Leptospirosis--here, now

[Diagnosis of leptospirosis in dogs]

Rapid confirmation of the diagnosis leptospirosis is important in order to apply appropriate treatment; in addition, infected dogs are a zoonotic risk. Culture and isolation of living leptospires from blood, urine, or tissues is considered the reference standard of diagnosis. However, sensitivity are low, and leptospires require weeks to months to grow. Therefore, diagnosis of leptospirosis is most commonly based on antibody testing or the detection of Leptospira spp. DNA by PCR. Microscopic agglutination test (MAT) is currently still the recommended confirmatory test for canine leptospirosis, despite its numerous limitations (e. g., negative results in early infection, positive results due to vaccine-associated antibodies). ELISA can differentiate between IgG and IgM antibodies and thus, discriminate current infections from previous vaccination or exposure. Point-of-care tests and in-house-PCR tests have recently been developed for use in private practice allowing easy and immediate diagnosis. However, only few data on sensitivity and specificity of these tests exist so far. A reliable diagnosis can only be established in case of a positive PCR result or a fourfold titre increase in MAT.

[Epidemiology and prevention of leptospirosis in dogs]

Leptospirosis is a zoonotic disease with increasing prevalence in dogs and humans. The various Leptospira serovars display different pathogenicity. Even healthy infected dogs can shed leptospires with their urine and thus, represent a risk for humans and other animals. Vaccination is the most important measure for prevention; it not only prevents disease in dogs, but also reduces shedding of leptospires in urine. For comprehensive protection through vaccination, tetravalent vaccines containing serovars of the serogroups relevant in the corresponding region should be used. The spread of the pathogen can be reduced by a wide application of these vaccines. A detailed owner education about the zoonotic potential of the infection and appropriate hygiene measures when handling the infected dog and its urine are essential.

Peptide specific monoclonal antibodies of Leptospiral LigA for acute diagnosis of leptospirosis

Leptospirosis is underdiagnosed due to low sensitivity, need of specialised equipment, and expensive reagents for serological and molecular diagnosis respectively. Considering the sensitivity, rapidity, inexpensive reagents and collection of clinical samples, the monoclonal antibody based antigen detection method from urine samples has been developed and evaluated. LigA (LK90) based B-cell specific epitopes were predicted and synthesised as peptides for the production of monoclonal antibody. LK90₅₄₃: SNAQKNQGNA (amino acids: 543 to 552), and LK90₁₁₁₀: DHHTQSSYTP (amino acids: 1110 to 1119) with VaxiJen score of 1.3719 and 1.2215, respectively were used. Thirty two and 28 urine samples from confirmed and seronegative healthy human subjects, respectively were included for the evaluation of MAb-based dot blot ELISA. The specificity of the evaluated MAbs, P1B1 and P4W2 were found to be in the range of ~93–96%. Moreover, the MAbs did not show cross-reactivity with other bacterial antigens as confirmed by IgG ELISA, further validating its specificity for leptospiral antigens. These findings suggest that the developed MAb based dot blot ELISA is a simple, rapid performed in less than 8 h, inexpensive with a ICER of $8.7/QALY, and affordable in developing countries and area where laboratory facilities are limited.

Structural and Enzymatic Characterization of a cAMP-Dependent Diguanylate Cyclase from Pathogenic Leptospira Species

Leptospira interrogans serovar Copenhageni is a human pathogen that causes leptospirosis, a worldwide zoonosis. The L. interrogans genome codes for a wide array of potential diguanylate cyclase (DGC) enzymes with characteristic GGDEF domains capable of synthesizing the cyclic dinucleotide c-di-GMP, known to regulate transitions between different cellular behavioral states in bacteria. Among such enzymes, LIC13137 (Lcd1), which has an N-terminal cGMP-specific phosphodiesterases, adenylyl cyclases, and FhlA (GAF) domain and a C-terminal GGDEF domain, is notable for having close orthologs present only in pathogenic Leptospira species. Although the function and structure of GGDEF and GAF domains have been studied extensively separately, little is known about enzymes with the GAF-GGDEF architecture. In this report, we address the question of how the GAF domain regulates the DGC activity of Lcd1. The full-length Lcd1 and its GAF domain form dimers in solution. The GAF domain binds specifically cAMP (K_D of 0.24μM) and has an important role in the regulation of the DGC activity of the GGDEF domain. Lcd1 DGC activity is negligible in the absence of cAMP and is significantly enhanced in its presence (specific activity of 0.13s^-1). The crystal structure of the Lcd1 GAF domain in complex with cAMP provides valuable insights toward explaining its specificity for cAMP and pointing to possible mechanisms by which this cyclic nucleotide regulates the assembly of an active DGC enzyme.

[Leptospira infections in cats]

Leptospirosis is a widespread zoonosis found in over 150 mammalian species. Subclinically infected rodents and farm animals serve as reservoir hosts. Cats are exposed to leptospires regularly, particularly through hunting infected rodents. However, clinical leptospirosis is rare in cats. Nevertheless, infected cats can shed the pathogen through urine and thus, cats could play an important role in the epidemiology of leptospires.

