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Athukorala N, Wickramasinghe S, Yatawara L, Weerakoon K. A Systematic Review of Zoonotic Disease Prevalence in Sri Lanka (2000-2022). Vector Borne Zoonotic Dis 2024; 24:453-472. [PMID: 38775108 DOI: 10.1089/vbz.2023.0141] [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] [Indexed: 08/10/2024] Open
Abstract
Background: The burden of zoonotic diseases in developing countries is significantly underestimated, influenced by various factors such as misdiagnosis, underreporting, natural disasters, climate change, resource limitations, rapid unplanned urbanization, poverty, animal migration, travel, ecotourism, and the tropical environmental conditions prevalent in the region. Despite Sri Lanka's provision of a publicly funded free health care system, zoonoses still contribute significantly to the burden of communicable diseases in the country. This study serves as a timely and exhaustive systematic review of zoonoses reported over the past 22 years in Sri Lanka. Materials and Methods: This systematic review adhered to the guidelines provided by the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA) statement. A systematic literature search was conducted between July and September 2022, utilizing the following databases and sources: Google Scholar, PubMed, Cochrane Library, Weekly Epidemiological Reports, and Rabies Statistical Bulletins published by the Ministry of Health, Sri Lanka. Results: From the initial database search, 1,710 articles were identified. After excluding nonzoonotic diseases, duplicated reports, inaccessible articles, and those not meeting the inclusion criteria, 570 reports were evaluated for eligibility. Of these, 91 reports were selected for data extraction, comprising 58 original research articles, 10 case reports, 16 weekly epidemiological reports, and 7 rabies statistical bulletins. Over the study period (2000-2022), 14 parasitic, 7 bacterial, and 7 viral zoonoses have been reported in Sri Lanka. Notably, leptospirosis emerged as the most reported zoonotic disease in the country. Conclusions: In response to these findings, we strongly recommend the implementation of a tailored, country-specific prevention and control program. To achieve this goal effectively, we emphasize the importance of adopting a country-specific "One Health" approach as a comprehensive framework for managing and controlling zoonotic diseases in Sri Lanka.
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Affiliation(s)
- Nadeesha Athukorala
- Department of Parasitology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Susiji Wickramasinghe
- Department of Parasitology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Lalani Yatawara
- Deparment of Medical Laboratory Science, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Kosala Weerakoon
- Department of Parasitology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Mihintale, Sri Lanka
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Rathinam SR, Kohila JG, Sundar BK, Gowri CP, Vedhanayagi R, Radhika M, Nadella V. Utility of demographic and clinical signs as diagnostic predictors for leptospiral uveitis: A retrospective study. Indian J Ophthalmol 2024; 72:869-877. [PMID: 38804803 PMCID: PMC11232860 DOI: 10.4103/ijo.ijo_1376_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 10/28/2023] [Accepted: 11/02/2023] [Indexed: 05/29/2024] Open
Abstract
PURPOSE Leptospirosis is a waterborne zoonotic disease prevalent in tropical regions, causing significant morbidity and mortality. It can involve any organ in its primary stage, and uveitis is its late complication. While advanced laboratory diagnosis is available only in tertiary care centers globally, a cost-effective bedside assessment of clinical signs and their scoring could offer a provisional diagnosis. AIM To analyze the diagnostic potential of demographic and clinical signs in a large cohort of serologically confirmed leptospiral uveitis patients. METHODS In this retrospective study, demographic and clinical parameters of 876 seropositive leptospiral uveitis patients and 1042 nonleptospiral uveitis controls were studied. Multivariable logistic regression analysis with bootstrap confidence interval (CI) characterized the diagnostic predictors. The performance of the model was evaluated using the area under the receiver operating curve (AUROC). RESULTS Presence of nongranulomatous uveitis (odds ratio [OR] = 6.9), hypopyon (OR = 4.6), vitreous infiltration with membranous opacities (OR = 4.3), bilateral involvement (OR = 4), panuveitis (OR = 3.3), vasculitis (OR = 1.9), disc hyperemia (OR = 1.6), absence of retinochoroiditis (OR = 15), and absence of cystoid macular edema (OR = 8.9) emerged as predictive parameters. The AUROC value was 0.86 with 95% CI of 0.846-0.874. At a cut-off score of 40, the sensitivity and specificity were 79.5 and 78.4, respectively. CONCLUSION The study demonstrates that ocular signs can serve as diagnostic predictors for leptospiral uveitis, enabling primary care ophthalmologists to make bedside diagnosis. This can be further confirmed by laboratory methods available at tertiary care centers.
