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PubMed2001

[Hematological parameters in characterization of anemia in leptospirosis].

Blood samples from 46 patients with leptospirosis were analyzed on a Cobas Vega (ABX, France) device over the course of disease. Hemoglobin content, erythrocyte count, mean volume of erythrocytes, mean content and mean concentration of hemoglobin in an erythrocyte, anisocytosis index, reticulocyte count, and content of free hemoglobin (FH) were analyzed. Anemia (normocytic normochromic hyperregeneratory) is a typical manifestation of leptospirosis during the second week of disease. The leading pathogenetic mechanism of anemia associated with leptospirosis is erythrocyte hemolysis, whose intensity during the acute period depends on the severity of intoxication and extracorporeal methods of detoxication. Persistence of anemia during convalescent period is due to involvement of the kidneys (nephrotic nephritis).

Adolescent↗
PubMed2001

Evaluation of darkground microscopy as a rapid diagnostic procedure in leptospirosis.

BACKGROUND & OBJECTIVES: Although darkground microscopy (DGM) is the method employed for examining the growth of leptospires in culture, it is not useful for diagnosis when used directly on body fluids. However, it continues to be used as a method for diagnosing leptospirosis in many centres in India. The present study was undertaken to evaluate the diagnostic accuracy of DGM by comparing it with established tests like culture, microscopic agglutination test (MAT), IgM ELISA and Lepto-Dipstick. METHODS: A total of 170 patients clinically suspected to have leptospirosis were included in the study. The gold standard for diagnosis was positive blood culture, or seroconversion, or a four-fold rise in titre in MAT. DGM was done on plasma after centrifugation at 1000 g and 3000 g and on serum. Indices of accuracy including sensitivity, specificity, predictive values and kappa value of agreement with the gold standard diagnostic criteria were calculated. RESULTS: DGM had a sensitivity of 40.2 per cent, specificity of 61.5 per cent, a positive predictive value of 55.2 per cent and a negative predictive value of 46.6 per cent. It had agreement with the gold standard in only 50 per cent cases the kappa value being 0.017141. INTERPRETATION & CONCLUSION: DGM has low indices of accuracy. The results obtained in patients who met the gold standard criteria for diagnosis and those who did not were identical indicating that the test results are not determined by the presence of leptospiral infection in the patient. DGM, therefore, is not recommended as a sole diagnostic procedure for early diagnosis of leptospirosis.

Humans↗
PubMed2002

Leptospirosis in northeastern Thailand: hypotension and complications.

During an outbreak of leptospirosis in northeastern Thailand, 148 patients with serologically diagnosed leptospirosis were seen in Loei Hospital. The clinical features were consistent with those described for the classic manifestation of the disease. However, hypotension was a common finding: noted in 94 patients (64%) upon admission or early in the course of the disease. Of these hypotensive patients, 64 (68%) had impaired renal function: 30 patients (32%) had prerenal azotemia and 34 (36%) were in renal failure. Pulmonary complications, including pulmonary edema, hemorrhage, ARDS, and interstitial pneumonitis, occurred in 22% of patients and were often associated with renal failure. A clear association existed between hypotension and renal failure and pulmonary complications. The overall mortality rate was 3.4%. The causes of death were pulmonary complications, renal failure, and sepsis. The death rate among patients with complications was 11.6%. Blood exchange, in addition to conventional treatment, was beneficial in severe leptospirosis with complications and hyperbilirubinemia.

Adult↗
PubMedDate not supplied

[Epidemiology of leptospirosis in the Kirov region].

The dynamics of leptospirosis morbidity in the Kirov region for many years is presented. The wide spread of leptospirosis foci, both natural and formed as the result of human activities, in the region is shown. The main role in infecting humans with leptospires belonged to the latter foci in a number of districts in the region was established. The etiological structure of leptospirosis cases among humans was represented, primarily, by leptospires of serogroup Grippotyphosa, following by serogroup Canicola and then serogroups Pomona, Tarassovi, Sejroe, Australis, Javanica. The dominating serogroups of leptospires were Grippotyphosa in wild rodents and Sejroe in agricultural animals. Persons belonging to the age group constituting the mainstay of work force (20-49 years) prevailed among the patients: town dwellers, factory and office workers. The main role in the transmission of infection to the population was played by the water factor.

Adolescent↗
PubMed2002

Leptospirosis among rice mill workers of Salem, South India.

