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Cardoso TL, de Freitas SB, Seixas Neto ACP, Balassiano IT, Hartwig DD. Advancing serologic diagnosis: assessing the efficacy of rErpY-like protein in human leptospirosis detection. Braz J Microbiol 2024; 55:2279-2284. [PMID: 38805148 PMCID: PMC11405570 DOI: 10.1007/s42770-024-01364-4] [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: 02/01/2024] [Accepted: 04/29/2024] [Indexed: 05/29/2024] Open
Abstract
Leptospirosis is a globally distributed infectious disease caused by pathogenic spirochetes of the Leptospira genus, often overlooked. It is estimated that the disease affects approximately one million people annually, resulting in more than 58,900 deaths. The gold standard for serodiagnosis of leptospirosis is the Microscopic Agglutination Test (MAT). However, the limitations of this technique necessitate the exploration of alternative diagnostic methods. In this study, we evaluated the ErpY-like recombinant protein (rErpY-like) in the development of a serologic diagnostic assay for human leptospirosis. Eighty-six human sera samples, characterized by MAT, underwent evaluation through indirect IgM-ELISA and IgG-ELISA. The sensitivity and specificity values obtained from IgM-ELISA were 60% and 76%, respectively, while those from IgG-ELISA were 96.4% and 100%, respectively. The use of the rErpY-like protein in both IgM-ELISA and IgG-ELISA proves to be a sensitive and specific method for antibody detection. This could potentially serve as a valuable alternative tool in the diagnosis of human leptospirosis.
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Affiliation(s)
- Thayná Laner Cardoso
- Laboratory of Bacteriology and Bioassays, Department of Microbiology and Parasitology, Institute of Biology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Stella Buchhorn de Freitas
- Laboratory of Bacteriology and Bioassays, Department of Microbiology and Parasitology, Institute of Biology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Amilton Clair Pinto Seixas Neto
- Laboratory of Bacteriology and Bioassays, Department of Microbiology and Parasitology, Institute of Biology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Ilana Teruszkin Balassiano
- Bacterial Zoonoses Laboratory, Leptospirosis National Reference Center/Leptospira Collection, WHO/PAHO Collaborating Center for Leptospirosis, Department of Bacteriology, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil
| | - Daiane Drawanz Hartwig
- Laboratory of Bacteriology and Bioassays, Department of Microbiology and Parasitology, Institute of Biology, Federal University of Pelotas, Pelotas, RS, Brazil.
- Federal University of Pelotas, University Campus, Pelotas, RS, CEP 96010-900, Brazil.
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Suwannin P, Jangpatarapongsa K, Polpanich D, Alhibshi A, Errachid A, Elaissari A. Enhancing leptospirosis control with nanosensing technology: A critical analysis. Comp Immunol Microbiol Infect Dis 2024; 104:102092. [PMID: 37992537 DOI: 10.1016/j.cimid.2023.102092] [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: 09/19/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 11/24/2023]
Abstract
Leptospirosis is a serious health problem in tropical areas; thus, animals shed leptospires in the environment. Humans are accidental hosts infected through exposure to contaminating bacteria in the environment. One health strategy can be applied to protect and eliminate leptospirosis because this cooperates and coordinates activities between doctors, veterinarians, and ecologists. However, conventional methods still have limitations. Therefore, the main challenges of leptospirosis control are the high sensing of detection methods to screen and control the pathogens. Interestingly, nano sensing combined with a leptospirosis detection approach can increase the sensitivity and eliminate some limitations. This article reviews nanomaterial development for an advanced leptospirosis detection method, e.g., latex beads-based agglutination test, magnetic nanoparticles enrichment, and gold-nanoparticles-based immunochromatographic assay. Thus, nanomaterials can be functionalized with biomolecules or sensing molecules utilized in various mechanisms such as biosensors. Over the last decade, many biosensors have been developed for Leptospira spp. pathogen and others. The evolution of biosensors for leptospirosis detection was designed for high efficiency and might be an alternative tool. In addition, the high-sensing fabrications are useful for leptospires screening in very low levels, for example, soil or water from the environment.
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Affiliation(s)
- Patcharapan Suwannin
- Center for Research Innovation and Biomedical Informatics, Faculty of Medical Technology, Mahidol University, Bangkok 10700, Thailand; Univ Lyon, University Claude Bernard Lyon-1, CNRS, ISA-UMR 5280, Villeurbanne 69622, France
| | - Kulachart Jangpatarapongsa
- Center for Research Innovation and Biomedical Informatics, Faculty of Medical Technology, Mahidol University, Bangkok 10700, Thailand
| | - Duangporn Polpanich
- National Nanotechnology Center (NANOTEC), National Science and Technology Development Agency (NSTDA), Pathum Thani 12120, Thailand
| | - Amani Alhibshi
- Department of Neuroscience Research, Institute of Research and Medical Consultations, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia
| | - Abdelhamid Errachid
- Univ Lyon, University Claude Bernard Lyon-1, CNRS, ISA-UMR 5280, Villeurbanne 69622, France
| | - Abdelhamid Elaissari
- Univ Lyon, University Claude Bernard Lyon-1, CNRS, ISA-UMR 5280, Villeurbanne 69622, France.
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Fernandes LGV, Avelar KES, Romero EC, Heinemann MB, Kirchgatter K, Nascimento ALTO. A New Recombinant Multiepitope Chimeric Protein of Leptospira interrogans Is a Promising Marker for the Serodiagnosis of Leptospirosis. Trop Med Infect Dis 2022; 7:362. [PMID: 36355904 PMCID: PMC9694704 DOI: 10.3390/tropicalmed7110362] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/20/2022] [Accepted: 11/02/2022] [Indexed: 09/10/2024] Open
Abstract
The zoonotic disease leptospirosis is caused by pathogenic species of the genus Leptospira and was recently included in the list of Neglected Diseases by the World Health Organization. Leptospirosis burden is estimated to have over a million human cases and cause 60 thousand deaths annually, in addition to its economic impact and veterinary concern. The microscopic agglutination test (MAT), recommended by the World Health Organization, exhibits reduced sensitivity at the beginning of the disease, in addition to being technically difficult. New recombinant antigens are being pursued for rapid and specific serodiagnostic tests, especially in the initial phase of the disease, and chimeric multiepitope proteins are a strategy with a great potential to be implemented in serology. Based on previous subproteomic results, we designed a synthetic construct comprising 10 conserved leptospiral surface antigens, and the recombinant protein was purified and evaluated regarding its diagnostic potential. The protein termed rChi2 was recognized by antibodies in serum from patients both at the onset (MAT-) and in the convalescent (MAT+) phase in 75 and 82% of responders, respectively. In addition, rChi2 immunization in hamsters elicited a strong humoral response, and anti-rChi2 antibodies recognized several immobilized intact Leptospira species, validating its potential as an early, broad, and cross-reactive diagnostic test.
