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PubMed1986

Thrombocytopenia in leptospirosis: the absence of evidence for disseminated intravascular coagulation.

In a prospective study of human leptospirosis, thrombocytopenia was demonstrated in 54% of 24 cases. The only additional laboratory evidence suggestive of disseminated intravascular coagulation lay in a mild elevation of fibrinogen degradation products, but this occurred with equal frequency in nonthrombocytopenic patients. There is therefore no causal relationship between disseminated intravascular coagulation and the thrombocytopenia of human leptospirosis.

Adult↗
PubMed1991

Cellular immune response analysis of patients with leptospirosis.

Peripheral blood mononuclear cells (PBMC) from acute leptospirosis patients with and without acute renal failure were studied in order to investigate the status of cellular immunity in this disease. We analyzed the lymphocyte subsets of leptospirosis patients by immunofluorescence and their responsiveness to the mitogens phytohemagglutinin (PHA) and pokeweed mitogen (PWM). Additionally, we investigated the effect of the patients' sera on normal PBMC proliferative response. We observed a decrease in the CD3+ and CD4+ cell subsets in patients with and without acute renal failure, or in percentage values alone in those who had recovered from renal failure. An increase in the number of B lymphocytes was observed in all patients, compared with controls. This increase in B lymphocytes was seen even in patients who had recovered from renal failure, when the number of CD3+ and CD4+ lymphocytes had already returned to normal levels. The low PHA response observed only with lymphocytes from patients with acute renal failure suggests a suppressive effect. The proliferative response to PWM was comparable to controls, even in the patients with acute renal failure. This latter result and the expansion of the B cell number could be related to leptospiral-derived factor(s). We also showed that sera from patients with and without acute renal failure exerted some inhibitory activity on normal PBMC responses to PHA and PWM. Although the redistribution of lymphocyte subsets and the serum suppressor activity were related to acute renal failure and leptospiral factor(s), we suggest that the cellular immune system was not irreversibly affected, which is compatible with the good prognosis seen in the patients studied.

Adolescent↗
PubMed1993

Active surveillance and risk factors for leptospirosis in Hawaii.

A clinic-hospital-based leptospirosis surveillance program was conducted to determine the morbidity and risk factors in nonepidemic settings. The study was conducted on two islands, Kauai and Hawaii (Big Island), in the state of Hawaii for one year during 1988 and 1989. An active, more comprehensive case detection system was used on the Big Island that enabled us to determine the incidence of clinical disease. Subjects from both islands were used to conduct a case-control study for risk factors. One hundred seventy-two subjects from the Big Island (who presented with any two of the following symptoms: fever, headache, myalgia, or nausea/vomiting) were enrolled in the study. Twenty cases were diagnosed by culture, serology, or fluorescent antibody tissue staining at autopsy. Six cases required hospitalization and two succumbed to fatal infections. We estimated that these cases represented an annual incidence rate of 128 per 100,000 person-years in our target population. For 33 cases, 77 controls were matched for island, age, sex, and time of onset of illness. Interviews were conducted retrospectively in a double-blinded fashion with cases and controls and evaluated approximately 30 risk factors. Factors that were associated most strongly with development of leptospirosis were household use of rainwater catchment systems (P = 0.003), presence of skin cuts during the incubation period (P = 0.008), contact with cattle or the urine of cattle (P = 0.05 and P = 0.03, respectively), and handling of animal tissues (P = 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1996

Public health importance of human leptospirosis in the South Pacific: a five-year study in New Caledonia.

A retrospective study of 192 cases of human leptospirosis in New Caledonia (South Pacific) diagnosed between 1989 and 1993 showed that the disease was endemic throughout the territory. The annual incidence rate was 30 per 100,000 population, and the disease was more frequent in males (67.5%). Cases occurred mainly in March each year. Forty isolates were obtained (20.8%) and identified as belonging to serovars icterohaemorrhagiae (28), pomona (6), pyrogenes (3), ballum (2), and javanica (1). Most cases (54.7%) presented as influenza-like illnesses, while classical Weil's syndrome (fever, jaundice, and renal involvement) occurred in only 15.6% of the patients. Severe ocular complications were found in 3.6% of the patients. Local differences in climate, environment and socioeconomic conditions determined the epidemiologic features. These data emphasize the potential public health importance of leptospirosis in the other insular states in the South Pacific.

Adult↗
PubMed1999

Assessment of the efficacy of an IgM-elisa and microscopic agglutination test (MAT) in the diagnosis of acute leptospirosis.

