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Widawati M, Dhewantara PW, Anasi R, Wahono T, Marina R, Pertiwi IP, Wibowo AA, Ruliansyah A, Riandi MU, Widiastuti D, Astuti EP. An investigation of geographical clusters of leptospirosis during the outbreak in Pangandaran, West Java, Indonesia. GEOSPATIAL HEALTH 2023; 18. [PMID: 37795863 DOI: 10.4081/gh.2023.1221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/10/2023] [Indexed: 10/06/2023]
Abstract
Leptospirosis is neglected in many tropical developing countries, including Indonesia. Our research on this zoonotic disease aimed to investigate epidemiological features and spatial clustering of recent leptospirosis outbreaks in Pangandaran, West Java. The study analysed data on leptospirosis notifications between September 2022 and May 2023. Global Moran I and local indicator for spatial association (LISA) were applied. Comparative analysis was performed to characterise the identified hotspots of leptospirosis relative to its neighbourhoods. A total of 172 reported leptospirosis in 40 villages from 9 sub-districts in Pangandaran District were analysed. Of these, 132 cases (76.7%) were male. The median age was 49 years (interquartile range [IQR]: 34-59 years). Severe outcomes including renal failure, lung failure, and hepatic necrosis were reported in up to 5% of the cases. A total of 30 patients died, resulting in the case fatality rate (CFR) of 17.4%. Moran's I analysis showed significant spatial autocorrelation (I=0.293; p=0.002) and LISA results identified 7 High-High clusters (hotspots) in the Southwest, with the total population at risk at 26,184 people. The hotspots had more cases among older individuals (median age: 51, IQR: 36-61 years; p<0.001), more farmers (79%, p=0.001) and more evidence of the presence of rats (p=0.02). A comprehensive One Health intervention should be targeted towards these high-risk areas to control the transmission of leptospirosis. More empirical evidence is needed to understand the role of climate, animals and sociodemographic characteristics on the transmission of leptospirosis in the area studied.
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Affiliation(s)
- Mutiara Widawati
- Vector-borne and Zoonotic Diseases Research Group, Research Center for Public Health and Nutrition, National Research and Innovation Agency, Cibinong, Bogor, West Java.
| | - Pandji Wibawa Dhewantara
- Vector-borne and Zoonotic Diseases Research Group, Research Center for Public Health and Nutrition, National Research and Innovation Agency, Cibinong, Bogor, West Java.
| | - Raras Anasi
- Health Development Policy Agency, Ministry of Health of Indonesia, Jakarta.
| | - Tri Wahono
- Vector-borne and Zoonotic Diseases Research Group, Research Center for Public Health and Nutrition, National Research and Innovation Agency, Cibinong, Bogor, West Java.
| | - Rina Marina
- Vector-borne and Zoonotic Diseases Research Group, Research Center for Public Health and Nutrition, National Research and Innovation Agency, Cibinong, Bogor, West Java.
| | - Intan Pandu Pertiwi
- Environmental Health Technology and Disease Control Agency, Ministry of Health of Indonesia, East Jakarta, DKI Jakarta.
| | - Agus Ari Wibowo
- Environmental Health Technology and Disease Control Agency, Ministry of Health of Indonesia, East Jakarta, DKI Jakarta.
| | - Andri Ruliansyah
- Pangandaran Public Health Laboratory, Ministry of Health of Indonesia, Pangandaran, West Java.
| | - Muhammad Umar Riandi
- Pangandaran Public Health Laboratory, Ministry of Health of Indonesia, Pangandaran, West Java.
| | - Dyah Widiastuti
- Vector-borne and Zoonotic Diseases Research Group, Research Center for Public Health and Nutrition, National Research and Innovation Agency, Cibinong, Bogor, West Java; School of Postgraduate Studies, Gadjah Mada University, Yogyakarta.
| | - Endang Puji Astuti
- Vector-borne and Zoonotic Diseases Research Group, Research Center for Public Health and Nutrition, National Research and Innovation Agency, Cibinong, Bogor, West Java.
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Petakh P, Rostoka L, Isevych V, Kamyshnyi A. Identifying risk factors and disease severity in leptospirosis: A meta-analysis of clinical predictors. Trop Doct 2023; 53:464-469. [PMID: 37501591 DOI: 10.1177/00494755231187673] [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: 07/29/2023]
Abstract
Leptospirosis is a bacterial zoonosis with a wide spectrum of clinical presentations. In order to identify potential risk factors and predictors of disease severity, a meta-analysis of the clinical features of severe and non-severe leptospirosis patients was conducted. PubMed was searched to collect studies on the difference in clinical characteristics of severe and nonsevere patients, and data were analyzed using Comprehensive Meta-Analysis V3 software. Results showed that patients with severe outcomes were more likely to have dyspnoea, oliguria, and hemorrhagic symptoms than nonsevere patients. Determining these predictors in the early stages of the disease could thus significantly reduce the development of severe cases and related mortality.
