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PubMed2000

A cluster of leptospirosis among abattoir workers.

In early December 1998, the Northern Rivers Public Health Unit (north-eastern New South Wales) was alerted to a possible cluster of leptospirosis cases by the supervising scientist of the Western Pacific Region World Health Organization/Food and Agricultural Organization Collaborating Centre for Reference and Research on Leptospirosis. Investigation revealed a cluster of eight leptospirosis cases diagnosed during October and November 1998. All were employees of a local meat works. Leptospira serovars isolated included pomona and hardjo. Symptoms included headache, fever, muscle pain, sore eyes, abdominal pain, vomiting, jaundice, and rash. Five of the eight cases were hospitalised. The infection could not be traced to any particular source. Unfortunately, records of stock killed during the exposure periods were not available. All cases reported exposure to large volumes of animal urine during the course of their work. Protective clothing provided included an apron, gloves, and rubber boots. All of the patients said they wore rubber boots and seven of the eight wore the apron provided. Only two patients reported wearing gloves, the remainder thought these were too difficult to work in.

Abattoirs↗
PubMed2005

Acute pancreatitis caused by leptospirosis: report of two cases.

Two cases of acute pancreatitis with leptospirosis are reported in this article. CASE 1: A 68-year-old woman, presented initially with abdominal pain, nausea, vomiting, and jaundice. She was in poor general condition, and had acute abdominal signs and symptoms on physical examination. Emergency laparotomy was performed, acute pancreatitis and leptospirosis were diagnosed on the basis of surgical findings and serological tests. The patient died on postoperative d 6. CASE 2: A 62-year-old man, presented with fever, jaundice, nausea, vomiting, and malaise. Acute pancreatitis associated with leptospirosis was diagnosed, according to abdominal CT scanning and serological tests. The patient recovered fully with antibiotic treatment and nutritional support within 19 d.

Acute Disease↗
PubMed1991

Gold immunoblot analysis of IgM-specific antibody in the diagnosis of human leptospirosis.

An immunoblot for the detection of leptospirosis was developed in our laboratory. Antigen prepared from Leptospira interrogans serovar bataviae was dotted onto nitrocellulose paper and blocked with skim milk. Test and control sera diluted 1:20 were applied to the dot, incubated, and washed. Anti-human IgM colloidal gold conjugate was added and the dots were washed. A positive reaction was shown by the development of a pink dot against a white background. The test was performed on 62 sera that tested positive for leptospirosis by a microagglutination (MA) test, on 40 sera that were positive by an indirect hemagglutination (IHA) test, and on sera from forty healthy blood donors. Four sera from the blood donors showed a faint pink dot, but the remainder showed a colorless reaction. All 62 sera that tested positive by MA were positive by this new test, while 95% of the 20 sera that tested positive by IHA were positive. Tests for IgG antibody were performed on 20 sera positive by MA using protein A-colloidal gold conjugate, and all showed weak reactivity. The results confirmed previous findings that most antibodies present in leptospirosis patients are of the IgM type. The ELISA takes three hours to perform, but the gold immunoblot can be completed in 30 min. In addition, the test blot can be kept as a permanent record, and is a significant improvement over existing tests.

Antibodies, Bacterial↗
PubMed1997

Immunodiagnosis of human leptospirosis by dot-ELISA for the detection of IgM, IgG, and IgA antibodies.

A dot-ELISA was evaluated using antigen obtained from Leptospira interrogans cultures of the serovars brasiliensis, canicola, cynopteri, hebdomadis, and icterohaemorrhagiae for the detection of human IgM, IgG, and IgA. Single serum samples from 63 patients with the icterohemorrhagic form of leptospirosis in the acute phase, collected 3-14 days (mean = 7 days) after the onset of symptoms were tested. Ten patients were examined during convalescence and followed up for a period of 4-12 months. For a control group, serum samples from 10 apparently healthy individuals with no clinical or epidemiologic history of leptospirosis, and from 38 patients with nonleptospiral illnesses were used. In the acute phase, IgM antibodies were detected in 62 (98%) of 63 patients and IgG and IgA were observed in 70% and 76% of them, respectively. For the admission serum samples, the predictive value negative of the dot-ELISA was 98% for IgM, 72% for IgG, and 76% for IgA detection. All 10 patients followed-up during convalescence showed IgM antibodies up to the sixth month, decreasing to 57% by the 10th month, and persisting in only one of six patients during the 11th and 12th months of follow-up. Immunoglobulin G was detected in six patients up to the fourth month and in two of six individuals up to the end of follow-up. Immunoglobulin A was observed in all patients up to the end of the first month, decreasing progressively up to the sixth month, and was no longer detected in any patients from seventh to the 12th months of follow-up. The dot-ELISA can be used as an important laboratory screening test, especially when detecting IgM antibodies. It proved to be effective in the diagnosis of human leptospirosis, and appears to have advantages in terms of yield, time, and case of execution and low cost.

