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Petakh P, Oksenych V, Kamyshnyi O. Corticosteroid Treatment for Leptospirosis: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:4310. [PMID: 39124577 PMCID: PMC11313367 DOI: 10.3390/jcm13154310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Revised: 07/21/2024] [Accepted: 07/23/2024] [Indexed: 08/12/2024] Open
Abstract
Background: Leptospirosis, a zoonotic disease prevalent in tropical regions, often leads to severe complications such as Weil's disease and acute respiratory distress syndrome (ARDS). This pioneering meta-analysis investigated the role of corticosteroids in treating severe leptospirosis, addressing a critical gap in the current clinical knowledge. Methods: We systematically reviewed studies from PubMed and Scopus, focusing on randomized controlled trials and observational cohort studies involving adult patients diagnosed with leptospirosis. Five studies comprising 279 participants met the inclusion criteria. Results: Although some studies suggest potential benefits, particularly for pulmonary complications, the evidence remains inconclusive due to the limited number of studies and their methodological limitations. Notably, while four of the five reviewed studies indicated a possible positive role of corticosteroids, the single randomized controlled trial showed no significant benefit, highlighting the need for more robust research. Conclusions: While the current evidence provides a basis for potential benefits, it is not sufficient to make definitive clinical recommendations. Further research is essential to clarify the role of corticosteroids in the treatment of severe leptospirosis, with the aim of improving patient outcomes and guiding clinical practices effectively.
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Affiliation(s)
- Pavlo Petakh
- Department of Biochemistry and Pharmacology, Uzhhorod National University, 88000 Uzhhorod, Ukraine;
- Department of Microbiology, Virology and Immunology, I. Horbachevsky Ternopil National Medical University, 46001 Ternopil, Ukraine
| | - Valentyn Oksenych
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, 5020 Bergen, Norway
| | - Oleksandr Kamyshnyi
- Department of Microbiology, Virology and Immunology, I. Horbachevsky Ternopil National Medical University, 46001 Ternopil, Ukraine
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Ashaiba A, Sapna K, Arun AB, Tellis RC, Prasad KS. Development and Evaluation of a Noninvasive Microfluidic-Based Paper Analytical Device for Leptospirosis Diagnosis. Anal Chem 2024; 96:11997-12005. [PMID: 38991147 DOI: 10.1021/acs.analchem.4c01934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
Leptospirosis is a re-emerging infectious disease that presents a diagnostic enigma for clinicians with frequent misdiagnosis due to lack of rapid and accurate diagnostic tests, as the current methods are encumbered by inherent limitations. The development of a diagnostic sensor with a sample-in-result-out capability is pivotal for prompt diagnosis. Herein, we developed a microfluidic paper-based analytical device (spin-μPAD) featuring a sample-in-result-out fashion for the detection of Leptospira specific urinary biomarker, sph2 sphingomyelinase, crucial for noninvasive point-of-care testing. Fabrication of paper devices involved precise photolithography techniques, ensuring a high degree of reproducibility and replicability. By optimizing the device's configuration and protein components, a remarkable sensitivity and specificity was achieved for detecting leptospiral sph2 in urine, even at low concentrations down to 1.5 fg/mL, with an assay time of 15 min. Further, the spin-μPAD was validated with 20 clinical samples, suspected of leptospirosis including other febrile illnesses, and compared with gold standard microscopic agglutination test, culture, Lepto IgM ELISA, darkfield microscopy, and Leptocheck WB spot test. In contrast to commercial diagnostic tools, the spin-μPAD was noninvasive, rapid, easy to use, specific, sensitive, and cost-effective. The results highlight the potential of this innovative spin-μPAD for an efficient and dependable approach to noninvasive leptospirosis diagnosis, addressing critical needs in the realms of public health and clinical settings.