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Affiliation(s)
- Luis G. V. Fernandes
- Laboratório de Desenvolvimento de Vacinas, Instituto Butantan, Avenida Vital Brazil, 1500, Sao Paulo 05503-900, SP, Brazil
| | - Kátia E. S. Avelar
- Laboratório de Referência Nacional para Leptospirose, Instituto Oswaldo Cruz—Fiocruz, Avenida Brasil, 4365, Manguinhos, Rio de Janeiro 21040-900, RJ, Brazil
| | - Eliete C. Romero
- Centro de Bacteriología, Instituto Adolfo Lutz, Sao Paulo 01246-902, SP, Brazil
| | - Marcos B. Heinemann
- Laboratório de Zoonoses Bacterianas do VPS, Faculdade de Medicina Veterinária e Zootecnia, USP, Sao Paulo 05508-270, SP, Brazil
| | - Karin Kirchgatter
- Laboratório de Bioquímica e Biologia Molecular, Instituto Pasteur, Sao Paulo 01027-000, SP, Brazil
- Programa de Pós Graduação em Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo 05403-000, SP, Brazil
| | - Ana L. T. O. Nascimento
- Laboratório de Desenvolvimento de Vacinas, Instituto Butantan, Avenida Vital Brazil, 1500, Sao Paulo 05503-900, SP, Brazil
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Serological Surveillance of Zoonotic Pathogens in Rats in Markets in Bogor, Indonesia. Vector Borne Zoonotic Dis 2022; 22:568-570. [DOI: 10.1089/vbz.2022.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Cunha M, Costa F, Ribeiro GS, Carvalho MS, Reis RB, Nery Jr N, Pischel L, Gouveia EL, Santos AC, Queiroz A, Wunder Jr. EA, Reis MG, Diggle PJ, Ko AI. Rainfall and other meteorological factors as drivers of urban transmission of leptospirosis. PLoS Negl Trop Dis 2022; 16:e0007507. [PMID: 35404948 PMCID: PMC9022820 DOI: 10.1371/journal.pntd.0007507] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 04/21/2022] [Accepted: 03/17/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Leptospirosis is an important public health problem affecting vulnerable urban slum populations in developing country settings. However, the complex interaction of meteorological factors driving the temporal trends of leptospirosis remain incompletely understood. METHODS AND FINDINGS From March 1996-March 2010, we investigated the association between the weekly incidence of leptospirosis and meteorological anomalies in the city of Salvador, Brazil by using a dynamic generalized linear model that accounted for time lags, overall trend, and seasonal variation. Our model showed an increase of leptospirosis cases associated with higher than expected rainfall, lower than expected temperature and higher than expected humidity. There was a lag of one-to-two weeks between weekly values for significant meteorological variables and leptospirosis incidence. Independent of the season, a weekly cumulative rainfall anomaly of 20 mm increased the risk of leptospirosis by 12% compared to a week following the expected seasonal pattern. Finally, over the 14-year study period, the annual incidence of leptospirosis decreased significantly by a factor of 2.7 (8.3 versus 3.0 per 100,000 people), independently of variations in climate. CONCLUSIONS Strategies to control leptospirosis should focus on avoiding contact with contaminated sources of Leptospira as well as on increasing awareness in the population and health professionals within the short time window after low-level or extreme high-level rainfall events. Increased leptospirosis incidence was restricted to one-to-two weeks after those events suggesting that infectious Leptospira survival may be limited to short time intervals.
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Affiliation(s)
- Marcelo Cunha
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Ministério da Saúde, Rio de Janeiro, Brazil
| | - Federico Costa
- Instituto de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
- Faculty of Health and Medicine, University of Lancaster, Lancaster, United Kingdom
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Heaven, Connecticut, United States of America
| | - Guilherme S. Ribeiro
- Instituto de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Brazil
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
| | - Marilia S. Carvalho
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Ministério da Saúde, Rio de Janeiro, Brazil
| | - Renato B. Reis
- Instituto de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Brazil
| | - Nivison Nery Jr
- Instituto de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | - Lauren Pischel
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Heaven, Connecticut, United States of America
| | - Edilane L. Gouveia
- Instituto de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Brazil
| | - Andreia C. Santos
- Instituto de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Brazil
| | - Adriano Queiroz
- Instituto de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Brazil
| | - Elsio A. Wunder Jr.
