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Selim A, Marzok M, Gattan HS, Abdelhady A, Salem M, Hereba AM. Seroprevalence and associated risk factors for bovine leptospirosis in Egypt. Sci Rep 2024; 14:4645. [PMID: 38409338 PMCID: PMC10897380 DOI: 10.1038/s41598-024-54882-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 02/17/2024] [Indexed: 02/28/2024] Open
Abstract
Leptospirosis is caused by pathogenic bacteria of the genus Leptospira and is one of causative agents of reproductive problems leading to negative economic impact on bovine worldwide. The goal of this study was to investigate the seroprevalence of Leptospira spp. in cattle in some governorates of Egypt's Nile Delta and assess the risk factors for infection. A total of 410 serum samples were collected from cattle and examined using microscopic agglutination test. The overall seroprevalence was 10.2% and the most prevalent serovars were Icterohaemorrhagiae, Pomona and Canicola. In addition, the potential risk factors were associated Leptospira spp. infection were age, herd size, history of abortion, presence of dogs and rodent control. Thus, leptospirosis is common in dairy cattle in the Nile Delta and the presence of rodents in feed and dog-accessible pastures increases the risk of Leptospira spp. infection among animals.
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Affiliation(s)
- Abdelfattah Selim
- Department of Animal Medicine (Infectious Diseases), Faculty of Veterinary Medicine, Benha University, Toukh, 13736, Egypt.
| | - Mohamed Marzok
- Department of Clinical Sciences, College of Veterinary Medicine, King Faisal University, 31982, Al-Ahsa, Saudi Arabia.
- Department of Surgery, Faculty of Veterinary Medicine, Kafr El Sheikh University, Kafr El Sheikh, Egypt.
| | - Hattan S Gattan
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
- Special Infectious Agents Unit, King Fahad Medical Research Center, King AbdulAziz University, Jeddah, Saudi Arabia
| | - Abdelhamed Abdelhady
- Department of Parasitology and Animal Diseases, National Research Center, Giza, Egypt
| | - Mohamed Salem
- Department of Clinical Sciences, College of Veterinary Medicine, King Faisal University, 31982, Al-Ahsa, Saudi Arabia
- Department of Medicine and Infectious Diseases, Faculty of Veterinary Medicine, Cairo University, 12613, Cairo, Egypt
| | - Abdelrahman M Hereba
- Department of Biomedical Physics, Medical Research Institute, Alexandria University, Alexandria, Egypt
- Department of Microbiology, College of Veterinary Medicine, King Faisal University, 31982, Al-Ahsa, Saudi Arabia
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Comia IR, Manuel L, Miambo RD, Carimo AA, Manjate PDF, Maholela AE, Banze LR, Buene TP, Nhancupe N, Sousa IM, Benson CA, Schooley RT, Sacarlal J, Noormahomed EV. A Cross Sectional Study on the Bidirectional Interactions Between Leptospirosis and HIV Infection Among Patients from Maputo Central Hospital, Mozambique. Res Rep Trop Med 2024; 15:1-11. [PMID: 38371361 PMCID: PMC10871144 DOI: 10.2147/rrtm.s445878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/19/2024] [Indexed: 02/20/2024] Open
Abstract
Introduction This study aims to determine the baseline seroprevalence of leptospirosis, a zoonotic and neglected disease, in people living with HIV (PWH) in Maputo, Mozambique, and to evaluate the relationship between selected HIV-related factors that might influence risk of coinfection with leptospirosis, such as degree of immunosuppression, as assessed by CD4 cell count, World Health Organization (WHO) HIV/AIDS clinical stage and antiretroviral therapy (ART) intake. Methods This was a descriptive cross-sectional analysis of 157 PWH, aged over 18 years old, admitted to the Maputo Central Hospital, in Maputo, Mozambique, between March 2020 and October 2021. The study participants were recruited as a convenience sample regardless of the reasons for their admission. We collected sociodemographic and clinical data, including ART and WHO HIV/AIDS clinical stage, and blood for CD4 cell count and detection of Leptospira IgG antibodies using a commercial Kit ab247199 Leptospira IgG ELISA (www.abcam.com/ab247199) with sensitivity and specificity of 100% and 97.3%, respectively. Laboratory testing was performed at the Faculty of Medicine, Eduardo Mondlane University and Laboratory of Clinical Analysis, in Maputo. Results Participants were aged 18 to 72 years (median age 39 years; SD ± 10.5), the majority were female 100 (63.7%), from urban areas 138 (87.9%), with secondary-level education 80 (51%). The overall seroprevalence of Leptospira IgG antibodies was 40.1%. The median CD4 cell count was 385 cells/µl (02 to 2297; SD ± 378.47). Higher seroprevalence of Leptospira antibodies was found among participants with CD4 cell counts <250 cells/µl (54.8%), WHO HIV/AIDS stage IV (70.2%) and those on ART (92%), though there were no statistically significant differences between groups with and without Leptospira antibodies. Conclusion Our study confirmed that Leptospira antibodies are highly prevalent in PWH in Maputo; however, Leptospira infection was not associated with the degree of immunosuppression, WHO HIV/AIDS clinical stage, or the use of ART. Our data support the need for routine screening for leptospirosis in PWH in Mozambique. Future studies are warranted to characterize the incidence and outcomes of symptomatic leptospirosis in this patient population and to identify circulating serovars and species in the country and region, as well as the implicated reservoirs.
