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Leptospirosis as an animal and public health problem in Latin America and the Caribbean area.

As a major livestock disease, leptospirosis cuts significantly into the world's supply of animal protein through its consequences of abortion and calf mortality, retarded growth, and reduced milk production. Evidently, such losses have severe economic implications as well. The disease's impact has been somewhat diminished in the developed countries thanks to mechanization of rural activities, improved personal and environmental hygiene, and broad application of preventive measures, including the administration of bacterins, in domestic animals. Still, even in these circumstances it remains a serious problem. In the developing countries, in which large percentages of the population live in close contact with animals, the spread of infection is much greater. Moreover, the ecology of tropical and subtropical America--with its abundant rainfall, natural water courses, and high temperatures--is particularly favorable for the transmission of leptospires. In such conditions the human disease is a growing threat as well. The spread of leptospirosis, both in animals and man, is facilitated by the fact that inefection from many of the serotypes can exist without presenting serious clinical manifestations. Hence the importance of laboratory diagnosis. Systematic studies over time of serotype distribution, coupled with wide and improved surveillance, will be a key factor in bringing the disease under control. According to the limited seroepidemiologic data available, 3 to 18 per cent of the general human population, 2 to 32 per cent of those belonging to exposed occupational groups, and 10 to 50 per cent of patients with fever of unknown origin have leptospiral antibody. The most predominant serogroups are Icterohaemorrhagiae, Canicola, Pomona, Hebdomadis, and Bataviae. So far more than 50 serotypes, from 15 serogroups, have been isolated from man and animals in Latin America and the Caribbean area.

Animals↗

[Comparative study of serologic techniques for the diagnosis of human leptospirosis].

A comparative study was carried out in order to assess 3 serological techniques employed at the Provincial Centers of Hygiene and Epidemiology for diagnosing leptospirosis. The study included 49 sera from patients with leptospirosis confirmed by the techniques of passive hemoagglutination (HA), plate macroscopic agglutination with thermoresistant antigen (TR) and indirect immunofluorescence (IIF). Sensitivity was 90% for HA, 96% for TR and 84% for IIF. IIF was performed with the use of 5 different antigens and the highest serological reactivity was obtained with the strain belonging to Canicola serogroup.

Agglutination Tests↗

[Leptospirosis. Description of a clinical case and review of the literature].

Leptospirosis is a world-wide diffused anthropozoonosis due to many strains of Leptospira. Initial symptoms may be mild, although in many cases severe systemic symptoms, including high fever, hypotension, etc. may be present since the beginning. In these latter circumstances, the diagnosis of leptospirosis can be very difficult because of the complexity of clinical picture especially when the history is lacking or incomplete. A case report of a 45 year-old man admitted to the hospital after severe jaundice and fever of unknown origin associated to altered mental status, renal failure and hypoxemia is presented. Because of the presence of septic shock and severe respiratory failure, the patient was transferred to the intensive care unit. The diagnostic hypothesis, based on clinical history, was confirmed by laboratory tests (leptospiral IgM antibodies detection). Therapeutical approach with the use of selected antibiotics (penicillin 24,000,000 U for day) and therapy of septic shock led to improvement of the patient's clinical conditions who was then transferred to a regular medical ward.

Humans↗

Leptospirosis infection through insemination of animals.

The semen of animals in spontaneous and experimental leptospirosis was investigated by bacteriological, immunological and biological methods. It has been found that pathogenic leptospirae (L. pomona, L. hebdomadis) are well preserved in the semen and in media used for its dilution. Leptospirae are eliminated with the semen. The initial strain of the agent was isolated from the semen and secretions of 6 out of 26 experimentally infected rabbits and 4 spontaneously recovered bulls (L. hebdomadis). Specific leptospiral antibodies appear in the semen of infected animals. The dynamics of the titre of these antibodies corresponds to the dynamics of the antibody titre in the blood. It is recommended to use the sement for the agglutination reaction. The application of semen infected with pathogenic leptospirae for artificial insemination causes the animals falling ill with leptospirosis accompanied by abortions, reduced fertility and stillbirths of rabbits.

