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PubMed2003

Leptospirosis in northern India: a clinical and serological study.

A total of 400 serum samples collected from patients, clinically suspected of leptospirosis, were evaluated for antibodies by LEPTO dipstick and microscopic agglutination test (MAT). Twenty of these patients (5%) had serological evidence of leptospirosis. Leptospira interrogans serovars Autumnalis and Icterohaemorrhagiae, Canicola and Javanica were serogroups recorded serologically. Fever and jaundice were the most common clinical presentations. Male preponderance was seen in the leptospirosis cases. Outdoor activities, agricultural activities, contact with animals were significantly associated with seropositivity for Leptospira. This study highlights that leptospirosis is a significant health problem in northern India, though grossly under reported due to the absence of routine laboratory diagnostic facilities for this disease.

Adult↗
PubMed2005

Leptospirosis presenting with fever and pulmonary hemorrhage.

Reports of leptospirosis have recently been increasing in Taiwan. We report a case of leptospirosis with the unusual initial manifestation of pulmonary hemorrhage. The patient presented with cough for 1 week and was admitted. After admission, fever, hemoptysis and severe dyspnea developed suddenly. Chest radiograph showed bilateral diffuse pulmonary infiltrates and he was transferred to the emergency room of our hospital. Oxygen saturation was 86% under room air and respiratory rate was 30 per minute. After admission to the thoracic ward on the third morning, parenteral penicillin and trimethoprim-sulfamethoxazole were given empirically, and a dramatic recovery ensued. Microscopic agglutination test showed an increased titer of 1:6400 against Leptospira interrogans serogroup shermani on the fourth day of hospitalization. Neither jaundice nor renal insufficiency occurred during treatment. Pulmonary hemorrhage may be an under-recognized manifestation of leptospirosis in Taiwanese patients. Leptospirosis should be taken into consideration in the differential diagnosis of pulmonary hemorrhage. Early treatment can lead to cure with reduced morbidity.

Adult↗
PubMed2005

Leptospirosis after recreational exposure to water in the Yaeyama islands, Japan.

Leptospirosis is a global zoonotic disease with a variety of clinical manifestations. We report an outbreak of leptospirosis in the Yaeyama Islands, Japan, in the summer of 1999 associated with heavy rainfall. Fourteen people were diagnosed with leptospirosis and required hospitalization. All cases were found to have exposure to contaminated soil or water. A history of recreational activities involving water sports was more frequent (71%) than occupational risk factors related to agriculture or construction (29%). Fever was the primary symptom in all cases, followed by chills (93%), headache (86%), myalgias (57%) and conjunctival suffusion (57%). All cases were successfully treated with antimicrobial therapy except one patient who improved spontaneously. Jarisch-Herxheimer reactions were seen in six cases (43%). The increasing incidence of leptospirosis related to recreational sports is an important public health problem in resort areas. A high-index of suspicion, early treatment, and prevention are crucial in this latently endemic area.

Adolescent↗
PubMedDate not supplied

Gel purified LipL32: a prospective antigen for detection of leptospirosis.

BACKGROUND: Leptospirosis, a zoonosis, is a re-emerging disease, affecting populations across the globe. However, the current methods of diagnosis are time- consuming, cumbersome, imprecise or expensive. AIM: To develop an assay for differential and early diagnosis of Leptospirosis. METHODS AND MATERIAL: IgG based ELISA for evaluation of three antigens, namely, a gel-purified recombinant protein (rLipL32), secreted proteins and whole organism sonicates of Leptospira spp. The antigens were evaluated using, rabbit polyclonal antiserum and human sera samples. RESULTS: Studies with a rabbit polyclonal antiserum indicated the utility of these antigens in differentiating Leptospira from other common pathogenic organisms. Evaluation of these antigens with fifteen representative human serum samples indicated gel-purified rLipL32 to be a potentially useful antigen for detection of leptospirosis. The results obtained with IgG ELISA were correlated with the results of microscopic agglutination test (MAT). CONCLUSION: Gel-purified rLipL32 is a valuable antigen for early and accurate diagnosis of leptospirosis. Further evaluation of this assay in field conditions and larger sera samples will indicate its suitability in case of an epidemic.

