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McPherson A, Hill PS, Kama M, Reid S. Exploring governance for a One Health collaboration for leptospirosis prevention and control in Fiji: Stakeholder perceptions, evidence, and processes. Int J Health Plann Manage 2018; 33:677-689. [PMID: 29602256 DOI: 10.1002/hpm.2521] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 03/06/2018] [Indexed: 01/13/2023] Open
Abstract
Fiji has a high burden of leptospirosis, with endemic infection and epidemic outbreaks with high mortality, often associated with flooding and cyclones. As a zoonosis, leptospirosis control requires interventions in sectors beyond the usual control of health-in Fiji, the dairy and sugar industries, and water and sanitation and rodent control in communities. This paper presents the findings of qualitative research to inform policy around governance for a One Health multisectoral approach to leptospirosis control. METHODS Key informants from relevant government agencies and industry organizations were interviewed in late 2014, and the interviews analyzed and triangulated with documentary analysis. FINDINGS The analysis identified 5 themes: perceptions of the impact of leptospirosis, governance processes, models for collaboration, leptospirosis control, and preferred leadership for leptospirosis management. Data were limited, with poor communication between ministries, and limited awareness of leptospirosis outside outbreaks. Collaboration during outbreaks was positive but not sustained in endemic periods. Mechanism for enhanced collaboration was developed for endemic and outbreak situations. CONCLUSION The findings informed a One Health governance approach to leptospirosis, framed within a National Strategic Plan, with a specific National Action Plan for Leptospirosis. The process provides a research based One Health template for application to other zoonotic diseases.
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Affiliation(s)
- Anna McPherson
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Peter S Hill
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Mike Kama
- Fiji Centre for Communicable Disease Control, Ministry of Health and Medical Services, Suva, Fiji
| | - Simon Reid
- School of Public Health, The University of Queensland, Brisbane, Australia
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Liegeon G, Delory T, Picardeau M. Antibiotic susceptibilities of livestock isolates of leptospira. Int J Antimicrob Agents 2018; 51:693-699. [PMID: 29305960 DOI: 10.1016/j.ijantimicag.2017.12.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 12/12/2017] [Accepted: 12/23/2017] [Indexed: 11/17/2022]
Abstract
Leptospirosis is the most common zoonotic disease and is endemic worldwide. The antibiotic susceptibilities of Leptospira strains isolated from both humans and animals are poorly documented. This issue is particularly important for isolates from food-producing animals which are regularly exposed to antibiotic treatments. This study assessed the susceptibility of 35 leptospira strains isolated from food-producing animals of diverse geographical origins between 1936 and 2016 to the antimicrobial agents used most commonly in animals. A broth microdilution method was used to determine the susceptibilities of Leptospira strains isolated from livestock to 11 antibiotics. All isolates were susceptible to penicillin, amoxicillin, clavulanate, cephalexin, ceftriaxone, doxycycline, tetracycline, streptomycin, enrofloxacin and spectinomycin, but not polymyxin [minimum inhibitory concentration (MIC) ≥ 4 μg/L]. For tetracycline and doxycycline, the MIC was significantly higher for the recent isolates from Sardinia, Italy than for the other isolates. Antimicrobial susceptibilities were also determined with 10- and 100-fold higher inocula. High inocula significantly diminished the antibacterial effect by at least 10-fold for enrofloxacin (MIC ≥256 μg/L), streptomycin (MIC ≥16 μg/L) and tetracycline (MIC ≥32 μg/L), suggesting selection of resistant strains for high inocula. These findings contribute to the assessment of whether certain antibiotics are potentially useful for the treatment of leptospirosis, and point out the risk of failure for some antibiotics during infection with a high inoculum in both animals and humans. This study strengthens the need to detect and prevent the emergence of antimicrobial resistance of this major emerging zoonotic pathogen.
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Affiliation(s)
- Geoffroy Liegeon
- Institut Pasteur, Biology of Spirochetes Unit, French National Reference Centre for Leptospirosis, Paris, France
| | - Tristan Delory
- Assistance publique-Hôpitaux de Paris, Hopital Saint-Louis, Paris, Department of Infectious Diseases, Paris, France
| | - Mathieu Picardeau
- Institut Pasteur, Biology of Spirochetes Unit, French National Reference Centre for Leptospirosis, Paris, France.
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Gorbea H, Garcia-Rivera EJ, Torres H, Lorenzi OD, Rivera A, Galloway RL, Sharp TM. Leptospirosis Cases Infected with Uncommon Serogroups, Puerto Rico, 2013-2015. Am J Trop Med Hyg 2018; 98:258-261. [PMID: 29141761 PMCID: PMC5928731 DOI: 10.4269/ajtmh.17-0538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Leptospirosis is an emerging bacterial zoonosis that is endemic but underrecognized throughout the tropics. Through prospective surveillance for acute febrile illness (AFI) among patients who presented to the emergency department of a hospital located in an urban region of Puerto Rico, four patients with laboratory-confirmed leptospirosis were identified. All patients had signs and symptoms of AFI, including fever, headache, and dehydration. Three patients had leukocytosis with thrombocytopenia and were admitted to the hospital. One hospitalized patient presented with jaundice, icteric sclera, and hematuria and developed rhabdomyolysis, whereas another patient with pulmonary edema was admitted to the intensive care unit. Microscopic agglutination titers among the four patients were highest against serogroups Icterohaemorrhagiae (serovar Mankarso), Australis (serovar Bratislava), Bataviae (serovar Bataviae), and Canicola (serovar Canicola). These case reports demonstrate that infection with these apparently uncommon serogroups can result in illness ranging from mild to life-threatening.
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Affiliation(s)
- Hector Gorbea
- University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | | | - Hilda Torres
- University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Olga D Lorenzi
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Aidsa Rivera
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Renee L Galloway
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tyler M Sharp
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
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Abstract
OBJECTIVES Leptospirosis causes reversible multiple organ failure, and its mortality remains high. The aim of this study was to determine the mortality rate of leptospirosis in an ICU offering all types of organ support available nowadays and to compare it with mortality in bacterial sepsis. DESIGN Retrospective, descriptive, and single-center cohort study. SETTINGS The largest ICU of Reunion Island (Indian Ocean) in a teaching hospital. PATIENTS Consecutive patients hospitalized in ICU for leptospirosis from January 2004 to January 2015. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We report 134 cases of patients with leptospirosis hospitalized in ICU. The median age was 40 years (interquartile range, 30-52 yr), with a Simplified Acute Physiology Score II of 38 (27-50) and a Sequential Organ Failure Assessment score of 10 (8-12). Forty-one patients (31%) required mechanical ventilation and 76 (56%) required renal replacement therapy. The door-to-renal replacement therapy time was 0 (0-1) day after admission with a median urea of 25 mmol/L (17-32 mmol/L). Five patients required extracorporeal membrane oxygenation. The mortality rate was 6.0% (95% CI, 2.6-11.4). Among patients hospitalized for sepsis, the standardized mortality ratio of patients with leptospirosis with regards to Simplified Acute Physiology Score II was dramatically low: 0.40 (95% CI, 0.17 - 0.79). CONCLUSIONS The mortality of severe leptospirosis is lower than for other bacterial infection, provided modern resuscitation techniques are available. Prompt organ support ensures very low mortality rates despite high severity scores.
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55
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Abstract
PURPOSE OF REVIEW The definitive diagnosis of leptospirosis, which results from infection with spirochetes of the genus Leptospira, currently relies on the use of culture, serological testing (microscopic agglutination testing), and molecular detection. The purpose of this review is to describe new molecular diagnostics for Leptospira and discuss advancements in the use of available methods. RECENT FINDINGS Efforts have been focused on improving the clinical sensitivity of Leptospira detection using molecular methods. In this review, we describe a reoptimized pathogenic species-specific real-time PCR (targeting lipL32) that has demonstrated improved sensitivity, findings by two groups that real-time reverse-transcription PCR assays targeting the 16S rrs gene can improve detection, and two new loop-mediated amplification techniques. Quantitation of leptospiremia, detection in different specimen types, and the complementary roles played by molecular detection and microscopic agglutination testing will be discussed. Finally, a protocol for Leptospira strain subtyping using variable number tandem repeat targets and high-resolution melting will be described. SUMMARY Molecular diagnostics have an established role for the diagnosis of leptospirosis and provide an actionable diagnosis in the acute setting. The use of real-time reverse-transcription PCR for testing serum/plasma and cerebrospinal fluid, when available, may improve the detection of Leptospira without decreasing clinical specificity.