- Instituto de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Brazil
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Heaven, Connecticut, United States of America
| | - Mitermayer G. Reis
- Instituto de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Brazil
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Heaven, Connecticut, United States of America
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
| | - Peter J Diggle
- Faculty of Health and Medicine, University of Lancaster, Lancaster, United Kingdom
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Heaven, Connecticut, United States of America
| | - Albert I. Ko
- Instituto de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Brazil
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Heaven, Connecticut, United States of America
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Fortes-Gabriel E, Guedes MS, Shetty A, Gomes CK, Carreira T, Vieira ML, Esteves L, Mota-Vieira L, Gomes-Solecki M. Enzyme immunoassays (EIA) for serodiagnosis of human leptospirosis: specific IgG3/IgG1 isotyping may further inform diagnosis of acute disease. PLoS Negl Trop Dis 2022; 16:e0010241. [PMID: 35196321 PMCID: PMC8901056 DOI: 10.1371/journal.pntd.0010241] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 03/07/2022] [Accepted: 02/09/2022] [Indexed: 12/24/2022] Open
Abstract
The laborious microscopic agglutination test (MAT) is the gold standard serologic test for laboratory diagnosis of leptospirosis. We developed EIA based serologic assays using recombinant proteins (rLigA, rLigB, rLipL32) and whole-cell extracts from eight Leptospira serovars as antigen and assessed the diagnostic performance of the new assay within each class, against MAT positive (MAT+) human sera panels from Portugal/PT (n = 143) and Angola/AO (n = 100). We found that a combination of recombinant proteins rLigA, rLigB and rLipL32 correctly identified antigen-specific IgG from patients with clinical and laboratory confirmed leptospirosis (MAT+) with 92% sensitivity and ~ 97% specificity (AUC 0.974) in serum from the provinces of Luanda (LDA) and Huambo (HBO) in Angola. A combination of whole cell extracts of L. interrogans sv Copenhageni (LiC), L. kirschneri Mozdok (LkM), L. borgpetersenii Arborea (LbA) and L. biflexa Patoc (LbP) accurately identified patients with clinical and laboratory confirmed leptospirosis (MAT+) with 100% sensitivity and ~ 98% specificity for all provinces of Angola and Portugal (AUC: 0.997 for AO/LDA/HBO, 1.000 for AO/HLA, 0.999 for PT/AZ and 1.000 for PT/LIS). Interestingly, we found that MAT+ IgG+ serum from Angola had a significantly higher presence of IgD and that IgG3/IgG1 isotypes were significantly increased in the MAT+ IgG+ serum from Portugal. Given that IgM/IgD class and IgG3/IgG1 specific isotypes are produced in the earliest course of infection, immunoglobulin G isotyping may be used to inform diagnosis of acute leptospirosis. The speed, ease of use and accuracy of EIA tests make them excellent alternatives to the laborious and expensive MAT for screening acute infection in areas where circulating serovars of pathogenic Leptospira are well defined.
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Affiliation(s)
- Elsa Fortes-Gabriel
- Instituto Superior Técnico Militar—Estado Maior General das Forças Armadas Angolanas, Luanda, Angola,Immuno Technologies Inc, Memphis, Tennessee, United States of America
| | | | - Advait Shetty
- Department of Pharmaceutical Sciences—University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
| | | | - Teresa Carreira
- Instituto de Higiene e Medicina Tropical—Universidade Nova de Lisboa, Lisbon, Portugal
| | - Maria Luísa Vieira
- Instituto de Higiene e Medicina Tropical—Universidade Nova de Lisboa, Lisbon, Portugal
| | - Lisa Esteves
- Molecular Genetics and Pathlogy Unit—Hospital do Divino Espírito Santo de Ponta Delgada, São Miguel Island—Azores, Portugal
| | - Luísa Mota-Vieira
- Molecular Genetics and Pathlogy Unit—Hospital do Divino Espírito Santo de Ponta Delgada, São Miguel Island—Azores, Portugal,Azores Genetics Research Group—Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Maria Gomes-Solecki
- Immuno Technologies Inc, Memphis, Tennessee, United States of America,Department of Pharmaceutical Sciences—University of Tennessee Health Science Center, Memphis, Tennessee, United States of America,* E-mail:
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Yasuda I, Saito N, Suzuki M, Umipig DV, Solante RM, Guzman FD, Sayo AR, Yasunami M, Koizumi N, Kitashoji E, Sakashita K, Ng CFS, Smith C, Ariyoshi K. Unique characteristics of new complete blood count parameters, the Immature Platelet Fraction and the Immature Platelet Fraction Count, in dengue patients. PLoS One 2021; 16:e0258936. [PMID: 34723977 PMCID: PMC8559939 DOI: 10.1371/journal.pone.0258936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 10/11/2021] [Indexed: 11/19/2022] Open
Abstract
The advanced platelet parameters Immature Platelet Fraction and Immature Platelet Fraction Count have been implemented in clinical practice as measures of thrombopoietic activity, mainly in hematologic disorders that cause thrombocytopenia. The purpose of this observational study was to examine thrombopoiesis as reflected by these 2 new CBC parameters in patients infected with dengue. The study was conducted in infectious disease referral hospital in Metro Manila, the Philippines. We enrolled hospitalized patients at admission who were diagnosed with acute dengue or community acquired bacterial infection (CABI). Immature Platelet Fraction (IPF) and Immature Platelet Fraction Count were evaluated at admission and during hospitalization. A total of 606 patients were enrolled from May 1, 2017 to June 1, 2018. The participants consisted of 152 patients with dengue infection, 180 confirmed CABI, and 274 suspected CABI patients. At admission, the percent IPF (IPF%) of the patients with dengue was significantly higher than that of the confirmed CABI patients (median 3.7% versus 1.9%; p <0.001). In a time course evaluation, there was no significant difference of IPF% between the patients with dengue infection and the confirmed CABI patients in the febrile phase (median 1.9% versus 2.4%; p = 0.488), however, the IPF% of the patients with dengue infection increased to be significantly higher than that of the confirmed CABI patients in the critical phase (median 5.2% versus 2.2%; p <0.001). Our study elucidated the unique characteristics and time-course trends of IPF percent and number (IPF#) in the patients with dengue infection. IPF% and IPF# are potentially valuable parameters in dengue and further investigation is required for the optimal use in clinical practice.