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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
| | - Larysa Rostoka
- Department of Biochemistry and Pharmacology, Uzhhorod National University, Uzhhorod, Ukraine
| | - Vitaliia Isevych
- Department of Biochemistry and Pharmacology, Uzhhorod National University, Uzhhorod, Ukraine
| | - Aleksandr Kamyshnyi
- Department of Microbiology, Virology, and Immunology, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
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Amin MA, Nahin S, Bonna AS, Kabir Rozars MF, Hossain Hawlader MD. Leptospirosis and COVID-19 co-infection case in Bangladesh. Heliyon 2022; 8:e11828. [DOI: 10.1016/j.heliyon.2022.e11828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 10/09/2022] [Accepted: 11/16/2022] [Indexed: 11/25/2022] Open
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Dung LP, Hai PT, Hoa LM, Mai TNP, Hanh NTM, Than PD, Tran VD, Quyet NT, Hai H, Ngoc DB, Thu NT, Mai LTP. A case-control study of agricultural and behavioral factors associated with leptospirosis in Vietnam. BMC Infect Dis 2022; 22:583. [PMID: 35768761 PMCID: PMC9245206 DOI: 10.1186/s12879-022-07561-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 06/17/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Leptospirosis is a neglected disease in Vietnam. Until now, there has been limited knowledge about risk factors of this disease in Vietnam. The study was carried out to identify agricultural and behavioral factors associated with the transmission of leptospirosis in Vietnam. Methods This matched retrospective hospital-community-based case–control study was conducted from 1 October 2018 to 31 October 2019. We recruited cases from 11 selected government hospitals in three provinces of Vietnam, while controls were selected from the same communes of cases and matched by age (± 2 years) and sex. Microscopic agglutination test (MAT) and enzyme-linked immunosorbent assay (ELISA) were applied to determine confirmed cases, while only MAT was used to identify controls with a single high MAT titer < 1:100. Results 504 participants (252 cases and 252 controls) were identified. Cultivating (OR 2.83, CI 1.38–5.79), animal farming (OR 8.26, CI 2.24–30.52), pig owners (OR 10.48, CI 5.05–21.73), cat owners (OR 2.62, CI 1.49–4.61) and drinking unboiled water (OR 1.72, CI 1.14 –2.59, p = 0.010) were significantly associated with human leptospirosis in Vietnam. Hand washing after farming/ gardening (OR 0.57, CI 0.38–0.86, p = 0.007) and bathing after farming, gardening, contact with cattle and poultry (OR 0.33, CI 0.19–0.58, p = 0.000) were determined as protective factors for this disease. Conclusions In short, the case–control study has revealed the risks in agricultural and animal practices and protective behavioral factors related to human leptospirosis in Vietnam. The findings suggested promotion of communication and health education programs targeting health behaviors in daily life and agricultural practices. Using personal protective equipment such as gowns, gloves, and boots during agricultural practices, especially cultivating and animal farming, is most recommended. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07561-6.
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Affiliation(s)
- Luu Phuong Dung
- Department of Public Health, National Institute of Hygiene and Epidemiology, 1 Yersin Street, Hai Ba Trung District, Hanoi, Vietnam
| | - Pham Thanh Hai
- Department of Public Health, National Institute of Hygiene and Epidemiology, 1 Yersin Street, Hai Ba Trung District, Hanoi, Vietnam
| | - Luong Minh Hoa
- Department of Public Health, National Institute of Hygiene and Epidemiology, 1 Yersin Street, Hai Ba Trung District, Hanoi, Vietnam
| | - Tran Ngoc Phuong Mai
- Department of Public Health, National Institute of Hygiene and Epidemiology, 1 Yersin Street, Hai Ba Trung District, Hanoi, Vietnam
| | - Nguyen Thi My Hanh
- Department of Public Health, National Institute of Hygiene and Epidemiology, 1 Yersin Street, Hai Ba Trung District, Hanoi, Vietnam
| | - Phan Dang Than
- Department of Public Health, National Institute of Hygiene and Epidemiology, 1 Yersin Street, Hai Ba Trung District, Hanoi, Vietnam
| | - Van Dinh Tran
- Department of Public Health, National Institute of Hygiene and Epidemiology, 1 Yersin Street, Hai Ba Trung District, Hanoi, Vietnam
| | - Nguyen Tu Quyet
- Department of Public Health, National Institute of Hygiene and Epidemiology, 1 Yersin Street, Hai Ba Trung District, Hanoi, Vietnam
| | - Hoang Hai
- Department of Public Health, National Institute of Hygiene and Epidemiology, 1 Yersin Street, Hai Ba Trung District, Hanoi, Vietnam
| | - Do Bich Ngoc
- Department of Public Health, National Institute of Hygiene and Epidemiology, 1 Yersin Street, Hai Ba Trung District, Hanoi, Vietnam
| | - Nguyen Thị Thu
- Hanoi Population and Family Planning Branch, Hanoi, Vietnam
| | - Le Thi Phuong Mai
- Department of Public Health, National Institute of Hygiene and Epidemiology, 1 Yersin Street, Hai Ba Trung District, Hanoi, Vietnam.