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Grants
- research work and student fellowship
- the National Institutes of Health
- Fogarty International Center
- titled Enhanced Advanced Biomedical Training in Mozambique
- Additionally, RTS and EVN received support from the above-mentioned grant to support their efforts as PI and co-PI, respectively. RDM, IMS, LB, and TB received support from the above grant as mentors. NN, AC, PFM, AM, CAB, RTS, JS, and EVN received support from the grant number R25TW011216 also from NIH-FIC and PEPFAR. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders
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Affiliation(s)
- Isac Rodrigues Comia
- Department of Research and Extension, Faculty of Health Sciences, Lúrio University, Nampula, Mozambique
- Department of Microbiology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- Mozambique Institute for Health Education and Research (MIHER), Maputo, Mozambique
| | - Leonardo Manuel
- Department of Research and Extension, Faculty of Health Sciences, Lúrio University, Nampula, Mozambique
- Department of Microbiology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- Mozambique Institute for Health Education and Research (MIHER), Maputo, Mozambique
| | - Regina Daniel Miambo
- Mozambique Institute for Health Education and Research (MIHER), Maputo, Mozambique
- Department of Para-Clinics, Faculty of Veterinary, Eduardo Mondlane University, Maputo, Mozambique
| | - Awa Abdul Carimo
- Mozambique Institute for Health Education and Research (MIHER), Maputo, Mozambique
- Department of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Percílio da Floca Manjate
- Mozambique Institute for Health Education and Research (MIHER), Maputo, Mozambique
- Department of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Ana Edith Maholela
- Mozambique Institute for Health Education and Research (MIHER), Maputo, Mozambique
- Department of Medicine, Maputo Central Hospital, Maputo, Mozambique
| | - Lucas Raimundo Banze
- Department of Microbiology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- Mozambique Institute for Health Education and Research (MIHER), Maputo, Mozambique
| | - Titos Paulo Buene
- Department of Microbiology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- Mozambique Institute for Health Education and Research (MIHER), Maputo, Mozambique
| | - Noémia Nhancupe
- Department of Microbiology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- Mozambique Institute for Health Education and Research (MIHER), Maputo, Mozambique
| | - Irina M Sousa
- Mozambique Institute for Health Education and Research (MIHER), Maputo, Mozambique
- Department of Biological Sciences, Faculty of Sciences, Eduardo Mondlane University, Maputo, Mozambique
| | - Constance A Benson
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, CA, USA
| | - Robert T Schooley
- Department of Medicine, Division of Infectious Diseases, University of California, San Diego, CA, USA
| | - Jahit Sacarlal
- Department of Microbiology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Emília Virgínia Noormahomed
- Department of Microbiology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- Mozambique Institute for Health Education and Research (MIHER), Maputo, Mozambique
- Department of Medicine, Division of Infectious Diseases, University of California, San Diego, CA, USA
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Oludele J, Alho P, Chongo I, Maholela P, Magaia V, Muianga A, Melchior B, Isaías T, Gatambire A, Zimba E, Nhavoto E, Notiço P, Inguana P, Cantoria J, António V, Monteiro V, Ali S, Inlamea O, Samo Gudo E. Emerging Zoonotic Diseases among Pastoral Communities of Caia and Búzi Districts, Sofala, Mozambique: Evidence of Antibodies against Brucella, Leptospira, Rickettsia, and Crimean-Congo Hemorrhagic Fever Virus. Viruses 2023; 15:2379. [PMID: 38140620 PMCID: PMC10748219 DOI: 10.3390/v15122379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/28/2023] [Accepted: 10/09/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Emerging zoonotic diseases are an increasing threat to public health. There is little data on the seroprevalence of zoonotic diseases among pastoralists in the country. We aim to carry out a cross-sectional study on the prevalence of major zoonotic diseases among pastoral communities in the Caia and Búzi districts. METHODS Between January and December 2018, a questionnaire was used to solicit socio-demographic data from consenting pastoralists with the collection of blood samples in the Caia and Búzi districts of the Sofala province. All samples were tested using ELISA commercial reagents for the detection of IgM antibodies against Brucella and Leptospira. Likewise, IgM and IgG antibodies against Rickettsia and CCHFV were determined using ELISA kits. RESULTS A total of 218 samples were tested, of which 43.5% (95/218) were from the district of Caia and 56.4% (123/218) from the Búzi district. Results from both districts showed that the seroprevalence of IgM antibodies against Brucella and Leptospira was 2.7% (6/218) and 30.3% (67/218), respectively. Positivity rates for IgM and IgG anti-Rickettsia and CCHFV were 8.7% (19/218), 2.7% (6/218), 4.1% (9/218), and 0.9% (2/218), respectively. CONCLUSIONS Results from our study showed evidence of antibodies due to exposure to Brucella, Leptospira, Rickettsia, and CCHFV with antibodies against Leptospira and Rickettsia being the most prevalent. Hence, laboratory diagnosis of zoonotic diseases is essential in the early detection of outbreaks, the identification of silent transmission, and the etiology of non-febrile illness in a pastoral community. There is a need to develop public health interventions that will reduce the risk of transmission.
