention policies toward these populations are necessary.
Collapse
|
21
|
Bauso J, Simoncini MS, Chiani Y, Schmeling MF, Larriera A, Vanasco NB, Piña CI. Presence of Leptospira spp. in Caiman latirostris (Crocodylia, Alligatoridae) populations in Santa Fe, Argentina. Heliyon 2020; 6:e03837. [PMID: 32420469 PMCID: PMC7218011 DOI: 10.1016/j.heliyon.2020.e03837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/03/2020] [Accepted: 04/21/2020] [Indexed: 11/30/2022] Open
Abstract
Leptospirosis is a disease caused by pathogenic spirochetes of the genus Leptospira, transmitted by wild and domestic animals. Rodents play a fundamental role in the transmission cycle of this zoonosis but the function of reptiles is unknown. For example, crocodilians could play an important role in the transmission of this disease by living in ideal environments (bodies of shallow water and high temperatures) for the colonization of this bacterium. However, few studies have documented the presence of zoonotic diseases in caiman populations. Our objective was to assess the prevalence of antibodies to leptospira and the presence of Leptospira spp. in wild and captive Caiman latirostris. Blood samples were taken from 45 individuals (20 wild and 25 captive). Before extraction, we cleaned each caiman's neck in order to prevent contamination of samples. We determined the presence of antibodies in serum by microscopic agglutination test (MAT) and polymerase chain reaction (PCR) to detect DNA of the bacteria. We excluded 9 of the 45 samples analyzed by MAT because 5 had lipemic serum and 4 were contaminated (colonized by other organisms). Of the 36 caimans studied by microscopic agglutination test (MAT), 56% (20/36) were considered reactive (titers ≥50). In 74% (14/19) of captive samples and 35% (6/17) of wild samples, antibodies to leptospira were detected by MAT. The serogroup with highest occurrence was Pyrogenes (85%, n = 17/20), presenting coagglutinations with Icterohaemorrhagiae (25%, n = 5/20). One sample from a captive animal was positive for PCR, and we could not isolate leptospires because of agar contamination. Of the 45 blood agar media, 17.8% were contaminated and the rest were negative. This work determined the presence of Leptospira spp. in one caiman and a high prevalence of antibodies in captive caiman relative to wild individuals.
Collapse
Affiliation(s)
- Jazmín Bauso
- CICYTTP (CONICET- Prov. de Entre Ríos-UAdER), FCyT, España 149, CP 3105, Diamante, Entre Ríos, Argentina
- Facultad de Bioquímica y Ciencias Biológicas, UNL, Ciudad Universitaria, Paraje El Pozo, CP 3000, Santa Fe, Argentina
- Proyecto Yacaré-Laboratorio de Zoología Aplicada: Anexo Vertebrados (FHUC-UNL/MASPyMA), Av. Aristobulo de Valle 8700, CP 3000, Santa Fe, Argentina
| | - Melina S. Simoncini
- CICYTTP (CONICET- Prov. de Entre Ríos-UAdER), FCyT, España 149, CP 3105, Diamante, Entre Ríos, Argentina
- Proyecto Yacaré-Laboratorio de Zoología Aplicada: Anexo Vertebrados (FHUC-UNL/MASPyMA), Av. Aristobulo de Valle 8700, CP 3000, Santa Fe, Argentina
| | - Yosena Chiani
- Instituto Nacional de Enfermedades Respiratorias (INER) “Dr. Emilio Coni”, Av. Blas Parera 8260, CP 3000, Santa Fe, Argentina
| | - María F. Schmeling
- Instituto Nacional de Enfermedades Respiratorias (INER) “Dr. Emilio Coni”, Av. Blas Parera 8260, CP 3000, Santa Fe, Argentina
| | - Alejandro Larriera
- Proyecto Yacaré-Laboratorio de Zoología Aplicada: Anexo Vertebrados (FHUC-UNL/MASPyMA), Av. Aristobulo de Valle 8700, CP 3000, Santa Fe, Argentina
- Facultad de Humanidades y Ciencias, UNL, Ciudad Universitaria, Paraje El Pozo, CP 3000, Santa Fe, Argentina
| | - Norma B. Vanasco
- Facultad de Bioquímica y Ciencias Biológicas, UNL, Ciudad Universitaria, Paraje El Pozo, CP 3000, Santa Fe, Argentina
- Instituto Nacional de Enfermedades Respiratorias (INER) “Dr. Emilio Coni”, Av. Blas Parera 8260, CP 3000, Santa Fe, Argentina
| | - Carlos I. Piña
- CICYTTP (CONICET- Prov. de Entre Ríos-UAdER), FCyT, España 149, CP 3105, Diamante, Entre Ríos, Argentina
- Proyecto Yacaré-Laboratorio de Zoología Aplicada: Anexo Vertebrados (FHUC-UNL/MASPyMA), Av. Aristobulo de Valle 8700, CP 3000, Santa Fe, Argentina
| |
Collapse
|
22
|
Altheimer K, Jongwattanapisan P, Luengyosluechakul S, Pusoonthornthum R, Prapasarakul N, Kurilung A, Broens EM, Wagenaar JA, Goris MGA, Ahmed AA, Pantchev N, Reese S, Hartmann K. Leptospira infection and shedding in dogs in Thailand. BMC Vet Res 2020; 16:89. [PMID: 32178664 PMCID: PMC7077098 DOI: 10.1186/s12917-020-2230-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 01/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Leptospirosis is a widespread zoonosis and has been recognized as a re-emerging infectious disease in humans and dogs, but prevalence of Leptospira shedding in dogs in Thailand is unknown. The aim of this study was to determine urinary shedding of Leptospira in dogs in Thailand, to evaluate antibody prevalence by microscopic agglutination test (MAT) and enzyme-linked immunosorbent assay (ELISA), and to assess risk factors for Leptospira infection. In Northern, Northeastern, and Central Thailand, 273 stray (n = 119) or client-owned (n = 154) dogs from rural (n = 139) or urban (n = 134) areas were randomly included. Dogs that had received antibiotics within 4 weeks prior to sampling were excluded. No dog had received vaccination against Leptospira. Urine was evaluated by real-time polymerase chain reaction (PCR) specific for lipL32 gene of pathogenic Leptospira. Additionally, urine was cultured for 6 months in Ellinghausen-McCullough-Johnson-Harris (EMJH) medium. Antibodies were measured by ELISA and MAT against 24 serovars belonging to 15 serogroups and 1 undesignated serogroup. Risk factor analysis was performed with backwards stepwise selection based on Wald. RESULTS Twelve of 273 (4.4%; 95% confidence interval (CI): 2.0-6.8%) urine samples were PCR-positive. In 1/273 dogs (0.4%; 95% CI: 0.01-1.1%) Leptospira could be cultured from urine. MAT detected antibodies in 33/273 dogs (12.1%; 95% CI: 8.2-16.0%) against 19 different serovars (Anhoa, Australis, Ballum, Bataviae, Bratislava, Broomi, Canicola, Copenhageni, Coxi, Grippotyphosa, Haemolytica, Icterohaemorrhagiae, Khorat, Paidjan, Patoc, Pyrogenes, Rachmati, Saxkoebing, Sejroe). In 111/252 dogs (44.0%; 95% CI: 37.9-50.2%) immunoglobulin M (IgM) and/or immunoglobulin G (IgG) antibodies were found by ELISA. Female dogs had a significantly higher risk for Leptospira infection (p = 0.023). CONCLUSIONS Leptospira shedding occurs in randomly sampled dogs in Thailand, with infection rates comparable to those of Europe and the USA. Therefore, the potential zoonotic risk should not be underestimated and use of Leptospira vaccines are recommended.
Collapse
Affiliation(s)
- Kerstin Altheimer
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, LMU Munich, Veterinaerstrasse 13, 80539 Munich, Germany
| | - Prapaporn Jongwattanapisan
- Department of Veterinary Medicine, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Supol Luengyosluechakul
- Department of Veterinary Medicine, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Rosama Pusoonthornthum
- Department of Veterinary Medicine, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Nuvee Prapasarakul
- Department of Veterinary Microbiology, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Alongkorn Kurilung
- Department of Veterinary Microbiology, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Els M. Broens
- Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands
| | - Jaap A. Wagenaar
- Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands
- Wageningen Bioveterinary Research, Lelystad, the Netherlands
| | - Marga G. A. Goris
- OIE and National Collaborating Centre for Reference and Research on Leptospirosis, Department of Medical Microbiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Ahmed A. Ahmed
- OIE and National Collaborating Centre for Reference and Research on Leptospirosis, Department of Medical Microbiology, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Sven Reese
- Department of Veterinary Sciences, Institute of Anatomy, Histology and Embryology, LMU Munich, Munich, Germany
| | - Katrin Hartmann
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, LMU Munich, Veterinaerstrasse 13, 80539 Munich, Germany
| |
Collapse
|
23
|
Environmental and Behavioral Risk Factors for Severe Leptospirosis in Thailand. Trop Med Infect Dis 2019; 4:tropicalmed4020079. [PMID: 31100812 PMCID: PMC6631942 DOI: 10.3390/tropicalmed4020079] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/07/2019] [Accepted: 05/10/2019] [Indexed: 01/02/2023] Open
Abstract
A nationwide prevention and control campaign for leptospirosis in Thailand has led to a decreased incidence rate, but the mortality and case fatality rates have remained stable. Regarding the limited knowledge of risk factors, a case-control study of the association between environmental and behavioral exposure with severe leptospirosis was implemented to identify the risk factors among adults in Thailand. The study was conducted in 12 hospital-based sites. Hospitalized patients with suspected clinical symptoms of leptospirosis were tested for leptospirosis by culture, loop mediated isothermal amplification (LAMP), real-time PCR, and the microscopic agglutination test (MAT). All participants answered a standardized questionnaire about potential risk factors. Risk factors were identified by univariable and multivariable logistic regression. Of the 44 confirmed cases, 33 (75.0%) presented with severe illness, as determined by clinical criteria, and were categorized as severe cases. Non-severe cases were defined as patients with non-severe symptoms of leptospirosis. Living nearby a rubber tree plantation (adjusted OR 11.65, 95% CI 1.08–125.53) and bathing in natural bodies of water (adjusted OR 10.45, 95% CI 1.17–93.35) were both significantly associated with an increased risk of severe leptospirosis. We recommend designating rubber plantations in Thailand as high-risk zones and closely monitoring hospitalized patients in those areas.