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Philip N, Priya SP, Jumah Badawi AH, Mohd Izhar MH, Mohtarrudin N, Tengku Ibrahim TA, Sekawi Z, Neela VK. Pulmonary haemorrhage as the earliest sign of severe leptospirosis in hamster model challenged with Leptospira interrogans strain HP358. PLoS Negl Trop Dis 2022; 16:e0010409. [PMID: 35584087 PMCID: PMC9116642 DOI: 10.1371/journal.pntd.0010409] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/10/2022] [Indexed: 11/18/2022] Open
Abstract
Background Severe leptospirosis is challenging as it could evolve rapidly and potentially fatal if appropriate management is not performed. An understanding of the progression and pathophysiology of Leptospira infection is important to determine the early changes that could be potentially used to predict the severe occurrence of leptospirosis. This study aimed to understand the kinetics pathogenesis of Leptospira interrogans strain HP358 in the hamster model and identify the early parameters that could be used as biomarkers to predict severe leptospirosis. Methodology/Principal findings Male Syrian hamsters were infected with Leptospira interrogans strain HP358 and euthanized after 24 hours, 3, 4, 5, 6 and 7 days post-infection. Blood, lungs, liver and kidneys were collected for leptospiral detection, haematology, serum biochemistry and differential expression of pro- and anti-inflammatory markers. Macroscopic and microscopic organ damages were investigated. Leptospira interrogans strain HP358 was highly pathogenic and killed hamsters within 6–7 days post-infection. Pulmonary haemorrhage and blood vessel congestion in organs were noticed as the earliest pathological changes. The damages in organs and changes in biochemistry value were preceded by changes in haematology and immune gene expression. Conclusion/Significance This study deciphered haemorrhage as the earliest manifestation of severe leptospirosis and high levels of IL-1β, CXCL10/IP-10, CCL3/MIP-α, neutrophils and low levels of lymphocytes and platelets serve as a cumulative panel of biomarkers in severe leptospirosis. As the severe form of leptospirosis could progress rapidly and be potentially fatal if not treated earlier, deciphering the pathophysiology kinetics of infection is crucial to determine the parameters of disease severity. To understand this, we challenged hamsters with the highly virulent Leptospira interrogans strain HP358. Pulmonary haemorrhage was observed as the earliest pathological change followed by liver and kidneys damages. The increased expression of IL-1β, CXCL10/IP-10, CCL3/MIP-α, high neutrophils and low lymphocytes and platelets production observed in the present study indicate that these parameters could serve as a cumulative panel of biomarkers in severe leptospirosis.
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Affiliation(s)
- Noraini Philip
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Sivan Padma Priya
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- RAK College of Dental Sciences, Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah, United Arab Emirates
| | - Ahmad Hussein Jumah Badawi
- Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Mohd Hafidz Mohd Izhar
- Comparative Medicine and Technology Unit, Institute of Bioscience, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Norhafizah Mohtarrudin
- Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Tengku Azmi Tengku Ibrahim
- Department of Veterinary Preclinical Sciences, Faculty of Veterinary Medicine, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Zamberi Sekawi
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Vasantha Kumari Neela
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- * E-mail:
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Toemjai T, Thongkrajai P, Nithikathkul C. Factors affecting preventive behavior against leptospirosis among the population at risk in Si Sa Ket, Thailand. One Health 2022; 14:100399. [PMID: 35686145 PMCID: PMC9171525 DOI: 10.1016/j.onehlt.2022.100399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 05/08/2022] [Accepted: 05/08/2022] [Indexed: 11/28/2022] Open
Abstract
Leptospirosis is a major public health problem in Si Sa Ket, Thailand. Humans can become infected via direct contact with the urine of infected animal reservoir hosts or by indirect contact with contaminated soil and water in the environment. This study examined the factors affecting preventive behavior against leptospirosis among the population at risk in Si Sa Ket, Thailand. A cross-sectional questionnaire was conducted by a representative population survey using a four-stage stratified random sampling to select 350 respondents aged 18–65 years from the fifth districts with the highest morbidity rate in 2010–2019. Data were analyzed by descriptive statistics and stepwise multiple regression. The majority of the respondents were male (53.40%), aged 46–55 years (31.20%), and agricultural workers (76.00%). Their knowledge (M = 10.78, SD = 1.60), perceived severity (M = 2.91, SD = 0.60), perceived probability (M = 2.98, SD = 0.64), self-efficacy expectations (M = 3.18, SD = 0.63), responses-efficacy expectations (M = 3.16, SD = 0.71), social support (M = 3.19, SD = 0.52), and preventive behavior against leptospirosis (M = 3.29, SD = 0.49) were at moderate level. Significant factors affecting leptospirosis preventive behaviors were history of leptospirosis illness (β = 0.312), social support (β = 0.240), perceived probability (β = 0.238), household members with a history of leptospirosis illness (β = 0.158), perceived severity (β = 0.114), self-efficacy expectations (β = 0.094) and knowledge (β = 0.088) regarding leptospirosis. All of these factors could together predict the preventive behavior against leptospirosis up to 42.8% (Adjusted R2 = 0.428). Public health interventions should be strengthening people's perception and awareness regarding leptospirosis and the promotion of preventive health behavior to prevent potential outbreaks.