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Affiliation(s)
- John Oludele
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Pascoal Alho
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Inocêncio Chongo
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Plácida Maholela
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Vlademiro Magaia
- Centro de Biotecnologia, Universidade Eduardo Mondlane, Maputo CP 257, Mozambique;
| | - Argentina Muianga
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Bibiana Melchior
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Telma Isaías
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Aline Gatambire
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Edna Zimba
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Emídio Nhavoto
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Paulo Notiço
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Pedro Inguana
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Juma Cantoria
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Virgílio António
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Vanessa Monteiro
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Sádia Ali
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
- Center for International Health, Division of Infectious Diseases and Tropical Medicine, LMU University Hospital, Ludwig Maximilian University of Munich, 80802 München, Germany
| | - Osvaldo Inlamea
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
| | - Eduardo Samo Gudo
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique; (P.A.); (I.C.); (P.M.); (A.M.); (B.M.); (T.I.); (A.G.); (E.Z.); (E.N.); (P.N.); (P.I.); (J.C.); (V.A.); (V.M.); (S.A.); (O.I.); (E.S.G.)
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Gizamba JM, Mugisha L. Leptospirosis in humans and selected animals in Sub-Saharan Africa, 2014-2022: a systematic review and meta-analysis. BMC Infect Dis 2023; 23:649. [PMID: 37784071 PMCID: PMC10546638 DOI: 10.1186/s12879-023-08574-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/29/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Leptospirosis is an emerging neglected tropical zoonotic disease of public health importance causing substantial morbidities and mortalities among humans. The infection is maintained within the population through interactions between humans, animals, and the environment. Understanding the burden of disease in both humans and animals is necessary for effective prevention and control in Sub-Saharan Africa (SSA). Therefore, we aimed to determine the seroprevalence of leptospirosis in humans, selected domestic animals, and rodents in SSA. METHODS A comprehensive search was done in six databases: Scopus, PubMed, Google Scholar, CINAHL, Web of Science, and African Journals Online databases for articles published between 01 January 2014 and 30 August 2022. Thirty-seven articles distributed across 14 out of 46 countries in SSA were included. The random effects meta-analysis model was used to pool the extracted seroprevalence data. RESULTS The overall pooled seroprevalence of leptospirosis among humans was 12.7% (95% CI: 7.5,20.8), 15.1% (95% CI: 9.4,23.5), and 4.5% (95% CI: 0.4, 35.6) based on results obtained using ELISA, MAT, and PCR diagnostic methods respectively. The pooled seroprevalence estimates among cattle were 29.2%, 30.1%, and 9.7% based on ELISA, MAT, and PCR respectively. Further, the pooled seroprevalence in goats was 30.0% for studies that used MAT, and among rodents, the pooled seroprevalence estimates were 21.0% for MAT and 9.6% for PCR diagnostic criteria. The seroprevalence of leptospirosis varied extensively between studies, across SSA regions and study setting (rural or urban). CONCLUSION Leptospirosis is widespread in SSA in both humans and animals based on the current results of the pooled seroprevalence in the limited studies available. The burden is high in animals and humans and underestimated due to limited studies and challenges with limited diagnostic capacity in most healthcare settings in SSA. Hence, we recommend that leptospirosis should be listed as a disease of concern and be included on the list of routine diagnostics among patients presenting with febrile illness in healthcare settings. Further, we recommend the enhancement of surveillance of leptospirosis in all countries in SSA and the development of strategies with a One Health perspective to effectively prevent and control leptospirosis.
