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Waranius B, Tillman C, Van Houten C, Harrist A, Digianantonio R, Hasel H, Atherstone C, Curren E. Human Case of Leptospirosis During a Canine Disease Outbreak - Wyoming, 2023. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2024; 73:602-606. [PMID: 38990767 PMCID: PMC11254349 DOI: 10.15585/mmwr.mm7327a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
Leptospirosis is a zoonotic bacterial disease spread through the urine of infected animals; the typical incubation period is 5-14 days. In approximately 90% of human cases, illness is asymptomatic or mild, characterized by fever, chills, myalgia, nausea, vomiting, diarrhea, headache, calf pain, and conjunctival suffusion, but severe illness can progress to multiorgan dysfunction and death. Although Wyoming is considered a low-risk area for leptospirosis because of its cold and semiarid climate, the Wyoming Department of Health was notified of a probable human case in August 2023, the first reported in the state since 1983. The patient had occupational exposure to dogs but did not report other risk factors. The same week that the human patient's illness began, public health authorities received notification of an increase in canine leptospirosis cases. Public health authorities investigated to determine potential sources of infection, identify additional cases, and recommend control measures. After public health outreach activities were implemented, canine vaccination practices changed substantially in the affected city: a survey conducted after the outbreak revealed that all responding veterinary clinics in the affected city were recommending the vaccine more frequently to dog owners and reporting higher levels of owner compliance with vaccination recommendations. Increased vaccination coverage offers protection from leptospirosis for both dogs and persons exposed to them. Leptospirosis should be considered in the differential diagnosis of persons with occupational exposure to animals and clinically compatible signs and symptoms, including fever, chills, myalgia, nausea, vomiting, diarrhea, headache, calf pain, and conjunctival suffusion, irrespective of geographic location.
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Camous L, Pommier JD, Tressières B, Martino F, Picardeau M, Loraux C, Valette M, Chaumont H, Carles M, Demoule A, Breurec S. Organ Involvement Related to Death in Critically Ill Patients With Leptospirosis: Unsupervised Analysis in a French West Indies ICU. Crit Care Explor 2024; 6:e1126. [PMID: 38980049 PMCID: PMC11233108 DOI: 10.1097/cce.0000000000001126] [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: 07/10/2024] Open
Abstract
OBJECTIVES To identify distinct phenotypes of critically ill leptospirosis patients upon ICU admission and their potential associations with outcome. DESIGN Retrospective observational study including all patients with biologically confirmed leptospirosis admitted to the ICU between January 2014 and December 2022. Subgroups of patients with similar clinical profiles were identified by unsupervised clustering (factor analysis for mixed data and hierarchical clustering on principal components). SETTING All patients admitted to the ICU of the University Hospital of Guadeloupe on the study period. PATIENTS One hundred thirty critically ill patients with confirmed leptospirosis were included. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS At ICU admission, 34% of the patients had acute respiratory failure, and 26% required invasive mechanical ventilation. Shock was observed in 52% of patients, myocarditis in 41%, and neurological involvement in 20%. Unsupervised clustering identified three clusters-"Weil's Disease" (48%), "neurological leptospirosis" (20%), and "multiple organ failure" (32%)-with different ICU courses and outcomes. Myocarditis and neurological involvement were key components for cluster identification and were significantly associated with death in ICU. Other factors associated with mortality included shock, acute respiratory failure, and requiring renal replacement therapy. CONCLUSIONS AND RELEVANCE Unsupervised analysis of critically ill patients with leptospirosis revealed three patient clusters with distinct phenotypic characteristics and clinical outcomes. These patients should be carefully screened for neurological involvement and myocarditis at ICU admission.
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Affiliation(s)
- Laurent Camous
- Réanimation Médicale et Chirurgicale, CHU de Guadeloupe, Guadeloupe, France
| | - Jean-David Pommier
- Réanimation Médicale et Chirurgicale, CHU de Guadeloupe, Guadeloupe, France
- Institut Pasteur de la Guadeloupe, Morne Jolivière, Guadeloupe, France
| | - Benoît Tressières
- Centre d’Investigation Clinique Antilles-Guyane, Inserm CIC 1424, CHU de Guadeloupe, Guadeloupe, France
| | - Frederic Martino
- Réanimation Médicale et Chirurgicale, CHU de Guadeloupe, Guadeloupe, France
- Université de Paris and Université des Antilles, INSERM, BIGR, Paris, France
| | - Mathieu Picardeau
- Unité de biologie des Spirochètes, French National Reference Centre for Leptospirosis, CNRS UMR 6047, Institut Pasteur, Université Paris Cité, Paris, France
| | - Cecile Loraux
- Laboratoire de Microbiologie, CHU de Guadeloupe, Guadeloupe, France
| | - Marc Valette
- Réanimation Médicale et Chirurgicale, CHU de Guadeloupe, Guadeloupe, France
| | - Hugo Chaumont
- Centre d’Investigation Clinique Antilles-Guyane, Inserm CIC 1424, CHU de Guadeloupe, Guadeloupe, France
- Service de Neurologie, CHU de Guadeloupe, Guadeloupe, France
| | - Michel Carles
- Service de maladies infectieuses et tropicales, CHU de Nice, Nice, France
| | - Alexandre Demoule
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
- Groupe Hospitalier Universitaire, Assistance Publique, Hôpitaux de Paris, Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive et Réanimation (Département R3S), Paris, France
| | - Sebastien Breurec
- Centre d’Investigation Clinique Antilles-Guyane, Inserm CIC 1424, CHU de Guadeloupe, Guadeloupe, France
- Université de Paris and Université des Antilles, INSERM, BIGR, Paris, France
- Laboratoire de Microbiologie, CHU de Guadeloupe, Guadeloupe, France
- Département de Pathogenèse et contrôle des infections chroniques et émergentes, Université de Montpellier, INSERM, Etablissement français du Sang, Montpellier, France
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Hagedoorn NN, Maze MJ, Carugati M, Cash-Goldwasser S, Allan KJ, Chen K, Cossic B, Demeter E, Gallagher S, German R, Galloway RL, Habuš J, Rubach MP, Shiokawa K, Sulikhan N, Crump JA. Global distribution of Leptospira serovar isolations and detections from animal host species: A systematic review and online database. Trop Med Int Health 2024; 29:161-172. [PMID: 38351504 PMCID: PMC11076152 DOI: 10.1111/tmi.13965] [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] [Indexed: 02/27/2024]
Abstract
OBJECTIVES Leptospira, the spirochaete causing leptospirosis, can be classified into >250 antigenically distinct serovars. Although knowledge of the animal host species and geographic distribution of Leptospira serovars is critical to understand the human and animal epidemiology of leptospirosis, current data are fragmented. We aimed to systematically review, the literature on animal host species and geographic distribution of Leptospira serovars to examine associations between serovars with animal host species and regions and to identify geographic regions in need of study. METHODS Nine library databases were searched from inception through 9 March 2023 using keywords including Leptospira, animal, and a list of serovars. We sought reports of detection of Leptospira, from any animal, characterised by cross agglutinin absorption test, monoclonal antibody typing, serum factor analysis, or pulsed-field gel electrophoresis to identify the serovar. RESULTS We included 409 reports, published from 1927 through 2022, yielding data on 154 Leptospira serovars. The reports included data from 66 (26.5%) of 249 countries. Detections were from 144 animal host species including 135 (93.8%) from the class Mammalia, 5 (3.5%) from Amphibia, 3 (2.1%) from Reptilia, and 1 (0.7%) from Arachnida. Across the animal host species, Leptospira serovars that were detected in the largest number of animal species included Grippotyphosa (n = 39), Icterohaemorrhagiae (n = 29), Pomona (n = 28), Australis (n = 25), and Ballum (n = 25). Of serovars, 76 were detected in a single animal host species. We created an online database to identify animal host species for each serovar by country. CONCLUSIONS We found that many countries have few or no Leptospira serovars detected from animal host species and that many serovars were detected from a single animal species. Our study highlights the importance of efforts to identify animal host species of leptospirosis, especially in places with a high incidence of human leptospirosis. We provide an updated resource for leptospirosis researchers.
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Affiliation(s)
| | - Michael J. Maze
- Centre for International Health, University of Otago, Dunedin, New Zealand
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Manuela Carugati
- Division of Infectious Diseases, Duke University Medical Center, Durham, United States of America
| | | | - Kathryn J. Allan
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | - Kevin Chen
- Infectious Diseases Department, Te Whatu Ora Hauora a Toi Bay of Plenty
| | - Brieuc Cossic
- College of Veterinary Medicine, Ithaca, NY, United States of America
| | - Elena Demeter
- College of Veterinary Medicine, Ithaca, NY, United States of America
| | - Sarah Gallagher
- Health Sciences Library, University of Otago, Dunedin, New Zealand
| | - Richard German
- Health Sciences Library, University of Otago, Dunedin, New Zealand
| | - Renee L. Galloway
- Bacterial Special Pathogens Branch, US Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Josipa Habuš
- Faculty of Veterinary Medicine, University of Zagreb
| | - Matthew P. Rubach
- Division of Infectious Diseases, Duke University Medical Center, Durham, United States of America
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
- Kilimanjaro Christian Medical University College, Tumaini University, Moshi, Tanzania
| | - Kanae Shiokawa
- School of Veterinary Medicine, Ross University, St Kitts
| | - Nadezhda Sulikhan
- Federal Scientific Center of East Asia Terrestrial Biodiversity, FEB Russian Academy of Sciences, Vladivostok, Russia
| | - John A. Crump
- Centre for International Health, University of Otago, Dunedin, New Zealand
- Division of Infectious Diseases, Duke University Medical Center, Durham, United States of America
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
- Kilimanjaro Christian Medical University College, Tumaini University, Moshi, Tanzania
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Hagedoorn NN, Maze MJ, Carugati M, Cash-Goldwasser S, Allan KJ, Chen K, Cossic B, Demeter E, Gallagher S, German R, Galloway RL, Habuš J, Rubach MP, Shiokawa K, Sulikhan N, Crump JA. Global distribution of Leptospira serovar isolations and detections from animal host species: a systematic review and online database. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.03.23296503. [PMID: 37873107 PMCID: PMC10593013 DOI: 10.1101/2023.10.03.23296503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Objectives Leptospira, the spirochaete causing leptospirosis, can be classified into >250 antigenically distinct serovars. Although knowledge of the animal host species and geographic distribution of Leptospira serovars is critical to understand the human and animal epidemiology of leptospirosis, currently data are fragmented. We aimed to systematically review the literature on animal host species and geographic distribution of Leptospira serovars to examine associations between serovars with animal host species and regions, and to identify geographic regions in need of study. Methods Nine library databases were searched from inception through 9 March 2023 using keywords including Leptospira, animal, and a list of serovars. We sought reports of detection of Leptospira, from any animal, characterized by cross agglutinin absorption test, monoclonal antibody typing, serum factor analysis, or pulsed-field gel electrophoresis to identify the serovar. Results We included 409 reports, published from 1927 through 2022, yielding data on 154 Leptospira serovars. The reports included data from 66 (26.5%) of 249 countries. Detections were from 144 animal host species including 135 (93.8%) from the class Mammalia, 5 (3.5%) from Amphibia, 3 (2.1%) from Reptilia, and 1 (0.7%) from Arachnida. Across the animal host species, Leptospira serovars that were detected in the largest number of animal species included Grippotyphosa (n=39), Icterohaemorrhagiae (n=29), Pomona (n=28), Australis (n=25), and Ballum (n=25). Of serovars, 76 were detected in a single animal host species. We created an online database to identify animal host species for each serovar by country. Conclusions We found that many countries have few or no Leptospira serovars detected from animal host species and that many serovars were detected from a single animal species. Our study highlights the importance of efforts to identify animal host species of leptospirosis, especially in places with a high incidence of human leptospirosis. We provide an updated resource for leptospirosis researchers.
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Affiliation(s)
| | - Michael J. Maze
- Centre for International Health, University of Otago, Dunedin, New Zealand
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Manuela Carugati
- Division of Infectious Diseases, Duke University Medical Center, Durham, United States of America
| | | | - Kathryn J. Allan
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | - Kevin Chen
- Infectious Diseases Department, Te Whatu Ora Hauora a Toi Bay of Plenty, New Zealand
| | - Brieuc Cossic
- College of Veterinary Medicine, Ithaca, NY, United States of America
| | - Elena Demeter
- College of Veterinary Medicine, Ithaca, NY, United States of America
| | - Sarah Gallagher
- Health Sciences Library, University of Otago, Dunedin, New Zealand
| | - Richard German
- Health Sciences Library, University of Otago, Dunedin, New Zealand
| | - Renee L. Galloway
- Bacterial Special Pathogens Branch, US Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Josipa Habuš
- Faculty of Veterinary Medicine, University of Zagreb
| | - Matthew P. Rubach
- Division of Infectious Diseases, Duke University Medical Center, Durham, United States of America
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
- Kilimanjaro Christian Medical University College, Tumaini University, Moshi, Tanzania
| | - Kanae Shiokawa
- School of Veterinary Medicine, Ross University, St Kitts
| | - Nadezhda Sulikhan
- Federal Scientific Center of East Asia Terrestrial Biodiversity, FEB Russian Academy of Sciences, Vladivostok, Russia
| | - John A. Crump
- Centre for International Health, University of Otago, Dunedin, New Zealand
- Division of Infectious Diseases, Duke University Medical Center, Durham, United States of America
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
- Kilimanjaro Christian Medical University College, Tumaini University, Moshi, Tanzania
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Parra Barrera EL, Bello Piruccini S, Rodríguez K, Duarte C, Torres M, Undurraga EA. Demographic and clinical risk factors associated with severity of lab-confirmed human leptospirosis in Colombia, 2015-2020. PLoS Negl Trop Dis 2023; 17:e0011454. [PMID: 37406001 DOI: 10.1371/journal.pntd.0011454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 06/09/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Leptospirosis is a common zoonoses and is a major global public health threat. Most cases are mild, typically presenting as a non-specific acute febrile illness. However, leptospirosis can have life-threatening manifestations, including pulmonary hemorrhage syndrome, and acute kidney injury. In Colombia, notification and lab-confirmation of suspected human cases are mandatory. However, little is known about the demographic and clinical factors associated with severe leptospirosis, which could help to reduce clinical complications and mortality. Our aim was to identify risk factors associated with severe leptospirosis, intensive care unit (ICU) admission, and mortality in lab-confirmed cases in Colombia, 2015-2020. METHODS AND FINDINGS We analyzed 201 lab-confirmed human leptospirosis cases by microagglutination test. We used a logistic regression to identify the demographic and clinical risk factors associated with severe leptospirosis, admission to ICU, and death. Most leptospirosis confirmed cases occurred in men (85.6%); the mean age was 36.7 years. We classified severe cases (43.3%) by clinical manifestations as renal (29.9%) and liver (27.4%) failure, multiple-organ failure (24.4%), septic shock (24.4%), Weil syndrome (18.4%), pulmonary hemorrhage (18.4%), and meningitis (2.5%), admitted to the ICU (30.3%), and fatal (8.5%). Clinical conditions associated with severe leptospirosis were dyspnea (OR: 5.54; 95% CI: 1.46 to 20.98), tachycardia (OR:9.69; 95% CI: 15.96 to 58.8), and rash (OR: 10.25; 95% CI: 25.01 to 42.08). CONCLUSIONS We identified demographic characteristics and clinical symptoms associated with severe leptospirosis in Colombia. We hope these results can support clinicians in providing timely treatment to leptospirosis patients to avoid preventable medical complications or deaths.