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Affiliation(s)
| | - Pramote Thongkrajai
- Tropical and Parasitic Diseases Research Unit, Faculty of Medicine, Mahasarakham University, Mahasarakham, Thailand
| | - Choosak Nithikathkul
- Tropical and Parasitic Diseases Research Unit, Faculty of Medicine, Mahasarakham University, Mahasarakham, Thailand
- Corresponding author at: Tropical and Parasitic Diseases Research Unit, Faculty of Medicine, Mahasarakham University, Muang District, Mahasarakham 44000, Thailand.
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Spatial-temporal patterns and risk factors for human leptospirosis in Thailand, 2012-2018. Sci Rep 2022; 12:5066. [PMID: 35332199 PMCID: PMC8948194 DOI: 10.1038/s41598-022-09079-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 03/16/2022] [Indexed: 01/04/2023] Open
Abstract
Leptospirosis is a globally important zoonotic disease. The disease is particularly important in tropical and subtropical countries. Infections in humans can be caused by exposure to infected animals or contaminated soil or water, which are suitable for Leptospira. To explore the cluster area, the Global Moran's I index was calculated for incidences per 100,000 population at the province level during 2012-2018, using the monthly and annual data. The high-risk and low-risk provinces were identified using the local indicators of spatial association (LISA). The risk factors for leptospirosis were evaluated using a generalized linear mixed model (GLMM) with zero-inflation. We also added spatial and temporal correlation terms to take into account the spatial and temporal structures. The Global Moran's I index showed significant positive values. It did not demonstrate a random distribution throughout the period of study. The high-risk provinces were almost all in the lower north-east and south parts of Thailand. For yearly reported cases, the significant risk factors from the final best-fitted model were population density, elevation, and primary rice crop arable areas. Interestingly, our study showed that leptospirosis cases were associated with large areas of rice production but were less prevalent in areas of high rice productivity. For monthly reported cases, the model using temperature range was found to be a better fit than using percentage of flooded area. The significant risk factors from the model using temperature range were temporal correlation, average soil moisture, normalized difference vegetation index, and temperature range. Temperature range, which has strongly negative correlation to percentage of flooded area was a significant risk factor for monthly data. Flood exposure controls should be used to reduce the risk of leptospirosis infection. These results could be used to develop a leptospirosis warning system to support public health organizations in Thailand.
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Suwannarong K, Soonthornworasiri N, Maneekan P, Yimsamran S, Balthip K, Maneewatchararangsri S, Saisongkorh W, Saengkul C, Sangmukdanun S, Phunta N, Singhasivanon P. Rodent–Human Interface: Behavioral Risk Factors and Leptospirosis in a Province in the Central Region of Thailand. Vet Sci 2022; 9:vetsci9020085. [PMID: 35202338 PMCID: PMC8878075 DOI: 10.3390/vetsci9020085] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/03/2022] [Accepted: 02/11/2022] [Indexed: 12/10/2022] Open
Abstract
This sequential explanatory mixed-method study consisted of analytical, cross-sectional, and qualitative studies. The research was conducted in the Khao Nor and Khao Kaew areas of the Banphot Pisai districts of Nakhon Sawan Province in 2019. Here, we examined the rodent contact characteristics of villagers in these areas and determined the potential characteristics/risk factors associated with rodents using a semi-structured questionnaire, key informant interview (KII), and focus group discussion (FGD). Results of the quantitative study (N1 = 372) characterized participants that contacted rodents per gender, age, occupation, knowledge, attitude, and practice (KAP), including their cultural contexts, and beliefs. Ninety participants (24.2%) reported contact with rodents, and the reasons for their direct physical rodent contact were hunting (35, 9.4%), killing (41, 11.0%), preparing rodents as food (33, 8.9%), consuming cooked meats (12, 3.2%), feeding food (4, 1.1%), cleaning feces (17, 4.6%), and cleaning carcasses (33, 8.9%). Moreover, logistic regression results showed that males encountering rodents were statistically significant (Adjusted OR = 3.137, 95% CI 1.914–5.139, p < 0.001). Low monthly household income (<THB 15,000 or <USD 450) was also negatively statistically significant with encountering rodents (Adjusted OR = 0.57, 95% CI 0.33–0.99, p = 0.04). Additionally, the villagers had a low level of knowledge toward zoonotic diseases and inappropriate attitudes and practices toward contacting rodents and zoonotic diseases. Thirty-five qualitative study participants (N2) participated in the KIIs and FGDs. Various rodent contact activities were also reported among the qualitative research participants, such as hunting, consumption, and selling them to their friends and neighbors. However, these rodents also destroyed their belongings, crops, and plants. Some participants also reported that rodents accounted for leptospirosis transmission. As a result, communication intervention should be planned to provide appropriate knowledge and attitude to the villagers, especially among those who have close contact with rodents in the understudied area.
