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Asaduzzaman M, Karmaker L, Rahman A, Rahman MS, Awaul MA, Chakraborty SR. Dengue and leptospirosis coinfection: a case series. J Med Case Rep 2024; 18:370. [PMID: 39107781 PMCID: PMC11304916 DOI: 10.1186/s13256-024-04675-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 06/22/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Both dengue and Leptospira infections are endemic to tropical and subtropical regions, with their prevalence increasing in recent decades. Coinfection with these pathogens presents significant diagnostic challenges for clinicians due to overlapping clinical manifestations and laboratory findings. This case report aims to elucidate two clinical scenarios where the coinfection of dengue and leptospirosis complicates the disease course, creating a diagnostic conundrum. CASE PRESENTATION We present the clinical scenarios of two Bangladeshi males, aged 25 and 35 years, who were admitted to our hospital with acute febrile illness. The first patient exhibited hepatic and renal involvement, while the second presented with symptoms initially suggestive of meningoencephalitis. Both cases were initially managed under the presumption of dengue infection based on positive serology. However, further evaluation revealed coinfection with Leptospira, complicating the disease course. Both patients received appropriate treatment for dengue and antibacterial therapy for leptospirosis, ultimately resulting in their recovery. CONCLUSION These case scenarios underscore the critical importance for clinicians in regions where dengue and Leptospira are endemic to consider both diseases when evaluating patients presenting with acute febrile illness.
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Affiliation(s)
- Md Asaduzzaman
- Department of Medicine, Sylhet MAG Osmani Medical College Hospital, Sylhet, 3100, Bangladesh.
| | - Liton Karmaker
- Department of Medicine, Sylhet MAG Osmani Medical College Hospital, Sylhet, 3100, Bangladesh
| | - Anisur Rahman
- Department of Medicine, Sylhet MAG Osmani Medical College Hospital, Sylhet, 3100, Bangladesh
| | - Mohammad Salvi Rahman
- Department of Medicine, Sylhet MAG Osmani Medical College Hospital, Sylhet, 3100, Bangladesh
| | - Md Abdul Awaul
- Department of Medicine, Sylhet MAG Osmani Medical College Hospital, Sylhet, 3100, Bangladesh
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da Rocha SMC, Pires RC, Monteiro DCS, Cronemberges TCR, de Souza NV, Colares JKB, Lima DM. Is there an overestimation of dengue compared with that of other acute febrile syndromes in childhood? PLoS Negl Trop Dis 2024; 18:e0012137. [PMID: 38848319 PMCID: PMC11161014 DOI: 10.1371/journal.pntd.0012137] [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: 05/05/2022] [Accepted: 04/05/2024] [Indexed: 06/09/2024] Open
Abstract
A group of children with clinical suspicion of dengue were assessed to determine if there was an overestimation of dengue compared with that of leptospirosis and leishmaniasis. This descriptive and analytical cross-sectional study, based on the active search of participants with acute febrile illness, was conducted at two pediatric hospitals. The collection of clinical and epidemiological data was performed using questionnaires, and laboratory tests specific for dengue were performed using immunochromatographic, serological, and molecular methods. Dengue-negative samples were assessed for Leptospira and Leishmania spp. using molecular tests. Data were assessed using analysis of variance (ANOVA), the chi-square test, and Fisher's exact test. In total, 86 participants were evaluated, of whom 39 (45%) were positive for dengue fever, 4 (5%) for leptospirosis, and 1 (1%) for leishmaniasis. Forty-two participants (49%) presented dengue-like symptoms. The predominant age range for the virus was 3-10 years. Most clinical manifestations were nonspecific, with frequent concomitant gastrointestinal and respiratory symptoms. Furthermore, we found that the acute febrile syndrome in childhood persists as a challenge for health professionals, especially in the early days of the disease, due to a plurality of diagnostic hypotheses, associated with the difficulty of establishing well-defined symptoms in children, especially in infants. Dengue fever continues to be a frequent pathology with acute febrile infections in childhood; however, there is an overestimation of the disease, especially in endemic regions, when one considers only the clinical epidemiological diagnosis.
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Affiliation(s)
- Sônia Maria Cavalcante da Rocha
- University of Fortaleza (UNIFOR), Graduate Program in Medical Sciences, Fortaleza, Ceará, Brazil
- Hospital Infantil Albert Sabin, Fortaleza, Ceará, Brazil
| | | | - Daniela Cristina Sensato Monteiro
- University of Fortaleza (UNIFOR), Graduate Program in Medical Sciences, Fortaleza, Ceará, Brazil
- University of Fortaleza (UNIFOR/RENORBIO), Postgraduate Program in Biotechnology, Ceará State University, Fortaleza, Ceará, Brazil
| | | | - Natália Vasconcelos de Souza
- University of Fortaleza (UNIFOR), Fortaleza, Ceará, Brazil
- University of Fortaleza (UNIFOR/RENORBIO), Postgraduate Program in Biotechnology, Ceará State University, Fortaleza, Ceará, Brazil
| | - Jeová Keny Baima Colares
- University of Fortaleza (UNIFOR), Graduate Program in Medical Sciences, Fortaleza, Ceará, Brazil
- University of Fortaleza (UNIFOR), Fortaleza, Ceará, Brazil
| | - Danielle Malta Lima
- University of Fortaleza (UNIFOR), Graduate Program in Medical Sciences, Fortaleza, Ceará, Brazil
- University of Fortaleza (UNIFOR), Fortaleza, Ceará, Brazil
- University of Fortaleza (UNIFOR/RENORBIO), Postgraduate Program in Biotechnology, Ceará State University, Fortaleza, Ceará, Brazil
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Douchet L, Menkes C, Herbreteau V, Larrieu J, Bador M, Goarant C, Mangeas M. Climate-driven models of leptospirosis dynamics in tropical islands from three oceanic basins. PLoS Negl Trop Dis 2024; 18:e0011717. [PMID: 38662800 DOI: 10.1371/journal.pntd.0011717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 05/07/2024] [Accepted: 04/05/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Leptospirosis is a neglected zoonosis which remains poorly known despite its epidemic potential, especially in tropical islands where outdoor lifestyle, vulnerability to invasive reservoir species and hot and rainy climate constitute higher risks for infections. Burden remains poorly documented while outbreaks can easily overflow health systems of these isolated and poorly populated areas. Identification of generic patterns driving leptospirosis dynamics across tropical islands would help understand its epidemiology for better preparedness of communities. In this study, we aim to model leptospirosis seasonality and outbreaks in tropical islands based on precipitation and temperature indicators. METHODOLOGY/PRINCIPAL FINDINGS We adjusted machine learning models on leptospirosis surveillance data from seven tropical islands (Guadeloupe, Reunion Island, Fiji, Futuna, New Caledonia, and Tahiti) to investigate 1) the effect of climate on the disease's seasonal dynamic, i.e., the centered seasonal profile and 2) inter-annual anomalies, i.e., the incidence deviations from the seasonal profile. The model was then used to estimate seasonal dynamics of leptospirosis in Vanuatu and Puerto Rico where disease incidence data were not available. A robust model, validated across different islands with leave-island-out cross-validation and based on current and 2-month lagged precipitation and current and 1-month lagged temperature, can be constructed to estimate the seasonal dynamic of leptospirosis. In opposition, climate determinants and their importance in estimating inter-annual anomalies highly differed across islands. CONCLUSIONS/SIGNIFICANCE Climate appears as a strong determinant of leptospirosis seasonality in tropical islands regardless of the diversity of the considered environments and the different lifestyles across the islands. However, predictive and expandable abilities from climate indicators weaken when estimating inter-annual outbreaks and emphasize the importance of these local characteristics in the occurrence of outbreaks.
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Affiliation(s)
- Léa Douchet
- ENTROPIE, IRD, Univ Reunion, CNRS, IFREMER, Univ Nouvelle Calédonie, Nouméa, New Caledonia
- ESPACE-DEV, IRD, Univ Montpellier, Univ. Antilles, Univ Guyane, Univ Réunion, Phnom Penh, Cambodia
| | - Christophe Menkes
- ENTROPIE, IRD, Univ Reunion, CNRS, IFREMER, Univ Nouvelle Calédonie, Nouméa, New Caledonia
| | - Vincent Herbreteau
- ESPACE-DEV, IRD, Univ Montpellier, Univ. Antilles, Univ Guyane, Univ Réunion, Phnom Penh, Cambodia
- Institut Pasteur du Cambodge, Epidemiology and Public Health Unit, Phnom Penh, Cambodia
| | - Joséphine Larrieu
- ENTROPIE, IRD, Univ Reunion, CNRS, IFREMER, Univ Nouvelle Calédonie, Nouméa, New Caledonia
| | - Margot Bador
- CECI Université de Toulouse, CERFACS/CNRS, Toulouse, France
| | - Cyrille Goarant
- Institut Pasteur in New Caledonia, Leptospirosis Research and Expertise Unit, Nouméa, New Caledonia
- Public Health Division, The Pacific Community, Nouméa, New Caledonia
| | - Morgan Mangeas
- ENTROPIE, IRD, Univ Reunion, CNRS, IFREMER, Univ Nouvelle Calédonie, Nouméa, New Caledonia
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Shiddapur G, Reddy VKK, Kondapalli MP, Adapa S, Agarwal S. Leptospirosis and Dengue Coinfection-Associated Multi-Organ Dysfunction Syndrome: A Case Report. Cureus 2024; 16:e52466. [PMID: 38371008 PMCID: PMC10870101 DOI: 10.7759/cureus.52466] [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] [Accepted: 01/17/2024] [Indexed: 02/20/2024] Open
Abstract
Dengue and leptospirosis are frequently discussed separately, with dengue causing rash and leptospirosis causing jaundice. Currently, there are more and more reports of coinfections. The comparable clinical symptoms of both infections make it challenging to distinguish between leptospirosis and dengue. Differentiating between leptospirosis and dengue is crucial since leptospirosis has a more favorable prognosis with early antibiotic therapy, whereas dengue does not have a specific treatment, although early detection is essential for close monitoring and cautious fluid management. Here, we highlight a case of dengue virus and leptospirosis coinfection in a female who presented with acute febrile illness, dyspnea, and altered sensorium, which progressed to multiorgan dysfunction syndrome, involving the neurological, respiratory, hepatic, and hematological systems.
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Affiliation(s)
- Govind Shiddapur
- General Medicine, Dr. D. Y. Patil College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Vutukuru Kalyan Kumar Reddy
- General Medicine, Dr. D. Y. Patil College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Mohith Prakash Kondapalli
- General Medicine, Dr. D. Y. Patil College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Saimounika Adapa
- General Medicine, Dr. D. Y. Patil College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Sonali Agarwal
- General Medicine, Dr. D. Y. Patil College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
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Garcia M, Gopalakrishna KV. A Case of Imported Leptospirosis: Rhabdomyolysis and Severe Hyperbilirubinemia in a Traveler Returning From Puerto Rico. Cureus 2023; 15:e34690. [PMID: 36909049 PMCID: PMC9994765 DOI: 10.7759/cureus.34690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 02/08/2023] Open
Abstract
Leptospirosis is a zoonosis transmitted through human contact with the urine or fecal material of infected animals. Here, we report the case of a young male who presented with hyperbilirubinemia and rhabdomyolysis after returning from Puerto Rico which was confirmed to be severe leptospirosis. An 18-year-old Caucasian male was admitted due to a four-day history of jaundice, fever, headache, abdominal pain, vomiting, dark urine, and pain in his calves. Two weeks before, in Puerto Rico, he swam in caves and at the shoreline in an area recently impacted by a hurricane. Laboratory studies demonstrated leukocytosis, thrombocytopenia, hypokalemia, acute kidney injury with elevated creatine kinase, and hyperbilirubinemia. Due to clinical suspicion of leptospirosis, a serological test was ordered which was positive for Leptospira IgM. In this case, the history of swimming in caves and on the shoreline a few weeks after a hurricane that caused flooding in the region made leptospirosis the most likely diagnosis. The patient's condition improved after initiation of intravenous penicillin G, 8 million units/day, with a resolution of symptoms after completing a seven-day course of antibiotics. Bilirubin started to trend down on day seven, and the patient was discharged on day eight of hospitalization with minimal jaundice. It is important to obtain a detailed medical history when treating patients who have returned from tropical areas, as leptospirosis can mimic other diseases and can be easily mistaken or underrecognized in non-endemic regions, such as the continental United States.
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Affiliation(s)
- Marcos Garcia
- Internal Medicine, Cleveland Clinic Fairview Hospital, Cleveland, USA
| | - K V Gopalakrishna
- Internal Medicine, Cleveland Clinic Fairview Hospital, Cleveland, USA
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Maillard O, Hirschinger D, Bénéteau S, Koumar Y, Vague A, Girerd R, DiAscia L, Jabot J, Cousty J, Randrianjohany A, Bertolotti A, Raffray L. C-reactive protein: An easy marker for early differentiation between leptospirosis and dengue fever in endemic area. PLoS One 2023; 18:e0285900. [PMID: 37195992 DOI: 10.1371/journal.pone.0285900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 05/04/2023] [Indexed: 05/19/2023] Open
Abstract
In tropical regions, leptospirosis and dengue fever (DF) are infectious diseases of epidemiological importance and have overlapping symptomatic features. The objective of this study was to identify the factors associated to diagnosing leptospirosis that differentiate it to DF at the initial hospital evaluation. A multicenter retrospective study was conducted comparing confirmed leptospirosis to DF cases. Clinical/laboratory findings were compiled at hospital admission on Reunion Island between 2018 and 2019. Multivariable logistic regression was used to identify the predictors of leptospirosis. In total, 98 leptospirosis and 673 DF patients were included with a mean age of 47.8 (±17.1) and 48.9 (±23.3) years, respectively. In the multivariate analyses, the main parameters associated with leptospirosis were: i) increased neutrophil counts, ii) C-reactive protein values, iii) the absence of prolonged partial thromboplastin time, and iv) a decrease of platelets. The most discriminating parameter was C-reactive protein (CRP). With a threshold of 50mg/L, CRP taken alone had a sensitivity of 94% and a specificity of 93.5%. The positive and negative likelihood ratios were 14.5 and 0.06, respectively. In the setting of an early presumptive diagnosis, we found that an increased CRP value (>50 mg/L) could help diagnose leptospirosis and aid the decision process for hospital surveillance and/or a potential antibiotic treatment regimen.
