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PubMed2006

[Leptospirosis laboratory of WSSE in Wrocław (1947-2005). Comment on its activity].

The article summarises the 1947-2005 activity of the Leptospire Laboratory of Voivodeship Sanitary-Epidemiological Station in Wrocław (1947-2005) which is the oldest and, presently, the only health care diagnostic laboratory offering leptospirosis testing in Poland. Based on own experience the authors analysed laboratory diagnosis of leptospirosis in Poland, identifying existing problems.

Bacteriological Techniques↗
PubMed2006

Diagnosis of leptospirosis and comparison of ELISA and MAT techniques.

Leptospirosis is perhaps the most common, most wide spread yet under diagnosed zoonosis in the world, Inada et al identified the causal agent in Japan in 1916. Microscopic agglutination test (MAT) developed initially by Martin and Pettit (1918) is the reference method that was successively done after ELISA test to evaluate and compare and make a reliable diagnosis. Blood samples were collected from August 2004 to September 2004 from hospitalized patients of South Gujarat region who were clinically suspected cases of leptospirosis according to WHO case definition. In our setup we separated the sera and carried out ELISA for detection of IgM antibodies and rest of the sera were stored at -20 degrees C. As we do not have the facility for performing MAT test in our centre, we personally carried these sera to Chennai for performing the MAT and identified the serovars prevalent in South Gujarat region. Out of 30 samples tested 16 samples (53.3%) were positive by ELISA and 12 samples (40%) were negative by ELISA. By MAT, 17 samples (56.67%) were found positive and 13 samples (43.33%) were negative. 2 samples were borderline by ELISA and these turned out to be negative by MAT. Cosidering MATas the gold standard the sensitivity of IgM ELISA in this study was 88% and specificity 90.90%. We concluded that IgM ELISA is rapid test and its results are quite similar to MAT. The most common serovars isolated and identified are L. hebdomadis, L. pyrogenes, L. autumnalis and L. grippotyphosa in this part of the country.

Agglutination Tests↗
PubMed2006

Alleviation of renal and pulmonary injury by immunomodulation in leptospirosis: hamster model.

OBJECTIVE: Severe leptospirosis manifestations include acute renal failure, caused by acute interstitial nephritis and pulmonary hemorrohage. Spirochete invasion and toxicity of outer membrane cause robust inflammatory host responses. These responses lead to the generation of cytokines, chemokines, and inflammatory cell infiltrations which result in severe organ dysfunctions. The immunomodulation by the modulation of host immune response may alleviate the renal and pulmonary injury. The authors determined whether the current immunosuppressive agents could alleviate the inflammation and minimize the organ injury in hamster model. MATERIAL AND METHOD: The animal experiments were conducted with the approval of The Ethical Research Committee of Chulalongkorn University Hospital. The leptospira interrogan serovar pyrogenese was isolated from a wild rat. The spirochete was grown in Fletcher's semisolid media and after subcultures were transferred to the Fletcher's liquid media. An amount of 0.5 ml of the spirochete culture media containing 1 x 10(8) leptospires/ml was intraperitoneally injected to golden Syrian hamsters (Mesocrietus auratus), age 4-6 weeks, weighing 60-80 grams. The hamsters were randomed into 5 groups (n = 4 in each group) namely, 1) Normal group (Control group), 2) Leptospira group, 3) CsA group (leptospira with cyclosporine feeding, 100 mg/kg/ day), 4) Rapa group (leptospira with rapamicin feeding, 0.6 mg/kg/day), and 5) Irra group (leptospira with irradiation). Cyclosporine and rapamicin were started at day 0 after the spirochete injection. Gamma ray dose 200 cGy was irradiated to the hamster 3 days before the spirochete inoculation. The animals were autopsied or euthanized if expired or at day 5 post inoculation. The blood samples for BUN, and creatinine were drawn before the inoculation and at autopsy or euthanasia. RESULTS: The inoculation of L Interrogan 0.5 ml (1 x 10(8) leptospires/ml) without immunomodulation cause mortality of all animals at day 4 or day 5 post inoculation. The blood chemistry showed acute severe azotemia. The autopsy findings revealed severe interstitial nephritis and severe pulmonary hemorrhage. The hamsters in the Rapa group had only minimal pulmonary hemorrhage and minimal focal interstitial inflammation of kidney. There were cytoadherance of inflammatory cells to the endothelial cells in lungs and kidneys without the intrusion into the interstitium. The blood chemistry in Rapa group showed mild elevation of BUN and Cr. The immunomodulation by cyclosporine and irradiation did not alleviate the disease. On the contrary, cyclosporine and irradiation caused more severe histopathology. CONCLUSION: The immunomodulation by rapamicin in leptospirosis in hamsters could alleviate the kidney and pulmonary injuries. The up-regulation of IL-2 in peripheral blood lymphocytes did not result in the kidney and pulmonary injuries.