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Affiliation(s)
- Kanokwan Suwannarong
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Ratchathewi, Bangkok 10400, Thailand; (K.S.); (P.M.); (S.Y.); (S.S.); (P.S.)
- SUPA71 Co., Ltd., Bangkok 10230, Thailand
| | - Ngamphol Soonthornworasiri
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Ratchathewi, Bangkok 10400, Thailand; (K.S.); (P.M.); (S.Y.); (S.S.); (P.S.)
- Correspondence: ; Tel./Fax: +66-2-6444436
| | - Pannamas Maneekan
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Ratchathewi, Bangkok 10400, Thailand; (K.S.); (P.M.); (S.Y.); (S.S.); (P.S.)
| | - Surapon Yimsamran
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Ratchathewi, Bangkok 10400, Thailand; (K.S.); (P.M.); (S.Y.); (S.S.); (P.S.)
| | | | - Santi Maneewatchararangsri
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand;
| | - Watcharee Saisongkorh
- Department of Medical Sciences, Ministry of Public Health, Muang District, Nonthaburi 11000, Thailand;
| | - Chutarat Saengkul
- Faculty of Public Health, Nakhon Sawan Campus, Mahidol University, Nakhon Sawan 60130, Thailand;
| | - Suntaree Sangmukdanun
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Ratchathewi, Bangkok 10400, Thailand; (K.S.); (P.M.); (S.Y.); (S.S.); (P.S.)
| | - Nittaya Phunta
- Ban Dan Health Promotion Hospital (under Ministry of Public Health Thailand), Ban Phot Pisai District, Nakhon Sawan 60180, Thailand;
| | - Pratap Singhasivanon
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Ratchathewi, Bangkok 10400, Thailand; (K.S.); (P.M.); (S.Y.); (S.S.); (P.S.)
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Going Micro in Leptospirosis Kidney Disease. Cells 2022; 11:cells11040698. [PMID: 35203344 PMCID: PMC8869946 DOI: 10.3390/cells11040698] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/13/2022] [Accepted: 02/14/2022] [Indexed: 02/05/2023] Open
Abstract
Leptospirosis is a zoonotic and waterborne disease worldwide. It is a neglected infectious disease caused by Leptospira spp., as well as a reemerging disease and global public health problem with respect to morbidity and mortality both in humans and animals. Leptospirosis emerges as a leading cause of acute febrile illness along with hepatorenal injury in many countries, including Thailand. While most affected persons are symptomatic in acute disease, which is always difficult to differentiate from other tropical diseases, there is growing evidence of subtle manifestations that cause unrecognized chronic symptoms. The kidney is one of the common organs affected by Leptospires. Although acute kidney injury in the spectrum of interstitial nephritis is a well-described characteristic in severe leptospirosis, chronic kidney disease from leptospirosis is widely discussed. Early recognition of severe leptospirosis leads to reduce morbidity and mortality. Thus, in this review, we highlight the spectrum of characteristics involved in leptospirosis kidney disease and the use of serologic and molecular methods, as well as the treatments of severe leptospirosis.