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Affiliation(s)
- Eliana L Parra Barrera
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile
- Multidisciplinary Initiative for Collaborative Research on Bacterial Pathogens and Resistance (MICROB-R), Santiago, RM Chile
- Grupo de Virología, Instituto Nacional de Salud, Bogotá, Colombia
| | | | - Karina Rodríguez
- Grupo de Microbiología, Instituto Nacional de Salud, Bogotá, Colombia
| | - Carolina Duarte
- Grupo de Microbiología, Instituto Nacional de Salud, Bogotá, Colombia
| | - Marisa Torres
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile
| | - Eduardo A Undurraga
- Multidisciplinary Initiative for Collaborative Research on Bacterial Pathogens and Resistance (MICROB-R), Santiago, RM Chile
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Santiago, RM, Chile
- CIFAR Azrieli Global Scholars program, CIFAR, Toronto, Canada
- Research Center for Integrated Disaster Risk Management (CIGIDEN), Santiago, RM Chile
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Mišić-Majerus L, Kišek TC, Ružić-Sabljić E. Leptospirosis and characterization of Leptospira isolates from patients in Koprivnica-Križevci County, Croatia from 2000-2004. Access Microbiol 2023; 5:acmi000431. [PMID: 37223056 PMCID: PMC10202403 DOI: 10.1099/acmi.0.000431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 02/28/2023] [Indexed: 05/25/2023] Open
Abstract
Introduction Leptospirosis, caused by spirochetes of the genus Leptospira , is present in the Koprivnica-Križevci County area, Croatia. Clinical manifestation can range from asymptomatic, short-term mild, non-specific febrile disease, to severe forms with high mortality rates. Aim The aim of the study was to valuate culture in front of microscopic agglutination test (MAT) for diagnosis of infection, and to evaluate clinical and laboratory features of the disease. Moreover, we want to characterize Leptospira strains involved in infection in Koprivnica-Križevci County, Croatia. Methods We included 68 patients with clinical presentation consistent with leptospirosis collected in a 5-year period (2000-2004). Clinical samples (blood, urine and cerebrospinal fluid, CSF) were inoculated in Kolthoff's medium; species of isolated Leptospira strains was determined with Tm of real-time PCR, serogroup/serovar with MAT and NotI-RFLP analysis. Demonstration of specific antibodies in patients' sera was done using microscopic agglutination test. Results Leptospira was isolated from the blood of 14/51(27.5 %) patients and the most often identified serogroup/serovar was Icterohaemorrhagiae (8/10, 80%) followed by Grippotyphosa (10%). Regarding to species level, 8/10 isolated belonged to L. interrogans sensu stricto and one to L. kirschneri species. MAT was carried out on 51 patients with suspected leptospirosis, and was positive in 11/51(21.5 %) patients. Most of our patients presented with moderate severe symptoms, were hospitalized from August to October, and were infected mainly during the work or recreation in our county. The frequency of particular clinical features and pathological laboratory findings correlated with the severity of the clinical condition. Conclusions Leptospirosis can be confirmed microbiologically, culture and MAT contributed almost equally to the diagnosis of infection. Serovar Icterohaemorrhagiae was found as the dominant one, and L. interrogans sensu stricto as dominant species in our county. Epidemiological data shown that leptospirosis occurs seasonally, affects the rural population, and most commonly is presented with moderate severe clinical course.
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Affiliation(s)
- Ljiljana Mišić-Majerus
- Department of Infectious Diseases, General Hospital "Dr. Tomislav Bardek", Željka Selingera 1, Koprivnica, Croatia
| | - Tjaša Cerar Kišek
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Ljubljana, Zaloška 4, Ljubljana, Slovenia
| | - Eva Ružić-Sabljić
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Ljubljana, Zaloška 4, Ljubljana, Slovenia
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Grillova L, Cokelaer T, Mariet JF, da Fonseca JP, Picardeau M. Core genome sequencing and genotyping of Leptospira interrogans in clinical samples by target capture sequencing. BMC Infect Dis 2023; 23:157. [PMID: 36918832 PMCID: PMC10012794 DOI: 10.1186/s12879-023-08126-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 02/28/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND The life-threatening pathogen Leptospira interrogans is the most common agent of leptospirosis, an emerging zoonotic disease. However, little is known about the strains that are currently circulating worldwide due to the fastidious nature of the bacteria and the difficulty to isolate cultures. In addition, the paucity of bacteria in blood and other clinical samples has proven to be a considerable challenge for directly genotyping the agent of leptospirosis directly from patient material. Our understanding of the genetic diversity of strains during human infection is therefore limited. METHODS Here, we carried out hybridization capture followed by Illumina sequencing of the core genome directly from 20 clinical samples that were PCR positive for pathogenic Leptospira to elucidate the genetic diversity of currently circulating Leptospira strains in mainland France. RESULTS Capture with RNA probes covering the L. interrogans core genome resulted in a 72 to 13,000-fold increase in pathogen reads relative to standard sequencing without capture. Variant analysis of the genomes sequenced from the biological samples using 273 Leptospira reference genomes was then carried out to determine the genotype of the infecting strain. For samples with sufficient coverage (19/20 samples with coverage > 8×), we could unambiguously identify L. interrogans serovars Icterohaemorrhagiae and Copenhageni (14 samples), L. kirschneri serovar Grippotyphosa (4 samples), and L. interrogans serovar Pyrogenes (1 sample) as the infecting strains. CONCLUSIONS We obtained high-quality genomic data with suitable coverage for confident core genome genotyping of the agent of leptospirosis for most of our clinical samples. The recovery of the genome of the serovars Icterohaemorrhagiae and Copenhageni directly from multiple clinical samples revealed low adaptive diversification of the core genes during human infection. The ability to generate culture-free genomic data opens new opportunities for better understanding of the epidemiology of this fastidious pathogen and pathogenesis of this neglected disease.
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Affiliation(s)
- Linda Grillova
- Biology of Spirochetes Unit, French National Reference Centre for Leptospirosis, CNRS UMR 6047, Institut Pasteur, Université Paris Cité, 75015, Paris, France.,Parasites and Microbes Programme, Wellcome Sanger Institute, Hinxton, UK
| | - Thomas Cokelaer
- Institut Pasteur, Université Paris Cité, Plate-Forme Technologique Biomics, 75015, Paris, France.,Département Biologie Computationnelle, Institut Pasteur, Université Paris Cité, Hub de Bioinformatique et Biostatistique, 75015, Paris, France
| | - Jean-François Mariet
- Biology of Spirochetes Unit, French National Reference Centre for Leptospirosis, CNRS UMR 6047, Institut Pasteur, Université Paris Cité, 75015, Paris, France
| | | | - Mathieu Picardeau
- Biology of Spirochetes Unit, French National Reference Centre for Leptospirosis, CNRS UMR 6047, Institut Pasteur, Université Paris Cité, 75015, Paris, France.
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Prognostic Factors for Leptospirosis Infection Severity. Trop Med Infect Dis 2023; 8:tropicalmed8020112. [PMID: 36828528 PMCID: PMC9963743 DOI: 10.3390/tropicalmed8020112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 02/08/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Leptospirosis is an important health problem in Thailand. People infected with leptospirosis may not have any mild symptoms, whereas some people have acute and severe illnesses. It is crucial to strengthen critical patients' diagnosis and treatment to prevent severe complications and reduce mortality. This study was performed to explore a set of parameters for the prediction of severe leptospirosis illness under routine clinical practice. METHODS A case-control study was conducted in eight general hospitals in Thailand. Retrospective collection data were used, and key information was retrieved from inpatient medical files. Patients were grouped into two severity categories, severe and non-severe infection. Backward elimination was used to reach the final multivariate model. RESULTS The six significant predictors identified in the study were hemoptysis (OR = 25.80, 95% CI 5.69, 116.92), hypotension (blood pressure < 90/60 mmHg) (OR = 17.33, 95% CI 6.89, 43.58), platelet count < 100,000/µL (OR = 8.37, 95% CI 4.65, 15.09), white blood cell count (WBC) > 14,000/µL (OR = 5.12, 95% CI 2.75, 9.51), hematocrit ≤ 30% (OR = 3.49, 95% CI 1.61, 7.57), and jaundice (OR = 3.11, 95% CI 1.71, 5.65). These predictors could correctly predict the severity of leptospirosis infection in 91.31% of the area under the receiver operation curve (AuROC). CONCLUSIONS The results of this study showed that severe leptospirosis infections have identifiable predictors. The predictors may be used to develop a scoring system for predicting the level of severity.
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Maillard O, Hirschinger D, Bénéteau S, Koumar Y, Vague A, Girerd R, DiAscia L, Jabot J, Cousty J, Randrianjohany A, Bertolotti A, Raffray L. C-reactive protein: An easy marker for early differentiation between leptospirosis and dengue fever in endemic area. PLoS One 2023; 18:e0285900. [PMID: 37195992 DOI: 10.1371/journal.pone.0285900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 05/04/2023] [Indexed: 05/19/2023] Open
Abstract
In tropical regions, leptospirosis and dengue fever (DF) are infectious diseases of epidemiological importance and have overlapping symptomatic features. The objective of this study was to identify the factors associated to diagnosing leptospirosis that differentiate it to DF at the initial hospital evaluation. A multicenter retrospective study was conducted comparing confirmed leptospirosis to DF cases. Clinical/laboratory findings were compiled at hospital admission on Reunion Island between 2018 and 2019. Multivariable logistic regression was used to identify the predictors of leptospirosis. In total, 98 leptospirosis and 673 DF patients were included with a mean age of 47.8 (±17.1) and 48.9 (±23.3) years, respectively. In the multivariate analyses, the main parameters associated with leptospirosis were: i) increased neutrophil counts, ii) C-reactive protein values, iii) the absence of prolonged partial thromboplastin time, and iv) a decrease of platelets. The most discriminating parameter was C-reactive protein (CRP). With a threshold of 50mg/L, CRP taken alone had a sensitivity of 94% and a specificity of 93.5%. The positive and negative likelihood ratios were 14.5 and 0.06, respectively. In the setting of an early presumptive diagnosis, we found that an increased CRP value (>50 mg/L) could help diagnose leptospirosis and aid the decision process for hospital surveillance and/or a potential antibiotic treatment regimen.
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Affiliation(s)
- Olivier Maillard
- Department of Public Health and Research, CHU Réunion, Saint-Pierre, Reunion, France
- Clinical Investigation Center, INSERM CIC 1410, CHU Réunion, Saint-Pierre, Reunion, France
| | - David Hirschinger
- Department of Emergency Medicine, CHU Réunion, Saint-Denis, Reunion, France
| | - Samuel Bénéteau
- Department of Public Health and Research, CHU Réunion, Saint-Pierre, Reunion, France
| | - Yatrika Koumar
- Department of Infectious Diseases, CHU Réunion, Saint-Pierre, Reunion, France
| | - Adrien Vague
- Department of Emergency Medicine, CHU Réunion, Saint-Pierre, Reunion, France
| | - Rémi Girerd
- Department of Emergency Medicine, CHU Réunion, Saint-Pierre, Reunion, France
| | - Laura DiAscia
- Department of Emergency Medicine, CHU Réunion, Saint-Denis, Reunion, France
| | - Julien Jabot
- Intensive Care Unit, CHU Réunion, Saint-Denis, Reunion, France
| | - Julien Cousty
- Intensive Care Unit, CHU Réunion, Saint-Pierre, Reunion, France
| | - Andry Randrianjohany
- Department of Internal Medicine, Groupe Hospitalier Est Réunion, Saint-Benoit, Reunion, France
| | - Antoine Bertolotti
- Clinical Investigation Center, INSERM CIC 1410, CHU Réunion, Saint-Pierre, Reunion, France
- Department of Infectious Diseases, CHU Réunion, Saint-Pierre, Reunion, France
| | - Loïc Raffray
- Department of Internal Medicine, CHU Réunion, Saint-Denis, Reunion, France
- UMR Processus Infectieux en Milieu Insulaire Tropical (PIMIT), CNRS 9192, INSERM U1187, IRD 249, Université de La Réunion, Sainte-Clotilde, Reunion, France
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10
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Petakh P, Isevych V, Mohammed IB, Nykyforuk A, Rostoka L. Leptospirosis: Prognostic Model for Patient Mortality in the Transcarpathian Region, Ukraine. Vector Borne Zoonotic Dis 2022; 22:584-588. [PMID: 36445174 DOI: 10.1089/vbz.2022.0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Leptospirosis is a bacterial zoonosis of worldwide distribution with a wide spectrum of clinical presentations that range from subclinical or mild to severe and fatal outcomes. Identifying clinical predictors for the severe form of the disease is critical to reduce disease complications and death. As a result, we conducted a retrospective case-control study to identify clinical markers of mortality in leptospirosis patients from the Transcarpathian region. Materials and Methods: The study used 102 medical records of patients with leptospirosis in the period from 2009 to 2019. There were 26 fatal cases and 76 survivors. Predictors were examined using univariate and bivariate statistics. Results: Fatal and nonfatal groups did not differ in age or gender composition (p > 0.5), nor did they differ in signs or symptoms, except that oliguria occurred significantly more often in fatal cases (p < 0.001). Laboratory diagnostic tests, however, differed between outcomes in 7/9 recorded variables; primarily associated with liver and kidney function as well thrombocytopenia and elevated white blood cell counts for fatal cases (p < 0.01 for all variables). Conclusions: Logistic regression analysis indicated that a combination of creatinine levels and direct bilirubin levels were the best predictors of patient outcome. The specificity of the model was 90.9% and the area under the receiver operator characteristic function as 93.6%. This model can be used when a patient is admitted to a hospital to better characterize patient risk.
