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Marteli AN, Genro LV, Diament D, Guasselli LA. Análise espacial da leptospirose no Brasil. SAÚDE EM DEBATE 2020. [DOI: 10.1590/0103-1104202012616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO A leptospirose é um problema de saúde pública mundial. No Brasil, ela é uma doença de notificação compulsória e está relacionada a áreas com precárias condições sanitárias. Foi realizado um estudo ecológico retrospectivo para observar a distribuição espacial e temporal de casos confirmados da leptospirose em escala nacional no período entre 2007 e 2017. A espacialização da leptospirose utilizou técnicas de geoprocessamento por análise de padrões pontuais e por mapas de densidade Kernel. Os resultados revelaram que, no período, foram registrados 42.310 casos confirmados de leptospirose no País, com média anual de 3.846 casos e prevalência de 1,9 a cada 100 mil habitantes. As localidades com mais casos prevalentes foram as regiões Sul e Norte. O Sudeste apresentou taxa de prevalência inferior à taxa nacional em virtude da alta densidade demográfica. O método Kernel se mostrou útil na análise global da situação epidemiológica da leptospirose nas regiões do Brasil.
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Jittimanee J, Wongbutdee J. Prevention and control of leptospirosis in people and surveillance of the pathogenic Leptospira in rats and in surface water found at villages. J Infect Public Health 2019; 12:705-711. [DOI: 10.1016/j.jiph.2019.03.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 01/10/2019] [Accepted: 03/24/2019] [Indexed: 01/12/2023] Open
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Leptospirosis Associated with the Ingestion of Packaged Foods and Working Environment Conditions: A Case Report. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2018. [DOI: 10.22207/jpam.12.3.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Cantwell T, Ferre A, Van Sint Jan N, Blamey R, Dreyse J, Baeza C, Diaz R, Regueira T. Leptospirosis-associated catastrophic respiratory failure supported by extracorporeal membrane oxygenation. J Artif Organs 2017; 20:371-376. [PMID: 29019017 PMCID: PMC7102126 DOI: 10.1007/s10047-017-0998-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 09/21/2017] [Indexed: 01/19/2023]
Abstract
A previously healthy, 39-year-old obese farmer, arrived hypotensive and tachycardic, with fever, myalgia, headache, abdominal pain, diarrhea, and progressive dyspnea. Ten days before symptoms onset, he was in direct contact with mice and working in a contaminated drain. Patient laboratory showed acute kidney injury and thrombocytopenia. Chest X-ray exhibited bilateral diffuse interstitial infiltrates. First-line empirical antibiotics were started and influenza discarded. Patient evolved with severe respiratory failure, associated with hemoptysis, and rapidly severe hemodynamic compromise. Despite neuromuscular blockade and prone positioning, respiratory failure increased. Accordingly, veno-venous ECMO was initiated, with bilateral femoral extraction and jugular return. After ECMO connection, there was no significant improvement in oxygenation, and low pre-membrane saturations and low arterial PaO2 of the membrane showed that we were out of the limits of the rated flow. Thus, a second membrane oxygenator was installed in parallel. Afterward, oxygenation improved, with subsequent perfusion enhancement. Regarding etiology, due to high suspicion index, Leptospira serology was performed, coming back positive and meropenem was maintained. The patient ultimately recovered and experience excellent outcome. The clinical relevance of the case is the scared evidence of leptospirosis-associated severe respiratory failure treated with ECMO. This experience emphasizes the importance of an optimal support, which requires enough membrane surface and flow for an obese, highly hyperdynamic patient, during this reversible disease. A high index of suspicion is needed for an adequate diagnosis of leptospirosis to implement the correct treatment, particularly in the association of respiratory failure, pulmonary hemorrhage, and an epidemiological-related context.
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Affiliation(s)
- Tamara Cantwell
- Centro de Pacientes Críticos, Clínica las Condes, Estoril 450, Las Condes, Santiago, Chile
| | - Andrés Ferre
- Centro de Pacientes Críticos, Clínica las Condes, Estoril 450, Las Condes, Santiago, Chile
| | - Nicolette Van Sint Jan
- Centro de Pacientes Críticos, Clínica las Condes, Estoril 450, Las Condes, Santiago, Chile
- Unidad de ECMO, Clínica las Condes, Santiago, Chile
| | - Rodrigo Blamey
- Departamento de Infectología, Clínica las Condes, Santiago, Chile
| | - Jorge Dreyse
- Centro de Pacientes Críticos, Clínica las Condes, Estoril 450, Las Condes, Santiago, Chile
| | - Cristian Baeza
- Departamento de Cardiocirugía, Clínica las Condes, Santiago, Chile
| | - Rodrigo Diaz
- Unidad de ECMO, Clínica las Condes, Santiago, Chile
| | - Tomás Regueira
- Centro de Pacientes Críticos, Clínica las Condes, Estoril 450, Las Condes, Santiago, Chile.
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Escandón-Vargas K, Osorio L, Astudillo-Hernández M. Seroprevalence and factors associated with Leptospira infection in an urban district of Cali, Colombia. CAD SAUDE PUBLICA 2017; 33:e00039216. [PMID: 28614448 DOI: 10.1590/0102-311x00039216] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 07/13/2016] [Indexed: 12/23/2022] Open
Abstract
Few studies have addressed Leptospira seroprevalence and risk factors in urban populations in Colombia. This study aimed to determine seroprevalence and factors associated with Leptospira infection in inhabitants of an urban district of Cali, Colombia. We collected sociodemographic and environmental data, as well as blood samples, from 353 subjects selected through a multistage cluster sampling design. We performed microagglutination test for the eight main Leptospira serogroups circulating in the region, considering a cut-off titer of ≥ 1:100. Most participants were female (226, 64.8%), with mean age 41.4 years, and 89 (32.6%) lived in low-low socioeconomic stratum (SES-1). Overall seroprevalence was 12.2% (95%CI: 10.3%-14.4%). Factors associated with Leptospira infection were SES 1, older age, single marital status, ethnic groups (Afro-Colombian and white/mestizo), school students, absence of toilet, barefoot walking, travel outside Cali in the previous month, and absence of skin and mucous-membrane lesions in the previous month. Our study suggests domestic and peridomiciliary transmission of Leptospira likely related to activities of daily living and inadequate environmental conditions. SES-1 is a major factor associated with Leptospira infection (adjusted OR = 4.08; 95%CI: 2.54-6.53; p < 0.001), suggesting that social and environmental conditions are key elements for endemicity of Leptospira infection in the study area. Epidemiological surveillance, improvement of environmental and sanitary conditions in various SES-1 areas, and community educational campaigns are recommended.