In a prospective study in Barbados between 1979 and 1989, 321 cases were diagnosed in 638 patients presenting at a hospital with symptoms of leptospirosis. Initial diagnosis was based on patient history and characteristic signs and symptoms. In 92 cases (29%), diagnosis was confirmed by isolation of organisms from the blood, urine, or dialysate fluid; in the remaining 229 cases (71%) diagnosis was confirmed by serology alone. Results of an IgM-ELISA and microscopic agglutination test (MAT) in cases with isolates and in non-leptospirosis cases were used to assess the sensitivity and specificity of the tests. The sensitivity of IgM detection by ELISA was 52% in the first acute-phase specimen, increasing to 89% and 93% in the second acute-phase and convalescent specimens, respectively. The specificity of the IgM-ELISA was high (> or = 94%) in all specimens. The sensitivity of the MAT was low (30%) in the first acute-phase specimen, increasing to 63% in the second acute-phase specimen and 76% in the convalescent specimen. The specificity of the MAT was > or = 97% in all specimens.

Acute Disease↗
PubMed2002

The importance of leptospirosis in Southeast Asia.

The importance of leptospirosis in Southeast Asia was assessed in conjunction with other studies supported by the U.S. Naval Medical Research Unit No. 2 (US NAMRU-2), Jakarta, Republic of Indonesia. These included studies of hospital-based, acute clinical jaundice in Indonesia, Lao PDR, and Socialist Republic of Vietnam; nonmalarial fever in Indonesia; and hemorrhagic fever in Cambodia. Background prevalence estimates of leptospiral infection were obtained by a cross-sectional, community-based study in Lao PDR. Laboratory testing methods involved serology, microscopic agglutination test, and reverse-transcriptase polymerase chain reaction. Suggestive evidence of recent leptospiral infections was detected in 17%, 13%, and 3% of patients selected on the basis of non-hepatitis A through E jaundice, nonmalarial fever, and hemorrhagic fever (in the absence of acute, dengue viral infections). Leptospiral IgG antibody, reflective of prior infections, was detected in 37% of human sera, collected in Lao PDR. The predominant leptospiral serogroups identified from cases with clinical jaundice were Hurstbridge, Bataviae, and Icterohaemorrhagiae tonkini LT 96 69. Among the nonmalarial febrile cases, Bataviae was the most frequently recognized serogroup. Pyrogenes and Hurstbridge were the principal serogroups among the hemorrhagic fever case subjects. These findings further attest to the relative importance of clinical leptospirosis in Southeast Asia. The wide spectrum of clinical signs and symptoms associated with probable, acute, leptospiral infections contributes to the potential of significant underreporting.

Adolescent↗
PubMed1986

A serological survey of leptospirosis in Gippsland dairy farmers.

Serological testing for leptospirosis was performed on sera from 1074 persons who were attending the 1983 Gippsland Field Days. The most common serological reactions were against representative serovars from serogroups Hebdomadis (12%), Panama (2%), Tarassovi (2%) and Pomona (1%). The reactions against serogroup Hebdomadis were attributed to exposure to serovar hardjo; the milking of dairy cows was found to be a major risk factor. The high prevalence of seropositive results among clinically normal dairy farmers highlights the need for caution in interpreting the results of laboratory testing for leptospirosis.

Adult↗
PubMed1987

Human leptospirosis in New South Wales, 1975-1985.

From July 1975 to June 1985, 14,630 sera from patients in New South Wales were tested for serological evidence of leptospirosis. Among these, 361 sera contained evidence of past infections and 150 of these 361 specimens had evidence of recent or current infections. Serologically-diagnosed cases of leptospirosis were distributed mainly in the central and eastern parts of the State. Pomona, hardjo and icterohaemorrhagiae were the most common serovars to be detected; male abattoir workers and farmers were the most common occupational groups that were infected. An increase in seropositive cases occurred from 1981, largely due to hardjo and to a lesser extent pomona infections among farmers. Clinical histories indicated that most cases presented as pyrexias of unknown origin or as febrile illnesses; however, four patients were reported to have presented with renal failure; three patients were reported to have presented with meningitis; and 10 patients were jaundiced at presentation.

Australia↗
PubMed1997

Leptospirosis presenting as a haemorrhagic fever in a traveller from Africa.

Leptospirosis is usually a mild illness, although the severity of clinical manifestations may vary between the serovars of leptospires. In May 1993, a 48-year-old man from Ghana presented with severe icteric leptospirosis, initially managed as viral haemorrhagic fever. The causative serovar, bataviae, had not been previously diagnosed in human infection in Australia.