Antibodies, Bacterial↗
PubMedDate not supplied

A study of sutopsy findings in 62 cases of leptospirosis in a metropolitan city in India.

BACKGROUND: Leptospirosis is an important sporadic zoonotic disease caused by the spirochete Leptospira icterohaemorrhagiae . The disease becomes a major public health problem, particularly during the monsoon months. MATERIALS AND METHODS: Analysis of autopsy findings of 62 cases of clinically suspected leptospirosis was carried out to identify the pathology and determine the cause of death. RESULTS: Most patients were young males who presented with fever, breathlessness, haemoptysis, bleeding, oliguria and icterus. They died after a brief stay in hospital. A post-mortem diagnosis of leptospirosis was made on the basis of characteristic organ findings, aided by results of serology, Levaditi's staining and / or immunohistochemistry (IHC) on kidney sections. Massive intra-alveolar haemorrhage (48 cases), acute interstitial nephritis and / or acute tubular necrosis (45 cases) and myocarditis (24 cases) were the main autopsy findings. Haemorrhage in various organs like the heart, gastrointestinal tract, brain, pancreas and adrenals were also seen. Thirty of 54 kidney sections were positive for leptospiral antigens by IHC. There was extensive haemorrhages in the lungs in 48 (77%) cases and that was the cause of death in most of these cases. CONCLUSION: Bleeding into various tissues and organs is the main finding noted in this study. The post-mortem examination of patients dying of leptospirosis revealed that pulmonary haemorrhage was the cause of death in most individuals.

Adolescent↗
PubMedDate not supplied

Screening of patients with acute febrile illness for leptospirosis using clinical criteria and serology.

BACKGROUND: Leptospirosis is one of the common zoonoses but, in most instances, the infection goes unnoticed. Rapid diagnostic modalities are needed to diagnose the disease in the early stages. We assessed the usefulness of clinical criteria and compared these with enzyme-linked immunosorbentassay (ELISA) for the early detection of leptospirosis. METHODS: One hundred patients with a febrile illness for > 7 days were screened by Faine criteria and their sera were subjected to both IgM and IgG ELISA using a commercially available kit (Institut Virion Serion GmbH, Warburg, Germany). RESULTS: Twenty-six patients satisfied the clinical criteria for leptospirosis and 8 of them tested positive for IgM antibodies while 1 patient who was clinically negative tested positive by serology. Thus, Faine criteria had a sensitivity of 88.9%, specificity of 80.2%, positive predictive value of 30.8% and a negative predictive value of 98.6%. Paired serum samples were obtained from 70 patients but the IgG levels of only 2 showed a 4-fold rise. CONCLUSION: Faine criteria has moderate sensitivity and specificity but a high negative predictive value in comparison with IgM ELISA. The high negative predictive value may help to screen patients with acute febrile illness for leptospirosis during the early phase of the disease.

Acute Disease↗
PubMed2006

Seroprevalence of leptospirosis among high-risk population of Andaman Islands, India.