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56
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Mišić-Majerus L, Habuš J, Štritof Z, Bujić N, Mađarić V, Kolaric-Sviben G, Vince S, Peršić Z, Turk N. Epidemiological and clinical features of leptospirosis in a highly endemic area over three time periods. Trop Med Int Health 2017; 22:1405-1413. [PMID: 28857412 DOI: 10.1111/tmi.12967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To present the features of human leptospirosis over three time periods (1970-1975; 2000-2005; 2010-2015), to compare the collected data and to determine whether the incidence, seasonal and spatial distribution, prevalence of presumptive infective serogroups and clinical features have changed over the last 50 years. METHODS Epidemiological and clinical data obtained from patients hospitalised and treated in a well-known endemic focus of leptospirosis, Koprivnica-Križevci County in Croatia, were analysed. RESULTS We observed a steady decline in the overall incidence of leptospirosis and a change in the patient age distribution, with the age ratio changing in favour of middle-aged and older patients. Although leptospirosis was most frequently diagnosed in August in all time periods, the number of cases increased in autumn. The most prevalent serogroup during the first and the second time period was Icterohaemorrhagiae, while in the third time period, the serogroup Australis prevailed. We also noted an increase in the number of severe clinical manifestations. CONCLUSIONS This retrospective research demonstrates a continuous decline in the incidence of human leptospirosis in Croatia. The pattern of disease has changed from predominantly mild clinical forms observed in children to more severe clinical forms observed in middle-aged to older patients, especially those working in agriculture. Additional epidemiological changes included an increase in the number of cases during the autumn months and changes in prevailing serogroups. Statistical analysis revealed a significant relationship between the severity of the clinical picture, patient age and presumed sources of infection.
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Affiliation(s)
- Ljiljana Mišić-Majerus
- Division of Infectious Diseases Dr. Tomislav Bardek General Hospital, Koprivnica, Croatia
| | - Josipa Habuš
- National Reference Laboratory for Leptospirosis, University of Zagreb, Zagreb, Croatia
| | - Zrinka Štritof
- National Reference Laboratory for Leptospirosis, University of Zagreb, Zagreb, Croatia
| | - Nevenka Bujić
- Division of Infectious Diseases Dr. Tomislav Bardek General Hospital, Koprivnica, Croatia
| | - Vesna Mađarić
- Division of Infectious Diseases Dr. Tomislav Bardek General Hospital, Koprivnica, Croatia
| | - Gordana Kolaric-Sviben
- Division of Infectious Diseases Dr. Tomislav Bardek General Hospital, Koprivnica, Croatia
| | - Silvijo Vince
- Reproduction and Obstetric Clinic, University of Zagreb, Zagreb, Croatia
| | - Zdenka Peršić
- Croatian National Reference Laboratory for Human Leptospirosis, Croatian Institute of Public Health, Zagreb, Croatia
| | - Nenad Turk
- National Reference Laboratory for Leptospirosis, University of Zagreb, Zagreb, Croatia
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57
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Davies P, Aoyagi Y. Leptospirosis presenting as acute acalculous cholecystitis. Clin Case Rep 2017; 5:1775-1779. [PMID: 29152269 PMCID: PMC5676275 DOI: 10.1002/ccr3.1173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/14/2017] [Accepted: 08/15/2017] [Indexed: 12/24/2022] Open
Abstract
Leptospirosis is the commonest zoonotic infection worldwide but is vastly underreported and extremely heterogeneous in its presentation. Acalculous cholecystitis is an under recognized presentation of acute leptospirosis. In the appropriate clinical context, with a clear exposure history, recognition of this association presents a unifying diagnosis and limits unnecessary surgical interventions.
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Affiliation(s)
- Peter Davies
- Medical Department Whangarei Base Hospital Whangarei New Zealand
| | - Yuki Aoyagi
- Medical Department Whangarei Base Hospital Whangarei New Zealand
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58
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Mutoh Y, Koizumi N, Morino E, Hayakawa K, Kato Y, Ohmagari N. Leptospirosis Cases in the Tokyo Metropolitan Area, Japan. Jpn J Infect Dis 2017; 70:669-671. [PMID: 28890513 DOI: 10.7883/yoken.jjid.2017.108] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In Japan, 20-50 cases of leptospirosis are reported annually, typically involving farmers or returnees from tropical areas. Here, we report on 5 indigenous leptospirosis cases that occurred in the Tokyo urban area. All patients were men (mean age, 66.4 ± 4.6 [SD] years) and presented with clinical features that included high fever, acute kidney injury, and jaundice. Three patients presented with pulmonary infiltration and ground-glass opacity on admission. Two of the 5 patients were intubated and underwent continuous hemodiafiltration. The mean length of hospitalization was 38.0 ± 17.0 days, and all patients were treated successfully with antibiotics. Notably, all patients had a history of exposure to rats prior to becoming symptomatic, suggesting that exposure to rats is a risk factor for urban leptospirosis. Although rare, even in metropolitan areas, leptospirosis should be considered by physicians when patients present with severe sepsis, acute kidney injury, and a history of exposure to rats.
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Affiliation(s)
- Yoshikazu Mutoh
- Disease Control and Prevention Center, National Center for Global Health and Medicine
| | - Nobuo Koizumi
- Department of Bacteriology I, National Institute of Infectious Diseases
| | - Eriko Morino
- Disease Control and Prevention Center, National Center for Global Health and Medicine
| | - Kayoko Hayakawa
- Disease Control and Prevention Center, National Center for Global Health and Medicine
| | - Yasuyuki Kato
- Disease Control and Prevention Center, National Center for Global Health and Medicine
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine
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59
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Tomizawa R, Sugiyama H, Sato R, Ohnishi M, Koizumi N. Male-specific pulmonary hemorrhage and cytokine gene expression in golden hamster in early-phase Leptospira interrogans serovar Hebdomadis infection. Microb Pathog 2017; 111:33-40. [PMID: 28811249 DOI: 10.1016/j.micpath.2017.08.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 08/11/2017] [Accepted: 08/11/2017] [Indexed: 01/19/2023]
Abstract
Leptospirosis causes severe clinical signs more frequently in men than in women, but the mechanism underlying the gender differences in leptospirosis remains unclear. In this study, petechial hemorrhage was observed in male but not in female hamster lung tissues infected with Leptospira interrogans serovar Hebdomadis at 120 h pi, demonstrating that male hamsters were more susceptible to the development of a severe disease upon Leptospira infection. No leptospiral DNA was detected in the lung tissues at 120 h pi when pulmonary hemorrhage was observed, indicating that pulmonary hemorrhage is attributable to the immune reactions of the host rather than from the direct effect of leptospires. The upregulation of nitric oxide synthase genes in the hamsters without pulmonary hemorrhage, inos and enos in female hamsters at 96 h pi and enos in male animals without hemorrhage at 120 h pi, may suggest that nitric oxide has a suppressive effect on leptospirosis-associated pulmonary hemorrhage.
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Affiliation(s)
- Rina Tomizawa
- Graduate School of Bio-Applications & Systems Engineering, Tokyo University of Agriculture and Technology, 2-24-16 Naka-cho, Koganei, Tokyo, 184-8588, Japan; Department of Bacteriology I, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo, 162-8640, Japan.
| | - Hiromu Sugiyama
- Department of Parasitology, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo, 162-8640, Japan.
| | - Ryoichi Sato
- Graduate School of Bio-Applications & Systems Engineering, Tokyo University of Agriculture and Technology, 2-24-16 Naka-cho, Koganei, Tokyo, 184-8588, Japan.
| | - Makoto Ohnishi
- Department of Bacteriology I, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo, 162-8640, Japan.
| | - Nobuo Koizumi
- Department of Bacteriology I, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo, 162-8640, Japan.
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60
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Raffray L, Giry C, Thirapathi Y, Reboux AH, Jaffar-Bandjee MC, Gasque P. Increased levels of soluble forms of E-selectin and ICAM-1 adhesion molecules during human leptospirosis. PLoS One 2017; 12:e0180474. [PMID: 28686648 PMCID: PMC5501535 DOI: 10.1371/journal.pone.0180474] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 06/15/2017] [Indexed: 01/09/2023] Open
Abstract
Leptospirosis is a multisystemic zoonotic disease with infiltration of visceral organs by Leptospira. The capacity of the vascular endothelium to grant immune cell recruitment and activation in target organs during the disease course remains poorly characterized. We ascertained the levels of expression of several soluble cell adhesion molecules (CAM) notably expressed by endothelial cells in human leptospirosis. We prospectively enrolled 20 hospitalized patients and compared them to 10 healthy controls. Disease severity was defined by one or more organ failures, or death. Plasmatic concentrations of soluble CAM were assessed by multiplex bead assay at the time of patient presentation (M0) and 1 month after hospital discharge. The levels of soluble E-selectin (sCD62E) and soluble intercellular adhesion molecule 1 (sICAM-1, sCD53) were significantly increased in patients compared to controls (p<0.0001) and at 1 month (p<0.0001) with median values at 978 ng/ml (interquartile ranges 787–1164; sCD62E) and 1021 ng/ml (690–1428; sCD53). At M0, Soluble P-selectin level (sCD62P) was found to be decreased with levels at 60 ng/ml (0–631) versus 711 ng/ml (343–1113) for healthy controls (p<0.05). Levels of sICAM-3 (sCD50), sVCAM-1 (vascular cell adhesion molecule, sCD106) and sPECAM-1 (platelet endothelial cell adhesion molecule, sCD31) were not different from healthy subjects at M0. This study shows that two adhesion molecules, shed as soluble forms, are elevated during the acute phase of leptospirosis: E-selectin and s-ICAM1. These molecules may interfere with the process of immune cell recruitment to clear Leptospira at tissue levels.
