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Mukadi Kakoni P, Munyeku Bazitama Y, Nepomuceno JR, Pukuta-Simbu E, Kawhata Mawika F, Kashitu Mujinga G, Palla L, Ahuka-Mundeke S, Muyembe Tamfum JJ, Koizumi N, Kubo Y, Ariyoshi K, Smith C. Leptospirosis as a cause of fever associated with jaundice in the Democratic Republic of the Congo. PLoS Negl Trop Dis 2021; 15:e0009670. [PMID: 34403427 PMCID: PMC8396788 DOI: 10.1371/journal.pntd.0009670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 08/27/2021] [Accepted: 07/20/2021] [Indexed: 11/18/2022] Open
Abstract
Background Fever with jaundice is a common symptom of some infectious diseases. In public health surveillance within the Democratic Republic of the Congo (DRC), yellow fever is the only recognized cause of fever with jaundice. However, only 5% of the surveillance cases are positive for yellow fever and thus indicate the involvement of other pathogens. Leptospira spp. are the causative agents of leptospirosis, a widespread bacterial zoonosis, a known cause of fever with jaundice. This study aimed to determine the seropositivity of anti-Leptospira antibodies among suspected yellow fever cases and map the geographical distribution of possible leptospirosis in the DRC. Methods We conducted a retrospective study using 1,300 samples from yellow fever surveillance in the DRC from January 2017 to December 2018. Serum samples were screened for the presence of IgM against Leptospira spp. by a whole cell-based IgM ELISA (Patoc-IgM ELISA) at the Institut National de Recherche Biomedicale in Kinshasa (INRB) according to World Health Organization (WHO) guidance. Exploratory univariable and multivariable logistic regression analyses were undertaken to assess associations between socio-demographic factors and the presence of Leptospira IgM. Results Of the 1,300 serum samples screened, 88 (7%) showed evidence of IgM against Leptospira spp. Most positive cases (34%) were young adult males in the 20–29-year group. There were statistically significant associations between having Leptospira IgM antibodies, age, sex, and living area. Observed positive cases were mostly located in urban settings, and the majority lived in the province of Kinshasa. There was a statistically significant association between seasonality and IgM Leptospira spp. positivity amongst those living in Kinshasa, where most of the positive cases occurred during the rainy season. Conclusions This study showed that leptospirosis is likely an overlooked cause of unexplained cases of fever with jaundice in the DRC and highlights the need to consider leptospirosis in the differential diagnosis of fever with jaundice, particularly in young adult males. Further studies are needed to identify animal reservoirs, associated risk factors, and the burden of human leptospirosis in the DRC. Leptospirosis is an important bacterial zoonosis with a worldwide distribution. Each year there are an estimated one million cases, with about 60,000 deaths. The true burden of the disease, however, is unknown. The burden of leptospirosis is probably underestimated due to the lack of specific clinical symptoms and diagnostic techniques that are not readily available. Clinical diagnosis of leptospirosis is difficult because of the diversity of symptoms, ranging from asymptomatic forms to severe multivisceral icteric states. Differential diagnoses with infections presenting with fever or fever and jaundice are numerous and may mislead the clinician. Leptospirosis is considered endemic in sub-Saharan Africa and is known to cause fever with jaundice in African countries; however, for most countries, available epidemiologic data are scarce, including in the Democratic Republic of Congo (DRC). An improved understanding of the epidemiology of leptospirosis will improve clinical management, lead to policy formulation, and have implications for national surveillance of infectious diseases in these countries. We conducted a retrospective seroepidemiological study to extend the description of the pathogens responsible for fever with jaundice in the DRC and to clarify the circulation of possible leptospirosis in the country. This study showed that leptospirosis is a likely cause of fever with jaundice in the DRC.