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Affiliation(s)
- Olivier Maillard
- Department of Public Health and Research, CHU Réunion, Saint-Pierre, Reunion, France
- Clinical Investigation Center, INSERM CIC 1410, CHU Réunion, Saint-Pierre, Reunion, France
| | - David Hirschinger
- Department of Emergency Medicine, CHU Réunion, Saint-Denis, Reunion, France
| | - Samuel Bénéteau
- Department of Public Health and Research, CHU Réunion, Saint-Pierre, Reunion, France
| | - Yatrika Koumar
- Department of Infectious Diseases, CHU Réunion, Saint-Pierre, Reunion, France
| | - Adrien Vague
- Department of Emergency Medicine, CHU Réunion, Saint-Pierre, Reunion, France
| | - Rémi Girerd
- Department of Emergency Medicine, CHU Réunion, Saint-Pierre, Reunion, France
| | - Laura DiAscia
- Department of Emergency Medicine, CHU Réunion, Saint-Denis, Reunion, France
| | - Julien Jabot
- Intensive Care Unit, CHU Réunion, Saint-Denis, Reunion, France
| | - Julien Cousty
- Intensive Care Unit, CHU Réunion, Saint-Pierre, Reunion, France
| | - Andry Randrianjohany
- Department of Internal Medicine, Groupe Hospitalier Est Réunion, Saint-Benoit, Reunion, France
| | - Antoine Bertolotti
- Clinical Investigation Center, INSERM CIC 1410, CHU Réunion, Saint-Pierre, Reunion, France
- Department of Infectious Diseases, CHU Réunion, Saint-Pierre, Reunion, France
| | - Loïc Raffray
- Department of Internal Medicine, CHU Réunion, Saint-Denis, Reunion, France
- UMR Processus Infectieux en Milieu Insulaire Tropical (PIMIT), CNRS 9192, INSERM U1187, IRD 249, Université de La Réunion, Sainte-Clotilde, Reunion, France
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Hamond C, Dirsmith KL, LeCount K, Soltero FV, Rivera-Garcia S, Camp P, Anderson T, Hicks JA, Galloway R, Sutherland G, Schafer IJ, Goris MGA, van der Linden H, Stuber T, Bayles DO, Schlater LK, Nally JE. Leptospira borgpetersenii serovar Hardjo and Leptospira santarosai serogroup Pyrogenes isolated from bovine dairy herds in Puerto Rico. Front Vet Sci 2022; 9:1025282. [PMID: 36467637 PMCID: PMC9712998 DOI: 10.3389/fvets.2022.1025282] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/31/2022] [Indexed: 10/13/2023] Open
Abstract
Leptospirosis is one of the most common zoonotic diseases in the world and endemic in the Caribbean Islands. Bovine leptospirosis is an important reproductive disease. Globally, cattle are recognized as a reservoir host for L. borgpetersenii serovar Hardjo, which is transmitted via urine, semen, and uterine discharges, and can result in abortion and poor reproductive performance. The dairy industry in Puerto Rico comprises up to 25% of agriculture-related income and is historically the most financially important agricultural commodity on the island. In this study, we report the isolation of two different pathogenic Leptospira species, from two different serogroups, from urine samples collected from dairy cows in Puerto Rico: L. borgpetersenii serogroup Sejroe serovar Hardjo and L. santarosai serogroup Pyrogenes. Recovered isolates were classified using whole-genome sequencing, serotyping with reference antisera and monoclonal antibodies, and immunoblotting. These results demonstrate that dairy herds in Puerto Rico can be concurrently infected with more than one species and serovar of Leptospira, and that bacterin vaccines and serologic diagnostics should account for this when applying intervention and diagnostic strategies.
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Affiliation(s)
- Camila Hamond
- National Veterinary Services Laboratories, Animal and Plant Health Inspection Service (APHIS), U.S. Department of Agriculture, Ames, IA, United States
- National Center for Animal Health Leptospira Working Group, U. S. Department of Agriculture, Ames, IA, United States
| | - Katherine L. Dirsmith
- Animal and Plant Health Inspection Service, U.S. Department of Agriculture, Veterinary Services Field Operations, San Juan, Puerto Rico
| | - Karen LeCount
- National Veterinary Services Laboratories, Animal and Plant Health Inspection Service (APHIS), U.S. Department of Agriculture, Ames, IA, United States
- National Center for Animal Health Leptospira Working Group, U. S. Department of Agriculture, Ames, IA, United States
| | - Fred V. Soltero
- Animal and Plant Health Inspection Service, U.S. Department of Agriculture, Veterinary Services Field Operations, San Juan, Puerto Rico
| | - Sarai Rivera-Garcia
- Animal and Plant Health Inspection Service, U.S. Department of Agriculture, Veterinary Services Field Operations, San Juan, Puerto Rico
| | - Patrick Camp
- National Veterinary Services Laboratories, Animal and Plant Health Inspection Service (APHIS), U.S. Department of Agriculture, Ames, IA, United States
| | - Tammy Anderson
- National Veterinary Services Laboratories, Animal and Plant Health Inspection Service (APHIS), U.S. Department of Agriculture, Ames, IA, United States
- National Center for Animal Health Leptospira Working Group, U. S. Department of Agriculture, Ames, IA, United States
| | - Jessica A. Hicks
- National Veterinary Services Laboratories, Animal and Plant Health Inspection Service (APHIS), U.S. Department of Agriculture, Ames, IA, United States
| | - Renee Galloway
- Bacterial Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Graham Sutherland
- Bacterial Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Ilana J. Schafer
- Bacterial Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Marga G. A. Goris
- Department of Medical Microbiology and Infection Prevention, World Organisation for Animal Health and National Collaborating Centre for Reference and Research on Leptospirosis, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Hans van der Linden
- Department of Medical Microbiology and Infection Prevention, World Organisation for Animal Health and National Collaborating Centre for Reference and Research on Leptospirosis, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Tod Stuber
- National Veterinary Services Laboratories, Animal and Plant Health Inspection Service (APHIS), U.S. Department of Agriculture, Ames, IA, United States
| | - Darrell O. Bayles
- Infectious Bacterial Diseases Research Unit, Agricultural Research Service, United States Department of Agriculture, Ames, IA, United States
| | - Linda K. Schlater
- National Veterinary Services Laboratories, Animal and Plant Health Inspection Service (APHIS), U.S. Department of Agriculture, Ames, IA, United States
- National Center for Animal Health Leptospira Working Group, U. S. Department of Agriculture, Ames, IA, United States
| | - Jarlath E. Nally
- National Center for Animal Health Leptospira Working Group, U. S. Department of Agriculture, Ames, IA, United States
- Infectious Bacterial Diseases Research Unit, Agricultural Research Service, United States Department of Agriculture, Ames, IA, United States
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Artus A, Schafer IJ, Cossaboom CM, Haberling DL, Galloway R, Sutherland G, Browne AS, Roth J, France V, Cranford HM, Kines KJ, Pompey J, Ellis BR, Walke H, Ellis EM. Seroprevalence, distribution, and risk factors for human leptospirosis in the United States Virgin Islands. PLoS Negl Trop Dis 2022; 16:e0010880. [PMID: 36378681 PMCID: PMC9665390 DOI: 10.1371/journal.pntd.0010880] [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: 08/01/2022] [Accepted: 10/10/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The first documented human leptospirosis cases in the U.S. Virgin Islands (USVI) occurred following 2017 Hurricanes Irma and Maria. We conducted a representative serosurvey in USVI to estimate the seroprevalence and distribution of human leptospirosis and evaluate local risk factors associated with seropositivity. METHODOLOGY/PRINCIPAL FINDINGS A stratified, two-stage cluster sampling design was used and consisted of three island strata and random selection of census blocks and then households. All eligible members of selected households were invited to participate (≥5 years old, resided in USVI ≥6 months and ≥6 months/year). Household and individual-level questionnaires were completed, and serum collected from each enrolled individual. Microscopic agglutination test serology was conducted, and bivariate and logistic regression analyses completed to identify risk factors for seropositivity. In March 2019, 1,161 individuals were enrolled from 918 households in St. Croix, St. Thomas, and St. John. The territory-wide weighted seroprevalence was 4.0% (95% CI:2.3-5.7). Characteristics/exposures independently associated with seropositivity using logistic regression included contact with cows (OR: 39.5; 95% CI: 9.0-172.7), seeing rodents/rodent evidence or contact with rodents (OR: 2.6; 95% CI: 1.1-5.9), and increasing age (OR: 1.02; 95% CI: 1.002-1.04); full or partial Caucasian/White race was negatively correlated with seropositivity (OR: 0.02, 95% CI: 0.04-0.7). Bivariate analysis showed self-reported jaundice since the 2017 hurricanes (pRR: 5.7; 95% CI: 1.0-33.4) was associated with seropositivity and using a cover/lid on cisterns/rainwater collection containers (pRR: 0.3; 95% CI: 0.08-0.8) was protective against seropositivity. CONCLUSIONS/SIGNIFICANCE Leptospirosis seropositivity of 4% across USVI demonstrates an important human disease that was previously unrecognized and emphasizes the importance of continued leptospirosis surveillance and investigation. Local risk factors identified may help guide future human and animal leptospirosis studies in USVI, strengthen leptospirosis public health surveillance and treatment timeliness, and inform targeted education, prevention, and control efforts.
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Affiliation(s)
- Aileen Artus
- Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ilana J. Schafer
- Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Caitlin M. Cossaboom
- Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Epidemic Intelligence Service, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Dana L. Haberling
- Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Renee Galloway
- Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Graham Sutherland
- Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - A. Springer Browne
- Epidemic Intelligence Service, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- U.S. Virgin Islands Department of Health, U.S. Virgin Islands, United States of America
| | - Joseph Roth
- U.S. Virgin Islands Department of Health, U.S. Virgin Islands, United States of America
- Division of Local and State Readiness, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Valicia France
- U.S. Virgin Islands Department of Health, U.S. Virgin Islands, United States of America
| | - Hannah M. Cranford
- U.S. Virgin Islands Department of Health, U.S. Virgin Islands, United States of America
| | - Kristine J. Kines
- Division of Preparedness and Emerging Infections, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Justine Pompey
- Division of Preparedness and Emerging Infections, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Brett R. Ellis
- U.S. Virgin Islands Department of Health, U.S. Virgin Islands, United States of America
| | - Henry Walke
- Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Esther M. Ellis
- U.S. Virgin Islands Department of Health, U.S. Virgin Islands, United States of America
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Role of Diagnostics in Epidemiology, Management, Surveillance, and Control of Leptospirosis. Pathogens 2022; 11:pathogens11040395. [PMID: 35456070 PMCID: PMC9032781 DOI: 10.3390/pathogens11040395] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/22/2022] [Accepted: 03/22/2022] [Indexed: 12/12/2022] Open
Abstract
A One Health approach to the epidemiology, management, surveillance, and control of leptospirosis relies on accessible and accurate diagnostics that can be applied to humans and companion animals and livestock. Diagnosis should be multifaceted and take into account exposure risk, clinical presentation, and multiple direct and/or indirect diagnostic approaches. Methods of direct detection of Leptospira spp. include culture, histopathology and immunostaining of tissues or clinical specimens, and nucleic acid amplification tests (NAATs). Indirect serologic methods to detect leptospiral antibodies include the microscopic agglutination test (MAT), the enzyme-linked immunosorbent assay (ELISA), and lateral flow methods. Rapid diagnostics that can be applied at the point-of-care; NAAT and lateral flow serologic tests are essential for management of acute infection and control of outbreaks. Culture is essential to an understanding of regional knowledge of circulating strains, and we discuss recent improvements in methods for cultivation, genomic sequencing, and serotyping. We review the limitations of NAATs, MAT, and other diagnostic approaches in the context of our expanding understanding of the diversity of pathogenic Leptospira spp. Novel approaches are needed, such as loop mediated isothermal amplification (LAMP) and clustered regularly interspaced short palindromic repeats (CRISPR)-based approaches to leptospiral nucleic acid detection.
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10
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Calero ML, Monti G. Assessment of the Current Surveillance System for Human Leptospirosis in Ecuador by Decision Analytic Modeling. Front Public Health 2022; 10:711938. [PMID: 35309218 PMCID: PMC8927665 DOI: 10.3389/fpubh.2022.711938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 01/25/2022] [Indexed: 11/13/2022] Open
Abstract
Leptospirosis is a globally disseminated zoonotic disease with no national surveillance systems. On the other hand, surveillance is crucial for improving population health, and surveillance systems produce data that motivates action. Unfortunately, like many other countries, Ecuador put in place a monitoring system that has never been tested. The goal of this study was to use scenario tree modeling to assess the sensitivity of Ecuador's current national surveillance system to human leptospirosis as the basis for an economic assessment of the system. We created a decision-tree model to analyze the current system's sensitivity. The inputs were described as probabilities distributions, and the model assessed the program's sensitivity as an output. The model also considers the geographical and weather variations across Ecuador's three continental regions: Andean, Amazonia, and the Coast. Several data sources were used to create the model, including leptospirosis records from Ecuador's Ministry of Public Health, national and international literature, and expert elicitation, all of which were incorporated in a Bayesian framework. We were able to determine the most critical parameters influencing each scenario's output (CSU) sensitivity through sensitivity analysis. The Coast region had the best sensitivity scenario, with a median of 0.85% (IC 95% 0.41-0.99), followed by the Amazonia with a median of 0.54% (CI 95% 0.18-0.99) and the Andes with a median of 0.29% (CI 95% 0.02-0.89). As per the sensitivity study, the most influential criteria on the system's sensitivity were "Attendance or probability of going to a health center" and "probability of having symptoms," notably for the Coast and Amazonia Regions.