Acute Kidney Injury↗
PubMedDate not supplied

Evaluation of a rapid slide agglutination test for the diagnosis of acute canine leptospirosis.

The standard method for the diagnostic of leptospirosis is the microscopic agglutination test (MAT). Nevertheless, it is time-consuming and presents risk of infection for laboratory personal. Several attempts to simplify and reduce the time, skill and expense required for serological testing were made. Rapid slide agglutination tests (RSAT) have been used nowadays as a reliable screening test for the detection of acute and recent infections by many laboratories. The purpose of that study was to evaluate a new antigen preparation for the rapid diagnoses of acute canine leptospirosis and to compare it with MAT results in clinically suspect serum samples. Two hundred and thirteen serum samples from dogs of both sexes and different ages were tested and 141 (66.2%) animals were considered as positive by MAT. The most frequent serovar was icterohaemorrhagiae, followed by canicola. RSAT results were very similar to those observed on MAT, with 139 (65.3%) reactive animals. Correlation between RSAT and MAT was positive (0.82) and significant (p < 0.01). Concordance of results was of 93.4% (199/ 213) of the animals correctly diagnosed by RSAT. Considering MAT as the standard test, sensitivity of RSAT was calculated on 94.3% (133/141) and specificity on 91.7% (66/72).

Agglutination Tests↗
PubMedDate not supplied

Leptospirosis following a flood in the Veneto area, North-east Italy.

In August 2002, an exceptional flood devastated a suburban area in the surroundings of Vicenza, North-east Italy. A fatal case of haemorrhagic pneumonia, which was presumptively diagnosed as leptospirosis, was observed as a consequence of the inundation. A local seroepidemiological survey was activated thereafter, with the principal aim of evaluating the risk of infection with Leptospirae in the population exposed to the flood. A 6.8% seroconversion rate was found in the population studied; however, the case previously observed remained unique, since an overt outbreak of leptospirosis did not occur.

Adult↗
PubMed1991

A serological survey of leptospirosis in Prince Edward Island swine herds and its association with infertility.

A serological survey was undertaken to determine the prevalence of leptospirosis, and to investigate associations between leptospiral antibody titers, and herd measures of reproduction. Production records and leptospirosis serology were analyzed for 25 slaughter hogs from each of eleven randomly sampled farrow-finish operations on Prince Edward Island. The effect of selected leptospiral serovars on nonproductive sow days per parity (NPSD/P) and the proportion of pigs born dead was evaluated. The four most common serovars to which antibodies were detected were Leptospira icterohaemorrhagiae, L. bratislava, L. autumnalis and L. pomona, with respective prevalences of 57.1%, 35.1%, 3.4% and 1.5% of PEI slaughter hogs. None of these serovars was associated with increased frequency of stillbirths (p greater than 0.05). However, farms with a higher prevalence of L. bratislava antibody titers tended to have more infertility, as measured by NPSD/P (r = 0.738, p = 0.036 with Bonferroni adjustment). Also, farms with L. pomona antibody titers had higher NPSD/P than farms without L. pomona antibody titers (p = 0.0008 with Bonferroni adjustment). There was no association between NPSD/P and antibodies to either L. autumnalis or L. icterohaemorrhagiae (p greater than 0.05).

Animals↗
PubMed1991

[A small-mammal study in the northeastern Kara Kum for leptospirosis infectivity].

