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Ji J, Wang W, Xiang S, Wei X, Pang G, Shi H, Dong J, Pang J. Diagnosis of leptospira by metagenomics next-generation sequencing with extracorporeal membrane oxygenation support: a case report. BMC Infect Dis 2023; 23:788. [PMID: 37957556 PMCID: PMC10644436 DOI: 10.1186/s12879-023-08793-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 11/06/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Leptospirosis is an infectious disease caused by pathogenic Leptospira spp., which could result in severe illnesses. Indirect contact with these pathogens is more common. Individuals could contract this disease through contact with contaminated water or during floods. In this case, we present the details of a 40-year-old male pig farmer who suffered from severe pulmonary hemorrhagic leptospirosis and multiple organ failure. The diagnosis of leptospirosis was confirmed through metagenomics next-generation sequencing (mNGS) while the patient received extracorporeal membrane oxygenation (ECMO) support, and antibiotic treatment was adjusted accordingly. The patient underwent comprehensive treatment and rehabilitation in the intensive care unit. CONCLUSION This case illustrates the importance of early diagnosis and treatment of leptospirosis. While obtaining the epidemiological history, second-generation metagenomics sequencing was utilized to confirm the etiology. The prompt initiation of ECMO therapy provided a crucial window of opportunity for addressing the underlying cause. This case report offers valuable insights for diagnosing patients with similar symptoms.
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Affiliation(s)
- Jianyu Ji
- Research Center of Communicable and Severe Diseases, Department of Intensive Care Unit, Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
- Guangxi Health Commission Key Laboratory of Diagnosis and Treatment of Acute Respiratory Distress Syndrome, Guangxi Academy of Medical Sciences, Nanning, Guangxi, China
- Guangxi Clinical Research Center Construction Project for Critical Treatment of Major Communicable Diseases, Guangxi Academy of Medical Sciences, Nanning, Guangxi, China
| | - Wei Wang
- Research Center of Communicable and Severe Diseases, Department of Intensive Care Unit, Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
- Guangxi Health Commission Key Laboratory of Diagnosis and Treatment of Acute Respiratory Distress Syndrome, Guangxi Academy of Medical Sciences, Nanning, Guangxi, China
- Guangxi Clinical Research Center Construction Project for Critical Treatment of Major Communicable Diseases, Guangxi Academy of Medical Sciences, Nanning, Guangxi, China
| | - Shulin Xiang
- Research Center of Communicable and Severe Diseases, Department of Intensive Care Unit, Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
- Guangxi Health Commission Key Laboratory of Diagnosis and Treatment of Acute Respiratory Distress Syndrome, Guangxi Academy of Medical Sciences, Nanning, Guangxi, China
- Guangxi Clinical Research Center Construction Project for Critical Treatment of Major Communicable Diseases, Guangxi Academy of Medical Sciences, Nanning, Guangxi, China
| | - Xiutian Wei
- Research Center of Communicable and Severe Diseases, Department of Intensive Care Unit, Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
- Guangxi Health Commission Key Laboratory of Diagnosis and Treatment of Acute Respiratory Distress Syndrome, Guangxi Academy of Medical Sciences, Nanning, Guangxi, China
- Guangxi Clinical Research Center Construction Project for Critical Treatment of Major Communicable Diseases, Guangxi Academy of Medical Sciences, Nanning, Guangxi, China
| | - Guangbao Pang
- Research Center of Communicable and Severe Diseases, Department of Intensive Care Unit, Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
- Guangxi Health Commission Key Laboratory of Diagnosis and Treatment of Acute Respiratory Distress Syndrome, Guangxi Academy of Medical Sciences, Nanning, Guangxi, China
- Guangxi Clinical Research Center Construction Project for Critical Treatment of Major Communicable Diseases, Guangxi Academy of Medical Sciences, Nanning, Guangxi, China
| | - Huirong Shi
- Research Center of Communicable and Severe Diseases, Department of Intensive Care Unit, Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
- Guangxi Health Commission Key Laboratory of Diagnosis and Treatment of Acute Respiratory Distress Syndrome, Guangxi Academy of Medical Sciences, Nanning, Guangxi, China
- Guangxi Clinical Research Center Construction Project for Critical Treatment of Major Communicable Diseases, Guangxi Academy of Medical Sciences, Nanning, Guangxi, China
| | - Jinda Dong
- Department of blood transfusion, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Jing Pang
- Research Center of Communicable and Severe Diseases, Department of Intensive Care Unit, Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China.
- Guangxi Health Commission Key Laboratory of Diagnosis and Treatment of Acute Respiratory Distress Syndrome, Guangxi Academy of Medical Sciences, Nanning, Guangxi, China.