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Affiliation(s)
- Loic Raffray
- Université de La Réunion, CNRS 9192, INSERM U1187, IRD 249, CHU de La Réunion, UMR PIMIT Unité Mixte Processus Infectieux en Milieu Insulaire Tropical, Plateforme Technologique CYROI, Sainte-Clotilde, La Réunion, France
- Laboratoire de Biologie, CHU La Réunion site Félix Guyon, St Denis, La Réunion, France
- Internal Medicine Unit, CHU La Réunion site Félix Guyon, St Denis, La Réunion, France
- * E-mail: (LR); (PG)
| | - Claude Giry
- Microbiology/Virology Laboratory, CHU La Réunion site Félix Guyon, St Denis, La Réunion, France
| | - Yoga Thirapathi
- Internal Medicine Unit, GHER Hospital, St Benoit, La Réunion, France
| | - Anne-Hélène Reboux
- Nephrology Dialysis and Transplantation Unit, CHU La Réunion site Félix Guyon, St Denis, La Réunion, France
| | - Marie-Christine Jaffar-Bandjee
- Université de La Réunion, CNRS 9192, INSERM U1187, IRD 249, CHU de La Réunion, UMR PIMIT Unité Mixte Processus Infectieux en Milieu Insulaire Tropical, Plateforme Technologique CYROI, Sainte-Clotilde, La Réunion, France
- Microbiology/Virology Laboratory, CHU La Réunion site Félix Guyon, St Denis, La Réunion, France
| | - Philippe Gasque
- Université de La Réunion, CNRS 9192, INSERM U1187, IRD 249, CHU de La Réunion, UMR PIMIT Unité Mixte Processus Infectieux en Milieu Insulaire Tropical, Plateforme Technologique CYROI, Sainte-Clotilde, La Réunion, France
- Laboratoire de Biologie, CHU La Réunion site Félix Guyon, St Denis, La Réunion, France
- * E-mail: (LR); (PG)
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Abstract
A 22-year-old man presented to the emergency department on Christmas Day with a 5-day history of myalgias, cough, dyspnea, nonbilious emesis, and nonbloody diarrhea. Although he had been ill for several days, he ultimately sought treatment because of intractable vomiting. He reported feeling feverish, although he had not measured his temperature, and noted one episode of hemoptysis.
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Affiliation(s)
- Sara Mixter
- From the Divisions of General Internal Medicine (S.M., R.S.M., L.P.) and Infectious Disease (S.C.K.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore; and the Department of Medicine and the Division of Infectious Disease, University of California, San Francisco, San Francisco (H.H.)
| | - Reza Sedighi Manesh
- From the Divisions of General Internal Medicine (S.M., R.S.M., L.P.) and Infectious Disease (S.C.K.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore; and the Department of Medicine and the Division of Infectious Disease, University of California, San Francisco, San Francisco (H.H.)
| | - Sara C Keller
- From the Divisions of General Internal Medicine (S.M., R.S.M., L.P.) and Infectious Disease (S.C.K.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore; and the Department of Medicine and the Division of Infectious Disease, University of California, San Francisco, San Francisco (H.H.)
| | - Laura Platt
- From the Divisions of General Internal Medicine (S.M., R.S.M., L.P.) and Infectious Disease (S.C.K.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore; and the Department of Medicine and the Division of Infectious Disease, University of California, San Francisco, San Francisco (H.H.)
| | - Harry Hollander
- From the Divisions of General Internal Medicine (S.M., R.S.M., L.P.) and Infectious Disease (S.C.K.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore; and the Department of Medicine and the Division of Infectious Disease, University of California, San Francisco, San Francisco (H.H.)
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62
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Matsui M, Roche L, Soupé-Gilbert ME, Hasan M, Monchy D, Goarant C. High level of IL-10 expression in the blood of animal models possibly relates to resistance against leptospirosis. Cytokine 2017; 96:144-151. [PMID: 28410507 DOI: 10.1016/j.cyto.2017.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 03/09/2017] [Accepted: 03/31/2017] [Indexed: 10/19/2022]
Abstract
Leptospirosis is a severe zoonosis which immunopathogenesis is poorly understood. We evaluated correlation between acute form of the disease and the ratio of the anti-inflammatory cytokine IL-10 to the pro-inflammatory TNF-α and IL-1β expression during the early phase of infection comparing resistant mice and susceptible hamsters infected with two different species of virulent Leptospira. The IL-10/TNF-α and IL-10/IL-1β expression ratios were higher in mouse compared to hamster independently of the Leptospira strain, suggesting a preponderant role of the host response and notably these cytokines in the clinical expression and survival to leptospirosis. Using an IL-10 neutralization strategy in Leptospira-infected mouse model, we also showed evidence of a possible role of this cytokine on host susceptibility, bacterial clearance and on regulation of cytokine gene expression.
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Affiliation(s)
- Mariko Matsui
- Institut Pasteur International Network, Institut Pasteur de Nouvelle-Calédonie, Group Immunity and Inflammation, Noumea, New Caledonia.
| | - Louise Roche
- Institut Pasteur International Network, Institut Pasteur de Nouvelle-Calédonie, Leptospirosis Research and Expertise Unit, Noumea, New Caledonia
| | - Marie-Estelle Soupé-Gilbert
- Institut Pasteur International Network, Institut Pasteur de Nouvelle-Calédonie, Leptospirosis Research and Expertise Unit, Noumea, New Caledonia
| | - Milena Hasan
- Center for Translational Research, Technology Core, Institut Pasteur, Paris, France
| | - Didier Monchy
- Anatomic Pathology Laboratory, Gaston-Bourret Territorial Hospital Center, Noumea, New Caledonia
| | - Cyrille Goarant
- Institut Pasteur International Network, Institut Pasteur de Nouvelle-Calédonie, Leptospirosis Research and Expertise Unit, Noumea, New Caledonia
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63
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Leptospirosis in Tropical Regions of Southeast Mexico: A Clinical Case Series Review. CURRENT TROPICAL MEDICINE REPORTS 2017. [DOI: 10.1007/s40475-017-0104-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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64
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Sociodemographic and clinical characteristics of patients infected with Leptospira spp. treated at four hospitals in Medellín, Colombia, 2008-2013. BIOMEDICA 2017; 37:62-67. [DOI: 10.7705/biomedica.v37i1.3280] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/31/2016] [Indexed: 11/21/2022]
Abstract
Introducción. La leptospirosis continúa siendo un problema significativo de salud en regiones tropicales, incluidos los países de Latinoamérica, donde es 100 veces más frecuente que en otras regiones del mundo. En los cuadros graves de la enfermedad, su mortalidad alcanza el 10 %. Su diagnóstico es un reto debido a que las manifestaciones clínicas en la fase inicial son inespecíficas y a la poca disponibilidad de pruebas diagnósticas.Objetivo. Describir las características sociodemográficas y clínicas, y el desenlace de la enfermedad en pacientes hospitalizados con leptospirosis.Materiales y métodos. Es un estudio retrospectivo que incluyó pacientes atendidos en cuatro instituciones de Medellín, entre enero de 2009 y diciembre de 2013, con un cuadro clínico sugestivo e IgM positiva para Leptospira spp.Resultados. Se incluyeron 119 pacientes, 80 % hombres y 58 % de procedencia rural. La duración promedio de los síntomas fue de 9,6 días (DE=9,6). El 89 % de los pacientes presentó fiebre; el 62 %, ictericia; el 74 %, mialgias; el 46 %, diarrea; el 41 %, hepatomegalia; el 13 %, esplenomegalia, y 13 %, enrojecimiento de los ojos. En 54 % de los pacientes hubo deterioro de la función renal, en 32 %, compromiso pulmonar y, en 13 %, falla hepática. El 16 % de los pacientes requirió atención en la unidad de cuidados intensivos, el 12 %, asistencia respiratoria mecánica, y el 11 %, administración de vasopresores. En 38,6 % de ellos la enfermedad cursó con síndrome de Weil y el 5 % falleció. La duración promedio de la hospitalización fue de 11 días (DE=9,6).Conclusiones. La leptospirosis en esta población tuvo manifestaciones clínicas y complicaciones similares a las reportadas en la literatura científica. Se observó una mortalidad general relativamente baja comparada con las estadísticas mundiales.