Search for natural foci of leptospirosis was carried out in 1987-1989 in humid biotopes of Tashauz Province, Turkmenistan. Such potential carriers of leptospirosis as house mice (Mus musculus) and tamarisk gerbils (Meriones tamariscinus) are widely spread in this area, and the size of their population can amount to great numbers. The sharpest fluctuations in the population size are characteristic of house mice inhabiting the shores of water collecting ponds and lakes in the regions of minimally used pastures. A moderate number of house mice was registered in spring and autumn at the area of irrigated agriculture. Only here and only in autumn a faint epizootic manifestation of the natural focus of L. grippotyphosa infection in house mice was registered for the first time in Turkmenistan. The titers in mouse blood sera, determined in the microagglutination test and the Leptospira lysis test, were 1:20 to 1:200. According to the data on the humidity and pH of the soil in the vicinity of irrigated fields, spring and summer months may be regarded as the most favorable period for the survival of leptospires in the environment. The probability of the aggravation of the epizootic situation seems to increase when irrigated fields adjoin pastures of are temporarily used as grazing ground for cattle.

Agriculture↗
PubMedDate not supplied

[Evaluation of counterimmunoelectrophoresis with antigens of icterohaemorrhagiae and patoc serovars in the serodiagnosis of human leptospirosis].

Counterimmunoelectrophoresis (CIE) was applied on paired sera from 135 patients with leptospirosis and on 69 sera from a control group. The sera from patients were subdivided in 4 groups according to the results obtained by the Microscopic Agglutination Test (MAT). The first samples sera from 58 patients were non reagent by MAT. Six monthly samples of sera were taken from 7 patients to follow-up and to determine the level of agglutinin and precipitin antibodies present using MAT and CIE. Serovars icterohaemorrhagiae and patoc were used as antigens. Three types of antigens were compared, 1) Triton-X-100 extracted; 2) heat extracted and 3) a pool of them. The CIE using icterohaemorrhagiae derived antigens types agreed with MAT in 92.64, 92.64 and 94.11% of the leptospirosis sera. The patoc antigens types reacted with the control group in 7.24, 86.95 and 84.05% of the samples, and consequently were eliminated from the present study. The icterohaemorrhagiae CIE reaction become positive earlier than MAT negative sera, and reverted to negative earlier in the follow-up samples from the patients. The CIE was sensitive and specific, gave rapid results and was easy to perform.

Agglutination Tests↗
PubMed1991

The respiratory complications of leptospirosis.

Leptospirosis is an uncommon disease. Respiratory failure attributable to this infection is unusual, but remains a major cause of mortality. Mechanical ventilation has been required for patients with significant alveolar hemorrhage and the adult respiratory distress syndrome. We report a patient with ventilatory failure due to the severe muscle weakness associated with leptospirosis and review the pulmonary consequences of this infection.

Humans↗
PubMed1990

[Leptospirosis in Mayotte].

We have got 42 leptospirosis cases from 1984 to 1989, in a retrospective study. The annual incidence is now, in a very high level (3.8/10,000 pers.). This rapid increasing is function of new diagnostics facilities. The leptospirosis epidemiology is not different from anywhere else in tropical countries, but the complicated cases are an important problem in public health in the island. The actual development of collective hygienic equipment is indispensable for any progress.

Adult↗
PubMed1990

[Severe leptospirosis. Description of a series of 10 cases].

Clinical aspects of 10 consecutive patients hospitalized for acute human leptospirosis, confirmed by serology using the microscopic agglutination test (MAT), between 1975 and 1988 in a 1000 beds Teaching Hospital are retrospectively analyzed. All of them were male, mean age of 55, presenting a suggestive epidemiological data to be at risk for Leptospira infection. Leptospira icterohaemorrhagiae was responsible for 8 cases and Leptospira canicola for 2. 7 patients were treated, after 3-4 days of admittance, with penicillin. 5 patients died. Cause of death was gastrointestinal haemorrhage in 3 and cardiogenic shock in 2. We discuss the clinical, biochemical, pathological and therapeutic aspects of the acute human leptospirosis.

Aged↗
PubMed1990

[A clinicopathological analysis of 12 cases of cerebrovascular leptospirosis].