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Ittyachen A, Xavier V, Baby B, George J. Covid-19 and leptospirosis, pulmonary involvement and response to steroids: A comparative observational study from a rural Tertiary care center in Kerala. J Family Med Prim Care 2022; 11:294-298. [PMID: 35309671 PMCID: PMC8930173 DOI: 10.4103/jfmpc.jfmpc_1414_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 12/05/2021] [Accepted: 12/07/2021] [Indexed: 11/24/2022] Open
Abstract
Background: COVID-19 is an emerging infectious disease with a global outreach. Leptospirosis is a zoonotic disease mainly confined to tropical areas. In both cases, most of those affected are asymptomatic or have only mild respiratory disease. Those who turn critical develop acute respiratory distress syndrome (ARDS) and/or multiple-organ failure occurs rapidly, with high fatality. Methodology: This is a retrospective observational study from 2020 involving COVID-19 and leptospirosis patients. The data were collected using a semi-structured proforma, and analysis was performed using Easy R (EZR) software. Results: There were five patients with COVIDC-19 and four patients with leptospirosis; with pulmonary involvement. All the patients were males. There was no significant difference in age, the onset of pulmonary involvement, time of initiation of steroids, duration of steroids, and outcome between the two groups. However, in the case of COVID-19, it took a longer period for clearing of infiltrates. Conclusion: Though COVID-19 and leptospirosis are two different diseases, both of them show a similar life-saving response to steroids, the common factor in the pathogenesis being cytokine storm. Primary care physicians in tropical areas of the world should be aware of the similarities between these two diseases, especially the initial clinical presentation, the pathogenesis, and the response to steroids.
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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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Flay KJ, Yang DA, Wilson MT, Lee SH, Bhardwaj V, Hill FI, Pfeiffer DU. Absence of serological or molecular evidence of Leptospira infection in farmed swine in the Hong Kong Special Administrative Region. One Health 2021; 13:100321. [PMID: 34504940 PMCID: PMC8411228 DOI: 10.1016/j.onehlt.2021.100321] [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: 03/31/2021] [Revised: 08/24/2021] [Accepted: 08/28/2021] [Indexed: 11/28/2022] Open
Abstract
Leptospirosis is an important zoonotic disease with several maintenance host species including swine. A cross sectional survey was undertaken between January to October 2020 to investigate the prevalence of leptospirosis in farmed swine in the Hong Kong Special Administrative Region (HKSAR) of China. Serum samples were collected from swine on seven farms (15 swine per farm; ten multiparous sows and five twelve-week-old weaners), while kidney samples were collected from 64 swine submitted for routine post-mortem (26 farms; average 2.4 swine per farm, range 1-6). Microscopic agglutination tests (MAT) to a panel of 24 Leptospira antigens did not reveal any evidence of seroconversion at a titre of 1:100. Polymerase chain reaction (PCR) testing of the kidney samples for Leptospira DNA did not detect any evidence of infection. Bayesian methods were used to compute the probability that the leptospirosis prevalence in farmed swine in the HKSAR was <3%, given none of the 105 swine sampled were positive on the MAT. The results of this study demonstrate no serological or molecular evidence of leptospirosis in farmed swine in the HKSAR. Subsequent statistical analysis supports the conclusion that the prevalence of leptospirosis in farmed swine in the HKSAR is negligible at present.
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Affiliation(s)
- Kate J. Flay
- Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon, Hong Kong, China
| | - Dan A. Yang
- Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon, Hong Kong, China
| | - Michael T. Wilson
- CityU Centre for Applied One Health Research and Policy Advice, City University of Hong Kong, Kowloon, Hong Kong, China
| | - Song H. Lee
- CityU Centre for Applied One Health Research and Policy Advice, City University of Hong Kong, Kowloon, Hong Kong, China
| | - Vidya Bhardwaj
- CityU Veterinary Diagnostic Laboratory Co, Ltd, City University of Hong Kong, Kowloon, Hong Kong, China
| | - Fraser I. Hill
- CityU Veterinary Diagnostic Laboratory Co, Ltd, City University of Hong Kong, Kowloon, Hong Kong, China
| | - Dirk U. Pfeiffer
- Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon, Hong Kong, China
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Evaluation of a genus-specific rGroEL 1-524 IgM-ELISA and commercial ELISA kits during the course of leptospirosis in Thailand. Sci Rep 2021; 11:19785. [PMID: 34611273 PMCID: PMC8492722 DOI: 10.1038/s41598-021-99377-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 09/23/2021] [Indexed: 01/29/2023] Open
Abstract
In the present study, we developed a genus-specific rGroEL1-524 IgM-ELISA assay for use in screening diagnosis of suspected leptospirosis among acute undifferentiated febrile illness patients during acute fever. The diagnostic accuracies of the rGroEL1–524 IgM-ELISA, commercial Panbio IgM-ELISA, and Virion-Serion Classic IgG-ELISA were evaluated using 133 Thai leptospirosis sera and 210 controls. Sensitivities were 91.7%, 59.6%, and 17.7% for acute infection, and the specificities were 92.6%, 90.2%, and 88.3% for the non-leptospirosis control, respectively. The rGroEL1-524 IgM-ELISA had high sensitivity, at 92.3% and 91.7%, among culture-positive and MAT-negative cases at 1–3 days post-onset of symptoms (DPO1–3), respectively. Impaired specificity on scrub typhus was found, possibly from antibody cross-reaction to ortholog GroEL. Commercial Panbio IgM-ELISA had sensitivities at DPO1–3 of 30.8% and 41.7% for culture-positive and MAT-negative cases whereas Virion-Serion IgG-ELISA showed sensitivities of 5.9% and 13.3%, respectively. The rGroEL1-524 IgM-ELISA could be useful as a screening test for early diagnosis. The performance of the commercial ELISA suggests the applicability of IgM-ELISA for diagnosis, while IgG-ELISA is useful for seroprevalence surveys. However, confirmation by reference tests is recommended.