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Brown PR, Aplin KP, Hinds LA, Jacob J, Thomas SE, Ritchie BJ. Rodent management issues in South Pacific islands: a review with case studies from Papua New Guinea and Vanuatu. WILDLIFE RESEARCH 2017. [DOI: 10.1071/wr17104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Rodents are a key pest to agricultural and rural island communities of the South Pacific, but there is limited information of their impact on the crops and livelihoods of small-scale farmers. The rodent pest community is known, but the type and scales of damage to different crops on different islands are unknown. Knowledge about rodent pest management in other geographical regions may not be directly transferable to the Pacific region. Many studies on islands have largely focussed on the eradication of rodents from uninhabited islands for conservation benefits. These broadscale eradication efforts are unlikely to translate to inhabited islands because of complex social and agricultural issues. The livelihoods, culture and customs of poor small-scale farmers in the South Pacific have a large bearing on the current management of rodents. The aim of the present review was to describe the rodent problems, impacts and management of rodents on South Pacific islands, and identify gaps for further research. We compared and contrasted two case studies. The situation in Papua New Guinea is emergent as several introduced rodent species are actively invading new areas with wide-ranging implications for human livelihoods and conservation. In Vanuatu, we show how rodent damage on cocoa plantations can be reduced by good orchard hygiene through pruning and weeding, which also has benefits for the management of black pod disease. We conclude that (1) damage levels are unknown and unreported, (2) the impacts on human health are unknown, (3) the relationships between the pest species and their food sources, breeding and movements are not known, and (4) the situation in Papua New Guinea may represent an emergent crisis that warrants further investigation. In addition, there is a need for greater understanding of the invasive history of pest rodents, so as to integrate biological information with management strategies. Ecologically based rodent management can be achieved on Pacific Islands, but only after significant well funded large-scale projects are established and rodent ecologists are trained. We can learn from experiences from other locations such as Southeast Asia to guide the way.
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Day NP. Leptospirosis. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00130-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Weeratunga PN, Fernando S, Sriharan S, Gunawardena M, Wijenayake S. Determinants of mortality and impact of therapy in patients with leptospirosis admitted for intensive care in a Sri Lankan hospital--a three year retrospective study. Pathog Glob Health 2016; 109:387-94. [PMID: 26924349 DOI: 10.1080/20477724.2015.1126032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION Leptospirosis is a disease of epidemic proportions in Sri Lanka. There is paucity of data on the determinants of mortality and impact of therapy in patients with leptospirosis admitted to critical care settings in endemic territories. METHODOLOGY This retrospective cross-sectional study was performed in patients with serologically confirmed leptospirosis admitted to the intensive care unit of the General Hospital, Kalutara from January 2011 to April 2014. Associations between socio-epidemiological, clinical and laboratory parameters and patient mortality were examined. RESULTS Forty-five patients were included. The mean age was 49.11(SD = 16.95) and majority (92%) were male. Percentage mortality was 44.4%. Patient mortality was associated with age > 40 (p = 0.012), symptoms of uremia (p = 0.017), evidence of CNS involvement (p = 0.039), presence of oliguria (p = 0.002) and anuria (p = 0.014), presence of multi-organ dysfunction syndrome (MODS) (p < 0.001), CRP > 96 (p = 0.036), platelet count < 20,000 (p = 0.045), Potassium > 5.0 (p = 0.05), metabolic acidosis with pH < 7.2 (p = 0.03), INR > 2 (p = 0.037) and requirement of mechanical ventilation (p < 0.001). Cox regression analysis revealed MODS and potassium > 5 to be independently associated with mortality. CONCLUSIONS A high mortality rate is noted. The presence of MODS and serum potassium concentration > 5.0 was independently associated with mortality in this retrospective study of patients with confirmed leptospirosis in a critical care setting.
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Affiliation(s)
- P N Weeratunga
- 1 University Medical Unit, National Hospital of Sri Lanka , Colombo, Sri Lanka
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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.
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Affiliation(s)
- Cyrille Goarant
- Institut Pasteur International Network, Institut Pasteur in New Caledonia, Leptospirosis Research and Expertise Unit, Nouméa, New Caledonia
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Rajapakse S, Weeratunga P, Niloofa MJR, Fernando N, Rodrigo C, Maduranga S, de Silva NL, Fernando NL, de Silva HJ, Karunanayake L, Handunnetti S. Clinical and laboratory associations of severity in a Sri Lankan cohort of patients with serologically confirmed leptospirosis: a prospective study. Trans R Soc Trop Med Hyg 2016; 109:710-6. [PMID: 26464233 DOI: 10.1093/trstmh/trv079] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Leptospirosis results in significant morbidity and mortality. This study elucidates markers of severity in a cohort of Sri Lankan patients. METHODS Patients presenting to three healthcare institutions in the Western province of Sri Lanka with leptospirosis serological confirmed by the microscopic agglutination test (MAT) were included. Prospective data regarding demographic, clinical and laboratory parameters was extracted. Univariate associations and subsequent multivariate logistic regression models were constructed. RESULTS The study included 232 patients, with 68.5% (159) demonstrating severe disease. Significant associations of severe disease at a significance level of p<0.05 were fever >38.8°C on presentation, age >40 years, muscle tenderness, tachycardia on admission, highest white cell count >12 350/mm(3) and <7900/mm(3), highest neutrophil percentage >84%, haemoglobin >11.2 g/dL and <10.2 g/dL, packed cell volume (PCV) >33.8% and <29.8%, lowest platelet count <63 500/mm(3), highest alanine transaminase (ALT) >70 IU/L and hyponatremia with sodium <131 mEq/L. On multivariate analysis, PCV <29.8% (p=0.011; OR 3.750; CI: 1.394-10.423), ALT >70 IU/L (p=0.044; OR 2.639; CI: 1.028-6.774) and hyponatremia <131 mEq/L (p=0.019; OR 6.413; CI: 1.353-30.388) were independent associations of severe disease. CONCLUSIONS Severity associations were demonstrated with both clinical and laboratory parameters. There is a need for novel biomarkers for prediction of severity in leptospirosis.
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Affiliation(s)
- Senaka Rajapakse
- Tropical Medicine Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo 08, Sri Lanka
| | - Praveen Weeratunga
- Tropical Medicine Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo 08, Sri Lanka
| | - M J Roshan Niloofa
- Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo, Colombo 03, Sri Lanka
| | - Narmada Fernando
- Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo, Colombo 03, Sri Lanka
| | - Chathuraka Rodrigo
- Tropical Medicine Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo 08, Sri Lanka
| | - Sachith Maduranga
- Tropical Medicine Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo 08, Sri Lanka
| | - Nipun Lakshitha de Silva
- Tropical Medicine Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo 08, Sri Lanka
| | - Nipun Lakshitha Fernando
- Tropical Medicine Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo 08, Sri Lanka
| | - H Janaka de Silva
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Lilani Karunanayake
- Department of Bacteriology, Medical Research Institute, Colombo 08, Sri Lanka
| | - Shiroma Handunnetti
- Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo, Colombo 03, Sri Lanka
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Hochedez P, Theodose R, Olive C, Bourhy P, Hurtrel G, Vignier N, Mehdaoui H, Valentino R, Martinez R, Delord JM, Herrmann C, Lamaury I, Césaire R, Picardeau M, Cabié A. Factors Associated with Severe Leptospirosis, Martinique, 2010-2013. Emerg Infect Dis 2016; 21:2221-4. [PMID: 26583702 PMCID: PMC4672444 DOI: 10.3201/eid2112.141099] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
To identify factors associated with disease severity, we examined 102 patients with quantitative PCR–confirmed leptospirosis in Martinique during 2010–2013. Associated factors were hypotension, chest auscultation abnormalities, icterus, oligo/anuria, thrombocytopenia, prothrombin time <68%, high levels of leptospiremia, and infection with L. interrogans serovar Icterohaemorrhagiae/Copenhageni.
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Biron A, Cazorla C, Amar J, Pfannstiel A, Dupont-Rouzeyrol M, Goarant C. Zika virus infection as an unexpected finding in a Leptospirosis patient. JMM Case Rep 2016; 3:e005033. [PMID: 28348757 PMCID: PMC5330225 DOI: 10.1099/jmmcr.0.005033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 03/23/2016] [Indexed: 11/22/2022] Open
Abstract
Introduction: Areas where leptospirosis and arboviruses are endemic largely overlap in the tropics. However, the number of arbovirus infections is usually much higher. The initial clinical presentation can be highly confusing; therefore, laboratory confirmation is key to an accurate diagnosis. Case Presentation: A 19–year–old man presented to a peripheral health centre with an acute febrile illness. Dengue was initially suspected, but the patient deteriorated to a shock syndrome. Leptospirosis as well as a co-infection with Zika virus were both confirmed in the laboratory, the latter being clinically masked in this dual infection. Conclusion: This case highlights the importance of not only considering the differential diagnosis of acute febrile syndromes, but also to consider the possibility of dual infections in the context of global spread of arboviruses. The specific context of travellers returning from endemic areas and pregnant women is also highlighted and discussed.