Adolescent↗
PubMed1998

Human leptospirosis in the Seychelles (Indian Ocean): a population-based study.

A leptospirosis surveillance program was carried out for 12 months on the entire population of the Seychelles. Diagnosis was assessed by both microagglutination test and polymerase chain reaction (PCR) assay. In this population of 74,331, leptospirosis was clinically suspected in 125 subjects and confirmed in 75 patients (incidence of 101 per 100,000; 95% confidence interval = 79-126). Leptospirosis was more frequent in middle-aged males with environmental exposure. Eight serogroups were identified and Icterohaemorrhagiae (31%) and Hurstbridge (20%) were the most frequent. Hurstbridge, a recently identified new serogroup, was implicated in severe cases and death. Influenza-like forms accounted for 37% of the cases while jaundice, acute renal failure, and pulmonary hemorrhage occurred in 52%, 28%, and 19%, respectively. Death occurred in six patients and was related to pulmonary hemorrhage. The PCR result was positive after completion of treatment in eight patients, suggesting that the administered five-day course of penicillin may be inadequate to eradicate the bacteria.

Adolescent↗
PubMed1999

Leptospirosis and Ebola virus infection in five gold-panning villages in northeastern Gabon.

An exhaustive epidemiologic and serologic survey was carried out in five gold-panning villages situated in northeastern Gabon to estimate the degree of exposure of to leptospirosis and Ebola virus. The seroprevalence was 15.7% for leptospirosis and 10.2% for Ebola virus. Sixty years after the last seroepidemiologic survey of leptospirosis in Gabon, this study demonstrates the persistence of this infection among the endemic population and the need to consider it as a potential cause of hemorrhagic fever in Gabon. There was no significant statistical correlation between the serologic status of populations exposed to both infectious agents, indicating the lack of common risk factors for these diseases.

Adolescent↗
PubMed2002

Population-based case-control investigation of risk factors for leptospirosis during an urban epidemic.

Between March and October 2000, 157 suspected cases of leptospirosis hospitalized with complications of Weil's syndrome and a mortality of 8% were identified in Salvador, Brazil. We conducted a population-based case-control study to identify risk factors for acquisition of leptospirosis in neighborhoods with high endemicity during the rainy season-associated urban epidemic. Sixty-six (65%) of 101 laboratory-confirmed cases and 125 age and sex-matched healthy neighborhood controls were interviewed. Residence in proximity to an open sewer (matched odds ratio [OR] = 5.15, 95% confidence interval [CI] = 1.80-14.74), peri-domiciliary sighting of rats (OR = 4.49, 95% CI = 1.57-12.83), sighting groups of five or more rats (OR = 3.90, 95% CI = 1.35-11.27), and workplace exposure to contaminated environmental sources (OR = 3.71, 95% CI = 1.35-10.17) were found to be independent risk factors for acquiring disease. Some of these risk factors are amenable to focused interventions, which include provision of closed drainage systems for sewage and reduction of rodent populations in the peri-domicilary environment. Environmental control of transmission may help to greatly reduce the incidence of severe leptospirosis.

Adolescent↗
PubMed2004

Impact of clinical and laboratory findings on prognosis in leptospirosis.

OBJECTIVE: The aim of this study was to evaluate epidemiological, clinical and laboratory features, and risk factors for mortality in leptospirosis. METHODS: Seventy-two adult leptospirosis cases were reviewed. Categorical clinical and laboratory findings of survivors and non-survivors were assessed by Chi square analysis. Non-categorical findings were assessed by the student t test. Clinical findings and laboratory data with p <0.05 were assessed by stepwise logistic regression analysis for mortality. RESULTS: Of all patients, mean age was 47.3 +/- 15.7 years, 82% were men and, 51% were farmers. Icterus occurred in 75%, and high fever was seen in 61 of the patients. The most frequently detected serotype was Leptospira icterohaemorrhagiae (30%). Overall mortality rate was 17%. In those non-survivors, altered mental status (p = 0.002), hepatomegaly (p = 0.037), haemorrhage (p = 0.019), ALT level (p = 0.008), AST level (p = 0.02), prolonged prothrombin time (p = 0.02) and increased serum potassium levels (p = 0.004) were seen more frequently than in survivors. Altered mental status (p = 0.01, OR: 8.9, CI 95%: 1.6-50.7) and serum potassium levels at hospital admission (p = 0.01, OR: 4.2, CI 95%: 1.4-13.1) were detected as independent risk factors for mortality. CONCLUSIONS: Leptospirosis patients with altered mental status and hyperpotassaemia at hospital admission are at high risk for mortality and should be followed up more closely at the intensive care unit.