Diagnostic Errors↗
PubMed1984

Doxycycline therapy for leptospirosis.

To study antibiotic efficacy, 29 patients with leptospirosis were treated in a randomized, double-blinded fashion with doxycycline, 100 mg orally twice a day, or placebo. Therapy was given for 7 days in a hospital, and patients were followed for 3 weeks afterwards. Duration of illness before therapy and severity of illness were the same in both groups. Doxycycline reduced the duration of illness by 2 days and favorably affected fever, malaise, headache, and myalgias. Treatment prevented leptospiruria and had no adverse effects. Doxycycline is effective in therapy for patients with leptospirosis.

Double-Blind Method↗
PubMed1977

Naturally-occurring leptospirosis in northern fur seals (Callorhinus ursinus).

A 4-year study of Northern fur seal (Callorhinus ursinus) leptospirosis in the Bering Sea has shown that in newborn pups Leptospira pomona is associated with a multiple hemorrhage syndrome. Adults may develop an interstitial nephritis and shed organisms in the urine. The hed prevalence, based on microscopic slide agglutination tests, ranged between 7.0% and 15.4% for adult females and 3-4 year old bachelor bulls, whereas nursing pups averaging 4 months of age had a prevalence of 2%. These results are used to conclude that leptospirosis is not acquired primarily on the breeding rookeries but rather is more frequently acquired subsequent to the purps leaving the rookeries, presumably through the food chain during their first pelagic cycle.

Animals↗
PubMed1996

Leptospirosis in California sea lions (Zalophus californianus) stranded along the central California coast, 1981-1994.

Prevalence of leptospirosis was determined in California sea lions (Zalophus californianus) stranded live along the central California (USA) coast between January 1981 and December 1994. Clinical signs of renal disease were seen in 764 (33%) of 2338 animals examined; 545 (71%) of these 764 animals died, with similar gross lesions of nephritis. In silver impregnation stains of sections of formalin-fixed kidney, numerous loosely coiled spiral organisms were observed. Leptospira pomona kenniwicki was cultured from four kidney samples in 1991. Epizootics of leptospirosis occurred in 1984, 1988, 1991, and 1994, and were more common in the autumn, typically affecting juvenile males. In 1991 and 1994, 47 animals sampled had antibody titers to L. pomona greater than 1:3200. In 1992, 20 animals sampled were seronegative, and in 1993 three of 20 animals sampled had low titers to L. pomona.

Animals↗
PubMed1976

[Leptospirosis in rodents in the old natural focus of Eastern Slovakia].

A total of 770 rodents (40 rats, 100 hamsters and 630 rodents) were serologicall examined in the old natural foci in some of the Eastern Slovakia regions; there were 10.6% of positive reactions to Leptospirosis in dilutions ranging from 1 : 100 to 1 : 1600. In rats 17 sers (40%) proved to be positive to leptospira, mostly reacting with the L. icterohaemorrhagiae. A positive reaction with the leptospira antigen was found in 13 sera (15%) of hamsters; the sera reacted with the Leptospira grypposa more frequently than with the L. serjoe. In the group of small rodents the greatest number of positive reactions to leptospirosis was obtained in microtus arvalis (10.7%); the sera reacted most frequently with L. grippotyphosa and L. serjoe. As many as 9 serological types were revealed in the group examined.

Animals↗
PubMed1976

[Epizootiology of leptospirosis on industrial swine-breeding complexes].

Epizoovotiologic studies were carried out at two industrial pigbreeding complexes for 40,000 and 33,000 animals with a record of leptospirosis. The serologic examination of pigs made use of the microagglutination reaction in the investigation of a total of 3,793 blood samples by groups corresponded to the technology of raising introduced at such complexes--sows, growing animals, replacement animals, and pigs for fattening, along with the study of 20,914 blood samples taken from pigs in various regions of the country. The total number of positively reacting pigs accounted for 12.9 per cent. Highest was the percent of positively reacting sows and growing pigs--19.1 and 12.9, while the replacement animals showed 8.31. No positively reacting animals were found among the pigs for fattening. Highest titers were noted among sows--up to 1:12,800 (infectious), and lowest among growing pigs--up to 1:100 (postnatal). State are the substantial economic losses caused by abortions and stillborn piglets--11 and 23 per cent, resp., for the two complexes. The basic Leptospira type for the two complexes and for the country as a whole proved L. pomona. The main source of infection were the carrier pigs that excreted Leptospira organisms, and the infection at the industrial complexes came from the hybrid sows and boars imported from abroad for grading purposes. A biologically justified and economically expedient programme of immunoprophylaxis in the control of Leptospirosis was worked out, providing vaccination of replacement pigs and sows only, treatment taking place after impregnation.