Leptospirosis is not commonly reported from the Salem district in central Tamil Nadu in India. In October 2000, a rice mill worker, who had fever and jaundice, tested positive in leptospiral IgM enzyme-linked immunosorbent assay (ELISA). Microbiological and serological investigations were performed on the patient, a sample population of the rice mill workers, and the animal and rodent populations living in the same premises. Leptospira was isolated from the patient about 2 weeks after the onset of symptoms when he had recovered from illness following a course of doxycycline. The isolate was serovar Icterohaemorrhagiae of serogroup Icterohaemorrhagiae. The patient also showed a fourfold rise in titers in microscopic agglutination test (MAT) and IgG ELISA. The rice mill workers had a seroprevalence rate of 68.3%, which was significantly higher than that among a control group consisting of persons engaged in other occupations. Serological studies conducted among cattle, dogs, cats, and rats showed seroprevalence rates of 52.9%, 50.0%, 66.6%, and 52.1%, respectively. Leptospires were isolated from two rats, but the isolates were lost during subculturing and could not be characterized. The most predominant serogroup identified by MAT was Autumnalis for rice mill workers and all animal populations. The other serogroups that reacted in MAT were Icterohaemorrhagiae, Australis, Grippotyphosa, and Patoc. Although Australis and Grippotyphosa showed agglutination in the case of human samples, none of the animals had detectable titers to these serogroups. The rice mills of Salem, having large rodent populations, various animals living in close proximity, a wet environment, and unprotected exposure of the workers to the environment, constitutes an ideal setting for transmission of leptospirosis and could be an epidemiological niche of leptospirosis.

Adult↗
PubMed2002

Resurgence of leptospirosis in dogs in Ontario: recent findings.

A marked increase in leptospirosis in dogs was observed in 2000, part of an increasing trend observed in previous years in Ontario. The highest frequency of seropositive cases occurred from September to December 2000, with the peak in November. Large breed dogs were particularly affected. Clinical and clinicopathological data for 31 dogs admitted between 1998 and 2000 to the Ontario Veterinary College Veterinary Teaching Hospital were analyzed. Major clinical presenting features were acute onset of anorexia, depression, fever, and vomiting. Ninety percent of dogs, on admission, showed biochemical evidence of injury to several organs, notably combinations in the order of kidney, muscle, pancreas, and liver. Almost all dogs showed increased serum urea and creatinine levels, and the majority had increased total creatine kinase, bilirubin, alkaline phosphatase, and leukocytosis with neutrophilia. One-third were thrombocytopenic. Of dogs with liver-related abnormalities, most had evidence of cholestasis, with or without hepatocellular damage. Based on serologic studies, in the year 2000, the major serovar involved was autumnalis, but bratislava, grippotyphosa, and pomona were also implicated. The microscopic agglutination test often gave a confusing pattern of reactivities to the serovars that were tested. The high reactivity to serovar autumnalis may represent an erroneous or "paradoxical" reaction typical of early leptospiral serology. The year 2000 was the warmest in Ontario in each of the 4 fall months (September-December) of the previous decade, as well as being the third wettest in the fall period in the last decade. The increase in canine leptospirosis, therefore, may, in part, reflect climate change. The number of positive cases declined in 2001 by about one-third of those in 2000, but the number of submissions of sera for diagnosis increased markedly over previous years. Further work is required to isolate and to identify definitively serovars involved in resurgent canine leptospirosis and the common sources for dogs.

Agglutination Tests↗
PubMed2003

[Bone marrow hematopoiesis in leptospirosis and its role in anemia pathogenesis].

Sternal biopsy was made for and the dynamics of medullary hemopoiesis was examined in 20 patients with leptospirosis caused by L. icterohaemorragiae, L. canicola and L. gebdomadis. A severe icteric disease form complicated on day 10.75 +/- 1.26 by anemia was observed in all patients. A moderate activation of erythropoiesis, irritation of the lymphomonocytic sprout as well as oppression of the basophile and neutrophile series were the characteristic features of myelograms at the acute illness stage. Leptospirosis did not affect the functional ability of the bone marrow and no oppressive myelotoxic action as produced by Leptospira was observed. Anemia in patients with leptospirosis is predominantly of the hyperregenerative nature with the normoblastic hemopoiesis type.

Adult↗
PubMedDate not supplied

[Epidemiological features of leptospirosis in Stavropol' region].

The data on leptospirosis morbidity among agricultural animals and humans in the Stavropol Territory for the last 10 years, as well as the serological picture of the causative agent of leptospirosis, are presented. The epidemiological importance of the main risk factors and their influence on the development and manifestations of the epidemic process are substantiated. As revealed in this investigation, the professional character of leptospirosis morbidity among humans has been almost completely lost under modern conditions, which requires further study with a view to the development of the rational complex of prophylactic measures.