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Affiliation(s)
- Patrick Mukadi Kakoni
- Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Institut National de Recherche Biomedicale (INRB), Kinshasa, the Democratic Republic of the Congo
- Faculté de Médecine, Université de Kinshasa, Kinshasa, the Democratic Republic of the Congo
- Program for Nurturing Global Leaders in Tropical and Emerging Communicable Diseases, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
- Department of Clinical Tropical Medicine, Institute of Tropical Medicine, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | - Yannick Munyeku Bazitama
- Institut National de Recherche Biomedicale (INRB), Kinshasa, the Democratic Republic of the Congo
- Faculté de Médecine, Université de Kinshasa, Kinshasa, the Democratic Republic of the Congo
| | - Jean Raphael Nepomuceno
- Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Elisabeth Pukuta-Simbu
- Institut National de Recherche Biomedicale (INRB), Kinshasa, the Democratic Republic of the Congo
| | | | - Gracia Kashitu Mujinga
- Faculté de Médecine, Université de Kinshasa, Kinshasa, the Democratic Republic of the Congo
| | - Luigi Palla
- Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Bacteriology I, National Institute of Infectious Diseases (NIID), Tokyo, Japan
| | - Steve Ahuka-Mundeke
- Institut National de Recherche Biomedicale (INRB), Kinshasa, the Democratic Republic of the Congo
- Faculté de Médecine, Université de Kinshasa, Kinshasa, the Democratic Republic of the Congo
| | - Jean-Jacques Muyembe Tamfum
- Institut National de Recherche Biomedicale (INRB), Kinshasa, the Democratic Republic of the Congo
- Faculté de Médecine, Université de Kinshasa, Kinshasa, the Democratic Republic of the Congo
| | - Nobuo Koizumi
- Department of Public Health and Infectious Diseases, University of Rome La Sapienza, Roma, Italy
| | - Yoshinao Kubo
- Program for Nurturing Global Leaders in Tropical and Emerging Communicable Diseases, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
- Department of Clinical Tropical Medicine, Institute of Tropical Medicine, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | - Koya Ariyoshi
- Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Clinical Tropical Medicine, Institute of Tropical Medicine, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | - Chris Smith
- Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
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Edrada EM, Lopez EB, Villarama JB, Salva Villarama EP, Dagoc BF, Smith C, Sayo AR, Verona JA, Trifalgar-Arches J, Lazaro J, Balinas EGM, Telan EFO, Roy L, Galon M, Florida CHN, Ukawa T, Villanueva AMG, Saito N, Nepomuceno JR, Ariyoshi K, Carlos C, Nicolasora AD, Solante RM. Correction to: First COVID-19 infections in the Philippines: a case report. Trop Med Health 2020; 48:30. [PMID: 32390757 PMCID: PMC7203260 DOI: 10.1186/s41182-020-00218-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
| | | | | | | | | | - Chris Smith
- 2School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.,3Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | | | | | - Lynsil Roy
- San Lazaro Hospital, Manila, Philippines
| | | | | | - Tatsuya Ukawa
- 2School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | | | - Nobuo Saito
- 4Department of Microbiology, Faculty of Medicine, Oita University, Oita, Japan
| | | | - Koya Ariyoshi
- 5Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Celia Carlos
- 6Research Institute for Tropical Medicine, Alabang, Philippines
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Edrada EM, Lopez EB, Villarama JB, Salva Villarama EP, Dagoc BF, Smith C, Sayo AR, Verona JA, Trifalgar-Arches J, Lazaro J, Balinas EGM, Telan EFO, Roy L, Galon M, Florida CHN, Ukawa T, Villaneuva AMG, Saito N, Nepomuceno JR, Ariyoshi K, Carlos C, Nicolasora AD, Solante RM. First COVID-19 infections in the Philippines: a case report. Trop Med Health 2020; 48:21. [PMID: 32308532 PMCID: PMC7154063 DOI: 10.1186/s41182-020-00203-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/22/2020] [Indexed: 12/23/2022] Open
Abstract
Background The novel coronavirus (COVID-19) is responsible for more fatalities than the SARS coronavirus, despite being in the initial stage of a global pandemic. The first suspected case in the Philippines was investigated on January 22, 2020, and 633 suspected cases were reported as of March 1. We describe the clinical and epidemiological aspects of the first two confirmed COVID-19 cases in the Philippines, both admitted to the national infectious disease referral hospital in Manila. Case presentation Both patients were previously healthy Chinese nationals on vacation in the Philippines travelling as a couple during January 2020. Patient 1, a 39-year-old female, had symptoms of cough and sore throat and was admitted to San Lazaro Hospital in Manila on January 25. Physical examination was unremarkable. Influenza B, human coronavirus 229E, Staphylococcus aureus and Klebsiella pneumoniae were detected by PCR on initial nasopharyngeal/oropharyngeal (NPS/OPS) swabs. On January 30, SARS-CoV-2 viral RNA was reported to be detected by PCR on the initial swabs and she was identified as the first confirmed COVID-19 case in the Philippines. Her symptoms resolved, and she was discharged. Patient 2, a 44-year-old male, had symptoms of fever, cough, and chills. Influenza B and Streptococcus pneumoniae were detected by PCR on initial NPS/OPS swabs. He was treated for community-acquired pneumonia with intravenous antibiotics, but his condition deteriorated and he required intubation. On January 31, SARS-CoV-2 viral RNA was reported to be detected by PCR on the initial swabs, and he was identified as the 2nd confirmed COVID-19 infection in the Philippines. On February 1, the patient's condition deteriorated, and following a cardiac arrest, it was not possible to revive him. He was thus confirmed as the first COVID-19 death outside of China. Conclusions This case report highlights several important clinical and public health issues. Despite both patients being young adults with no significant past medical history, they had very different clinical courses, illustrating how COVID-19 can present with a wide spectrum of disease. As of March 1, there have been three confirmed COVID-19 cases in the Philippines. Continued vigilance is required to identify new cases.
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Affiliation(s)
| | | | | | | | | | - Chris Smith
- 2School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.,3Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | | | | | - Lynsil Roy
- San Lazaro Hospital, Manila, Philippines
| | | | | | - Tatsuya Ukawa
- 2School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | | | - Nobuo Saito
- 4Department of Microbiology, Faculty of Medicine, Oita University, Oita, Japan
| | | | - Koya Ariyoshi
- 5Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Celia Carlos
- 6Research Institute for Tropical Medicine, Alabang, Philippines
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