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Affiliation(s)
- Antoine Biron
- Institut Pasteur de Nouvelle-Caledonie, Medical Virology Laboratory , Nouméa , New Caledonia
| | - Cécile Cazorla
- Centre Hospitalier Territorial de Nouvelle-Caledonie, Infectious Disease Department , Nouméa , New Caledonia
| | - Julien Amar
- Centre Hospitalier Territorial de Nouvelle-Caledonie, Intensive Care Unit , Nouméa , New Caledonia
| | - Anne Pfannstiel
- Gouvernement de la Nouvelle-Caledonie, Direction des Affaires Sanitaires et Sociales , Nouméa , New Caledonia
| | - Myrielle Dupont-Rouzeyrol
- Institut Pasteur de Nouvelle-Caledonie, Arbovirus Research and Expertise Unit , Nouméa , New Caledonia
| | - Cyrille Goarant
- Institut Pasteur de Nouvelle-Caledonie, Leptospirosis Research and Expertise Unit , Nouméa , New Caledonia
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Bouchard J, Mehta RL. Acute Kidney Injury in Western Countries. KIDNEY DISEASES 2016; 2:103-110. [PMID: 27921037 DOI: 10.1159/000445091] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 03/01/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is frequent and is associated with poor outcomes, including increased mortality, higher risk of chronic kidney disease, and prolonged hospital lengths of stay. The epidemiology of AKI mainly derives from studies performed in Western high-income countries. More limited data are available from Western low-income and middle-income countries (LMICs) located in Central and South America. SUMMARY In this review, we summarize the most recent data on the epidemiology of AKI in Western countries, aiming to contrast results from industrialized high-income countries with LMICs. The global picture of AKI in LMICs is not as well characterized as in the USA and Europe. In addition, in some LMICs, the epidemiology of AKI may vary depending on the region and socioeconomic status, which contributes to the difficulty of getting a better portrait of the clinical condition. In low-income regions and tropical countries, AKI is frequently attributed to diarrhea, infections, nephrotoxins, as well as obstetric complications. As opposed to the situation in high-income countries, access to basic care in LMICs is limited by economic constraints, and treatment is often delayed due to late presentation and recognition of the condition, which contribute to worse outcomes. In addition, dialysis is often not available or must be paid by patients, which further restricts its use. KEY MESSAGES There are great disparities in the epidemiology of AKI between Western high-income countries and Western LMICs. In LMICs, education and training programs should increase the public awareness of AKI and improve preventive and basic treatments to improve AKI outcomes. FACTS FROM EAST AND WEST (1) More than 90% of the patients recruited in AKI studies using KDIGO-equivalent criteria originate from North America, Europe, or Oceania, although these regions represent less than a fifth of the global population. However, the pooled incidence of AKI in hospitalized patients reaches 20% globally with moderate variance between regions. (2) The lower incidence rates observed in Asian countries (except Japan) may be due to a poorer recognition rate, for instance because of less systematically performed serum creatinine tests. (3) AKI patients in South and Southeastern Asia are younger than in East Asia and Western countries and present with fewer comorbidities. (4) Asian countries (and to a certain extent Latin America) face specific challenges that lead to AKI: nephrotoxicity of traditional herbal and less strictly regulated nonprescription medicines, environmental toxins (snake, bee, and wasp venoms), and tropical infectious diseases (malaria and leptospirosis). A higher incidence and less efficient management of natural disasters (particularly earthquakes) are also causes of AKI that Western countries are less likely to encounter. (5) The incidence of obstetric AKI decreased globally together with an improvement in socioeconomic levels particularly in China and India in the last decades. However, antenatal care and abortion management must be improved to reduce AKI in women, particularly in rural areas. (6) Earlier nephrology referral and better access to peritoneal dialysis should improve the outcome of AKI patients.
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Sharp TM, Rivera García B, Pérez-Padilla J, Galloway RL, Guerra M, Ryff KR, Haberling D, Ramakrishnan S, Shadomy S, Blau D, Tomashek KM, Bower WA. Early Indicators of Fatal Leptospirosis during the 2010 Epidemic in Puerto Rico. PLoS Negl Trop Dis 2016; 10:e0004482. [PMID: 26914210 PMCID: PMC4767218 DOI: 10.1371/journal.pntd.0004482] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 02/01/2016] [Indexed: 12/12/2022] Open
Abstract
Background Leptospirosis is a potentially fatal bacterial zoonosis that is endemic throughout the tropics and may be misdiagnosed as dengue. Delayed hospital admission of leptospirosis patients is associated with increased mortality. Methodology/Principal Findings During a concurrent dengue/leptospirosis epidemic in Puerto Rico in 2010, suspected dengue patients that tested dengue-negative were tested for leptospirosis. Fatal and non-fatal hospitalized leptospirosis patients were matched 1:1–3 by age. Records from all medical visits were evaluated for factors associated with fatal outcome. Among 175 leptospirosis patients identified (4.7 per 100,000 residents), 26 (15%) were fatal. Most patients were older males and had illness onset during the rainy season. Fatal case patients first sought medical care earlier than non-fatal control patients (2.5 vs. 5 days post-illness onset [DPO], p < 0.01), but less frequently first sought care at a hospital (52.4% vs. 92.2%, p < 0.01). Although fatal cases were more often diagnosed with leptospirosis at first medical visit (43.9% vs. 9.6%, p = 0.01), they were admitted to the hospital no earlier than non-fatal controls (4.5 vs. 6 DPO, p = 0.31). Cases less often developed fever (p = 0.03), but more often developed jaundice, edema, leg pain, hemoptysis, and had a seizure (p ≤ 0.03). Multivariable analysis of laboratory values from first medical visit associated with fatal outcome included increased white blood cell (WBC) count with increased creatinine (p = 0.001), and decreased bicarbonate with either increased WBC count, increased creatinine, or decreased platelet count (p < 0.001). Conclusions/Significance Patients with fatal leptospirosis sought care earlier, but were not admitted for care any earlier than non-fatal patients. Combinations of routine laboratory values predictive of fatal outcome should be considered in admission decision-making for patients with suspected leptospirosis. Leptospirosis is a common tropical illness that results from exposure to the urine of animals infected with Leptospira bacteria. Because leptospirosis shares signs and symptoms with other common tropical illnesses such as dengue, identification of patients with leptospirosis can be challenging. Early identification of patients with leptospirosis is necessary to initiate antibiotic therapy and in some cases provide in-hospital management. During an epidemic of leptospirosis in Puerto Rico that occurred during a concomitant dengue epidemic, we identified leptospirosis patients by screening specimens from suspected dengue patients. Of 175 leptospirosis patients identified, 26 (15%) died. After comparing leptospirosis patients that died to patients of a similar age that were hospitalized but survived, we observed that fatal cases were more often sent home after their first medical visit. We next identified several routinely available laboratory values from patients’ first medical visit that were associated with patients that died. Clinicians can use such laboratory values to diagnose and hospitalize leptospirosis patients at increased risk for fatal outcome.
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Affiliation(s)
- Tyler M. Sharp
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
- * E-mail:
| | | | - Janice Pérez-Padilla
- Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Renee L. Galloway
- Bacterial Special Pathogens Branch, Division of High Consequence Pathogens, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Marta Guerra
- Bacterial Special Pathogens Branch, Division of High Consequence Pathogens, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kyle R. Ryff
- Puerto Rico Department of Health, San Juan, Puerto Rico
| | - Dana Haberling
- Bacterial Special Pathogens Branch, Division of High Consequence Pathogens, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sharada Ramakrishnan
- Bacterial Special Pathogens Branch, Division of High Consequence Pathogens, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sean Shadomy
- Bacterial Special Pathogens Branch, Division of High Consequence Pathogens, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Dianna Blau
- Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kay M. Tomashek
- Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - William A. Bower
- Bacterial Special Pathogens Branch, Division of High Consequence Pathogens, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Daher EDF, Soares DS, de Menezes Fernandes ATB, Girão MMV, Sidrim PR, Pereira EDB, Rocha NA, da Silva GB. Risk factors for intensive care unit admission in patients with severe leptospirosis: a comparative study according to patients' severity. BMC Infect Dis 2016; 16:40. [PMID: 26830173 PMCID: PMC4736552 DOI: 10.1186/s12879-016-1349-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 01/13/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study is to investigate predictive factors for intensive care unit (ICU) admission among patients with severe leptospirosis. METHODS This is a retrospective study with all patients with severe leptospirosis admitted to a tertiary hospital. Patients were divided in ICU and ward groups. Demographical, clinical and laboratory data of the groups were compared as well as acute kidney injury (AKI) severity, according to the RIFLE criteria (R = Risk, I = Injury, F = Failure, L = Loss, E = End-stage kidney disease). RESULTS A total of 206 patients were included, 83 admitted to ICU and 123 to ward. Mean age was 36 ± 15.8 years, with 85.9% males. Patients in ICU group were older (38.8 ± 15.7 vs. 34.16 ± 15.9 years, p = 0.037), had a shorter hospital stay (4.13 ± 3.1 vs. 9.5 ± 5.2 days, p = 0.0001), lower levels of hematocrit (29.6 ± 6.4 vs. 33.1 ± 8.6%, p = 0.003), hemoglobin (10.2 ± 2.4 vs. 11.6 ± 1.9 g/dL, p < 0.0001), and platelets (94,427 ± 86,743 vs. 128,896 ± 137,017/mm(3), p = 0.035), as well as higher levels of bilirubin (15.0 ± 12.2 vs. 8.6 ± 9.5 mg/dL, p = 0.001). ICU group also had a higher frequency of severe AKI (RIFLE-"Failure": 73.2% vs. 54.2%, p < 0.0001) and a higher prevalence of dialysis requirement (57.3% vs. 27.6%, p < 0.0001). Mortality was higher among ICU patients (23.5% vs. 5.7%, p < 0.0001). Independent predictors for ICU admission were tachypnea (p = 0.027, OR = 13, CI = 1.3-132), hypotension (p = 0.009, OR = 5.27, CI = 1.5-18) and AKI (p = 0.029, OR = 14, CI = 1.3-150). Ceftriaxone use was a protective factor (p = 0.001, OR = 0.13, CI = 0.04-0.4). CONCLUSIONS Independent risk factors for ICU admission in leptospirosis include tachypnea, hypotension and AKI. Ceftriaxone was a protective factor for ICU admission, suggesting that its use may prevent severe forms of the disease.