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Affiliation(s)
- Ikkoh Yasuda
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- Department of General Internal Medicine and Clinical Infectious Diseases, Fukushima Medical University, Fukushima, Japan
| | - Nobuo Saito
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- Department of Microbiology, Oita University Faculty of Medicine, Oita, Japan
| | - Motoi Suzuki
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | | | | | | | | | - Michio Yasunami
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Nobuo Koizumi
- Department of Bacteriology I, National Institute of Infectious Diseases, Toyama, Shinjuku-ku, Tokyo, Japan
| | - Emi Kitashoji
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Kentaro Sakashita
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Basic Mycobacteriology, Graduate School of Biomedical Science, Nagasaki University, Nagasaki, Japan
| | - Chris Fook Sheng Ng
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Chris Smith
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Koya Ariyoshi
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
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Mukadi Kakoni P, Munyeku Bazitama Y, Nepomuceno JR, Pukuta-Simbu E, Kawhata Mawika F, Kashitu Mujinga G, Palla L, Ahuka-Mundeke S, Muyembe Tamfum JJ, Koizumi N, Kubo Y, Ariyoshi K, Smith C. Leptospirosis as a cause of fever associated with jaundice in the Democratic Republic of the Congo. PLoS Negl Trop Dis 2021; 15:e0009670. [PMID: 34403427 PMCID: PMC8396788 DOI: 10.1371/journal.pntd.0009670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 08/27/2021] [Accepted: 07/20/2021] [Indexed: 11/18/2022] Open
Abstract
Background Fever with jaundice is a common symptom of some infectious diseases. In public health surveillance within the Democratic Republic of the Congo (DRC), yellow fever is the only recognized cause of fever with jaundice. However, only 5% of the surveillance cases are positive for yellow fever and thus indicate the involvement of other pathogens. Leptospira spp. are the causative agents of leptospirosis, a widespread bacterial zoonosis, a known cause of fever with jaundice. This study aimed to determine the seropositivity of anti-Leptospira antibodies among suspected yellow fever cases and map the geographical distribution of possible leptospirosis in the DRC. Methods We conducted a retrospective study using 1,300 samples from yellow fever surveillance in the DRC from January 2017 to December 2018. Serum samples were screened for the presence of IgM against Leptospira spp. by a whole cell-based IgM ELISA (Patoc-IgM ELISA) at the Institut National de Recherche Biomedicale in Kinshasa (INRB) according to World Health Organization (WHO) guidance. Exploratory univariable and multivariable logistic regression analyses were undertaken to assess associations between socio-demographic factors and the presence of Leptospira IgM. Results Of the 1,300 serum samples screened, 88 (7%) showed evidence of IgM against Leptospira spp. Most positive cases (34%) were young adult males in the 20–29-year group. There were statistically significant associations between having Leptospira IgM antibodies, age, sex, and living area. Observed positive cases were mostly located in urban settings, and the majority lived in the province of Kinshasa. There was a statistically significant association between seasonality and IgM Leptospira spp. positivity amongst those living in Kinshasa, where most of the positive cases occurred during the rainy season. Conclusions This study showed that leptospirosis is likely an overlooked cause of unexplained cases of fever with jaundice in the DRC and highlights the need to consider leptospirosis in the differential diagnosis of fever with jaundice, particularly in young adult males. Further studies are needed to identify animal reservoirs, associated risk factors, and the burden of human leptospirosis in the DRC. Leptospirosis is an important bacterial zoonosis with a worldwide distribution. Each year there are an estimated one million cases, with about 60,000 deaths. The true burden of the disease, however, is unknown. The burden of leptospirosis is probably underestimated due to the lack of specific clinical symptoms and diagnostic techniques that are not readily available. Clinical diagnosis of leptospirosis is difficult because of the diversity of symptoms, ranging from asymptomatic forms to severe multivisceral icteric states. Differential diagnoses with infections presenting with fever or fever and jaundice are numerous and may mislead the clinician. Leptospirosis is considered endemic in sub-Saharan Africa and is known to cause fever with jaundice in African countries; however, for most countries, available epidemiologic data are scarce, including in the Democratic Republic of Congo (DRC). An improved understanding of the epidemiology of leptospirosis will improve clinical management, lead to policy formulation, and have implications for national surveillance of infectious diseases in these countries. We conducted a retrospective seroepidemiological study to extend the description of the pathogens responsible for fever with jaundice in the DRC and to clarify the circulation of possible leptospirosis in the country. This study showed that leptospirosis is a likely cause of fever with jaundice in the DRC.
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Affiliation(s)
- Patrick Mukadi Kakoni
- Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Institut National de Recherche Biomedicale (INRB), Kinshasa, the Democratic Republic of the Congo
- Faculté de Médecine, Université de Kinshasa, Kinshasa, the Democratic Republic of the Congo
- Program for Nurturing Global Leaders in Tropical and Emerging Communicable Diseases, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
- Department of Clinical Tropical Medicine, Institute of Tropical Medicine, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | - Yannick Munyeku Bazitama
- Institut National de Recherche Biomedicale (INRB), Kinshasa, the Democratic Republic of the Congo
- Faculté de Médecine, Université de Kinshasa, Kinshasa, the Democratic Republic of the Congo
| | - Jean Raphael Nepomuceno
- Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Elisabeth Pukuta-Simbu
- Institut National de Recherche Biomedicale (INRB), Kinshasa, the Democratic Republic of the Congo
| | | | - Gracia Kashitu Mujinga
- Faculté de Médecine, Université de Kinshasa, Kinshasa, the Democratic Republic of the Congo
| | - Luigi Palla
- Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Bacteriology I, National Institute of Infectious Diseases (NIID), Tokyo, Japan
| | - Steve Ahuka-Mundeke
- Institut National de Recherche Biomedicale (INRB), Kinshasa, the Democratic Republic of the Congo
- Faculté de Médecine, Université de Kinshasa, Kinshasa, the Democratic Republic of the Congo
| | - Jean-Jacques Muyembe Tamfum
- Institut National de Recherche Biomedicale (INRB), Kinshasa, the Democratic Republic of the Congo
- Faculté de Médecine, Université de Kinshasa, Kinshasa, the Democratic Republic of the Congo
| | - Nobuo Koizumi
- Department of Public Health and Infectious Diseases, University of Rome La Sapienza, Roma, Italy
| | - Yoshinao Kubo
- Program for Nurturing Global Leaders in Tropical and Emerging Communicable Diseases, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
- Department of Clinical Tropical Medicine, Institute of Tropical Medicine, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | - Koya Ariyoshi
- Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Clinical Tropical Medicine, Institute of Tropical Medicine, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | - Chris Smith
- Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
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Abstract
The diagnosis of leptospirosis depends on specific laboratory tests because nonspecific and diverse clinical manifestations make clinical diagnosis difficult and it is easily confused with other infectious diseases in the tropics. Suitable laboratory diagnostic tests vary depending on the stage of the disease, requiring the combination of diagnostic tests using appropriate specimens at each disease stage.
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Affiliation(s)
- Nobuo Koizumi
- Department of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan.