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Affiliation(s)
- María Laura Calero
- PhD Program in Veterinary Sciences, Faculty of Veterinary Sciences, Universidad Austral de Chile, Valdivia, Chile
| | - Gustavo Monti
- Faculty of Veterinary Sciences, Institute of Preventive Veterinary Medicine, Universidad Austral de Chile, Valdivia, Chile
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11
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Del Valle-Mendoza J, Palomares-Reyes C, Carrillo-Ng H, Tarazona-Castro Y, Kym S, Aguilar-Luis MA, Del Valle LJ, Aquino-Ortega R, Martins-Luna J, Peña-Tuesta I, Verne E, Silva-Caso W. Leptospirosis in febrile patients with suspected diagnosis of dengue fever. BMC Res Notes 2021; 14:209. [PMID: 34051849 PMCID: PMC8164282 DOI: 10.1186/s13104-021-05627-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 05/20/2021] [Indexed: 12/23/2022] Open
Abstract
Objective This study was carried out to determine the prevalence of leptospirosis among febrile patients with a suspicious clinical diagnosis of dengue fever in northern Peru. Results A total of 276 serum samples from patients with acute febrile illness (AFI) and suspected diagnosis for dengue virus (DENV) were analyzed. We identified an etiological agent in 121 (47.5%) patients, DENV was detected in 30.4% of the cases, leptospirosis in 11.2% and co-infection by both pathogens was observed in 5.9% of the patients. In this study the most common clinical symptoms reported by the patients were: headache 89.1%, myalgias 86.9% and arthralgias 82.9%. No differences in symptomatology was observed among the different study groups.
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Affiliation(s)
- Juana Del Valle-Mendoza
- School of Medicine, Research and Innovation Center of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru. .,Laboratorio de Biologia Molecular, Instituto de Investigación Nutricional, Lima, Peru.
| | - Carlos Palomares-Reyes
- School of Medicine, Research and Innovation Center of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Hugo Carrillo-Ng
- Laboratorio de Biologia Molecular, Instituto de Investigación Nutricional, Lima, Peru.,Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Yordi Tarazona-Castro
- School of Medicine, Research and Innovation Center of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,Laboratorio de Biologia Molecular, Instituto de Investigación Nutricional, Lima, Peru
| | - Sungmin Kym
- Division of Infectious Disease, Department of Internal Medicine, Chungnam National University School of Medicine , Daejeon, Korea
| | - Miguel Angel Aguilar-Luis
- School of Medicine, Research and Innovation Center of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,Laboratorio de Biologia Molecular, Instituto de Investigación Nutricional, Lima, Peru
| | - Luis J Del Valle
- Barcelona Research Center for Multiscale Science and Engineering, Departament D'Enginyeria Química, EEBE, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - Ronald Aquino-Ortega
- School of Medicine, Research and Innovation Center of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,Laboratorio de Biologia Molecular, Instituto de Investigación Nutricional, Lima, Peru
| | - Johanna Martins-Luna
- School of Medicine, Research and Innovation Center of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,Laboratorio de Biologia Molecular, Instituto de Investigación Nutricional, Lima, Peru
| | - Isaac Peña-Tuesta
- School of Medicine, Research and Innovation Center of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,Laboratorio de Biologia Molecular, Instituto de Investigación Nutricional, Lima, Peru
| | | | - Wilmer Silva-Caso
- School of Medicine, Research and Innovation Center of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru. .,Laboratorio de Biologia Molecular, Instituto de Investigación Nutricional, Lima, Peru.
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12
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Abd-Jamil J, Azizan NS, Che-Mat-Seri NAA, Yaacob CN, Samsudin NI, Mahfodz NH, Zulkifli MMS, Poh HS, Teoh BT, AbuBakar S. Detection and confirmation of dengue pre- and postintroduction of dengue NS1-antigen test at the University Malaya Medical Centre: An observational study. J Med Virol 2021; 93:4714-4719. [PMID: 33421159 DOI: 10.1002/jmv.26790] [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: 12/03/2020] [Revised: 12/11/2020] [Accepted: 01/07/2021] [Indexed: 11/10/2022]
Abstract
Early diagnosis of dengue is important to ensure proper management of patients and effective implementation of control measures. The present study was undertaken to determine the outcome of the implementation of dengue NS1-antigen (Ag) rapid diagnostic test (RDT) in the confirmation of dengue at the first patient hospital visit at the University Malaya Medical Centre. A total of 1036 and 1097 sera from the year 2008 and 2015 were used, representing samples from before and after dengue NS1-Ag RDT was implemented as routine diagnostic at the hospital. Results showed that similar dengue confirmation percentage (56%) was made in 2008 and 2015, regardless of the main laboratory diagnostic method used. Confirmation of dengue, however, increased to 68% and 73% when dengue NS1-Ag test or dengue immunoglobulin M-capture enzyme-linked immunosorbent assay was used as the second test for the 2008 and 2015 samples, respectively. Detection of dengue virus (DENV) using multiplex reverse transcription-polymerase chain reaction (RT-PCR) showed that DENV-1 was the highest in circulation in 2008 and that both DENV-1 and DENV-2 were dominant in 2015. In summary, the present study demonstrated that the introduction and use of the dengue NS1-Ag RDT did not change or compromise confirmation of dengue, highlighting the advantage of using the method. With the reducing cost of molecular detection tools, DENV detection using RT-PCR remains a viable option for further confirmation of dengue in hospital settings.
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Affiliation(s)
- Juraina Abd-Jamil
- Tropical Infectious Diseases Research & Education Centre (TIDREC), University Malaya, Kuala Lumpur, Malaysia
| | - Noor-Syahida Azizan
- Tropical Infectious Diseases Research & Education Centre (TIDREC), University Malaya, Kuala Lumpur, Malaysia
| | | | - Che-Norainon Yaacob
- Tropical Infectious Diseases Research & Education Centre (TIDREC), University Malaya, Kuala Lumpur, Malaysia
| | - Nur-Izyan Samsudin
- Tropical Infectious Diseases Research & Education Centre (TIDREC), University Malaya, Kuala Lumpur, Malaysia
| | - Nur-Hidayana Mahfodz
- Tropical Infectious Diseases Research & Education Centre (TIDREC), University Malaya, Kuala Lumpur, Malaysia
| | - Mulya-Mustika-Sari Zulkifli
- Tropical Infectious Diseases Research & Education Centre (TIDREC), University Malaya, Kuala Lumpur, Malaysia
| | - Hooi-Sim Poh
- Diagnostic Virology Laboratory, University Malaya Medical Centre, University Malaya, Kuala Lumpur, Malaysia
| | - Boon-Teong Teoh
- Tropical Infectious Diseases Research & Education Centre (TIDREC), University Malaya, Kuala Lumpur, Malaysia
| | - Sazaly AbuBakar
- Tropical Infectious Diseases Research & Education Centre (TIDREC), University Malaya, Kuala Lumpur, Malaysia
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13
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Lebeau-Desmoulin L, Bruneau L, Commins J, Herbreteau V, Raffray L. Identifying factors associated with treatment delay in leptospirosis: A retrospective study of patients admitted to hospital in Reunion (Indian Ocean) between 2014 and 2015. Med Mal Infect 2019; 50:352-360. [PMID: 31582278 DOI: 10.1016/j.medmal.2019.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 10/14/2018] [Accepted: 09/03/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Leptospirosis is a life-threatening zoonotic disease for which delayed treatment onset has been associated to poor prognosis. The purpose of the study was to identify the determinants of therapeutic delay in hospitalized leptospirosis cases. PATIENTS AND METHODS We carried out a retrospective multicenter study in the 4 public hospitals of Reunion Island, South Western Indian Ocean. Medical records of confirmed leptospirosis cases occurring in 2014-2015 were reviewed for socio-economic, demographic, geographic and medical data. The primary outcome measure was the therapeutic delay, defined as the time elapsed between the onset of symptoms and initiation of antibiotics. RESULTS Of the 117 patients included, 107 were men, with an average age of 44.9±15years. The median therapeutic delay was 4 days (interquartile: 2-5 days) and this delay was not found to be associated with severity. The following were found to be at increased risk of having a longer therapeutic delay: cases occurring outside the epidemic period, or rainy season (OR 2.8 [1.08-7.3], P=0.04) and cases with first medical evaluation in primary health care (OR 4.63 [1.43-14.93]; P=0.01) instead of emergency unit. No socio-economic or geographic characteristics were found to be linked to a longer therapeutic delay. CONCLUSION Although delayed treatment was not associated to disease severity, our results indicate that leptospirosis awareness is needed all year in the subtropical area of Reunion Island and particularly in primary care.
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Affiliation(s)
- L Lebeau-Desmoulin
- Service d'accueil des urgences, CHU La Réunion, site Félix-Guyon, allée des Topazes, CS11021, 97400 Saint-Denis, Reunion
| | - L Bruneau
- Unité de soutien méthodologique, CHU La Réunion, site Félix-Guyon, allée des Topazes, CS11021, 97400 Saint-Denis, Reunion
| | - J Commins
- IRD, UMR 228 ESPACE-DEV (IRD/UM/UR/UG/UA), station SEAS-OI, Saint-Pierre, Reunion
| | - V Herbreteau
- IRD, UMR 228 ESPACE-DEV (IRD/UM/UR/UG/UA), station SEAS-OI, Saint-Pierre, Reunion
| | - L Raffray
- Service de médecine interne et dermatologie, CHU La Réunion, site Félix-Guyon, allée des Topazes, CS11021, 97400 Saint-Denis, Reunion.
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14
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Briskin EA, Casanovas-Massana A, Ryff KR, Morales-Estrada S, Hamond C, Perez-Rodriguez NM, Benavidez KM, Weinberger DM, Castro-Arellano I, Wunder EA, Sharp TM, Rivera-Garcia B, Ko AI. Seroprevalence, Risk Factors, and Rodent Reservoirs of Leptospirosis in an Urban Community of Puerto Rico, 2015. J Infect Dis 2019; 220:1489-1497. [PMID: 31342075 PMCID: PMC6761939 DOI: 10.1093/infdis/jiz339] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 07/01/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The burden of leptospirosis in Puerto Rico remains unclear due to underreporting. METHODS A cross-sectional survey and rodent trapping was performed in a community within San Juan, Puerto Rico to determine the seroprevalence and risk factors for Leptospira infection. The microscopic agglutination test was used to detect anti-Leptospira antibodies as a marker of previous infection. We evaluated Leptospira carriage by quantitative polymerase chain reaction among rodents trapped at the community site. RESULTS Of 202 study participants, 55 (27.2%) had Leptospira agglutinating antibodies. Among the 55 seropositive individuals, antibodies were directed most frequently against serogroups Icterohaemorrhagiae (22.0%) and Autumnalis (10.6%). Of 18 captured rodents, 11 (61.1%) carried pathogenic Leptospira (Leptospira borgpetersenii, 7 and Leptospira interrogans, 2). Four participants showed their highest titer against an isolate obtained from a rodent (serogroup Ballum). Increasing household distance to the canal that runs through the community was associated with decreased risk of infection (odds ratio = 0.934 per 10-meter increase; 95% confidence interval, .952-.992). CONCLUSIONS There are high levels of Leptospira exposure in an urban setting in Puerto Rico, for which rodents may be an important reservoir for transmission. Our findings indicate that prevention should focus on mitigating risk posed by infrastructure deficiencies such as the canal.
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Affiliation(s)
- Emily A Briskin
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut
| | - Arnau Casanovas-Massana
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut
| | - Kyle R Ryff
- Office of Epidemiology, Puerto Rico Department of Health, San Juan Puerto Rico
| | | | - Camila Hamond
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut
| | - Nicole M Perez-Rodriguez
- Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | | | - Daniel M Weinberger
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut
| | | | - Elsio A Wunder
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut
- Centro de Pesquisas Gonçalo Moniz, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador, Bahia, Brazil
| | - Tyler M Sharp
- Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | | | - Albert I Ko
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut
- Centro de Pesquisas Gonçalo Moniz, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador, Bahia, Brazil
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15
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Le Turnier P, Bonifay T, Mosnier E, Schaub R, Jolivet A, Demar M, Bourhy P, Nacher M, Djossou F, Epelboin L. Usefulness of C-Reactive Protein in Differentiating Acute Leptospirosis and Dengue Fever in French Guiana. Open Forum Infect Dis 2019; 6:ofz323. [PMID: 31660403 PMCID: PMC6735690 DOI: 10.1093/ofid/ofz323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/03/2019] [Indexed: 02/06/2023] Open
Abstract
Objective Leptospirosis and dengue fever (DF) are hard-to-differentiate diseases in cocirculating areas, especially during DF epidemics. Misdiagnosis and ensuing lack of antibiotic therapy can be detrimental in leptospirosis. The objective of this study was to identify factors that help differentiate acute leptospirosis from dengue fever on admission. Method Patients with leptospirosis (positive serology or polymerase chain reaction) were compared with patients with DF (positive nonstructural 1 [NS1] antigen) in a case-control study with age matching. Data on admission were compared using bivariate analysis and multivariate analysis. Results Seventy-two patients with leptospirosis were compared to 216 patients with DF. In bivariate analysis, the factors associated with leptospirosis were male gender, cough, anemia, and elevated blood levels of C-reactive protein (CRP), leukocytes, creatinine, bilirubin, and creatine phosphokinase. Exanthema, purpura, myalgia, headache, and neutropenia were associated with DF. In multivariate analysis, elevated blood levels of leukocytes, bilirubin, and CRP were associated with leptospirosis. The CRP threshold of 50 mg/L taken alone had elevated sensitivity and specificity. Conclusions The CRP level, an easy-to-obtain biomarker, was a powerful tool to differentiate on admission leptospirosis and DF. Facing a dengue-like syndrome in cocirculating areas and awaiting new specific rapid diagnostic tests, CRP dosing could help the clinician to promptly consider the diagnosis of leptospirosis and initiate antibiotic therapy early.