Animals↗

Leptospirosis infection through insemination of animals.

The semen of animals in spontaneous and experimental leptospirosis was investigated by bacteriological, immunological and biological methods. It has been found that pathogenic leptospirae (L. pomona, L. hebdomadis) are well preserved in the semen and in media used for its dilution. Leptospirae are eliminated with the semen. The initial strain of the agent was isolated from the semen and secretions of 6 out of 26 experimentally infected rabbits and 4 spontaneously recovered bulls (L. hebdomadis). Specific leptospiral antibodies appear in the semen of infected animals. The dynamics of the titre of these antibodies corresponds to the dynamics of the antibody titre in the blood. It is recommended to use the semen for the agglutination reaction. The application of semen infected with pathogenic leptospirae for artificial insemination causes the animals falling ill with leptospirosis accompanied by abortions, reduced fertility and stillbirths of rabbits.

Animals↗

Respiratory failure in leptospirosis (Weil's disease).

Two patients with leptospirosis (Weil's disease), with acute respiratory failure necessitating mechanical ventilation, are described. Adult respiratory distress syndrome (ARDS) in one patient and profuse pulmonary bleeding in the other were the respective causes of respiratory failure. One patient died after developing the multiple organ dysfunction syndrome (MODS), the other patient recovered completely. Respiratory failure is an uncommon complication of leptospirosis and is due to severe pulmonary bleeding and/or ARDS.

Adult↗

Leptospirosis in trout farmers.

A worker on a trout farm died from serologically confirmed leptospirosis. Four other workers at the trout farm had recently had an influenza-like illness; one had had jaundice. The man with jaundice had high leptospiral antibody titres, and two others had titres of 1/30. The remaining serum sample was negative. Family members and neighbours not associated with the farm had no detectable leptospiral antibodies. There was evidence of rat infestation around the ponds and in a shed used for storing trout food. Pond water or trout food contaminated with rat urine is believed to have been responsible for the outbreak. Another case occurred in a fish farmer elsewhere and it is thought he was infected through wading in rat polluted water with defective rubber boots. A survey to determine the incidence of leptospirosis in fish farm workers is under way.

Animal Feed↗

Placebo-controlled trial of intravenous penicillin for severe and late leptospirosis.

The effect of a 7-day course of intravenous penicillin (6 million units/day) on severe, advanced leptospirosis was examined in a randomised, placebo-controlled, double-blind trial involving 42 patients. Every measurable aspect of the disease was favourably affected by penicillin. Fever lasted more than twice as long in the placebo group (11.6 [SD 8.34] days vs 4.7 [4.19] days, p less than 0.005), and by the fourth day after starting penicillin more than half the treatment group, but only 1 of 19 in the placebo group, were afebrile (p less than 0.005). Creatinine rises persisted more than thrice as long in the patients receiving only placebo (8.3 [8.46] days vs 2.7 [1.90] days; p less than 0.01). Penicillin also shortened the hospital stay and prevented leptospiruria. Intravenous penicillin should be given to patients with severe leptospirosis, even if therapy can be begun only late in the course of their disease.

Adolescent↗

[Clinical aspects and prognostic factors of icterohemorrhagic leptospirosis in adults. Apropos of 249 cases in La Reunion].

Human leptospirosis of the classical and severe icterohemorrhagic type, usually due to the L. icterohaemorrhagiae serogroup, is frequent in La Réunion. In a retrospective study conducted between 1980 and 1984 in 249 adult patients, the mortality rate was 13 p. 100. Our data and those found in the literature indicate that the main cause of death is pneumopathy, followed by profuse haemorrhages, arrhythmias and cardiovascular collapse. Acute renal failure is common and often severe; it facilitates gastrointestinal bleeding and is of poor prognosis, particularly in patients with prolonged anuria, a possible cause of lethal hyperkalaemia. Other factors of unfavourable outcome have been demonstrated statistically; they include disturbances of consciousness, hypoprothrombinaemia, epigastric muscle rigidity, hyperleukocytosis, thrombocytopenia, high aspartate aminotransferase levels and chronic alcoholism. At the moment, pulmonary, cardiac and haemorrhagic complications concur with renal failure to darken the prognosis of these severe forms of leptospirosis.