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10
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Haake DA, Matsunaga J. Leptospiral Immunoglobulin-Like Domain Proteins: Roles in Virulence and Immunity. Front Immunol 2021; 11:579907. [PMID: 33488581 PMCID: PMC7821625 DOI: 10.3389/fimmu.2020.579907] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 11/05/2020] [Indexed: 02/03/2023] Open
Abstract
The virulence mechanisms required for infection and evasion of immunity by pathogenic Leptospira species remain poorly understood. A number of L. interrogans surface proteins have been discovered, lying at the interface between the pathogen and host. Among these proteins, the functional properties of the Lig (leptospiral immunoglobulin-like domain) proteins have been examined most thoroughly. LigA, LigB, and LigC contain a series of, 13, 12, and 12 closely related domains, respectively, each containing a bacterial immunoglobulin (Big) -like fold. The multidomain region forms a mostly elongated structure that exposes a large surface area. Leptospires wield the Lig proteins to promote interactions with a range of specific host proteins, including those that aid evasion of innate immune mechanisms. These diverse binding events mediate adhesion of L. interrogans to the extracellular matrix, inhibit hemostasis, and inactivate key complement proteins. These interactions may help L. interrogans overcome the physical, hematological, and immunological barriers that would otherwise prevent the spirochete from establishing a systemic infection. Despite significant differences in the affinities of the LigA and LigB proteins for host targets, their functions overlap during lethal infection of hamsters; virulence is lost only when both ligA and ligB transcription is knocked down simultaneously. Lig proteins have been shown to be promising vaccine antigens through evaluation of a variety of different adjuvant strategies. This review serves to summarize current knowledge of Lig protein roles in virulence and immunity and to identify directions needed to better understand the precise functions of the Lig proteins during infection.
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Affiliation(s)
- David A. Haake
- Division of Infectious Diseases, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
- Departments of Medicine, and Microbiology, Immunology, and Molecular Genetics, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | - James Matsunaga
- Research Service, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
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11
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Sabharwal P, Sushmitha C, Amritha CK, Natraj U, Murthy MRN, Savithri HS. Development of pepper vein banding virus chimeric virus-like particles for potential diagnostic and therapeutic applications. Arch Virol 2020; 165:1163-1176. [DOI: 10.1007/s00705-020-04581-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 02/05/2020] [Indexed: 12/18/2022]
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12
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Zhang H, Zhang C, Zhu Y, Mehmood K, Liu J, McDonough SP, Tang Z, Chang YF. Leptospirosis trends in China, 2007-2018: A retrospective observational study. Transbound Emerg Dis 2019; 67:1119-1128. [PMID: 31765064 DOI: 10.1111/tbed.13437] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 11/11/2019] [Accepted: 11/18/2019] [Indexed: 12/13/2022]
Abstract
Leptospirosis is one of the most common and neglected tropical waterborne diseases in China, causing serious economic losses, and constituting a significant public health threat. Leptospirosis has recently received increased attention and is considered a re-emerging infectious disease in many countries. The incidence of leptospirosis among people suggests that occupation, age, season, sex and water recreational activities are significant risk factors. The aim of this study was to describe the epidemiological profiles of leptospirosis in China during the 2007-2018 period. The morbidity data of leptospirosis by age, season (month), gender, occupation and geographic location (different provinces) were obtained from the public health science data centre of China for subsequent epidemiological analysis. The results indicate that the incidence of leptospirosis has shown a slow downward trend from 2007 to 2018, but morbidity rates were still relatively high (0.0660-0.0113). The incidence of leptospirosis varied in different provinces of China; cases localized mainly to the Southern and Central provinces, areas with warm weather and ample rainfall. Older people (aged 60-75), males, farmers, students and field workers were high-risk populations. During the 2007-2018 observation period, morbidity rates increased beginning in May, remained at high levels in August and September and decreased after November. The present investigation highlights the re-emergence of leptospirosis in some provinces of China (especially in Yunnan and Fujian) and shows that leptospirosis remains a serious public health threat. The results of this study should enhance measures taken for the prevention, control, and surveillance of leptospirosis in China.
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Affiliation(s)
- Hui Zhang
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, China.,Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY, USA
| | - Cuicai Zhang
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Yongzhang Zhu
- Department of Clinical Microbiology, Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
| | - Khalid Mehmood
- University College of Veterinary & Animal Sciences, Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Jinjing Liu
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY, USA
| | - Sean P McDonough
- Department of Biomedical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Zhaoxin Tang
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
| | - Yung-Fu Chang
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY, USA
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13
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Yang B, de Vries SG, Ahmed A, Visser BJ, Nagel IM, Spijker R, Grobusch MP, Hartskeerl RA, Goris MGA, Leeflang MMG. Nucleic acid and antigen detection tests for leptospirosis. Cochrane Database Syst Rev 2019; 8:CD011871. [PMID: 31425612 PMCID: PMC6699653 DOI: 10.1002/14651858.cd011871.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Early diagnosis of leptospirosis may contribute to the effectiveness of antimicrobial therapy and early outbreak recognition. Nucleic acid and antigen detection tests have the potential for early diagnosis of leptospirosis. With this systematic review, we assessed the sensitivity and specificity of nucleic acid and antigen detection tests. OBJECTIVES To determine the diagnostic test accuracy of nucleic acid and antigen detection tests for the diagnosis of human symptomatic leptospirosis. SEARCH METHODS We searched electronic databases including MEDLINE, Embase, the Cochrane Library, and regional databases from inception to 6 July 2018. We did not apply restrictions to language or time of publication. SELECTION CRITERIA We included diagnostic cross-sectional studies and case-control studies of tests that made use of nucleic acid and antigen detection methods in people suspected of systemic leptospirosis. As reference standards, we considered the microscopic agglutination test alone (which detects antibodies against leptospirosis) or in a composite reference standard with culturing or other serological tests. Studies were excluded when the controls were healthy individuals or when there were insufficient data to calculate sensitivity and specificity. DATA COLLECTION AND ANALYSIS At