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Affiliation(s)
- Elizabeth De Francesco Daher
- Departament of Internal Medicine, School of Medicine, Division of Nephrology, Federal University of Ceará, Rua Vicente Linhares, 1198, Fortaleza, Ceará, CEP: 60135-270, Brazil. .,Medical Sciences Graduate Program, School of Medicine, Federal University of Ceará, Rua Vicente Linhares, 1198, Fortaleza, Ceará, CEP: 60135-270, Brazil.
| | - Douglas Sousa Soares
- Departament of Internal Medicine, School of Medicine, Division of Nephrology, Federal University of Ceará, Rua Vicente Linhares, 1198, Fortaleza, Ceará, CEP: 60135-270, Brazil.
| | - Anna Tereza Bezerra de Menezes Fernandes
- Departament of Internal Medicine, School of Medicine, Division of Nephrology, Federal University of Ceará, Rua Vicente Linhares, 1198, Fortaleza, Ceará, CEP: 60135-270, Brazil.
| | - Marília Maria Vasconcelos Girão
- Departament of Internal Medicine, School of Medicine, Division of Nephrology, Federal University of Ceará, Rua Vicente Linhares, 1198, Fortaleza, Ceará, CEP: 60135-270, Brazil.
| | - Pedro Randal Sidrim
- Departament of Internal Medicine, School of Medicine, Division of Nephrology, Federal University of Ceará, Rua Vicente Linhares, 1198, Fortaleza, Ceará, CEP: 60135-270, Brazil.
| | - Eanes Delgado Barros Pereira
- Departament of Internal Medicine, School of Medicine, Division of Nephrology, Federal University of Ceará, Rua Vicente Linhares, 1198, Fortaleza, Ceará, CEP: 60135-270, Brazil. .,Medical Sciences Graduate Program, School of Medicine, Federal University of Ceará, Rua Vicente Linhares, 1198, Fortaleza, Ceará, CEP: 60135-270, Brazil.
| | | | - Geraldo Bezerra da Silva
- Public Health Graduate Program, School of Medicine, Health Sciences Center, University of Fortaleza, Fortaleza, Ceará, Brazil.
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Abstract
Melioidosis is an infectious disease caused by Burkholderia pseudomallei, a bacterium endemic in Southeast Asia and northern Australia. In New Caledonia, sporadic cases were first described in 2005; since then, more cases have been identified. To improve our understanding of melioidosis epidemiology in New Caledonia, we compared the local cases and B. pseudomallei isolates with those from endemic areas. Nineteen melioidosis cases have been diagnosed in New Caledonia since 1999, mostly severe and with frequent bacteraemia, leading to three (16%) fatalities. All but one occurred in the North Province. Besides sporadic cases caused by non-clonal strains, we also identified a hotspot of transmission related to a clonal group of B. pseudomallei that is phylogenetically related to Australian strains.
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Massenet D, Yvon JF, Couteaux C, Goarant C. An Unprecedented High Incidence of Leptospirosis in Futuna, South Pacific, 2004 - 2014, Evidenced by Retrospective Analysis of Surveillance Data. PLoS One 2015; 10:e0142063. [PMID: 26528546 PMCID: PMC4631516 DOI: 10.1371/journal.pone.0142063] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 10/17/2015] [Indexed: 11/18/2022] Open
Abstract
Futuna is a small Polynesian island in the South Pacific with a population of 3,612 in 2013. The first human leptospirosis case was confirmed in 1997. Active surveillance started in 2004. Cases were confirmed by PCR or real time PCR, or by serology using MAT or a combination of IgM-ELISA and MAT. A retrospective analysis of surveillance data shows that the disease was endemic with a mean annual incidence of 844 cases per 100,000 over an 11-year period from 2004 to 2014. An epidemic peak as high as 1,945 cases per 100,000 occurred in 2008. Serogroup Australis was predominant until 2007, Icterohaemorrhagiae was dominant afterwards. Cluster analysis revealed different hot spots over time. Lifestyle habits, such as walking barefoot in irrigated taro fields or pig pens probably contributed to contamination from the swine and rodent reservoirs to humans. Severe forms were rare, and the case fatality rate was 0.5%. The medical community and general population were aware of leptospirosis and rapid treatment with amoxycillin was the main treatment, probably contributing to this low fatality rate.
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Affiliation(s)
- Denis Massenet
- Agence de Santé des îles Wallis & Futuna, Laboratoire de biologie médicale/hôpital de SIA, BP 4G, 98 600 Mata'Utu, Wallis & Futuna
| | - Jean-François Yvon
- Agence de Santé des îles Wallis & Futuna, Laboratoire de biologie médicale/hôpital de SIA, BP 4G, 98 600 Mata'Utu, Wallis & Futuna
- Laboratoire de Ducos, BP 3931, 98846 Nouméa, New Caledonia
| | - Clément Couteaux
- Agence de Santé des îles Wallis & Futuna, Laboratoire de biologie médicale/hôpital de SIA, BP 4G, 98 600 Mata'Utu, Wallis & Futuna
| | - Cyrille Goarant
- Institut Pasteur in New Caledonia, Institut Pasteur International Network, Leptospirosis Research and Expertise Unit, 9–11 Avenue Paul Doumer, BP 61, 98 845 Noumea, New Caledonia
- * E-mail:
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Libório AB, Braz MBM, Seguro AC, Meneses GC, Neves FMDO, Pedrosa DC, Cavalcanti LPDG, Martins AMC, Daher EDF. Endothelial glycocalyx damage is associated with leptospirosis acute kidney injury. Am J Trop Med Hyg 2015; 92:611-6. [PMID: 25624405 DOI: 10.4269/ajtmh.14-0232] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Leptospirosis is a common disease in tropical countries, and the kidney is one of the main target organs. Membrane proteins of Leptospira are capable of causing endothelial damage in vitro, but there have been no studies in humans evaluating endothelial glycocalyx damage and its correlation with acute kidney injury (AKI). We performed a cohort study in an outbreak of leptospirosis among military personnel. AKI was diagnosed in 14 of 46 (30.4%) patients. Leptospirosis was associated with higher levels of intercellular adhesion molecule-1 (ICAM-1; 483.1 ± 31.7 versus 234.9 ± 24.4 mg/L, P < 0.001) and syndecan-1 (73.7 ± 15.9 versus 21.2 ± 7.9 ng/mL, P < 0.001) compared with exposed controls. Patients with leptospirosis-associated AKI had increased level of syndecan-1 (112.1 ± 45.4 versus 41.5 ± 11.7 ng/mL, P = 0.021) and ICAM-1 (576.9 ± 70.4 versus 434.9 ± 35.3, P = 0.034) compared with leptospirosis patients with no AKI. Association was verified between syndecan-1 and ICAM-1 with serum creatinine elevation and neutrophil gelatinase-associated lipocalin (NGAL) levels. This association remained even after multivariate analysis including other AKI-associated characteristics. Endothelial injury biomarkers are associated with leptospirosis-associated renal damage.