Collapse
|
24
|
Zida S, Kania D, Sotto A, Brun M, Picardeau M, Castéra J, Bolloré K, Kagoné T, Traoré J, Ouoba A, Dujols P, Van de Perre P, Méda N, Tuaillon E. Leptospirosis as Cause of Febrile Icteric Illness, Burkina Faso. Emerg Infect Dis 2019; 24:1569-1572. [PMID: 30016238 PMCID: PMC6056135 DOI: 10.3201/eid2408.170436] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Patients in Burkina Faso who sought medical attention for febrile jaundice were tested for leptospirosis. We confirmed leptospirosis in 27 (3.46%) of 781 patients: 23 (2.94%) tested positive using serologic assays and 4 (0.51%) using LipL32 PCR. We further presumed leptospirosis in 16 (2.82%) IgM-positive specimens.
Collapse
|
25
|
Zubach O, Telegina T, Semenyshyn O, Vasiunets L, Zinchuk A. Leptospirosis in Ukraine (Lviv Oblast): Clinical and Epidemiological Features. Vector Borne Zoonotic Dis 2018; 19:341-346. [PMID: 30335592 PMCID: PMC6486673 DOI: 10.1089/vbz.2018.2375] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The article describes the results of a retrospective analysis of medical records of 395 patients with a clinical diagnosis of leptospirosis treated at the Lviv Oblast Infectious Disease Clinical Hospital (Ukraine) between 2002 and 2016. The main risk factors for leptospirosis were contact with rodents or their excrements (26.84%) and bathing in ponds, small lakes, and reservoirs (10.63%). Among 276 patients in whom the anti-leptospira antibodies were detected by the microscopic agglutination test (MAT), the most common serotypes were Leptospira icterohaemorrhagiae (33.33%) and Leptospira grippotyphosa (25.0%). The mortality rate was significantly higher in patients where leptospirosis diagnosis was established based on clinical symptoms without confirmation by MAT (15.13% vs. 5.43%, p < 0.01).
Collapse
Affiliation(s)
- Olena Zubach
- 1 Department of Infectious Diseases, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Tetiana Telegina
- 1 Department of Infectious Diseases, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Oksana Semenyshyn
- 2 State Institution Lviv Oblast Laboratory Center of the Ministry of Health of Ukraine, Lviv, Ukraine
| | - Lilya Vasiunets
- 2 State Institution Lviv Oblast Laboratory Center of the Ministry of Health of Ukraine, Lviv, Ukraine
| | - Aleksander Zinchuk
- 1 Department of Infectious Diseases, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| |
Collapse
|
26
|
Gurumurthy K, Narasimha HB, Wyawahare M, Biswal N. Leptospirosis: a diagnostic conundrum. Trop Doct 2018; 48:306-309. [PMID: 30124128 DOI: 10.1177/0049475518788470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Leptospirosis is a serious public health concern worldwide. It is highly endemic in the Andaman Islands and its prevalence is increasing in other Indian states. Clinical features are non-specific and diagnosis relies on laboratory confirmation. The gold standard is microscopic agglutination testing, but this is not widely available. Real-time polymerase chain reaction testing of LipL32 antigen provides the earliest detection of pathogenic Leptospira in the body. We found it to be 100% specific, but it should be used in the first 10 days of illness for reliable results.
Collapse
Affiliation(s)
- Keerthivasan Gurumurthy
- 1 Assistant Professor, Department of Microbiology, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Harish Belgode Narasimha
- 2 Senior Professor, Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Mukta Wyawahare
- 3 Associate Professor, Department of General Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Niranjan Biswal
- 4 Professor, Department of Paediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| |
Collapse
|
27
|
Chen HW, Lukas H, Becker K, Weissenberger G, Halsey ES, Guevara C, Canal E, Hall E, Maves RC, Tilley DH, Kuo L, Kochel TJ, Ching WM. An Improved Enzyme-Linked Immunoassay for the Detection of Leptospira-Specific Antibodies. Am J Trop Med Hyg 2018; 99:266-274. [PMID: 29943710 DOI: 10.4269/ajtmh.17-0057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Leptospirosis is a neglected zoonotic disease with worldwide endemicity and continues to be a significant public health burden on resource-limited populations. Previously, we produced three highly purified recombinant antigens (rLipL32, rLipL41, and rLigA-Rep) and evaluated their performance of detecting Leptospira-specific antibodies in enzyme-linked immunosorbent assay (ELISA) as compared with the microscopic agglutination test (MAT). The overall sensitivity of this assay approached 90%. Recently, another recombinant antigen (rLigB-Rep) was prepared. We tested each individual antigen and a 1:1:1:1 mixture of these four antigens for the detection of Leptospira-specific antibodies in ELISA. The performance of these recombinant antigens was evaluated with a much larger febrile patient panel (337 MAT-confirmed positive sera and 92 MAT-negative sera from febrile patients). Combining the detection results of immunoglobulin M and immunoglobulin G from these four individual antigens, the overall sensitivity was close to 90% but the specificity was only 66%, based on the MAT reference method. The overall sensitivity and specificity of the four-antigen mixture were 82% and 86%, respectively. The mixture of four antigens also exhibited a broader reactivity with MAT-positive samples of 18 serovars from six major pathogenic Leptospira species. Given the limitations of MAT, the data were further analyzed by Bayesian latent class model, showing that ELISA using a 1:1:1:1 mixture still maintained high sensitivity (79%) and specificity (88%) as compared with the sensitivity (90%) and specificity (83%) of MAT. Therefore, ELISA using a mixture of these four antigens could be a very useful test for seroprevalence studies.
Collapse
Affiliation(s)
- Hua-Wei Chen
- Naval Medical Research Center, Silver Spring, Maryland
| | - Heather Lukas
- Naval Medical Research Center, Silver Spring, Maryland
| | - Kira Becker
- Naval Medical Research Center, Silver Spring, Maryland
| | | | | | | | | | - Eric Hall
- Naval Medical Research Center, Silver Spring, Maryland
| | - Ryan C Maves
- Naval Medical Center San Diego, San Diego, California.,Naval Medical Research Unit No. 6, Lima, Peru
| | | | - Lynn Kuo
- Department of Statistics, University of Connecticut, Storrs, Connecticut
| | | | - Wei-Mei Ching
- Naval Medical Research Center, Silver Spring, Maryland
| |
Collapse
|
28
|
Tomari K, Toyokawa T, Takahashi T, Kakita T, Okano S, Kyan H, Tonegawa N, Okawa T, Matsuoka T, Matsumora T. Childhood leptospirosis in an industrialized country: Population-based study in Okinawa, Japan. PLoS Negl Trop Dis 2018. [PMID: 29518084 PMCID: PMC5860792 DOI: 10.1371/journal.pntd.0006294] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Leptospirosis is considered underdiagnosed because of its nonspecific presentation and lack of proper understanding of its epidemiology. Early diagnosis and treatment are crucial. However, few data are available on confirmed leptospirosis cases in children in industrialized countries. We therefore aimed to describe epidemiologic and clinical characteristics of laboratory-confirmed childhood leptospirosis in Okinawa, Japan. We reviewed the national surveillance data of pediatric leptospirosis in Okinawa, Japan from January 2003 through December 2015. The database included all of laboratory-confirmed leptospirosis diagnosed at the only central laboratory for leptospirosis in the region. There were 44 children (0–20 years of age) with laboratory-confirmed leptospirosis. Of these, 90% were male, 91% were 10–20 years of age, and 96% of cases occurred in August and September. The number of laboratory-confirmed patients ranged from 0 to 11 per year (mean: 3.3 per year), and the estimated annual rate was 1.0 per 100,000 pediatric populations. In all cases, the presumed infection route was recreational exposure to river water. Commonly observed manifestations include fever (95%), myalgia (52%), and conjunctival suffusion (52%). Childhood leptospirosis in Okinawa, Japan occurred predominantly in teenage boys after freshwater exposure in summer, and most patients had characteristic conjunctival suffusion. Cohort studies would be helpful to better understand more detailed clinical manifestations in association with prognosis. Leptospirosis is a bacterial disease that affects humans and animals. It is caused by Leptospira. Leptospira is a spiral-shaped Gram-negative spirochete with internal flagella, which enters the host through mucosa and broken skin. Leptospirosis is a worldwide zoonosis, but it is considered underdiagnosed because of its nonspecific presentation and lack of proper understanding of its epidemiology, especially in children. In human, it can cause a wide range of symptoms in acute phase include fever, chills, headache, muscle aches, vomiting, and diarrhea. Some of these symptoms can be observed in other febrile diseases such as typhoid fever, rickettsiosis, Kawasaki disease, and adenovirus infections. Although Leptospirosis can be deadly in severe, untreated cases, few data are available on leptospirosis in children, industrialized countries, and confirmed cases. This study conducted a population-based study to describe epidemiologic and clinical characteristics of childhood leptospirosis in a leptospirosis-endemic area in an industrialized country, Okinawa, Japan. This new knowledge may contribute to a better overall understanding of the Leptospirosis in children.