Leptospirosis is a severe spirochetal zoonosis in the world. It is considered an occupational disease of persons engaged in agriculture, sewage works, forestry, and animal slaughtering. A study was conducted with an objective of assessing the seroprevalence of leptospirosis among the high-risk groups of Andaman Islands. A total of 611 sera samples from different high-risk populations were collected and tested by microscopic agglutination test (MAT). Genetic characterization of the isolate was done by randomly amplified polymorphic DNA (RAPD) fingerprinting, and serological characterization was done using monoclonal antibody technique. Antibodies to leptospires were detected in 322 samples giving an overall seroprevalence of 52.7%. The seroprevalence was highest among agriculture workers (62.5%) followed by sewage workers (39.4%), animal handlers (37.5%), forest workers (27.3%), and butchers (30.0%). Seroprevalence among control population was 14.7%, which was comparatively less than that of the high-risk population groups. Subject sera were most commonly reacted with organisms of the serogroup Grippotyphosa followed by Australis, and the pattern was similar in control group. Four leptospires were isolated from agriculture workers who were admitted to the public health center (PHC) with complaints of fever and body ache. Human isolates were compared with two rodent (Rattus norvegicus) isolates from the same area of agriculture workers to get initial information about the transmission cycle of leptospirosis in the study community. Randomly amplified polymorphic DNA fingerprinting pattern of the strains recovered from the rodents and human patients were identified as belonged to genomo-species Leptospira interrogans. The antigenic characterization of the strains recovered from them belonged to serovar Valbuzzi of serogroup Grippotyphosa. The study showed that people engaged in high-risk activities such as agriculture, sewage cleaning, animal handling, animal slaughtering, and forestry are frequently exposed to leptospirosis, and hence control strategies targeting these populations could be more effective.

Adult↗
PubMed2005

The use of latex agglutination for the diagnosis of acute human leptospirosis.

The authors evaluated a simple latex agglutination test for the serodiagnosis of acute human leptospirosis. A total of 380 serum samples from 85 confirmed leptospirosis patients and 202 non-leptospirosis patients were selected Using the selected cut-off value of weakly positive, the overall sensitivity and overall specificity of the test were 94.1% and 97.0% respectively. The weighted kappa value for agreement reading between two independent examiners was 0.82. When focused on the first sera obtained from the patients, the sensitivity of the test for acute infection sera was only 17.6%. The latex agglutination test is easy to perform with no need for training and no requirement of special equipment. The assay has a good sensitivity and specificity. This is an interesting alternative assay for serodiagnosis of acute human leptospirosis.

Antibodies, Bacterial↗
PubMed2006

Western immunoblot analysis using a ten leptospira serovars combined antigen for serodiagnosis of leptospirosis.

Leptospirosis is a major zoonotic disease throughout the world. There are unavailable accuracy diagnostic methods for the acute phase of infection. To demonstrate the advantage of Western immunoblot, a mixed leptospira serovars antigen for the serodiagnosis of leptospirosis was employed. SDS-PAGE and Western immunoblot was performed using a 10 mixed leptospira serovars antigen and stained with 16 reference rabbit anti-leptospirosis antibodies. The result showed different immunoreactive band patterns for each reference serum. The bands with molecular weights of 15-20, 23-24, 41 and 45 kDa were commonly found (88% to 100% of the 16 reference sera). Using combined leptospira antigens in a Western immunoblot technique is an alternative and practical strategy for a more sensitive leptospirosis serodiagnosis.

Antibodies, Bacterial↗
PubMed1991

[Acute adult respiratory distress syndrome in leptospirosis].

The respiratory manifestations of leptospirosis are usually benign. A case is reported of leptospirosis with serious pulmonary affection. Pulmonary involvement in leptospirosis is infrequently predominant and usually without bearing on prognosis. Clinical and roentgenological features are reviewed. Severe forms with massive hemoptysis or acute respiratory failure occur occasionally. The clinical symptoms, the radiological manifestations and haemodynamic investigation were suggestive of an acute respiratory distress by non haemodynamic pulmonary oedema. In accordance with other authors, one could be justified in including this acute respiratory failure as part of the adult respiratory distress syndrome. Since leptospirosis has extremely diverse clinical features, physicians should have this diagnosis in mind in many circumstances and should request the appropriate examinations at the right moment. Carefully performed microbiological techniques may reduce the problems encountered in isolating leptospires. Serological tests requested after the 12th day of the disease and repeated several times should improve the diagnosis confirmation. The potential severity of certain forms justifies curative antibiotic therapy.

Adolescent↗
PubMed1990

[Progression and control of leptospirosis in a sow herd].