Adult↗

[Fulminant course of leptospirosis complicated by multiple organ failure].

We describe a case of a 39-year-old male, who initially presented with severe muscle pain, fever, shortness of breath and tachycardia. He was admitted to hospital with suspected myocarditis. The next days he developed a generalized icterus and acute renal failure. Suspecting leptospirosis an intravenous therapy with penicillin was started. Due to pulmonary and circulatory insufficiency intensive care was necessary. In course the patient developed all known manifestations of leptospirosis including, cardiac arrhythmia and asystolia due to AV-block III degrees, recurrent atelectases of the lungs, hyperbilirubinemia, thrombocytopenia, hepatitis, pancreatitis, very severe rhabdomyolysis and polyradiculitis with areflexia and tetraplegia. Additionally, the patient had a transient hyperthyreosis, which has not been described in the literature so far. After 33 days the patient left the intensive care unit and was discharged out of hospital a fortnight later. 4 weeks later he was able to return to work. The only residuum of this illness is a partial paresis of his right quadriceps muscle.

Acute Kidney Injury↗

The efficacy of a leptospirosis vaccine in preventing leptospiruria in pigs.

A commercially manufactured leptospirosis vaccine containing serovars pomona and hardjo and licensed for use in cattle and sheep was investigated to determine if it would prevent leptospiruria in pigs exposed to serovar pomona. Twenty piglets were each vaccinated twice at an interval of three weeks. Twenty other piglets were unvaccinated and served as controls. Three weeks after the second dose of vaccine all animals were exposed for 64 to 89 days to a natural infection with pomona. During the investigation blood samples were examined serologically and urine samples were examined by dark ground microscopy and cultured for the presence of leptospirae. Attempts were made to culture leptospirae from kidneys at slaughter. Kidneys were also examined histologically for evidence of leptospira infection. One vaccinated animal developed a respiratory disease. It was treated with antibiotics and removed from the trial. Leptosphuria was demonstrated in six of the remaining 19 vaccinated pigs and leptospirae were found in nine of 578 (1.5%) urine samples examined from these animals during the period of exposure. In contrast leptospiruria occurred in 19 of 20 unvaccinated pigs and leptospirae were found in 253 of 642 (39.4%) urine samples examined from these animals. Histopathological lesions consistent with leptospirosis were found in kidneys examined from two of 16 vaccinates and 17 of 18 non-vaccinates. Antibodies to serovar pomona were detected in 12 of 19 vaccinated pigs examined three weeks after the second dose of vaccine and before exposure to infection, and in all of 18 unvaccinated pigs examined after exposure to infection. It was concluded that use of this vaccine in pigs resulted in a significant degree of protection against leptospiruria.

Journal Article↗

Outbreak of leptospirosis associated with swimming.

Between July 7 and 18, 1991, five boys from a small town in rural Illinois experienced the onset of an acute febrile illness subsequently confirmed as leptospirosis by serologic tests. A cohort study found that swimming in a small swimming hole, Steel Tunnel Pond, was associated with disease (P < 0.01), the attack rate being 28%. Leptospira interrogans serovar grippotyphosa was isolated from urine cultures from two of the case patients and from a culture of Steel Tunnel Pond water. A high seroprevalence for grippotyphosa was found in animals near the pond. Drought conditions had been present in the month before the outbreak, creating an environment in the pond which probably facilitated transmission of the organism from area animals to humans. Although leptospirosis is infrequently reported in humans in the United States, it is endemic in animals and the potential for outbreaks exists, especially when environmental conditions are favorable.

Adolescent↗

Leptospirosis-induced meningitis and acute renal failure in a 19-month-old male child.

An unusual case of leptospirosis is described in a 19-month-old male child presenting with meningitis and acute renal failure without jaundice. Some aspects concerning the pathogenesis and treatment of this potentially life-threatening disease are also discussed. Leptospirosis was diagnosed on the basis of history and serological tests.