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Affiliation(s)
- Asiamma Ashaiba
- Department of Microbiology, Yenepoya Medical College, Yenepoya (Deemed to be University), Deralakatte, Mangalore 575 018, India
- Nanomaterial Research Laboratory, Yenepoya Research Centre, Yenepoya (Deemed to be University), Deralakatte, Mangalore 575 018, India
| | - Kannan Sapna
- Nanomaterial Research Laboratory, Yenepoya Research Centre, Yenepoya (Deemed to be University), Deralakatte, Mangalore 575 018, India
| | | | - Rouchelle C Tellis
- Department of Microbiology, Yenepoya Medical College, Yenepoya (Deemed to be University), Deralakatte, Mangalore 575 018, India
| | - Kariate Sudhakara Prasad
- Nanomaterial Research Laboratory, Yenepoya Research Centre, Yenepoya (Deemed to be University), Deralakatte, Mangalore 575 018, India
- Centre for Nutrition Studies, Yenepoya (Deemed to be University), Mangalore 575 018, India
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Uduwawala H, Manamperi A, Gunaratna GPS, Karunanayake L, Ceruti A, Abd El Wahed A, Fernando L, Premaratna R, Hapugoda M. Detection of pathogenic Leptospira with rapid extraction followed by recombinase polymerase amplification (RPA) and quantitative polymerase chain reaction (qPCR) assay-A comprehensive study from Sri Lanka. PLoS One 2024; 19:e0295287. [PMID: 38489285 PMCID: PMC10942058 DOI: 10.1371/journal.pone.0295287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/16/2023] [Indexed: 03/17/2024] Open
Abstract
Leptospirosis is the most widespread zoonosis in the world. The disease is more prevalent in tropical regions where the majority of developing countries are located. Leptospirosis is considered a protean manifestation zoonosis with severity of the disease ranging from a mild febrile illness to a severe and life-threatening illness. Clinical symptoms of leptospirosis overlap with other tropical febrile illnesses. Early, rapid, and definitive diagnosis is important for effective patient management. Since Polymerase Chain Reaction (PCR)-based assays are not readily available in most clinical settings, there is a need for an affordable, simple, and rapid diagnostic test. Quantitative PCR (qPCR) and Recombinase Polymerase Amplification (RPA) were implemented at the Faculty of Medicine, University of Kelaniya, and a prospective study to evaluate RPA for diagnosis of acute phase of leptospirosis was conducted. Results indicate that RPA and qPCR were positive in 81% (98/121) of the total positive and acute clinical samples. Of the 81 positive MAT confirmed patients 60 (74%) and 53 (65%) were positive with qPCR and RPA respectively. Retrospective evaluation revealed a high diagnostic accuracy (sensitivity-70% and specificity-87%) of RPA compared to MAT as the reference gold standard. Results further suggest that there is no significant difference between the two assays, qPCR and RPA-SwiftX (P = 0.40). Laboratory procedures for the extraction and detection by qPCR in the laboratory have been optimized to obtain results within 6 hours. However, the RPA-SwiftX method under field conditions took 35 minutes. The RPA-SwiftX method could replace the qPCR which shows similar sensitivity and specificity. Therefore, RPA established under the current study presents a powerful tool for the early and rapid diagnosis of leptospirosis at point-of-care.
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Affiliation(s)
- Hansi Uduwawala
- Molecular Medicine Unit, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Aresha Manamperi
- Molecular Medicine Unit, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Gayana P. S. Gunaratna
- Department of Medical Microbiology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Lilani Karunanayake
- National Reference Laboratory for Leptospirosis, Medical Research Institute, Colombo, Sri Lanka
| | - Arianna Ceruti
- Institute of Animal Hygiene and Veterinary Public Health, Leipzig University, Leipzig, Germany
| | - Ahmed Abd El Wahed
- Institute of Animal Hygiene and Veterinary Public Health, Leipzig University, Leipzig, Germany
| | - Lakkumar Fernando
- Centre for Clinical Management of Dengue & Dengue Haemorrhagic Fever, District General Hospital, Negombo, Sri Lanka
| | - Ranjan Premaratna
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Menaka Hapugoda
- Molecular Medicine Unit, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
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Win TZ, Perinpanathan T, Mukadi P, Smith C, Edwards T, Han SM, Maung HT, Brett-Major DM, Lee N. Antibiotic prophylaxis for leptospirosis. Cochrane Database Syst Rev 2024; 3:CD014959. [PMID: 38483067 PMCID: PMC10938880 DOI: 10.1002/14651858.cd014959.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