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Affiliation(s)
- Kevin Escandón-Vargas
- Escuela de Medicina, Facultad de Salud, Universidad del Valle, Cali, Colombia.,Escuela de Ciencias Básicas, Facultad de Salud, Universidad del Valle, Cali, Colombia
| | - Lyda Osorio
- Escuela de Salud Pública, Facultad de Salud, Universidad del Valle, Cali, Colombia
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Adiga DSA, Mittal S, Venugopal H, Mittal S. Serial Changes in Complete Blood Counts in Patients with Leptospirosis: Our Experience. J Clin Diagn Res 2017; 11:EC21-EC24. [PMID: 28658767 DOI: 10.7860/jcdr/2017/25706.9836] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 03/13/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Leptospirosis is an infectious disease caused by Leptospira interrogans. It is endemic in many parts of the world. The symptoms vary between milder forms to severe type with organ dysfunction. The disease presents with diagnostic challenge as it clinically mimics acute febrile illness due to other causes. AIM To study serial changes in complete blood counts in patients with leptospirosis. MATERIALS AND METHODS A retrospectively collected data was prospectively studied for clinical and laboratory data of leptospirosis patients proven by raised IgM titres by ELISA on day 2 (counted from day of admission of patient to hospital) of unexplained fever. The changes in complete blood counts from admission upto the discharge of the patient were studied. SPSS version 13 (SPSS Inc. Chicago) was used for data analysis. The collected data was analysed using frequency, percentage, mean, median, standard deviation and Mann-Whitney test. A p-value less than 0.05 were considered significant. RESULTS Mean haemoglobin concentration showed a progressive decline (<12.5 gm/dl) from day 1 to day 7 in both mild and severe disease. Platelet counts were significantly low (p=0.002), (<1,50,000 cells/mm3) in severe disease and showed a declining trend as compared to mild disease. Total leukocyte counts were significantly higher (p=0.001), (>11,000 cells/m3) in patients with severe disease from day 4 to day 5 of the illness. CONCLUSION Complete blood count is a routine test done in the monitoring of patients with leptospirosis. Declining haemoglobin, marked thrombocytopenia and a normal to high total leukocyte count will help in early detection of severe disease and thus preventing mortality by timely management.
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Affiliation(s)
| | - Salony Mittal
- Assistant Professor, Department of Pathology, Kasturba Medical College, Mangalore, Karnataka, India
| | - Harini Venugopal
- MBBS Student, Department of Pathology, Kasturba Medical College, Mangalore, Karnataka, India
| | - Sowmya Mittal
- Senior Resident, Department of Neurology, Kasturba Medical College, Mangalore, Karnataka, India
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Castaño A, Volcy M, García FA, Uribe CS, Bigal ME, Restrepo M. Headache in Symptomatic Intracranial Hypertension Secondary to Leptospirosis: A Case Report. Cephalalgia 2016; 25:309-11. [PMID: 15773829 DOI: 10.1111/j.1468-2982.2004.00841.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A Castaño
- Universidad de Antioquia, Hospital Universitario San Vicente de Paúl, Medellín, Colombia.
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Song ATW, Abas L, Andrade LC, Andraus W, D'Albuquerque LAC, Abdala E. A first report of leptospirosis after liver transplantation. Transpl Infect Dis 2016; 18:137-40. [PMID: 26671230 DOI: 10.1111/tid.12490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 10/15/2015] [Accepted: 10/17/2015] [Indexed: 12/01/2022]
Abstract
Leptospirosis has been rarely reported in solid organ transplant recipients. We report the first case to our knowledge of leptospirosis in a liver transplant recipient who developed jaundice and renal insufficiency. We describe his favorable clinical progression and discuss the possible mechanisms involved in the more benign disease course. We also review the previously published cases of leptospirosis in solid organ transplant recipients. Although this disease does not appear to present any particularities in this context, we highlight the importance of clinical suspicion in this setting, particularly after liver transplantation.
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Affiliation(s)
- A T W Song
- Liver and Digestive Organ Transplantation Division, Gastroenterology Department, Clinicas Hospital, University of São Paulo Medical School, São Paulo, Brazil.,Liver Transplant and Surgery Laboratory - LIM37, University of São Paulo Medical School, São Paulo, Brazil
| | - L Abas
- Liver and Digestive Organ Transplantation Division, Gastroenterology Department, Clinicas Hospital, University of São Paulo Medical School, São Paulo, Brazil
| | - L C Andrade
- Nephrology Department, Clinicas Hospital, University of São Paulo Medical School, São Paulo, Brazil
| | - W Andraus
- Liver and Digestive Organ Transplantation Division, Gastroenterology Department, Clinicas Hospital, University of São Paulo Medical School, São Paulo, Brazil
| | - L A C D'Albuquerque
- Liver and Digestive Organ Transplantation Division, Gastroenterology Department, Clinicas Hospital, University of São Paulo Medical School, São Paulo, Brazil.,Liver Transplant and Surgery Laboratory - LIM37, University of São Paulo Medical School, São Paulo, Brazil
| | - E Abdala
- Viral Hepatitis Laboratory - LIM-47, University of São Paulo Medical School, São Paulo, Brazil.,Infectious Diseases Department, Clinicas Hospital, University of São Paulo Medical School, São Paulo, Brazil
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Allwood P, Muñoz-Zanzi C, Chang M, Brown PD. Knowledge, perceptions, and environmental risk factors among Jamaican households with a history of leptospirosis. J Infect Public Health 2014; 7:314-22. [PMID: 24816244 DOI: 10.1016/j.jiph.2014.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 03/20/2014] [Accepted: 03/24/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Leptospirosis is a globally important zoonotic disease caused by pathogenic Leptospira, and outbreaks typically follow heavy rainfall and flooding. This study examined the knowledge and perceptions concerning leptospirosis, factors associated with environmental hygiene and sanitation, and the presence of Leptospira in water samples from households with or without a history of the disease in the parish of St. Mary, Jamaica. METHODS The study employed a cross-sectional design in 43 communities within the parish of St. Mary, Jamaica between September 2008 and March 2009. Households that had at least one confirmed case of leptospirosis during the 2005 or 2007 outbreaks were assessed for living conditions, environmental hygiene, and for knowledge and risk perceptions about leptospirosis. A parallel sampling scheme was used for households with no reported cases during the outbreak years. RESULTS Almost 97% of the participants reported having heard of leptospirosis; however, less than 40% of respondents from households with a history of leptospirosis agreed that leptospirosis was a problem in the parish. Among households without a history of leptospirosis, this perception was greater in urban/peri-urban households than in rural households (59% vs. 21%; p=0.04). Risk behaviors or living conditions were common; however, there was a high level of awareness about the health risks associated with flooding. Among households with history of leptospirosis, the perception that nothing can be done to control rodents was significantly higher (p<0.04) in rural (50%) than in urban/peri-urban (17.6%) households. Nine (4%) water samples were positive for Leptospira; 56% of these were from water stored for domestic purposes. Overall, residence in rural communities, presence of a garbage dump, and leptospiral DNA in water samples correlated with households with the history of the disease (p<0.01). CONCLUSIONS Education of rural communities regarding leptospirosis and its prevention through proper waste disposal and rodent control should be urgently initiated.