Collapse
Affiliation(s)
- Kouki Tomari
- Department of General Pediatrics, Okinawa Prefectural Nanbu Medical Center & Children’s Medical Center, Okinawa, Japan
- * E-mail:
| | - Takao Toyokawa
- Department of Infectious Disease, Okinawa Prefectural Nanbu Medical Center & Children’s Medical Center, Okinawa, Japan
| | - Takuto Takahashi
- Department of Pediatrics, SUNY Downstate Medical Center, Brooklyn, NY, United States of America
| | - Tetsuya Kakita
- Medical Microbiology and Zoology Section, Okinawa Prefectural Institute of Health and Environment, Okinawa, Japan
| | - Sho Okano
- Medical Microbiology and Zoology Section, Okinawa Prefectural Institute of Health and Environment, Okinawa, Japan
| | - Hisako Kyan
- Medical Microbiology and Zoology Section, Okinawa Prefectural Institute of Health and Environment, Okinawa, Japan
| | - Naoya Tonegawa
- Department of General Pediatrics, Okinawa Prefectural Nanbu Medical Center & Children’s Medical Center, Okinawa, Japan
| | - Teppei Okawa
- Department of General Pediatrics, Okinawa Prefectural Nanbu Medical Center & Children’s Medical Center, Okinawa, Japan
| | - Takashi Matsuoka
- Department of General Pediatrics, Okinawa Prefectural Nanbu Medical Center & Children’s Medical Center, Okinawa, Japan
| | - Tsutomu Matsumora
- Department of General Pediatrics, Okinawa Prefectural Nanbu Medical Center & Children’s Medical Center, Okinawa, Japan
| |
Collapse
|
29
|
Nascimento Filho EG, Vieira ML, Teixeira AF, Santos JC, Fernandes LGV, Passalia FJ, Daroz BB, Rossini A, Kochi LT, Cavenague MF, Pimenta DC, Nascimento ALTO. Proteomics as a tool to understand Leptospira physiology and virulence: Recent advances, challenges and clinical implications. J Proteomics 2018; 180:80-87. [PMID: 29501847 DOI: 10.1016/j.jprot.2018.02.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/14/2018] [Accepted: 02/22/2018] [Indexed: 01/24/2023]
Affiliation(s)
- Edson G Nascimento Filho
- Laboratório Especial de Desenvolvimento de Vacinas, Instituto Butantan, Avenida Vital Brazil, 1500, 05503-900 Sao Paulo, SP, Brazil
| | - Monica L Vieira
- Laboratório Especial de Desenvolvimento de Vacinas, Instituto Butantan, Avenida Vital Brazil, 1500, 05503-900 Sao Paulo, SP, Brazil
| | - Aline F Teixeira
- Laboratório Especial de Desenvolvimento de Vacinas, Instituto Butantan, Avenida Vital Brazil, 1500, 05503-900 Sao Paulo, SP, Brazil
| | - Jademilson C Santos
- Laboratório Especial de Desenvolvimento de Vacinas, Instituto Butantan, Avenida Vital Brazil, 1500, 05503-900 Sao Paulo, SP, Brazil
| | - Luis G V Fernandes
- Laboratório Especial de Desenvolvimento de Vacinas, Instituto Butantan, Avenida Vital Brazil, 1500, 05503-900 Sao Paulo, SP, Brazil
| | - Felipe J Passalia
- Laboratório Especial de Desenvolvimento de Vacinas, Instituto Butantan, Avenida Vital Brazil, 1500, 05503-900 Sao Paulo, SP, Brazil; Programa de Pos-Graduação Interunidades em Biotecnologia, Instituto de Ciências Biomédicas, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Brenda B Daroz
- Laboratório Especial de Desenvolvimento de Vacinas, Instituto Butantan, Avenida Vital Brazil, 1500, 05503-900 Sao Paulo, SP, Brazil; Programa de Pos-Graduação Interunidades em Biotecnologia, Instituto de Ciências Biomédicas, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Amanda Rossini
- Laboratório Especial de Desenvolvimento de Vacinas, Instituto Butantan, Avenida Vital Brazil, 1500, 05503-900 Sao Paulo, SP, Brazil; Programa de Pos-Graduação Interunidades em Biotecnologia, Instituto de Ciências Biomédicas, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Leandro T Kochi
- Laboratório Especial de Desenvolvimento de Vacinas, Instituto Butantan, Avenida Vital Brazil, 1500, 05503-900 Sao Paulo, SP, Brazil; Programa de Pos-Graduação Interunidades em Biotecnologia, Instituto de Ciências Biomédicas, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Maria F Cavenague
- Laboratório Especial de Desenvolvimento de Vacinas, Instituto Butantan, Avenida Vital Brazil, 1500, 05503-900 Sao Paulo, SP, Brazil; Programa de Pos-Graduação Interunidades em Biotecnologia, Instituto de Ciências Biomédicas, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Daniel C Pimenta
- Laboratório de Bioquímica e Biofísica, Instituto Butantan, Avenida Vital Brazil, 1500, 05503-900 Sao Paulo, SP, Brazil
| | - Ana L T O Nascimento
- Laboratório Especial de Desenvolvimento de Vacinas, Instituto Butantan, Avenida Vital Brazil, 1500, 05503-900 Sao Paulo, SP, Brazil.
| |
Collapse
|
30
|
Lizer J, Velineni S, Weber A, Krecic M, Meeus P. Evaluation of 3 Serological Tests for Early Detection Of Leptospira-specific Antibodies in Experimentally Infected Dogs. J Vet Intern Med 2018; 32:201-207. [PMID: 29131400 PMCID: PMC5787205 DOI: 10.1111/jvim.14865] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 08/29/2017] [Accepted: 09/27/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Leptospirosis in dogs is a disease of global importance. Early detection and appropriate therapeutic intervention are necessary to resolve infection and prevent zoonotic transmission. However, its diagnosis is hindered by nonspecific clinical signs and lack of rapid diagnostic tests of early infection. Recently, 2 rapid point-of-care tests (WITNESS Lepto [WITNESS Lepto, Zoetis LLC, Kalamazoo, MI, USA] and SNAP Lepto [SNAP Lepto, IDEXX Laboratories, Westbrook, ME, USA]) for detection of Leptospira-specific antibodies in canine sera were developed. HYPOTHESIS Immunoglobulin M-based WITNESS Lepto containing multiple detection antigens can detect Leptospira-specific antibodies to common leptospiral serovars earlier in the course of infection as compared to microscopic agglutination test (MAT) and SNAP Lepto. ANIMALS Four groups of 8 6- to 8-month-old male Beagle dogs were used. METHODS Thirty-two healthy seronegative dogs were inoculated experimentally with serovars Canicola, Grippotyphosa, Icterohaemorrhagiae, and Pomona (8 dogs/serovar). Acute-phase sera were collected at regular intervals and monitored for Leptospira-specific antibodies by WITNESS Lepto, MAT, and SNAP Lepto. RESULTS Seroconversion was detected in all dogs by day 10 by WITNESS Lepto and in 30 of 32 dogs by day 14 by MAT. The SNAP Lepto test detected seroconversion in 3 dogs during the 2 weeks postchallenge. CONCLUSIONS Immunoglobulin M-based WITNESS Lepto detected immune responses specific to multiple leptospiral serovars early in the course of infection and identified seroconversion in all animals earlier than did the gold standard MAT. The SNAP Lepto test displayed considerably lower and inconsistent performance during the study period. At the point-of-care, WITNESS Lepto should be the test of choice for rapid and reliable screening of acutely ill dogs suspected to have leptospirosis.
Collapse
Affiliation(s)
- J. Lizer
- Veterinary Medicine Research and DevelopmentZoetisKalamazooMI
| | - S. Velineni
- Veterinary Medicine Research and DevelopmentZoetisKalamazooMI
| | - A. Weber
- Veterinary Medicine Research and DevelopmentZoetisKalamazooMI
| | | | - P. Meeus
- Veterinary Medicine Research and DevelopmentZoetisKalamazooMI
| |
Collapse
|
31
|
Rosa MI, Reis MFD, Simon C, Dondossola E, Alexandre MC, Colonetti T, Meller FO. IgM ELISA for leptospirosis diagnosis: a systematic review and meta-analysis. CIENCIA & SAUDE COLETIVA 2017; 22:4001-4012. [DOI: 10.1590/1413-812320172212.14112016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 08/25/2016] [Indexed: 11/22/2022] Open
Abstract
Abstract A systematic review with meta-analysis was performed to estimate the accuracy of IgM ELISA for Leptospirosis diagnosis. A search of Medline, Lilacs, Embase, Cochrane Central Register of Controlled Trials and Grey literature (Google Scholar and British Library) was conducted. The medical subject headings (MeSHs) and the words “leptospirosis”, “human leptospirosis” and “IgM ELISA” were used. Fifty-two studies were analyzed, which included 10,775 samples. The pooled sensitivity of all the studies was 86% (CI 95%, 85%-87%) and specificity was 90% (CI 95%, 89%-91%). In studies of the acute phase, the sensitivity and specificity were 84% (CI 95%, 82%-85%) and 91% (CI 95%, 90%-91%), respectively. In conclusion, IgM ELISA is sensitive for use as an initial screen for leptospiral infections.
