Incidence and underreporting of leptospirosis comparing three diagnostic methods in the endemic region of Urabá, Colombia

Acute human leptospirosis in a Caribbean region of Colombia: From classic to emerging risk factors

BACKGROUND

Leptospirosis is a zoonosis of worldwide incidence, with a broad spectrum of health risk factors.

AIM

The objective was to determine risk factors associated with acute human leptospirosis and to explore predictive variables of risk to human leptospirosis.

METHODS

The study was carried out in the Department of Córdoba, in the north of Colombia. We conducted a longitudinal prospective descriptive study with non-probabilistic sampling, which included 339 patients suspected of leptospirosis. Positive cases were confirmed by MAT and PCR. The determination of social and environmental risk factors was done with a survey on epidemiological and environmental variables to establish an association between cases of leptospirosis and risk factors as well as predictive variables.

RESULTS

We found 19.8% (67/339) cases of acute leptospirosis, and the seroprevalence was 27.1% (92/339). The most frequent serogroups were Sejroe, Australis, Pomona, Batavie, Pyrogenes and Grippotyphosa. We identified the following risk factors: age between 10 and 19 years (OR = 2.571; 95% CI); pig ownership (OR = 2.019; 95% CI); bathing or recreational activities in lake/lagoon (OR = 3.85; 95% CI) and in dams (OR = 3.0; 95% CI); floodings 30 days before the onset of symptoms (OR = 2.019; 95% CI), and a mean temperature of 28°C (p 0.044; 95%CI). As significant predictor variables, we identified age (10-19 years), bathing or recreational activities in the lake/lagoon, and flooding 30 days before symptoms were again evidenced. This region presents classic risk factors (pig ownership) and emerging environmental risk factors (recreational practice or bathing in a lake/lagoon and flooding 30 days before the onset of symptoms), and demographic factors such as young age (10-19 years).

CONCLUSIONS

These factors are also predictors of human cases of acute leptospirosis and provide contextual information on environmental and public health that should be considered for epidemiological surveillance in this endemic area.

Eco-epidemiological study of seropositivity against Rickettsia and Leptospira agents in rural areas of Urabá, Colombia

Rickettsioses and leptospirosis are infectious diseases that are often underdiagnosed due to a lack of knowledge about their epidemiology, pathophysiology, diagnosis, management, among others.

Objetive

to characterize the seroprevalence and seroincidence of both Rickettsia and Leptospira agents and determine the risk factors for these outcomes in rural areas of Urabá, Antioquia.

Methods

a secondary data analysis using information on Rickettsia and Leptospira exposure from a prior prospective study that explored sociocultural and ecological aspects of Rickettsia infection in rural Urabá, Colombia. A multinomial mixed logistic regression model was employed to analyze factors linked to seroprevalent cases of Rickettsia, Leptospira and both, along with descriptive analyses of seroincident cases.

Results

the concomitant seroprevalence against Rickettsiaand Leptospira was 9.38% [95%CI 6.08%-13.37%] (56/597). The factors associated with this seroprevalence were age (ORa= 1.02 [95%CI 1.007-1.03]), male gender (ORa= 3.06 [95%CI 1.75-5.37]), fever history (ORa= 1.71 [95%CI 1.06-2.77]) the presence of breeding pigs (ORa= 2.29 [95%CI 1.36-3.88]), peridomicile yucca crops(ORa= 2.5 [95%CI 1.1-5.62]), and deforestation practices(ORa= 1.74 [95%CI 1.06-2.87]). The concomitant seroincidence against Rickettsia and Leptospira was 1.09% (3/274) [95%CI 0.29%-4.05%], three cases were female, with a median age of 31.83 years-old (IQR 8.69-56.99). At the household level, all the seroincident cases had households built partially or totally with soil floors, wooden walls, and zinc roofs. Two seroincident cases described the presence of equines, canines, and domestic chickens in intra or peri-domicile. Finally, two cases were exposed to synanthropic rodents, and one case to tick infestation.