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Affiliation(s)
- Paul Allwood
- Division of Environmental Health, School of Public Health, University of Minnesota, 420 Delaware Street S.E., Minneapolis, MN 55455, United States
| | - Claudia Muñoz-Zanzi
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S. Second Street, Suite 300, Minneapolis, MN 55454, United States
| | - Martin Chang
- Division of Environmental Health, School of Public Health, University of Minnesota, 420 Delaware Street S.E., Minneapolis, MN 55455, United States
| | - Paul D Brown
- Department of Basic Medical Sciences, University of West Indies, Mona, Kingston 7, Jamaica.
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Gancheva G, Karcheva M. Severe leptospirosis observed in a man who had just returned from abroad. Balkan Med J 2013; 30:116-9. [PMID: 25207081 DOI: 10.5152/balkanmedj.2012.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 09/17/2012] [Indexed: 11/22/2022] Open
Abstract
Leptospirosis, a re-emerging zoonosis caused by pathogenic Leptospira, has a low incidence in Bulgaria. This paper reports a case of leptospirosis in Pleven, Bulgaria, in which the subject was infected after wading through irrigative canal in northern Greece. Two days later, he had a fever, myalgia and vomiting followed by jaundice, darkness of urine and oliguria. The patient was admitted to Clinic of Infectious Diseases at University Hospital-Pleven after returning to Bulgaria. The history and laboratory findings suggested icterohaemorrhagic leptospirosis. Penicillin G was prescribed and intensive supportive treatment was initiated. Dialysis was performed two hours after admission and was followed by poliuric stage of acute renal failure (peak urine output 16 600 mL/day). Microaglutination test (MAT) for sero-diagnosis was positive (L. hardjo 1:1600, L. icterohaemorrhagiae 1:800). The patient was discharged after sixteen days with improved renal and liver functions. In conclusion, The probability of leptospirosis should not be ignored in patients with fever after returning from abroad. The prompt dialysis and adequate treatment improve prognosis.
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Affiliation(s)
- Galya Gancheva
- Department of Infectious Diseases, Epidemiology, Parasitology and Tropical Medicine, Medical University, Pleven, Bulgaria
| | - Milena Karcheva
- Department of Infectious Diseases, Epidemiology, Parasitology and Tropical Medicine, Medical University, Pleven, Bulgaria
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Abstract
Leptospirosis has a spectrum of presentation which ranges from mild disease to a severe form comprising of jaundice and renal failure. Involvement of the lung can vary from subtle clinical features to deadly pulmonary hemorrhage and acute respiratory distress syndrome. Of late, it has been identified that leptospirosis can present atypically with predominant pulmonary manifestations. This can delay diagnosis making and hence optimum treatment. The purpose of this review is to bring together all the reported pulmonary manifestations of leptospirosis and the recent trends in the management.
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Affiliation(s)
- Sameer Gulati
- Department of Internal Medicine, St Stephen's Hospital, Tis Hazari, Delhi, India
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Majd NS, Darian EK, Khaki P, Bidhendi SM, Yahaghi E, Mirnejad R. Epidemiological patterns of Leptospira spp. among slaughterhouse workers in Zanjan– Iran. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2012. [DOI: 10.1016/s2222-1808(12)60218-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Azevedo AFC, Miranda-Filho DDB, Henriques-Filho GT, Leite A, Ximenes RAA. Randomized controlled trial of pulse methyl prednisolone × placebo in treatment of pulmonary involvement associated with severe leptospirosis. [ISRCTN74625030]. BMC Infect Dis 2011; 11:186. [PMID: 21718474 PMCID: PMC3162901 DOI: 10.1186/1471-2334-11-186] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Accepted: 06/30/2011] [Indexed: 12/11/2022] Open
Abstract
Background The lungs are involved in up to 70% of cases of leptospirosis. In the more severe forms-bleeding from the lungs and acute respiratory distress syndrome-the lethality is high. The treatment proposed for leptospirotic pneumonitis includes just care for patients in critical condition. Clinical and experimental studies point to the involvement of immunological mechanisms in the physiopathology of lung damage caused by leptospirosis. The aim of this study is to evaluate pulse treatment with methylprednisolone × placebo for leptospirotic pneumonitis. Study design This is a randomized double-blind clinical trial to test the efficacy of pulse treatment with methylprednisolone in patients with leptospirotic pneumonitis, compared with a placebo. The patients are recruited from three hospitals in the city of Recife, in the Brazilian State of Pernambuco. The exclusion criteria include patients aged under 15 years, a history of hypersensitivity to the use of corticosteroids, the presence of active infection of fungal, tuberculous or bacterial origin apart from the infection by leptospira itself, the presence of hemoconcentration or atypical lymphocyte count on admission to hospital, the presence of co-morbidities that could be responsible for the radiological and gasometric alterations used to diagnose leptospirotic pneumonitis, evidence of recent cranial trauma, neurosurgery, peptic ulcer, and participation in another clinical trial. The patients are followed until they are discharged from hospital or die. The intervention consists of endovenous pulse treatment with 1 g methylprednisolone for three consecutive days in the study group and a placebo in the control group. The primary end-point is mortality from leptospirotic pneumonitis. The secondary end-points are: evolution of lung disease; the occurrence of nosocomial respiratory infection; duration of mechanical ventilation; duration of intensive care unit (ICU) stay; duration of hospital stay; occurrence of other infection-related complications; other respiratory complications; and adverse effects of methylprednisolone. The study is designed to recruit 266 patients and has a statistical "power" of 80% to detect a 50% reduction in mortality. Discussion Lung involvement in leptospirosis is a serious manifestation, with a high and variable mortality rate. There is still no specific clearly-established treatment. Well-designed studies are needed to pave the way towards development of such a treatment.
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Affiliation(s)
- Ana Flávia C Azevedo
- Department of Tropical Medicine, Federal University of Pernambuco, Recife, Brazil.
