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Two patients with concomitant leptospirosis and the acquired immunodeficiency syndrome (AIDS) are reported. In these cases different clinical aspects that can be attributed to simultaneity of these pathologies was not observed.
In order to obtain data about clinical manifestations of symptomatic leptospiral infection in children, the authors reviewed 188 microscopic agglutination tests performed on sera of patients aged 0 to 12 years, made at the National Reference Laboratory of Leptospirosis (FIOCRUZ-RJ) from January 1983 to June 1991. Fifty two (27.6%) sera were positive. Twenty three (12.2%) children had serological evidence of acute infection. The most frequent signs and symptoms of these 23 cases were: fever (100%); myalgia (69.5%); headache (52.1%); jaundice (47.8%); vomit (34.8%); abdominal pain, hemorrhagic manifestations and impaired renal function (17.4%); conjunctivitis (13%); hepatomegaly (4.3%).
The hemorrhagic syndrome of leptospirosis was studied in guinea pigs. The study correlates hematological, histopathological and immunohistochemical alterations in sixty animals inoculated by the intraperitoneal route with 1ml of the culture of virulent strain of Leptospira interrogans serovar copenhageni. Leptospirae antigens were detected by immunoperoxidase, chiefly in liver, kidney and heart muscle capillaries. Possible pathogenic mechanisms responsible for hemorrhagic syndrome are discussed with emphasis on toxic and anoxic attacks causing damage to endothelia, platelet depletion and alterations to hemostasia rates: prothrombin time [PT], partial thromboplastin time [PTT] and fibrinogen concentrations. The clinical-laboratory picture is compatible with the histopathological observation of disseminated intravascular coagulation [DIC] in most of the guinea pigs from day 4 of infection.
The present study evaluated patients that were attended at the Health Center of Guaraci Municipality, Paraná State, Brazil. Three (2.6%) patients were leptospirosis positive from a total of 115 samples. No significant statistical differences were observed for risk factors. There was no positive test for brucellosis.
Four cases of severe pulmonary form of leptospirosis (SPFL) are described. In all four of these blood culture proven cases, there was severe pulmonary injury characterized by alveolar hemorrhage and acute respiratory failure. Three patients died in less than 48 hours after onset of the first respiratory signs. Leptospiral antigen detection in lung tissues was positive by immunoperoxidase in all three of these cases, suggesting that the microorganism exerts a local direct destructive action. Patients with SPFL should be carefully monitored, as the abrupt onset of severe alveolar hemorrhage can lead to respiratory insufficiency and death. The authors emphasize the importance of radiological findings and blood gas analysis for prompt clinical diagnosis, and suggest that corticosteroids, associated with antibiotics, early respiratory support, and platelet transfusions are useful as an attempt to prevent further development of SPFL.
OBJECTIVES: To assess the sensitivity, specificity, reproducibility, and stability of five latex agglutination systems for detecting antibodies against leptospira in human and animal sera, by using the Leptospira serotypes that are most widely prevalent in Cuba. METHODS: We performed an analytic and descriptive study with 706 human sera (65 tested positive for antibodies against leptospira with microagglutination (MAT) and hemagglutination (HA) techniques; 156 sera that tested negative with MAT and HA); 485 sera from 424 patients who had clinical or epidemiologic signs of leptospirosis; and 29 animal sera (16 from equines, 6 from bovines, 5 from porcines, 1 from a canine, and 1 from an ovine). All of the samples were tested with five latex conjugates made from whole cells of Leptospira interrogans, specifically the four serogroups that circulated most widely in Cuba from 2002 to 2004. The cells obtained from cultured cell lines yielded four specific conjugates (latex-canicola, latex-icterohemorrhagiae, latexpomona, and latex-sejroe), as well as one latex conjugate made from a combination of all four serogroups in equal quantities (latex-pool). In addition, samples were tested with the commercial latex agglutination Lepto Tek Tri Dot (bioMeriuex, France) kit. The stability and reproducibility of the latex conjugates were assessed through monthly controls over a period of 6 months with positive and negative sera. RESULTS: Of the systems that were assessed, the best combination of sensitivity and specificity was obtained with the latex-Pool conjugate (93,8% and 90,4%, respectively). The best combination of positive and negative predictive values was seen with the latex-Sejroe conjugate (90,9% and 95,8%), respectively), followed by the latex-Pool conjugate (94.2% and 96.6%, respectively). The positive and negative predictive values of the Lepto Tek Dri Dot commercial system were 78.5% and 88.4%, respectively. Among the 137 patient samples that tested positive for one of the serotypes when MAT was used, latex conjugates succeeded in correctly identifying 107 (78.1%), whereas the latex-Pool conjugate detected 116 (84.7%) positive sera. When animal sera were tested, the latex-Pool conjugate detected the greatest number of positive serum samples and showed the greatest concordance with MAT (93.1%). The conjugates studied showed good stability and reproducibility. CONCLUSIONS: Latex conjugates made from whole cells of the most widely circulating leptospira in Cuba showed a degree of concordance with MAT that was similar to or better than that seen with the Lepto Tek Dri Dot commercial system, both in human and animal sera. We recommend more widespread use of the latex-Pool conjugate in Cuba in the initial screening for antibodies against leptospira.