After a short review about etiology, epidemiology, clinical symptoms, diagnosis and therapy of leptospirosis the course and therapy of an acute leptospirosis outbreak in a breeding herd with nearly 240 sows is described. The microscopic agglutination test (MAT) served for diagnosis and was most reliable for estimation the actually stage of infection when used twice with an interval of several weeks. As causative agent serovar L. pomona was identified, whereby cross-reactions were seen to serovars L. grippotyphosa, L. bratislava and L. copenhageni. Therapy of all animals with Terramycin/LA (Pfizer) at three times with intervals of five days and doses of 20 mg oxytetracycline/kg b.w. distinctly reduced the incidence of abortion and stillborn or mummified pigs. Local irritations, relative to the intramuscular administration of oxytetracycline, mostly were low-graded and temporary. For the next months acute infections could not be registered. Probably due to infections from leptospires-reservoirs, maintained by numerous existing mice and puddles on the pasture-ground, leptospirosis occurred again six months later. Only another antibiotic therapy of the whole herd and simultaneous eradication of rodents as well as closing the pasture led to a long-termed control of leptospirosis in this herd.

Animals↗
PubMed1986

[Role of serodiagnosis in recognizing atypical forms of leptospirosis in Krasnodar Territory].

The work deals with the epidemiological situation with respect to Leptospira infections in the Krasnodar territory. The work demonstrates that, in comparison with 1960-ies characterized by the prevalence of diseases caused by L. pomona and L. grippotyphosa, in 1970-ies the increase of the specific proportion of infections caused by L. icterohaemorrhagiae was registered. In recent 5 years (1980-1984) this leptospirosis constituted 73.5-94.8% of the total morbidity rate in the territory. Such situation was caused by active prophylactic measures in cattle breeding, as well as by the increase of the number of leptospirosis foci, appearing as the result of human activities and providing favorable conditions for the life and multiplication of Norway rats, the main source of infection caused by L. icterohaemorrhagiae as indicated by the fact that up to 23.9% of the Norway rats examined in this study proved to be contaminated. The detection of cases of leptospirosis among febrile patients and mistakes in clinical diagnosis confirm the necessity of the serological examination of febrile patients with the acute onset of the disease with temperature reaching 38 degrees C and higher for 3-5 days and the clinical picture of the disease being unclear in order to find out patients presenting with the atypical clinical picture of leptospirosis.

Adolescent↗
PubMed1988

Epidemiology and characterization of leptospirosis at an urban and provincial site in Thailand.

Patients with FUOs at the Children's Hospital in Bangkok and the Chao Phya Abhai Bhu Bejhr Hospital in Prachinburi were screened for leptospirosis by blood and urine culture in addition to microagglutination testing of their serum. Animal populations in urban and periurban areas of Bangkok were surveyed for evidence of leptospira infection. Three rural sites near the Prachinburi Provincial Hospital were also surveyed. The rodents' and domestic animals' blood, urine, and/or kidney cell samples were cultured for leptospira. Sera from these animals were also tested for leptospira antibody. The bataviae serovar was the most commonly detected leptospiral agent in both man and animals. Presenting symptoms varied with age with children showing primarily fever, vomiting, headache, abdominal and generalized muscle pain and diarrhea whereas adults had fever, headache, anorexia, muscle pain and constipation. Blood samples from patients suspected of having leptospirosis were tested for antibody by the MAT and cultured in EMJH media. The following serogroups were identified: bataviae, autumanalis, javanica, hebdomadis, and pyrogens. Leptospirosis incidence in humans was much higher in the rainy/flooding year of 1983 compared to the relatively dry year of 1984. Results of our animal surveillance studies indicate that in addition to rats, which have previously been mentioned, dogs, bandicoots, cattle and pigs could be the source of human leptospirosis infection in both urban and provincial locations in Thailand.

Animals↗
PubMed1969

Sensitized-erythrocyte-lysis (SEL) test as an epidemiological tool for human leptospirosis serological surveys.