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Affiliation(s)
- Alexandre Braga Libório
- Department of Clinical Medicine, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Medical Sciences Post-Graduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Laboratório de Investigação Médica (LIM 12) do Hospital das Clínicas da Faculdade de Medicina USP, São Paulo, SP, Brazil; Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Ceara, Fortaleza, Ceara, Brazil; Departamento de Saúde Comunitária, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil
| | - Marcelo Boecker Munoz Braz
- Department of Clinical Medicine, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Medical Sciences Post-Graduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Laboratório de Investigação Médica (LIM 12) do Hospital das Clínicas da Faculdade de Medicina USP, São Paulo, SP, Brazil; Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Ceara, Fortaleza, Ceara, Brazil; Departamento de Saúde Comunitária, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil
| | - Antonio Carlos Seguro
- Department of Clinical Medicine, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Medical Sciences Post-Graduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Laboratório de Investigação Médica (LIM 12) do Hospital das Clínicas da Faculdade de Medicina USP, São Paulo, SP, Brazil; Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Ceara, Fortaleza, Ceara, Brazil; Departamento de Saúde Comunitária, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil
| | - Gdayllon C Meneses
- Department of Clinical Medicine, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Medical Sciences Post-Graduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Laboratório de Investigação Médica (LIM 12) do Hospital das Clínicas da Faculdade de Medicina USP, São Paulo, SP, Brazil; Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Ceara, Fortaleza, Ceara, Brazil; Departamento de Saúde Comunitária, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil
| | - Fernanda Macedo de Oliveira Neves
- Department of Clinical Medicine, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Medical Sciences Post-Graduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Laboratório de Investigação Médica (LIM 12) do Hospital das Clínicas da Faculdade de Medicina USP, São Paulo, SP, Brazil; Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Ceara, Fortaleza, Ceara, Brazil; Departamento de Saúde Comunitária, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil
| | - Danielle Carvalho Pedrosa
- Department of Clinical Medicine, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Medical Sciences Post-Graduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Laboratório de Investigação Médica (LIM 12) do Hospital das Clínicas da Faculdade de Medicina USP, São Paulo, SP, Brazil; Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Ceara, Fortaleza, Ceara, Brazil; Departamento de Saúde Comunitária, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil
| | - Luciano Pamplona de Góes Cavalcanti
- Department of Clinical Medicine, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Medical Sciences Post-Graduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Laboratório de Investigação Médica (LIM 12) do Hospital das Clínicas da Faculdade de Medicina USP, São Paulo, SP, Brazil; Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Ceara, Fortaleza, Ceara, Brazil; Departamento de Saúde Comunitária, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil
| | - Alice Maria Costa Martins
- Department of Clinical Medicine, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Medical Sciences Post-Graduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Laboratório de Investigação Médica (LIM 12) do Hospital das Clínicas da Faculdade de Medicina USP, São Paulo, SP, Brazil; Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Ceara, Fortaleza, Ceara, Brazil; Departamento de Saúde Comunitária, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil
| | - Elizabeth de Francesco Daher
- Department of Clinical Medicine, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Medical Sciences Post-Graduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Laboratório de Investigação Médica (LIM 12) do Hospital das Clínicas da Faculdade de Medicina USP, São Paulo, SP, Brazil; Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Ceara, Fortaleza, Ceara, Brazil; Departamento de Saúde Comunitária, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil
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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).
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Sivaprakasam V, Zochowski WJ, Palmer MF. Clinical spectrum of severe leptospirosis in the UK. JMM Case Rep 2014; 1:e000003. [PMID: 28663802 PMCID: PMC5415923 DOI: 10.1099/jmmcr.0.000003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 11/06/2014] [Indexed: 11/24/2022] Open
Abstract
Introduction: Human leptospirosis is a global zoonotic infection with a characteristic biphasic illness and protean clinical manifestations. The majority are mild flu-like infections. The severe forms cause multiorgan damage with a greater predilection to hepatorenal failure. Case presentation: We attempted to analyse the clinical presentation of severe leptospirosis and decipher the clinical spectrum within this group by reviewing a series of 15 patients with leptospirosis requiring intensive care support for their management. We noticed complications becoming apparent before antibodies became detectable in the blood in a significant number of patients. This appears to belie the biphasic nature of leptospirosis and raises the question of whether the complications occur during the leptospiraemic phase or the immune phase of the infection. The presence of leptospiral DNA in the blood at this time as detected by a molecular assay strengthened this suspicion. Among the 15 patients with severe leptospirosis, only 3 (20 %) had an overseas travel history and the remaining 12 patients acquired their infection within the UK. Fourteen of the 15 patients had hepatorenal dysfunction, with seven requiring dialysis. Eight of the 15 patients received intravenous ceftriaxone with very good outcomes. Three showed significant clinical improvement after the administration of steroids. Conclusion: Many patients with severe leptospirosis will have complications on presentation. Molecular testing is now available for early diagnosis, facilitating early interventions. Ceftriaxone has been effective in treating severe leptospirosis. This study reminds clinicians to consider leptospirosis in the differential diagnosis of similar clinical spectra and offers tools for appropriate management.
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Affiliation(s)
| | - Wendy J Zochowski
- Leptospira Reference Unit, Wye Valley NHS Trust, Hereford HR12ER, UK
| | - Martin F Palmer
- Leptospira Reference Unit, Wye Valley NHS Trust, Hereford HR12ER, UK
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Mikulski M, Boisier P, Lacassin F, Soupé-Gilbert ME, Mauron C, Bruyere-Ostells L, Bonte D, Barguil Y, Gourinat AC, Matsui M, Vernel-Pauillac F, Goarant C. Severity markers in severe leptospirosis: a cohort study. Eur J Clin Microbiol Infect Dis 2014; 34:687-95. [PMID: 25413923 DOI: 10.1007/s10096-014-2275-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 11/03/2014] [Indexed: 01/03/2023]
Abstract
We aimed to evaluate parameters for their value as severity markers in hospitalized leptospirosis patients. We recruited 47 informed adult consenting patients and assessed a number of clinical, hematological, biochemical, and biological variables. Patients were sorted according to severity based on fatality or the requirement of mechanical ventilation or dialysis; the parameters studied were compared between groups on inclusion and the next day. Beside septic shock presentation or a high severity score (Simplified Acute Physiology Score; SAPS II), increased lactate, total bilirubin, lipase, and AST/ALT ratio or a decreased cytokines IL-10/TNF-α ratio were all significantly associated with severity. The gene expression of the IL-1 receptor antagonist IL-1ra, IL-1α, and the long pentraxin PTX-3 were also transcribed at higher levels in most severe cases. Patients could rapidly improve or deteriorate, highlighting the need for a new assessment the next day. Our results add to the limited body of knowledge about severity markers in leptospirosis. They also suggest that patients should be reassessed the next day before being possibly discharged from the hospital. Further studies are needed in order to confirm relevant and reliable prognostic parameters in leptospirosis that would be helpful for the purpose of triage.
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Affiliation(s)
- M Mikulski
- Intensive Care Unit, Centre Hospitalier Territorial, Nouméa, New Caledonia
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81
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Becker TK, Jacquet GA, Marsh R, Schroeder ED, Foran M, Bartels S, Duber HC, Cockrell H, Levine AC. Global emergency medicine: a review of the literature from 2013. Acad Emerg Med 2014; 21:810-7. [PMID: 25040254 DOI: 10.1111/acem.12414] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 04/14/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The Global Emergency Medicine Literature Review (GEMLR) conducts an annual search of peer-reviewed and grey literature relevant to global emergency medicine (EM) to identify, review, and disseminate the most important new research in this field to a worldwide audience of academics and clinical practitioners. METHODS This year 8,768 articles written in six languages were identified by our search. These articles were distributed among 22 reviewers for initial screening based on their relevance to the field of global EM. An additional two reviewers searched the grey literature. A total of 434 articles were deemed appropriate by at least one reviewer and approved by an editor for formal scoring of overall quality and importance. RESULTS Of the 434 articles that met our predetermined inclusion criteria, 65% were categorized as emergency care in resource-limited settings, 18% as EM development, and 17% as disaster and humanitarian response. A total of 24 articles received scores of 18 or higher and were selected for formal summary and critique. Interrater reliability for two reviewers using our scoring system was good, with an intraclass correlation coefficient of 0.63 (95% confidence interval = 0.55 to 0.69). Infectious diseases, trauma, and the diagnosis and treatment of diseases common in resource-limited settings represented the majority of articles selected for final review. CONCLUSIONS In 2013, there were more emergency care in resource-limited settings articles, while the number of disaster and humanitarian response articles decreased, when compared to the 2012 review. However, the distribution of articles selected for full review did not change significantly. As in prior years, the majority of articles focused on infectious diseases, as well as trauma and injury prevention.