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Affiliation(s)
- Pavlo Petakh
- Department of Microbiology, Virology and Immunology, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine.,Department of Biochemistry and Pharmacology, Uzhhorod National University, Uzhhorod, Ukraine
| | | | | | - Andriy Nykyforuk
- Department of Biochemistry and Pharmacology, Uzhhorod National University, Uzhhorod, Ukraine
| | - Larysa Rostoka
- Department of Biochemistry and Pharmacology, Uzhhorod National University, Uzhhorod, Ukraine
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11
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Sumaiya K, Natarajaseenivasan K. Macrophage migration inhibitory factor gene promoter polymorphism (−173G/C SNP) determines host susceptibility and severity of leptospirosis. Microb Pathog 2022; 164:105445. [DOI: 10.1016/j.micpath.2022.105445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/08/2022] [Accepted: 02/08/2022] [Indexed: 10/19/2022]
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12
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Grillová L, Robinson MT, Chanthongthip A, Vincent AT, Nieves C, Oppelt J, Mariet JF, Lorioux C, Vongsouvath M, Mayxay M, Phonemeexay O, Rattanavong S, Phommasone K, Douangnouvong A, Šmajs D, Veyrier FJ, Newton PN, Picardeau M. Genetic diversity of Leptospira isolates in Lao PDR and genome analysis of an outbreak strain. PLoS Negl Trop Dis 2021; 15:e0010076. [PMID: 34962921 PMCID: PMC8746763 DOI: 10.1371/journal.pntd.0010076] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 01/10/2022] [Accepted: 12/09/2021] [Indexed: 11/18/2022] Open
Abstract
Background Although Southeast Asia is one of the most leptospirosis afflicted regions, little is known about the diversity and molecular epidemiology of the causative agents of this widespread and emerging zoonotic disease. Methodology/Principal findings We used whole genome sequencing to examine genetic variation in 75 Leptospira strains isolated from patients in the Lao PDR (Laos) between 2006 and 2017. Eleven serogroups from 4 Leptospira species and 43 cgMLST-defined clonal groups (CGs) were identified. The most prevalent CG was CG272 (n = 18, 26.8%), composed of L. interrogans serogroup Autumnalis isolates. This genotype was recovered throughout the 12-year period and was associated with deaths, and with a large outbreak in neighbouring Thailand. Genome analysis reveals that the CG272 strains form a highly clonal group of strains that have, for yet unknown reasons, recently spread in Laos and Thailand. Additionally, accessory genes clearly discriminate CG272 strains from the other Leptospira strains. Conclusions/Significance The present study reveals a high diversity of Leptospira genotypes in Laos, thus extending our current knowledge of the pan- and core-genomes of these life-threatening pathogens. Our results demonstrate that the CG272 strains belong to a unique clonal group, which probably evolved through clonal expansion following niche adaptation. Additional epidemiological studies are required to better evaluate the spread of this genotype in Southeast Asia. To further investigate the key factors driving the virulence and spread of these pathogens, more intense genomic surveillance is needed, combining detailed clinical and epidemiological data. Pathogenic Leptospira are the causative agents for leptospirosis, a neglected and emerging zoonosis occurring worldwide. In this study, we investigated the genetic diversity of Leptospira strains isolated from patients over a 12-year period in Lao PDR. Our genome analysis revealed a high diversity of Leptospira genotypes in this endemic country for leptospirosis, including a group of clonal strains which was responsible for a large outbreak in neighboring Thailand. Further progress in our understanding of the epidemiology of Leptospira circulating genotypes should contribute to the implementation of prevention and intervention measures to reduce the risk of leptospirosis transmission.
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Affiliation(s)
- Linda Grillová
- Biology of Spirochetes Unit, Institut Pasteur, Paris, France
- Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Matthew T. Robinson
- Lao-Oxford-Mahosot Hospital-Wellcome Trust-Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Anisone Chanthongthip
- Lao-Oxford-Mahosot Hospital-Wellcome Trust-Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
| | - Antony T. Vincent
- INRS-Centre Armand-Frappier Santé-Biotechnologie, Bacterial Symbionts Evolution, Laval, Canada
| | - Cecilia Nieves
- INRS-Centre Armand-Frappier Santé-Biotechnologie, Bacterial Symbionts Evolution, Laval, Canada
| | - Jan Oppelt
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
| | | | - Céline Lorioux
- Biology of Spirochetes Unit, Institut Pasteur, Paris, France
| | - Manivanh Vongsouvath
- Lao-Oxford-Mahosot Hospital-Wellcome Trust-Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
| | - Mayfong Mayxay
- Lao-Oxford-Mahosot Hospital-Wellcome Trust-Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Institute of Research and Education Development (IRED), University of Health Sciences, Ministry of Health, Vientiane, Lao People’s Democratic Republic
| | - Ooyanong Phonemeexay
- Lao-Oxford-Mahosot Hospital-Wellcome Trust-Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
| | - Sayaphet Rattanavong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust-Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
| | - Koukeo Phommasone
- Lao-Oxford-Mahosot Hospital-Wellcome Trust-Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
| | - Anousone Douangnouvong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust-Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
| | - David Šmajs
- Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Frédéric J. Veyrier
- INRS-Centre Armand-Frappier Santé-Biotechnologie, Bacterial Symbionts Evolution, Laval, Canada
| | - Paul N. Newton
- Lao-Oxford-Mahosot Hospital-Wellcome Trust-Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Mathieu Picardeau
- Biology of Spirochetes Unit, Institut Pasteur, Paris, France
- * E-mail:
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13
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Kakita T, Okano S, Kyan H, Miyahira M, Taira K, Kitashoji E, Koizumi N. Laboratory diagnostic, epidemiological, and clinical characteristics of human leptospirosis in Okinawa Prefecture, Japan, 2003-2020. PLoS Negl Trop Dis 2021; 15:e0009993. [PMID: 34905535 PMCID: PMC8670671 DOI: 10.1371/journal.pntd.0009993] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/12/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Leptospirosis is considered an endemic disease among agricultural workers in Okinawa Prefecture, which is the southernmost part of Japan and has a subtropical climate, but data on the current status and trend of this disease are scarce. METHODOLOGY/PRINCIPAL FINDINGS We conducted a retrospective study of clinically suspected leptospirosis patients whose sample and information were sent to the Okinawa Prefectural Institute of Health and Environment from November 2003 to December 2020. Laboratory diagnosis was established using culture, nested polymerase chain reaction (PCR), and/or microscopic agglutination test (MAT) with blood, cerebrospinal fluid, and/or urine samples. Statistical analyses were performed to compare the epidemiological information, clinical features, and sensitivities of diagnostic methods among laboratory-confirmed cases. Serogroups and the species of Leptospira isolates were determined by MAT using 13 antisera and flaB sequencing. A total of 531 clinically suspected patients were recruited, among whom 246 (46.3%) were laboratory confirmed to have leptospirosis. Among the confirmed cases, patients aged 20-29 years (22.4%) and male patients (85.7%) were the most common. The most common estimated sources of infection were recreation (44.5%) and labor (27.8%) in rivers. Approximately half of the isolates were of the L. interrogans serogroup Hebdomadis. The main clinical symptoms were fever (97.1%), myalgia (56.3%), and conjunctival hyperemia (52.2%). Headache occurred significantly more often in patients with Hebdomadis serogroup infections than those with other serogroup infections. The sensitivities of culture and PCR exceeded 65% during the first 6 days, while the sensitivity of MAT surpassed that of culture and PCR in the second week after onset. PCR using blood samples was a preferable method for the early diagnosis of leptospirosis. CONCLUSIONS/SIGNIFICANCE The results of this study will support clinicians in the diagnosis and treatment of undifferentiated febrile patients in Okinawa Prefecture as well as patients returning from Okinawa Prefecture.
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Affiliation(s)
- Tetsuya Kakita
- Department of Biological Sciences, Okinawa Prefectural Institute of Health and Environment, Uruma, Okinawa, Japan
| | - Sho Okano
- Department of Biological Sciences, Okinawa Prefectural Institute of Health and Environment, Uruma, Okinawa, Japan
| | - Hisako Kyan
- Department of Biological Sciences, Okinawa Prefectural Institute of Health and Environment, Uruma, Okinawa, Japan
| | - Masato Miyahira
- Department of Biological Sciences, Okinawa Prefectural Institute of Health and Environment, Uruma, Okinawa, Japan
| | - Katsuya Taira
- Department of Biological Sciences, Okinawa Prefectural Institute of Health and Environment, Uruma, Okinawa, Japan
| | - Emi Kitashoji
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Nagasaki, Japan
| | - Nobuo Koizumi
- Department of Bacteriology I, National Institute of Infectious Disease, Shinjuku, Tokyo, Japan
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14
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Gruel G, Diouf MB, Abadie C, Chilin-Charles Y, Etter EMC, Geffroy M, Herrmann Storck C, Meyer DF, Pagès N, Pressat G, Teycheney PY, Umber M, Vega-Rúa A, Pradel J. Critical Evaluation of Cross-Sectoral Collaborations to Inform the Implementation of the "One Health" Approach in Guadeloupe. Front Public Health 2021; 9:652079. [PMID: 34409004 PMCID: PMC8366749 DOI: 10.3389/fpubh.2021.652079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 07/02/2021] [Indexed: 11/17/2022] Open
Abstract
In Guadeloupe, a French overseas territory located in the Eastern Caribbean, infectious and non-infectious diseases, loss of biodiversity, natural disasters and global change threaten the health and well-being of animals, plants, and people. Implementing the “One Health” (OH) approach is crucial to reduce the archipelago's vulnerability to these health threats. However, OH remains underdeveloped in Guadeloupe, hampering efficient and effective intersectoral and transdisciplinary collaborations for disease surveillance and control. A multidisciplinary research group of volunteer researchers working in Guadeloupe, with collective expertise in infectious diseases, undertook a study to identify key attributes for OH operationalization by reviewing past and current local collaborative health initiatives and analyzing how much they mobilized the OH framework. The research group developed and applied an operational OH framework to assess critically collaborative initiatives addressing local health issues. Based on a literature review, a set of 13 opinion-based key criteria was defined. The criteria and associated scoring were measured through semi-directed interviews guided by a questionnaire to critically evaluate four initiatives in animal, human, plant, and environmental health research and epidemiological surveillance. Gaps, levers, and prospects were identified that will help health communities in Guadeloupe envision how to implement the OH approach to better address local health challenges. The methodology is simple, generic, and pragmatic and relies on existing resources. It can be transposed and adapted to other contexts to improve effectiveness and efficiency of OH initiatives, based on lessons-learned of local past or current multi-interdisciplinary and intersectoral initiatives.
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Affiliation(s)
- Gaëlle Gruel
- Laboratory for the Study of Microbial Ecosystem Interactions, Institut Pasteur of Guadeloupe, Unit Transmission Reservoir and Pathogens Diversity, Les Abymes, France
| | - Mame Boucar Diouf
- INRAE, UR ASTRO, F-97170, Petit-Bourg, France.,CIRAD, UMR AGAP Institut, F-97130, Capesterre Belle-Eau, France.,AGAP Institut, Univ Montpellier, CIRAD, INRAE, Institut Agro, Montpellier, France
| | - Catherine Abadie
- BGPI, Univ Montpellier, CIRAD, INRAE, Institut Agro, Montpellier, France
| | - Yolande Chilin-Charles
- BGPI, Univ Montpellier, CIRAD, INRAE, Institut Agro, Montpellier, France.,CIRAD, UMR BGPI, F-97130, Capesterre Belle-Eau, France
| | - Eric Marcel Charles Etter
- CIRAD, UMR ASTRE, F-97170, Petit-Bourg, France.,ASTRE, Univ Montpellier, CIRAD INRAE, Montpellier, France
| | - Mariana Geffroy
- CIRAD, UMR ASTRE, F-97170, Petit-Bourg, France.,ASTRE, Univ Montpellier, CIRAD INRAE, Montpellier, France
| | - Cécile Herrmann Storck
- Centre Hospitalier Universitaire CHU de Guadeloupe, Laboratoire de Microbiologie Humaine et Environnementale, Les Abymes, France
| | - Damien F Meyer
- CIRAD, UMR ASTRE, F-97170, Petit-Bourg, France.,ASTRE, Univ Montpellier, CIRAD INRAE, Montpellier, France
| | - Nonito Pagès
- CIRAD, UMR ASTRE, F-97170, Petit-Bourg, France.,ASTRE, Univ Montpellier, CIRAD INRAE, Montpellier, France
| | - Gersende Pressat
- CIRAD, UMR AGAP Institut, F-97130, Capesterre Belle-Eau, France.,AGAP Institut, Univ Montpellier, CIRAD, INRAE, Institut Agro, Montpellier, France
| | - Pierre-Yves Teycheney
- CIRAD, UMR AGAP Institut, F-97130, Capesterre Belle-Eau, France.,AGAP Institut, Univ Montpellier, CIRAD, INRAE, Institut Agro, Montpellier, France
| | - Marie Umber
- INRAE, UR ASTRO, F-97170, Petit-Bourg, France
| | - Anubis Vega-Rúa
- Laboratory of Vector Control Research, Institut Pasteur of Guadeloupe, Unit Transmission Reservoir and Pathogens Diversity, Les Abymes, France
| | - Jennifer Pradel
- CIRAD, UMR ASTRE, F-97170, Petit-Bourg, France.,ASTRE, Univ Montpellier, CIRAD INRAE, Montpellier, France
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15
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Jayasundara D, Senavirathna I, Warnasekara J, Gamage C, Siribaddana S, Kularatne SAM, Matthias M, Mariet JF, Picardeau M, Agampodi S, M. Vinetz J. 12 Novel clonal groups of Leptospira infecting humans in multiple contrasting epidemiological contexts in Sri Lanka. PLoS Negl Trop Dis 2021; 15:e0009272. [PMID: 33735202 PMCID: PMC8009393 DOI: 10.1371/journal.pntd.0009272] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 03/30/2021] [Accepted: 02/25/2021] [Indexed: 12/13/2022] Open
Abstract
Leptospirosis is a ubiquitous zoonotic disease and a major clinical challenge owing to the multitude of clinical presentations and manifestations that are possibly attributable to the diversity of Leptospira, the understanding of which is key to study the epidemiology of this emerging global disease threat. Sri Lanka is a hotspot for leptospirosis with high levels of endemicity as well as annual epidemics. We carried out a prospective study of Leptospira diversity in Sri Lanka, covering the full range of climatic zones, geography, and clinical severity. Samples were collected for leptospiral culture from 1,192 patients from 15 of 25 districts in Sri Lanka over two and half years. Twenty-five isolates belonging to four pathogenic Leptospira species were identified: L. interrogans, L. borgpetersenii, L. weilii, and L. kirschneri. At least six serogroups were identified among the isolates: Autumnalis (6), Pyrogenes (4), Icterohaemorrhagiae (2), Celledoni (1), Grippotyphosa (2) and Bataviae (1). Seven isolates did not agglutinate using available antisera panels, suggesting new serogroups. Isolates were sequenced using an Illumina platform. These data add 25 new core genome sequence types and were clustered in 15 clonal groups, including 12 new clonal groups. L. borgpetersenii was found only in the dry zone and L. weilii only in the wet zone. Acute kidney injury and cardiovascular involvement were seen only with L. interrogans infections. Thrombocytopenia and liver impairment were seen in both L. interrogans and L. borgpetersenii infections. The inadequate sensitivity of culture isolation to identify infecting Leptospira species underscores the need for culture-independent typing methods for Leptospira. There is a huge diversity in pathogenic Leptospira species worldwide, and our knowledge of the currently circulating species is deficient owing to limited isolation and identification of Leptospira species from endemic countries. This prospective study reveals the wide pathogen diversity that causes human leptospirosis in Sri Lanka, representing four species, more than six serogroups, and fifteen clonal groups. Further, the different geographic and climatic zone distributions and clinical manifestations observed underscores the need for prospective studies to expand the molecular epidemiological approaches to combat leptospirosis.