least two review authors independently extracted data from each study. We used the revised Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2) to assess risk of bias. We calculated study-specific values for sensitivity and specificity with 95% confidence intervals (CI) and pooled the results in a meta-analysis when appropriate. We used the bivariate model for index tests with one positivity threshold, and we used the hierarchical summary receiver operating characteristic model for index tests with multiple positivity thresholds. As possible sources of heterogeneity, we explored: timing of index test, disease prevalence, blood sample type, primers or target genes, and the real-time polymerase chain reaction (PCR) visualisation method. These were added as covariates to the meta-regression models. MAIN RESULTS We included 41 studies evaluating nine index tests (conventional PCR (in short: PCR), real-time PCR, nested PCR, PCR performed twice, loop-mediated isothermal amplification, enzyme-linked immunosorbent assay (ELISA), dot-ELISA, immunochromatography-based lateral flow assay, and dipstick assay) with 5981 participants (1834 with and 4147 without leptospirosis). Methodological quality criteria were often not reported, and the risk of bias of the reference standard was generally considered high. The applicability of findings was limited by the frequent use of frozen samples. We conducted meta-analyses for the PCR and the real-time PCR on blood products.The pooled sensitivity of the PCR was 70% (95% CI 37% to 90%) and the pooled specificity was 95% (95% CI 75% to 99%). When studies with a high risk of bias in the reference standard domain were excluded, the pooled sensitivity was 87% (95% CI 44% to 98%) and the pooled specificity was 97% (95% CI 60% to 100%). For the real-time PCR, we estimated a summary receiver operating characteristic curve. To illustrate, a point on the curve with 85% specificity had a sensitivity of 49% (95% CI 30% to 68%). Likewise, at 90% specificity, sensitivity was 40% (95% CI 24% to 59%) and at 95% specificity, sensitivity was 29% (95% CI 15% to 49%). The median specificity of real-time PCR on blood products was 92%. We did not formally compare the diagnostic test accuracy of PCR and real-time PCR, as direct comparison studies were lacking. Three of 15 studies analysing PCR on blood products reported the timing of sample collection in the studies included in the meta-analyses (range 1 to 7 days postonset of symptoms), and nine out of 16 studies analysing real-time PCR on blood products (range 1 to 19 days postonset of symptoms). In PCR studies, specificity was lower in settings with high leptospirosis prevalence. Other investigations of heterogeneity did not identify statistically significant associations. Two studies suggested that PCR and real-time PCR may be more sensitive on blood samples collected early in the disease stage. Results of other index tests were described narratively. AUTHORS' CONCLUSIONS The validity of review findings are limited and should be interpreted with caution. There is a substantial between-study variability in the accuracy of PCR and real-time PCR, as well as a substantial variability in the prevalence of leptospirosis. Consequently, the position of PCR and real-time PCR in the clinical pathway depends on regional considerations such as disease prevalence, factors that are likely to influence accuracy, and downstream consequences of test results. There is insufficient evidence to conclude which of the nucleic acid and antigen detection tests is the most accurate. There is preliminary evidence that PCR and real-time PCR are more sensitive on blood samples collected early in the disease stage, but this needs to be confirmed in future studies.
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Affiliation(s)
- Bada Yang
- Amsterdam University Medical Centers, University of AmsterdamDepartment of Clinical Epidemiology, Biostatistics and BioinformaticsMeibergdreef 9AmsterdamNoord‐HollandNetherlands1105 AZ
| | - Sophia G de Vries
- Amsterdam University Medical Centers, location AMC, University of AmsterdamCenter of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal MedicineMeibergdreef 9AmsterdamNoord‐HollandNetherlands1105 AZ
| | - Ahmed Ahmed
- Academic Medical Centre (AMC), University of AmsterdamMedical Microbiology, OIE and National Collaborating Centre for Reference and Research on LeptospirosisMeibergdreef 39AmsterdamNetherlands1105 AZ
| | - Benjamin J Visser
- Amsterdam University Medical Centers, location AMC, University of AmsterdamCenter of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal MedicineMeibergdreef 9AmsterdamNoord‐HollandNetherlands1105 AZ
| | - Ingeborg M Nagel
- Amsterdam UMC, University of AmsterdamMedical LibraryMeibergdreef 9AmsterdamNetherlands1105 AZ
| | - René Spijker
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht UniversityCochrane NetherlandsRoom Str. 6.127P.O. Box 85500UtrechtNetherlands3508 GA
- Amsterdam UMC, University of Amsterdam, Amsterdam Public HealthMedical LibraryMeibergdreef 9AmsterdamNetherlands
| | - Martin P Grobusch
- Amsterdam University Medical Centers, location AMC, University of AmsterdamCenter of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal MedicineMeibergdreef 9AmsterdamNoord‐HollandNetherlands1105 AZ
| | - Rudy A Hartskeerl
- OIE and National Collaborating Centre for Reference and Research on LeptospirosisMeibergdreef 39AmsterdamNetherlands1105 AZ
| | - Marga GA Goris
- Academic Medical Centre (AMC), University of AmsterdamMedical Microbiology, OIE and National Collaborating Centre for Reference and Research on LeptospirosisMeibergdreef 39AmsterdamNetherlands1105 AZ
| | - Mariska MG Leeflang
- Amsterdam University Medical Centers, University of AmsterdamDepartment of Clinical Epidemiology, Biostatistics and BioinformaticsMeibergdreef 9AmsterdamNoord‐HollandNetherlands1105 AZ
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14
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Lee N, Kitashoji E, Koizumi N, Lacuesta TLV, Ribo MR, Dimaano EM, Saito N, Suzuki M, Ariyoshi K, Parry CM. Building prognostic models for adverse outcomes in a prospective cohort of hospitalised patients with acute leptospirosis infection in the Philippines. Trans R Soc Trop Med Hyg 2019. [PMID: 29518223 DOI: 10.1093/trstmh/try015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Leptospirosis is endemic to the Philippines. Ten per cent of cases will develop severe or fatal disease. Predicting progression to severity is difficult. Risk factors have been suggested, but few attempts have been made to create predictive models to guide clinical decisions. We present two models to predict the risk of mortality and progression to severe disease. Data was used from a prospective cohort study conducted between 2011 and 2013 in San Lazaro Hospital, Manila. Predictive factors were identified from a literature review. A strategy utilizing backwards stepwise-elimination and multivariate fractional polynomials identified key predictive factors. A total of 203 patients met the inclusion criteria. The overall mortality rate was 6.84%. Multivariable logistic regression revealed that neutrophil counts [OR 1.38, 95% CI 1.15-1.67] and platelet counts [OR 0.99, 95% CI 0.97-0.99] were predictive for risk of mortality. Multivariable logistic regression revealed that male sex (OR 3.29, 95% CI 1.22-12.57) and number of days between symptom onset and antibiotic use (OR 1.28, 95% CI 1.08-1.53) were predictive for risk of progression to severe disease. The multivariable prognostic models for the risks of mortality and progression to severe disease developed could be useful in guiding clinical management by the early identification of patients at risk of adverse outcomes.