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Affiliation(s)
- Paul Le Turnier
- Unité des Maladies Infectieuses et Tropicales, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Timothée Bonifay
- Unité des Maladies Infectieuses et Tropicales, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana.,Département de Médecine Générale, Université Antilles Guyane, Pointe-à-Pitre, Guadeloupe
| | - Emilie Mosnier
- Unité des Maladies Infectieuses et Tropicales, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana.,Ecosystèmes Amazoniens et Pathologie Tropicale, Université de la Guyane, Cayenne, French Guiana.,Centres Délocalisés de Prévention et de Soins, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Roxane Schaub
- Ecosystèmes Amazoniens et Pathologie Tropicale, Université de la Guyane, Cayenne, French Guiana.,Centre d'Investigation Clinique Antilles Guyane, INSERM CIC 1424, Cayenne, French Guiana
| | - Anne Jolivet
- Service de Santé Publique, Hopital Franck Joly, Saint-Laurent du Maroni, French Guiana
| | - Magalie Demar
- Ecosystèmes Amazoniens et Pathologie Tropicale, Université de la Guyane, Cayenne, French Guiana.,Laboratoire Hospitalo-Universitaire de Parasitologie Mycologie, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Pascale Bourhy
- Institut Pasteur, Centre National de Référence de la Leptospirose, Paris, France
| | - Mathieu Nacher
- Ecosystèmes Amazoniens et Pathologie Tropicale, Université de la Guyane, Cayenne, French Guiana.,Centre d'Investigation Clinique Antilles Guyane, INSERM CIC 1424, Cayenne, French Guiana
| | - Félix Djossou
- Unité des Maladies Infectieuses et Tropicales, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana.,Ecosystèmes Amazoniens et Pathologie Tropicale, Université de la Guyane, Cayenne, French Guiana
| | - Loïc Epelboin
- Unité des Maladies Infectieuses et Tropicales, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana.,Ecosystèmes Amazoniens et Pathologie Tropicale, Université de la Guyane, Cayenne, French Guiana
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16
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Wangdi K, Kasturiaratchi K, Nery SV, Lau CL, Gray DJ, Clements ACA. Diversity of infectious aetiologies of acute undifferentiated febrile illnesses in south and Southeast Asia: a systematic review. BMC Infect Dis 2019; 19:577. [PMID: 31272417 PMCID: PMC6610835 DOI: 10.1186/s12879-019-4185-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 06/12/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Acute undifferentiated febrile illness (AUFI) is caused by a multitude of diverse pathogens, with significant morbidity and mortality in the developing world. The objective of this review was to characterise the diversity and relative importance of common infectious aetiologies of AUFI in South and Southeast Asia. METHODS We conducted a comprehensive literature review to identify common aetiologies of AUFI in Asian countries. Four medical and life sciences databases including PubMed, Medline, Embase and Cochrane Central, and Google Scholar were searched for articles published from January 1998 to March 2019. RESULTS Forty-three studies met the inclusion criteria. Among AUFI cases, viral aetiologies at 18.5% (14888) were more common than bacterial aetiologies (12.9% [10384]). From 80,554 cases, dengue fever was the most common aetiology (11.8%, 9511), followed by leptospirosis (4.4%, 3549), typhoid (4.0%, 3258), scrub typhus (4.0%, 3243) and influenza other than H1N1 (3.1%, 2514). In both adults and children: dengue fever was the leading cause of AUFI with 16.6% (1928) and 18.7% (1281) of the total cases. In admitted patients, dengue fever was the main cause of AUFI at 16.4% (2377), however leptospirosis at 13.9% (2090) was the main cause of AUFI for outpatients. In South Asia, dengue fever was the main cause of AUFI, causing 12.0% (6821) of cases, whereas in Southeast Asia, leptospirosis was the main diagnosis, causing 12.1% (2861) of cases. CONCLUSIONS In this study the most common causes of AUFI were viral, followed by bacterial and protozoal (malaria) infections. Dengue was the commonest virus that caused AUFI while leptospirosis and typhoid were important bacterial infectious causes. Therefore, it is imperative to maintain a sound epidemiological knowledge of AUFI so that evidence-based diagnostic criteria and treatment guidelines can be developed.
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Affiliation(s)
- Kinley Wangdi
- Department of Global Health, Research School of Population Health, Australian National University, Action, ACT, Canberra, Australia.
| | | | - Susana Vaz Nery
- Department of Global Health, Research School of Population Health, Australian National University, Action, ACT, Canberra, Australia.,Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Colleen L Lau
- Department of Global Health, Research School of Population Health, Australian National University, Action, ACT, Canberra, Australia.,Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, QLD, South Brisbane, Australia
| | - Darren J Gray
- Department of Global Health, Research School of Population Health, Australian National University, Action, ACT, Canberra, Australia
| | - Archie C A Clements
- Department of Global Health, Research School of Population Health, Australian National University, Action, ACT, Canberra, Australia.,Faculty of Health Sciences, Curtin University, Perth, WA, Australia
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17
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Abdullah NM, Mohammad WMZW, Shafei MN, Sukeri S, Idris Z, Arifin WN, Nozmi N, Saudi SNS, Samsudin S, Zainudin AW, Hamat RA, Ibrahim R, Masri SN, Saliluddin SM, Daud A, Osman M, Jamaluddin TZMT. Leptospirosis and its prevention: knowledge, attitude and practice of urban community in Selangor, Malaysia. BMC Public Health 2019; 19:628. [PMID: 31117995 PMCID: PMC6532156 DOI: 10.1186/s12889-019-6981-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 05/15/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Leptospirosis is still endemic in Malaysia and has been prevalent in Selangor where cases have been underreported. Primarily, this was due to lack of awareness in the urban community in this region. This study determined the knowledge, attitude and preventive practice (KAP) of leptospirosis, and identified the significant predictors influencing KAP among urban community in Hulu Langat, Selangor. METHODS This cross-sectional study was conducted from 2015 to 2017 using validated questionnaire. Sampling methods included multistage cluster sampling, followed by simple random sampling to obtain 315 respondents. Descriptive analysis was performed to determine the KAP while χ2 and the subsequent logistic regression analysis were carried out to identify associations and predictors between variables. RESULTS Respondents were mainly Malaysian Bumiputra with a mean (Standard Deviation (SD)) age of 32.5 (13.0) years. Of 315 respondents, 80.3% (n = 253) had poor knowledge, 87.0% (n = 274) had good attitude, and 81.3% (n = 256) showed unacceptable practice towards leptospirosis and its prevention. Regression analysis identified age as the sole predictor influencing good knowledge (AOR 2.388; 95% CI = 1.298, 4.396; p = 0.005). Education level (AOR 2.197; 95% CI = 1.109, 4.352; p = 0.024) was also noted as the significant predictor influencing the overall practice. CONCLUSIONS The urban community in Selangor showed a positive attitude in waste management despite having little knowledge regarding the disease itself. The study also discovered inadequacy in preventive practice, hence marking the importance of the proper integration of knowledge and attitude into forming an acceptable practice to reduce transmission of Leptospira among urban population in Malaysia.
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Affiliation(s)
- Nurul Munirah Abdullah
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Wan Mohd Zahiruddin Wan Mohammad
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Mohd Nazri Shafei
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Surianti Sukeri
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Zawaha Idris
- Health Promotion Unit, Penang State Health Department, Floor 7, Bangunan Persekutuan, Jalan Anson, 10400, Penang, Malaysia
| | - Wan Nor Arifin
- Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Noramira Nozmi
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Siti Nor Sakinah Saudi
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Suhailah Samsudin
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Abdul-Wahab Zainudin
- Health Department of Federal Territory Kuala Lumpur & Putrajaya, Jalan Cenderasari, 50590, Kuala Lumpur, Malaysia
| | - Rukman Awang Hamat
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Rosni Ibrahim
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Siti Norbaya Masri
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | | | - Aziah Daud
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Malina Osman
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
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Benavidez KM, Guerra T, Torres M, Rodriguez D, Veech JA, Hahn D, Miller RJ, Soltero FV, Ramírez AEP, Perez de León A, Castro-Arellano I. The prevalence of Leptospira among invasive small mammals on Puerto Rican cattle farms. PLoS Negl Trop Dis 2019; 13:e0007236. [PMID: 31107872 PMCID: PMC6544380 DOI: 10.1371/journal.pntd.0007236] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 05/31/2019] [Accepted: 02/12/2019] [Indexed: 12/17/2022] Open
Abstract
Leptospirosis, an emerging infectious disease caused by bacteria of the genus Leptospira, is thought to be the most widespread zoonotic disease in the world. A first step in preventing the spread of Leptospira is delineating the animal reservoirs that maintain and disperse the bacteria. Quantitative PCR (qPCR) methods targeting the LipL32 gene were used to analyze kidney samples from 124 House mice (Mus musculus), 94 Black rats (Rattus rattus), 5 Norway rats (R. norvegicus), and 89 small Indian mongooses (Herpestes auropunctatus) from five cattle farms in Puerto Rico. Renal carriage of Leptospira was found in 38% of the sampled individuals, with 59% of the sampled mice, 34% of Black rats, 20% of Norway rats, and 13% of the mongooses. A heterogeneous distribution of prevalence was also found among sites, with the highest prevalence of Leptospira-positive samples at 52% and the lowest at 30%. Comparative sequence analysis of the LipL32 gene from positive samples revealed the presence of two species of Leptospira, L. borgpetersenii and L. interrogans in mice, detected in similar percentages in samples from four farms, while samples from the fifth farm almost exclusively harbored L. interrogans. In rats, both Leptospira species were found, while mongooses only harbored L. interrogans. Numbers tested for both animals, however, were too small (n = 7 each) to relate prevalence of Leptospira species to location. Significant associations of Leptospira prevalence with anthropogenic landscape features were observed at farms in Naguabo and Sabana Grande, where infected individuals were closer to human dwellings, milking barns, and ponds than were uninfected individuals. These results show that rural areas of Puerto Rico are in need of management and longitudinal surveillance of Leptospira in order to prevent continued infection of focal susceptible species (i.e. humans and cattle).
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Affiliation(s)
- Kathryn M. Benavidez
- Department of Biology, Texas State University, San Marcos, Texas, United States of America
| | - Trina Guerra
- Department of Biology, Texas State University, San Marcos, Texas, United States of America
| | - Madison Torres
- Department of Biology, Texas State University, San Marcos, Texas, United States of America
| | - David Rodriguez
- Department of Biology, Texas State University, San Marcos, Texas, United States of America
| | - Joseph A. Veech
- Department of Biology, Texas State University, San Marcos, Texas, United States of America
| | - Dittmar Hahn
- Department of Biology, Texas State University, San Marcos, Texas, United States of America
| | - Robert J. Miller
- Cattle Fever Tick Research Laboratory, United States Department of Agriculture–Agricultural Research Service, MAB 6419, Edinburg, Texas, United States of America
| | - Fred V. Soltero
- Animal and Plant Health Inspection Service PR and USVI SPRS District 2, United States Department of Agriculture, Hato Rey, Puerto Rico
| | - Alejandro E. Pérez Ramírez
- Agrological Laboratory Analysis & Registration of Agricultural Materials PR Dept. of Agriculture 7 Carr. 693 Dorado, PR
| | - Adalberto Perez de León
- Knippling-Bushland U.S. Livestock Insects Research Laboratory, United States Department of Agriculture–Agricultural Research Service, Kerrville, Texas, United States of America
- Veterinary Pest Genomics Center, United States Department of Agriculture–Agricultural Research Service, Kerrville, TX, United States of America
| | - Iván Castro-Arellano
- Department of Biology, Texas State University, San Marcos, Texas, United States of America
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Ghafouri RR, Araj-Khodaei M, Targhi ST, Varshochi M, Parsian Z, Yarani R, Golzari SEJ. First Report of a Disease by Rhazes 10 Centuries Ago. Int J Prev Med 2019; 10:6. [PMID: 30774840 PMCID: PMC6360843 DOI: 10.4103/ijpvm.ijpvm_216_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 06/18/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Abu Bakr Mohammad Ibn Zakariya Al-Razi (865-925 CE), who was known as "Rhazes" in the west, was a famous scientist of medieval ages. He has more than 200 books and treatises. His masterpiece on medicine "Kitab Al-Hawi Fi Al-Tibb" contains around 900 case reports. Some of the diseases which seem to be recently reported have been stated previously, but not well described. Considering symptoms of the patient described at that time, differential diagnosis will be discussed. CASE PRESENTATION Rhazes described a patient with bilious fever. He had developed bloody urine and stool on the fourth day and fatigue. Subsequently, the patient's urine and stool color turned into dark and black, respectively, and died the following day. According to Rhazes attitude, it was malignant measles. Meyerhof in his book has referred to post-measles acute glomerulonephritis, but more appropriate differential diagnoses are compatible with this patient. DISCUSSION One of the best diagnoses for this case can be Weil's syndrome. Presence of fever, icterus, hemorrhage and renal injury, all suggest Weil's syndrome without pulmonary involvement. The other probable diagnosis is thrombotic thrombocytopenic purpura (TTP). Meningococcal sepsis is the other possible diagnosis. CONCLUSION To sum up, as three compatible diseases with the case; have been described more than a thousand years after Rhazes (Weil's syndrome 1886, TTP 1925 and meningococcemia 1805); if the case is either Weil's or TTP or meningococcal sepsis, it is the first report of the disease in the world by Rhazes.