- Guangxi Clinical Research Center Construction Project for Critical Treatment of Major Communicable Diseases, Guangxi Academy of Medical Sciences, Nanning, Guangxi, China.
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Galan DI, Schneider MC, Roess AA. Leptospirosis Risk among Occupational Groups in Brazil, 2010-2015. Am J Trop Med Hyg 2023; 109:376-386. [PMID: 37400068 PMCID: PMC10397431 DOI: 10.4269/ajtmh.21-0181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/20/2022] [Indexed: 07/05/2023] Open
Abstract
Leptospirosis is a zoonotic disease that is primarily transmitted through close contact with contaminated environments or infected animals. Brazil has the highest number of reported cases of leptospirosis in the Americas (approximately 4,000 annual cases). The purpose of this study is to identify the occupational groups with a higher risk of leptospirosis in Brazil from 2010 through 2015 among suspected cases reported to the national surveillance system. Confirmed and unconfirmed cases of leptospirosis with laboratory diagnosis, 20,193 and 59,034 respectively, were classified into 12 occupational groups. Confirmed cases were predominantly male (79.4%), between 25 and 59 years of age (68.3%), white (53.4%), illiterate or with incomplete primary education (51.1%), and participating in agricultural work (19.9%). After controlling for age, sex, race, and area of residency, the multivariate analysis identified that between confirmed and unconfirmed cases of leptospirosis reported to the Brazilian national surveillance system, five occupational groups are at higher risk for leptospirosis: garbage and recycling collectors (odds ratio [OR] = 4.10; 95% CI = 3.36-4.99); agricultural, forestry, and fishery workers (OR = 1.65; 95% CI = 1.49-1.84); prisoners (OR = 1.56; 95% CI = 1.04-2.35); building workers (OR = 1.36; 95% CI = 1.22-1.51); cleaners and mining workers (OR = 1.25; 95% CI = 1.07-1.45). This is the first nationwide study to examine leptospirosis risk by occupational group in Brazil using national surveillance data. Our results suggest that among suspected cases there was an increased risk among occupational groups with low income and low educational levels.
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Affiliation(s)
- Deise I. Galan
- Department of Environmental and Occupational Health, The George Washington University, Washington, District of Columbia
| | - Maria Cristina Schneider
- Department of International Health, Georgetown University, Washington, District of Columbia
- Institute of Studies in Collective Health, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Amira A. Roess
- Department of Global and Community Health, George Mason University, Fairfax, Virginia
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Motto SK, Shirima GM, de Clare Bronsvoort BM, Cook EAJ. Epidemiology of leptospirosis in Tanzania: A review of the current status, serogroup diversity and reservoirs. PLoS Negl Trop Dis 2021; 15:e0009918. [PMID: 34784354 PMCID: PMC8631673 DOI: 10.1371/journal.pntd.0009918] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 11/30/2021] [Accepted: 10/16/2021] [Indexed: 11/18/2022] Open
Abstract
Background Tanzania is among the tropical countries of Sub-Saharan Africa with the environmental conditions favorable for transmission of Leptospira. Leptospirosis is a neglected zoonotic disease, and although there are several published reports from Tanzania, the epidemiology, genetic diversity of Leptospira and its host range are poorly understood. Methods We conducted a comprehensive review of human and animal leptospirosis within the 26 regions of the Tanzanian mainland. Literature searches for the review were conducted in PubMed and Google Scholar. We further manually identified studies from reference lists among retrieved studies from the preliminary search. Results We identified thirty-four studies describing leptospirosis in humans (n = 16), animals (n = 14) and in both (n = 4). The number of studies varied significantly across regions. Most of the studies were conducted in Morogoro (n = 16) followed by Kilimanjaro (n = 9) and Tanga (n = 5). There were a range of study designs with cross-sectional prevalence studies (n = 18), studies on leptospirosis in febrile patients (n = 13), a case control study in cattle (n = 1) and studies identifying novel serovars (n = 2). The most utilized diagnostic tool was the microscopic agglutination test (MAT) which detected antibodies to 17 Leptospira serogroups in humans and animals. The Leptospira serogroups with the most diverse hosts were Icterohaemorrhagiae (n = 11), Grippotyphosa (n = 10), Sejroe (n = 10), Pomona (n = 9) and Ballum (n = 8). The reported prevalence of Leptospira antibodies in humans ranged from 0.3–29.9% and risk factors were associated with occupational animal contact. Many potential reservoir hosts were identified with the most common being rodents and cattle. Conclusion Leptospirosis is prevalent in humans and animals in Tanzania, although there is regional and host variation in the reports. Many regions do not have information about the disease in either humans or their animal reservoirs. More studies are required to understand human leptospirosis determinants and the role of livestock in leptospirosis transmission to humans for the development of appropriate control strategies. Bacteria from the genus Leptospira is an important agent for causing a disease called leptospirosis in humans and a range of animal species. Leptospirosis is often under-recognized as it presents varied symptoms that mimic malaria, typhoid, brucellosis and other diseases. More than 250 pathogenic Leptospira serovars are known to cause leptospirosis in humans and animals. The diversity of Leptospira serovars and their distribution in humans and animals is little defined in Tanzania. We conducted a systematic review to gather information on the diversity of Leptospira serovars with their reservoir distribution and the most common diagnostics methods used. We included studies (n = 34) in the review and found 17 serogroups described in 28 studies that utilized microscopic agglutination test (MAT). So far human and other animal hosts including cattle, dogs, pigs, bats, buffalo, fish, rodents, goats, lion, zebra, sheep and shrews have been investigated for leptospirosis in Tanzania. Our results show that cattle and rodents are likely to be important reservoirs of pathogenic Leptospira spp. and can be a source of human leptospirosis principally in the farming system. Further studies are needed to explore predominant serovars in livestock for the development of prevention strategies to reduce transmission and risks in humans.