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Affiliation(s)
- S R Rathinam
- Uveitis Service, Aravind Eye Hospital and PG Institute of Ophthalmology, Anna Nagar, Madurai, Tamil Nadu, India
| | - Jeya G Kohila
- Department of Biostatistics, Aravind Eye Hospital and PG Institute of Ophthalmology, Anna Nagar, Madurai, Tamil Nadu, India
| | - Balagiri K Sundar
- Department of Immunology, Aravind Medical Research Foundation, Anna Nagar, Madurai, Tamil Nadu, India
| | - Chidambaranathan P Gowri
- Department of Immunology, Aravind Medical Research Foundation, Anna Nagar, Madurai, Tamil Nadu, India
| | - Rajesh Vedhanayagi
- Department of Immunology, Aravind Medical Research Foundation, Anna Nagar, Madurai, Tamil Nadu, India
| | - Manoj Radhika
- Department of Immunology, Aravind Medical Research Foundation, Anna Nagar, Madurai, Tamil Nadu, India
| | - Venu Nadella
- Amaravati Hospital, Vijayawada, Andhra Pradesh, India
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Rathinam SR, Vedhanayagi R, Radhika M, Balamurugan MS, Balagiri K, Priya CG, Kohila GJ. Why do Doctors Miss the Diagnosis of Leptospiral Uveitis? Emergence of New Serovars and Challenges in Diagnosis. Ocul Immunol Inflamm 2023:1-6. [PMID: 38127787 DOI: 10.1080/09273948.2023.2291477] [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: 09/22/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE Leptospirosis is an endemic disease in India and uveitis is its late complication. Several Indian reports showed diversity of serovars, changing patterns and existence of new serovars. Failure to add new serovars in testing panel result in increased false-negativity in serology. AIM To analyse seroprevalence, changing patterns and to discuss the resulting challenges in diagnosis. METHODS In this retrospective study covering the period from 1994 to 2020, we analysed data from laboratory records of patients diagnosed with leptospiral uveitis in South India. Microscopic agglutination Test (MAT) and/or Enzyme-Linked Immunosorbent Assay (ELISA) were performed on clinically diagnosed leptospiral uveitis cases from our hospital, as well as on systemic leptospirosis patients from government and private hospitals. RESULTS Out of a total of 87 216 new uveitis cases with varying causes over 27 years, 3,658 (4.1%) were clinically diagnosed as leptospiral uveitis. Among them, 1,268 (34.7%) patients were seropositive. In 1994, 92% of clinically diagnosed leptospirosis patients were seropositive in the MAT performed at the Centers for Disease Control and Prevention in Atlanta. However, the positivity rate gradually declined to 35% over the years. The predominant serovars identified were L. autumnalis, L. icterohaemorrhagiae, and L. australis. There were notable variations in the distribution of serovars over the years. CONCLUSIONS The data suggest a declining sensitivity of MAT and ELISA, possibly due to the emergence of new serovars. Customizing the panel based on local isolates could enhance the performance of MAT. Critical need is the addition of advanced molecular techniques to improve the diagnosis.
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Affiliation(s)
- S R Rathinam
- Institute of Ophthalmology, Uveitis Service, Aravind Eye Hospital & PG, Madurai, India
| | - Rajesh Vedhanayagi
- Institute of Ophthalmology, Uveitis Service, Aravind Eye Hospital & PG, Madurai, India
| | - Manoj Radhika
- Institute of Ophthalmology, Uveitis Service, Aravind Eye Hospital & PG, Madurai, India
| | - M S Balamurugan
- Institute of Ophthalmology, Uveitis Service, Aravind Eye Hospital & PG, Pondicherry, India
| | - K Balagiri
- Institute of Ophthalmology, Uveitis Service, Aravind Eye Hospital & PG, Madurai, India
| | - C Gowri Priya
- Immunology Laboratory, Aravind Medical Research Foundation, Madurai, India
| | - G Jeya Kohila
- Institute of Ophthalmology, Uveitis Service, Aravind Eye Hospital & PG, Madurai, India
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Baharani A, Reddy P RR. Leptospiral Uveitis: Case Series and Review of Literature. Ocul Immunol Inflamm 2023:1-9. [PMID: 38128077 DOI: 10.1080/09273948.2023.2296037] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023]
Abstract
AIM To present the clinical features and review of literature of leptospiral uveitis. METHODS We present clinical features of patients with leptospiral uveitis with positive Leptospira IgM antibodies. RESULTS Twenty-six eyes of 24 patients, 11 males (45.8%), were included. The mean age was 37.5 ± 15.6 years. 91.7% had unilateral uveitis, 88.5% panuveitis, 11.5% anterior uveitis, 15.4% had hypopyon, 8% had cataract and 3.8% eyes had cystoid macular edema. Vitritis with characteristic vitreous membranes was an important feature. Retinal and choroidal vasculature were preserved on swept-source optical coherence tomography angiography. Mean presenting BCVA was logMAR0.49 ± 0.41, while final BCVA was logMAR0.04 ± 0.13. The mean duration for complete resolution of uveitis was 39.1 ± 15.5 days. 84.6% eyes achieved BCVA 6/6. CONCLUSION Leptospiral uveitis is an under-reported entity. It may present as anterior uveitis or panuveitis. It must be included in the differential diagnosis of non-granulomatous uveitis. The visual prognosis is usually favorable even in severe cases.