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Affiliation(s)
- Rouzbeh R Ghafouri
- Emergency Medicine Research Team, Tabriz University of Medical Science, Tabriz, Iran
| | | | - Somaiyeh T Targhi
- Aging Research Institute, Tabriz University of Medical Science, Tabriz, Iran
| | - Mojtaba Varshochi
- Department of Infectious Diseases, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zahra Parsian
- Emergency Medicine Research Team, Tabriz University of Medical Science, Tabriz, Iran
| | - Reza Yarani
- Department of Pediatrics E, Copenhagen Diabetes Research Center (CPH-DIRECT), Herlev University Hospital, Herlev, Denmark
| | - Samad E J Golzari
- Department of Anesthesiology and Intensive Care Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Cao Y, Xie X, Zhang W, Wu D, Tu C. Low-dose Norfloxacin-treated leptospires induce less IL-1β release in J774A.1 cells following discrepant leptospiral gene expression. Microb Pathog 2018; 119:125-130. [DOI: 10.1016/j.micpath.2018.03.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 03/16/2018] [Accepted: 03/19/2018] [Indexed: 02/07/2023]
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Hishamshah M, Ahmad N, Mohd Ibrahim H, Nur Halim NA, Nawi S, Amran F. Demographic, clinical and laboratory features of leptospirosis and dengue co-infection in Malaysia. J Med Microbiol 2018; 67:806-813. [PMID: 29724267 DOI: 10.1099/jmm.0.000750] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose. In this study, we aim to describe and compare the demographical, clinical and laboratory features of leptospirosis and dengue co-infections (LDCI) against single leptospirosis infections in Malaysia.Methodology. Data of patients admitted to various hospitals in Malaysia from 2011 to 2015 diagnosed with leptospirosis in our laboratory were obtained from their admission records. Co-infection with dengue was determined by collecting dengue serology results. Multivariate analysis and multiple logistic regression were used to differentiate features between single leptospirosis infection and confirmed LDCI.Results/Key findings. Only 602 (29.11 %) out of 2068 leptospira-positive patients were concurrently tested for dengue during their admission in which 44 (7.31 %) patients had positive non-structural protein 1 (confirmed LDCI) while 140 (23.26 %) were positive for dengue IgM (probable LDCI) with the highest number of cases recorded in high-density suburban districts. Myalgia and arthralgia were the only significant distinguishing clinical feature of LDCI while significant laboratory features were thrombocytopenia and high levels of alanine and aspartate transaminases. Only thrombocytopenia displayed a predictive value for LDCI from analysis of multiple logistic regression. Death occurred in 19 (3.16 %) patients in this dataset studied but only three (0.50 %) were attributed to LDCI.Conclusion. There is a considerable prevalence of LDCI in this country of which overlapping demographic, clinical and laboratory presentations pose diagnostic and therapeutic challenges. Efforts to raise awareness regarding LDCI, better access to diagnostic services and further prospective studies are warranted.
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Affiliation(s)
| | - Norazah Ahmad
- Institute for Medical Research, Kuala Lumpur, Malaysia
| | | | | | - Salbiah Nawi
- Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Fairuz Amran
- Institute for Medical Research, Kuala Lumpur, Malaysia
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22
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Prospective evaluation of accuracy and clinical utility of the Dual Path Platform (DPP) assay for the point-of-care diagnosis of leptospirosis in hospitalized patients. PLoS Negl Trop Dis 2018; 12:e0006285. [PMID: 29462146 PMCID: PMC5834199 DOI: 10.1371/journal.pntd.0006285] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 03/02/2018] [Accepted: 01/31/2018] [Indexed: 11/19/2022] Open
Abstract
Early detection of leptospirosis with field-ready diagnostics may improve clinical management and mitigate outbreaks. We previously validated the point-of-care Dual Path Platform (DPP) for leptospirosis with sera in the laboratory. This prospective study compares the diagnostic accuracy and clinical utility of the DPP using finger stick blood (FSB) against the serum DPP, venous whole blood (VWB) DPP, IgM-ELISA, and clinical impression. We sequentially enrolled 98 patients hospitalized for acute febrile illnesses, of which we confirmed 32 by leptospirosis reference tests. Among syndromes consistent with classic leptospirosis, the FSB DPP showed similar sensitivity and specificity (Se 93% and Sp 80%), and positive and negative predictive values (PPV 74% and NPV 95%), to VWB DPP (Se 96%, Sp 75%, PPV 68%, and NPV 97%), serum DPP (Se 85%, Sp 87%, PPV 79%, and NPV 91%) and IgM-ELISA (Se 81%, Sp 100%, PPV 100%, and NPV 90%). The FSB DPP provided a favorable likelihood ratio profile (positive LR 4.73, negative LR 0.09) in comparison to other assays and clinical impression alone. Additionally, we identified four of five leptospirosis-associated meningitis patients by whole blood DPP, none of which clinicians suspected. This demonstrates potential for the DPP in routine detection of this less common syndrome. The FSB DPP demonstrated similar discrimination for severe human leptospirosis compared with serum assays, and it is a simpler option for diagnosing leptospirosis. Its performance in other epidemiological settings and geographic regions, and for detecting atypical presentations, demands further evaluation. The reliable, portable, point-of-care DPP assay effectively discriminates case status for patients presenting to hospital with acute febrile syndromes consistent with classic leptospirosis. Diagnostic accuracy of the finger stick DPP using the initial acute-phase specimen at the bedside is similar to serum DPP and IgM-ELISA, yet diagnosticians can perform the DDP assay in 20 minutes without laboratory equipment. The finger stick DPP expands rapid diagnostic options at the bedside for severe leptospirosis in humans.
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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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24
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Doungchawee G, Sutdan D, Niwatayakul K, Inwisai T, Sitthipunya A, Boonsathorn N, Sakulterdkiat T, Sirawaraporn W, Thongboonkerd V. Development and evaluation of an immunochromatographic assay to detect serum anti-leptospiral lipopolysaccharide IgM in acute leptospirosis. Sci Rep 2017; 7:2309. [PMID: 28536483 PMCID: PMC5442160 DOI: 10.1038/s41598-017-02654-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 04/12/2017] [Indexed: 01/22/2023] Open
Abstract
Leptospirosis is a common life-threatening disease worldwide. However, its diagnosis is frequently ineffective because the gold standard bacterial culture and microscopic agglutination test (MAT) are usually positive 1-2 weeks after the disease onset. We thus developed an immunochromatographic assay (LEPkit) to detect serum anti-leptospiral lipopolysaccharide (LPS) IgM for rapid diagnosis of acute leptospirosis. Using referenced sera of 77 leptospirosis and 91 non-leptospirosis cases, LEPkit yielded 97.4% sensitivity, 94.5% specificity, 93.8 positive predictive value (PPV), 97.7% negative predictive value (NPV), and 95.8% accuracy. The stability of this kit stored for up to 18 months and its reproducibility were confirmed. Testing in 74 new cases using samples at admission-phase and subsequent paired samples (total n = 135), overall sensitivity was 98.5%, whereas that of culture and single MAT (≥1:400) was 15.6% and 35.6%, respectively. When only the samples at admission-phase were used (n = 74), the sensitivity remained at 98.7%, whereas that of culture and single MAT (≥1:400) was 28.4% and 13.5%, respectively. In summary, our LEPkit was far more effective than any conventional methods for the diagnosis of acute leptospirosis, especially within the first few days after the disease onset. The ease of use, stability and reproducibility further enhance its feasibility for clinical use on-site.
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Affiliation(s)
- Galayanee Doungchawee
- Department of Pathobiology, Faculty of Science, Mahidol University, Bangkok, Thailand.
| | | | | | - Tasanee Inwisai
- Department of Pathobiology, Faculty of Science, Mahidol University, Bangkok, Thailand
| | - Athisri Sitthipunya
- Department of Pathobiology, Faculty of Science, Mahidol University, Bangkok, Thailand
| | | | | | - Worachart Sirawaraporn
- Center of Excellence for Vectors and Vector-Borne Diseases, Faculty of Science, Mahidol University, Salaya Campus, Nakhon Pathom, Thailand
| | - Visith Thongboonkerd
- Medical Proteomics Unit, Office for Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. .,Center for Research in Complex Systems Science, Mahidol University, Bangkok, Thailand.
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25
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Benacer D, Zain SNM, Ooi PT, Thong KL. Antimicrobial susceptibility of Leptospira spp. isolated from environmental, human and animal sources in Malaysia. Indian J Med Microbiol 2017; 35:124-128. [PMID: 28303833 DOI: 10.4103/ijmm.ijmm_15_458] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Leptospirosis is a zoonosis with worldwide distribution caused by pathogenic spirochetes of the genus Leptospira. The aim of this study was to evaluate the susceptibility of isolates obtained from different hosts. A total of 65 Leptospira isolates from humans (n = 1), zoonoses (rat, n = 60; dog, n = 1; swine, n = 1) and environment (n = 2) were tested against six antibiotics. All the isolates were resistant to trimethoprim and sulphamethoxazole and had high MIC toward chloramphenicol (MIC90: 6.25 μg/ml). All except one environment isolate were sensitive to ampicillin, doxycycline and penicillin G.
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Affiliation(s)
- Douadi Benacer
- Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
| | - Siti Nursheena Mohd Zain
- Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
| | - Peck Toung Ooi
- Faculty of Veterinary Medicine, Universiti Putra Malaysia, Selangor, Malaysia
| | - Kwai Lin Thong
- Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
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26
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Herman HS, Mehta S, Cárdenas WB, Stewart-Ibarra AM, Finkelstein JL. Micronutrients and Leptospirosis: A Review of the Current Evidence. PLoS Negl Trop Dis 2016; 10:e0004652. [PMID: 27387046 PMCID: PMC4936698 DOI: 10.1371/journal.pntd.0004652] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Leptospirosis is one of the most widespread zoonoses and represents a major threat to human health. Due to the high burden of disease, limitations in diagnostics, and limited coverage and availability of effective human and veterinary vaccines, leptospirosis remains an important neglected zoonotic disease. Improved surveillance and identification of modifiable risk factors for leptospirosis are urgently needed to inform preventive interventions and reduce the risk and severity of Leptospira infection. METHODOLOGY/PRINCIPAL FINDINGS This review was conducted to examine the evidence that links micronutrient status and Leptospira infection. A total of 56 studies were included in this review: 28 in vitro, 17 animal, and 11 observational human studies. Findings indicated that Leptospira infection is associated with higher iron and calcium concentrations and hypomagnesemia. CONCLUSIONS/SIGNIFICANCE Few prospective studies and no randomized trials have been conducted to date to examine the potential role of micronutrients in Leptospira infection. The limited literature in this area constrains our ability to make specific recommendations; however, the roles of iron, calcium, and magnesium in leptospirosis represent important areas for future research. The role of micronutrients in leptospirosis risk and severity needs to be elucidated in larger prospective human studies to inform public health interventions.
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Affiliation(s)
- Heather S. Herman
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, United States of America
| | - Saurabh Mehta
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, United States of America
- St. John's Research Institute, Bangalore, India
| | - Washington B. Cárdenas
- Laboratorio de Biomedicina, Escuela Superior Politécnica del Litoral, ESPOL, Guayaquil, Ecuador
| | - Anna M. Stewart-Ibarra
- Department of Medicine and the Center for Global Health and Translational Science, State University of New York (SUNY) Upstate Medical University, Syracuse, New York, United States of America
| | - Julia L. Finkelstein
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, United States of America
- St. John's Research Institute, Bangalore, India
- * E-mail:
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Iroh Tam PY, Obaro SK, Storch G. Challenges in the Etiology and Diagnosis of Acute Febrile Illness in Children in Low- and Middle-Income Countries. J Pediatric Infect Dis Soc 2016; 5:190-205. [PMID: 27059657 PMCID: PMC7107506 DOI: 10.1093/jpids/piw016] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 03/04/2016] [Indexed: 01/01/2023]
Abstract
Acute febrile illness is a common cause of hospital admission, and its associated infectious causes contribute to substantial morbidity and death among children worldwide, especially in low- and middle-income countries. Declining transmission of malaria in many regions, combined with the increasing use of rapid diagnostic tests for malaria, has led to the increasing recognition of leptospirosis, rickettsioses, respiratory viruses, and arboviruses as etiologic agents of fevers. However, clinical discrimination between these etiologies can be difficult. Overtreatment with antimalarial drugs is common, even in the setting of a negative test result, as is overtreatment with empiric antibacterial drugs. Viral etiologies remain underrecognized and poorly investigated. More-sensitive diagnostics have led to additional dilemmas in discriminating whether a positive test result reflects a causative pathogen. Here, we review and summarize the current epidemiology and focus particularly on children and the challenges for future research.
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Affiliation(s)
- Pui-Ying Iroh Tam
- Department of Pediatrics
,
University of Minnesota Medical School
,
Minneapolis,Corresponding Author:
Pui-Ying Iroh Tam, MD, 3-210 MTRF, 2001 6th St. SE, Minneapolis, MN 55455. E-mail:
| | - Stephen K. Obaro
- Department of Pediatrics, University of Nebraska Medical Center, Omaha
| | - Gregory Storch
- Department of Pediatrics
,
Washington University School of Medicine
,
St Louis, Missouri
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28
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Fontes RM, Cavalcanti LPDG, Oliveira ACA, Bezerra LFDM, Gomes AMM, Colares JKB, Lima DM. A NEW POSSIBILITY FOR SURVEILLANCE: DO WE IDENTIFY ALL CASES OF LEPTOSPIROSIS? Rev Inst Med Trop Sao Paulo 2016; 57:443-6. [PMID: 26603235 PMCID: PMC4660457 DOI: 10.1590/s0036-46652015000500014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 02/23/2015] [Indexed: 01/08/2023] Open
Abstract
Leptospirosis is a febrile disease with a typically underestimated global incidence, especially in regions where dengue is endemic. Therefore, it is difficult to accurately determine the number of leptospirosis cases in these areas, which contributes to significant under-reporting this disease. In this study, we estimated the number of possible leptospirosis cases among dengue-like cases that were reported during 2008, 2010, and 2012 in the city of Fortaleza, northeast Brazil. Patients were evaluated for dengue and leptospirosis using immunoenzymatic tests for IgM antibodies that were specific to each pathogen. Among the suspected cases of dengue that resulted as negative in laboratory tests, 10.8% (2008), 19.2% (2010), and 30.8% (2012) were confirmed to be leptospirosis. Considering the cases reported by the surveillance authority as dengue that were subsequently discarded based on the laboratory test results, we estimate that the number of actual leptospirosis cases may be 26 to 49 times higher than those diagnosed and reported by the Health Services. Furthermore, we believe that approximately 20% of dengue-like cases may be leptospirosis cases in areas where the two diseases are endemic.