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Marchiori E, Lourenço S, Setúbal S, Zanetti G, Gasparetto TD, Hochhegger B. Clinical and imaging manifestations of hemorrhagic pulmonary leptospirosis: a state-of-the-art review. Lung 2010; 189:1-9. [PMID: 21152929 DOI: 10.1007/s00408-010-9273-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 11/23/2010] [Indexed: 12/20/2022]
Abstract
Leptospirosis, a spirochetal zoonosis, is frequently unrecognized due to its manifestation as an undifferentiated fever. It is an emerging infectious disease that has changed from an occupational disease of veterinarians, farmers, butchers, and other animal handlers to a cause of epidemics in poor and decayed urban communities in developing countries. Humans are infected when mucous membranes or abraded skin come into direct contact with the urine of infected animals, especially rats and dogs. Mortality from severe leptospirosis is high, even when optimal treatment is provided. The diagnosis of leptospirosis is based on clinical findings, history of direct or indirect exposure to infected animals in endemic areas, and positive serological tests. It should be considered in the differential diagnosis of patients with febrile illnesses associated with pneumonitis and respiratory failure, especially when hemoptysis is present. Severe pulmonary involvement in leptospirosis consists primarily of hemorrhagic pneumonitis. In advanced cases, adult respiratory distress syndrome and massive pulmonary hemorrhage may occur. Chest radiographs show bilateral alveolar infiltrates and/or resemble viral pneumonia, bronchopneumonia, tuberculosis, adult respiratory distress syndrome, and other causes of pulmonary hemorrhage such as Goodpasture syndrome. High-resolution computed tomography scans may show nodular infiltrates, areas of consolidation, ground-glass attenuation, and crazy-paving patterns. Bronchoalveolar lavage and autopsy studies have suggested that ground-glass opacities and air-space consolidations are secondary to pulmonary hemorrhage. Although not specific, the presence of these computed tomography findings in a febrile patient with an appropriate history should suggest a diagnosis of leptospirosis.
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Affiliation(s)
- Edson Marchiori
- Department of Radiology, Fluminense Federal University, Rua Thomaz Cameron, 438 Valparaiso, CEP 25685.120, Petrópolis, Rio de Janeiro, Brazil.
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Craig SB, Graham GC, Burns MA, Dohnt MF, Smythe LD, McKay DB. Haematological and clinical-chemistry markers in patients presenting with leptospirosis: a comparison of the findings from uncomplicated cases with those seen in the severe disease. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2010; 103:333-41. [PMID: 19508751 DOI: 10.1179/136485909x435058] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In a retrospective study, the laboratory findings from the first blood samples taken following hospital presentation in patients with uncomplicated leptospirosis have been compared with the corresponding data for patients admitted, to a high-dependency medical ward or intensive-care unit, with severe leptospirosis. The aim was to identify those laboratory markers that differentiate the two clinical groups upon initial presentation. Marked differences were observed, in some of the haematological and clinical-chemistry markers, between the patients with severe leptospirosis and those with the uncomplicated disease. Statistically significant differences were found in haemoglobin concentrations, haematocrits, counts of erythrocytes, leucocytes, neutrophils and platelets, and serum concentrations of creatinine, urea, protein and albumin. These markers may therefore be useful in the assessment and early detection of disease severity in patients with suspected leptospirosis. Investigations into the use of albumin treatments, which might significantly improve the clinical care of patients with acute leptospirosis, appear to be justified.
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Affiliation(s)
- S B Craig
- WHO/FAO/OIE Collaborating Centre for Reference and Research on Leptospirosis, Communicable Diseases Unit, Queensland Health Forensic and Scientific Services, P.O. Box 594, Archerfield, Queensland, 4108, Australia.
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Daher EF, Lima RS, Silva Júnior GB, Silva EC, Karbage NN, Kataoka RS, Carvalho Júnior PC, Magalhães MM, Mota RM, Libório AB. Clinical presentation of leptospirosis: a retrospective study of 201 patients in a metropolitan city of Brazil. Braz J Infect Dis 2010. [DOI: 10.1016/s1413-8670(10)70002-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Liao S, Sun A, Ojcius DM, Wu S, Zhao J, Yan J. Inactivation of the fliY gene encoding a flagellar motor switch protein attenuates mobility and virulence of Leptospira interrogans strain Lai. BMC Microbiol 2009; 9:253. [PMID: 20003186 PMCID: PMC3224694 DOI: 10.1186/1471-2180-9-253] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2009] [Accepted: 12/09/2009] [Indexed: 12/20/2022] Open
Abstract
Background Pathogenic Leptospira species cause leptospirosis, a zoonotic disease of global importance. The spirochete displays active rotative mobility which may contribute to invasion and diffusion of the pathogen in hosts. FliY is a flagellar motor switch protein that controls flagellar motor direction in other microbes, but its role in Leptospira, and paricularly in pathogenicity remains unknown. Results A suicide plasmid for the fliY gene of Leptospira interrogans serogroup Icterohaemorrhagiae serovar Lai strain Lai that was disrupted by inserting the ampicillin resistance gene (bla) was constructed, and the inactivation of fliY gene in a mutant (fliY-) was confirmed by PCR and Western Blot analysis. The inactivation resulted in the mRNA absence of fliP and fliQ genes which are located downstream of the fliY gene in the same operon. The mutant displayed visibly weakened rotative motion in liquid medium and its migration on semisolid medium was also markedly attenuated compared to the wild-type strain. Compared to the wild-type strain, the mutant showed much lower levels of adhesion to murine macrophages and apoptosis-inducing ability, and its lethality to guinea pigs was also significantly decreased. Conclusion Inactivation of fliY, by the method used in this paper, clearly had polar effects on downstream genes. The phentotypes observed, including lower pathogenicity, could be a consequence of fliY inactivation, but also a consequence of the polar effects.
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Affiliation(s)
- Sumei Liao
- Department of Medical Microbiology and Parasitology, College of Medicine, Zhejiang University, Hangzhou 310058, PR China.
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Liverpool J, Francis S, Liverpool CE, Dean GT, Mendez DD. Leptospirosis: case reports of an outbreak in Guyana. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2008; 102:239-45. [PMID: 18348778 DOI: 10.1179/136485908x278784] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Although leptospirosis is a globally important zoonotic disease that affects humans on all continents, in both urban and rural areas, it often goes undiagnosed because its clinical manifestations are frequently non-specific. Even when leptospirosis is suspected, confirmation is made difficult by problems in isolating the causative organism in culture and by the low sensitivity of the available serological tests. Following torrential rains and flooding in January-February 2005, an outbreak of leptospirosis was suspected in Guyana, South America. Overall, 108 suspected cases presented at a medical post in the East Coast area of Guyana, and some of these cases are described in detail here. A better understanding of the clinical and paraclinical characteristics of leptospirosis should improve the recognition and appropriate treatment of the disease. Health education could reduce exposure, and physicians and primary healthcare workers could be made more aware of the signs and symptoms of leptospirosis.
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Affiliation(s)
- J Liverpool
- Morehouse School of Medicine, Stone Mountain, GA 30087, USA.