Animals↗
PubMed1999

Clinico-epidemiological study of hospitalized cases of severe leptospirosis.

In an attempt to understand the clinical spectrum and pathological and biochemical abnormalities and their prognostic importance in leptospirosis, a prospective study was carried out in Port Blair during September 1996 to August 1997. Out of 80 patients suspected to have leptospirosis, 58 were proved to have current leptospiral infection using serological tests and among these, 14 died giving a case fatality rate of 24.1 per cent. The incidence of the disease showed two separate peaks roughly coinciding with the paddy sowing and harvesting season and the majority of the patients had history of exposure to wet and water logged environment prior to the attack of the disease. The disease presented as two separate clinical syndromes--the hepato-renal form and the pulmonary form though some degree of overlap was present. Hepatic and renal complications occurred in 30 patients each with 26 of them having both. These generally occurred late in the course of the disease and the mortality rate was relatively low. In contrast pulmonary complication occurred quite early and the case fatality rate in those patients was very high (6.7% vs 42.9%). The other complications encountered in the current series of cases were refractory hypotension probably due to myocarditis in 40 per cent and neck stiffness and altered sensorium due to central nervous involvement in 12.1 per cent of the patients. The chances of the patients developing complications were considerably low if treated early and very few of them developed any complications after 2 days of hospitalized treatment. The early occurrence of pulmonary complications indicates a pathogenesis totally different from that responsible for the other complications.

Adolescent↗
PubMed1999

Leptospirosis in the South-Eastern Health Board region of the Republic of Ireland: 1990 to 1996.

The South-Eastern Health Board (SEHB) has the highest annual incidence of leptospirosis in the Republic of Ireland (12.3/million according to hospital inpatient enquiry data; 10.4/million by serology). Discharge diagnosis correlates strongly with numbers of cattle, but not of other livestock, which may indicate a true association with leptospirosis or may reflect an increased clinical suspicion in areas where livestock are prevalent.

Animals↗
PubMed1999

[An old disease with a new face: canine leptospirosis does not lose its relevance].

The clinical features of the disease are presented based on retrospective analysis of the records of eleven dogs diagnosed with leptospirosis using clinical signs and results of the microagglutination test (MAT) between 1991 and 1996. Additionally, Leptospira titres were determined in 30 healthy dogs and 20 hospitalised dogs without clinical or laboratory evidence of leptospirosis. A positive titre for L. grippotyphosa, L. pomona, L. bratislava, L. australis, L. icterohaemorrhagiae and/or L. canicola was found in 16 normal dogs and only one hospitalised patient. Eight of these dogs had titres of > or = 1:800. Only one of them had been vaccinated shortly before sampling. These results suggest that many dogs from the surroundings of Bern, Switzerland have contact with various Leptospira interrogans serovars. In ten healthy dogs, the Leptospira titre was determined before and four weeks after vaccination with leptospiral antigen. Only two of the dogs showed a serologically measurable response to the antigen contained in the vaccine. In dogs MAT titers presumably do not reliably reflect the immune status against leptospiral infections.

Agglutination Tests↗
PubMedDate not supplied

[The evaluation of the reactogenicity and immunogenic activity of a new concentrated inactivated leptospirosis vaccine].

In the controlled field trial the reactogenicity, safety and antigenic activity of a new concentrated inactivated leptospirosis vaccine after its administration in one and two injections of 0.5 ml were studied in comparison with those of the existing commercial vaccine, introduced in two injections in doses of 2.0 and 2.5 ml. The new experimental vaccine exhibited low reactogenicity and was found to be safe and highly immunogenic when introduced in a single injection of 0.5 ml. As shown in this trial, the immunogenic characteristics of immunization made in a single injection were not inferior than those obtained as the result of immunization made in two injections, yielding high percentage of seroconversions (89.8% to 98.3%) with respect to 4 Leptospira serogroups and leading to the production of the protective titers of corresponding antibodies. The existing commercial vaccine was inferior to the experimental one in antigenic activity (the frequency of seroconversions, antibody titers). The results of the trial make it possible to recommend the experimental concentrated leptospirosis vaccine for use in medical practice in a dose of 0.5 ml introduced in a single injection.

Adolescent↗