Collapse
|
32
|
Mørch K, Manoharan A, Chandy S, Chacko N, Alvarez-Uria G, Patil S, Henry A, Nesaraj J, Kuriakose C, Singh A, Kurian S, Gill Haanshuus C, Langeland N, Blomberg B, Vasanthan Antony G, Mathai D. Acute undifferentiated fever in India: a multicentre study of aetiology and diagnostic accuracy. BMC Infect Dis 2017; 17:665. [PMID: 28978319 PMCID: PMC5628453 DOI: 10.1186/s12879-017-2764-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 09/25/2017] [Indexed: 01/04/2023] Open
Abstract
Background The objectives of this study were to determine the proportion of malaria, bacteraemia, scrub typhus, leptospirosis, chikungunya and dengue among hospitalized patients with acute undifferentiated fever in India, and to describe the performance of standard diagnostic methods. Methods During April 2011–November 2012, 1564 patients aged ≥5 years with febrile illness for 2–14 days were consecutively included in an observational study at seven community hospitals in six states in India. Malaria microscopy, blood culture, Dengue rapid NS1 antigen and IgM Combo test, Leptospira IgM ELISA, Scrub typhus IgM ELISA and Chikungunya IgM ELISA were routinely performed at the hospitals. Second line testing, Dengue IgM capture ELISA (MAC-ELISA), Scrub typhus immunofluorescence (IFA), Leptospira Microscopic Agglutination Test (MAT), malaria PCR and malaria immunochromatographic rapid diagnostic test (RDT) Parahit Total™ were performed at the coordinating centre. Convalescence samples were not available. Case definitions were as follows: Leptospirosis: Positive ELISA and positive MAT. Scrub typhus: Positive ELISA and positive IFA. Dengue: Positive RDT and/or positive MAC-ELISA. Chikungunya: Positive ELISA. Bacteraemia: Growth in blood culture excluding those defined as contaminants. Malaria: Positive genus-specific PCR. Results Malaria was diagnosed in 17% (268/1564) and among these 54% had P. falciparum. Dengue was diagnosed in 16% (244/1564). Bacteraemia was found in 8% (124/1564), and among these Salmonella typhi or S. paratyphi constituted 35%. Scrub typhus was diagnosed in 10%, leptospirosis in 7% and chikungunya in 6%. Fulfilling more than one case definition was common, most frequent in chikungunya where 26% (25/98) also had positive dengue test. Conclusions Malaria and dengue were the most common causes of fever in this study. A high overlap between case definitions probably reflects high prevalence of prior infections, cross reactivity and subclinical infections, rather than high prevalence of coinfections. Low accuracy of routine diagnostic tests should be taken into consideration when approaching the patient with acute undifferentiated fever in India.
Collapse
Affiliation(s)
- Kristine Mørch
- National Centre for Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway. .,Department of Clinical Science, University of Bergen, Bergen, Norway.
| | - Anand Manoharan
- Infectious Diseases Training and Research Centre, Department of Medicine, Christian Medical College, Vellore, India
| | - Sara Chandy
- Infectious Diseases Training and Research Centre, Department of Medicine, Christian Medical College, Vellore, India
| | | | | | - Suvarna Patil
- B.K.L. Walawalkar Hospital, Ratnagiri, Maharashtra, India
| | - Anil Henry
- Christian Hospital, Mungeli, Chhattisgarh, India
| | | | - Cijoy Kuriakose
- Christian Fellowship Hospital, Oddanchatram, Tamil Nadu, India
| | - Ashita Singh
- Baptist Christian Hospital, Tezpur, Assam, India
| | - Siby Kurian
- Infectious Diseases Training and Research Centre, Department of Medicine, Christian Medical College, Vellore, India
| | - Christel Gill Haanshuus
- National Centre for Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Nina Langeland
- National Centre for Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Bjørn Blomberg
- National Centre for Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - George Vasanthan Antony
- Infectious Diseases Training and Research Centre, Department of Medicine, Christian Medical College, Vellore, India
| | - Dilip Mathai
- Infectious Diseases Training and Research Centre, Department of Medicine, Christian Medical College, Vellore, India
| |
Collapse
|
33
|
Rapid, actionable diagnosis of urban epidemic leptospirosis using a pathogenic Leptospira lipL32-based real-time PCR assay. PLoS Negl Trop Dis 2017; 11:e0005940. [PMID: 28915243 PMCID: PMC5617227 DOI: 10.1371/journal.pntd.0005940] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 09/27/2017] [Accepted: 09/06/2017] [Indexed: 12/31/2022] Open
Abstract
Background With a conservatively estimated 1 million cases of leptospirosis worldwide and a 5–10% fatality rate, the rapid diagnosis of leptospirosis leading to effective clinical and public health decision making is of high importance, and yet remains a challenge. Methodology Based on parallel, population-based studies in two leptospirosis-endemic regions in Brazil, a real-time PCR assay which detects lipL32, a gene specifically present in pathogenic Leptospira, was assessed for the diagnostic effectiveness and accuracy. Patients identified by active hospital-based surveillance in Salvador and Curitiba during large urban leptospirosis epidemics were tested. Real-time PCR reactions were performed with DNA-extracted samples obtained from 127 confirmed and 23 unconfirmed cases suspected of leptospirosis, 122 patients with an acute febrile illness other than leptospirosis, and 60 healthy blood donors. Principal findings The PCR assay had a limit of detection of 280 Leptospira genomic equivalents/mL. Sensitivity for confirmed cases was 61% for whole blood and 29% for serum samples. Sensitivity was higher (86%) for samples collected within the first 6 days after onset of illness compared to those collected after 7 days (34%). The real-time PCR assay was able to detect leptospiral DNA in blood from 56% of serological non-confirmed cases. The overall specificity of the assay was 99%. Conclusions These findings indicate that real-time PCR may be a reliable tool for early diagnosis of leptospirosis, which is decisive for clinical management of severe and life-threatening cases and for public health decision making. In this study, we describe the performance testing and diagnostic accuracy assessment of a previously described real-time PCR assay aiming at the validation for early diagnosis of human leptospirosis. We found that diagnostic sensitivity was higher for EDTA whole blood samples (61%) than for serum samples (29%). We demonstrated that the molecular diagnosis was optimal when performed with EDTA whole samples collected within the first 6 days with symptoms, condition in which the sensitivity was 86%. The real-time PCR assay was able to detect leptospiral DNA in EDTA whole blood from 56% of serological non-confirmed cases for whom a convalescent sample was not available. The test overall specificity was 99%. Our findings demonstrate that real-time PCR is a reliable diagnostic tool suited for early diagnosis, and its results could support early medical interventions that could have a decisive impact on clinical outcome and thus decrease both the severity and fatality of cases.
Collapse
|
34
|
Tunjungputri RN, Gasem MH, van der Does W, Sasongko PH, Isbandrio B, Urbanus RT, de Groot PG, van der Ven A, de Mast Q. Platelet dysfunction contributes to bleeding complications in patients with probable leptospirosis. PLoS Negl Trop Dis 2017; 11:e0005915. [PMID: 28934202 PMCID: PMC5626517 DOI: 10.1371/journal.pntd.0005915] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 10/03/2017] [Accepted: 08/28/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Severe leptospirosis is frequently complicated by a hemorrhagic diathesis, of which the pathogenesis is still largely unknown. Thrombocytopenia is common, but often not to the degree that spontaneous bleeding is expected. We hypothesized that the hemorrhagic complications are not only related to thrombocytopenia, but also to platelet dysfunction, and that increased binding of von Willebrand factor (VWF) to platelets is involved in both platelet dysfunction and increased platelet clearance. METHODOLOGY/PRINCIPAL FINDINGS A prospective study was carried out in Semarang, Indonesia, enrolling 33 hospitalized patients with probable leptospirosis, of whom 15 developed clinical bleeding, and 25 healthy controls. Platelet activation and reactivity were determined using flow cytometry by measuring the expression of P-selectin and activation of the αIIbβ3 integrin by the binding of fibrinogen in unstimulated samples and after ex vivo stimulation by the platelet agonists adenosine-diphosphate (ADP) and thrombin-receptor activating peptide (TRAP). Platelet-VWF binding, before and after VWF stimulation by ristocetin, as well as plasma levels of VWF, active VWF, the VWF-inactivating enzyme ADAMTS13, thrombin-antithrombin complexes (TAT) and P-selectin were also measured. Bleeding complications were graded using the WHO bleeding scale. Our study revealed that platelet activation, with a secondary platelet dysfunction, is a feature of patients with probable leptospirosis, especially in those with bleeding manifestations. There was a significant inverse correlation of bleeding score with TRAP-stimulated P-selectin and platelet-fibrinogen binding (R = -0.72, P = 0.003 and R = -0.66, P = 0.01, respectively) but not with platelet count. Patients with bleeding also had a significantly higher platelet-VWF binding. Platelet counts were inversely correlated with platelet-VWF binding (R = -0.74; P = 0.0009. There were no correlations between platelet-VWF binding and the degree of platelet dysfunction, suggesting that increased platelet-VWF binding does not directly interfere with the platelet αIIbβ3 signaling pathway in patients with probable leptospirosis. CONCLUSION/SIGNIFICANCE Platelet dysfunction is common in probable leptospirosis patients with manifest bleeding. Increased VWF-platelet binding may contribute to the activation and clearance of platelets.