Conclusion

there is evidence of seroprevalent and seroincident cases of seropositivity against both Rickettsia and Leptospira in rural areas of Urabá, Colombia. These findings can help improve public health surveillance systems in preventing, detecting, and attending to the different clinical cases caused by these pathogens.

Molecular Diagnosis as an Alternative for Public Health Surveillance of Leptospirosis in Colombia

Leptospirosis represents a public health problem in Colombia. However, the underreporting of the disease is an unfortunate reality, with a clear trend towards a decrease in cases since 2019, when the guidelines for its confirmatory diagnosis changed with the requirement of two paired samples. The purpose of this review is to highlight the importance of leptospirosis. While the access to rapid diagnosis is available at practically all levels of care for dengue and malaria, leptospirosis-a doubly neglected disease-deserves recognition as a serious public health problem in Colombia. In this manner, it is proposed that molecular tests are a viable diagnostic alternative that can improve the targeted treatment of the patient and the timeliness of data and case reporting to SIVIGILA, and reduce the underreporting of the disease. Taking advantage of the strengthened technological infrastructure derived from the SARS-CoV-2 pandemic for molecular diagnosis in Colombia, with a network of 227 laboratories distributed throughout the national territory, with an installed capacity for PCR testing, it is proposed that molecular diagnosis can be used as an alternative for early diagnosis. This would allow case confirmation through the public health network in Colombia, and, together with the microagglutination (MAT) technique, the epidemiological surveillance of this disease in this country would be strengthened.

Leptospira Seroprevalence in Colombian Dairy Herds

Simple Summary

Leptospirosis is one of the waterborne diseases whose spread could be significantly affected by global changes that act on the environment, both in Latin America and in other parts of the world. However, there are few studies regarding leptospirosis in cattle from Latin America, especially from Colombia. The aim of the present study was to determine the overall and within-herd seroprevalence and mapping of different Leptospira serovars in dairy cattle from farms located in some municipalities of the Colombian department of Boyacá. A high proportion (95%) of herds with at least one seropositive animal was found. Moreover, within-herd seroprevalence was very high in 20% of the herds. The frequent presence of other domestic animals on farms could be a risk factor for the spread of the infection. Human leptospirosis seroprevalence in some areas of Colombia is high. However, we found that the most common serotypes involved in human disease were the ones with the lowest seroprevalences in cattle in the investigated area. This suggests that cattle could represent a minor risk factor for the transmission of Leptospira infection to humans. Nevertheless, the need for stricter preventive measures in cattle farms has emerged.

Abstract

Leptospirosis in cattle has important economic effects on the infected farms. Moreover, livestock farming is considered a major occupational risk factor for the transmission of Leptospira infection to humans. A survey was performed to determine the overall and within-herd seroprevalence and mapping of different Leptospira serovars in dairy cattle from farms located in some municipalities of the Colombian department of Boyacá. Nine hundred and fifty-nine animals, from 20 unvaccinated and one vaccinated herd, were included in the study. Anti-Leptospira serum antibodies were detected by the microscopic agglutination test (MAT). Only one herd was seronegative. Overall seroprevalence to at least one serovar of Leptospira was 24.1% for unvaccinated animals and 62.3% for animals from the vaccinated herd. A very high within-herd seroprevalence (>60%) was present in 20% of the unvaccinated herds. The presence in the vaccinated herd of 20/398 animals showing high titers, between 1000 and 4000, to at least one serovar of Leptospira suggest that some animals could have been infected. Moreover, due to the presence of seronegative animals, a failure of vaccination immunity or the presence of unvaccinated animals in the vaccinated herd cannot be excluded. In all farms, domestic animals other than cattle were present. Considering the farming practices occurring on dairy farms in the study area, higher hygienic standards and stricter biosecurity measures are suggested.