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Affiliation(s)
- Jacob Mugoya Gizamba
- Department of Wildlife and Aquatic Animal Resources, College of Veterinary Medicine, Animal Resources & Biosecurity, Makerere University, Kampala, Uganda.
- Spatial Science Institute, University of Southern California, Los Angeles, USA.
| | - Lawrence Mugisha
- Department of Wildlife and Aquatic Animal Resources, College of Veterinary Medicine, Animal Resources & Biosecurity, Makerere University, Kampala, Uganda.
- Ecohealth Research Group, Conservation &Ecosystem Health Alliance, Kampala, Uganda.
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Mugabe VA, Inlamea OF, Ali S, Maholela P, Melchior B, Muianga AF, Oludele J, Sumail A, António V, Monteiro VO, Chongo I, Kitron U, Ribeiro GS, Gudo ES. Surveillance for arboviruses and leptospirosis among non-malarial acute febrile illness outpatients in areas affected by Cyclones Idai and Kenneth in Mozambique. FRONTIERS IN TROPICAL DISEASES 2023. [DOI: 10.3389/fitd.2023.1091545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
The floods associated with the landfall of cyclones Idai and Kenneth in Mozambique between March and April 2019 had a major impact on the country’s public health and placed the affected population at risk for vector- and rodent-borne diseases. Aiming to improve the diagnostic capacity, yield information to guide public health responses, and assess potential short-term effects of cyclones Idai and Kenneth on arboviruses (dengue, Zika, and chikungunya) and leptospirosis, a clinical and laboratory surveillance for non-malarial acute febrile illness was established in six health units located in different districts within the two provinces (Sofala and Cabo Delgado) affected by the cyclones. Patients were tested using real-time reverse transcriptase polymerase chain reaction (qRT-PCR) for dengue (DENV), Zika (ZIKV), and chikungunya (CHIKV) viruses and using enzyme linked immunoassays (ELISA) to detect nonstructural DENV protein 1 (NS1), as well as DENV, ZIKV, CHIKV, and Leptospira IgM antibodies. From April to September 2019, 305 patients aged ≥15 years were enrolled, of which 58.4% were women and the median age was 30 years old. All patients were qRT-PCR negative for the targeted arboviruses, but three (1.0%) were positive for DENV NS1 ELISA. Specific IgM antibodies against DENV, ZIKV, CHIKV or Leptospira were found in the serum of 104 (34.1%) patients. Our results indicate that vector- and rodent-borne disease transmission occurred in all districts under investigation in the wake of cyclones Idai and Kenneth, including some regions where cases had not been previously detected. The investigation provided useful information for post-cyclone emergency response purposes.
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Comia IR, Miambo RD, Noormahomed EV, Mahoche M, Pondja A, Schooley RT, Benson C, Sacarlal J. A systematic review and meta-analysis of the epidemiology of Leptospirosis in HIV uninfected and in people living with HIV from the Southern African Development Community. PLoS Negl Trop Dis 2022; 16:e0010823. [PMID: 36508469 PMCID: PMC9744292 DOI: 10.1371/journal.pntd.0010823] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 09/16/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Leptospirosis is an occupational, neglected febrile disease of bacterial origin transmitted between humans and animals. In this manuscript we summarize available data on Leptospira infection in HIV uninfected and in people living with HIV from the Southern African Development Community (SADC) countries, identifying gaps in knowledge and recommend future research priorities. METHODOLOGY Articles published between 1990 and 2021 were accessed by an online search of Google Scholar and Medline/PubMed performed between February 2020 and July 2022. The STATA program was used for the Meta-analysis. Pooled prevalence values with 95% confidence intervals and heterogeneity were determined. RESULTS Thirty studies from eight SADC countries, reporting the prevalence on Leptospira were reviewed. A pooled prevalence of 19% (CI: 13-25%), a heterogeneity level of 96% and index score ranging from 2 to 9 was determined. Only four (4) studies reported HIV co-infection status. Three species of Leptospira (Leptospira interrogans (4), L. kirschneri (3), Leptospira borgpetersenii (1) and 23 serogroups were identified. The most frequently reported serogroups were Icterohaemorrhagiae (13), Grippotyphosa and Australis (10) followed by Sejroe (8). CONCLUSION Studies on human leptospirosis in the SADC region are scarce, especially in people living with HIV. Additional studies aimed at determining the prevalence and the role of the pathogen in people living with HIV, including detailed clinical, molecular and demographic data are recommended.