Collapse
Affiliation(s)
- Rahajeng N. Tunjungputri
- Department of Internal Medicine, Radboud university medical center, Nijmegen, The Netherlands
- Center for Tropical and Infectious Disease (CENTRID), Faculty of Medicine Diponegoro University, Dr Kariadi Hospital, Semarang, Indonesia
| | - Muhammad Hussein Gasem
- Center for Tropical and Infectious Disease (CENTRID), Faculty of Medicine Diponegoro University, Dr Kariadi Hospital, Semarang, Indonesia
| | - Willemijn van der Does
- Department of Internal Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Pandu H. Sasongko
- Center for Tropical and Infectious Disease (CENTRID), Faculty of Medicine Diponegoro University, Dr Kariadi Hospital, Semarang, Indonesia
| | - Bambang Isbandrio
- National Reference Laboratory for Leptospira, Dr. Kariadi Hospital, Semarang, Indonesia
| | - Rolf T. Urbanus
- Department of Clinical Chemistry and Haematology, University Medical Center, Utrecht, The Netherlands
| | - Philip G. de Groot
- Department of Internal Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Andre van der Ven
- Department of Internal Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Quirijn de Mast
- Department of Internal Medicine, Radboud university medical center, Nijmegen, The Netherlands
| |
Collapse
|
35
|
Potula HH, Richer L, Werts C, Gomes-Solecki M. Pre-treatment with Lactobacillus plantarum prevents severe pathogenesis in mice infected with Leptospira interrogans and may be associated with recruitment of myeloid cells. PLoS Negl Trop Dis 2017; 11:e0005870. [PMID: 28841659 PMCID: PMC5589268 DOI: 10.1371/journal.pntd.0005870] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 09/07/2017] [Accepted: 08/11/2017] [Indexed: 02/03/2023] Open
Abstract
Recent estimates on global morbidity and mortality caused by Leptospirosis point to one million cases and almost 60,000 deaths a year worldwide, especially in resource poor countries. We analyzed how a commensal probiotic immunomodulator, Lactobacillus plantarum, affects Leptospira interrogans pathogenesis in a murine model of sub-lethal leptospirosis. We found that repeated oral pre-treatment of mice with live L. plantarum restored body weight to normal levels in mice infected with L. interrogans. Pre-treatment did not prevent L. interrogans access to the kidney but it affected the inflammatory response and it reduced histopathological signs of disease. Analysis of the immune cell profiles in lymphoid tissues of mice pre-treated with L. plantarum showed increased numbers of B cells as well as naïve and memory CD4+ helper T cell populations in uninfected mice that shifted towards increased numbers of effector CD4+ helper T in infected mice. CD8+ cytotoxic T cell profiles in pre-treated uninfected and infected mice mirrored the switch observed for CD4+ except that CD8+ memory T cells were not affected. In addition, pre-treatment led to increased populations of monocytes in lymphoid tissues of uninfected mice and to increased populations of macrophages in the same tissues of infected mice. Immunohistochemistry of kidney sections of pre-treated infected mice showed an enrichment of neutrophils and macrophages and a reduction of total leucocytes and T cells. Our results suggest that complex myeloid and T cell responses orchestrate the deployment of monocytes and other cells from lymphoid tissue and the recruitment of neutrophils and macrophages to the kidney, and that, the presence of these cells in the target organ may be associated with reductions in pathogenesis observed in infected mice treated with L. plantarum. Leptospirosis is an emerging neglected zoonotic disease with worldwide distribution that affects nearly all vertebrates and causes infection in ~1 million people on a yearly basis. Effective cross-protective vaccines are not available and antibiotic treatment is only effective if used early in the course of infection. In this study we describe how repeated oral treatment of mice with a commonly used probiotic, Lactobacillus plantarum, did not completely prevent colonization of the kidney by Leptospira interrogans but it did reduce signs and symptoms of leptospirosis. We also analyzed a number of immune cell types in spleen, lymph nodes and kidney after treatment and found that complex responses orchestrate the deployment of phagocytes to the kidney in infected mice. Our results suggest that pre-treatment with L. plantarum modulates systemic immune responses in a beneficial way in a mammalian host later exposed to L. interrogans infection.
Collapse
Affiliation(s)
- Hari-Hara Potula
- Department of Microbiology, Immunology and Biochemistry, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
| | - Luciana Richer
- Immuno Technologies Inc., Memphis, Tennessee, United States of America
| | - Catherine Werts
- Institut Pasteur, Unit Biology and Genetics of the Bacterial Cell Wall, Paris, France
- INSERM, Équipe Avenir, Paris, France
| | - Maria Gomes-Solecki
- Department of Microbiology, Immunology and Biochemistry, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
- Immuno Technologies Inc., Memphis, Tennessee, United States of America
- * E-mail:
| |
Collapse
|
36
|
Lim TK, Siow WT. Pneumonia in the tropics. Respirology 2017; 23:28-35. [PMID: 28763150 PMCID: PMC7169137 DOI: 10.1111/resp.13137] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 05/27/2017] [Accepted: 06/12/2017] [Indexed: 12/19/2022]
Abstract
Pneumonia in the tropics poses a heavy disease burden. The complex interplay of climate change, human migration influences and socio-economic factors lead to changing patterns of respiratory infections in tropical climate but also increasingly in temperate countries. Tropical and poorer countries, especially South East Asia, also bear the brunt of the global tuberculosis (TB) pandemic, accounting for almost one-third of the burden. But, as human migration patterns evolve, we expect to see more TB cases in higher income as well as temperate countries, and rise in infections like scrub typhus from ecotourism activities. Fuelled by the ease of air travel, novel zoonotic infections originating from the tropics have led to global respiratory pandemics. As such, clinicians worldwide should be aware of these new conditions as well as classical tropical bacterial pneumonias such as melioidosis. Rarer entities such as co-infections of leptospirosis and chikungunya or dengue will need careful consideration as well. In this review, we highlight aetiologies of pneumonia seen more commonly in the tropics compared with temperate regions, their disease burden, variable clinical presentations as well as impact on healthcare delivery.
Collapse
Affiliation(s)
- Tow Keang Lim
- Division of Respiratory and Critical Care Medicine, National University Hospital, Singapore
| | - Wen Ting Siow
- Division of Respiratory and Critical Care Medicine, National University Hospital, Singapore
| |
Collapse
|
37
|
Bergmann M, Llewellyn JR, Hartmann K. [Diagnosis of leptospirosis in dogs]. TIERARZTLICHE PRAXIS. AUSGABE K, KLEINTIERE/HEIMTIERE 2017; 45:170-177. [PMID: 28513759 DOI: 10.15654/tpk-170039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 03/15/2017] [Indexed: 12/29/2022]
Abstract
Rapid confirmation of the diagnosis leptospirosis is important in order to apply appropriate treatment; in addition, infected dogs are a zoonotic risk. Culture and isolation of living leptospires from blood, urine, or tissues is considered the reference standard of diagnosis. However, sensitivity are low, and leptospires require weeks to months to grow. Therefore, diagnosis of leptospirosis is most commonly based on antibody testing or the detection of Leptospira spp. DNA by PCR. Microscopic agglutination test (MAT) is currently still the recommended confirmatory test for canine leptospirosis, despite its numerous limitations (e. g., negative results in early infection, positive results due to vaccine-associated antibodies). ELISA can differentiate between IgG and IgM antibodies and thus, discriminate current infections from previous vaccination or exposure. Point-of-care tests and in-house-PCR tests have recently been developed for use in private practice allowing easy and immediate diagnosis. However, only few data on sensitivity and specificity of these tests exist so far. A reliable diagnosis can only be established in case of a positive PCR result or a fourfold titre increase in MAT.
Collapse
Affiliation(s)
- Michèle Bergmann
- Michèle Bergmann, Medizinische Kleintierklinik, Ludwig-Maximilians-Universität München, Veterinärstraße 13, 80539 München, E-Mail:
| | | | | |
Collapse
|
38
|
Peptide specific monoclonal antibodies of Leptospiral LigA for acute diagnosis of leptospirosis. Sci Rep 2017; 7:3250. [PMID: 28607384 PMCID: PMC5468321 DOI: 10.1038/s41598-017-03658-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 05/03/2017] [Indexed: 01/09/2023] Open
Abstract
Leptospirosis is underdiagnosed due to low sensitivity, need of specialised equipment, and expensive reagents for serological and molecular diagnosis respectively. Considering the sensitivity, rapidity, inexpensive reagents and collection of clinical samples, the monoclonal antibody based antigen detection method from urine samples has been developed and evaluated. LigA (LK90) based B-cell specific epitopes were predicted and synthesised as peptides for the production of monoclonal antibody. LK90543: SNAQKNQGNA (amino acids: 543 to 552), and LK901110: DHHTQSSYTP (amino acids: 1110 to 1119) with VaxiJen score of 1.3719 and 1.2215, respectively were used. Thirty two and 28 urine samples from confirmed and seronegative healthy human subjects, respectively were included for the evaluation of MAb-based dot blot ELISA. The specificity of the evaluated MAbs, P1B1 and P4W2 were found to be in the range of ~93–96%. Moreover, the MAbs did not show cross-reactivity with other bacterial antigens as confirmed by IgG ELISA, further validating its specificity for leptospiral antigens. These findings suggest that the developed MAb based dot blot ELISA is a simple, rapid performed in less than 8 h, inexpensive with a ICER of $8.7/QALY, and affordable in developing countries and area where laboratory facilities are limited.
Collapse
|
39
|
Chadsuthi S, Bicout DJ, Wiratsudakul A, Suwancharoen D, Petkanchanapong W, Modchang C, Triampo W, Ratanakorn P, Chalvet-Monfray K. Investigation on predominant Leptospira serovars and its distribution in humans and livestock in Thailand, 2010-2015. PLoS Negl Trop Dis 2017; 11:e0005228. [PMID: 28182662 PMCID: PMC5325611 DOI: 10.1371/journal.pntd.0005228] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 02/24/2017] [Accepted: 12/03/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Leptospirosis is a worldwide zoonotic bacterial disease caused by infection with leptospires. Leptospirosis in humans and livestock is an endemic and epidemic disease in Thailand. Livestock may act as reservoirs for leptospires and source for human infection. METHODOLOGY/PRINCIPAL FINDINGS Data on leptospirosis infection in humans and livestock (Buffaloes, Cattle, and Pigs) species during 2010 to 2015 were analyzed. Serum samples were examined using Microscopic Agglutination Test (MAT) to identify antibodies against Leptospira serovars using a cut-off titer ≥ 1:100. The seroprevalence was 23.7% in humans, 24.8% in buffaloes, 28.1% in cattle, and 11.3% in pigs. Region specific prevalence among humans and livestock was found in a wide range. The most predominant serovars were Shermani, followed by Bratislava, Panama, and Sejroe in human, Shermani, Ranarum, and Tarassovi in buffaloes, and Shermani and Ranarum in cattle and pigs. Equally highest MAT titers against multiple serovars per one sample were found mainly in buffaloes and cattle showing equally titers against Ranarum and Shermani. The correlations of distribution of serovars across Thailand's regions were found to be similar in pattern for cattle but not for buffaloes. In humans, the serovar distribution in the south differed from other regions. By logistic regression, the results indicated that livestock is more susceptible to infection by serovar Shermani when compared to humans. CONCLUSIONS/SIGNIFICANCE This study gives a detailed picture of the predominance of Leptospira serovars in relation to region, humans and typical livestock. The broad spatial distribution of seroprevalence was analyzed across and within species as well as regions in Thailand. Our finding may guide public health policy makers to implement appropriate control measures and help to reduce the impact of leptospirosis in Thailand.