Adolescent↗
PubMed1983

Human leptospirosis in Victoria.

Between May, 1979, and May, 1981, leptospirosis was diagnosed, on the basis of serological and culture findings, in specimens from 208 of 2516 patients with symptoms which suggested leptospirosis or other zoonoses. The most common serological reactions were with serovars hardjo (69%), pomona (29%) and tarassovi (2%). There was a clear association between infection and occupation in 101 farmers, 44 meat workers and 11 meat inspectors. It would seem prudent to consider leptospirosis in the differential diagnosis of pyrexia in patients who have occupational contact with animals, and to institute appropriate serological and culture examinations.

Adolescent↗
PubMed1998

Leptospirosis associated with severe pulmonary haemorrhage in Far North Queensland.

Pulmonary haemorrhage as a manifestation of leptospirosis is rarely diagnosed in developed countries. Five patients with proven leptospirosis associated with severe pulmonary haemorrhage presented to one hospital in Far North Queensland between January 1994 and June 1997. Four required admission to the intensive care unit and one patient died. Pulmonary haemorrhage is an uncommon but severe complication of leptospirosis and may be a source of diagnostic confusion in tropical areas of Australia.

Adolescent↗
PubMed2005

Leptospirosis in northern elephant seals (Mirounga angustirostris) stranded along the California coast.

Leptospirosis was identified in six northern elephant seals (Mirounga angustirostris) that were stranded in 1995 along the coast of California (USA). Histologic lesions in all seals included tubulointerstitial nephritis with tubular degeneration and necrosis. Infection was confirmed through identification of spirochetes using an immunohistochemical stain for Leptospira sp. antigens. One affected seal had an elevated titer to Leptospira interrogans serovar pomona. Four of the six seals developed leptospirosis during rehabilitation, and two seals had evidence of exposure in the wild. Potential sources of infection during rehabilitation include other elephant seals, California sea lions (Zalophus californianus), Pacific harbor seals (Phoca vitulina richardsii), or free-ranging wildlife. These results indicate that northern elephant seals are susceptible to leptospirosis and can develop disease both in the natural environment and in a rehabilitation setting.

Animals↗
PubMed1999

[Epidemiologic and clinical study of leptospirosis in Bourail (New Caledonia)].

Leptospirosis is a frequent zoonosis in New Caledonia, mostly in the Bourail area, with an incidence of 9.5/1000 inhabitants. This town is an important cross-roads between the main town, Noumea, and the bush. An agricultural show takes place every year in this town, concentrating a great number of domestic animals and several thousand people coming from all over the island. A study was carried out on 78 patients with leptospirosis. The patients were mostly men (70%) of all ages of Melanesian and European origin. People who were living in the bush were more often attacked by leptospirosis than people living in towns. There were two annual peak values (March-April and July-August). Three symptoms (fever, headache, myalgia) were frequent (56%). Leucocytosis increased in 45% of cases. The serogroup icterohaemorrhagiae was the more common (38%). After treatment by penicillin, patients recovered in 83% of cases, but a fatal outcome occurred in 4 patients. An information campaign was necessary in order that people seek medical care as soon as the first symptoms appeared. At present, vaccination does not seem to be possible in such a context.

Adolescent↗
PubMed1999

[Demonstration for periodicity of leptospirosis in Yichang City of Hubei Province during 1960-1997].

OBJECTIVE: To study the periodicity of leptospirosis incidence. METHODS: Data of leptospirosis epidemics in Yichang City collected during the past 38 years from 1960 to 1997 were analyzed with periodic graphics method. RESULTS: Cause-specific incidence rate of leptospirosis was 15.43 per 100,000 in average, with an epidemic interval of 10 years, with statistical significance in periodic vibration (J = 4.179, P < 0.05). CONCLUSION: The results mentioned above provided scientific basis for the effective control and prevention of the disease.

China↗
PubMed1997

[Analysis on speciems of serum and urine in 66 cases of early leptospirosis by PCR and biotin-AMPPD hybridization].