Leptospirosis is an acute anthropo-zoonotic infection of worldwide significance caused by spirochaete Leptospira interrogans which has 23 serogroups and >200 serovars. Various factors influencing the animal activity, suitability of the environment for the survival of the organism and behavorial and occupational habits of human beings can be the determinants of incidence and prevalence of the disease. The disease was considered inconsequential till recently, but it is emerging as an important public health problem during the last decade or so due to sudden upsurge in the number of reported cases and outbreaks. Since isolation rate of the microorganism from clinical specimens is low due to prior indiscriminate use of antibiotics, serological techniques remain the cornerstone of diagnosis.
Twelve cases of leptospirosis followed by the Infectious Diseases Clinic of the Cukurova University Medical School, Adana, Turkey, between January 1994 and November 1995 are reported. Included are their clinical manifestation, laboratory findings and serotype. Nine men and three women with an average age of 40.4 years were studied. Symptoms, clinical manifestations, laboratory findings and treatment of the disease are evaluated. All of the patients had fever and chills and the following symptoms: nausea and vomiting (91.6%), lower back pain and myalgia (58.3%), headache (50%), epistaxis (16.6%) and confusion (25%). The predominant clinical findings were jaundice (91.6%), hepatomegaly (41.6%), dyspnea (25%), conjunctival suffusion (33%), and nuchal rigidity (33%). Diagnosis was based on dark-field examination of the blood, cerebrospinal fluid and urine specimens. Also, microscopic agglutination tests (MAT) were carried out for serodiagnosis. MAT showed L. interrogans serovar icterohaemorrhagiae in 11 cases and L. interrogans serovar grippomosocova in one case. There was cross reaction with L. biflexa patoc in all cases. Agglutinations were tested in the same specimens twice and confirmed in the Microbiology Laboratory of the Etlik Veterinary Research Institute in Ankara. All cases were treated with penicillin and doxycycline. In the end; 83.3% of the patients were cured and 16.6% died due to hepatorenal failure.
The authors describe work in progress at the laboratory in Brescia, Italy, on the application of molecular methods to the diagnosis of leptospirosis. This work includes the following: a) Development of polymerase chain reaction (PCR) assays capable of amplifying specific deoxyribonucleic acid fragments from most Leptospira interrogans strains. b) Development of a microtitre-based assay for rapid detection of PCR-positive samples. c) Characterisation of Leptospira strains through restriction endonuclease analysis of PCR products and amplified fragment length polymorphism.
There are a whole series of emerging and re-emerging zoonotic diseases present in the Northern Hemisphere and the author describes four of them, namely, bartonellosis, leptospirosis, Lyme borreliosis and plague. Reasons for the emergence or re-emergence of such diseases are not clear, but factors such as human demographics, economic development and land use, international travel and commerce, and microbial adaptation, are thought to be involved. Control of emerging and re-emerging diseases has become a major challenge for the international community and it is important to disseminate information about diagnosis and control capabilities, particularly to people working in public health.
Five clustered cases of leptospirosis were diagnosed in the area of Rochefort, France, in June 2001, among teenagers who had swum in the Genouillé canal. The symptoms included fever, headache, abdominal pain and vomiting, chills and myalgia. Three cases were confirmed by PCR and serology. The mean cumulative duration of bathing was significantly higher in cases (23.8 hours) compared to controls (14.4 hours). No other particular risk factor was observed. The environmental investigation revealed the presence of rodents excreting of leptospires near the bathing area. For all antigens considered, the occurence of seropositive rodents was 30.8%, L. icterohaemorrhagiae being the predominant serogroup (23,1%).