Collapse
Affiliation(s)
- Sudarat Chadsuthi
- Department of Physics, Faculty of Science, Naresuan University, Phitsanulok, Thailand
| | - Dominique J. Bicout
- Biomathematics & Epidemiology, EPHP–TIMC Lab, UMR 5525 CNRS Univ Grenoble Alpes, VetAgro Sup, 69280 Marcy l’Etoile, France
| | - Anuwat Wiratsudakul
- Department of Clinical Sciences and Public Health, and the Monitoring and Surveillance Center for Zoonotic Diseases in Wildlife and Exotic Animals, Faculty of Veterinary Science, Mahidol University, Nakhon Pathom, Thailand
| | - Duangjai Suwancharoen
- National Institute of Animal Health, Department of Livestock Development, Bangkok, Thailand
| | - Wimol Petkanchanapong
- National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nontaburi, Thailand
| | - Charin Modchang
- Biophysics Group, Department of Physics, Faculty of Science, Mahidol University, Bangkok, Thailand
- Centre of Excellence in Mathematics, CHE, 328, Si Ayutthaya Road, Bangkok, Thailand
| | - Wannapong Triampo
- Biophysics Group, Department of Physics, Faculty of Science, Mahidol University, Bangkok, Thailand
- Centre of Excellence in Mathematics, CHE, 328, Si Ayutthaya Road, Bangkok, Thailand
| | - Parntep Ratanakorn
- Department of Clinical Science and Public Health, Faculty of Veterinary Science, Mahidol University, Nakhon Pathom, Thailand
| | | |
Collapse
|
40
|
Maze MJ, Biggs HM, Rubach MP, Galloway RL, Cash-Goldwasser S, Allan KJ, Halliday JEB, Hertz JT, Saganda W, Lwezaula BF, Cleaveland S, Mmbaga BT, Maro VP, Crump JA. Comparison of the Estimated Incidence of Acute Leptospirosis in the Kilimanjaro Region of Tanzania between 2007-08 and 2012-14. PLoS Negl Trop Dis 2016; 10:e0005165. [PMID: 27911902 PMCID: PMC5135036 DOI: 10.1371/journal.pntd.0005165] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 11/06/2016] [Indexed: 12/27/2022] Open
Abstract
Background The sole report of annual leptospirosis incidence in continental Africa of 75–102 cases per 100,000 population is from a study performed in August 2007 through September 2008 in the Kilimanjaro Region of Tanzania. To evaluate the stability of this estimate over time, we estimated the incidence of acute leptospirosis in Kilimanjaro Region, northern Tanzania for the time period 2012–2014. Methodology and Principal Findings Leptospirosis cases were identified among febrile patients at two sentinel hospitals in the Kilimanjaro Region. Leptospirosis was diagnosed by serum microscopic agglutination testing using a panel of 20 Leptospira serovars belonging to 17 separate serogroups. Serum was taken at enrolment and patients were asked to return 4–6 weeks later to provide convalescent serum. Confirmed cases required a 4-fold rise in titre and probable cases required a single titre of ≥800. Findings from a healthcare utilisation survey were used to estimate multipliers to adjust for cases not seen at sentinel hospitals. We identified 19 (1.7%) confirmed or probable cases among 1,115 patients who presented with a febrile illness. Of cases, the predominant reactive serogroups were Australis 8 (42.1%), Sejroe 3 (15.8%), Grippotyphosa 2 (10.5%), Icterohaemorrhagiae 2 (10.5%), Pyrogenes 2 (10.5%), Djasiman 1 (5.3%), Tarassovi 1 (5.3%). We estimated that the annual incidence of leptospirosis was 11–18 cases per 100,000 population. This was a significantly lower incidence than 2007–08 (p<0.001). Conclusions We estimated a much lower incidence of acute leptospirosis than previously, with a notable absence of cases due to the previously predominant serogroup Mini. Our findings indicate a dynamic epidemiology of leptospirosis in this area and highlight the value of multi-year surveillance to understand leptospirosis epidemiology. Leptospirosis is an infectious disease that causes a fever. It can be severe or fatal. Understanding how many people get leptospirosis helps to determine priorities in allocating resources for disease diagnosis, treatment, and prevention. There are few data about leptospirosis incidence in sub-Saharan African countries. The only mainland estimate is from northern Tanzania for the years 2007–08. To see if leptospirosis incidence had changed since 2007–08, we measured leptospirosis incidence in the same location in 2012–2014. To do this, we systematically approached people at two hospitals in the Kilimanjaro Region and tested them for leptospirosis. We adjusted the number of identified cases of leptospirosis found at the hospitals to account for people with fever who did not come to hospital for testing and care. We also adjusted for imperfect testing methods. We found that the number of people who developed leptospirosis annually had dropped from 75–102 cases per 100,000 people during 2007–08 to 11–18 cases per 100,000 people during 2012–14. Also, the subtype of leptospirosis responsible for the most cases during 2007–08 was not present during 2012–14. The number of people developing leptospirosis was not stable, highlighting the value of measuring how commonly leptospirosis occurs over several years.
Collapse
Affiliation(s)
- Michael J. Maze
- Centre for International Health, University of Otago, Dunedin, New Zealand
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- * E-mail:
| | - Holly M. Biggs
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Matthew P. Rubach
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Renee L. Galloway
- Centers for Disease Control and Prevention, Bacterial Special Pathogens Branch, Atlanta, Georgia, United States of America
| | - Shama Cash-Goldwasser
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Kathryn J. Allan
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Jo E. B. Halliday
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Julian T. Hertz
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | | | | | | | - Blandina T. Mmbaga
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Venance P. Maro
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - John A. Crump
- Centre for International Health, University of Otago, Dunedin, New Zealand
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| |
Collapse
|
41
|
Abstract
Leptospirosis is a widespread bacterial zoonosis with highest burden in low-income populations living in tropical and subtropical regions, both in urban and in rural environments. Rodents are known as the main reservoir animals, but other mammals may also significantly contribute to human infections in some settings. Clinical presentation of leptospirosis is nonspecific and variable, and most of the early signs and symptoms point to the so-called “acute fever of unknown origin”, a major diagnostic challenge in tropical and subtropical areas. However, leptospirosis can rapidly evolve to life-threatening complications, especially if left untreated. There is a need for good awareness of leptospirosis and rapid antibiotic treatment based on clinical and epidemiological suspicion. Severe leptospirosis cases include renal and/or respiratory failure and shock, necessitating intensive care, also seldom available or with limited capacity. Confirmation of leptospirosis relies on biological diagnosis, which unfortunately uses tricky methods seldom available. This biological confirmation, however, is essential for surveillance and public health purpose. A good knowledge of leptospirosis epidemiology (eg, the reservoir animals involved, the Leptospira strains circulating, the seasonal and geographical patterns, and specific populations at risk) can be achieved through adequate surveillance and diagnosis. This can pave the way to prevention and intervention strategies and in turn alleviate the toll leptospirosis takes on affected populations. Over the past few years, leptospirosis has been increasingly recognized, as the need for multidisciplinary approaches in a One-Health perspective has been acknowledged, raising hope to successfully tackle the challenges of this zoonosis.
Collapse
Affiliation(s)
- Cyrille Goarant
- Institut Pasteur International Network, Institut Pasteur in New Caledonia, Leptospirosis Research and Expertise Unit, Nouméa, New Caledonia
| |
Collapse
|
42
|
Exact inference for the risk ratio with an imperfect diagnostic test. Epidemiol Infect 2016; 145:187-193. [PMID: 27608542 DOI: 10.1017/s0950268816002028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The risk ratio quantifies the risk of disease in a study population relative to a reference population. Standard methods of estimation and testing assume a perfect diagnostic test having sensitivity and specificity of 100%. However, this assumption typically does not hold, and this may invalidate naive estimation and testing for the risk ratio. We propose procedures that control for sensitivity and specificity of the diagnostic test, given the risks are measured by proportions, as it is in cross-sectional studies or studies with fixed follow-up times. These procedures provide an exact unconditional test and confidence interval for the true risk ratio. The methods also cover the case when sensitivity and specificity differ in the two groups (differential misclassification). The resulting test and confidence interval may be useful in epidemiological studies as well as in clinical and vaccine trials. We illustrate the method with real-life examples which demonstrate that ignoring sensitivity and specificity of the diagnostic test may lead to considerable bias in the estimated risk ratio.
Collapse
|
43
|
Hem S, Ly S, Votsi I, Vogt F, Asgari N, Buchy P, Heng S, Picardeau M, Sok T, Ly S, Huy R, Guillard B, Cauchemez S, Tarantola A. Estimating the Burden of Leptospirosis among Febrile Subjects Aged below 20 Years in Kampong Cham Communities, Cambodia, 2007-2009. PLoS One 2016; 11:e0151555. [PMID: 27043016 PMCID: PMC4820258 DOI: 10.1371/journal.pone.0151555] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 03/01/2016] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Leptospirosis is an emerging but neglected public health challenge in the Asia/Pacific Region with an annual incidence estimated at 10-100 per 100,000 population. No accurate data, however, are available for at-risk rural Cambodian communities. METHOD We conducted anonymous, unlinked testing for IgM antibodies to Leptospira spp. on paired sera of Cambodian patients <20 years of age between 2007-2009 collected through active, community-based surveillance for febrile illnesses in a convenience sample of 27 rural and semi-rural villages in four districts of Kampong Cham province, Cambodia. Leptospirosis testing was done on paired serological samples negative for Dengue, Japanese encephalitis and Chikungunya viruses after random selection. Convalescent samples found positive while initial samples were negative were considered as proof of acute infection. We then applied a mathematical model to estimate the risk of fever caused by leptospirosis, dengue or other causes in rural Cambodia. RESULTS A total of 630 samples are coming from a randomly selected subset of 2358 samples. IgM positive were found on the convalescent serum sample, among which 100 (15.8%) samples were IgM negative on an earlier sample. Seventeen of these 100 seroconversions were confirmed using a Microagglutination Test. We estimated the probability of having a fever due to leptospirosis at 1. 03% (95% Credible Interval CI: 0. 95%-1. 22%) per semester. In comparison, this probability was 2. 61% (95% CI: 2. 55%, 2. 83%) for dengue and 17. 65% (95% CI: 17. 49%, 18. 08%) for other causes. CONCLUSION Our data from febrile cases aged below 20 years suggest that the burden of leptospirosis is high in rural Cambodian communities. This is especially true during the rainy season, even in the absence of identified epidemics.