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Traxler RM, Callinan LS, Holman RC, Steiner C, Guerra MA. Leptospirosis-associated hospitalizations, United States, 1998-2009. Emerg Infect Dis 2016; 20:1273-9. [PMID: 25076111 PMCID: PMC4111189 DOI: 10.3201/eid2008.130450] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Average cost and duration of hospitalizations were significantly greater than for other infectious diseases. A small percentage of persons with leptospirosis, a reemerging zoonosis, experience severe complications that require hospitalization. The number of leptospirosis cases in the United States is unknown. Thus, to estimate the hospitalization rate for this disease, we analyzed US hospital discharge records for 1998–2009 for the total US population by using the Nationwide Inpatient Sample. During that time, the average annual rate of leptospirosis-associated hospitalizations was 0.6 hospitalizations/1,000,000 population. Leptospirosis-associated hospitalization rates were higher for persons >20 years of age and for male patients. For leptospirosis-associated hospitalizations, the average age of patients at admission was lower, the average length of stay for patients was longer, and hospital charges were higher than those for nonleptospirosis infectious disease–associated hospitalizations. Educating clinicians on the signs and symptoms of leptospirosis may result in earlier diagnosis and treatment and, thereby, reduced disease severity and hospitalization costs.
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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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Costa F, Hagan JE, Calcagno J, Kane M, Torgerson P, Martinez-Silveira MS, Stein C, Abela-Ridder B, Ko AI. Global Morbidity and Mortality of Leptospirosis: A Systematic Review. PLoS Negl Trop Dis 2015; 9:e0003898. [PMID: 26379143 PMCID: PMC4574773 DOI: 10.1371/journal.pntd.0003898] [Citation(s) in RCA: 965] [Impact Index Per Article: 107.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 06/10/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Leptospirosis, a spirochaetal zoonosis, occurs in diverse epidemiological settings and affects vulnerable populations, such as rural subsistence farmers and urban slum dwellers. Although leptospirosis is a life-threatening disease and recognized as an important cause of pulmonary haemorrhage syndrome, the lack of global estimates for morbidity and mortality has contributed to its neglected disease status. METHODOLOGY/PRINCIPAL FINDINGS We conducted a systematic review of published morbidity and mortality studies and databases to extract information on disease incidence and case fatality ratios. Linear regression and Monte Carlo modelling were used to obtain age and gender-adjusted estimates of disease morbidity for countries and Global Burden of Disease (GBD) and WHO regions. We estimated mortality using models that incorporated age and gender-adjusted disease morbidity and case fatality ratios. The review identified 80 studies on disease incidence from 34 countries that met quality criteria. In certain regions, such as Africa, few quality assured studies were identified. The regression model, which incorporated country-specific variables of population structure, life expectancy at birth, distance from the equator, tropical island, and urbanization, accounted for a significant proportion (R(2) = 0.60) of the variation in observed disease incidence. We estimate that there were annually 1.03 million cases (95% CI 434,000-1,750,000) and 58,900 deaths (95% CI 23,800-95,900) due to leptospirosis worldwide. A large proportion of cases (48%, 95% CI 40-61%) and deaths (42%, 95% CI 34-53%) were estimated to occur in adult males with age of 20-49 years. Highest estimates of disease morbidity and mortality were observed in GBD regions of South and Southeast Asia, Oceania, Caribbean, Andean, Central, and Tropical Latin America, and East Sub-Saharan Africa. CONCLUSIONS/SIGNIFICANCE Leptospirosis is among the leading zoonotic causes of morbidity worldwide and accounts for numbers of deaths, which approach or exceed those for other causes of haemorrhagic fever. Highest morbidity and mortality were estimated to occur in resource-poor countries, which include regions where the burden of leptospirosis has been underappreciated.
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Affiliation(s)
- Federico Costa
- Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador, Bahia, Brazil
- Institute of Collective Health, Federal University of Bahia, UFBA, Salvador, Brazil
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - José E. Hagan
- Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador, Bahia, Brazil
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Juan Calcagno
- Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador, Bahia, Brazil
| | - Michael Kane
- Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Paul Torgerson
- Section of Epidemiology, Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
| | | | - Claudia Stein
- Division of Information, Evidence, Research and Innovation, World Health Organization, Regional Office for Europe, UN City, Copenhagen Ø, Denmark
| | - Bernadette Abela-Ridder
- Department for the Control of Neglected Tropical Diseases, World Health Organization, Genève, Switzerland
| | - Albert I. Ko
- Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador, Bahia, Brazil
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
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Reverse-Transcriptase PCR Detection of Leptospira: Absence of Agreement with Single-Specimen Microscopic Agglutination Testing. PLoS One 2015; 10:e0132988. [PMID: 26177295 PMCID: PMC4503744 DOI: 10.1371/journal.pone.0132988] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 06/23/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Reference diagnostic tests for leptospirosis include nucleic acid amplification tests, bacterial culture, and microscopic agglutination testing (MAT) of acute and convalescent serum. However, clinical laboratories often do not receive paired specimens. In the current study, we tested serum samples using a highly sensitive real-time nucleic acid amplification test for Leptospira and compared results to MAT performed on the same specimens. METHODS/PRINCIPAL FINDINGS 478 serum samples from suspected leptospirosis cases in Rio de Janeiro were tested using a real-time RT-PCR for the diagnosis of leptospirosis, malaria and dengue (the Lepto-MD assay). The Lepto-MD assay detects all species of Leptospira (saprophytic, intermediate, and pathogenic), and in the current study, we demonstrate that this assay amplifies both Leptospira RNA and DNA. Dengue virus RNA was identified in 10 patients, and no cases of malaria were detected. A total of 65 samples (13.6%) were positive for Leptospira: 35 samples (7.3%) in the Lepto-MD assay, 33 samples (6.9%) by MAT, and 3 samples tested positive by both (kappa statistic 0.02). Poor agreement between methods was consistent regardless of the titer used to define positive MAT results or the day of disease at sample collection. Leptospira nucleic acids were detected in the Lepto-MD assay as late as day 22, and cycle threshold values did not differ based on the day of disease. When Lepto-MD assay results were added to the MAT results for all patients in 2008 (n=818), the number of detected leptospirosis cases increased by 30.4%, from 102 (12.5%) to 133 (16.3%). CONCLUSIONS/SIGNIFICANCE This study demonstrates a lack of agreement between nucleic acid detection of Leptospira and single-specimen MAT, which may result from the clearance of bacteremia coinciding with the appearance of agglutinating antibodies. A combined testing strategy for acute leptospirosis, including molecular and serologic testing, appears necessary to maximize case detection.
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Backstedt BT, Buyuktanir O, Lindow J, Wunder EA, Reis MG, Usmani-Brown S, Ledizet M, Ko A, Pal U. Efficient Detection of Pathogenic Leptospires Using 16S Ribosomal RNA. PLoS One 2015; 10:e0128913. [PMID: 26091292 PMCID: PMC4474562 DOI: 10.1371/journal.pone.0128913] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 05/01/2015] [Indexed: 01/30/2023] Open
Abstract
Pathogenic Leptospira species cause a prevalent yet neglected zoonotic disease with mild to life-threatening complications in a variety of susceptible animals and humans. Diagnosis of leptospirosis, which primarily relies on antiquated serotyping methods, is particularly challenging due to presentation of non-specific symptoms shared by other febrile illnesses, often leading to misdiagnosis. Initiation of antimicrobial therapy during early infection to prevent more serious complications of disseminated infection is often not performed because of a lack of efficient diagnostic tests. Here we report that specific regions of leptospiral 16S ribosomal RNA molecules constitute a novel and efficient diagnostic target for PCR-based detection of pathogenic Leptospira serovars. Our diagnostic test using spiked human blood was at least 100-fold more sensitive than corresponding leptospiral DNA-based quantitative PCR assays, targeting the same 16S nucleotide sequence in the RNA and DNA molecules. The sensitivity and specificity of our RNA assay against laboratory-confirmed human leptospirosis clinical samples were 64% and 100%, respectively, which was superior then an established parallel DNA detection assay. Remarkably, we discovered that 16S transcripts remain appreciably stable ex vivo, including untreated and stored human blood samples, further highlighting their use for clinical detection of L. interrogans. Together, these studies underscore a novel utility of RNA targets, specifically 16S rRNA, for development of PCR-based modalities for diagnosis of human leptospirosis, and also may serve as paradigm for detection of additional bacterial pathogens for which early diagnosis is warranted.
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Affiliation(s)
- Brian T. Backstedt
- Department of Veterinary Medicine and Virginia-Maryland Regional College of Veterinary Medicine, University of Maryland, College Park, Maryland, United States of America
| | - Ozlem Buyuktanir
- Department of Veterinary Medicine and Virginia-Maryland Regional College of Veterinary Medicine, University of Maryland, College Park, Maryland, United States of America
| | - Janet Lindow
- Department of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, Connecticut, United States of America
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Elsio A. Wunder
- Department of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, Connecticut, United States of America
| | - Mitermayer G. Reis
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | | | - Michel Ledizet
- L2 Diagnostics, New Haven, Connecticut, United States of America
| | - Albert Ko
- Department of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, Connecticut, United States of America
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Utpal Pal
- Department of Veterinary Medicine and Virginia-Maryland Regional College of Veterinary Medicine, University of Maryland, College Park, Maryland, United States of America
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Sensitive real-time PCR detection of pathogenic Leptospira spp. and a comparison of nucleic acid amplification methods for the diagnosis of leptospirosis. PLoS One 2014; 9:e112356. [PMID: 25379890 PMCID: PMC4224423 DOI: 10.1371/journal.pone.0112356] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 10/03/2014] [Indexed: 02/06/2023] Open
Abstract
Background Bacteria of the genus Leptospira, the causative agents of leptospirosis, are categorized into pathogenic and non-pathogenic species. However, the benefit of using a clinical diagnostic that is specific for pathogenic species remains unclear. In this study, we present the development of a real-time PCR (rtPCR) for the detection of pathogenic Leptospira (the pathogenic rtPCR), and we perform a comparison of the pathogenic rtPCR with a published assay that detects all Leptospira species [the undifferentiated febrile illness (UFI) assay] and a reference 16S Leptospira rtPCR, which was originally designed to detect pathogenic species. Methodology/Principal Findings For the pathogenic rtPCR, a new hydrolysis probe was designed for use with primers from the UFI assay, which targets the 16S gene. The pathogenic rtPCR detected Leptospira DNA in 37/37 cultured isolates from 5 pathogenic and one intermediate species. Two strains of the non-pathogenic L. biflexa produced no signal. Clinical samples from 65 patients with suspected leptospirosis were then tested using the pathogenic rtPCR and a reference Leptospira 16S rtPCR. All 65 samples had tested positive for Leptospira using the UFI assay; 62 (95.4%) samples tested positive using the pathogenic rtPCR (p = 0.24). Only 24 (36.9%) samples tested positive in the reference 16S rtPCR (p<0.0001 for comparison with the pathogenic rtPCR and UFI assays). Amplicon sequencing confirmed the detection of pathogenic Leptospira species in 49/50 cases, including 3 cases that were only detected using the UFI assay. Conclusions/Significance The pathogenic rtPCR displayed similar sensitivity to the UFI assay when testing clinical specimens with no difference in specificity. Both assays proved significantly more sensitive than a real-time molecular test used for comparison. Future studies are needed to investigate the clinical and epidemiologic significance of more sensitive Leptospira detection using these tests.
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Pérez Rodríguez NM, Galloway R, Blau DM, Traxler R, Bhatnagar J, Zaki SR, Rivera A, Torres JV, Noyd D, Santiago-Albizu XE, Rivera García B, Tomashek KM, Bower WA, Sharp TM. Case series of fatal Leptospira spp./dengue virus co-infections-Puerto Rico, 2010-2012. Am J Trop Med Hyg 2014; 91:760-5. [PMID: 25092820 DOI: 10.4269/ajtmh.14-0220] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Co-infection with pathogens that cause acute febrile illness creates a diagnostic challenge as a result of overlapping clinical manifestations. Here, we describe four fatal cases of Leptospira species/dengue virus co-infection in Puerto Rico. Although all patients sought care early, antibiotic administration was delayed for most. Steroids were administered to all patients, in most cases before antibiotics. These cases show the need for clinicians evaluating patients in or recently returned from the tropics with acute febrile illness to consider both dengue and leptospirosis. Furthermore, they illustrate the need for nucleic acid- or antigen-based rapid diagnostic tests to enable timely patient diagnosis and management. In particular, antibiotic therapy should be initiated early for patients with suspected leptospirosis, and steroids should not be administered to patients with suspected dengue.