BACKGROUND Leptospirosis is a global zoonotic and waterborne disease caused by pathogenic Leptospira species. Antibiotics are used as a strategy for prevention of leptospirosis, in particular in travellers and high-risk groups. However, the clinical benefits are unknown, especially when considering possible treatment-associated adverse effects. This review assesses the use of antibiotic prophylaxis in leptospirosis and is an update of a previously published review in the Cochrane Library (2009, Issue 3). OBJECTIVES To evaluate the benefits and harms of antibiotic prophylaxis for human leptospirosis. SEARCH METHODS We identified randomised clinical trials through electronic searches of the Cochrane Hepato-Biliary Group Controlled Trials Register, CENTRAL, MEDLINE, Embase, LILACS, Science Citation Index Expanded, and other resources. We searched online clinical trial registries to identify unpublished or ongoing trials. We checked reference lists of the retrieved studies for further trials. The last date of search was 17 April 2023. SELECTION CRITERIA We included randomised clinical trials of any trial design, assessing antibiotics for prevention of leptospirosis, and with no restrictions on age, sex, occupation, or comorbidity of trial participants. We looked for trials assessing antibiotics irrespective of route of administration, dosage, and schedule versus placebo or no intervention. We also included trials assessing antibiotics versus other antibiotics using these criteria, or the same antibiotic but with another dose or schedule. DATA COLLECTION AND ANALYSIS We followed Cochrane methodology. The primary outcomes were all-cause mortality, laboratory-confirmed leptospirosis regardless of the presence of an identified clinical syndrome (inclusive of asymptomatic cases), clinical diagnosis of leptospirosis regardless of the presence of laboratory confirmation, clinical diagnosis of leptospirosis confirmed by laboratory diagnosis (exclusive of asymptomatic cases), and serious adverse events. The secondary outcomes were quality of life and the proportion of people with non-serious adverse events. We assessed the risk of bias of the included trials using the RoB 2 tool and the certainty of evidence using GRADE. We presented dichotomous outcomes as risk ratios (RR) and continuous outcomes as mean difference (MD), with their 95% confidence intervals (CI). We used a random-effects model for our main analyses and the fixed-effect model for sensitivity analyses. Our primary outcome analyses included trial data at the longest follow-up. MAIN RESULTS We identified five randomised clinical trials comprising 2593 participants that compared antibiotics (doxycycline, azithromycin, or penicillin) with placebo, or one antibiotic compared with another. Four trials assessed doxycycline with different durations, one trial assessed azithromycin, and one trial assessed penicillin. One trial had three intervention groups: doxycycline, azithromycin, and placebo. Three trials assessed pre-exposure prophylaxis, one trial assessed postexposure prophylaxis, and one did not report this clearly. Four trials recruited residents in endemic areas, and one trial recruited soldiers who experienced limited time exposure. The participants' ages in the included trials were 10 to 80 years. Follow-up ranged from one to three months. Antibiotics versus placebo Doxycycline compared with placebo may result in little to no difference in all-cause mortality (RR 0.15, 95% CI 0.01 to 2.83; 1 trial, 782 participants; low-certainty evidence). Prophylactic antibiotics may have little to no effect on laboratory-confirmed leptospirosis, but the evidence is very uncertain (RR 0.56, 95% CI 0.25 to 1.26; 5 trials, 2593 participants; very low-certainty evidence). Antibiotics may result in little to no difference in the clinical diagnosis of leptospirosis regardless of laboratory confirmation (RR 0.76, 95% CI 0.53 to 1.08; 4 trials, 1653 participants; low-certainty evidence) and the clinical diagnosis of leptospirosis with laboratory confirmation (RR 0.57, 95% CI 0.26 to 1.26; 4 trials, 1653 participants; low-certainty evidence). Antibiotics compared with placebo may increase non-serious adverse events, but the evidence is very uncertain (RR 10.13, 95% CI 2.40 to 42.71; 3 trials, 1909 participants; very low-certainty evidence). One antibiotic versus another antibiotic One trial assessed doxycycline versus azithromycin but did not report mortality. Compared to azithromycin, doxycycline may have little to no effect on laboratory-confirmed leptospirosis regardless of the presence of an identified clinical syndrome (RR 1.49, 95% CI 0.51 to 4.32; 1 trial, 137 participants), on the clinical diagnosis of leptospirosis regardless of the presence of laboratory confirmation (RR 4.18, 95% CI 0.94 to 18.66; 1 trial, 137 participants), on the clinical diagnosis of leptospirosis confirmed by laboratory diagnosis (RR 4.18, 95% CI 0.94 to 18.66; 1 trial, 137 participants), and on non-serious adverse events (RR 1.12, 95% CI 0.36 to 3.48; 1 trial, 137 participants), but the evidence is very uncertain. The certainty of evidence for all the outcomes was very low. None of the five included trials reported serious adverse events or assessed quality of life. One study is awaiting classification. Funding Four of the five trials included statements disclosing their funding/supporting sources, and the remaining trial did not include this. Three of the four trials that disclosed their supporting sources received the supply of trial drugs directly from the same pharmaceutical company, and the remaining trial received financial support from a governmental source. AUTHORS' CONCLUSIONS We do not know if antibiotics versus placebo or another antibiotic has little or have no effect on all-cause mortality or leptospirosis infection because the certainty of evidence is low or very low. We do not know if antibiotics versus placebo may increase the overall risk of non-serious adverse events because of very low-certainty evidence. We lack definitive rigorous data from randomised trials to support the use of antibiotics for the prophylaxis of leptospirosis infection. We lack trials reporting data on clinically relevant outcomes.