Adult↗
PubMed2003

Preliminary survey of leptospirosis amongst febrile patients from urban slums of East Delhi.

AIM: To determine the possibility of leptospirosis among patients from urban slums presenting with febrile illness during monsoon and post-monsoon season. METHODS: Evidence of leptospirosis in 180 patients with febrile illness was determined by looking for presence of immunoglobulin M (IgM) antibodies by leptospiral IgM enzyme linked immunosorbent assay (ELISA). The test was carried out on 160 Widal test negative and 20 Widal test positive sera received from febrile patients during June to September 2001. RESULTS: Twenty-seven out of 180 (15%) sera were positive for leptospiral IgM antibodies. CONCLUSIONS: This preliminary survey indicates that leptospirosis could be an important cause of febrile illness in patients from urban slums during monsoon and post-monsoon season.

Fever↗
PubMed2003

Detection of IgM specific antibody using indirect immunofluorescent assay for diagnosis of acute leptospirosis.

Leptospirosis is a worldwide zoonosis, caused by Leptospira interrogans. At the earlier stage of the disease, the IgM immunoassays are expected to have more sensitivity than other immunoassays. Previous reports showed that the indirect immunofluorescent assay for detection of immunoglobulins (IFA-Igs) against Leptospira spp showed higher sensitive and specific than some genus specific tests. The authors determined an efficacy of the indirect immunofluorescent assay for detection of IgM specific leptospiral antibody (IFA-IgM). One hundred and eighty patients with acute febrile illness without localizing signs admitted to Hat Yai Hospital were studied. Using the cut-off value of > or = 1:400, the overall sensitivity, and overall specificity of the IFA-IgM were 89.2 per cent and 95.1 per cent, respectively. They were slightly greater than those of the conventional IFA-Igs (86.5% and 91.6%). The first sera obtained from patients including acute sera and single sera showed a low sensitivity (32.4%) but still higher than the IFA-Igs (29.7%). None of the patients with various diseases commonly confused with leptospirosis or healthy blood donors gave a titer greater than 1:200. In conclusion, the IFA-IgM has the same protocol as the IFA-Igs but the sensitivity and specificity is slightly greater than the IFA-Igs. This is another alternative test for the diagnosis of acute leptospirosis.

Acute Disease↗
PubMed2003

Clinical presentation and medical complication in 59 cases of laboratory-confirmed leptospirosis in Bangkok.

We reviewed the laboratory-confirmed cases of leptospirosis in Ramathibodi Hospital, a medical-school hospital in Bangkok, to assess the documented cases of leptospirosis in Bangkok and the medical complications of severe cases. There were 59 cases from January 1994 to December 2000. More than half of the cases were Bangkok residents and did not travel outside Bangkok in the preceding 2 weeks. The majority of the cases presented in late rainy season. The clinical presentation, laboratory findings, medical complication, treatment and outcome are given. Leptospirosis in the urban area is common and should be recognized, particularly in rainy season.

Anti-Bacterial Agents↗
PubMed1992

[The detection and analysis of leptospiral DNA in patients' serum of early leptospirosis by polymerase chain reaction and DNA hybridization with digoxigenin-AMPPD].

We have detected and analysed the leptospiral DNA in serum of patients with early Leptospirosis from the epidemic area of China by PCR and DNA hybridization with Digoxigenin (Dig)-3-(2'-Spiroadamantane)-4-methoxy-4-(3"-phosphoryloxy)- phenyl-1,2-dioxetane (AMPPD) to develop a sensitive, specific and reliable technique for the early diagnosis of leptospirosis, and full satisfactory results have obtained. Fourteen serum specimens from patients with leptospirosis proven by blood culture and serological test were prepared according to Boom's methods for PCR test, and oligonucleotide primers, named G1 G2, were obtained from a genomic library of leptospira interrogans. PCR amplification with serum specimens was performed. Each cycle of amplification consisted of denaturation at 94 degrees C for 1 min, annealing at 55 degrees C for 1 min and elongation at 72 degrees C for 2 min. Each sample was subjected to 32 cycles. The amplified DNA were separated by electrophoresis with 2% agarose gel and hybridized with the homologous DNA probe labelling with Dig-AMPPD by means of Southern blotting. All of 14 samples revealed the presence of leptospira and the strong signals were visualized with homologous DNA probe hybridization by Southern blotting. Negative and positive controls appeared correctly. The DNA fragment generated from PCR amplification homologically hybridized with the DNA of 16 strains which are from Yasudas' genomic species and represent the different genomic groups of leptospires. The single recognized band (about 400 bps) from 6 out of the 16 strains has come out which are representative of the principal strains in Sichuan, China.(ABSTRACT TRUNCATED AT 250 WORDS)

Adamantane↗
PubMed1992

Advances in research on leptospira and human leptospirosis in China.