We used polymerase chain reaction (PCR) and Biotin-AMPPD hybridization to detect leptospiral DNA in blood and urine samples in 66 patients at the early stage of leptospirosis. The results showed that PCR and Biotin-AMPPD hybridization not only ruled out the non-specific PCR amplification and increased the reliability for clinical specineus of leptospirosis but also raised the detecting sensibility (from 71.3% to 86.1%). The positive rates of PCR resulted from serum and urine showed no statistical difference; therefore urine sample is worthy of application and dissemination for detecting leptospires at the early stage of leptospirosis. Urine sample is easier for one to collect, preserve and has less intervention. The primers G1, G2 are optimal opplication of PCR in epdemic areas in China.

Biotin↗
PubMed1999

[Human leptospirosis. A short review concerning a caseload].

Leptospirosis, a zoonosis with worldwide distribution, may have a broad spectrum of clinical manifestations that can delay the diagnosis, especially in wet climates where other conditions may dissimulate the main aspects. The authors describe 42 cases of patients with leptospirosis admitted to the Infectious Diseases Unit of a general hospital since 1990. The goal was to analyse epidemiological features, clinical manifestations, laboratory findings, treatment and evolution. There were 23 males (54.7%) and 19 females (45.2%), with ages ranging from 17 to 82 years. Most cases occurred in occupational settings, especially in those in contact with animals or stagnant water. All the cases had serological confirmation (by MAT or ELISA methods). Anicteric forms represented 42.9% of the total, which implies that in many cases a diagnosis is not immediately evident. The main symptoms, other than fever (97.6%) and jaundice (57.1%), were myalgia (71.4%), headache (42.8%) and nausea (33.3%). Renal involvement was common (52%), but the most severe forms occurred in 3 patients who required hemodialysis; followed by D.I.C. in 9.5%; meningitis in 4.7% and pulmonary involvement in 2.3% of the cases. The serovars most commonly identified were L. icterohaemorraghiae (28.5%), L. australis (14.3%), L. grippothyphosa (11.9%) and L. canicola (9.5%). The patients were treated with penicillin G (83.3%) or doxycyclin (9.5%). Two of them deceased (4.7%) and the remainder had a good evolution. The diagnosis of leptospirosis may be delayed if physicians fail to include this infection in the initial differential diagnosis. In view of this, the authors emphasize that when nonspecific clinical manifestations occur, a good epidemiological history is useful in proposing this diagnosis.

Adult↗
PubMed1975

Leptospirosis: an underdiagnosed cause of acute febrile illness.

Two cases of leptospirosis diagnosed at the Texas Medical Center in a two-week period are presented. Most cases of leptospirosis go undiagnosed because the symptoms and signs are nonspecific. Leptospirosis should enter the differential diagnosis when symptoms of influenzal illness, aseptic meningitis, and viral gastroenteritis occur, especially if abnormal hepatic and renal function are shown to be present. Many, but by no means all, patients will give history of exposure to livestock or rodents. Diagnosis is best made by serologic methods; Treatment is usually not required since the disease is self-limited, and even in the more severe form, antibiotics have not been conclusively shown to be of benefit.

Acute Disease↗
PubMed2000

Leptospirosis occurring in two children after fresh water immersion.

Leptospirosis is relatively uncommon in children. Two cases of severe leptospirosis occurred in teenaged boys who shared a common exposure via immersion in fresh water. While both patients had laboratory-confirmed leptospirosis, their symptoms differed in many respects.

Adolescent↗
PubMed2001

[Fever and chills due to leptospirosis after travel to Thailand].

Two weeks after rafting on a river in Thailand a Dutch 54-year-old male experienced chills and high fever. While rafting he had wounded his hand. Because of the history (water contact, the wound, high fever with chills), of the findings at examination (fever, conjunctivitis) and of the laboratory findings (leukocytosis, albuminuria, disturbance of liver enzymes), a clinical diagnosis of 'leptospirosis' was made. This was confirmed by serological tests and culturing of Leptospirae from the blood. Leptospirosis is a zoonosis, in man associated with certain occupations, water sports and inundations. The clinical picture varies from a mild febrile disease (sometimes pyrexia of unknown origin) to a severe condition with kidney and liver failure, bleeding tendency, lung oedema (Weil's syndrome). In travellers with fever, water contact, leukocytosis and neutrophilia, leptospirosis must be considered and specific diagnostic tests applied.

Antibodies, Bacterial↗