12 pathologically verified cases of cerebrovascular leptospirosis were analysed of its clinical characteristics and types. Formation and development of cerebral panarteritis and infarctions were also discussed. It occurred in rural areas among children and adolescents after infection by leptospira pomona, especially following latent infection. Multiple occlusive vascular disorder presenting as a late manifestation of pomona infection occurred in 9 cases, intracranial hemorrhage in 2, and intracranial hypertension in 1 case. Cerebral panarteritis involved the main trunks of larger arteries at the base of the brain. Owing to invariable narrowing of intracranial portions of internal carotid arteries, infarcts always appeared in areas supplied by the middle cerebral artery, often accompanied by marginal infarction at watershed areas. It was suggested that cerebrovascular leptospirosis could be ascribed to residual infection of cerebral arteries soaked in CSF during the septicemic stage of pomona infection.

Adolescent↗
PubMed1990

[Electrocardiographic changes in leptospirosis].

The study involved 239 ECGs recorded in acute period of various leptospirosis forms. In 86.2% of cases there were changes evidencing impairment of neuromuscular system and atrial (76.6%) or ventricular (61.9%) conduction. The above cardiac manifestations arise early, have peculiar characteristic features. The discussion covers their patho- and morphogenesis, frequency of detection, necessary time-course ECG control over leptospirosis patients and convalescents.

Adolescent↗
PubMed1989

Respiratory failure in leptospirosis.

We report on four cases of leptospirosis with pulmonary manifestations as their presenting features. With adequate supportive therapy the prognosis is good. Leptospirosis should be considered in the differential diagnosis of pulmonary haemorrhage.

Adolescent↗
PubMed1989

Urinary diagnostic indices in the management of leptospirosis. Selection of patients for dialysis therapy.

Cases of leptospirosis admitted to the Queen Elizabeth Hospital (QEH), Barbados, were assessed for the presence of "pre-renal azotaemia" (NON-ARF) as opposed to "acute renal failure" (ARF). Distinction between the two diagnoses was made on the basis of clinical course. Peritoneal dialysis was inappropriately utilised in 26% of patients receiving such therapy. This study evaluates diagnostic tests for pre-renal azotaemia, and acute renal failure in leptospirosis, and indicates guidelines for the management of azotaemia in such patients. U/P urea and osmolar ratios show high sensitivity and specificity in diagnosing pre-renal azotaemia. While "early" dialysis is essential for patients with acute leptospiral renal failure, in those with plasma creatinines less than 600 mumol/litre on entry and indices indicating NON-ARF, decisions regarding dialysis can safely be delayed for 48-72 hours while the effect of rehydration is assessed.

Acute Kidney Injury↗
PubMed1989

[Leptospirosis].

Recent epidemiological data show that leptospirosis is widespread in the animal kingdom, and not only among Muridae, and, that the number of human cases is greater than in the past while being still underestimated. To the classical occupational contaminations must now be added those due to water sports. 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 diagnostic confirmation. The potential severity of certain forms justifies not only a curative antibiotic therapy, but also prophylactic measures including wider immunization campaigns, notably among people professionally exposed to the infestation.

Anti-Bacterial Agents↗
PubMed1989

Leptospirosis in Chonbuk Province of Korea in 1987: a study of 93 patients.

Leptospirosis is a zoonosis with protean clinical manifestation. Diagnosis requires a high index of suspicion and is confirmed by isolation of the organism or, more commonly, by serologic studies. In the fall of 1987, after severe flooding, we saw 93 patients with leptospirosis, confirmed by a microagglutination test. Thirteen percent of the patients had no clinical or laboratory findings except fever and headache, but the rest had mild to severe manifestations. Jaundice, renal failure, and aseptic meningitis were not common, but pulmonary symptoms, when present, were striking. The mortality rate was 5%. The main cause of death was asphyxiation due to massive hemoptysis from pulmonary hemorrhage and acute respiratory failure.

Agglutination Tests↗
PubMed1988

[Sero-epidemiologic study of 277 cases of human leptospirosis in the central eastern region of France between 1972 and 1984].

We reported 277 clinical cases of Leptospirosis with a significant serological title (greater than 100) by lyse-agglutination. Sera were sampled from 1972 to 1984 among 9182 subjects living in Central-Eastern departments of France) for immunological diagnosis of leptospirosis. We noted the stability of the average yearly rate in this region, the difficulty in evaluating the incidence of the disease, the clinical predominance of icterus and the good clinical prognosis with specific antibiotherapy.

France↗