Leptospirosis in the republic of Korea: historical perspectives, current status and future challenges

Leptospirosis is an important public health problem in the Republic of Korea (ROK), occurring sporadically or in outbreaks during the autumn season. Wild rodents, Apodemus agrarius, have been mainly involved in human leptospirosis. The majority of carrier animals are infected with Leptospira interrogans serovar lai. The characteristic pulmonary involvement or hemorrhage may increase the clinical severity or result in fatal outcomes, and these aspects continue to be a threat to people in endemic areas. While the disease incidence has been relatively low in recent years, there have been newer findings of livestock (zoo animals and racing horses) and rats (Rattus norvegicus) captured in urban environments as potential animal carriers. Many avenues of research are still open to define current changes in ecology, epidemiology, and the disease burden in both humans and animals in the ROK, together with global warming and climate change issues. In addition, national policy regarding the weighted wildlife monitoring system and the enhanced disease surveillance program is required to facilitate better monitoring and understanding of this disease.

Sero-epidemiology of canine leptospirosis in Trinidad: serovars, implications for vaccination and public health

A sero-epidemiological study on canine leptospirosis was conducted in house, stray, farm and hunting dogs, as well as in suspect cases of clinical canine leptospirosis. Serum samples were collected from apparently healthy (vaccinated and non-vaccinated), house dogs. A questionnaire was administered to the owners to elicit information on risk factors for leptospirosis. The microscopic agglutination test was used to screen for leptospirosis using 17 international serovars. Reciprocal titres of between 100 and <800 were considered as evidence of past exposure while reciprocal titres of 800 or greater were classified as suggestive of acute/current infection. Of a total of 419 serum samples tested, 61 (14.6%) were seropositive for Leptospira agglutinins, 23 (5.5%) had mixed infections and 16 (3.8%) had current infection. Amongst 50 suspected cases of clinical leptospirosis, 24 (48.0%) were seropositive and only 13 (26.0%) had current infection compared with 10 (6.3%) and three (1.9%) of 160 apparently healthy house dogs respectively. The difference was statistically significant (P < 0.05; chi2). Twelve (25.5%) of 47 hunting dogs, 10 (20.4%) of 49 farm dogs and five (4.4%) of 113 stray dogs were seropositive (P < 0.05; chi2). Overall, a total of nine serovars were detected with serovars mankarso, icterohaemorrhagiae RGA, autumnalis and copenhageni being involved in 29 (47.5%), 20 (32.8%), 25 (41.0%) and 10 (16.4%) respectively in 61 seropositive dogs (P < 0.05; chi2). Serovar mankarso was most predominant in seropositive apparently healthy dogs, 37.8% (14/37), suspected clinical cases of leptospirosis, 62.5% (15/24) compared with serovar icterohaemorrhagiae with a frequency of 21.6% (8/37) and 50.0% (12/24), the difference being statistically significant (P < 0.05; chi2). Although all vaccines used for prevention of canine leptospirosis in the country contain serovars canicola and icterohaemorrhagiae, serovar mankarso was mostly associated with infection and disease and may be a good candidate for inclusion in the vaccine used locally. The public health risk posed to owners of dogs infected with Leptospira cannot be over-emphasized considering the zoonotic nature of the disease.

Leptospirosis in Western Australia, 1983-1984

The diagnosis of leptospirosis is often difficult to make because of vague and mild symptoms. Patients who present with a "flu-like" illness and who have had either direct or indirect contact with infected animals should be investigated by serological examination. In Western Australia during 1983 and 1984, the sera of 937 patients were tested for the presence of leptospiral antibodies. Of these, 131 gave positive results; in 45, these were consistent with recently acquired infection. Apart from one veterinary worker, all the cases that were diagnosed serologically occurred in farmers and meatworkers. Farmers were most often infected with serovar hardjo. Meatworkers demonstrated a high degree of cross-reactivity among serovars pomona, hardjo, and to a lesser extent, icterohaemorrhagiae. However, in cases in which the infecting serovar was identifiable serologically, serovar pomona predominated.

A serological survey of leptospirosis in Gippsland dairy farmers

Serological testing for leptospirosis was performed on sera from 1074 persons who were attending the 1983 Gippsland Field Days. The most common serological reactions were against representative serovars from serogroups Hebdomadis (12%), Panama (2%), Tarassovi (2%) and Pomona (1%). The reactions against serogroup Hebdomadis were attributed to exposure to serovar hardjo; the milking of dairy cows was found to be a major risk factor. The high prevalence of seropositive results among clinically normal dairy farmers highlights the need for caution in interpreting the results of laboratory testing for leptospirosis.

Human leptospirosis in Victoria

Between May, 1979, and May, 1981, leptospirosis was diagnosed, on the basis of serological and culture findings, in specimens from 208 of 2516 patients with symptoms which suggested leptospirosis or other zoonoses. The most common serological reactions were with serovars hardjo (69%), pomona (29%) and tarassovi (2%). There was a clear association between infection and occupation in 101 farmers, 44 meat workers and 11 meat inspectors. It would seem prudent to consider leptospirosis in the differential diagnosis of pyrexia in patients who have occupational contact with animals, and to institute appropriate serological and culture examinations.