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Affiliation(s)
- Dinesha Jayasundara
- Leptospirosis Research Laboratory, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
- Department of Microbiology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Indika Senavirathna
- Leptospirosis Research Laboratory, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
- Department of Biochemistry, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Janith Warnasekara
- Leptospirosis Research Laboratory, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Chandika Gamage
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Sisira Siribaddana
- Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | | | - Michael Matthias
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | | | | | - Suneth Agampodi
- Leptospirosis Research Laboratory, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
- * E-mail:
| | - Joseph M. Vinetz
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
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16
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Biscornet L, de Comarmond J, Bibi J, Mavingui P, Dellagi K, Tortosa P, Pagès F. An Observational Study of Human Leptospirosis in Seychelles. Am J Trop Med Hyg 2020; 103:999-1008. [PMID: 32700658 PMCID: PMC7470538 DOI: 10.4269/ajtmh.19-0228] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A 1-year population-based prospective study was launched in Seychelles, a country with one of the highest human incidence of leptospirosis worldwide, to describe the characteristic features of the epidemiology of the disease and highlight the most prominent risk factors. Diagnosis was based on the IgM enzyme-linked immunosorbent assay, microscopic agglutination test, and real-time PCR. A standardized questionnaire was administered to 219 patients aged ≥ 13 years consulting for acute febrile illness. The high incidence of leptospirosis in Seychelles was confirmed. The disease was particularly severe, as the case fatality rate was 11.8%. Leptospirosis was positively associated in univariate analysis with socio-professional and clinical variables including gardening/farming, oliguria, jaundice, conjunctivitis, history of hepatitis C virus infection, anemia, thrombocytopenia, and/or biological renal failure. Epidemiological analyses of the questionnaires highlighted a link of the disease with living in houses (versus apartment), the presence of animals around and in houses, gardening, and misuse of personal protective equipment. Multivariate analyses indicated that being a farmer/landscaper and having cattle and cats around the home are the most significant drivers of leptospirosis. Biological features most associated with leptospirosis were thrombocytopenia, leukocytosis, high values for renal function tests, and elevated total bilirubin. We report changes in behavior and exposure compared with data collected on leptospirosis 25 years ago, with indication that healthcare development has lowered case fatality. Continuous health education campaigns are recommended as well as further studies to clarify the epidemiology of human leptospirosis, especially the role of domestic animals.
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Affiliation(s)
- Leon Biscornet
- Infectious Disease Surveillance Unit, Seychelles Public Health Laboratory, Public Health Authority, Ministry of Health, Victoria, Seychelles.,Université de La Réunion, UMR PIMIT (Processus Infectieux en Milieu Insulaire Tropical), INSERM U 1187, CNRS 9192, IRD 249, Plateforme de Recherche CYROI, Sainte Clotilde, France
| | - Jeanine de Comarmond
- Disease Surveillance and Response Unit, Epidemiology and Statistics Section, Public Health Authority, Ministry of Health, Victoria, Seychelles
| | - Jastin Bibi
- Disease Surveillance and Response Unit, Epidemiology and Statistics Section, Public Health Authority, Ministry of Health, Victoria, Seychelles
| | - Patrick Mavingui
- Université de La Réunion, UMR PIMIT (Processus Infectieux en Milieu Insulaire Tropical), INSERM U 1187, CNRS 9192, IRD 249, Plateforme de Recherche CYROI, Sainte Clotilde, France
| | - Koussay Dellagi
- Université de La Réunion, UMR PIMIT (Processus Infectieux en Milieu Insulaire Tropical), INSERM U 1187, CNRS 9192, IRD 249, Plateforme de Recherche CYROI, Sainte Clotilde, France
| | - Pablo Tortosa
- Université de La Réunion, UMR PIMIT (Processus Infectieux en Milieu Insulaire Tropical), INSERM U 1187, CNRS 9192, IRD 249, Plateforme de Recherche CYROI, Sainte Clotilde, France
| | - Frédéric Pagès
- Regional Office of the French Institute for Public Health Surveillance (Santé Publique France), Saint-Denis, France
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17
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Circulating genotypes of Leptospira in French Polynesia : An 9-year molecular epidemiology surveillance follow-up study. PLoS Negl Trop Dis 2020; 14:e0008662. [PMID: 32986693 PMCID: PMC7544043 DOI: 10.1371/journal.pntd.0008662] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 10/08/2020] [Accepted: 07/31/2020] [Indexed: 12/05/2022] Open
Abstract
Background Leptospirosis is a widespread zoonosis with global impact, particularly among vulnerable populations in resource-poor settings in tropical countries. Rodents have been considered to be the main reservoir of the disease; however, a wide variety of mammals can act as hosts as well. Here we examine the genetic diversity of Leptospira strains from biological samples of patients and animals in French Polynesia (FP) from 2011 to 2019. Methodology/Principal findings From 2011 to 2019, we have collected 444 blood samples from patients diagnosed as having leptospirosis. The limited volume of clinical material and low amount of leptospiral DNA in blood samples led us to develop a nested PCR targeting the secY locus that enabled us to amplify and sequence 244 samples (55%). In addition, 20 Leptospira strains recovered from the blood of patients from 2002 to 2011 were sequenced and fully characterized at the serogroup level and used as reference strains for the association of different phylogenetic branches with respective serogroups. The secY sequences were compared with publicly available sequences from patients and animal reservoirs in FP (n = 79). We identified rats as the main source of infection for L. borgpetersenii serogroup Ballum and L. interrogans serogroup Icterohaemorrhagiae, dogs as the main source of infection for L. interrogans serogroup Australis, and farm pigs as the main source of infection for L. interrogans serogroups Pomona or Canicola. L. interrogans was associated with the most severe infections with 10 and 5 fatal cases due to serogroups Icterohaemorrhagiae and Australis, respectively. Mortality was significantly associated with older age (p-value < 0.001). Conclusions/Significance We described the population dynamics of leptospires circulating among patients in FP, including two patients who were reinfected with unrelated Leptospira genotypes, and clarified the local role of the animal reservoirs in the transmission route of leptospirosis to humans. Routine Leptospira genotyping directly on biological samples should allow the epidemiological follow-up of circulating strains and assess the impact of control interventions on disease transmission. Pathogenic Leptospira are the causative agents for leptospirosis, a neglected zoonosis occurring worldwide with the highest incidence of the disease found in the Pacific region, including French Polynesia (FP). In this study, a nested PCR of blood specimens allowed a high isolation frequency of Leptospira DNA among patients with febrile illness in FP. Infecting Leptospira isolates were characterized by sequencing of the secY gene from 244 clinical samples from 2011 to 2019. The genotypes have been assigned to Leptospira species and serogroups by comparing the secY sequences with the genomes of strains isolated prior to 2011 in FP. This study therefore enables to follow the distribution of genotypes/serogroups over a 18-year time period. Leptospiral sequences from patients were also compared with secY sequences from different animal reservoirs from a previous study in FP showing that not only rats but also dogs and pigs might play an important role in the circulation of pathogenic Leptospira strains in FP. Further progress in our understanding of the epidemiology of Leptospira circulating genotypes should contribute to the implementation of prevention and intervention measures to reduce the risk of leptospirosis transmission in FP.
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Sandhu RS, Ismail HB, Ja’afar MHB, Rampal S. The Predictive Factors for Severe Leptospirosis Cases in Kedah. Trop Med Infect Dis 2020; 5:tropicalmed5020079. [PMID: 32422911 PMCID: PMC7344897 DOI: 10.3390/tropicalmed5020079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/08/2020] [Accepted: 05/12/2020] [Indexed: 12/18/2022] Open
Abstract
Over the past decade, increased awareness about leptospirosis disease in developing and industrialized countries has resulted in increased numbers of leptospirosis cases being reported worldwide. About 5% to 15% of leptospirosis patients end up with severe forms of the disease. Complication due to leptospirosis requires monitoring, specific treatments, and intensive care admission, thus increasing the cost of treating severe leptospirosis cases. Currently, we have data on incident and mortality rates, but we do not have data on the number of patients with severe form of leptospirosis or how many patients have complications, and whether or not these complications were resolved. Therefore, we carried out this study to determine the predictive factors for severe leptospirosis cases in Kedah. We conducted a cross-sectional study. The data of patients diagnosed with leptospirosis were obtained from the surveillance unit, Kedah Health Department, through the e-notification system. These data were then sorted according to the hospitals where the patients were admitted. The patients’ medical records were collected, and their information was obtained using a checklist. A total of 456 confirmed leptospirosis cases were included in the study, with 199 patients classified as severe cases and 257 patients as mild cases, based on the Malaysian leptospirosis guidelines. Most patients were male (71.5%) with a mean SD age of 36.62 ± 20.75 years. The predictive factors for severe leptospirosis include abnormal lung sounds (OR: 3.07 [CI 1.58–6.00]), hepatomegaly (OR: 7.14 [1.10–45.98]), hypotension (OR: 2.16 [1.08–4.34]), leukocytosis (OR: 2.12 [1.37–3.29]), low hematocrit (OR: 2.33 [1.43–3.81]), and increased alanine aminotransferase (SGPT ALT) (OR: 2.12 [1.36–3.30]). In conclusion, knowing these predictive factors will help clinicians identify severe leptospirosis cases earlier and develop their treatment plans accordingly, to reduce the complications and death from severe leptospirosis.
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Affiliation(s)
- Rakesh Singh Sandhu
- Department of Community Health, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia; (H.B.I.); (M.H.B.J.)
- Sik District Health Office, Ministry of Health Malaysia, Sik Kedah 08200, Malaysia
- Correspondence:
| | - Halim Bin Ismail
- Department of Community Health, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia; (H.B.I.); (M.H.B.J.)
| | - Mohd Hasni Bin Ja’afar
- Department of Community Health, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia; (H.B.I.); (M.H.B.J.)
| | - Sanjay Rampal
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 56000, Malaysia;
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Wang HK, Lee MH, Chen YC, Hsueh PR, Chang SC. Factors associated with severity and mortality in patients with confirmed leptospirosis at a regional hospital in northern Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2020; 53:307-314. [DOI: 10.1016/j.jmii.2018.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 05/30/2018] [Accepted: 05/30/2018] [Indexed: 01/11/2023]
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Miailhe AF, Mercier E, Maamar A, Lacherade JC, Le Thuaut A, Gaultier A, Asfar P, Argaud L, Ausseur A, Ben Salah A, Botoc V, Chaoui K, Charpentier J, Cracco C, De Prost N, Eustache ML, Ferré A, Gauvin E, Goursaud S, Grall M, Guiot P, Jonas M, Lambiotte F, Landais M, Lemarié J, Lesieur O, Lhommet C, Michel P, Monseau Y, Moschietto S, Nseir S, Osman D, Pillot J, Piton G, Sedillot N, Sirodot M, Thevenin D, Zafrani L, Zerbib Y, Bourhy P, Lascarrou JB, Reignier J. Severe leptospirosis in non-tropical areas: a nationwide, multicentre, retrospective study in French ICUs. Intensive Care Med 2019; 45:1763-1773. [PMID: 31654079 DOI: 10.1007/s00134-019-05808-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 09/26/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE To report the incidence, risk factors, clinical presentation, and outcome predictors of severe leptospirosis requiring intensive care unit (ICU) admission in a temperate zone. METHODS LEPTOREA was a retrospective multicentre study conducted in 79 ICUs in metropolitan France. Consecutive adults admitted to the ICU for proven severe leptospirosis from January 2012 to September 2016 were included. Multiple correspondence analysis (MCA) and hierarchical classification on principal components (HCPC) were performed to distinguish different clinical phenotypes. RESULTS The 160 included patients (0.04% of all ICU admissions) had median values of 54 years [38-65] for age, 40 [28-58] for the SAPSII, and 11 [8-14] for the SOFA score. Hospital mortality was 9% and was associated with older age; worse SOFA score and early need for endotracheal ventilation and/or renal replacement therapy; chronic alcohol abuse and worse hepatic dysfunction; confusion; and higher leucocyte count. Four phenotypes were identified: moderately severe leptospirosis (n = 34, 21%) with less organ failure and better outcomes; hepato-renal leptospirosis (n = 101, 63%) with prominent liver and kidney dysfunction; neurological leptospirosis (n = 8, 5%) with the most severe organ failures and highest mortality; and respiratory leptospirosis (n = 17, 11%) with pulmonary haemorrhage. The main risk factors for leptospirosis contamination were contact with animals, contact with river or lake water, and specific occupations. CONCLUSIONS Severe leptospirosis was an uncommon reason for ICU admission in metropolitan France and carried a lower mortality rate than expected based on the high severity and organ-failure scores. The identification in our population of several clinical presentations may help clinicians establish an appropriate index of suspicion for severe leptospirosis.