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Affiliation(s)
- Tin Zar Win
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Tanaraj Perinpanathan
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Patrick Mukadi
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- Program for Nurturing Global Leaders in Tropical and Emerging Communicable Diseases, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
- Institut National de Recherche Biomedicale (INRB), Kinshasa, DRC
| | - Chris Smith
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Tansy Edwards
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Su Myat Han
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Hsu Thinzar Maung
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - David M Brett-Major
- Department of Preventive Medicine and Biometrics, Uniformed Services University, Bethesda, MD, USA
| | - Nathaniel Lee
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Yang QF, Shu CM, Ji QY. Diagnosis of pulmonary hemorrhagic leptospirosis complicated by invasive pulmonary aspergillosis complemented by metagenomic next-generation sequencing: a case report. Front Med (Lausanne) 2024; 11:1365096. [PMID: 38500954 PMCID: PMC10944945 DOI: 10.3389/fmed.2024.1365096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/22/2024] [Indexed: 03/20/2024] Open
Abstract
Background Leptospirosis is a bacterial zoonosis with variable clinical manifestations. Pulmonary diffuse hemorrhagic leptospirosis often occurs rapidly and, when not promptly diagnosed and treated, it can be life-threatening. Aspergillus flavus is an opportunistic fungus that is commonly seen in immunosuppressed patients. Invasive pulmonary aspergillosis also progresses rapidly. This case study describes a patient with severe pneumonia caused by pulmonary hemorrhagic leptospirosis combined with invasive pulmonary aspergillosis. We have found almost no clinical reports to date on these two diseases occurring in the same patient. Case presentation A 73-year-old male arrived at our hospital complaining of fever, general malaise, and hemoptysis that had lasted 4 days. The patient was initially diagnosed with severe pneumonia in the emergency department, but he did not respond well to empiric antibiotics. Subsequently, the patient's condition worsened and was transferred to the ICU ward after emergency tracheal intubation and invasive ventilator. In the ICU, antibacterial drugs were adjusted to treat bacteria and fungi extensively. Although the inflammatory indices decreased, the patient still had recurrent fever, and a series of etiological tests were negative. Finally, metagenomic next-generation sequencing (mNGS) of bronchial alveolar lavage fluid detected Leptospira interrogans and Aspergillus flavus. After targeted treatment with penicillin G and voriconazole, the patient's condition improved rapidly, and he was eventually transferred out of the ICU and recovered. Conclusion Early recognition and diagnosis of leptospirosis is difficult, especially when a patient is co-infected with other pathogens. The use of mNGS to detect pathogens in bronchial alveolar lavage fluid is conducive to early diagnosis and treatment of the disease, and may significantly improve the prognosis in severe cases.
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Hamer M, Watanabe O, Saraullo V, Ortega F, Sánchez C, Martínez M, Brihuega B, Grune Loffler S. Optimization and comparative analysis of LAMP and PCR techniques for the detection of leptospiral DNA in Golden Syrian hamsters. Vet Res Commun 2024; 48:103-111. [PMID: 37540477 DOI: 10.1007/s11259-023-10183-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/20/2023] [Indexed: 08/05/2023]
Abstract
Leptospirosis is a zoonotic disease with significant public health and economic impact worldwide. Rapid and accurate diagnosis is essential for effective prevention and treatment. This study optimized a loop-mediated isothermal amplification (LAMP) assay using BFo isothermal DNA polymerase with different colorimetric indicators. LAMP was able to detect DNA from pathogenic and intermediate leptospires, while non-pathogenic leptospires and other non-leptospiral microorganisms were negative. LAMP assay combined with calcein showed a tenfold higher limit of detection (1 ng of leptospiral DNA per reaction) than LAMP combined with hydroxynaphthol blue or end-point PCR lipL32 (10 ng of DNA per reaction). Animal samples were collected from infected and non-infected Golden Syrian hamsters (Mesocricetus auratus) to evaluate and compare the performance of LAMP and PCR. These techniques showed a substantial agreement according to Cohen's kappa statistic, being both useful techniques for detecting leptospiral DNA in clinical samples. Overall, this study demonstrates that the LAMP assay is a sensitive, specific, rapid, and simple tool for the detection of leptospiral DNA. It has the potential to facilitate the diagnosis of leptospirosis, particularly in low-income regions with limited diagnosis resources.
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Affiliation(s)
- Micaela Hamer
- Laboratory of Leptospirosis (WOAH Reference Laboratory), Institute of Veterinary Pathobiology- UEDD IPVET, National Institute of Agricultural Technology (INTA) - National Research Council of Argentina (CONICET), Buenos Aires, Argentina.