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19
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Comparison between early and delayed acute kidney injury secondary to infectious disease in the intensive care unit. Int Urol Nephrol 2008; 40:731-9. [PMID: 18368509 DOI: 10.1007/s11255-008-9352-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2007] [Accepted: 02/08/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND Results from a number of studies suggest that the delayed manifestation of acute kidney injury (AKI) is associated with higher in-hospital mortality, while other studies were unable to demonstrate any difference among early and delayed AKI in terms of in-hospital mortality. OBJECTIVE The aim of this study was to investigate differences in outcome among patients with AKI upon admission to an intensive care unit (ICU) and those who develop AKI post-admission. METHODS We studied patients with AKI secondary to infectious diseases admitted to the ICU. We retrospectively compared data on patients admitted with AKI (early AKI) with data on those who developed AKI 24 h after admission (delayed AKI). RESULTS Acute kidney injury occurred in 147 of 829 (17.7%) patients admitted to the ICU. Of these, 96 (65%) had early AKI and 51 (35%) had delayed AKI. Renal failure was classified according to RIFLE criteria-an AKI-specific severity score that is used to place patients into one of five categories: risk, injury, failure, loss or end-stage renal disease. Based on these criteria, 6% of the early AKI and 4% of the delayed AKI patients were in risk category, 18% of the early AKI and 27% of the delayed AKI patients were in the injury category and 76% of the early AKI and 69% of the delayed AKI patients were in the failure category. We found no significant association between RIFLE and death. On admission, patients with early AKI had statistically significantly higher serum urea and creatinine levels than delayed AKI patients (P<0.0001). Arterial bicarbonate was lower in early AKI (P=0.02). Sepsis, hypotension and use of mechanical ventilation were more frequent in delayed AKI (P<0.05). The APACHE II score was higher in early AKI (P=0.05) patients. In total, 98 (66.7%) patients died, with a tendency towards higher mortality in patients with delayed AKI (61.5 vs. 76.5%, P=0.07). CONCLUSION Mortality among patients with infectious diseases-associated AKI admitted to the ICU is high, with a trend to be higher in those who developed delayed AKI.
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Erdogan HM, Karapehlivan M, Citil M, Atakisi O, Uzlu E, Unver A. Serum sialic acid and oxidative stress parameters changes in cattle with leptospirosis. Vet Res Commun 2008; 32:333-9. [DOI: 10.1007/s11259-008-9036-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2007] [Accepted: 01/14/2008] [Indexed: 10/22/2022]
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Mendoza P, Mayor P, Gálvez HA, Céspedes MJ, Jori F. Antibodies against Leptospira spp. in captive collared peccaries, Peru. Emerg Infect Dis 2008; 13:793-4. [PMID: 18044048 PMCID: PMC2738441 DOI: 10.3201/eid1305.060027] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
| | - Pedro Mayor
- Autonomous University of Barcelona, Bellaterra, Spain
| | | | | | - Ferran Jori
- Centre de Coopération Internationale en Recherche Agronomique pour le Développement, Montpellier, France
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Liu Y, Zheng W, Li L, Mao Y, Yan J. Pathogenesis of leptospirosis: interaction of Leptospira interrogans with in vitro cultured mammalian cells. Med Microbiol Immunol 2007; 196:233-9. [PMID: 17429690 DOI: 10.1007/s00430-007-0047-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2007] [Indexed: 02/02/2023]
Abstract
Interactions of virulent Leptospira interrogans with murine monocyte-macrophage-like J774A.1 cells and Vero (African green monkey kidney fibroblasts) cells from attachment to internalization were investigated by a series of morphological analysis. Fontana silver staining revealed that only the pathogenic leptospires were able to attach to host cells and the attachment pattern varied depending on cell types that they interacted with. Transmission electron microscopy (TEM) analysis confirmed the formation of the leptospires-containing phagosomes and their colocalization with lysosomes in macrophages were verified by confocal microscopic analysis. Results of F-actin rearrangements examination indicated that virulent leptospires invaded host cells via a microfilament-independent pathway.
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Affiliation(s)
- Yunying Liu
- Department of Medical Microbiology and Parasitology, School of Medicine, Zhejiang University, Hangzhou, 310058, People's Republic of China
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Abstract
AIMS Acute lung injury (ALI) is a serious clinical problem. We investigated the pathogenetic mechanisms of ALI caused by leptospirosis. METHODS The study included five cases of leptospirosis. We monitored the arterial pressure (AP) and heart rate (HR) and analysed the AP and HR variabilities for assessment of autonomic functions. Histopathological changes in the lung, brain, kidney, and liver were examined. In addition, we identified the expression of inducible nitric oxide synthase (iNOS) using immunohistochemical stain. RESULTS Five patients associated with leptospirosis died of ALI. Before death, severe hypotension and bradycardia occurred. Spectral analysis of AP and HR variabilities indicated decreased sympathetic drive with increased parasympathetic activity. Pathological examinations revealed alveolar haemorrhage and necrotic lesions in various organs. Immunohistochemical stain disclosed iNOS activity in multiple organs. Biochemical determinations indicated hypoxia, hyperglycaemia, increased nitrite/nitrate, methyl guanidine and other factors. CONCLUSIONS These changes suggest that leptospirosis causes severe hypotension and bradycardia accompanied by autonomic dysfunction. Finally, multiple organ failure and damage ensued. The pathogenesis of lung and organ injury may involve iNOS and NO production.
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Affiliation(s)
- Hsing I Chen
- Institute of Integrative Physiology and Clinical Sciences and of Medical Sciences, Tzu Chi University, Hualien, Taiwan
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Li L, Ojcius DM, Yan J. Comparison of invasion of fibroblasts and macrophages by high- and low-virulence Leptospira strains: colonization of the host-cell nucleus and induction of necrosis by the virulent strain. Arch Microbiol 2007; 188:591-8. [PMID: 17622516 DOI: 10.1007/s00203-007-0280-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2007] [Revised: 05/23/2007] [Accepted: 06/21/2007] [Indexed: 01/29/2023]
Abstract
The infection cycle of low- and high-virulence strains of Leptospira interrogans was compared in fibroblasts and macrophages. L. interrogans serovar Lai strain Lai was used as a representative high-virulence strain, while L. interrogans serovars Pomona strain Luo was used as a low-virulence strain. L. biflexa serovar Patoc strain Patoc I, a nonparasitic strain of Leptospira, was used as a control. Both the high- and low-virulence strains could adhere to fibroblasts and macrophages using one or both ends of the spirochete, which was followed by phagocytosis of both strains. Both strains adhered more strongly to macrophages than fibroblasts. However, the high-virulence strain could invade the host-cell nucleus, while the low-virulence strain remained in phagosomes. The L. biflexa strain neither adhered to nor invaded either cell type. Both of the L. interrogans strains also induced cell death (mostly necrosis) of macrophages, whether or not the spirochetes were viable, suggesting that leptospiral virulence is unrelated to macrophage death. However, the high-virulence strain induced mainly necrosis in fibroblasts, while the low-virulence strain induced more apoptosis. Thus, the main feature distinguishing the two L. interrogans strains is the ability of the high-virulence strain to invade the host-cell nucleus and induce pro-inflammatory necrosis in fibroblasts.