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Affiliation(s)
- Isac Rodrigues Comia
- Faculty of Health Sciences, Lúrio University, Nampula, Mozambique
- Department of Microbiology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Regina Daniel Miambo
- Department of Para-Clinics, Faculty of Veterinary, Eduardo Mondlane University, Maputo, Mozambique
- Mozambique Institute for Health Education and Research (MIHER), Maputo, Mozambique
- * E-mail:
| | - Emília Virgínia Noormahomed
- Department of Microbiology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- Mozambique Institute for Health Education and Research (MIHER), Maputo, Mozambique
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, California, United States of America
| | - Manuel Mahoche
- Faculty of Health Sciences, Lúrio University, Nampula, Mozambique
- Mozambique Institute for Health Education and Research (MIHER), Maputo, Mozambique
| | - Alberto Pondja
- Department of Para-Clinics, Faculty of Veterinary, Eduardo Mondlane University, Maputo, Mozambique
| | - Robert Turner Schooley
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, California, United States of America
| | - Constance Benson
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, California, United States of America
| | - Jahit Sacarlal
- Mozambique Institute for Health Education and Research (MIHER), Maputo, Mozambique
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Wainaina M, Vey da Silva DA, Dohoo I, Mayer-Scholl A, Roesel K, Hofreuter D, Roesler U, Lindahl J, Bett B, Al Dahouk S. A systematic review and meta-analysis of the aetiological agents of non-malarial febrile illnesses in Africa. PLoS Negl Trop Dis 2022; 16:e0010144. [PMID: 35073309 PMCID: PMC8812962 DOI: 10.1371/journal.pntd.0010144] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 02/03/2022] [Accepted: 01/04/2022] [Indexed: 12/16/2022] Open
Abstract
Background The awareness of non-malarial febrile illnesses (NMFIs) has been on the rise over the last decades. Therefore, we undertook a systematic literature review and meta-analysis of causative agents of non-malarial fevers on the African continent. Methodology We searched for literature in African Journals Online, EMBASE, PubMed, Scopus, and Web of Science databases to identify aetiologic agents that had been reported and to determine summary estimates of the proportional morbidity rates (PMr) associated with these pathogens among fever patients. Findings A total of 133 studies comprising 391,835 patients from 25 of the 54 African countries were eligible. A wide array of aetiologic agents were described with considerable regional differences among the leading agents. Overall, bacterial pathogens tested from blood samples accounted for the largest proportion. The summary estimates from the meta-analysis were low for most of the agents. This may have resulted from a true low prevalence of the agents, the failure to test for many agents or the low sensitivity of the diagnostic methods applied. Our meta-regression analysis of study and population variables showed that diagnostic methods determined the PMr estimates of typhoidal Salmonella and Dengue virus. An increase in the PMr of Klebsiella spp. infections was observed over time. Furthermore, the status of patients as either inpatient or outpatient predicted the PMr of Haemophilus spp. infections. Conclusion The small number of epidemiological studies and the variety of NMFI agents on the African continent emphasizes the need for harmonized studies with larger sample sizes. In particular, diagnostic procedures for NMFIs should be standardized to facilitate comparability of study results and to improve future meta-analyses. Reliable NMFI burden estimates will inform regional public health strategies. Previous systematic reviews have highlighted the research priorities of causative agents for non-malarial febrile illnesses by counting the number of publications attributed to an agent. However, proportional morbidity rates are calculated by dividing the number of cases with a specific disease (numerator) by the total number of diagnosed fever cases (denominator) and are better indicators of the relative importance of aetiological agents in a population. Therefore, we present the leading causes of non-malarial febrile illnesses in African patients in both healthcare and community settings. Preference is given to HIV-negative patients when data could be found. We also determined summary estimates of Brucella spp., Chikungunya virus, Dengue virus, Haemophilus spp., Klebsiella spp., Leptospira spp., non-typhoidal Salmonella spp., typhoidal Salmonella spp., Staphylococcus spp., and Streptococcus spp. The wide array of aetiological agents causing febrile illnesses on the African continent does not only complicate malaria control programs but may also hamper response to epidemic and pandemic illnesses such as Ebola and COVID-19. The harmonisation of diagnostics and study designs will reduce between-study differences, which may result in better estimates of disease burden on the continent and in the different African regions. This information is important for Pan-African surveillance and control efforts.