Collapse
Affiliation(s)
- Sopheak Hem
- Institut Pasteur in Cambodia, Phnom Penh, Cambodia
| | - Sowath Ly
- Institut Pasteur in Cambodia, Phnom Penh, Cambodia
| | - Irene Votsi
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Paris, France
| | - Florian Vogt
- Masters of Science in Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nima Asgari
- World Health Organization, Phnom Penh, Cambodia
| | | | - Seiha Heng
- Institut Pasteur in Cambodia, Phnom Penh, Cambodia
| | - Mathieu Picardeau
- Institut Pasteur, National Reference Center and WHO Collaborating Center for Leptospirosis, Paris, France
| | - Touch Sok
- Communicable Diseases Control Department of the Ministry of Health, Phnom Penh, Cambodia
| | - Sovann Ly
- Communicable Diseases Control Department of the Ministry of Health, Phnom Penh, Cambodia
| | - Rekol Huy
- National Dengue Control Program, National Center for Entomology, Parasitology, and Malaria Control, Phnom Penh, Cambodia
| | | | - Simon Cauchemez
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Paris, France
| | | |
Collapse
|
44
|
Bhatia M, Umapathy BL, Navaneeth BV. An evaluation of dark field microscopy, culture and commercial serological kits in the diagnosis of leptospirosis. Indian J Med Microbiol 2016; 33:416-21. [PMID: 26068347 DOI: 10.4103/0255-0857.158570] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
CONTEXT This study was conducted to analyze the clinical utility of various leptospira diagnostic modalities. AIMS To evaluate the role of dark field microscopy (DFM), culture, immunochromatography (IgM Leptocheck), IgM enzyme-linked immunosorbent assay (IgM ELISA), macroscopic slide agglutination test (MSAT) and microscopic agglutination test (MAT) in diagnosing leptospirosis in febrile patients. SETTINGS AND DESIGN Descriptive study conducted in a tertiary care hospital from January 2011 to April 2012. SUBJECTS AND METHODS Blood, urine and paired sera from 100 patients with clinical suspicion of leptospirosis (study group) were collected and subjected to DFM, culture, IgM Leptocheck, IgM ELISA and MSAT. Fifty randomly selected sera from febrile patients tested positive for infections other than leptospirosis (control sera) were also subjected to the aforementioned serological assays. All the leptospira seropositive samples were subjected to MAT. STATISTICAL ANALYSIS USED Positive predictive values (PPV) and coefficient of agreement (kappa). RESULTS None of the clinical samples showed positivity by DFM. Leptospira inadai was isolated from a urine sample. The seropositivity of IgM Leptocheck, IgM ELISA and MSAT was 16%, 46% and 47%, respectively. The PPV of these assays was 14.3%, 8.7% and 6.5%, respectively. Poor agreement was obtained among these assays. Only four study group leptospira seropositive samples were confirmed by MAT with Australis being the predominant serovar. None of the leptospira-positive control sera were confirmed by MAT. CONCLUSIONS DFM and culture have limited utility in diagnosing leptospirosis with serology being the mainstay. The present study shows discordant results with the commercially available serological kits. Further studies should be done to evaluate the various diagnostic modalities.
Collapse
Affiliation(s)
- M Bhatia
- Department of Microbiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Jawahar Lal Nehru Marg, New Delhi, India
| | | | | |
Collapse
|
45
|
Iwasaki H, Chagan-Yasutan H, Leano PSA, Koizumi N, Nakajima C, Taurustiati D, Hanan F, Lacuesta TL, Ashino Y, Suzuki Y, Gloriani NG, Telan EFO, Hattori T. Combined antibody and DNA detection for early diagnosis of leptospirosis after a disaster. Diagn Microbiol Infect Dis 2016; 84:287-91. [PMID: 26860351 DOI: 10.1016/j.diagmicrobio.2016.01.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 01/06/2016] [Indexed: 01/17/2023]
Abstract
Early diagnosis based on laboratory confirmation is essential for managing leptospirosis. This study investigated the effectiveness of a novel method of detecting leptospirosis that combines measurement of anti-Leptospira antibodies by the microscopic agglutination test (MAT), enzyme-linked immunosorbent assay (ELISA), and immunochromatographic test (ICT) and leptospiral DNA by loop-mediated isothermal amplification (LAMP) and real-time PCR in plasma and 2 types of urine pellets. Of 113 suspected cases, 68.1%, 76.1%, and 60.2% were positive by MAT, ELISA, and ICT, respectively. Real-time PCR using DNA purified from urine pellets collected by low-speed centrifugation yielded positive signals for patients in late acute as well as early phase who were positive by LAMP using plasma DNA or urine pellets. Among antibody-negative patients, 9.5% were positive by DNA detection. These findings indicate that the leptospirosis detection rate is increased by combining antibody and DNA detection, providing a new tool for timely diagnosis of infection.
Collapse
Affiliation(s)
- Hiroko Iwasaki
- Division of Disaster-Related Infectious Diseases, International Research Institute of Disaster Science, Tohoku University, Sendai, Japan
| | - Haorile Chagan-Yasutan
- Division of Disaster-Related Infectious Diseases, International Research Institute of Disaster Science, Tohoku University, Sendai, Japan; Division of Emerging Infectious Diseases, Department of Internal Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Prisca Susan A Leano
- National Reference Laboratory for HIV/AIDS, Hepatitis, and Other STDs, STD/AIDS Cooperative Central Laboratory, Manila, Philippines
| | - Nobuo Koizumi
- Department of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Chie Nakajima
- Research Center for Zoonosis Control, Hokkaido University, Sapporo, Japan
| | - Delsi Taurustiati
- Division of Emerging Infectious Diseases, Department of Internal Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Firmanto Hanan
- Division of Emerging Infectious Diseases, Department of Internal Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | | | - Yugo Ashino
- Division of Disaster-Related Infectious Diseases, International Research Institute of Disaster Science, Tohoku University, Sendai, Japan; Division of Emerging Infectious Diseases, Department of Internal Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Yasuhiko Suzuki
- Research Center for Zoonosis Control, Hokkaido University, Sapporo, Japan
| | - Nina G Gloriani
- Department of Medical Microbiology, College of Public Health, University of the Philippines-Manila, Manila, Philippines
| | - Elizabeth Freda O Telan
- National Reference Laboratory for HIV/AIDS, Hepatitis, and Other STDs, STD/AIDS Cooperative Central Laboratory, Manila, Philippines
| | - Toshio Hattori
- Division of Disaster-Related Infectious Diseases, International Research Institute of Disaster Science, Tohoku University, Sendai, Japan; Division of Emerging Infectious Diseases, Department of Internal Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan.
| |
Collapse
|
46
|
Schreiber PW, Aceto L, Korach R, Marreros N, Ryser-Degiorgis MP, Günthard HF. Cluster of Leptospirosis Acquired Through River Surfing in Switzerland. Open Forum Infect Dis 2015; 2:ofv102. [PMID: 26269796 PMCID: PMC4531225 DOI: 10.1093/ofid/ofv102] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 07/03/2015] [Indexed: 02/06/2023] Open
Abstract
Background. In Switzerland, leptospirosis is still considered as a travel-associated disease. After the surprising diagnosis of leptospirosis in a patient who was initially suspected as having primary human immunodeficiency virus infection, we recognized that acquisition of leptospirosis occurred through recreational activities and we identified additional affected individuals. Methods. Detailed anamnesis, excluding occupational exposure, acquisition abroad, and pet contacts, enabled us to detect the source of infection and identify a cluster of leptospirosis. Convalescent sera testing was performed to confirm Leptospira infection. Microscopic agglutination tests were used to determine the infecting serovar. Results. We identified a cluster of leptospirosis in young, previously healthy persons. Acquisition of leptospirosis was traced back to a surfing spot on a river in Switzerland (Reuss, Aargau). Clinical presentation was indistinct. Two of the 3 reported cases required hospitalization, and 1 case even suffered from meningitis. Serologic tests indicated infection with the serovar Grippotyphosa in all cases. With the exception of the case with meningitis, no antibiotics were administered, because leptospirosis was diagnosed after spontaneous resolution of most symptoms. Despite a prolonged period of convalescence in 2 cases, full recovery was achieved. Recent reports on beavers suffering from leptospirosis in this region underline the possible water-borne infection of the 3 cases and raise the question of potential wildlife reservoirs. Conclusions. Insufficient awareness of caregivers, which may be promoted by the missing obligation to report human leptospirosis, combined with the multifaceted presentation of the disease result in significant underdiagnosis. More frequent consideration of leptospirosis as differential diagnosis is inevitable, particularly as veterinary data suggest re-emergence of the disease.
Collapse
Affiliation(s)
- Peter W. Schreiber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich
- University of Zurich, Institute of Medical Virology
| | - Leonardo Aceto
- Division of Infectious Diseases, Triemli Hospital Zurich
| | | | - Nelson Marreros
- University of Bern, Centre for Fish and Wildlife Health, Vetsuisse Faculty, Switzerland
| | | | - Huldrych F. Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich
- University of Zurich, Institute of Medical Virology
| |
Collapse
|
47
|
Schlichting D, Nöckler K, Bahn P, Luge E, Greiner M, Müller-Graf C, Mayer-Scholl A. Estimation of the sensitivity and specificity of a Leptospira spp. in-house ELISA through Bayesian modelling. Int J Med Microbiol 2015; 305:756-61. [PMID: 26358915 DOI: 10.1016/j.ijmm.2015.08.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
The microscopic agglutination test (MAT) is still considered the gold standard for the diagnosis of leptospirosis, although studies have shown that the test is an imperfect gold standard for clinical samples and unsuitable for epidemiological studies. Here, test characteristics of an in-house ELISA were identified for both subclinical and clinical populations by Bayesian latent class models. A conditional dependence model for two diagnostic tests and two populations was adapted to analyse a clinical and a subclinical scenario, respectively. These Bayesian models were used to estimate the sensitivity and specificity of the in-house ELISA and the MAT as well as the prevalences. The Bayesian estimates of the in-house ELISA were: clinical sensitivity=83.0%, clinical specificity=98.5%, subclinical sensitivity=85.7% and subclinical specificity=99.1%. In contrast, the estimates of the MAT were: clinical sensitivity=65.6%, clinical specificity=97.7%, subclinical sensitivity 54.9% and subclinical specificity=97.3%. The results show the suitability of the in-house ELISA for both clinical investigations and epidemiological studies in mildly endemic areas.