| | - Olivia Watanabe
- Laboratory of Leptospirosis (WOAH Reference Laboratory), Institute of Veterinary Pathobiology- UEDD IPVET, National Institute of Agricultural Technology (INTA) - National Research Council of Argentina (CONICET), Buenos Aires, Argentina
| | - Vanina Saraullo
- Laboratory of Leptospirosis (WOAH Reference Laboratory), Institute of Veterinary Pathobiology- UEDD IPVET, National Institute of Agricultural Technology (INTA) - National Research Council of Argentina (CONICET), Buenos Aires, Argentina
| | - Facundo Ortega
- Laboratory of Leptospirosis (WOAH Reference Laboratory), Institute of Veterinary Pathobiology- UEDD IPVET, National Institute of Agricultural Technology (INTA) - National Research Council of Argentina (CONICET), Buenos Aires, Argentina
| | - Cristina Sánchez
- Laboratory of Leptospirosis (WOAH Reference Laboratory), Institute of Veterinary Pathobiology- UEDD IPVET, National Institute of Agricultural Technology (INTA) - National Research Council of Argentina (CONICET), Buenos Aires, Argentina
| | - Mara Martínez
- Laboratory of Leptospirosis (WOAH Reference Laboratory), Institute of Veterinary Pathobiology- UEDD IPVET, National Institute of Agricultural Technology (INTA) - National Research Council of Argentina (CONICET), Buenos Aires, Argentina
| | - Bibiana Brihuega
- Laboratory of Leptospirosis (WOAH Reference Laboratory), Institute of Veterinary Pathobiology- UEDD IPVET, National Institute of Agricultural Technology (INTA) - National Research Council of Argentina (CONICET), Buenos Aires, Argentina
- Veterinary School, University of El Salvador, Buenos Aires, Argentina
| | - Sylvia Grune Loffler
- Centre of Human and Animal Virology (CEVHAN), Interamerican Open University (UAI) - National Research Council of Argentina (CONICET), Buenos Aires, Argentina
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Arboleda M, Mejía-Torres M, Posada M, Restrepo N, Ríos-Tapias P, Rivera-Pedroza LA, Calle D, Sánchez-Jiménez MM, Marín K, Agudelo-Flórez P. Molecular Diagnosis as an Alternative for Public Health Surveillance of Leptospirosis in Colombia. Microorganisms 2023; 11:2759. [PMID: 38004770 PMCID: PMC10673046 DOI: 10.3390/microorganisms11112759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/24/2023] [Accepted: 10/30/2023] [Indexed: 11/26/2023] Open
Abstract
Leptospirosis represents a public health problem in Colombia. However, the underreporting of the disease is an unfortunate reality, with a clear trend towards a decrease in cases since 2019, when the guidelines for its confirmatory diagnosis changed with the requirement of two paired samples. The purpose of this review is to highlight the importance of leptospirosis. While the access to rapid diagnosis is available at practically all levels of care for dengue and malaria, leptospirosis-a doubly neglected disease-deserves recognition as a serious public health problem in Colombia. In this manner, it is proposed that molecular tests are a viable diagnostic alternative that can improve the targeted treatment of the patient and the timeliness of data and case reporting to SIVIGILA, and reduce the underreporting of the disease. Taking advantage of the strengthened technological infrastructure derived from the SARS-CoV-2 pandemic for molecular diagnosis in Colombia, with a network of 227 laboratories distributed throughout the national territory, with an installed capacity for PCR testing, it is proposed that molecular diagnosis can be used as an alternative for early diagnosis. This would allow case confirmation through the public health network in Colombia, and, together with the microagglutination (MAT) technique, the epidemiological surveillance of this disease in this country would be strengthened.
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Affiliation(s)
- Margarita Arboleda
- Tropical Medicine Group, Colombian Institute of Tropical Medicine, Sabaneta 055450, Colombia; (M.M.-T.); (M.P.); (N.R.); (P.R.-T.); (L.A.R.-P.); (D.C.); (M.M.S.-J.); (K.M.)
| | - Mariana Mejía-Torres
- Tropical Medicine Group, Colombian Institute of Tropical Medicine, Sabaneta 055450, Colombia; (M.M.-T.); (M.P.); (N.R.); (P.R.-T.); (L.A.R.-P.); (D.C.); (M.M.S.-J.); (K.M.)
| | - Maritza Posada
- Tropical Medicine Group, Colombian Institute of Tropical Medicine, Sabaneta 055450, Colombia; (M.M.-T.); (M.P.); (N.R.); (P.R.-T.); (L.A.R.-P.); (D.C.); (M.M.S.-J.); (K.M.)
| | - Nicaela Restrepo
- Tropical Medicine Group, Colombian Institute of Tropical Medicine, Sabaneta 055450, Colombia; (M.M.-T.); (M.P.); (N.R.); (P.R.-T.); (L.A.R.-P.); (D.C.); (M.M.S.-J.); (K.M.)
| | - Paola Ríos-Tapias
- Tropical Medicine Group, Colombian Institute of Tropical Medicine, Sabaneta 055450, Colombia; (M.M.-T.); (M.P.); (N.R.); (P.R.-T.); (L.A.R.-P.); (D.C.); (M.M.S.-J.); (K.M.)
| | - Luis Alberto Rivera-Pedroza
- Tropical Medicine Group, Colombian Institute of Tropical Medicine, Sabaneta 055450, Colombia; (M.M.-T.); (M.P.); (N.R.); (P.R.-T.); (L.A.R.-P.); (D.C.); (M.M.S.-J.); (K.M.)
| | - David Calle
- Tropical Medicine Group, Colombian Institute of Tropical Medicine, Sabaneta 055450, Colombia; (M.M.-T.); (M.P.); (N.R.); (P.R.-T.); (L.A.R.-P.); (D.C.); (M.M.S.-J.); (K.M.)