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Affiliation(s)
- Martin Wainaina
- Department of Biological Safety, German Federal Institute for Risk Assessment, Berlin, Germany
- Department of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
- International Livestock Research Institute, Nairobi, Kenya
- * E-mail:
| | - David Attuy Vey da Silva
- Department of Biological Safety, German Federal Institute for Risk Assessment, Berlin, Germany
- Department of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - Ian Dohoo
- University of Prince Edward Island, Charlottetown, Canada
| | - Anne Mayer-Scholl
- Department of Biological Safety, German Federal Institute for Risk Assessment, Berlin, Germany
| | - Kristina Roesel
- Department of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
- International Livestock Research Institute, Nairobi, Kenya
| | - Dirk Hofreuter
- Department of Biological Safety, German Federal Institute for Risk Assessment, Berlin, Germany
| | - Uwe Roesler
- Institute for Animal Hygiene and Environmental Health, Freie Universität Berlin, Berlin, Germany
| | - Johanna Lindahl
- International Livestock Research Institute, Nairobi, Kenya
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Bernard Bett
- International Livestock Research Institute, Nairobi, Kenya
| | - Sascha Al Dahouk
- Department of Biological Safety, German Federal Institute for Risk Assessment, Berlin, Germany
- Department of Internal Medicine, RWTH Aachen University Hospital, Aachen, Germany
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8
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Afzal I, Thaker R, Weissman S, Kothari M. Leptospirosis as an unusual culprit of acute pancreatitis and portal vein thrombosis in a New Yorker. Clin Case Rep 2020; 8:690-695. [PMID: 32274037 PMCID: PMC7141725 DOI: 10.1002/ccr3.2736] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 12/16/2019] [Accepted: 01/13/2020] [Indexed: 11/10/2022] Open
Abstract
Leptospirosis often takes clinicians by surprise when presenting in urban locations with unusual manifestations. This delays diagnosis and treatment which increases mortality rate. Our case illustrates the importance of taking into account the socioeconomic backgrounds, environmental exposures, and clinical presentations of patients to create a good differential diagnosis.
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Affiliation(s)
- Iman Afzal
- NewYork‐Presbyterian Brooklyn Methodist Hospital affiliate of Weill Medical College of Cornell UniversityBrooklynNew York
| | - Rishi Thaker
- NewYork‐Presbyterian Brooklyn Methodist Hospital affiliate of Weill Medical College of Cornell UniversityBrooklynNew York
| | - Simcha Weissman
- Hackensack University‐Palisades Medical CenterNorth BergenNew Jersey
| | - Megha Kothari
- NewYork‐Presbyterian Brooklyn Methodist Hospital affiliate of Weill Medical College of Cornell UniversityBrooklynNew York
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9
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Romero-Sandoval N, Cifuentes L, León G, Lecaro P, Ortiz-Rico C, Cooper P, Martín M. High Rates of Exposures to Waterborne Pathogens in Indigenous Communities in the Amazon Region of Ecuador. Am J Trop Med Hyg 2020; 101:45-50. [PMID: 31162016 DOI: 10.4269/ajtmh.18-0970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Waterborne pathogens, associated with poverty and poor sanitary conditions, are a major cause of morbidity and mortality worldwide. There are limited data on the epidemiology of waterborne pathogens in indigenous populations living in the Amazon region. We did a cross-sectional survey in two indigenous Shuar communities in the Amazon region of Ecuador in which we documented the presence of pathogens representing different sources of environmental contamination of water. We detected protozoa and soil-transmitted helminths by microscopy of fecal samples and the presence of IgG antibodies to hepatitis A and Leptospira spp. in blood samples from individuals older than 2 years and collected data by questionnaire on sociodemographic factors and knowledge of infectious diseases. Seroprevalence for hepatitis A and Leptospira spp. were 98.1% (95% CI: 97.0-99.8) and 50.0% (95% CI: 43.3-56.6), respectively, whereas 62.6% (95% CI: 55.8-69.4) had enteric parasites in stool samples. In participants older than 6 years, eight of 10 had evidence of infection with or exposure to at least one of the pathogens studied. Although prevalence of pathogens varied by age, it did not vary significantly by gender, temporal migration, illiteracy, perceived morbidity, receipt of conditional cash transfers, water boiling practices, poor housing conditions, and anthropometric status. These findings indicate a high level of contamination of drinking water by human pathogens in these indigenous communities and the need for interventions to improve access to and use of clean drinking water in these marginalized communities.