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Affiliation(s)
- Shabani Kiyabo Motto
- Department of Global Health and Bio-Medical Sciences, School of Life Science and Bio-engineering, The Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
- Tanzania Veterinary Laboratory Agency, Central Veterinary Laboratory, Dar es Salaam, Tanzania
- * E-mail: (SKM); (EAJC)
| | - Gabriel Mkilema Shirima
- Department of Global Health and Bio-Medical Sciences, School of Life Science and Bio-engineering, The Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | - Barend Mark de Clare Bronsvoort
- The Roslin Institute, University of Edinburgh, Easter Bush, United Kingdom
- Centre for Tropical Livestock Genetics and Health, The Roslin Institute, University of Edinburgh, Easter Bush, United Kingdom
| | - Elizabeth Anne Jessie Cook
- International Livestock Research Institute (ILRI), Nairobi, Kenya
- Centre for Tropical Livestock Genetics and Health, ILRI, Nairobi, Kenya
- * E-mail: (SKM); (EAJC)
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Viroj J, Claude J, Lajaunie C, Cappelle J, Kritiyakan A, Thuainan P, Chewnarupai W, Morand S. Agro-Environmental Determinants of Leptospirosis: A Retrospective Spatiotemporal Analysis (2004-2014) in Mahasarakham Province (Thailand). Trop Med Infect Dis 2021; 6:115. [PMID: 34203491 PMCID: PMC8293432 DOI: 10.3390/tropicalmed6030115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/19/2021] [Accepted: 06/23/2021] [Indexed: 12/03/2022] Open
Abstract
Leptospirosis has been recognized as a major public health concern in Thailand following dramatic outbreaks. We analyzed human leptospirosis incidence between 2004 and 2014 in Mahasarakham province, Northeastern Thailand, in order to identify the agronomical and environmental factors likely to explain incidence at the level of 133 sub-districts and 1982 villages of the province. We performed general additive modeling (GAM) in order to take the spatial-temporal epidemiological dynamics into account. The results of GAM analyses showed that the average slope, population size, pig density, cow density and flood cover were significantly associated with leptospirosis occurrence in a district. Our results stress the importance of livestock favoring leptospirosis transmission to humans and suggest that prevention and control of leptospirosis need strong intersectoral collaboration between the public health, the livestock department and local communities. More specifically, such collaboration should integrate leptospirosis surveillance in both public and animal health for a better control of diseases in livestock while promoting public health prevention as encouraged by the One Health approach.
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Affiliation(s)
- Jaruwan Viroj
- Faculty of Public Health, Mahasarakham University, Mahasarakham 44150, Thailand;
| | - Julien Claude
- Institut des Sciences de l’Evolution, CNRS/UM/IRD/EPHE, Montpellier Université, 35095 Montpellier, France;
| | - Claire Lajaunie
- Inserm, UMR LPED (IRD, Aix-Marseille Université), 13001 Marseille, France;
| | - Julien Cappelle
- CIRAD, UMR ASTRE, 34398 Montpellier, France;
- UMR EpiA, INRA, VetAgro Sup, 69280 Marcy l’Etoile, France
| | - Anamika Kritiyakan
- Faculty of Veterinary Technology, Kasetsart University, Bangkok 10200, Thailand;
| | - Pornsit Thuainan
- Mahasarakham Provincial Public Health Office, Mahasarakham 44000, Thailand;
| | | | - Serge Morand
- CIRAD, UMR ASTRE, 34398 Montpellier, France;
- Mahasarakham Provincial Public Health Office, Mahasarakham 44000, Thailand;
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