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Affiliation(s)
- Nicole M Pérez Rodríguez
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico; Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia; Medicolegal and Toxicological Investigation Division, Puerto Rico Institute of Forensic Sciences, San Juan, Puerto Rico; San Lucas Episcopal Hospital, Ponce, Puerto Rico; Division of Epidemiology, Puerto Rico Department of Health, San Juan, Puerto Rico
| | - Renee Galloway
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico; Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia; Medicolegal and Toxicological Investigation Division, Puerto Rico Institute of Forensic Sciences, San Juan, Puerto Rico; San Lucas Episcopal Hospital, Ponce, Puerto Rico; Division of Epidemiology, Puerto Rico Department of Health, San Juan, Puerto Rico
| | - Dianna M Blau
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico; Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia; Medicolegal and Toxicological Investigation Division, Puerto Rico Institute of Forensic Sciences, San Juan, Puerto Rico; San Lucas Episcopal Hospital, Ponce, Puerto Rico; Division of Epidemiology, Puerto Rico Department of Health, San Juan, Puerto Rico
| | - Rita Traxler
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico; Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia; Medicolegal and Toxicological Investigation Division, Puerto Rico Institute of Forensic Sciences, San Juan, Puerto Rico; San Lucas Episcopal Hospital, Ponce, Puerto Rico; Division of Epidemiology, Puerto Rico Department of Health, San Juan, Puerto Rico
| | - Julu Bhatnagar
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico; Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia; Medicolegal and Toxicological Investigation Division, Puerto Rico Institute of Forensic Sciences, San Juan, Puerto Rico; San Lucas Episcopal Hospital, Ponce, Puerto Rico; Division of Epidemiology, Puerto Rico Department of Health, San Juan, Puerto Rico
| | - Sherif R Zaki
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico; Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia; Medicolegal and Toxicological Investigation Division, Puerto Rico Institute of Forensic Sciences, San Juan, Puerto Rico; San Lucas Episcopal Hospital, Ponce, Puerto Rico; Division of Epidemiology, Puerto Rico Department of Health, San Juan, Puerto Rico
| | - Aidsa Rivera
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico; Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia; Medicolegal and Toxicological Investigation Division, Puerto Rico Institute of Forensic Sciences, San Juan, Puerto Rico; San Lucas Episcopal Hospital, Ponce, Puerto Rico; Division of Epidemiology, Puerto Rico Department of Health, San Juan, Puerto Rico
| | - Jose V Torres
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico; Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia; Medicolegal and Toxicological Investigation Division, Puerto Rico Institute of Forensic Sciences, San Juan, Puerto Rico; San Lucas Episcopal Hospital, Ponce, Puerto Rico; Division of Epidemiology, Puerto Rico Department of Health, San Juan, Puerto Rico
| | - David Noyd
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico; Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia; Medicolegal and Toxicological Investigation Division, Puerto Rico Institute of Forensic Sciences, San Juan, Puerto Rico; San Lucas Episcopal Hospital, Ponce, Puerto Rico; Division of Epidemiology, Puerto Rico Department of Health, San Juan, Puerto Rico
| | - Xavier E Santiago-Albizu
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico; Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia; Medicolegal and Toxicological Investigation Division, Puerto Rico Institute of Forensic Sciences, San Juan, Puerto Rico; San Lucas Episcopal Hospital, Ponce, Puerto Rico; Division of Epidemiology, Puerto Rico Department of Health, San Juan, Puerto Rico
| | - Brenda Rivera García
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico; Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia; Medicolegal and Toxicological Investigation Division, Puerto Rico Institute of Forensic Sciences, San Juan, Puerto Rico; San Lucas Episcopal Hospital, Ponce, Puerto Rico; Division of Epidemiology, Puerto Rico Department of Health, San Juan, Puerto Rico
| | - Kay M Tomashek
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico; Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia; Medicolegal and Toxicological Investigation Division, Puerto Rico Institute of Forensic Sciences, San Juan, Puerto Rico; San Lucas Episcopal Hospital, Ponce, Puerto Rico; Division of Epidemiology, Puerto Rico Department of Health, San Juan, Puerto Rico
| | - William A Bower
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico; Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia; Medicolegal and Toxicological Investigation Division, Puerto Rico Institute of Forensic Sciences, San Juan, Puerto Rico; San Lucas Episcopal Hospital, Ponce, Puerto Rico; Division of Epidemiology, Puerto Rico Department of Health, San Juan, Puerto Rico
| | - Tyler M Sharp
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico; Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia; Medicolegal and Toxicological Investigation Division, Puerto Rico Institute of Forensic Sciences, San Juan, Puerto Rico; San Lucas Episcopal Hospital, Ponce, Puerto Rico; Division of Epidemiology, Puerto Rico Department of Health, San Juan, Puerto Rico
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Stoddard ST, Wearing HJ, Reiner RC, Morrison AC, Astete H, Vilcarromero S, Alvarez C, Ramal-Asayag C, Sihuincha M, Rocha C, Halsey ES, Scott TW, Kochel TJ, Forshey BM. Long-term and seasonal dynamics of dengue in Iquitos, Peru. PLoS Negl Trop Dis 2014; 8:e3003. [PMID: 25033412 PMCID: PMC4102451 DOI: 10.1371/journal.pntd.0003003] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 06/02/2014] [Indexed: 12/02/2022] Open
Abstract
Introduction Long-term disease surveillance data provide a basis for studying drivers of pathogen transmission dynamics. Dengue is a mosquito-borne disease caused by four distinct, but related, viruses (DENV-1-4) that potentially affect over half the world's population. Dengue incidence varies seasonally and on longer time scales, presumably driven by the interaction of climate and host susceptibility. Precise understanding of dengue dynamics is constrained, however, by the relative paucity of laboratory-confirmed longitudinal data. Methods We studied 10 years (2000–2010) of laboratory-confirmed, clinic-based surveillance data collected in Iquitos, Peru. We characterized inter and intra-annual patterns of dengue dynamics on a weekly time scale using wavelet analysis. We explored the relationships of case counts to climatic variables with cross-correlation maps on annual and trimester bases. Findings Transmission was dominated by single serotypes, first DENV-3 (2001–2007) then DENV-4 (2008–2010). After 2003, incidence fluctuated inter-annually with outbreaks usually occurring between October and April. We detected a strong positive autocorrelation in case counts at a lag of ∼70 weeks, indicating a shift in the timing of peak incidence year-to-year. All climatic variables showed modest seasonality and correlated weakly with the number of reported dengue cases across a range of time lags. Cases were reduced after citywide insecticide fumigation if conducted early in the transmission season. Conclusions Dengue case counts peaked seasonally despite limited intra-annual variation in climate conditions. Contrary to expectations for this mosquito-borne disease, no climatic variable considered exhibited a strong relationship with transmission. Vector control operations did, however, appear to have a significant impact on transmission some years. Our results indicate that a complicated interplay of factors underlie DENV transmission in contexts such as Iquitos. Description of long-term temporal patterns in disease occurrence improves our understanding of pathogen transmission dynamics and facilitates predicting new epidemics. Dengue, the most prevalent mosquito-borne, viral disease of humans, typically varies seasonally and on longer, inter-annual time scales. In most studies of these patterns, however, only a fraction of putative dengue cases are confirmed with laboratory diagnostics. Here we analyzed 10 years of fully confirmed dengue cases reported to a sentinel surveillance system in Iquitos, Peru. We describe the inter and intra-annual patterns of weekly case counts and relate these to climate and local vector control efforts. We show that dengue case counts vary seasonally in Iquitos despite very little variation in key climatic conditions, such as temperature and humidity. Overall, transmission correlated poorly with climate regardless of time lag. In seasons when vector control was conducted early, there was an apparent decline in cases later that season. We speculate that the relationships between climatic conditions and transmission of DENV in Iquitos are complex and non-linear, and that other factors, such as herd immunity, virus diversity, and vector control efforts, play key roles determining the timing and intensity of transmission.
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Affiliation(s)
- Steven T. Stoddard
- Department of Entomology and Nematology, University of California, Davis, Davis, California, United States of America
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, United States of America
- * E-mail:
| | - Helen J. Wearing
- University of New Mexico, Albuquerque, Albuquerque, New Mexico, United States of America
| | - Robert C. Reiner
- Department of Entomology and Nematology, University of California, Davis, Davis, California, United States of America
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Amy C. Morrison
- Department of Entomology and Nematology, University of California, Davis, Davis, California, United States of America
- U.S. Naval Medical Research Unit No. 6, Lima, Peru
| | | | | | | | | | | | | | | | - Thomas W. Scott
- Department of Entomology and Nematology, University of California, Davis, Davis, California, United States of America
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Tadeusz J. Kochel
- U.S. Naval Medical Research Center, Silver Spring, Maryland, United States of America
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Lindo J, Brown PD, Vickers I, Brown M, Jackson ST, Lewis-Fuller E. Leptospirosis and malaria as causes of febrile illness during a dengue epidemic in Jamaica. Pathog Glob Health 2014; 107:329-34. [PMID: 24188242 DOI: 10.1179/2047773213y.0000000112] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Epidemics of febrile illnesses are often associated with rainy seasons in the tropics. During 2007-2008 an epidemic of dengue was identified in Jamaica based on serological testing of sera. METHODS A subset of 3165 of 5400 sera submitted for dengue analysis was tested for Leptospira IgM and malaria IgG using ELISA to determine their role in causing epidemic fever. FINDINGS Seropositivity for dengue, leptospirosis, and malaria were 38·4 and 6·0 and 6·5%, respectively, indicative of three concurrent epidemics. Mixed exposure to all three diseases was rare (0·1%), as were mixed dengue/malaria (2·4%); dengue/leptospirosis (1·6%), and leptospirosis/malaria (0·03%) exposure. Exposure to dengue and malaria appeared to occur most frequently among children while leptospirosis was more common among adults. CONCLUSION While serological diagnosis definitively established that dengue was the main cause of the epidemic febrile illness, the data suggested that there may be other causes of fever, which may occur simultaneously. Consequently, leptospirosis and malaria should be considered as causes of fever during epidemics of dengue in endemic areas.
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Affiliation(s)
- John Lindo
- University of the West Indies, Mona, Kingston, Jamaica
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Armien B, Pascale JM, Muñoz C, Mariñas J, Núñez H, Herrera M, Trujillo J, Sánchez D, Mendoza Y, Hjelle B, Koster F. Hantavirus fever without pulmonary syndrome in Panama. Am J Trop Med Hyg 2013; 89:489-94. [PMID: 23836565 DOI: 10.4269/ajtmh.12-0334] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
In Panama, hantavirus pulmonary syndrome (HPS) is caused by Choclo virus, a species phylogenetically related to Andes and Maporal viruses. Up to 60% of the population has been positive for specific serum antibody in community-based surveys, but mortality is very uncommon. In four western Panama clinics, we tested individuals presenting with a severe febrile prodrome for acute hantavirus (HV) infection by immunoglobulin M enzyme-linked immunosorbent assay and reverse transcription polymerase chain reaction as well as clinically similar infections, such as dengue and leptospirosis. From 2006 to 2009, at least 21% of 117 patients diagnosed with HV infection had HV Fever (HF) with no evidence of pulmonary edema (no respiratory distress or radiographic lung infiltrates), and 44% of patients had very mild HPS (radiographic pulmonary edema but no respiratory insufficiency). HV infection caused by Choclo virus in Panama presents often as HF, which contrasts with HV in the Americas but is consistent with the high seroprevalence in endemic regions.
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Affiliation(s)
- Blas Armien
- Epidemiology and Microbiology, Gorgas Memorial Institute for Health Research, Panama City, Panama.
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Halsey ES, Vilcarromero S, Forshey BM, Rocha C, Bazan I, Stoddard ST, Kochel TJ, Casapia M, Scott TW, Morrison AC. Performance of the tourniquet test for diagnosing dengue in Peru. Am J Trop Med Hyg 2013; 89:99-104. [PMID: 23716410 DOI: 10.4269/ajtmh.13-0103] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The tourniquet test (TT) is a physical examination maneuver often performed on patients suspected of having dengue. It has been incorporated into dengue diagnostic guidelines and is used in clinical studies. However, little is known about TT performance characteristics in different patient types or epidemiologic conditions. In the dengue-endemic city of Iquitos, Peru, we performed TTs and dengue laboratory assays on 13,548 persons with febrile disease, recruited through either active (n = 1,095) or passive (n = 12,453) surveillance. The sensitivity was 52% and 56%, the specificity was 58% and 68%, the positive predictive value was 45% and 55%, and the negative predictive value was 64% and 69% for persons enrolled in active and passive surveillance, respectively. We demonstrated that the TT was more sensitive identifying dengue disease in women and those of younger age and that sensitivity increased the later a person came to a medical clinic for care.
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Affiliation(s)
- Eric S Halsey
- U.S. Naval Medical Research Unit No. 6, Lima and Iquitos, Peru.
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Abstract
Malaria, diarrhea, respiratory infections, and cutaneous larva migrans are common travel-related infections observed in children and adolescents returning from trips to developing countries. Children visiting friends and relatives are at the highest risk because few visit travel clinics before travel, their stays are longer, and the sites they visit are more rural. Clinicians must be able to prepare their pediatric-age travelers before departure with preventive education, prophylactic and self-treating medications, and vaccinations. Familiarity with the clinical manifestations and treatment of travel-related infections will secure prompt and effective therapy.
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Lorenzi OD, Gregory CJ, Santiago LM, Acosta H, Galarza IE, Hunsperger E, Muñoz J, Bui DM, Oberste MS, Peñaranda S, García-Gubern C, Tomashek KM. Acute febrile illness surveillance in a tertiary hospital emergency department: comparison of influenza and dengue virus infections. Am J Trop Med Hyg 2013; 88:472-80. [PMID: 23382160 DOI: 10.4269/ajtmh.12-0373] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In 2009, an increased proportion of suspected dengue cases reported to the surveillance system in Puerto Rico were laboratory negative. As a result, enhanced acute febrile illness (AFI) surveillance was initiated in a tertiary care hospital. Patients with fever of unknown origin for 2-7 days duration were tested for Leptospira, enteroviruses, influenza, and dengue virus. Among the 284 enrolled patients, 31 dengue, 136 influenza, and 3 enterovirus cases were confirmed. Nearly half (48%) of the confirmed dengue cases met clinical criteria for influenza. Dengue patients were more likely than influenza patients to have hemorrhage (81% versus 26%), rash (39% versus 9%), and a positive tourniquet test (52% versus 18%). Mean platelet and white blood cell count were lower among dengue patients. Clinical diagnosis can be particularly difficult when outbreaks of other AFI occur during dengue season. A complete blood count and tourniquet test may be useful to differentiate dengue from other AFIs.