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Affiliation(s)
- Liwei Li
- Department of Medical Microbiology and Parasitology, Medical School of Zhejiang University, Hangzhou, 310058 China
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Bukhari H. An Unusual Cause of Hemoptysis in a Young Male Patient. J Taibah Univ Med Sci 2007. [DOI: 10.1016/s1658-3612(07)70029-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Abstract
This article describes infectious diseases that are of special importance to intensivists. The emphasis on epidemiology notwithstanding, it also addresses clinical, diagnostic, and treatment issues related to each infection described. The discussion avoids terrorism-related aspects of these infections, because they were very well covered in the October 2005 issue of the Critical Care Clinics.
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Affiliation(s)
- Raul E Istúriz
- Department of Medicine, Infectious Diseases, Centro Médico de Caracas, Av. El Estanque, San Bernardino, Caracas 1011, Venezuela.
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Yang HL, Jiang XC, Zhang XY, LI WJ, HU BY, Zhao GP, Guo XK. Thrombocytopenia in the experimental leptospirosis of guinea pig is not related to disseminated intravascular coagulation. BMC Infect Dis 2006; 6:19. [PMID: 16451735 PMCID: PMC1434752 DOI: 10.1186/1471-2334-6-19] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2005] [Accepted: 02/02/2006] [Indexed: 11/10/2022] Open
Abstract
Background Thrombocytopenia is commonly observed in severe leptospirosis. However, previous studies on coagulation alterations during leptospirosis resulted in inconsistent conclusions. Some findings showed that the prominent levels of thrombocytopenia observed in severe leptospirosis did not reflect the occurrence of disseminated intravascular coagulation (DIC) syndrome, while the others reached the conclusion that the hemorrhages observed in leptospirosis were due to DIC. The aim of this study is to elucidate whether DIC is an important feature of leptospirosis. Methods The leptospirosis model of guinea pig was established by intraperitoneal inoculation of Leptospira interrogans strain Lai. Hematoxylin and eosin (HE) staining, electron microscopy and immunohistochemistry staining were used to detect the pathologic changes. Platelet thrombus or fibrin thrombus was detected by HE, Martius Scarlet Blue (MSB) staining and electron microscopy. Hemostatic molecular markers such as 11-dehydrogenate thromboxane B2 (11-DH-TXB2), thrombomodulin (TM), thrombin-antithrombin III complex (TAT), D-Dimer and fibrin (ogen) degradation products (FDPs) in the plasma were examined by quantitative enzyme-linked immunosorbent assay (ELISA) to evaluate the hematological coagulative alterations in leptospirosis models. Results Pulmonary hemorrhage appeared in the model guinea pig 24 hours after leptospires intraperitoneal inoculation, progressing to a peak at 96 hours after the infection. Leptospires were detected 24 hours post-inoculation in the liver, 48 hours in the lung and 72 hours in the kidney by immunohistochemistry staining. Spiral form of the bacteria was initially observed in the liver, lung and kidney suggestive of intact leptospires, granular form of leptospires was seen as the severity increased. Platelet aggregation in hepatic sinusoid as well as phagocytosis of erythrocytes and platelets by Kupffer cells were both observed. Neither platelet thrombus nor fibrin thrombus was found in the liver, lung or kidney via morphological observation. Thrombocytopenia was observed in all infected guinea pigs of our experimental leptospirosis study. Analysis of hematologic molecular markers showed that 11-DH-TXB2 and TM in the plasma were elevated significantly. TAT that reflects the thrombin activation had a trend of decline after infection. Although D-dimer and FDPs increased statistically, the increasing may not bear clinical significance. Conclusion Pathologic and hematological studies for experimental leptospirosis of guinea pig indicated that the thrombocytopenia found in guinea pigs did not correlate with the occurrence of DIC. The platelet aggregation and Kupffer cells phagocytosis might be the potential causes of thrombocytopenia in severe leptospirosis.
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Affiliation(s)
- Hong-Liang Yang
- Department of Pathology, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Department of Microbiology and Parasitology, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Xu-Cheng Jiang
- Department of Pathology, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Xiang-Yan Zhang
- Department of Microbiology and Parasitology, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Wen-Jun LI
- Department of Pathology, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Bao-Yu HU
- Department of Microbiology and Parasitology, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Guo-Ping Zhao
- Chinese National Human Genome Center at Shanghai, Zhangjiang High Tech Park, Shanghai 201203, China
| | - Xiao-Kui Guo
- Department of Microbiology and Parasitology, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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Tassinari WDS, Pellegrini DDCP, Sabroza PC, Carvalho MS. [Spatial distribution of leptospirosis in the city of Rio de Janeiro, Brazil, 1996-1999]. CAD SAUDE PUBLICA 2004; 20:1721-9. [PMID: 15608875 DOI: 10.1590/s0102-311x2004000600031] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Leptospirosis, one of the most widely disseminated zoonoses in the world, is endemic in Brazil and is characterized by outbreaks during seasons with the greatest rainfall. In 1996 the city of Rio de Janeiro experienced one of the largest urban epidemics in the country, shortly after heavy rainstorms in the month of February, with 1,732 reported cases and 51 deaths. The objective of this work was to describe the spatial distribution of leptospirosis in the city of Rio de Janeiro during the period 1996-1999. Data were from the National Information System for Reportable Diseases. The kernel ratio for cases and population generated a smoothed surface, which estimates the intensity of the leptospirosis incidence rate. In the resulting maps over the course of the study period, the sites with the highest leptospirosis intensity were not repeated, and the sites normally considered as having the highest risk -- slum areas and flooded areas -- were not always the most heavily affected. The techniques used can represent an important methodological acquisition for establishing territory-based surveillance.
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Meites E, Jay MT, Deresinski S, Shieh WJ, Zaki SR, Tompkins L, Smith DS. Reemerging leptospirosis, California. Emerg Infect Dis 2004; 10:406-12. [PMID: 15109405 PMCID: PMC3322787 DOI: 10.3201/eid1003.030431] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Leptospirosis is a reemerging infectious disease in California. Leptospirosis is the most widespread zoonosis throughout the world, though it is infrequently diagnosed in the continental United States. From 1982 to 2001, most reported California cases occurred in previously healthy young adult white men after recreational exposures to contaminated freshwater. We report five recent cases of human leptospirosis acquired in California, including the first documented common-source outbreak of human leptospirosis acquired in this state, and describe the subsequent environmental investigation. Salient features in the California cases include high fever with uniform renal impairment and mild hepatitis. Because leptospirosis can progress rapidly if untreated, this reemerging infection deserves consideration in febrile patients with a history of recreational freshwater exposure, even in states with a low reported incidence of infection.