| | - Miryan M. Sánchez-Jiménez
- Tropical Medicine Group, Colombian Institute of Tropical Medicine, Sabaneta 055450, Colombia; (M.M.-T.); (M.P.); (N.R.); (P.R.-T.); (L.A.R.-P.); (D.C.); (M.M.S.-J.); (K.M.)
| | - Katerine Marín
- Tropical Medicine Group, Colombian Institute of Tropical Medicine, Sabaneta 055450, Colombia; (M.M.-T.); (M.P.); (N.R.); (P.R.-T.); (L.A.R.-P.); (D.C.); (M.M.S.-J.); (K.M.)
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Gonzalez HC, Gordon SC. Hepatic Manifestations of Systemic Diseases. Med Clin North Am 2023; 107:465-489. [PMID: 37001948 DOI: 10.1016/j.mcna.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
In addition to being the primary target of infections such as viral hepatitis, the liver may also be affected by systemic disease. These include bacterial, mycotic, and viral infections, as well as autoimmune and infiltrative diseases. These conditions generally manifest as abnormal liver biochemistries, often with a cholestatic profile, and may present with additional signs/symptoms such as jaundice and fever. A high index of suspicion and familiarity with potential causal entities is necessary to guide appropriate testing, diagnosis, and treatment.
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Affiliation(s)
- Humberto C Gonzalez
- Division of Gastroenterology and Hepatology, Henry Ford Health, 2799 West Grand Boulevard, Detroit, MI 48202, USA; Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI 48201, USA.
| | - Stuart C Gordon
- Division of Gastroenterology and Hepatology, Henry Ford Health, 2799 West Grand Boulevard, Detroit, MI 48202, USA; Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI 48201, USA
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9
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Li D, Liang H, Yi R, Xiao Q, Zhu Y, Chang Q, Zhou L, Liu B, He J, Liu T, Fan Z, Cheng W, Wang W, Zhang Y, Pan P. Clinical characteristics and prognosis of patient with leptospirosis: A multicenter retrospective analysis in south of China. Front Cell Infect Microbiol 2022; 12:1014530. [PMID: 36325463 PMCID: PMC9618720 DOI: 10.3389/fcimb.2022.1014530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/29/2022] [Indexed: 01/18/2023] Open
Abstract
Purpose Leptospirosis is a zoonotic disease caused by pathogenic spirochetes of the genus Leptospira. However, there is currently no consensual definition or diagnostic criteria for severe and different forms of leptospirosis. Therefore, more insight on clinical manifestations, risk factors, and outcomes of leptospirosis is warranted. The identification of leptospirosis with distinct clinical manifestations and prognosis in our population. Methods Multiple correspondence analysis and hierarchical classification on principal components were presented to identify different clinical types of leptospirosis. The outcomes were clinical phenotypes, laboratory and imaging findings, and prognosis. Results The 95 enrolled patients had median values of 54.0 years (39.0-65.0) for age, 9.0 (7.0-14.0) for total hospital stay lengths, of whom 86.3% was male and 40.0% was transferred to ICU. Three clinical types were distinguished: mild leptospirosis (n=43, 45.3%) with less organ dysfunction and shorter hospital stays; respiratory leptospirosis (n=28, 29.5%) with hemoptysis, and respiratory and circulatory failure; and hepato-renal leptospirosis (n=24, 25.3%) with worst liver and kidney dysfunction. Total hospital mortality was 15.8% and was associated with dyspnea and high levels of neutrophil counts. Conclusions The identification of leptospirosis with distinct clinical manifestations and prognosis in our population may assist clinicians to distinguish leptospirosis-like disease. Moreover, dyspnea and neutrophil count were found to be independent risk factors for severe leptospirosis progression.