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Maze MJ, Shirima GM, Lukambagire AHS, Bodenham RF, Rubach MP, Cash-Goldwasser S, Carugati M, Thomas KM, Sakasaka P, Mkenda N, Allan KJ, Kazwala RR, Mmbaga BT, Buza JJ, Maro VP, Galloway RL, Haydon DT, Crump JA, Halliday JEB. Prevalence and risk factors for human leptospirosis at a hospital serving a pastoralist community, Endulen, Tanzania. PLoS Negl Trop Dis 2023; 17:e0011855. [PMID: 38117858 PMCID: PMC10766184 DOI: 10.1371/journal.pntd.0011855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 01/04/2024] [Accepted: 12/11/2023] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND Leptospirosis is suspected to be a major cause of illness in rural Tanzania associated with close contact with livestock. We sought to determine leptospirosis prevalence, identify infecting Leptospira serogroups, and investigate risk factors for leptospirosis in a rural area of Tanzania where pastoralist animal husbandry practices and sustained livestock contact are common. METHODS We enrolled participants at Endulen Hospital, Tanzania. Patients with a history of fever within 72 hours, or a tympanic temperature of ≥38.0°C were eligible. Serum samples were collected at presentation and 4-6 weeks later. Sera were tested using microscopic agglutination testing with 20 Leptospira serovars from 17 serogroups. Acute leptospirosis cases were defined by a ≥four-fold rise in antibody titre between acute and convalescent serum samples or a reciprocal titre ≥400 in either sample. Leptospira seropositivity was defined by a single reciprocal antibody titre ≥100 in either sample. We defined the predominant reactive serogroup as that with the highest titre. We explored risk factors for acute leptospirosis and Leptospira seropositivity using logistic regression modelling. RESULTS Of 229 participants, 99 (43.2%) were male and the median (range) age was 27 (0, 78) years. Participation in at least one animal husbandry practice was reported by 160 (69.9%). We identified 18 (7.9%) cases of acute leptospirosis, with Djasiman 8 (44.4%) and Australis 7 (38.9%) the most common predominant reactive serogroups. Overall, 69 (30.1%) participants were Leptospira seropositive and the most common predominant reactive serogroups were Icterohaemorrhagiae (n = 20, 29.0%), Djasiman (n = 19, 27.5%), and Australis (n = 17, 24.6%). Milking cattle (OR 6.27, 95% CI 2.24-7.52) was a risk factor for acute leptospirosis, and milking goats (OR 2.35, 95% CI 1.07-5.16) was a risk factor for Leptospira seropositivity. CONCLUSIONS We identified leptospirosis in approximately one in twelve patients attending hospital with fever from this rural community. Interventions that reduce risks associated with milking livestock may reduce human infections.
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Affiliation(s)
- Michael J. Maze
- Department of Medicine, University of Otago, Christchurch, New Zealand
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Gabriel M. Shirima
- School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | | | | | - Matthew P. Rubach
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, United States
| | - Shama Cash-Goldwasser
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States
| | - Manuela Carugati
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, United States
| | - Kate M. Thomas
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Philoteus Sakasaka
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Nestory Mkenda
- Endulen Hospital, Ngorongoro Conservation Area, Endulen, Tanzania
| | - Kathryn J. Allan
- School of Biodiversity, One Health and Veterinary Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Rudovick R. Kazwala
- Department of Veterinary Medicine and Public Health, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Blandina T. Mmbaga
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Joram J. Buza
- School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | - Venance P. Maro
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Renee L. Galloway
- Special Pathogens Branch, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Daniel T. Haydon
- School of Biodiversity, One Health and Veterinary Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - John A. Crump
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Jo E. B. Halliday
- School of Biodiversity, One Health and Veterinary Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
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Agampodi S, Gunarathna S, Lee JS, Excler JL. Global, regional, and country-level cost of leptospirosis due to loss of productivity in humans. PLoS Negl Trop Dis 2023; 17:e0011291. [PMID: 37616329 PMCID: PMC10482283 DOI: 10.1371/journal.pntd.0011291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 09/06/2023] [Accepted: 08/06/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Leptospirosis, a prevalent zoonotic disease with One Health priority and a disease of poverty, lacks global economic burden estimates. This study aims to determine the global, regional, and country-level cost of leptospirosis due to loss of productivity. METHODOLOGY/PRINCIPAL FINDINGS The cost of leptospirosis due to loss of productivity (referred to as productivity cost hereafter) was estimated by converting the disability-adjusted life years (DALYs) lost due to leptospirosis to a monetary value using the per capita gross domestic product (GDP). The country-specific DALYs lost were obtained from the global burden of leptospirosis study published previously. Non-health GDP per capita (GDP- per capita health expenditure) was used for the cost conversion of DALYs. Country-specific GDP and health expenditure data were obtained from the World Bank data repositories. Estimates were done using both nominal and international dollars. The estimated global productivity cost of leptospirosis in 2019 was Int$ 29.3 billion, with low and high estimates ranging from Int$ 11.6 billion to 52.3 billion. China (Int$ 4.8 billion), India (Int$ 4.6 billion), Indonesia (Int$ 2.8 billion), Sri Lanka (Int$ 2.1 billion), and the United States (Int$ 1.3 billion) had the highest productivity cost due to leptospirosis. Eight out of 10 countries with the highest burden were in the Asia-Pacific region. In addition, lower-middle-income countries had an annual productivity cost of Int$ 13.8 billion, indicating that the disease is poverty-related. CONCLUSION Although significant, the cost estimate due to loss of productivity is merely a fraction of the overall economic burden of this disease, which also includes other direct, indirect, and intangible costs. The existing partial estimates of the different components of economic cost suggest a profound economic burden that demands the inclusion of leptospirosis in the global health agenda for comprehensive disease control and prevention efforts, including vaccine development.