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Affiliation(s)
- Elissa Meites
- Stanford University School of Medicine, Stanford, California, USA
| | - Michele T. Jay
- California Department of Health Services, Sacramento, California, USA
| | - Stanley Deresinski
- California Department of Health Services, Sacramento, California, USA
- Santa Clara Valley Medical Center, San Jose, California, USA
| | - Wun-Ju Shieh
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sherif R. Zaki
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lucy Tompkins
- Stanford University School of Medicine, Stanford, California, USA
| | - D. Scott Smith
- Stanford University School of Medicine, Stanford, California, USA
- Kaiser Permanente Medical Group, Redwood City, California, USA
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Luo YH, Yan J, Mao YF, Li SP. Determination of the genus-specific antigens in outer membrane proteins from the strains of Leptospira interrogans and Leptospira biflexa with different virulence. JOURNAL OF ZHEJIANG UNIVERSITY. SCIENCE 2004; 5:462-466. [PMID: 14994438 DOI: 10.1631/jzus.2004.0462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To determine the existence of genus-specific antigens in outer membrane proteins (OMPs) of leptospira with different virulence. METHODS Microscope agglutination test (MAT) was applied to detect the agglutination between commercial rabbit antiserum against leptospiral genus-specific TR/Patoc I antigen and 17 strains of Leptospira interrongans belonging to 15 serogroups and 2 strains of Leptospira biflexa belonging to 2 serogroups. The outer envelopes (OEs) of L.interrogans serogroup Icterohaemorrhagiae serovar lai strain lai (56601) with strong virulence and serogroup Pomona serovar pomona strain Luo (56608) with low virulence, and L.biflexa serogroup Semaranga serovar patoc strain Patoc I without virulence were prepared by using the method reported in Auran et al.(1972). OMPs in the OEs were obtained by treatment with sodium deoxycholate. SDS-PAGE and western blot were used for analyzing the features of the OMPs on electrophoretic pattern and the immunoreactivity to the antiserum against TR/Patoc I antigen, respectively. RESULTS All the tested strains belonging to different leptospiral serogroups agglutinated to the antiserum against leptospiral genus-specific TR/Patoc I antigen with agglutination titers ranging from 1:256-1:512. A similar SDS-PAGE pattern of the OMPs from the three strains of leptospira with different virulence was shown and the molecular weight of a major protein fragment in the OMPs was found to be approximately 60 KDa. A positive protein fragment with approximately 32 KDa confirmed by Western blot, was able to react with the antiserum against leptospiral genus-specific TR/Patoc I antigen, and was found in each the OMPs of the three stains of leptospira. CONCLUSION There are genus-specific antigens on the surface of L.interrogans and L.biflexa. The OMP with molecular weight of 32 KDa may be one of the genus-specific protein antigens of leptospira.
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Affiliation(s)
- Yi-hui Luo
- Department of Medical Microbiology and Parasitology, College of Medical Science, Zhejiang University, Hangzhou 310006, China
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Burriel AR, Dalley C, Woodward MJ. Prevalence of leptospira species among farmed and domestic animals in Greece. Vet Rec 2003; 153:146-8. [PMID: 12934797 DOI: 10.1136/vr.153.5.146] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
A total of 1527 serum samples from pigs, goats, sheep, cattle and dogs in Greece were examined by the microscopic agglutination test and 11-8 per cent of them had antibodies against one or more Leptospira serovars at titres of 1/100 or more. The predominant serovar affecting farm animal species was Bratislava, and Copenhageni was common among dogs and the second most important serovar when all animals were considered together. Another prevalent serovar was Australis, but antibodies to Pomona were detected only in goats and cattle.
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Affiliation(s)
- A R Burriel
- Faculty of Veterinary Medicine, University of Thessaly, Karditsa 43100, Box 199, Greece
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Luks AM, Lakshminarayanan S, Hirschmann JV. Leptospirosis presenting as diffuse alveolar hemorrhage: case report and literature review. Chest 2003; 123:639-43. [PMID: 12576395 DOI: 10.1378/chest.123.2.639] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
The literature on diffuse alveolar hemorrhage heavily emphasizes the causal role of vasculitides. We present a patient with diffuse alveolar hemorrhage caused by leptospirosis. Although the pathology in leptospirosis occurs secondary to a vasculitic process, this disease is not listed as a cause of diffuse alveolar hemorrhage in the review literature. In the right clinical scenario, the disease should be considered in a patient presenting with diffuse alveolar hemorrhage.
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Affiliation(s)
- Andrew M Luks
- Department of Medicine (Dr. Luks), University of Washington, Seattle 98108, USA
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Abstract
OBJECTIVE Leptospirosis in children is an often under diagnosed condition due to the non specificity of the presentations except for the classical Weil's disease. METHODS Children presenting with symptoms and signs suggestive of Leptospirosis were included in the study. Diagnostic criteria were fever, myalgia, conjunctival suffusion, Jaundice, headache, altered sensorium, seizures, bleeding manifestation and oliguria. Their clinical profile, lab parameters (general and specific), response to treatment and outcome were analysed. RESULT One hundred and thirty nine cases were diagnosed during a 4-year period. The commonest symptoms were fever 133 (96%), headache and myalgia 34 (24%). Jaundice was present in only 25 (18%) of cases with renal failure in 2 cases. The frequently encountered clinical signs were hepatomegaly in 100 (72%), myalgia in 34 (24%) with icterus in 25 (18%), 12 (9%) of children presented with shock and 10 (7%) had meningitis. CPK estimated was a useful index of myositis. The diagnosis was confirmed by Dark field microscopy and paired or single high serological tests (MAT, ELISA IgM). Overlapping infections such as culture positive Salmonella typhi with leptospirosis (Serology positive) or Dengue Hemorrhagic fever with Leptospirosis presented with complications such as a myocarditis, shock and ARDS. CONCLUSION Presentation of non-icteric forms of Leptospirosis are often non-specific and may be missed unless there is a high index of suspicion. This study emphasizes the myositis and meningitis forms of leptospirosis. Delayed diagnosis leads to increased mortality and morbidity.
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Affiliation(s)
- Sarala Rajajee
- Kanchi Kamakoti Childs Trust Hospital, Nungambakkam, Chennai, India. saralarajaje@yahoocom
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Abstract
Leptospirosis is a worldwide disease. In this time of globalization knowledge about leptospirosis is important. Although pulmonary involvement has an incidence varying from 20% to 70% and its exteriorization may vary from mild to severe, The severe form appears to be becoming more prevalent (at least in Brazil) and may be associated with higher mortality.