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Affiliation(s)
- Dianwu Li
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China
- Center of Respiratory Medicine, Xiangya Hospital of Central South University, Changsha, China
- Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, China
- Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
| | - Huaying Liang
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China
- Center of Respiratory Medicine, Xiangya Hospital of Central South University, Changsha, China
- Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, China
- Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
| | - Rong Yi
- Department of Pulmonary and Critical Care Medicine, Zhuzhou Central Hospital, Zhuzhou, China
| | - Qian Xiao
- Department of Anaesthesiology, Hunan Provincial People’s Hospital, Changsha, China
| | - Yiqun Zhu
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China
- Center of Respiratory Medicine, Xiangya Hospital of Central South University, Changsha, China
- Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, China
- Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
| | - Qinyu Chang
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China
- Center of Respiratory Medicine, Xiangya Hospital of Central South University, Changsha, China
- Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, China
- Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
| | - Lihua Zhou
- Department of Respiratory Medicine, Changsha Central Hospital, Changsha, China
| | - Bin Liu
- Department of Emergency, Xiangtan Central Hospital, Xiangtan, China
| | - Junjun He
- Department of General Surgery, Shaoyang Central Hospital, Shaoyang, China
| | - Tianxing Liu
- Department of Orthopaedic Surgery, Yongzhou Central Hospital, Yongzhou, China
| | - Zhijun Fan
- Department of Cardiothoracic Surgery, Liuyang People’s Hospital, Liuyang, China
| | - Wei Cheng
- Department of Respiratory, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Weizhong Wang
- Department of Respiratory, The First Affiliated Hospital of University of South China, Hengyang, China
| | - Yan Zhang
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China
- Center of Respiratory Medicine, Xiangya Hospital of Central South University, Changsha, China
- Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, China
- Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
- *Correspondence: Pinhua Pan, ; Yan Zhang,
| | - Pinhua Pan
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China
- Center of Respiratory Medicine, Xiangya Hospital of Central South University, Changsha, China
- Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, China
- Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
- *Correspondence: Pinhua Pan, ; Yan Zhang,
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10
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Win TZ, Tabei K, Mukadi P, Edwards T, Smith C, Lee N. Corticosteroids for treatment of leptospirosis. Hippokratia 2022. [DOI: 10.1002/14651858.cd014935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Tin Zar Win
- School of Tropical Medicine and Global Health; Nagasaki University; Nagasaki Japan
| | - Kozue Tabei
- School of Tropical Medicine and Global Health; Nagasaki University; Nagasaki Japan
| | - Patrick Mukadi
- Department of Clinical Medicine; Institute of Tropical Medicine, Nagasaki University; Nagasaki Japan
- Program for Nurturing Global Leaders in Tropical and Emerging Communicable Diseases; Graduate School of Biomedical Sciences, Nagasaki University; Nagasaki Japan
- Institut National de Recherche Biomedicale (INRB); Kinshasa Costa Rica
| | - Tansy Edwards
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health; London School of Hygiene & Tropical Medicine; London UK
| | - Chris Smith
- School of Tropical Medicine and Global Health; Nagasaki University; Nagasaki Japan
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases; London School of Hygiene & Tropical Medicine; London UK
| | - Nathaniel Lee
- Hospital for Tropical Diseases; University College London Hospital NHS Foundation Trust; London UK
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11
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Tabei K, Win TZ, Kitashoji E, Brett-Major DM, Edwards T, Smith C, Mukadi P. Antibiotic prophylaxis for leptospirosis. Hippokratia 2022. [DOI: 10.1002/14651858.cd014959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kozue Tabei
- School of Tropical Medicine and Global Health; Nagasaki University; Nagasaki Japan
| | - Tin Zar Win
- School of Tropical Medicine and Global Health; Nagasaki University; Nagasaki Japan
| | - Emi Kitashoji
- Department of Clinical Medicine; Institute of Tropical Medicine, Nagasaki University; Nagasaki Japan
| | - David M Brett-Major
- Department of Preventive Medicine and Biometrics; Uniformed Services University; Bethesda MD USA
| | - Tansy Edwards
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health; London School of Hygiene & Tropical Medicine; London UK
| | - Chris Smith
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases; London School of Hygiene & Tropical Medicine; London UK
| | - Patrick Mukadi
- Department of Clinical Medicine; Institute of Tropical Medicine, Nagasaki University; Nagasaki Japan
- Program for Nurturing Global Leaders in Tropical and Emerging Communicable Diseases; Graduate School of Biomedical Sciences, Nagasaki University; Nagasaki Japan
- Institut National de Recherche Biomedicale (INRB); Kinshasa DRC
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12
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Ukhovskyi V, Pyskun A, Korniienko L, Aliekseieva H, Moroz O, Pyskun O, Kyivska G, Mezhenskyi A. Serological prevalence of Leptospira serovars among pigs in Ukraine during the period of 2001-2019. VET MED-CZECH 2022; 67:13-27. [PMID: 39169955 PMCID: PMC11334960 DOI: 10.17221/50/2021-vetmed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 08/24/2021] [Indexed: 08/23/2024] Open
Abstract
Leptospirosis is a widespread infection among pigs throughout the world. In most cases in Ukraine, only the microscopic agglutination test (MAT) is used for the diagnosis of leptospirosis in animals. In general, during the period of 2001-2019, 2 381 163 samples of blood sera from swine were tested in our country and 85 338 positive reactions were received, which is 3.58% [binomial confidence intervals (BCI), 3.56-3.61%]. It was established that the serovars copenhageni - 33.91% (BCI, 33.59-34.23%), bratislava - 14.14% (BCI, 13.90-14.37%), pomona - 8.58% (BCI, 8.39-8.77%), and tarassovi - 7.12% (BCI, 6.95-7.30%) play a leading role in the aetiological structure of swine leptospirosis. A large number of positive reactions to several serovars was observed - 29.78% (BCI, 29.47-30.09%) of the total number of positive cases. In addition, the article presents data according to a retrospective analysis of the eight serovars circulating among pigs in Ukraine. Thus, during the nineteen year period, there was a decrease in the number of positive reactions to bratislava, pomona, and tarassovi and an increase in the number of positive reactions to copenhageni, polonica, and kabura. Mapping Ukraine's territory for leptospirosis among pigs was carried out. This allows one to identify zones with a risk of leptospirosis infections among swine. The maps show that the highest incidence rates were identified in the eastern and central parts of Ukraine.