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Affiliation(s)
- Torben K. Becker
- The Department of Emergency Medicine; University of Michigan; Ann Arbor MI
| | - Gabrielle A. Jacquet
- The Department of Emergency Medicine; Boston University School of Medicine; Boston MA
- The Boston University Center for Global Health and Development; Boston MA
| | - Regan Marsh
- The Department of Emergency Medicine; Brigham and Women's Hospital; Boston MA
- The Department of Emergency Medicine; Partners In Health; Boston MA
| | - Erika D. Schroeder
- The Department of Emergency Medicine; Providence Regional Medical Center; Everett WA
| | - Mark Foran
- The Department of Emergency Medicine; New York University; New York NY
- The Harvard Humanitarian Initiative; Cambridge MA
| | - Susan Bartels
- The Harvard Humanitarian Initiative; Cambridge MA
- The Department of Emergency Medicine; Beth Israel Deaconess Medical Center; Boston MA
- The FXB Center for Health and Human Rights; Boston MA
| | - Herbert C. Duber
- The Division of Emergency Medicine; University of Washington; Seattle WA
| | - Hannah Cockrell
- The Department of Emergency Medicine; Rhode Island Hospital; Providence RI
| | - Adam C. Levine
- The Harvard Humanitarian Initiative; Cambridge MA
- The Department of Emergency Medicine; Rhode Island Hospital; Providence RI
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Legris T, Jaffar-Bandjee MC, Favre O, Lefrançois N, Genin R, Ragot C, Fernandez C, Reboux AH. Ameboma: an unusual cause of gastrointestinal bleeding during severe leptospirosis. BMC Infect Dis 2014; 14:299. [PMID: 24894109 PMCID: PMC4047549 DOI: 10.1186/1471-2334-14-299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 05/21/2014] [Indexed: 11/14/2022] Open
Abstract
Background Severe leptospirosis occurs mainly in a tropical environment and includes icterus, acute renal failure and hemorrhages. These bleedings, which are mainly a consequence of acute homeostatic disturbances, can also reveal simultaneous diseases. Coinfections with other tropical diseases have been previously reported during leptospirosis. To our knowledge, invasive amebiasis, which can induce gastrointestinal bleedings, has never been described in the course of severe leptospirosis. Case presentation In this report, we describe a case of a 60 year-old man living in Reunion Island (Indian Ocean, France) admitted to our intensive care unit for severe Leptospira interrogans serovar icterohaemorrhagiae infection with neurological, renal, liver and hematological involvement. Two lower gastrointestinal bleedings occurred 7 and 15 days after admission. The first episode was promoted by hemostatic disturbances while the second bleeding occurred during low-dose heparin therapy. Colonoscopy revealed a pseudo-tumoral inflammatory mass of the recto-sigmoid junction. Histological examination found trophozoites inside mucinous exudate suggestive of Entamoeba histolytica. Amoebic serology was strongly positive whereas careful detection of cysts or trophozoites on saline-wet mount was negative in three consecutive samples of stools. Amoxicillin followed by metronidazole therapy, combined with supportive care, led to an improvement in the clinical and biological patient’s condition and endoscopic appearances. Conclusion Clinicians should be aware that gastrointestinal bleeding during severe leptospirosis could not solely be the consequences of hemostatic disturbances. Careful endoscopic evaluation that may reveal curable coinfections should also be considered.
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Affiliation(s)
- Tristan Legris
- Service de Néphrologie, Dialyse et Transplantation Rénale, Centre Hospitalier Universitaire Felix Guyon, Saint-Denis, La Réunion, France.
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Yew KL, San Go C, Razali F. Pancreatitis and myopericarditis complication in leptospirosis infection. J Formos Med Assoc 2014; 114:785-6. [PMID: 24630490 DOI: 10.1016/j.jfma.2014.01.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 01/28/2014] [Accepted: 01/31/2014] [Indexed: 11/18/2022] Open
Affiliation(s)
- Kuan Leong Yew
- Sarawak General Hospital Heart Center, Kota Samarahan, Sarawak, Malaysia.
| | - Chin San Go
- Department of Medicine, Sarawak General Hospital, Sarawak, Malaysia
| | - Farah Razali
- Department of Anaesthesiology, Sarawak General Hospital, Sarawak, Malaysia
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84
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Hoenigl M, Wallner C, Allerberger F, Schmoll F, Seeber K, Wagner J, Valentin T, Zollner-Schwetz I, Flick H, Krause R. Autochthonous leptospirosis in South-East Austria, 2004-2012. PLoS One 2014; 9:e85974. [PMID: 24465820 PMCID: PMC3896426 DOI: 10.1371/journal.pone.0085974] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 12/03/2013] [Indexed: 11/19/2022] Open
Abstract
Background Leptospirosis is one of the world’s mostly spread zoonoses causing acute fever. Over years, leptospirosis has been reported to occur rarely in Austria and Germany (annual incidence of 0.06/100,000 in Germany). Only imported cases have been on the increase. Objectives of this case-series study were to retrospectively assess epidemiologic and clinical characteristics of leptospirosis illnesses in South-East Austria, to describe risk exposures for autochthonous infections, and to compare patients with imported versus autochthonous infection. Methodology/Principal Findings During the 9-year period between 2004 and 2012, 127 adult patients (49 females, 78 males) who tested positive by rapid point-of-care test for Leptospira-specific IgM (Leptocheck®) were identified through electronic hospital databases. Follow-up telephone interviews were conducted with 82 patients. A total of 114 (89.8%) of the 127 patients enrolled had acquired leptospirosis within Austria and 13 (10.2%) had potentially imported infections. Most autochthonous cases were diagnosed during the months of June and July, whereas fewest were diagnosed during the winter months. Exposure to rodents, recreational activities in woods or wet areas, gardening, cleaning of basements or huts were the most common risk exposures found in autochthonous infection. Serogroups Australis (n = 23), Sejroe (n = 22), and Icterohaemorrhagiae (n = 11) were identified most frequently by MAT testing in autochthonous infections. Patients with imported leptospirosis were significantly younger, less likely to be icteric and had significantly lower liver transaminase levels (p = 0.004) than those with autochthonous infections. Conclusions/Significance Leptospirosis is endemic in South-East Austria. In contrast to reports from other countries we found a relatively high proportion of leptospirosis cases to be female (39% vs. ∼10%), likely the result of differing risk exposures for South-East Austria.
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Affiliation(s)
- Martin Hoenigl
- Section of Infectious Diseases and Tropical Medicine, Department of Medicine, Medical University of Graz, Graz, Austria
- Division of Pulmonology, Department of Medicine, Medical University of Graz, Graz, Austria
- * E-mail: (RK); (MH)
| | - Carina Wallner
- Section of Infectious Diseases and Tropical Medicine, Department of Medicine, Medical University of Graz, Graz, Austria
| | | | | | - Katharina Seeber
- Section of Infectious Diseases and Tropical Medicine, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Jasmin Wagner
- Section of Infectious Diseases and Tropical Medicine, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Thomas Valentin
- Section of Infectious Diseases and Tropical Medicine, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Ines Zollner-Schwetz
- Section of Infectious Diseases and Tropical Medicine, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Holger Flick
- Division of Pulmonology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Robert Krause
- Section of Infectious Diseases and Tropical Medicine, Department of Medicine, Medical University of Graz, Graz, Austria
- * E-mail: (RK); (MH)
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Guerrier G, Hie P, Gourinat AC, Huguon E, Polfrit Y, Goarant C, D'Ortenzio E, Missotte I. Association between age and severity to leptospirosis in children. PLoS Negl Trop Dis 2013; 7:e2436. [PMID: 24086780 PMCID: PMC3784464 DOI: 10.1371/journal.pntd.0002436] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 08/09/2013] [Indexed: 11/21/2022] Open
Abstract
Background In endemic areas, leptospirosis is more common and more severe in adults compared with children. Reasons to explain this discrepancy remain unclear and limited data focusing on adolescents are available. The objective of the study was to describe disease spectrum and outcome differences in children and adolescents admitted for leptospirosis in a large at-risk population. Methods Clinical and laboratory data were obtained on hospitalized cases in New Caledonia from 2006 to 2012. Results Data of 60 patients <18 years of age (25 children under 14 and 35 adolescents aged 14 to 17) with confirmed leptospirosis were analyzed. Compared with children, adolescents presented more often with classic features of Weil disease (p = 0.02), combining hepatic and renal involvement with or without pulmonary participation. Jarisch-Herxheimer reactions were observed more often among adolescents (p<0.01). The overall case fatality rate was low (1 adolescent versus 0 children). Conclusion Severe leptospirosis in adolescents may be more likely to show adults' characteristics compared with children. Further studies are required to explore age-dependant host factors, including puberty-related physiological changes. Leptospirosis is endemic in tropical areas and seems to affect adults more often and more severely than children. Factors responsible for such differences have not been clearly established. However, host-related factors are believed to play a role in the development of severe leptospirosis. The study aimed to describe disease spectrum and outcome differences in confirmed cases in children and adolescents in New Caledonia. One major finding is the milder presentation of children compared with adolescents. Clinical and biological characteristics in adolescents are similar to adults, including occurrence of Jarisch-Herxheimer reactions. Further studies are required to explore age-dependant host factors, including puberty-related physiological changes.
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Affiliation(s)
- Gilles Guerrier
- Intensive Care Unit, Centre Hospitalier Territorial, Noumea, New Caledonia
- * E-mail:
| | - Pauline Hie
- Paediatrics, Centre Hospitalier Territorial, Noumea, New Caledonia
| | - Ann-Claire Gourinat
- Laboratory of Virology, Institut Pasteur in New Caledonia, Noumea, New Caledonia
| | - Emilie Huguon
- Paediatrics, Centre Hospitalier Territorial, Noumea, New Caledonia
| | - Yann Polfrit
- Paediatrics, Centre Hospitalier Territorial, Noumea, New Caledonia
| | - Cyrille Goarant
- Laboratory of Microbiology Research Unit, Institut Pasteur in New Caledonia, Noumea, New Caledonia
| | - Eric D'Ortenzio
- Infectious Diseases Epidemiology Unit, Institut Pasteur in New Caledonia, Noumea, New Caledonia
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