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Affiliation(s)
- Nathaniel Lee
- London School of Hygiene and Tropical Medicine, London, UK
| | - Emi Kitashoji
- Institute of Tropical Medicine, Nagasaki University, Nagasaki
| | - Nobuo Koizumi
- National Institute of Infectious Diseases, Toyama, Shinjuku-ku, Tokyo, Japan
| | | | | | | | - Nobuo Saito
- Institute of Tropical Medicine, Nagasaki University, Nagasaki
| | - Motoi Suzuki
- Institute of Tropical Medicine, Nagasaki University, Nagasaki
| | - Koya Ariyoshi
- Institute of Tropical Medicine, Nagasaki University, Nagasaki.,School of Tropical Medicine and Global Health, Nagasaki University, Japan
| | - Christopher M Parry
- School of Tropical Medicine and Global Health, Nagasaki University, Japan.,Liverpool School of Tropical Medicine, Liverpool, UK
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15
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Chen HW, Lukas H, Becker K, Weissenberger G, Halsey ES, Guevara C, Canal E, Hall E, Maves RC, Tilley DH, Kuo L, Kochel TJ, Ching WM. An Improved Enzyme-Linked Immunoassay for the Detection of Leptospira-Specific Antibodies. Am J Trop Med Hyg 2018; 99:266-274. [PMID: 29943710 DOI: 10.4269/ajtmh.17-0057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Leptospirosis is a neglected zoonotic disease with worldwide endemicity and continues to be a significant public health burden on resource-limited populations. Previously, we produced three highly purified recombinant antigens (rLipL32, rLipL41, and rLigA-Rep) and evaluated their performance of detecting Leptospira-specific antibodies in enzyme-linked immunosorbent assay (ELISA) as compared with the microscopic agglutination test (MAT). The overall sensitivity of this assay approached 90%. Recently, another recombinant antigen (rLigB-Rep) was prepared. We tested each individual antigen and a 1:1:1:1 mixture of these four antigens for the detection of Leptospira-specific antibodies in ELISA. The performance of these recombinant antigens was evaluated with a much larger febrile patient panel (337 MAT-confirmed positive sera and 92 MAT-negative sera from febrile patients). Combining the detection results of immunoglobulin M and immunoglobulin G from these four individual antigens, the overall sensitivity was close to 90% but the specificity was only 66%, based on the MAT reference method. The overall sensitivity and specificity of the four-antigen mixture were 82% and 86%, respectively. The mixture of four antigens also exhibited a broader reactivity with MAT-positive samples of 18 serovars from six major pathogenic Leptospira species. Given the limitations of MAT, the data were further analyzed by Bayesian latent class model, showing that ELISA using a 1:1:1:1 mixture still maintained high sensitivity (79%) and specificity (88%) as compared with the sensitivity (90%) and specificity (83%) of MAT. Therefore, ELISA using a mixture of these four antigens could be a very useful test for seroprevalence studies.
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Affiliation(s)
- Hua-Wei Chen
- Naval Medical Research Center, Silver Spring, Maryland
| | - Heather Lukas
- Naval Medical Research Center, Silver Spring, Maryland
| | - Kira Becker
- Naval Medical Research Center, Silver Spring, Maryland
| | | | | | | | | | - Eric Hall
- Naval Medical Research Center, Silver Spring, Maryland
| | - Ryan C Maves
- Naval Medical Center San Diego, San Diego, California.,Naval Medical Research Unit No. 6, Lima, Peru
| | | | - Lynn Kuo
- Department of Statistics, University of Connecticut, Storrs, Connecticut
| | | | - Wei-Mei Ching
- Naval Medical Research Center, Silver Spring, Maryland
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16
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Matsushita N, Ng CFS, Kim Y, Suzuki M, Saito N, Ariyoshi K, Salva EP, Dimaano EM, Villarama JB, Go WS, Hashizume M. The non-linear and lagged short-term relationship between rainfall and leptospirosis and the intermediate role of floods in the Philippines. PLoS Negl Trop Dis 2018; 12:e0006331. [PMID: 29659576 PMCID: PMC5919665 DOI: 10.1371/journal.pntd.0006331] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 04/26/2018] [Accepted: 02/21/2018] [Indexed: 12/21/2022] Open
Abstract
Background Leptospirosis is a worldwide bacterial zoonosis. Outbreaks of leptospirosis after heavy rainfall and flooding have been reported. However, few studies have formally quantified the effect of weather factors on leptospirosis incidence. We estimated the association between rainfall and leptospirosis cases in an urban setting in Manila, the Philippines, and examined the potential intermediate role of floods in this association. Methods/Principal findings Relationships between rainfall and the weekly number of hospital admissions due to leptospirosis from 2001 to 2012 were analyzed using a distributed lag non-linear model in a quasi-Poisson regression framework, controlling for seasonally varying factors other than rainfall. The role of floods on the rainfall–leptospirosis relationship was examined using an indicator. We reported relative risks (RRs) by rainfall category based on the flood warning system in the country. The risk of post-rainfall leptospirosis peaked at a lag of 2 weeks (using 0 cm/week rainfall as the reference) with RRs of 1.30 (95% confidence interval: 0.99–1.70), 1.53 (1.12–2.09), 2.45 (1.80–3.33), 4.61 (3.30–6.43), and 13.77 (9.10–20.82) for light, moderate, heavy, intense and torrential rainfall (at 2, 5, 16, 32 and 63 cm/week), respectively. After adjusting for floods, RRs (at a lag of 2 weeks) decreased at higher rainfall levels suggesting that flood is on the causal pathway between rainfall and leptospirosis. Conclusions Rainfall was strongly associated with increased hospital admission for leptospirosis at a lag of 2 weeks, and this association was explained in part by floods. Leptospirosis is a worldwide bacterial zoonosis which is mainly transmitted through contact with water contaminated by rodents’ urine. It manifests with various symptoms, ranging from fever and muscle pain to a severe syndrome characterized by jaundice, renal failure and pulmonary hemorrhage. Outbreaks of leptospirosis after heavy rainfall and flooding have been reported, but few studies have evaluated the effect of weather factors on leptospirosis. We estimated the association between rainfall and leptospirosis cases in an urban setting in Manila, the Philippines, and examined the potential intermediate role of floods in this association. The risk of post-rainfall leptospirosis peaked at a lag of 2 weeks. After adjusting for floods, the effect of rainfall at lag 2 decreased at higher rainfall levels suggesting that flooding is on the causal pathway between heavy rainfall and leptospirosis. The results are useful for public health interventions to prepare hospitals and clinics for increased number of patients in case of an outbreak, which can help reduce the disease burden.