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Affiliation(s)
- Carlos Roberto Ribeiro Carvalho
- Division of Respiratory Diseases, Heart Institute (InCor), University of São Paulo Medical School, Rua Maria Figueiredo 396, Apt. 141, CEP 04002-002, São Paulo, Brazil
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Diament D, Brunialti MKC, Romero EC, Kallas EG, Salomao R. Peripheral blood mononuclear cell activation induced by Leptospira interrogans glycolipoprotein. Infect Immun 2002; 70:1677-83. [PMID: 11895929 PMCID: PMC127819 DOI: 10.1128/iai.70.4.1677-1683.2002] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Leptospira interrogans glycolipoprotein (GLP) has been implicated in pathological and functional derangement seen in leptospirosis. The goal of this study was to evaluate GLP's ability to induce cellular activation, as assessed by cytokine production and expression of surface activation markers. GLP extracted from either pathogenic L. interrogans serovar Copenhageni or nonpathogenic Leptospira biflexa serovar Patoc (GLPp) was used to stimulate peripheral blood mononuclear cell cultures from healthy donors. Supernatant cytokine levels were measured by enzyme-linked immunosorbent assay. Expression of CD69 and HLA-DR on lymphocytes and monocytes, as well as lipopolysaccharide (LPS) binding, were measured by flow cytometry. At 6 h of incubation, GLP induced a significant rise in tumor necrosis factor alpha levels, which dropped progressively until 72 h of incubation. Interleukin-10 peak levels were obtained at between 24 and 48 h, with sustained levels until 72 h of incubation. The response magnitude was proportional to the GLP dose. CD69 expression on T lymphocytes and monocytes increased significantly, as did HLA-DR expression on monocytes. GLPp induced no CD69 or HLA-DR expression. GLP did not block biotinylated LPS binding to monocytes, suggesting that different pathways are used to induce cell activation. In conclusion, GLP induces cellular activation and may play a major role in the pathogenesis of leptospirosis.
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Affiliation(s)
- Decio Diament
- Escola Paulista de Medicina, Federal University of São Paulo, Instituto de Infectologia Emilio Ribas, São Paulo, Brazil
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Flannery B, Costa D, Carvalho FP, Guerreiro H, Matsunaga J, Da Silva ED, Ferreira AG, Riley LW, Reis MG, Haake DA, Ko AI. Evaluation of recombinant Leptospira antigen-based enzyme-linked immunosorbent assays for the serodiagnosis of leptospirosis. J Clin Microbiol 2001; 39:3303-10. [PMID: 11526167 PMCID: PMC88335 DOI: 10.1128/jcm.39.9.3303-3310.2001] [Citation(s) in RCA: 117] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2001] [Accepted: 07/01/2001] [Indexed: 11/20/2022] Open
Abstract
There is an urgent need for development of new serodiagnostic strategies for leptospirosis, an emerging zoonosis with worldwide distribution. We have evaluated the diagnostic utility of five recombinant antigens in enzyme-linked immunosorbent assays (ELISAs) for serodiagnosis of leptospirosis. Sera from 50 healthy residents of a high-incidence region were used to determine cutoff values for 96% specificity. In paired sera from 50 cases of leptospirosis confirmed by the microscopic agglutination test, immunoglobulin G (IgG) but not IgM reacted with the recombinant leptospiral proteins. The recombinant LipL32 IgG ELISA had the highest sensitivities in the acute (56%) and convalescent (94%) phases of leptospirosis. ELISAs based on recombinant OmpL1, LipL41, and Hsp58 had sensitivities of 16, 24, and 18% during the acute phase and 72, 44, and 32% during convalescence, respectively. Compared to sera from healthy individuals, patient sera did not react significantly with recombinant LipL36 (P > 0.05). Recombinant LipL32 IgG ELISA demonstrated 95% specificity among 100 healthy individuals, and specificities ranging from 90 to 97% among 30 dengue patients, 30 hepatitis patients, and 16 patients with diseases initially thought to be leptospirosis. Among 39 Venereal Disease Research Laboratory test-positive individuals and 30 Lyme disease patients, 13 and 23% of sera, respectively, reacted positively with the rLipL32 antigen. These findings indicate that rLipL32 may be an useful antigen for the serodiagnosis of leptospirosis.
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Affiliation(s)
- B Flannery
- School of Public Health, University of California, Berkeley, California 94720, USA
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Guerreiro H, Croda J, Flannery B, Mazel M, Matsunaga J, Galvão Reis M, Levett PN, Ko AI, Haake DA. Leptospiral proteins recognized during the humoral immune response to leptospirosis in humans. Infect Immun 2001; 69:4958-68. [PMID: 11447174 PMCID: PMC98588 DOI: 10.1128/iai.69.8.4958-4968.2001] [Citation(s) in RCA: 124] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Leptospirosis is an emerging zoonosis caused by pathogenic spirochetes belonging to the genus Leptospira. An understanding of leptospiral protein expression regulation is needed to develop new immunoprotective and serodiagnostic strategies. We used the humoral immune response during human leptospirosis as a reporter of protein antigens expressed during infection. Qualitative and quantitative immunoblot analysis was performed using sera from 105 patients from Brazil and Barbados. Sera from patients with other diseases and healthy individuals were evaluated as controls. Seven proteins, p76, p62, p48, p45, p41, p37, and p32, were identified as targets of the humoral response during natural infection. In both acute and convalescent phases of illness, antibodies to lipopolysaccharide were predominantly immunoglobulin M (IgM) while antibodies to proteins were exclusively IgG. Anti-p32 reactivity had the greatest sensitivity and specificity: positive reactions were observed in 37 and 84% of acute- and convalescent-phase sera, respectively, while only 5% of community control individuals demonstrated positive reactions. Six immunodominant antigens were expressed by all pathogenic leptospiral strains tested; only p37 was inconsistently expressed. Two-dimensional immunoblots identified four of the seven infection-associated antigens as being previously characterized proteins: LipL32 (the major outer membrane lipoprotein), LipL41 (a surface-exposed outer membrane lipoprotein), and heat shock proteins GroEL and DnaK. Fractionation studies demonstrated LipL32 and LipL41 reactivity in the outer membrane fraction and GroEL and DnaK in the cytoplasmic fraction, while p37 appeared to be a soluble periplasmic protein. Most of the other immunodominant proteins, including p48 and p45, were localized to the inner membrane. These findings indicate that leptospiral proteins recognized during natural infection are potentially useful for serodiagnosis and may serve as targets for vaccine design.
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Affiliation(s)
- H Guerreiro
- Gonçalo Moniz Research Center, Oswaldo Cruz Foundation, Brazilian Ministry of Health, 40295-001, Brazil
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Stone SC, McNutt E. Update: Outbreak of acute febrile illness among athletes participating in Eco-Challenge-Sabah 2000--Borneo, Malaysia, 2000. Ann Emerg Med 2001; 38:83-4. [PMID: 11423818 DOI: 10.1067/mem.2001.116399] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- S C Stone
- Department of Emergency Medicine, LA County & USC Medical Center, Los Angeles, CA, USA
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