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Notobroto HB, Mirasa YA, Rahman FS. Sociodemographic, behavioral, and environmental factors associated with the incidence of leptospirosis in highlands of Ponorogo Regency, Province of East Java, Indonesia. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2021.100911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Human, animal, water source interactions and leptospirosis in Thailand. Sci Rep 2021; 11:3215. [PMID: 33547388 PMCID: PMC7864926 DOI: 10.1038/s41598-021-82290-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 01/18/2021] [Indexed: 12/03/2022] Open
Abstract
In Thailand, leptospirosis is primarily associated with those who work in agricultural occupations. Leptospirosis control is hampered by a poor understanding of the complex interactions between humans, animal reservoirs, Leptospira, and the variable spatial environment in which these factors coexist. We aimed to address key knowledge gaps concerning leptospirosis disease dynamics and the human–animal–water-source interface in two high-risk areas in Thailand. We conducted a cross-sectional survey among 746 study participants in two high-risk areas for leptospirosis in Thailand: Sisaket (SSK) and Nakhon Si Thammarat (NST). Interactions among humans, animals and water sources were quantified and analyzed. The presence of different animal species and thus contact patterns were different in NST and SSK. The consumption of water from the shared sources between the two areas was different. Those whose occupations were related to animals or environmental water and those who consumed water from more than two sources were more likely to have been infected with leptospirosis, with adjusted odds ratios 4.31 (95% CI 1.17–15.83) and 10.74 (95% CI 2.28–50.53), respectively. Understanding specific water-source sharing networks and human–animal contact patterns is useful when designing national and area-specific control programmes to prevent and control leptospirosis outbreaks.
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Chaiwattanarungruengpaisan S, Thepapichaikul W, Paungpin W, Ketchim K, Suwanpakdee S, Thongdee M. Potentially Pathogenic Leptospira in the Environment of an Elephant Camp in Thailand. Trop Med Infect Dis 2020; 5:tropicalmed5040183. [PMID: 33291225 PMCID: PMC7768412 DOI: 10.3390/tropicalmed5040183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 11/16/2022] Open
Abstract
Leptospira is the causative agent of leptospirosis, a globally emerging zoonotic disease. The infection is commonly acquired through contact with the contaminated environment. To extend the knowledge on environmental source of leptospirosis, we investigated the presence of Leptospira in an elephant camp setting where the interaction between humans, animals, and the shared environment occur particularly when engaging in recreational activities. In this study, a total of 24 environmental samples were collected from an elephant camp area in western Thailand. All samples were processed for Leptospira isolation using the EMJH medium. The identification of Leptospira species was carried out by partial 16S rRNA and secY gene sequencing. Of those 24 samples, 18 samples (75%) were culture-positive for Leptospira. The recovered leptospires were mostly derived from water and soil sampled from a river and a mud pond, the main areas for recreational activities. The majority of the isolates were classified into “Pathogens” clade (89%, 16/18) and more than half of the isolates (61%, 11/18) contained species of the “Saprophytes” clade. Notably, two soil isolates from the river beach sampling area were found to contain leptospiral DNA with high similarity to the pathogenic L. interrogans and L. santarosai. The evidence of diverse Leptospira species, particularly those belonging to the “Pathogens” clade, suggest that the shared environments of an elephant camp can serve as potential infection source and may pose a risk to the elephant camp tourists and workers.
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Affiliation(s)
- Somjit Chaiwattanarungruengpaisan
- The Monitoring and Surveillance Center for Zoonotic Diseases in Wildlife and Exotic Animals, Faculty of Veterinary Science, Mahidol University, Salaya, Nakhon Pathom 73170, Thailand; (S.C.); (W.P.); (K.K.); (S.S.)
| | - Wasinee Thepapichaikul
- Livestock and Wildlife Hospital, Faculty of Veterinary Science, Mahidol University, Sai Yok, Kanchanaburi 71150, Thailand;
| | - Weena Paungpin
- The Monitoring and Surveillance Center for Zoonotic Diseases in Wildlife and Exotic Animals, Faculty of Veterinary Science, Mahidol University, Salaya, Nakhon Pathom 73170, Thailand; (S.C.); (W.P.); (K.K.); (S.S.)
| | - Kanokwan Ketchim
- The Monitoring and Surveillance Center for Zoonotic Diseases in Wildlife and Exotic Animals, Faculty of Veterinary Science, Mahidol University, Salaya, Nakhon Pathom 73170, Thailand; (S.C.); (W.P.); (K.K.); (S.S.)
| | - Sarin Suwanpakdee
- The Monitoring and Surveillance Center for Zoonotic Diseases in Wildlife and Exotic Animals, Faculty of Veterinary Science, Mahidol University, Salaya, Nakhon Pathom 73170, Thailand; (S.C.); (W.P.); (K.K.); (S.S.)