Collapse
Affiliation(s)
- Daniela Schlichting
- Federal Institute for Risk Assessment (BfR), Consultant Laboratory for Leptospirosis, Max-Dohrn-Str. 8-10, 10589 Berlin, Germany.
| | - Karsten Nöckler
- Federal Institute for Risk Assessment (BfR), Consultant Laboratory for Leptospirosis, Max-Dohrn-Str. 8-10, 10589 Berlin, Germany
| | - Peter Bahn
- Federal Institute for Risk Assessment (BfR), Consultant Laboratory for Leptospirosis, Max-Dohrn-Str. 8-10, 10589 Berlin, Germany
| | - Enno Luge
- Federal Institute for Risk Assessment (BfR), Consultant Laboratory for Leptospirosis, Max-Dohrn-Str. 8-10, 10589 Berlin, Germany
| | - Matthias Greiner
- Federal Institute for Risk Assessment (BfR), Consultant Laboratory for Leptospirosis, Max-Dohrn-Str. 8-10, 10589 Berlin, Germany
| | - Christine Müller-Graf
- Federal Institute for Risk Assessment (BfR), Consultant Laboratory for Leptospirosis, Max-Dohrn-Str. 8-10, 10589 Berlin, Germany
| | - Anne Mayer-Scholl
- Federal Institute for Risk Assessment (BfR), Consultant Laboratory for Leptospirosis, Max-Dohrn-Str. 8-10, 10589 Berlin, Germany
| |
Collapse
|
48
|
Reverse-Transcriptase PCR Detection of Leptospira: Absence of Agreement with Single-Specimen Microscopic Agglutination Testing. PLoS One 2015; 10:e0132988. [PMID: 26177295 PMCID: PMC4503744 DOI: 10.1371/journal.pone.0132988] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 06/23/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Reference diagnostic tests for leptospirosis include nucleic acid amplification tests, bacterial culture, and microscopic agglutination testing (MAT) of acute and convalescent serum. However, clinical laboratories often do not receive paired specimens. In the current study, we tested serum samples using a highly sensitive real-time nucleic acid amplification test for Leptospira and compared results to MAT performed on the same specimens. METHODS/PRINCIPAL FINDINGS 478 serum samples from suspected leptospirosis cases in Rio de Janeiro were tested using a real-time RT-PCR for the diagnosis of leptospirosis, malaria and dengue (the Lepto-MD assay). The Lepto-MD assay detects all species of Leptospira (saprophytic, intermediate, and pathogenic), and in the current study, we demonstrate that this assay amplifies both Leptospira RNA and DNA. Dengue virus RNA was identified in 10 patients, and no cases of malaria were detected. A total of 65 samples (13.6%) were positive for Leptospira: 35 samples (7.3%) in the Lepto-MD assay, 33 samples (6.9%) by MAT, and 3 samples tested positive by both (kappa statistic 0.02). Poor agreement between methods was consistent regardless of the titer used to define positive MAT results or the day of disease at sample collection. Leptospira nucleic acids were detected in the Lepto-MD assay as late as day 22, and cycle threshold values did not differ based on the day of disease. When Lepto-MD assay results were added to the MAT results for all patients in 2008 (n=818), the number of detected leptospirosis cases increased by 30.4%, from 102 (12.5%) to 133 (16.3%). CONCLUSIONS/SIGNIFICANCE This study demonstrates a lack of agreement between nucleic acid detection of Leptospira and single-specimen MAT, which may result from the clearance of bacteremia coinciding with the appearance of agglutinating antibodies. A combined testing strategy for acute leptospirosis, including molecular and serologic testing, appears necessary to maximize case detection.
Collapse
|
49
|
Niloofa R, Fernando N, de Silva NL, Karunanayake L, Wickramasinghe H, Dikmadugoda N, Premawansa G, Wickramasinghe R, de Silva HJ, Premawansa S, Rajapakse S, Handunnetti S. Diagnosis of Leptospirosis: Comparison between Microscopic Agglutination Test, IgM-ELISA and IgM Rapid Immunochromatography Test. PLoS One 2015; 10:e0129236. [PMID: 26086800 PMCID: PMC4472754 DOI: 10.1371/journal.pone.0129236] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 05/06/2015] [Indexed: 12/03/2022] Open
Abstract
Background Leptospirosis is diagnosed on clinical grounds, and confirmed by microscopic agglutination test (MAT). IgM-ELISA (Serion-Virion) and immunochromatography test (Leptocheck-WB) are two immunodiagnostic assays for leptospirosis. Their sensitivity, specificity and applicability in Sri Lanka have not been systematically evaluated. Methods Clinically diagnosed leptospirosis patients (n = 919) were recruited from three hospitals in the Western Province of Sri Lanka, during June 2012 to December 2013. MAT, IgM-ELISA and Leptocheck-WB were performed on all patient sera. MAT titer of ≥400 in single sample, four-fold rise or seroconversion ≥100 in paired samples were considered as positive for MAT. For diagnostic confirmation, MAT was performed during both acute and convalescent phases. Anti-leptospiral IgM ≥20 IU/ml and appearance of a band in the test window were considered as positive for IgM-ELISA and Leptocheck-WB test respectively. Patients with an alternative diagnosis (n = 31) were excluded. Data analysis was performed using two methods, i) considering MAT as reference standard and ii) using Bayesian latent class model analysis (BLCM) which considers each test as imperfect. Results MAT, IgM-ELISA and Leptocheck-WB positivity were 39.8%, 45.8% and 38.7% respectively during the acute phase. Acute-phase MAT had specificity and sensitivity of 95.7% and 55.3% respectively, when compared to overall MAT positivity. IgM-ELISA and Leptocheck-WB had similar diagnostic sensitivity when compared with acute-phase MAT as the gold standard, although IgM-ELISA showed higher specificity (84.5%) than Leptocheck-WB (73.3%). BLCM analysis showed that IgM-ELISA and Leptocheck-WB had similar sensitivities (86.0% and 87.4%), while acute-phase MAT had the lowest sensitivity (77.4%). However, acute-phase MAT had high specificity (97.6%), while IgM-ELISA and Leptocheck-WB showed similar but lower specificity (84.5% and 82.9%). Conclusions Both IgM-ELISA and Leptocheck-WB shows similar sensitivities and specificities. IgM-ELISA may be superior to MAT during the acute phase and suitable for early diagnosis of leptospirosis. Leptocheck-WB is suitable as a rapid immunodiagnostic screening test for resource limited settings.
Collapse
Affiliation(s)
- Roshan Niloofa
- Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo, Colombo, Sri Lanka
- * E-mail:
| | - Narmada Fernando
- Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo, Colombo, Sri Lanka
| | | | - Lilani Karunanayake
- National Reference Laboratory for Leptospira, Medical Research Institute, Colombo, Sri Lanka
| | | | | | | | | | | | | | - Senaka Rajapakse
- Tropical Medicine Research Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Shiroma Handunnetti
- Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo, Colombo, Sri Lanka
| |
Collapse
|
50
|
Abstract
Leptospirosis is a widespread and potentially fatal zoonosis that is endemic in many tropical regions and causes large epidemics after heavy rainfall and flooding. Infection results from direct or indirect exposure to infected reservoir host animals that carry the pathogen in their renal tubules and shed pathogenic leptospires in their urine. Although many wild and domestic animals can serve as reservoir hosts, the brown rat (Rattus norvegicus) is the most important source of human infections. Individuals living in urban slum environments characterized by inadequate sanitation and poor housing are at high risk of rat exposure and leptospirosis. The global burden of leptospirosis is expected to rise with demographic shifts that favor increases in the number of urban poor in tropical regions subject to worsening storms and urban flooding due to climate change. Data emerging from prospective surveillance studies suggest that most human leptospiral infections in endemic areas are mild or asymptomatic. Development of more severe outcomes likely depends on three factors: epidemiological conditions, host susceptibility, and pathogen virulence (Fig. 1). Mortality increases with age, particularly in patients older than 60 years of age. High levels of bacteremia are associated with poor clinical outcomes and, based on animal model and in vitro studies, are related in part to poor recognition of leptospiral LPS by human TLR4. Patients with severe leptospirosis experience a cytokine storm characterized by high levels of IL-6, TNF-alpha, and IL-10. Patients with the HLA DQ6 allele are at higher risk of disease, suggesting a role for lymphocyte stimulation by a leptospiral superantigen. Leptospirosis typically presents as a nonspecific, acute febrile illness characterized by fever, myalgia, and headache and may be confused with other entities such as influenza and dengue fever. Newer diagnostic methods facilitate early diagnosis and antibiotic treatment. Patients progressing to multisystem organ failure have widespread hematogenous dissemination of pathogens. Nonoliguric (high output) renal dysfunction should be supported with fluids and electrolytes. When oliguric renal failure occurs, prompt initiation of dialysis can be life saving. Elevated bilirubin levels are due to hepatocellular damage and disruption of intercellular junctions between hepatocytes, resulting in leaking of bilirubin out of bile caniliculi. Hemorrhagic complications are common and are associated with coagulation abnormalities. Severe pulmonary hemorrhage syndrome due to extensive alveolar hemorrhage has a fatality rate of >50 %. Readers are referred to earlier, excellent summaries related to this subject (Adler and de la Peña-Moctezuma 2010; Bharti et al. 2003; Hartskeerl et al. 2011; Ko et al. 2009; Levett 2001; McBride et al. 2005).
Collapse
|