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Affiliation(s)
- Olga D Lorenzi
- Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico.
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Sharp TM, Bracero J, Rivera A, Shieh WJ, Bhatnagar J, Rivera-Diez I, Hunsperger E, Munoz-Jordan J, Zaki SR, Tomashek KM. Fatal human co-infection with Leptospira spp. and dengue virus, Puerto Rico, 2010. Emerg Infect Dis 2013; 18:878-80. [PMID: 22516301 PMCID: PMC3358057 DOI: 10.3201/eid1805.111555] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Leptospirosis prevalence in patients with initial diagnosis of dengue. J Trop Med 2012; 2012:519701. [PMID: 22685476 PMCID: PMC3368196 DOI: 10.1155/2012/519701] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 02/23/2012] [Accepted: 02/23/2012] [Indexed: 11/18/2022] Open
Abstract
Objective. To determine the prevalence of leptospirosis in patients from Veracruz with initial diagnosis of dengue and its association with risk factors. Materials and Methods. Transversal study in patients who sought medical attention under the suspicion of dengue. Backgrounds were researched and blood samples were drawn to determine dengue (NS1, RT-PCR) and leptospirosis (IFI). Simple frequencies, central tendency and dispersion measures, and prevalence and trust intervals at 95% (IC95%) were obtained. Prevalence reasons (RP) and IC(95%) were obtained and a multivariate logistic model was applied, using SPSS V15. Results. 171 patients were included, 56% women (32 ± 14 years) and 44% men (32 ± 17 years). 48% of the cases (IC95% 40.5-55.4) was positive to dengue, with a cut point of 1 : 80, seroprevalence for leptospirosis was of 6% (IC(95%) 2.7-10); 12% (IC95% 7-16.5) was positive to both pathologies and 34% was negative to both tests. Although the largest number of isolations corresponded to serotype 2, the four dengue virus serotypes were identified. In the bivariate analysis, overcrowding RP = 1.33, (IC = 0.46-3.5), bathing in rivers (RP = 1.31, IC = 0.13-7.4), and walking barefoot (RP = 1.39, IC = 0.58-3.3) were the variables associated with leptospirosis, although the relation was not statistically significant. Conclusions. Leptospirosis prevalence in subjects under suspicion of dengue fever is high, as well as the coincidence of both infections. The results show the coexistence of overlapped outbreaks of several diseases sharing the side of transmission. It is necessary the intentional search of other pathologies, such as influenza, rickettsiosis, and brucella, among others.
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Knowledge, attitudes and practices of Trinidadian households regarding leptospirosis and related matters. Int Health 2011; 3:131-7. [DOI: 10.1016/j.inhe.2011.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Forshey BM, Guevara C, Laguna-Torres VA, Cespedes M, Vargas J, Gianella A, Vallejo E, Madrid C, Aguayo N, Gotuzzo E, Suarez V, Morales AM, Beingolea L, Reyes N, Perez J, Negrete M, Rocha C, Morrison AC, Russell KL, J. Blair P, Olson JG, Kochel TJ. Arboviral etiologies of acute febrile illnesses in Western South America, 2000-2007. PLoS Negl Trop Dis 2010; 4:e787. [PMID: 20706628 PMCID: PMC2919378 DOI: 10.1371/journal.pntd.0000787] [Citation(s) in RCA: 179] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Accepted: 07/12/2010] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Arthropod-borne viruses (arboviruses) are among the most common agents of human febrile illness worldwide and the most important emerging pathogens, causing multiple notable epidemics of human disease over recent decades. Despite the public health relevance, little is know about the geographic distribution, relative impact, and risk factors for arbovirus infection in many regions of the world. Our objectives were to describe the arboviruses associated with acute undifferentiated febrile illness in participating clinics in four countries in South America and to provide detailed epidemiological analysis of arbovirus infection in Iquitos, Peru, where more extensive monitoring was conducted. METHODOLOGY/FINDINGS A clinic-based syndromic surveillance system was implemented in 13 locations in Ecuador, Peru, Bolivia, and Paraguay. Serum samples and demographic information were collected from febrile participants reporting to local health clinics or hospitals. Acute-phase sera were tested for viral infection by immunofluorescence assay or RT-PCR, while acute- and convalescent-phase sera were tested for pathogen-specific IgM by ELISA. Between May 2000 and December 2007, 20,880 participants were included in the study, with evidence for recent arbovirus infection detected for 6,793 (32.5%). Dengue viruses (Flavivirus) were the most common arbovirus infections, totaling 26.0% of febrile episodes, with DENV-3 as the most common serotype. Alphavirus (Venezuelan equine encephalitis virus [VEEV] and Mayaro virus [MAYV]) and Orthobunyavirus (Oropouche virus [OROV], Group C viruses, and Guaroa virus) infections were both observed in approximately 3% of febrile episodes. In Iquitos, risk factors for VEEV and MAYV infection included being male and reporting to a rural (vs urban) clinic. In contrast, OROV infection was similar between sexes and type of clinic. CONCLUSIONS/SIGNIFICANCE Our data provide a better understanding of the geographic range of arboviruses in South America and highlight the diversity of pathogens in circulation. These arboviruses are currently significant causes of human illness in endemic regions but also have potential for further expansion. Our data provide a basis for analyzing changes in their ecology and epidemiology.
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Affiliation(s)
- Brett M. Forshey
- United States Naval Medical Research Center Detachment, Iquitos and Lima, Peru
| | - Carolina Guevara
- United States Naval Medical Research Center Detachment, Iquitos and Lima, Peru
| | | | | | | | | | | | | | | | - Eduardo Gotuzzo
- Instituto de Medicina Tropical “Alexander von Humboldt”, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | | | - Luis Beingolea
- Dirección General de Epidemiología, Ministerio de Salud, Lima, Peru
| | - Nora Reyes
- Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Juan Perez
- United States Naval Medical Research Center Detachment, Iquitos and Lima, Peru
| | - Monica Negrete
- United States Naval Medical Research Center Detachment, Iquitos and Lima, Peru
| | - Claudio Rocha
- United States Naval Medical Research Center Detachment, Iquitos and Lima, Peru
| | - Amy C. Morrison
- United States Naval Medical Research Center Detachment, Iquitos and Lima, Peru
- University of California Davis, Davis, California, United States of America
| | - Kevin L. Russell
- United States Naval Medical Research Center Detachment, Iquitos and Lima, Peru
| | - Patrick J. Blair
- United States Naval Medical Research Center Detachment, Iquitos and Lima, Peru
| | - James G. Olson
- United States Naval Medical Research Center Detachment, Iquitos and Lima, Peru
| | - Tadeusz J. Kochel
- United States Naval Medical Research Center Detachment, Iquitos and Lima, Peru
- * E-mail:
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Laoprasopwattana K, Pruekprasert P, Dissaneewate P, Geater A, Vachvanichsanong P. Outcome of dengue hemorrhagic fever-caused acute kidney injury in Thai children. J Pediatr 2010; 157:303-9. [PMID: 20362302 DOI: 10.1016/j.jpeds.2010.02.008] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Revised: 01/20/2010] [Accepted: 02/04/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To examine the outcome of acute kidney injury (AKI) in children with dengue hemorrhagic fever (DHF), the cause(s) of AKI, and the risk of AKI and fatality. STUDY DESIGN The medical records of patients age <15 years during 1989 to 2007 were reviewed. DHF-caused AKI and patients with DHF with no AKI were matched 1:2 by age. RESULTS DHF-caused AKI was clinically estimated to be 0.9% (25/2893) of admissions, with a high mortality rate of 64.0%. Risk factors of AKI were DHF grade IV and obesity (odds ratio, 16.9; 95% CI, 4.2 to 68.5, and odds ratio, 6.3; 95% CI, 1.4 to 28.8, respectively). Respiratory failure, hepatic failure, and massive bleeding were complications found in 80.0%, 96.0%, and 84.0% of cases with AKI, respectively. Fatality was more likely in cases with DHF grade IV, oliguric AKI, respiratory failure, or prolongation of prothrombin or activated partial thromboplastin time more than twice that of reference specimens. Among the survivors, none had chronic kidney disease, and serum creatinine levels returned to normal in 32 (1 to 48) days. CONCLUSIONS Patients with DHF and AKI had a high mortality rate, although those who survived had a full return to normal function within 1 month. DHF grade IV and obesity were the major risk factors of AKI.
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Affiliation(s)
- Kamolwish Laoprasopwattana
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
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Gregory CJ, Santiago LM, Argüello DF, Hunsperger E, Tomashek KM. Clinical and laboratory features that differentiate dengue from other febrile illnesses in an endemic area--Puerto Rico, 2007-2008. Am J Trop Med Hyg 2010; 82:922-9. [PMID: 20439977 DOI: 10.4269/ajtmh.2010.09-0552] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Dengue infection can be challenging to diagnose early in the course of infection before severe manifestations develop, but early diagnosis can improve patient outcomes and promote timely public health interventions. We developed age-based predictive models generated from 2 years of data from an enhanced dengue surveillance system in Puerto Rico. These models were internally validated and were able to differentiate dengue infection from other acute febrile illnesses with moderate accuracy. The accuracy of the models was greater than either the current World Health Organization case definition for dengue fever or a proposed modification to this definition, while requiring the collection of fewer data. In young children, thrombocytopenia and the absence of cough were associated with dengue infection; for adults, rash, leucopenia, and the absence of sore throat were associated with dengue infection; in all age groups, retro-orbital pain was associated with dengue infection.
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Affiliation(s)
- Christopher J Gregory
- Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Incidence of leptospirosis in a select population in Nepal. Trans R Soc Trop Med Hyg 2010; 104:551-5. [PMID: 20494385 DOI: 10.1016/j.trstmh.2010.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 04/14/2010] [Accepted: 04/14/2010] [Indexed: 01/15/2023] Open
Abstract
The geographic distribution of leptospirosis is widespread but no national surveillance program exists in Nepal to establish the incidence of leptospirosis or the disease burden. This study reports the incidence of symptomatic leptospirosis in military personnel participating in an efficacy study of a hepatitis E virus vaccine in Nepal. Among the 1566 study volunteers who completed follow-up, we evaluated 271 illnesses over 2.2 years for the presence of leptospira IgM antibodies by ELISA. Positive ELISA results were confirmed by the microscopic agglutination test. The annual incidence of disease was between 3.5 and 6.1 cases/1000. The prevalence of confirmed leptospirosis was 9% among hepatitis cases and 8% among febrile cases. The most reactive serovars were Bratislava, Autumnalis, Icterohaemorrhagiae, and Sejroe. Leptospirosis should be considered in the differential diagnosis of febrile illnesses and icteric syndromes in Nepal. Additional studies are needed to establish the broader distribution and the spectrum of disease in Nepal.
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HATAZOE T, HOBO S, YAMASHITA N, KOMATSU K, MISUMI K. Case study of equine leptospirosis associated with renal failure. ACTA ACUST UNITED AC 2009. [DOI: 10.12935/jvma.62.303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Takashi HATAZOE
- Kyushu Stallion Station, The Japan Bloodhorse Breeders' Association,
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50
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Ellis T, Imrie A, Katz AR, Effler PV. Underrecognition of leptospirosis during a dengue fever outbreak in Hawaii, 2001-2002. Vector Borne Zoonotic Dis 2008; 8:541-7. [PMID: 18447625 DOI: 10.1089/vbz.2007.0241] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
During the 10-year period from 1997 through 2006, the reported mean annual incidence rate of leptospirosis in the state of Hawaii was 3.3/100,000 with a range of 22-60 infections reported each year. Because the clinical presentation is highly variable, however, leptospirosis illness is challenging to recognize and may be underdiagnosed. To assess whether the incidence may be substantially higher than reported figures indicate, we retrospectively studied the prevalence of anti-Leptospira IgM antibodies among specimens obtained over a 12-month period (May 2001 to April 2002) from patients presenting with febrile illness during a dengue fever outbreak in Hawaii. Of 1206 patients testing negative or indeterminate for dengue, 54 (4.5%; 95% confidence interval: 3.3%-5.7%) were positive for anti-Leptospira IgM antibodies using a commercially available dipstick enzyme-linked immunosorbent assay (ELISA). The most common clinical symptoms reported by laboratory-positive leptospirosis patients were fever (92%), headache (88%), and myalgia (83%). Three clinical symptoms were significantly less common among persons laboratory positive for leptospirosis when compared with the 122 patients who had been diagnosed with dengue fever during the outbreak: rash (p < 0.0001), chills (p = 0.05), and petechiae (p = 0.0005). Laboratory-positive leptospirosis infections were identified in persons exposed on each of the 5 most populous islands and illness onsets spanned a 10-month period, reflecting an endemic pattern of disease. If added to the figures obtained via routine passive surveillance, the number of leptospirosis infections identified through this study would more than double the annual incidence rate for Hawaii during 2001. These findings indicate that many leptospiral infections in Hawaii go undiagnosed. Physicians should maintain a high index of suspicion for leptospirosis when assessing patients presenting with acute febrile illness among residents and visitors to Hawaii.
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Affiliation(s)
- Tania Ellis
- Department of Public Health Sciences, John A. Burns School of Medicine, University of Hawaii at Manoa, Manoa, Hawaii, USA
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