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Affiliation(s)
- Natalia Romero-Sandoval
- Grups de Recerca d'Amèrica i Àfrica Llatines - GRAAL, Barcelona, Spain.,School of Medicine, Universidad Internacional del Ecuador, Quito, Ecuador
| | - Lizeth Cifuentes
- School of Medicine, Universidad Internacional del Ecuador, Quito, Ecuador
| | - Gabriela León
- School of Medicine, Universidad Internacional del Ecuador, Quito, Ecuador
| | - Paola Lecaro
- School of Medicine, Universidad Internacional del Ecuador, Quito, Ecuador
| | - Claudia Ortiz-Rico
- Grupo Salud-Comunid-Universidad de Santander, Facultad de Ciencias de la Salud, Universidad de Santander, Bucaramanga, Colombia.,Unidad de Bioestadística, Facultad de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Philip Cooper
- Fundación Ecuatoriana para la Investigación en Salud, FEPIS, Quinindé, Ecuador.,St. George's University, London, United Kingdom.,School of Medicine, Universidad Internacional del Ecuador, Quito, Ecuador
| | - Miguel Martín
- Unidad de Bioestadística, Facultad de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain.,Grups de Recerca d'Amèrica i Àfrica Llatines - GRAAL, Barcelona, Spain.,School of Medicine, Universidad Internacional del Ecuador, Quito, Ecuador
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10
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Systematic Review of Important Bacterial Zoonoses in Africa in the Last Decade in Light of the 'One Health' Concept. Pathogens 2019; 8:pathogens8020050. [PMID: 30995815 PMCID: PMC6631375 DOI: 10.3390/pathogens8020050] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 02/07/2023] Open
Abstract
Zoonoses present a major public health threat and are estimated to account for a substantial part of the infectious disease burden in low-income countries. The severity of zoonotic diseases is compounded by factors such as poverty, living in close contact with livestock and wildlife, immunosuppression as well as coinfection with other diseases. The interconnections between humans, animals and the environment are essential to understand the spread and subsequent containment of zoonoses. We searched three scientific databases for articles relevant to the epidemiology of bacterial zoonoses/zoonotic bacterial pathogens, including disease prevalence and control measures in humans and multiple animal species, in various African countries within the period from 2008 to 2018. The review identified 1966 articles, of which 58 studies in 29 countries met the quality criteria for data extraction. The prevalence of brucellosis, leptospirosis, Q fever ranged from 0–40%, 1.1–24% and 0.9–28.2%, respectively, depending on geographical location and even higher in suspected outbreak cases. Risk factors for human zoonotic infection included exposure to livestock and animal slaughters. Dietary factors linked with seropositivity were found to include consumption of raw milk and locally fermented milk products. It was found that zoonoses such as leptospirosis, brucellosis, Q fever and rickettsiosis among others are frequently under/misdiagnosed in febrile patients seeking treatment at healthcare centres, leading to overdiagnoses of more familiar febrile conditions such as malaria and typhoid fever. The interactions at the human–animal interface contribute substantially to zoonotic infections. Seroprevalence of the various zoonoses varies by geographic location and species. There is a need to build laboratory capacity and effective surveillance processes for timely and effective detection and control of zoonoses in Africa. A multifaceted ‘One Health’ approach to tackle zoonoses is critical in the fight against zoonotic diseases. The impacts of zoonoses include: (1) Humans are always in contact with animals including livestock and zoonoses are causing serious life-threatening infections in humans. Almost 75% of the recent major global disease outbreaks have a zoonotic origin. (2) Zoonoses are a global health challenge represented either by well-known or newly emerging zoonotic diseases. (3) Zoonoses are caused by all-known cellular (bacteria, fungi and parasites) and noncellular (viruses or prions) pathogens. (4) There are limited data on zoonotic diseases from Africa. The fact that human health and animal health are inextricably linked, global coordinated and well-established interdisciplinary research efforts are essential to successfully fight and reduce the health burden due to zoonoses. This critically requires integrated data from both humans and animals on zoonotic diseases.