Resistant oliguria with increasing serum creatine phosphokinase (CPK) level are the most important early signs of the development of acute renal failure in leptospirosis. This symptomocomplex must be considered as indication for urgent hemosorption. Diuresis and normalisation of creatine phosphokinase level are the criteria for accessing the efficiency of hemosorptions.
We reviewed all serologically confirmed cases of leptospirosis from 1985 to 1999 in Israel, where the disease is endemic. There were 59 cases, with an average annual incidence of 0.05/100,000. The dominant serogroup, Leptospira icterohemorrhagica, occurred in 29% of patients; in an earlier study (1970-1979), it accounted for only 2%. Serogroups that occurred mainly in rural areas accounted previously for 79% but had declined to 32%.
Human infection by leptospires has highly variable clinical manifestations, which range from subclinical infection to fulminant disease. We conducted a population-based, cross-sectional seroepidemiologic study in Peru to determine potential relationships of environmental context to human exposure to Leptospira and disease associated with seroconversion. Three areas were studied: a flooded, urban slum in the Peruvian Amazon city of Iquitos; rural, peri-Iquitos villages; and a desert shantytown near Lima. Seroprevalence in Belen was 28% (182/650); in rural areas, 17% (52/316); and in a desert shantytown, 0.7% (1/150). Leptospira-infected peridomestic rats were found in all locales. In Belen, 20 (12.4%) of 161 patients seroconverted between dry and wet seasons (an incidence rate of 288/1,000). Seroconversion was associated with history of febrile illness; severe leptospirosis was not seen. Human exposure to Leptospira in the Iquitos region is high, likely related both to the ubiquity of leptospires in the environment and human behavior conducive to transmission from infected zoonotic sources.
We diagnosed leptospirosis in 2 patients exposed to southern flying squirrels imported from the United States to Japan. Patients worked with exotic animals in their company. Leptospira isolates from 1 patient and 5 of 10 squirrels at the company were genetically and serologically identical and were identified as Leptospira kirschneri.
We report a case of a 61-year-old man who presented with fatigue, abdominal pain and hepatomegaly. Computed tomography (CT) of the abdomen showed hepatomegaly and multiple hepatic lesions highly suggestive of metastatic diseases. Due to the endoscopic finding of colon ulcer, colon cancer with liver metastases was suspected. Biochemically a slight increase of transaminases, alkaline phosphatase and gammaglutamyl transpeptidase were present; alpha-fetoprotein, carcinoembryogenic antigen and carbohydrate 19-9 antigen serum levels were normal. Laboratory and instrumental investigations, including colon and liver biopsies revealed no signs of malignancy. In the light of spontaneous improvement of symptoms and CT findings, his personal history was reevaluated revealing direct contact with pigs and their tissues. Diagnosis of leptospirosis was considered and confirmed by detection of an elevated titer of antibodies to leptospira. After two mo, biochemical data, CT and colonoscopy were totally normal.
This report describes the epizootiology, clinical presentation, diagnosis and treatment of an outbreak of leptospirosis caused by Leptospira canicola in feedlot calves. The infection appeared to be of high morbidity with a cumulative clinical incidence of 15.6%, cumulative subclinical incidence of 39% and high mortality (8.3%). Clinical disease was diagnosed in 4-8-month-old calves, while subclinical infection occurred in 9-12-month-old calves. Subclinical infection was based on serological evidence only. The zoonotic aspects of the infection are emphasised.
The rat population (Rattus norvegicus) in the city of Detroit was surveyed to determine the incidence of leptospirosis. Four methods of survey were used--serological, direct examination of urine, culture of urine, kidney and brain, and histopathological examination. Of 358 sera tested by the microscopic-agglutination test, 277 (77.4%) had significant agglutinins for serotype icterohaemorrhagiae. Significant differences were found between adult and young animals in both incidence and antibody titers, titers of 1:50 or higher being present in 90.3% and 38.8%, respectively, of adult and young rats. Examination of freshly drawn urine by dark field microscopy revealed that 59.6% of the animals were shedding leptospirae. When stained with Steiner's silver stain, 91.9% of the kidney sections were positive for leptospirae, showing this to be the most sensitive test of those used. Leptospirae were isolated from one or more cultures of kidney, urine, or brain from 221 (59.2%) of the 358 rats examined.