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Affiliation(s)
- Naohiko Matsushita
- Department of Paediatric Infectious Diseases, Institute of Tropical Medicine (NEKKEN), Nagasaki University. Nagasaki, Japan
- Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
- * E-mail:
| | - Chris Fook Sheng Ng
- Department of Paediatric Infectious Diseases, Institute of Tropical Medicine (NEKKEN), Nagasaki University. Nagasaki, Japan
| | - Yoonhee Kim
- Department of Global Environmental Health, The School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Motoi Suzuki
- Department of Clinical Infectious Diseases, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
| | - Nobuo Saito
- Department of Clinical Infectious Diseases, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
| | - Koya Ariyoshi
- Department of Clinical Infectious Diseases, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
| | | | | | | | - Winston S. Go
- San Lazaro Hospital, Manila, Republic of the Philippines
| | - Masahiro Hashizume
- Department of Paediatric Infectious Diseases, Institute of Tropical Medicine (NEKKEN), Nagasaki University. Nagasaki, Japan
- Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
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17
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Courdurie C, Le Govic Y, Bourhy P, Alexer D, Pailla K, Theodose R, Cesaire R, Rosine J, Hochedez P, Olive C. Evaluation of different serological assays for early diagnosis of leptospirosis in Martinique (French West Indies). PLoS Negl Trop Dis 2017; 11:e0005678. [PMID: 28644889 PMCID: PMC5500375 DOI: 10.1371/journal.pntd.0005678] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 07/06/2017] [Accepted: 06/04/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Leptospirosis is a potentially life-threatening but curable zoonosis whose prognosis depends on accurate and timely diagnosis. Because of its non-specific clinical presentation, laboratory testing is essential to confirm the diagnosis. Here, we aimed to assess the performance of two enzyme-linked immunosorbent assays (ELISAs) (ELISA Serion and ELISA-Hb Pasteur) and one immunodot (GenBio) using quantitative PCR (qPCR) as gold standard, instead of the traditional microscopic agglutination test, for the diagnosis of acute leptospirosis in an endemic area. METHODOLOGY/PRINCIPAL FINDINGS Between January 2011 and December 2012, a total of 122 patients were diagnosed with leptospirosis, as confirmed by qPCR at the University Hospital of Martinique. Among them, 103 had at least one serum sample available for analysis. Performance of each serological assay was evaluated according to days' post onset of symptoms (DPO) and local species diversity (which included L. santarosai, L. interrogans, L. kirschneri, L. borgpetersenii, L. noguchii, and L. kmetyi). Several thresholds were tested to optimize accuracy. When considering the manufacturer's threshold, the sensitivity of ELISA Serion, ELISA-Hb Pasteur and GenBio immunodot was 75%, 67% and 64%, while specificity was 92%, 98% and 100%, respectively. Moreover, the threshold optimization allowed a significant improvement in specificity for the ELISA Serion from 92% to 99% (p<0.05). During the first 5 DPO, sensitivities were 35%, 30% and 42% for ELISA Serion, ELISA-Hb Pasteur and GenBio immunodot, respectively. However, between 6─10 DPO, these sensitivities dramatically increased to reach 86%, 76% and 67%, respectively. Performances of the three assays were not affected by the species studied. CONCLUSIONS/SIGNIFICANCE All these serological assays showed the potential for diagnosing leptospirosis after (but not before) 6 days' post onset of symptoms. In a high prevalence setting, where highest specificities are needed, threshold optimizing should be performed for this purpose.
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Affiliation(s)
- Christophe Courdurie
- Department of Bacteriology and Hygiene, University Hospital of Fort-de-France, Martinique, French West Indies
| | - Yohann Le Govic
- Department of Bacteriology and Hygiene, University Hospital of Fort-de-France, Martinique, French West Indies
| | - Pascale Bourhy
- Department of Spirochetes Biology, Pasteur Institute, National Reference Center and WHO Collaborating Center for Leptospirosis, Paris, France
| | - Dorothee Alexer
- Department of Bacteriology and Hygiene, University Hospital of Fort-de-France, Martinique, French West Indies
| | - Karine Pailla
- Department of Bacteriology and Hygiene, University Hospital of Fort-de-France, Martinique, French West Indies
| | - Rafaelle Theodose
- Department of Bacteriology and Hygiene, University Hospital of Fort-de-France, Martinique, French West Indies
| | - Raymond Cesaire
- Department of Virology, University Hospital of Fort-de-France, Martinique, French West Indies
| | - Jacques Rosine
- Interregional Epidemiology Unit, French Institute for Public Health Surveillance, Fort-de-France, Martinique, French West Indies
| | - Patrick Hochedez
- Department of Infectious Diseases, University Hospital of Fort-de-France, Martinique, French West Indies
| | - Claude Olive
- Department of Bacteriology and Hygiene, University Hospital of Fort-de-France, Martinique, French West Indies
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