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Affiliation(s)
- Arnaud-Félix Miailhe
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Emmanuelle Mercier
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Bretonneau, CRICS-TRIGGERSEP network, Tours, France
| | - Adel Maamar
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Jean-Claude Lacherade
- Service de Médecine Intensive Réanimation, Centre Hospitalier Départemental de la Vendée, La Roche sur Yon, France
| | - Aurélie Le Thuaut
- Direction de la recherche, Plateforme de Méthodologie et Biostatistique, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Aurélie Gaultier
- Direction de la recherche, Plateforme de Méthodologie et Biostatistique, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Pierre Asfar
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Angers, Angers, France
| | - Laurent Argaud
- Service de Réanimation médicale, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Antoine Ausseur
- Service de Réanimation polyvalente, Centre Hospitalier de Cholet, Cholet, France
| | - Adel Ben Salah
- Service de Réanimation polyvalente, Centre Hospitalier de Chartres, Chartres, France
| | - Vlad Botoc
- Service de Réanimation et surveillance continue, Centre Hospitalier de Saint Malo, Saint-Malo, France
| | - Karim Chaoui
- Service de Réanimation polyvalente, Centre Hospitalier de Cahors, Cahors, France
| | - Julien Charpentier
- Service de Médecine Intensive Réanimation, Hôpital Cochin, Groupe Hospitalier Centre-Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Christophe Cracco
- Service de réanimation polyvalente et surveillance continue, Centre Hospitalier d'Angoulême, Angoulême, France
| | - Nicolas De Prost
- Service de Réanimation Médicale, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Marie-Line Eustache
- Service de Réanimation polyvalente, Centre Hospitalier Bretagne-Atlantique, Vannes, France
| | - Alexis Ferré
- Service de Réanimation médico-chirurgicale, Centre hospitalier de Versailles, site André Mignot, Le Chesnay, France
| | - Elena Gauvin
- Service de Réanimation polyvalente, Centre Hospitalier de Niort, Niort, France
| | - Suzanne Goursaud
- Service de Réanimation médicale, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Maximilien Grall
- Service de Réanimation médicale, Hôpital Charles Nicolle, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | - Philippe Guiot
- Service de réanimation médicale, GHRMSA, Mulhouse, France
| | - Maud Jonas
- Service de Réanimation polyvalente et USC, Centre Hospitalier de Saint Nazaire, Saint Nazaire, France
| | - Fabien Lambiotte
- Service de Réanimation polyvalente, Centre Hospitalier de Valenciennes, Valenciennes, France
| | - Mickael Landais
- Service de Réanimation polyvalente, Centre Hospitalier du Mans, Le Mans, France
| | - Jérémie Lemarié
- MD, INSERM, U1116, 54500, Vandoeuvre-lès-Nancy, France.,Université de Lorraine, Nancy, France.,Service de Réanimation Médicale, Centre Hospitalier Universitaire de Nancy, Hôpital Central, Nancy, France
| | - Olivier Lesieur
- Service de Réanimation et surveillance continue, Hôpital Saint-Louis, La Rochelle, France
| | - Claire Lhommet
- Service de Réanimation polyvalente, Centre Hospitalier de Saint Brieuc, Saint Brieuc, France
| | - Philippe Michel
- Service de réanimation médico-chirurgicale, Centre Hospitalier René-Dubos, Pontoise, France
| | - Yannick Monseau
- Service de Réanimation polyvalente, Centre Hospitalier de Périgueux, Périgueux, France
| | - Sébastien Moschietto
- Service de Médecine Intensive Réanimation, Centre Hospitalier Henri Duffaut, Avignon, France
| | - Saad Nseir
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Lille, Lille, France.,Faculté de Médecine, Université de Lille, Lille, France
| | - David Osman
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jérome Pillot
- Service de réanimation polyvalente, Hôpital Saint-Léon, Centre hospitalier de la Côte Basque, Bayonne, France
| | - Gaël Piton
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Nicholas Sedillot
- Service de réanimation polyvalente, Centre Hospitalier Fleyriat, Bourg-en-Bresse, France
| | - Michel Sirodot
- Service de Médecine Intensive Réanimation, Centre Hospitalier Annecy, Annecy, France
| | - Didier Thevenin
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Lens, Lens, France
| | - Lara Zafrani
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Yoann Zerbib
- Service de Réanimation médicale, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
| | - Pascale Bourhy
- Unité de Biologie des Spirochètes, Institut Pasteur, Paris, France
| | - Jean-Baptiste Lascarrou
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Jean Reignier
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France. .,Université de Nantes, Nantes, France. .,Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Hotel-Dieu, 30 Bd. Jean Monnet, 44093, Nantes Cedex 1, France.
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Lebeau-Desmoulin L, Bruneau L, Commins J, Herbreteau V, Raffray L. Identifying factors associated with treatment delay in leptospirosis: A retrospective study of patients admitted to hospital in Reunion (Indian Ocean) between 2014 and 2015. Med Mal Infect 2019; 50:352-360. [PMID: 31582278 DOI: 10.1016/j.medmal.2019.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 10/14/2018] [Accepted: 09/03/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Leptospirosis is a life-threatening zoonotic disease for which delayed treatment onset has been associated to poor prognosis. The purpose of the study was to identify the determinants of therapeutic delay in hospitalized leptospirosis cases. PATIENTS AND METHODS We carried out a retrospective multicenter study in the 4 public hospitals of Reunion Island, South Western Indian Ocean. Medical records of confirmed leptospirosis cases occurring in 2014-2015 were reviewed for socio-economic, demographic, geographic and medical data. The primary outcome measure was the therapeutic delay, defined as the time elapsed between the onset of symptoms and initiation of antibiotics. RESULTS Of the 117 patients included, 107 were men, with an average age of 44.9±15years. The median therapeutic delay was 4 days (interquartile: 2-5 days) and this delay was not found to be associated with severity. The following were found to be at increased risk of having a longer therapeutic delay: cases occurring outside the epidemic period, or rainy season (OR 2.8 [1.08-7.3], P=0.04) and cases with first medical evaluation in primary health care (OR 4.63 [1.43-14.93]; P=0.01) instead of emergency unit. No socio-economic or geographic characteristics were found to be linked to a longer therapeutic delay. CONCLUSION Although delayed treatment was not associated to disease severity, our results indicate that leptospirosis awareness is needed all year in the subtropical area of Reunion Island and particularly in primary care.
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Affiliation(s)
- L Lebeau-Desmoulin
- Service d'accueil des urgences, CHU La Réunion, site Félix-Guyon, allée des Topazes, CS11021, 97400 Saint-Denis, Reunion
| | - L Bruneau
- Unité de soutien méthodologique, CHU La Réunion, site Félix-Guyon, allée des Topazes, CS11021, 97400 Saint-Denis, Reunion
| | - J Commins
- IRD, UMR 228 ESPACE-DEV (IRD/UM/UR/UG/UA), station SEAS-OI, Saint-Pierre, Reunion
| | - V Herbreteau
- IRD, UMR 228 ESPACE-DEV (IRD/UM/UR/UG/UA), station SEAS-OI, Saint-Pierre, Reunion
| | - L Raffray
- Service de médecine interne et dermatologie, CHU La Réunion, site Félix-Guyon, allée des Topazes, CS11021, 97400 Saint-Denis, Reunion.
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Sharma B, Thille K, Rametta N, Sharma R. Detection of Leptospira spp. using polymerase chain reaction technique from kidney of Rattus norvegicus from Grenada, West Indies. INTERNATIONAL JOURNAL OF ONE HEALTH 2019. [DOI: 10.14202/ijoh.2019.81-85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aim: This study aimed to find out the prevalence of active infection of Leptospira spp. in Rattus norvegicus from Grenada, West Indies, through polymerase chain reaction (PCR). Materials and Methods: One hundred and forty-nine rats were trapped, anesthetized and their kidneys collected aseptically. DNA was extracted from the kidney tissue of each rat. PCR was performed targeting LipL32 gene. Eighteen PCR-positive amplicons for LipL32 gene segment were purified and sent for direct sequencing to the sequencing facility of MCLAB (South San Francisco, USA). Results of sequencing were read and interpreted. The prevalence of Leptospira spp. in relation to sex and age was also recorded. Results: All amplified sequences were compared to the sequences present in GenBank using basic local alignment search tool (BLAST) from the online website National Center for Biotechnology Information, the results revealed that six samples had similarity to Leptospira interrogans strain 1399/2016 and eight samples had similarity with Leptospira borgpetersenii serovar Hardjo-bovis strain L49. Of 149 kidney samples, only 14 were positive for Leptospira spp. by PCR giving an incidence of 9.3%. There was no significant difference found in relation to sex and age. Conclusion: This is the first report confirming active infection of Leptospira spp. in Rattus norvegicus in Grenada using PCR. The presence of active infection in rats can be considered as high risk for humans. Further research to understand the epidemiology of leptospirosis in Grenada is suggested.
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Affiliation(s)
- Bhumika Sharma
- Department of Pathobiology, School of Veterinary Medicine, St. George's University, Grenada, West Indies
| | - Katelyn Thille
- Department of Pathobiology, School of Veterinary Medicine, St. George's University, Grenada, West Indies
| | - Nia Rametta
- Department of Pathobiology, School of Veterinary Medicine, St. George's University, Grenada, West Indies
| | - Ravindra Sharma
- Department of Pathobiology, School of Veterinary Medicine, St. George's University, Grenada, West Indies
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Marquez A, Khalil RA, Fourel I, Ovarbury T, Pinot A, Rosine A, Thalmensi G, Jaffory G, Kodjo A, Benoit E, Lattard V. Resistance to anticoagulant rodenticides in Martinique could lead to inefficient rodent control in a context of endemic leptospirosis. Sci Rep 2019; 9:13491. [PMID: 31530819 PMCID: PMC6749056 DOI: 10.1038/s41598-019-49661-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 08/23/2019] [Indexed: 12/16/2022] Open
Abstract
Leptospirosis is a re-emergent worldwide zoonosis. It is endemic in Martinique where transmission conditions are favourable. Humans are usually infected through contact with water contaminated with urine of rodents. Recent human leptospirosis outbreaks in Martinique require today effective rodent management to prevent leptospirosis transmission. Nowadays, use of anticoagulant rodenticides (AR) is the main method implemented to control rodent populations. Nevertheless, intensive use of these AR has selected worldwide many VKORC1-based resistant rodent strains to AR. Our aim was to characterize the sensitivity of Martinique commensal rodents to AR to better prevent leptospirosis transmission. Resistance of house mice to first-generation and in rare cases even to second-generation ARs were clearly demonstrated in Martinique with the detection of the Y139C mutation with a very high allelic frequency of 40% and the A26T/Y139C double-mutation with an allelic frequency of 0.9%. In black rat, the most prevalent rodent in Martinique, 3 new Vkorc1 coding mutations were detected, the H68N, A115T and S149N mutations associated with moderate resistance to first generation AR. Therefore, rodent management in Martinique must be carried carefully to avoid resistance diffusion and maintain long-term effective rodent management, to be able to efficiently prevent leptospirosis transmission.
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Affiliation(s)
- Aurélie Marquez
- USC 1233 RS2GP, VetAgro Sup, INRA, Univ Lyon, F-69280, Marcy l'étoile, France
| | - Rami Abi Khalil
- USC 1233 RS2GP, VetAgro Sup, INRA, Univ Lyon, F-69280, Marcy l'étoile, France
| | - Isabelle Fourel
- USC 1233 RS2GP, VetAgro Sup, INRA, Univ Lyon, F-69280, Marcy l'étoile, France
| | - Teddy Ovarbury
- FREDON Martinique, Route du Lycée agricole, Chemin Tolobe, Croix Rivail, 97224, Ducos, Martinique
| | - Adrien Pinot
- UMR 0874 UREP, VetAgro Sup, INRA, Univ Clermont, Clermont-Ferrand, France
| | - Armand Rosine
- FREDON Martinique, Route du Lycée agricole, Chemin Tolobe, Croix Rivail, 97224, Ducos, Martinique
| | - Gérard Thalmensi
- ARS Martinique, Centre d'affaires AGORA, Zac de l'Etang Z'abricot, Pointe des grives, CS 80 656, 97263, Fort de France Cedex, Martinique
| | - Georges Jaffory
- ARS Martinique, Centre d'affaires AGORA, Zac de l'Etang Z'abricot, Pointe des grives, CS 80 656, 97263, Fort de France Cedex, Martinique
| | - Angeli Kodjo
- USC 1233 RS2GP, VetAgro Sup, INRA, Univ Lyon, F-69280, Marcy l'étoile, France
| | - Etienne Benoit
- USC 1233 RS2GP, VetAgro Sup, INRA, Univ Lyon, F-69280, Marcy l'étoile, France
| | - Virginie Lattard
- USC 1233 RS2GP, VetAgro Sup, INRA, Univ Lyon, F-69280, Marcy l'étoile, France.
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Kallel H, Rozé B, Pons B, Mayence C, Mathien C, Resiere D, Melot B, Hommel D, Mehdaoui H, Carles M. Infections tropicales graves dans les départements français d’Amérique, Antilles françaises et Guyane. MEDECINE INTENSIVE REANIMATION 2019. [DOI: 10.3166/rea-2019-0103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Les Antilles-Guyane (AG) sont les départements français du continent américain, situés en zone intertropicale. La diversité des écosystèmes ainsi que le climat tropical à très forte pluviosité exposent à un vaste panel de pathologies infectieuses. Ces territoires sont de plus l’objet de mouvements importants de populations, voyageurs ou migrants, ce qui joue un rôle significatif dans le développement d’épidémies et/ou de pathologies émergentes. Ces pathologies infectieuses dites « tropicales » peuvent nécessiter une prise en charge en réanimation. Nous rapportons ici les principales données récentes concernant ces pathologies (hors infection liée au VIH) ainsi que les stratégies diagnostiques et thérapeutiques, à l’usage des réanimateurs amenés à exercer en zone tropicale AG ou recevant en métropole des patients issus de cette région.