Acute Kidney Injury↗

Repetitive sequence element cloned from Leptospira interrogans serovar hardjo type hardjo-bovis provides a sensitive diagnostic probe for bovine leptospirosis.

A repetitive sequence element was cloned from the primary etiological agent causing bovine leptospirosis in North America, Leptospira interrogans serovar hardjo type hardjo-bovis. This element was used to design a sensitive diagnostic probe which distinguishes hardjo-bovis from other pathogenic leptospires which commonly infect domestic animals in North America and discriminates between hardjo-bovis and the reference strain for serovar hardjo, hardjoprajitno. By using this probe, it was possible to identify infected cattle shedding hardjo-bovis in their urine. This is the first practical demonstration of a cloned DNA probe for leptospirosis, and it provides a sensitive method for studying the transmission and pathogenesis of L. interrogans infections. Control measures for L. interrogans infections may now be improved by rapidly and efficiently identifying infected animals.

Animals↗

Risk factors associated with the seroprevalence of leptospirosis among students at the veterinary school of Zaragoza University.

The prevalence and risk factors associated with leptospirosis were studied in veterinary students in Zaragoza. Sera were collected at the beginning and end of the academic year 1994 to 1995 and were tested by ELISA against a pool of Leptospira interrogans serovars bratislava, canicola, grippotyphosa, hardjo, icterohaemorrhagiae and pomona antigens. At the beginning of the study the prevalence was 8.14 per cent and at the end it was 11.4 per cent. The incidence of the disease during the study was 0.0394. Risk factors associated with leptospirosis included: taking the course specialising in food inspection and technology, on-farm work, contact with pets in general, and particularly carnivores, and contact with animal traders. The symptoms associated with the disease were myalgia and fever, and the treatment of the symptoms provided some protection.

Antibodies, Bacterial↗

Desmopressin therapy for massive hemoptysis associated with severe leptospirosis.

Massive hemoptysis in patients with severe leptospirosis is often resistant to conventional therapies and can rapidly become fatal. Desmopressin is a fast-acting blood-saving agent used in various hereditary and acquired clotting disorders. We used desmopressin infusions to treat massive pulmonary hemorrhage in six leptospirosis patients with respiratory failure, shock, and multiple organ dysfunction. Hemoptysis ceased rapidly in every case, and five patients finally recovered. Two additional patients with less severe hemoptysis were also successfully treated.

Adolescent↗

Leptospirosis presenting as diffuse alveolar hemorrhage: case report and literature review.

The literature on diffuse alveolar hemorrhage heavily emphasizes the causal role of vasculitides. We present a patient with diffuse alveolar hemorrhage caused by leptospirosis. Although the pathology in leptospirosis occurs secondary to a vasculitic process, this disease is not listed as a cause of diffuse alveolar hemorrhage in the review literature. In the right clinical scenario, the disease should be considered in a patient presenting with diffuse alveolar hemorrhage.

Diagnosis, Differential↗

Is rhabdomyolysis an additional factor in the pathogenesis of acute renal failure in leptospirosis?

Leptospirosis is an important cause of acute renal failure in our environment. Although several mechanisms are implicated, the role of rhabdomyolysis in the pathogenesis of acute renal failure in leptospirosis has not been analysed. Sixteen patients with the diagnosis of leptospiroses consecutively admitted to the hospital were prospectively studied. The disease was characterized by sudden onset in all patients and, at admission, jaundice, conjunctival suffusion and myalgias. Mild to moderate proteinuria with unremarkable urinary sediment was recorded in 37.5% of the patients and abnormal levels of urea creatinine were found in 87.5% and 74.0%, respectively. Increased levels of aminotranspherase were documented in all 12 and CPK in all 10 patients studied. Serum myoglobin levels greater than 120 micrograms/l recorded in 56.2%. A correlation between myoglobin and renal failure or severity of disease, however, could not be established.

Acute Kidney Injury↗