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Affiliation(s)
- Suneth Agampodi
- International Vaccine Institute, Seoul, Republic of Korea
- Department of Internal Medicine, School of Medicine, Yale University, New Heaven, Connecticut, United States of America
| | - Sajaan Gunarathna
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Mihintale, Sri Lanka
| | - Jung-Seok Lee
- International Vaccine Institute, Seoul, Republic of Korea
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Rathinam SR, Kohila GJ, Gowri PC, Balagiri KS. Leptospiral uveitis- "Transition 'from epidemic to endemic form" difficulties in laboratory confirmations. Indian J Ophthalmol 2023; 71:3031-3038. [PMID: 37530277 PMCID: PMC10538821 DOI: 10.4103/ijo.ijo_61_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 05/02/2023] [Accepted: 05/29/2023] [Indexed: 08/03/2023] Open
Abstract
Purpose Leptospirosis is a waterborne zoonotic disease that primarily causes systemic illness, followed by uveitis. After heavy flooding in Madurai district, an epidemic outbreak of systemic and ocular leptospirosis occurred in 1994. Our data shows a transition to endemicity after each epidemic. Aim The aim of this study is to report the clinical signs, epidemic outbreaks, and persistent endemicity of leptospiral uveitis, as well as the diagnostic dilemmas associated with it. Methods A retrospective analysis of clinical signs was conducted using medical records of leptospiral uveitis patients over a period of 27 years (1994-2020) in a tertiary care eye hospital. The clinical workup of uveitis included a detailed clinical history, systemic, and ophthalmic examination. Microagglutination tests (MATs) was done at the Centers for Disease Control and Prevention (CDC) in Atlanta and later in our regional laboratory. Serum samples were collected from human systemic leptospirosis cases and a small group of animals in and around Madurai. Results The first epidemic outbreak resulted in 200 seropositive patients. Subsequent epidemic outbreaks occurred in 1997, 1998, 2001, 2005, and 2012, with Madurai experiencing multiple outbreaks. However, the disease remained endemic, with 25-50 patients being observed per year in between the peaks. Ocular examination revealed acute non-granulomatous uveitis (94.9%), pan uveitis (59.8%), vitreous inflammatory reaction (55.4%), retinal vasculitis (29.5%), disc hyperemia (20.9%), and hypopyon. (16.2%). New serovars emerged every year, resulting in decreased sensitivity of the MAT. Over time, the MAT started to miss diagnoses. Conclusion The persistent endemicity of leptospiral uveitis emphasizes the need for accessible diagnostic tests. The low performance of the MAT can be attributable to the use of an older panel. The incorporation of new isolates in the MAT by a national laboratory will improve the accuracy of diagnosis.
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Affiliation(s)
- SR. Rathinam
- Aravind Eye Hospital and PG. Institute of Ophthalmology, Aravind Medical Research Foundation, Madurai, Tamil Nadu, India
| | - G. Jeya Kohila
- Aravind Eye Hospital and PG. Institute of Ophthalmology, Aravind Medical Research Foundation, Madurai, Tamil Nadu, India
| | | | - KS. Balagiri
- Biostatistics, Aravind Medical Research Foundation, Madurai, Tamil Nadu, India
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Ocular leptospirosis: lack of awareness among ophthalmologists and challenges in diagnosis. Curr Opin Ophthalmol 2022; 33:532-542. [DOI: 10.1097/icu.0000000000000896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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