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Environmental and Behavioral Risk Factors for Severe Leptospirosis in Thailand. Trop Med Infect Dis 2019; 4:tropicalmed4020079. [PMID: 31100812 PMCID: PMC6631942 DOI: 10.3390/tropicalmed4020079] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/07/2019] [Accepted: 05/10/2019] [Indexed: 01/02/2023] Open
Abstract
A nationwide prevention and control campaign for leptospirosis in Thailand has led to a decreased incidence rate, but the mortality and case fatality rates have remained stable. Regarding the limited knowledge of risk factors, a case-control study of the association between environmental and behavioral exposure with severe leptospirosis was implemented to identify the risk factors among adults in Thailand. The study was conducted in 12 hospital-based sites. Hospitalized patients with suspected clinical symptoms of leptospirosis were tested for leptospirosis by culture, loop mediated isothermal amplification (LAMP), real-time PCR, and the microscopic agglutination test (MAT). All participants answered a standardized questionnaire about potential risk factors. Risk factors were identified by univariable and multivariable logistic regression. Of the 44 confirmed cases, 33 (75.0%) presented with severe illness, as determined by clinical criteria, and were categorized as severe cases. Non-severe cases were defined as patients with non-severe symptoms of leptospirosis. Living nearby a rubber tree plantation (adjusted OR 11.65, 95% CI 1.08–125.53) and bathing in natural bodies of water (adjusted OR 10.45, 95% CI 1.17–93.35) were both significantly associated with an increased risk of severe leptospirosis. We recommend designating rubber plantations in Thailand as high-risk zones and closely monitoring hospitalized patients in those areas.
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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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Ghazaei C. Pathogenic Leptospira: Advances in understanding the molecular pathogenesis and virulence. Open Vet J 2018; 8:13-24. [PMID: 29445617 PMCID: PMC5806663 DOI: 10.4314/ovj.v8i1.4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 01/08/2018] [Indexed: 12/16/2022] Open
Abstract
Leptospirosis is a common zoonotic disease has emerged as a major public health problem, with developing countries bearing disproportionate burdens. Although the diverse range of clinical manifestations of the leptospirosis in humans is widely documented, the mechanisms through which the pathogen causes disease remain undetermined. In addition, leptospirosis is a much-neglected life-threatening disease although it is one of the most important zoonoses occurring in a diverse range of epidemiological distribution. Recent advances in molecular profiling of pathogenic species of the genus Leptospira have improved our understanding of the evolutionary factors that determine virulence and mechanisms that the bacteria employ to survive. However, a major impediment to the formulation of intervention strategies has been the limited understanding of the disease determinants. Consequently, the association of the biological mechanisms to the pathogenesis of Leptospira, as well as the functions of numerous essential virulence factors still remain implicit. This review examines recent advances in genetic screening technologies, the underlying microbiological processes, the virulence factors and associated molecular mechanisms driving pathogenesis of Leptospira species.
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Affiliation(s)
- Ciamak Ghazaei
- Department of Microbiology, University of Mohaghegh Ardabili, P.O. Box 179, Ardabil, Iran
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Abstract
OBJECTIVES Leptospirosis causes reversible multiple organ failure, and its mortality remains high. The aim of this study was to determine the mortality rate of leptospirosis in an ICU offering all types of organ support available nowadays and to compare it with mortality in bacterial sepsis. DESIGN Retrospective, descriptive, and single-center cohort study. SETTINGS The largest ICU of Reunion Island (Indian Ocean) in a teaching hospital. PATIENTS Consecutive patients hospitalized in ICU for leptospirosis from January 2004 to January 2015. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We report 134 cases of patients with leptospirosis hospitalized in ICU. The median age was 40 years (interquartile range, 30-52 yr), with a Simplified Acute Physiology Score II of 38 (27-50) and a Sequential Organ Failure Assessment score of 10 (8-12). Forty-one patients (31%) required mechanical ventilation and 76 (56%) required renal replacement therapy. The door-to-renal replacement therapy time was 0 (0-1) day after admission with a median urea of 25 mmol/L (17-32 mmol/L). Five patients required extracorporeal membrane oxygenation. The mortality rate was 6.0% (95% CI, 2.6-11.4). Among patients hospitalized for sepsis, the standardized mortality ratio of patients with leptospirosis with regards to Simplified Acute Physiology Score II was dramatically low: 0.40 (95% CI, 0.17 - 0.79). CONCLUSIONS The mortality of severe leptospirosis is lower than for other bacterial infection, provided modern resuscitation techniques are available. Prompt organ support ensures very low mortality rates despite high severity scores.
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Peters A, Vokaty A, Portch R, Gebre Y. Leptospirosis in the Caribbean: a literature review. Rev Panam Salud Publica 2017; 41:e166. [PMID: 31384278 PMCID: PMC6650629 DOI: 10.26633/rpsp.2017.166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 06/21/2017] [Indexed: 01/04/2023] Open
Abstract
Objective To describe leptospirosis epidemiology, seroprevalence, and serovars among humans and animals in the Caribbean from 1979 - 2013. Methods A retrospective study of the literature was performed on the general epidemiology, historical records, and geographical locations of leptospirosis outbreaks and cases in the Caribbean from 1979 - 2013. The primary sources of information were identified with PubMed Central, Google Scholar, CAREC, CaribVET, and The School of Veterinary Medicine at the University of the West Indies. Search terms used were: "human leptospirosis," "animal leptospirosis," "serovars," "livestock," "seroprevalence," "Caribbean countries," "risk factors," "confirmed cases," "suspected cases," "MAT," and "ELISA." Confirmed and suspected cases of human and animal leptospirosis were identified through laboratory analysis. Results Most cases of leptospirosis occurred during the rainy season (June - December) and had a positive correlation with flood conditions. The disease was more prevalent in males than females due to behavioral and occupational exposure. The highest incidence rates of human leptospirosis were recorded in Barbados, Trinidad and Tobago, and Jamaica. In animals, leptospirosis has been found in rodents, livestock, and dogs in many Caribbean countries. Inadequate active surveillance and misdiagnosis of human leptospirosis has contributed to under-reporting of the disease. Conclusion This review highlights the epidemiology and distribution of leptospirosis in the Caribbean. Prevalence rates and serovars vary greatly among the countries. Leptospirosis poses a significant health risk for humans and animals in the Caribbean and requires a "One Health" multisectoral approach to reduce incidence rates and protect at-risk individuals. Increased laboratory capacity to identify leptospirosis cases is required, along with awareness campaigns for both the public and animal and human health professionals.
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Affiliation(s)
- Abena Peters
- Pan American Health Organization (PAHO) Country Office, Port of Spain, Trinidad and Tobago. Pan American Health Organization (PAHO) Country Office, Port of Spain, Trinidad and Tobago
| | - Alexandra Vokaty
- Pan American Health Organization (PAHO) Country Office, Port of Spain, Trinidad and Tobago. Pan American Health Organization (PAHO) Country Office, Port of Spain, Trinidad and Tobago
| | - Richard Portch
- Pan American Health Organization (PAHO) Country Office, Port of Spain, Trinidad and Tobago. Pan American Health Organization (PAHO) Country Office, Port of Spain, Trinidad and Tobago
| | - Yitades Gebre
- PAHO Country Office Paramaribo Suriname PAHO Country Office, Paramaribo, Suriname
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Mišić-Majerus L, Habuš J, Štritof Z, Bujić N, Mađarić V, Kolaric-Sviben G, Vince S, Peršić Z, Turk N. Epidemiological and clinical features of leptospirosis in a highly endemic area over three time periods. Trop Med Int Health 2017; 22:1405-1413. [PMID: 28857412 DOI: 10.1111/tmi.12967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To present the features of human leptospirosis over three time periods (1970-1975; 2000-2005; 2010-2015), to compare the collected data and to determine whether the incidence, seasonal and spatial distribution, prevalence of presumptive infective serogroups and clinical features have changed over the last 50 years. METHODS Epidemiological and clinical data obtained from patients hospitalised and treated in a well-known endemic focus of leptospirosis, Koprivnica-Križevci County in Croatia, were analysed. RESULTS We observed a steady decline in the overall incidence of leptospirosis and a change in the patient age distribution, with the age ratio changing in favour of middle-aged and older patients. Although leptospirosis was most frequently diagnosed in August in all time periods, the number of cases increased in autumn. The most prevalent serogroup during the first and the second time period was Icterohaemorrhagiae, while in the third time period, the serogroup Australis prevailed. We also noted an increase in the number of severe clinical manifestations. CONCLUSIONS This retrospective research demonstrates a continuous decline in the incidence of human leptospirosis in Croatia. The pattern of disease has changed from predominantly mild clinical forms observed in children to more severe clinical forms observed in middle-aged to older patients, especially those working in agriculture. Additional epidemiological changes included an increase in the number of cases during the autumn months and changes in prevailing serogroups. Statistical analysis revealed a significant relationship between the severity of the clinical picture, patient age and presumed sources of infection.
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Affiliation(s)
- Ljiljana Mišić-Majerus
- Division of Infectious Diseases Dr. Tomislav Bardek General Hospital, Koprivnica, Croatia
| | - Josipa Habuš
- National Reference Laboratory for Leptospirosis, University of Zagreb, Zagreb, Croatia
| | - Zrinka Štritof
- National Reference Laboratory for Leptospirosis, University of Zagreb, Zagreb, Croatia
| | - Nevenka Bujić
- Division of Infectious Diseases Dr. Tomislav Bardek General Hospital, Koprivnica, Croatia
| | - Vesna Mađarić
- Division of Infectious Diseases Dr. Tomislav Bardek General Hospital, Koprivnica, Croatia
| | - Gordana Kolaric-Sviben
- Division of Infectious Diseases Dr. Tomislav Bardek General Hospital, Koprivnica, Croatia
| | - Silvijo Vince
- Reproduction and Obstetric Clinic, University of Zagreb, Zagreb, Croatia
| | - Zdenka Peršić
- Croatian National Reference Laboratory for Human Leptospirosis, Croatian Institute of Public Health, Zagreb, Croatia
| | - Nenad Turk
- National Reference Laboratory for Leptospirosis, University of Zagreb, Zagreb, Croatia
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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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De Francesco Daher E, de Carvalho GSG, de Sousa Soares D, Mendes MH, Parente Filho SLA, Rocha HAL, da Silva Junior GB. Changing patterns in leptospirosis: a three-decade study in Brazil. Int J Infect Dis 2017; 60:4-10. [PMID: 28483723 DOI: 10.1016/j.ijid.2017.04.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 04/25/2017] [Accepted: 04/28/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND This study was conducted to investigate changes in the clinical pattern of leptospirosis over time, analyzing its clinical and laboratory presentations in a metropolitan city of Brazil. METHOD This was a retrospective study including all patients with leptospirosis admitted to tertiary care hospitals in Fortaleza in the northeast of Brazil, between 1985 and 2015. Patients were divided into three groups according to the year of hospital admission: group I for the years 1985-1995, group II for 1996-2005, and group III for 2006-2015. Demographic, clinical, and laboratory data were compared between the groups. RESULTS A total of 507 patients were included. Their mean age was 37.3±15.9years and 82.4% were male. The mean time between symptom onset and admission was 7±4 days. There was a linear decrease in the levels of serum urea (190.1±92.7, 135±79.5, and 95.6±73.3mg/dl, respectively, p <0.0001) and creatinine (5.8±2.9, 3.8±2.6, and 3.0±2.5mg/dl, respectively, p <0.0001) in each decade, while levels of hemoglobin (10.31±1.9, 10.8±2.0, and 11.5±2.1g/dl, respectively, p <0.0001) and platelets (57.900±52.650, 80.130±68.836, and 107.101±99.699×109/l, respectively, p<0.0001) increased. There was a tendency towards a linear decrease in mortality (22%, 14%, and 11.6%, respectively, p=0.060). CONCLUSIONS Leptospirosis showed significant changes over time in this region. The main changes point to a decrease in disease severity and complications, such as acute kidney injury. Mortality has decreased, being close to 11%.
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Affiliation(s)
- Elizabeth De Francesco Daher
- Department of Internal Medicine, School of Medicine, Walter Cantídio University Hospital, Federal University of Ceará, Fortaleza, Ceará, Brazil.
| | | | - Douglas de Sousa Soares
- Department of Internal Medicine, School of Medicine, Walter Cantídio University Hospital, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Matheus Henrique Mendes
- Department of Internal Medicine, School of Medicine, Walter Cantídio University Hospital, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Sérgio Luiz Arruda Parente Filho
- Department of Internal Medicine, School of Medicine, Walter Cantídio University Hospital, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | | | - Geraldo Bezerra da Silva Junior
- School of Medicine, Public Health Graduate Program, Health Sciences Center, University of Fortaleza, Fortaleza, Ceará, Brazil
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Sociodemographic and clinical characteristics of patients infected with Leptospira spp. treated at four hospitals in Medellín, Colombia, 2008-2013. BIOMEDICA 2017; 37:62-67. [DOI: 10.7705/biomedica.v37i1.3280] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/31/2016] [Indexed: 11/21/2022]
Abstract
Introducción. La leptospirosis continúa siendo un problema significativo de salud en regiones tropicales, incluidos los países de Latinoamérica, donde es 100 veces más frecuente que en otras regiones del mundo. En los cuadros graves de la enfermedad, su mortalidad alcanza el 10 %. Su diagnóstico es un reto debido a que las manifestaciones clínicas en la fase inicial son inespecíficas y a la poca disponibilidad de pruebas diagnósticas.Objetivo. Describir las características sociodemográficas y clínicas, y el desenlace de la enfermedad en pacientes hospitalizados con leptospirosis.Materiales y métodos. Es un estudio retrospectivo que incluyó pacientes atendidos en cuatro instituciones de Medellín, entre enero de 2009 y diciembre de 2013, con un cuadro clínico sugestivo e IgM positiva para Leptospira spp.Resultados. Se incluyeron 119 pacientes, 80 % hombres y 58 % de procedencia rural. La duración promedio de los síntomas fue de 9,6 días (DE=9,6). El 89 % de los pacientes presentó fiebre; el 62 %, ictericia; el 74 %, mialgias; el 46 %, diarrea; el 41 %, hepatomegalia; el 13 %, esplenomegalia, y 13 %, enrojecimiento de los ojos. En 54 % de los pacientes hubo deterioro de la función renal, en 32 %, compromiso pulmonar y, en 13 %, falla hepática. El 16 % de los pacientes requirió atención en la unidad de cuidados intensivos, el 12 %, asistencia respiratoria mecánica, y el 11 %, administración de vasopresores. En 38,6 % de ellos la enfermedad cursó con síndrome de Weil y el 5 % falleció. La duración promedio de la hospitalización fue de 11 días (DE=9,6).Conclusiones. La leptospirosis en esta población tuvo manifestaciones clínicas y complicaciones similares a las reportadas en la literatura científica. Se observó una mortalidad general relativamente baja comparada con las estadísticas mundiales.