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11
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de Vries SG, Visser BJ, Stoney RJ, Wagenaar JFP, Bottieau E, Chen LH, Wilder-Smith A, Wilson M, Rapp C, Leder K, Caumes E, Schwartz E, Hynes NA, Goorhuis A, Esposito DH, Hamer DH, Grobusch MP. Leptospirosis among Returned Travelers: A GeoSentinel Site Survey and Multicenter Analysis-1997-2016. Am J Trop Med Hyg 2018; 99:127-135. [PMID: 29761761 PMCID: PMC6085784 DOI: 10.4269/ajtmh.18-0020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 04/04/2018] [Indexed: 12/24/2022] Open
Abstract
Leptospirosis is a potentially fatal emerging zoonosis with worldwide distribution and a broad range of clinical presentations and exposure risks. It typically affects vulnerable populations in (sub)tropical countries but is increasingly reported in travelers as well. Diagnostic methods are cumbersome and require further improvement. Here, we describe leptospirosis among travelers presenting to the GeoSentinel Global Surveillance Network. We performed a descriptive analysis of leptospirosis cases reported in GeoSentinel from January 1997 through December 2016. We included 180 travelers with leptospirosis (mostly male; 74%; mostly tourists; 81%). The most frequent region of infection was Southeast Asia (52%); the most common source countries were Thailand (N = 52), Costa Rica (N = 13), Indonesia, and Laos (N = 11 each). Fifty-nine percent were hospitalized; one fatality was reported. We also distributed a supplemental survey to GeoSentinel sites to assess clinical and diagnostic practices. Of 56 GeoSentinel sites, three-quarters responded to the survey. Leptospirosis was reported to have been most frequently considered in febrile travelers with hepatic and renal abnormalities and a history of freshwater exposure. Serology was the most commonly used diagnostic method, although convalescent samples were reported to have been collected infrequently. Within GeoSentinel, leptospirosis was diagnosed mostly among international tourists and caused serious illness. Clinical suspicion and diagnostic workup among surveyed GeoSentinel clinicians were mainly triggered by a classical presentation and exposure history, possibly resulting in underdiagnosis. Suboptimal usage of available diagnostic methods may have resulted in additional missed, or misdiagnosed, cases.
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Affiliation(s)
- Sophia G. de Vries
- Center for Tropical Medicine and Travel Medicine, Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, The Netherlands
| | - Benjamin J. Visser
- Center for Tropical Medicine and Travel Medicine, Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, The Netherlands
| | - Rhett J. Stoney
- Travelers’ Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Jiri F. P. Wagenaar
- Department of Medical Microbiology, Leptospirosis Reference Center, Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, The Netherlands
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Lin H. Chen
- Travel Medicine Center, Mount Auburn Hospital, Cambridge, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Annelies Wilder-Smith
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
| | - Mary Wilson
- School of Medicine Global Health Sciences, University of California, San Francisco, San Francisco, California
| | - Christophe Rapp
- Service des Maladies Infectieuses et Tropicales, Hôpital d'Instruction des Armées Bégin, Paris, France
- CMETE Travel clinic, Paris, France
| | - Karin Leder
- School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Victorian Infectious Disease Service, Royal Melbourne Hospital at the Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Eric Caumes
- Service des Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Eli Schwartz
- Department of Internal Medicine “C”, The Center of Geographical Medicine, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noreen A. Hynes
- Division of Infectious Diseases, Geographic Medicine Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Abraham Goorhuis
- Center for Tropical Medicine and Travel Medicine, Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, The Netherlands
| | - Douglas H. Esposito
- Travelers’ Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Davidson H. Hamer
- Department of Global Health, Boston University School of Public Health, Boston, Maryland
| | - Martin P. Grobusch
- Center for Tropical Medicine and Travel Medicine, Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, The Netherlands
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
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12
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Recent findings related to immune responses against leptospirosis and novel strategies to prevent infection. Microbes Infect 2018; 20:578-588. [PMID: 29452258 DOI: 10.1016/j.micinf.2018.02.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 02/02/2018] [Accepted: 02/06/2018] [Indexed: 12/11/2022]
Abstract
What are the new approaches and emerging ideas to prevent leptospirosis, a neglected bacterial re-emerging zoonotic disease? How do Leptospira interrogans escape the host defenses? We aim here to review and discuss the most recent literature that provides some answers to these questions, in particular data related to a better understanding of adaptive and innate immunity towards leptospires, and design of vaccines. This is an opinion paper, not a comprehensive review. We will try to highlight the new strategies and technologies boosting the search for drugs and vaccines. We will also address the bottlenecks and difficulties impairing the search for efficient vaccines and the many gaps in our knowledge of immunity against leptospirosis. Finally, we aim to delineate how Leptospira spp. escape the innate immune responses of Toll-Like receptors (TLR) and Nod-Like receptors (NLR). The rational use of TLR and NLR agonists as adjuvants could be key to design future vaccines against pathogenic leptospires.
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