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Affiliation(s)
- Vitalii Ukhovskyi
- Department of Epizootology, State Scientific and Research Institute of Laboratory Diagnostic and Veterinary and Sanitary Expertise, Kyiv, Ukraine
| | - Anton Pyskun
- Department of Immunological Research, State Scientific and Research Institute of Laboratory Diagnostic and Veterinary and Sanitary Expertise, Kyiv, Ukraine
| | - Leonid Korniienko
- Department of Epizootology, State Scientific and Research Institute of Laboratory Diagnostic and Veterinary and Sanitary Expertise, Kyiv, Ukraine
| | - Halyna Aliekseieva
- Department of Immunological Research, State Scientific and Research Institute of Laboratory Diagnostic and Veterinary and Sanitary Expertise, Kyiv, Ukraine
| | - Olexandr Moroz
- Department of Epizootology, State Scientific and Research Institute of Laboratory Diagnostic and Veterinary and Sanitary Expertise, Kyiv, Ukraine
| | - Olena Pyskun
- Department of Organization of Scientific and International Work, State Scientific and Research Institute of Laboratory Diagnostic and Veterinary and Sanitary Expertise, Kyiv, Ukraine
| | - Ganna Kyivska
- Department of Organization of Scientific and International Work, State Scientific and Research Institute of Laboratory Diagnostic and Veterinary and Sanitary Expertise, Kyiv, Ukraine
| | - Andrii Mezhenskyi
- State Scientific and Research Institute of Laboratory Diagnostic and Veterinary and Sanitary Expertise, Kyiv, Ukraine
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13
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Guedes IB, Souza GOD, Castro JFDP, Cavalini MB, Filho AFDS, Aizawa J, Cortez A, Heinemann MB. Improvement of the enrichment used in the EMJH medium (Ellinghausen-McCullough-Johnson-Harris) for the cultivation of Leptospira spp. Rev Argent Microbiol 2021; 54:95-99. [PMID: 34083031 DOI: 10.1016/j.ram.2021.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 01/29/2021] [Accepted: 03/28/2021] [Indexed: 11/19/2022] Open
Abstract
Changes were made to the original formulation of the EMJH medium (Ellinghausen-McCullough-Johnson-Harris) enrichment and some aspects such as growth time of Leptospira and utilization in the microscopic agglutination test (MAT) were evaluated and compared to the original enrichment and to a commercially available enrichment (DIFCO™). Leptospira samples (24 antigens) that make up our panel of antigens used in MAT were used, among them, reference and autochthonous strains isolated in Brazil. The samples were grown individually in the EMJH medium under the three previously mentioned conditions (adapted enrichment, original enrichment and commercial enrichment). In addition, 89 blood serums from domestic and wild animals were analyzed by MAT using the antigens grown in these media. All samples tested grew efficiently with the adapted enrichment, and the MAT results were satisfactory. Therefore, other laboratories could also benefit from the use of this adapted enrichment when culturing the Leptospira strains applied in their MAT panels.
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Affiliation(s)
- Israel Barbosa Guedes
- Laboratório de Zoonoses Bacterianas, Departamento de Medicina Veterinária Preventiva e Saúde Animal, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Gisele Oliveira de Souza
- Laboratório de Zoonoses Bacterianas, Departamento de Medicina Veterinária Preventiva e Saúde Animal, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Juliana Fernandes de Paula Castro
- Laboratório de Zoonoses Bacterianas, Departamento de Medicina Veterinária Preventiva e Saúde Animal, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Matheus Burilli Cavalini
- Laboratório de Zoonoses Bacterianas, Departamento de Medicina Veterinária Preventiva e Saúde Animal, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Antônio Francisco de Souza Filho
- Laboratório de Zoonoses Bacterianas, Departamento de Medicina Veterinária Preventiva e Saúde Animal, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Juliana Aizawa
- Laboratory of Microbiology, Parasitology and Hygiene, Department of Pharmaceutical Sciences, University of Antwerp, Wilrijk, Belgium
| | - Adriana Cortez
- Curso de Medicina Veterinária, Universidade Santo Amaro, São Paulo, SP, Brazil
| | - Marcos Bryan Heinemann
- Laboratório de Zoonoses Bacterianas, Departamento de Medicina Veterinária Preventiva e Saúde Animal, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, SP, Brazil.
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