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Rajapakse S, Weeratunga P, Niloofa MJR, Fernando N, Rodrigo C, Maduranga S, de Silva NL, Fernando NL, de Silva HJ, Karunanayake L, Handunnetti S. Clinical and laboratory associations of severity in a Sri Lankan cohort of patients with serologically confirmed leptospirosis: a prospective study. Trans R Soc Trop Med Hyg 2016; 109:710-6. [PMID: 26464233 DOI: 10.1093/trstmh/trv079] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Leptospirosis results in significant morbidity and mortality. This study elucidates markers of severity in a cohort of Sri Lankan patients. METHODS Patients presenting to three healthcare institutions in the Western province of Sri Lanka with leptospirosis serological confirmed by the microscopic agglutination test (MAT) were included. Prospective data regarding demographic, clinical and laboratory parameters was extracted. Univariate associations and subsequent multivariate logistic regression models were constructed. RESULTS The study included 232 patients, with 68.5% (159) demonstrating severe disease. Significant associations of severe disease at a significance level of p<0.05 were fever >38.8°C on presentation, age >40 years, muscle tenderness, tachycardia on admission, highest white cell count >12 350/mm(3) and <7900/mm(3), highest neutrophil percentage >84%, haemoglobin >11.2 g/dL and <10.2 g/dL, packed cell volume (PCV) >33.8% and <29.8%, lowest platelet count <63 500/mm(3), highest alanine transaminase (ALT) >70 IU/L and hyponatremia with sodium <131 mEq/L. On multivariate analysis, PCV <29.8% (p=0.011; OR 3.750; CI: 1.394-10.423), ALT >70 IU/L (p=0.044; OR 2.639; CI: 1.028-6.774) and hyponatremia <131 mEq/L (p=0.019; OR 6.413; CI: 1.353-30.388) were independent associations of severe disease. CONCLUSIONS Severity associations were demonstrated with both clinical and laboratory parameters. There is a need for novel biomarkers for prediction of severity in leptospirosis.
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Affiliation(s)
- Senaka Rajapakse
- Tropical Medicine Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo 08, Sri Lanka
| | - Praveen Weeratunga
- Tropical Medicine Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo 08, Sri Lanka
| | - M J Roshan Niloofa
- Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo, Colombo 03, Sri Lanka
| | - Narmada Fernando
- Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo, Colombo 03, Sri Lanka
| | - Chathuraka Rodrigo
- Tropical Medicine Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo 08, Sri Lanka
| | - Sachith Maduranga
- Tropical Medicine Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo 08, Sri Lanka
| | - Nipun Lakshitha de Silva
- Tropical Medicine Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo 08, Sri Lanka
| | - Nipun Lakshitha Fernando
- Tropical Medicine Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo 08, Sri Lanka
| | - H Janaka de Silva
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Lilani Karunanayake
- Department of Bacteriology, Medical Research Institute, Colombo 08, Sri Lanka
| | - Shiroma Handunnetti
- Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo, Colombo 03, Sri Lanka
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Hochedez P, Theodose R, Olive C, Bourhy P, Hurtrel G, Vignier N, Mehdaoui H, Valentino R, Martinez R, Delord JM, Herrmann C, Lamaury I, Césaire R, Picardeau M, Cabié A. Factors Associated with Severe Leptospirosis, Martinique, 2010-2013. Emerg Infect Dis 2016; 21:2221-4. [PMID: 26583702 PMCID: PMC4672444 DOI: 10.3201/eid2112.141099] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
To identify factors associated with disease severity, we examined 102 patients with quantitative PCR–confirmed leptospirosis in Martinique during 2010–2013. Associated factors were hypotension, chest auscultation abnormalities, icterus, oligo/anuria, thrombocytopenia, prothrombin time <68%, high levels of leptospiremia, and infection with L. interrogans serovar Icterohaemorrhagiae/Copenhageni.
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Traxler RM, Callinan LS, Holman RC, Steiner C, Guerra MA. Leptospirosis-associated hospitalizations, United States, 1998-2009. Emerg Infect Dis 2016; 20:1273-9. [PMID: 25076111 PMCID: PMC4111189 DOI: 10.3201/eid2008.130450] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Average cost and duration of hospitalizations were significantly greater than for other infectious diseases. A small percentage of persons with leptospirosis, a reemerging zoonosis, experience severe complications that require hospitalization. The number of leptospirosis cases in the United States is unknown. Thus, to estimate the hospitalization rate for this disease, we analyzed US hospital discharge records for 1998–2009 for the total US population by using the Nationwide Inpatient Sample. During that time, the average annual rate of leptospirosis-associated hospitalizations was 0.6 hospitalizations/1,000,000 population. Leptospirosis-associated hospitalization rates were higher for persons >20 years of age and for male patients. For leptospirosis-associated hospitalizations, the average age of patients at admission was lower, the average length of stay for patients was longer, and hospital charges were higher than those for nonleptospirosis infectious disease–associated hospitalizations. Educating clinicians on the signs and symptoms of leptospirosis may result in earlier diagnosis and treatment and, thereby, reduced disease severity and hospitalization costs.
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Lau CL, Skelly C, Dohnt M, Smythe LD. The emergence of Leptospira borgpetersenii serovar Arborea in Queensland, Australia, 2001 to 2013. BMC Infect Dis 2015; 15:230. [PMID: 26072306 PMCID: PMC4465322 DOI: 10.1186/s12879-015-0982-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 06/09/2015] [Indexed: 01/04/2023] Open
Abstract
Background Leptospirosis is an emerging infectious disease, with increasing frequency and severity of outbreaks, changing epidemiology of populations at risk, and the emergence of new serovars. Environmental drivers of disease transmission include flooding, urbanisation, poor sanitation, changes in land use and agricultural practices, and socioeconomic factors. In Queensland, human infection with Leptosira borgpetersenii serovar Arborea was first reported in 2001. This study aims to report the emergence of serovar Arborea in Queensland from 2001 to 2013, and investigate potential risk factors for infection and drivers of emergence. Methods Data on laboratory-confirmed cases of human leptospirosis in Queensland were obtained from the enhanced surveillance system at the WHO/FAO/OIE Collaborating Centre for Reference and Research on Leptospirosis in Brisbane, Australia. The changing epidemiology of serovar Arborea from 2001 to 2003 was described with respect to case numbers, proportion of leptospirosis cases attributed to the serovar, and geographic distribution. Differences in risk factors for the most common serovars were compared. Results During this period, 1289 cases of leptospirosis were reported, including 233 cases attributed to serovar Arborea. Risk factors for infection include male gender (91 % of cases), occupation, and recreational exposure. Most common occupations recorded were banana workers (28.4 %), meat workers (7.2 %), dairy farmers (5.8 %), graziers/stockmen (5.5 %), ‘other agricultural/rural workers’ (16.4 %), and tourists or tourism operators (4.6 %). Time trend analysis showed that while non-Arborea cases decreased over the study period, Arborea cases increased by 3.4 cases per year. The proportion of annual cases attributed to Arborea peaked at 49 % in 2011 after unprecedented flooding in Queensland. Mapping of cases by residential location showed expansion of the geographic range of serovar Arborea, concentrating mostly around Brisbane, Cairns and Innisfail. Serovars varied significantly between ages and occupational groups, and serovar Arborea was most strongly associated with ‘other agricultural/rural workers’. Conclusions Leptospira borgpetersenii serovar Arborea has been emerging in Queensland since 2001, with increase in case numbers, the proportion of leptospirosis infections attributed to the serovar, as well as expansion of its geographic distribution. Reasons for this emergence are unknown, but climatic factors and environmental change are likely to have played important roles. Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-0982-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Colleen L Lau
- Queensland Children's Medical Research Institute, Brisbane, Australia. .,WHO Collaborating Centre for Children's Health and Environment, The University of Queensland, Brisbane, Australia. .,Research School of Population Health, Australian National University, Canberra, Australia.
| | | | - Michael Dohnt
- WHO/FAO/OIE Collaborating Centre for Reference and Research on Leptospirosis, Forensic and Scientific Services, Health Support Queensland, Department of Health, Brisbane, Australia.
| | - Lee D Smythe
- WHO/FAO/OIE Collaborating Centre for Reference and Research on Leptospirosis, Forensic and Scientific Services, Health Support Queensland, Department of Health, Brisbane, Australia.
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Mikulski M, Boisier P, Lacassin F, Soupé-Gilbert ME, Mauron C, Bruyere-Ostells L, Bonte D, Barguil Y, Gourinat AC, Matsui M, Vernel-Pauillac F, Goarant C. Severity markers in severe leptospirosis: a cohort study. Eur J Clin Microbiol Infect Dis 2014; 34:687-95. [PMID: 25413923 DOI: 10.1007/s10096-014-2275-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 11/03/2014] [Indexed: 01/03/2023]
Abstract
We aimed to evaluate parameters for their value as severity markers in hospitalized leptospirosis patients. We recruited 47 informed adult consenting patients and assessed a number of clinical, hematological, biochemical, and biological variables. Patients were sorted according to severity based on fatality or the requirement of mechanical ventilation or dialysis; the parameters studied were compared between groups on inclusion and the next day. Beside septic shock presentation or a high severity score (Simplified Acute Physiology Score; SAPS II), increased lactate, total bilirubin, lipase, and AST/ALT ratio or a decreased cytokines IL-10/TNF-α ratio were all significantly associated with severity. The gene expression of the IL-1 receptor antagonist IL-1ra, IL-1α, and the long pentraxin PTX-3 were also transcribed at higher levels in most severe cases. Patients could rapidly improve or deteriorate, highlighting the need for a new assessment the next day. Our results add to the limited body of knowledge about severity markers in leptospirosis. They also suggest that patients should be reassessed the next day before being possibly discharged from the hospital. Further studies are needed in order to confirm relevant and reliable prognostic parameters in leptospirosis that would be helpful for the purpose of triage.
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Affiliation(s)
- M Mikulski
- Intensive Care Unit, Centre Hospitalier Territorial, Nouméa, New Caledonia
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Somasundaram A, Loganathan N, Varghese J, Shivakumar S, Jayanthi V. Does leptospirosis behave adversely in cirrhosis of the liver? Indian J Gastroenterol 2014; 33:512-6. [PMID: 25239730 DOI: 10.1007/s12664-014-0500-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 08/20/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM Leptospirosis, endemic in India, is complicated by jaundice and renal failure. Whether leptospirosis could result in a worsening of preexisting chronic liver disease (CLD) is not known. Aim of the study was to analyze the clinical profile and natural course of leptospirosis in decompensated CLD in comparison to those acquiring the infection in an otherwise healthy individual. METHODS Cases were patients with liver cirrhosis who presented with fever and/or jaundice and were screened and found positive for leptospirosis. Controls were patients diagnosed to have leptospirosis during the same period, but in the absence of liver disease. Both cases and controls were followed up until recovery or death. RESULTS Thirty-one patients had cirrhosis of the liver, and 91 controls had leptospirosis. Significantly more number of cirrhotics had jaundice (87.1 % vs. 16.5 %; p = 0.001), elevated blood urea (41.9 % vs. 18.7 %; p = 0.01), and serum creatinine (41.9 % vs. 19.8 %; p = 0.03) compared to the controls. There were four deaths due to hepatorenal dysfunction and coagulopathy in cirrhotics and no deaths in the control group (4 vs. 0; p = 0.001). CONCLUSION Leptospirosis should be considered as yet another important cause of acute-on-chronic liver failure in endemic areas associated with poor outcome. Death is often due to hepatorenal dysfunction.
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Affiliation(s)
- Aravindh Somasundaram
- Department of Gastroenterology, Stanley Medical College and Hospital, Chennai, 600 001, India,
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Estavoyer J, Chirouze C, Faucher J, Floret N, Couetdic G, Leroy J, Hoen B. Leptospirosis in Franche-Comté (FRANCE): Clinical, biological, and therapeutic data. Med Mal Infect 2013; 43:379-85. [DOI: 10.1016/j.medmal.2013.06.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 05/28/2013] [Accepted: 06/18/2013] [Indexed: 10/26/2022]
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Bourhy P, Herrmann Storck C, Theodose R, Olive C, Nicolas M, Hochedez P, Lamaury I, Zinini F, Brémont S, Landier A, Cassadou S, Rosine J, Picardeau M. Serovar diversity of pathogenic Leptospira circulating in the French West Indies. PLoS Negl Trop Dis 2013; 7:e2114. [PMID: 23516654 PMCID: PMC3597474 DOI: 10.1371/journal.pntd.0002114] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 01/30/2013] [Indexed: 12/04/2022] Open
Abstract
Background Leptospirosis is one of the most important neglected tropical bacterial diseases in Latin America and the Caribbean. However, very little is known about the circulating etiological agents of leptospirosis in this region. In this study, we describe the serological and molecular features of leptospires isolated from 104 leptospirosis patients in Guadeloupe (n = 85) and Martinique (n = 19) and six rats captured in Guadeloupe, between 2004 and 2012. Methods and Findings Strains were studied by serogrouping, PFGE, MLVA, and sequencing 16SrRNA and secY. DNA extracts from blood samples collected from 36 patients in Martinique were also used for molecular typing of leptospires via PCR. Phylogenetic analyses revealed thirteen different genotypes clustered into five main clades that corresponded to the species: L. interrogans, L. kirschneri, L. borgpetersenii, L. noguchi, and L. santarosai. We also identified L. kmetyi in at least two patients with acute leptospirosis. This is the first time, to our knowledge, that this species has been identified in humans. The most prevalent genotypes were associated with L. interrogans serovars Icterohaemorrhagiae and Copenhageni, L. kirschneri serovar Bogvere, and L. borgpetersenii serovar Arborea. We were unable to identify nine strains at the serovar level and comparison of genotyping results to the MLST database revealed new secY alleles. Conclusions The overall serovar distribution in the French West Indies was unique compared to the neighboring islands. Typing of leptospiral isolates also suggested the existence of previously undescribed serovars. Leptospirosis is an emerging zoonotic disease caused by infection with pathogenic strains of Leptospira. Isolation of Leptospira strains is rare, making it difficult to assess their distribution worldwide. In this study, we characterized cultures of Leptospira obtained from more than one hundred leptospirosis patients from the French West Indies by serology and various molecular typing methods to identify the strains circulating in this endemic region. Typing of leptospiral isolates showed that causative agents of leptospirosis in the French West Indies are mainly from the serogroups Icterohaemorrhagiae and Ballum, but we also identified new genotypes. We also found that the distribution of the predominant pathogenic leptospiral serovars differed between the Caribbean islands. A better understanding of the epidemiology of leptospirosis will improve our knowledge in the distribution of this emerging neglected tropical disease worldwide. The identification of the circulating etiological agents of leptospirosis in the French West Indies will also help establish appropriate control and prevention measures in this area where the disease is endemic.