Epidemiological studies of human leptospirosis have generally been limited to countries with specialized laboratories employing the microscopic-agglutination (MA) test. The sensitized-erythrocyte-lysis (SEL) test is much simpler for routine hospital laboratories to carry out and it has been found valuable in the diagnosis of human leptospirosis. This paper reports the results of studies of the SEL test as an epidemiological tool in serological surveys.The results showed that the significant SEL titre was 1:80 and that the sensitivity of the test depended possibly on the antigen preparation and the amount of complement used. Most of the SEL antibodies were found to persist at significant titres for about 1 year after active infection, but less than half persisted longer than that. The SEL test is therefore useful for detecting recent infections and for indicating that stability of leptospirosis in an area.The endemicity of leptospirosis in West Malaysia was confirmed by the SEL test, based on the employment of 1:80 as the significant titre.

Antibodies↗
PubMed1981

[Human and animal leptospirosis in irrigated lands].

To study the influence of amelioration on the spread of leptospirosis, the survey of humans, agricultural animals and rodent was made on the territory where the irrigation system was under construction and during 2 years after the beginning of irrigation. This survey failed to establish the occurrence of significant changes in the number of rodents and their species composition, as well as in the number of agricultural animals showing the positive reaction to leptospirosis. No cases of leptospirosis were registered, and during the first years after the beginning of irrigation antibodies in low titers were detected only in 4 out of 536 subjects. The results obtained in this survey suggest that during the first years of artificial irrigation the conditions for a wider spread of leptospirosis do not appear, but the final solution of this problem can be made on the basis of observations lasting for many years.

Agriculture↗
PubMed1982

Risks of contracting leptospirosis on the dairy farm.

The sera of 460 people associated with farming were examined for evidence of leptospiral agglutinins. Of these, 308 were dairy farm workers, 62 percent of whom were from the Waikato. Forty-four percent of dairy farm workers, 8 percent of sheep and beef farmers and 25 percent of pig farmers ware seropositive. Of the 137 seropositive dairy farm workers, 65 percent had titres to serovar hardjo and 53 percent to pomona. There were no significant differences between the serological prevalences of workers in different geographical regions. Analysis of factors significantly associated with seropositive workers included; being male, a previous history of medically confirmed leptospirosis in the worker, a clinical history of leptospirosis in the cattle, the size of the milking herd, the type of milking shed, and vaccination of the herd against leptospirosis. These findings indicate that the incidence of leptospirosis in dairy farm workers can only be effectively controlled by reducing the prevalence of infection in dairy cattle.

Agglutination Tests↗
PubMed1976

[Leptospirosis in a Dakar hospital: results of a new survey].

The incidence of leptospirosis in West Africa is still almost unknown. Doubtful or positive serological tests were found in approx. 35% of the patients admitted to the hospital, among which leptospirosis could clinically or biologically be suspected. This rather high proportion reflects the frequency of recent or past contacts with leptospira antigen. It is in agreement with the high infestation prevalence observed among several domestic or wild animals, besides small rodents. On the countrary, it should be noted that the leptospirosis-illness, at least in its pure form, with its characteristic hepatic, renal and neurological signs, is seldom seen. Seven typical cases only (among which five at the hosptical Le Dantec) have been diagnosed in Dakar during these last 6 years. Even taking into account that the proportion of atypical, fruste or undiagnosed forms is not negligible, leptospirosis does not appear to be a major medical problem in Senegal.

Adult↗
PubMed1997

Leptospirosis in the Republic of Ireland: 1985 to 1996.

Official government statistics and serological laboratory data provide limited information about the incidence of leptospirosis in the Republic of Ireland. The mean annual notified incidence in the Republic of Ireland from 1985 to 1996 was 1.3/million. The incidence according to hospital discharge diagnosis was higher at 4.9/million. One hundred and seventy-five serologically confirmed cases of leptospirosis were reported from 1986 to 1996, giving a mean annual incidence of 4.5/million. The true incidence of leptospirosis in the Republic of Ireland is probably higher, as hospital discharge data are incomplete and full serological testing was not always performed. Our data indicate that leptospirosis is an underestimated public health problem with only 26% of cases being notified. A national communicable disease surveillance centre in the Republic of Ireland would facilitate better monitoring and understanding of this disease.

Adult↗