Leptospirosis exists in 26 of 30 provinces (exclusive of Taiwan province) in China. Up to now, a total of 18 serogroups and 70 serovars of pathogenic leptospires have been identified, including 35 serovars first found in China. A great deal of work has gone into the study of the leptospires and leptospirosis, and the present paper reviews these works, concentrating on serovar lai (the major serovar in China) and pulmonary diffuse hemorrhage (PDH), a traumatic consequence of leptospirosis.

Animals↗
PubMed1992

[Self-maintenance of foci of bovine leptospirosis].

The relationship between the rate of cattle infection with leptospirosis and the total number of livestock at cattle-breeding farms has been established. The annual dynamics of this infection has been found to give two morbidity rises among the animals, occurring not due to their contacts with the natural foci of leptospirosis, but as a consequence of the animal vertical and horizontal "circulation". The mechanisms of self-maintenance of the foci of leptospirosis among cattle are discussed.

Animals↗
PubMed2003

Clinical and epidemiological correlation of Leptospirosis among patients attending KMCH, Manipal.

Leptospirosis is one of the most widespread zoonotic diseases in the world. Infection may range from sub clinical infection to death of the patient. It may also occur endemically in tropical countries, showing seasonal incidences following heavy rainfall. As the diagnosis is difficult due to vague clinical symptoms, laboratory investigations are essential for the confirmation of the disease. This study was undertaken to correlate the clinical findings, occupation and behavioural pattern in seropositive cases of Leptospirosis. A total of 733 patients suspected of Leptospirosis were tested for specific IgM ELISA and clinical findings, occupation and behavioural pattern were noted.

Antibodies, Bacterial↗
PubMed2003

[Leptospirosis in Espiritu Santo, Vanuatu, 8 case reports].

Our review of the literature on leptospirosis in Vanatu turned up only one previous report describing 3 cases at the Central Port Vila Hospital in 1992. The purpose of this report is to describe 8 cases of leptospirosis in patients admitted to the North District Hospital on Espiritu Santo Island in 1997. There were 6 men and 2 women with a mean age of 45 +/- 16 years. At the onset of the disease patients presented fever, myalgia, and diarrhea. After an average of four days initial symptoms were followed by visceral involvement with severe jaundice in all cases. Kidney failure occurred in 6 cases and neurological manifestations in 5. Subconjunctival hemorrhage was observed in 2 cases. Laboratory studies demonstrated hyperleukocytosis in 6 cases and liver enzyme abnormalities in 6 cases. Three patients presented Weil syndrome. Microscopic agglutination testing performed more than a week after the onset of disease was positive at 1/800 in 6 cases and at 1/200 with typical clinical abnormalities and positive serum PCR in 2 cases. All patients responded favorably to antimicrobial therapy using penicillin IV and symptomatic treatment. The estimated incidence of leptospirosis in the North District of the Island of Espiritu Santo, in 1997 was 40/100,000 person-year but this was probably an underestimation because of unawareness of the disease, poor access to medical care, and underdiagnosis.

Adult↗
PubMed2003

Leptospirosis and Weil's disease in eastern India.

Leptospirosis is characterised by a broad spectrum of clinical manifestations varying from inapparent infection to fulminant fatal disease. Severe leptospirosis characterised by profound jaundice is referred to as Weil's disease. In the present study 20 patients of leptospirosis, of which 7 belonged to Weil's disease, were diagnosed based on the demonstration of IgM antileptospira antibody and supported by clinical correlation and appropriate biochemical markers. Overall, the male and female ratio was 17:3 and the same ratio for the Weil's disease was 6:1. The most common presentation involved fever, malaise and myalgia. Conjunctival congestion was found in 75% of the cases and jaundice was encountered in 90% of the cases. The prognosis of all these patients, including that of Weil's disease was excellent. Early recognition and initiation of antibiotic therapy were found to be important.

Adult↗
PubMed2003

A case of severe leptospirosis with pancytopaenia.

Pancytopaenia is a rare clinical presentation of severe leptospirosis. We would like to report a case of severe leptospirosis that progressed to pancytopaenia despite initial penicillin therapy. The patient needed a second course of antibiotic with doxycycline to improve his persistent symptoms and cytopaenia. Persistent pancytopaenia in severe leptospirosis and its management were reviewed.

Doxycycline↗