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Affiliation(s)
- Pascale Bourhy
- Institut Pasteur, Unité de Biologie des Spirochètes, National Reference Center and WHO Collaborating Center for Leptospirosis, Paris, France
| | - Cécile Herrmann Storck
- University Hospital of Pointe à Pitre, Department of Bacteriology and Infectious and Tropical Diseases, Guadeloupe, French West Indies
| | - Rafaelle Theodose
- University Hospital of Fort de France, Department of Bacteriology and Infectious and Tropical Diseases, Martinique, French West Indies
| | - Claude Olive
- University Hospital of Fort de France, Department of Bacteriology and Infectious and Tropical Diseases, Martinique, French West Indies
| | - Muriel Nicolas
- University Hospital of Pointe à Pitre, Department of Bacteriology and Infectious and Tropical Diseases, Guadeloupe, French West Indies
| | - Patrick Hochedez
- University Hospital of Fort de France, Department of Bacteriology and Infectious and Tropical Diseases, Martinique, French West Indies
| | - Isabelle Lamaury
- University Hospital of Pointe à Pitre, Department of Bacteriology and Infectious and Tropical Diseases, Guadeloupe, French West Indies
| | - Farida Zinini
- Institut Pasteur, Unité de Biologie des Spirochètes, National Reference Center and WHO Collaborating Center for Leptospirosis, Paris, France
| | - Sylvie Brémont
- Institut Pasteur, Unité de Biologie des Spirochètes, National Reference Center and WHO Collaborating Center for Leptospirosis, Paris, France
| | - Annie Landier
- Institut Pasteur, Unité de Biologie des Spirochètes, National Reference Center and WHO Collaborating Center for Leptospirosis, Paris, France
| | - Sylvie Cassadou
- French Institute for Public Health Surveillance (InVS), Interregional epidemiology unit of French West Indies (Cire Antilles-Guyane), Fort-de-France, Martinique, French West Indies
| | - Jacques Rosine
- French Institute for Public Health Surveillance (InVS), Interregional epidemiology unit of French West Indies (Cire Antilles-Guyane), Fort-de-France, Martinique, French West Indies
| | - Mathieu Picardeau
- Institut Pasteur, Unité de Biologie des Spirochètes, National Reference Center and WHO Collaborating Center for Leptospirosis, Paris, France
- * E-mail:
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Risk factors and predictors of severe leptospirosis in New Caledonia. PLoS Negl Trop Dis 2013; 7:e1991. [PMID: 23326614 PMCID: PMC3542117 DOI: 10.1371/journal.pntd.0001991] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Accepted: 11/16/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Leptospirosis is a major public health concern in New Caledonia (NC) and in other tropical countries. Severe manifestations of the disease are estimated to occur in 5-15% of all human infections worldwide and factors associated with these forms are poorly understood. Our objectives were to identify risk factors and predictors of severe forms of leptospirosis in adults. METHODS AND FINDINGS We conducted a retrospective case-control study of inpatients with laboratory-confirmed leptospirosis who were admitted to two public hospitals in NC in 2008-2011. Cases were patients with fatal or severe leptospirosis, as determined by clinical criteria. This approach was meant to be pragmatic and to reflect the routine medical management of patients. Controls were defined as patients hospitalized for milder leptospirosis. Risk and prognostic factors were identified by multivariate logistic regression. Among the 176 patients enrolled in the study, 71 had criteria of severity including 10 deaths (Case Fatality Rate = 14.1%). Three risk factors were independently associated with severe leptospirosis: current cigarette smoking (OR = 2.94 [CI 1.45-5.96]); delays >2 days between the onset of symptoms and the initiation of antibiotherapy (OR = 2.78 [CI 1.31-5.91]); and Leptospira interrogans serogroup Icterohaemorrhagiae as the infecting strain (OR = 2.79 [CI 1.26-6.18]). The following post-admission laboratory results correlated with poor prognoses: platelet count ≤50,000/µL (OR = 6.36 [CI 1.79-22.62]), serum creatinine >200 mM (OR = 5.86 [CI 1.61-21.27]), serum lactate >2.5 mM (OR = 5.14 [CI 1.57-16.87]), serum amylase >250 UI/L (OR = 4.66 [CI 1.39-15.69]) and leptospiremia >1000 leptospires/mL (OR = 4.31 [CI 1.17-15.92]). CONCLUSIONS To assess the risk of developing severe leptospirosis, our study illustrates the benefit for clinicians to have: i) the identification of the infective strain, ii) a critical threshold of qPCR-determined leptospiremia and iii) early laboratory results. In New Caledonia, preventative measures should focus on early presumptive antibacterial therapy and on rodent (reservoir of Icterohaemorrhagiae serogroup) control.
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Abstract
PURPOSE OF REVIEW Bacterial zoonoses are increasingly described in association with travel. Some bacterial zoonoses constitute important causes of post-travel illness. We focus on leptospirosis and rickettsiosis - the most common travel-associated bacterial zoonoses. RECENT FINDINGS Leptospirosis is regarded to be the most common zoonotic disease worldwide. In industrialized countries recreational exposures, both domestic and overseas, are increasingly becoming a major source of infection. Asymptomatic infection is rare among travelers. Rickettsial diseases account for approximately 1.5-3.5% of febrile travelers. In several series of travel-related rickettsioses, the most common travel-related rickettsial disease is Rickettsia africae. Other rickettsioses including Q fever, scrub typhus and murine typhus are considered rare among travelers. Whereas timely diagnosis of both diseases is still based on exposure history, antigen detection tools to aid the diagnosis during the acute illness are under research and far from being available. Due to these constrains, currently, the true incidence of both diseases is probably underestimated. SUMMARY Both leptospirosis and spotted fever may be rapidly fatal. Empiric doxycycline in severely ill febrile travelers should be considered. There is an urgent need for widely available antigen detection diagnostic tools to improve the detection of leptospirosis and rickettsial infections during the acute illness.
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Outpatient follow-up of patients hospitalized for acute leptospirosis. Int J Infect Dis 2011; 15:e486-90. [PMID: 21616696 DOI: 10.1016/j.ijid.2011.03.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 02/14/2011] [Accepted: 03/31/2011] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The outcome of leptospirosis after the resolution of acute disease, either spontaneously or after treatment, is not well described. The aim of this study was to assess the possible sequelae of acute leptospirosis after hospital discharge. METHODS We report here a prospective study carried out in São Paulo, Brazil in which patients hospitalized for leptospirosis were followed in the outpatient setting. RESULTS Forty-seven patients were serially assessed: 32 severe and 15 mild cases. Early and late complications were not common in either group, but subjective complaints were common in the first few weeks after hospital discharge (53% of severe cases, 40% of mild cases). Two patients had continuing complaints: one had profound general malaise and the other developed new onset panic disorder. The sample analyzed represented 26% of the patients hospitalized with leptospirosis in the city of São Paulo during the study period. The duration of follow-up was an average of approximately 20 days at the first visit, and approximately 40 days at the second visit. Forty-seven patients came for one follow-up visit and 22 of the same patients had two follow-up visits. CONCLUSIONS While two of 47 patients reported continuing symptoms after hospitalization for acute leptospirosis, no definitive, objective evidence of chronic sequelae due to this infection was proven. While preliminary, these observations point to the need for a prospective, rigorous and systematic study to definitively determine and characterize late complications and chronic disease after acute leptospirosis.
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Katz AR, Buchholz AE, Hinson K, Park SY, Effler PV. Leptospirosis in Hawaii, USA, 1999-2008. Emerg Infect Dis 2011; 17:221-6. [PMID: 21291592 PMCID: PMC3204774 DOI: 10.3201/eid1702.101109] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Although infrequently diagnosed in the United States, leptospirosis is a notable reemerging infectious disease throughout developing countries. Until 1995, when the disease was eliminated from the US list of nationally notifiable diseases, Hawaii led the nation in reported annual incidence rates. Leptospirosis remains a notifiable disease in Hawaii. To ascertain the status of leptospirosis in Hawaii since the most recent US report in 2002, we reviewed 1999–2008 data obtained from case investigation reports by the Hawaii State Department of Health. Of the 345 case reports related to in-state exposures, 198 (57%) were laboratory confirmed. Our findings indicate a change in seasonal disease occurrence from summer to winter and in the infective serogroup from Icterohemorrhagiae to Australis. Also, during the past 20 years, recreational exposures have plateaued, while occupational exposures have increased. Ongoing surveillance is needed to clarify and track the dynamic epidemiology of this widespread zoonosis.
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Affiliation(s)
- Alan R Katz
- Department of Public Health Sciences, John A. Burns School of Medicine, University of Hawaii, Biomedical Sciences Building, Rm D104M, 1960 East-West Rd, Honolulu, HI 96822, USA.
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Marchiori E, Lourenço S, Setúbal S, Zanetti G, Gasparetto TD, Hochhegger B. Clinical and imaging manifestations of hemorrhagic pulmonary leptospirosis: a state-of-the-art review. Lung 2010; 189:1-9. [PMID: 21152929 DOI: 10.1007/s00408-010-9273-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 11/23/2010] [Indexed: 12/20/2022]
Abstract
Leptospirosis, a spirochetal zoonosis, is frequently unrecognized due to its manifestation as an undifferentiated fever. It is an emerging infectious disease that has changed from an occupational disease of veterinarians, farmers, butchers, and other animal handlers to a cause of epidemics in poor and decayed urban communities in developing countries. Humans are infected when mucous membranes or abraded skin come into direct contact with the urine of infected animals, especially rats and dogs. Mortality from severe leptospirosis is high, even when optimal treatment is provided. The diagnosis of leptospirosis is based on clinical findings, history of direct or indirect exposure to infected animals in endemic areas, and positive serological tests. It should be considered in the differential diagnosis of patients with febrile illnesses associated with pneumonitis and respiratory failure, especially when hemoptysis is present. Severe pulmonary involvement in leptospirosis consists primarily of hemorrhagic pneumonitis. In advanced cases, adult respiratory distress syndrome and massive pulmonary hemorrhage may occur. Chest radiographs show bilateral alveolar infiltrates and/or resemble viral pneumonia, bronchopneumonia, tuberculosis, adult respiratory distress syndrome, and other causes of pulmonary hemorrhage such as Goodpasture syndrome. High-resolution computed tomography scans may show nodular infiltrates, areas of consolidation, ground-glass attenuation, and crazy-paving patterns. Bronchoalveolar lavage and autopsy studies have suggested that ground-glass opacities and air-space consolidations are secondary to pulmonary hemorrhage. Although not specific, the presence of these computed tomography findings in a febrile patient with an appropriate history should suggest a diagnosis of leptospirosis.
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Affiliation(s)
- Edson Marchiori
- Department of Radiology, Fluminense Federal University, Rua Thomaz Cameron, 438 Valparaiso, CEP 25685.120, Petrópolis, Rio de Janeiro, Brazil.
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Rahelinirina S, Léon A, Harstskeerl RA, Sertour N, Ahmed A, Raharimanana C, Ferquel E, Garnier M, Chartier L, Duplantier JM, Rahalison L, Cornet M. First isolation and direct evidence for the existence of large small-mammal reservoirs of Leptospira sp. in Madagascar. PLoS One 2010; 5:e14111. [PMID: 21124843 PMCID: PMC2991340 DOI: 10.1371/journal.pone.0014111] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2010] [Accepted: 11/03/2010] [Indexed: 11/30/2022] Open
Abstract
Background Leptospirosis has long been a major public health concern in the southwestern Indian Ocean. However, in Madagascar, only a few, old studies have provided indirect serological evidence of the disease in humans or animals. Methodology/Principal Findings We conducted a large animal study focusing on small-mammal populations. Five field trapping surveys were carried out at five sites, from April 2008 to August 2009. Captures consisted of Rattus norvegicus (35.8%), R. rattus (35.1%), Mus musculus (20.5%) and Suncus murinus (8.6%). We used microbiological culture, serodiagnosis tests (MAT) and real-time PCR to assess Leptospira infection. Leptospira carriage was detected by PCR in 91 (33.9%) of the 268 small mammals, by MAT in 17 of the 151 (11.3%) animals for which serum samples were available and by culture in 9 of the 268 animals (3.3%). Rates of infection based on positive PCR results were significantly higher in Moramanga (54%), Toliara (48%) and Mahajanga (47.4%) than in Antsiranana (8.5%) and Toamasina (14%) (p = 0.001). The prevalence of Leptospira carriage was significantly higher in R. norvegicus (48.9%), S. murinus (43.5%) and R. rattus (30.8%) than in M. musculus (9.1%) (p<0.001). The MAT detected antibodies against the serogroups Canicola and Icterohaemorrhagiae. Isolates were characterized by serology, secY sequence-based phylogeny, partial sequencing of rrs, multi-locus VNTR analysis and pulsed field gel electrophoresis. The 10 isolates obtained from nine rats were all identified as species L. interrogans serogroup Canicola serovar Kuwait and all had identical partial rrs and secY sequences. Conclusions/Significance We present here the first direct evidence of widespread leptospiral carriage in small mammals in Madagascar. Our results strongly suggest a high level of environmental contamination, consistent with probable transmission of the infection to humans. This first isolation of pathogenic Leptospira strains in this country may significantly improve the detection of specific antibodies in human cases.
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Affiliation(s)
| | | | - Rudy A. Harstskeerl
- WHO/FAO/OIE and National Leptospirosis Reference Centre, KIT Biomedical Research, Amsterdam, The Netherlands
| | - Natacha Sertour
- National Reference Centre for Borrelia, Pasteur Institute, Paris, France
| | - Ahmed Ahmed
- WHO/FAO/OIE and National Leptospirosis Reference Centre, KIT Biomedical Research, Amsterdam, The Netherlands
| | | | - Elisabeth Ferquel
- National Reference Centre for Borrelia, Pasteur Institute, Paris, France
| | - Martine Garnier
- National Reference Centre for Borrelia, Pasteur Institute, Paris, France
| | | | | | - Lila Rahalison
- Plague Unit, Pasteur Institute, Antananarivo, Madagascar
| | - Muriel Cornet
- National Reference Centre for Borrelia, Pasteur Institute, Paris, France
- Parasitology-Mycology Laboratory, CHU Grenoble, University Joseph Fourier, Grenoble, France
- * E-mail:
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