- Department of Clinical Sciences and Public Health, Faculty of Veterinary Science, Mahidol University, Salaya, Nakhon Pathom 73170, Thailand
| | - Metawee Thongdee
- The Monitoring and Surveillance Center for Zoonotic Diseases in Wildlife and Exotic Animals, Faculty of Veterinary Science, Mahidol University, Salaya, Nakhon Pathom 73170, Thailand; (S.C.); (W.P.); (K.K.); (S.S.)
- Correspondence: ; Tel.: +66-2441-5236
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Abstract
The majority of patients with Covid-19 have a good outcome. However, complications principally of acute respiratory distress syndrome (ARDS) and multiple-organ failure can occur rapidly. Leptospirosis, a zoonotic disease, is similar to Covid-19 in that most infections are mild or asymptomatic and only a small number develop ARDS. Cytokine storm is considered to be the main incriminating factor in both. High dose steroids have been used to ameliorate the effects in leptospirosis, and similarly, reports suggest a benefit in Covid-19. SARS CoV-2 and leptospira, one a virus and the other a bacterium, are two species separated by millions of years of evolution, but producing illnesses with similar spectra, with cytokine storm being the common precipitating factor. As data are accrued from around the world, more light may be shed on features analogous to both pathways.
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Affiliation(s)
- Abraham M Ittyachen
- Professor of Medicine and Consultant in Critical Care, M.O.S.C Medical College & Hospital, Ernakulam, India
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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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Gkentzi D, Lagadinou M, Bountouris P, Dimitrakopoulos O, Triantos C, Marangos M, Paliogianni F, Assimakopoulos SF. Epidemiology, clinical and laboratory findings of leptospirosis in Southwestern Greece. Infect Dis (Lond) 2020; 52:413-418. [PMID: 32178560 DOI: 10.1080/23744235.2020.1739745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Leptospirosis is a zoonosis with global distribution. The aim of the present study was to determine epidemiological, clinical and laboratory characteristics of leptospirosis in Greece.Methods: We retrospectively reviewed the clinical and laboratory profile as well as the outcome of all adults with confirmed leptospirosis in our Tertiary Referral centre in Southwestern Greece from 2013 to 2017.Results: Thirty-one men and fourteen women (mean age: 55.5 ± 13.8 years), were diagnosed with leptospirosis based on compatible clinical course and positive serology for IgM antibodies. Thirty-two (71.1%) lived in rural areas and the majority of infections (88.8%) were autochthonous, acquired in Southwestern Greece. Eighteen patients (40%) reported occupational exposure. The most prevalent clinical feature was fever (93.3%), followed by headache (66%), hematuria (31.1%), conjunctival suffusion and hepatomegaly (26.6%), dyspnoea, tachypnoea and splenomegaly (17.7%). One patient died due to pulmonary hemorrhage. Increased CRP (median 19 mg/dL) was the most common laboratory abnormality detected (93.3%), followed by thrombocytopenia (80%), increased aminotransferases (AST in 73.3% and ALT in 66.6%), anemia (66.6%) and hematuria (>100 RBC per high power field) in 66.6%. Empiric treatment with at least one active antibiotic against Leptospira was administered in 40 patients (88.8%).Conclusions: We found a higher disease incidence in our area compared to previous reports in Greece. Clinical signs of leptospirosis are diverse and generally nonspecific. Further epidemiological studies conducted ideally at a national level are required to determine the true disease incidence and better understand risk factors associated with unfavorable outcomes.
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Affiliation(s)
- Despoina Gkentzi
- Department of Paediatrics, University Hospital of Patras, Patras, Greece
| | - Maria Lagadinou
- Department of Emergency Medicine, University Hospital of Patras, Patras, Greece
| | | | | | - Christos Triantos
- Department of Internal Medicine, University Hospital of Patras, Patras, Greece
| | - Markos Marangos
- Department of Internal Medicine, Division of Infectious Diseases, University Hospital of Patras, Patras, Greece
| | - Fotini Paliogianni
- Department of Microbiology, University Hospital of Patras, Patras, Greece
| | - Stelios F Assimakopoulos
- Department of Internal Medicine, Division of Infectious Diseases, University Hospital of Patras, Patras, Greece
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