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Following an "extreme-adventure" athletic event on the island of Guam, 21 of 105 participants reported being ill. Three of 10 participants who reporting having a fever (temp > 101EF) had laboratory confirmed leptospirosis. An analysis of risk factors reported by both ill and not-ill race participants suggested that exposure to recreational waters was responsible for these infections.
The emergence of an outbreak of leptospirosis in a nurses' hostel in Chennai presented a challenge to identify and control the source of the outbreak. Sixty-nine residents and staff members were interviewed to assess exposure factors. Blood samples from the acute and convalescent patients were tested with the Microscopic Agglutination Test using the serovars prevalent in Chennai. Polymerase Chain Reaction (PCR) was conducted on serum and water samples. Based on preliminary investigation, control measures with standard hygienic measures were instituted. The attack rate was 35%. The epidemic curve suggested continuous or intermittent exposure to infection over a five-week period. Twenty residents (three asymptomatic) developed laboratory confirmed Leptospira icterohemorrhagiae. Residents collected water from an underground storage tank that was filled twice weekly from a mobile water tanker with a bucket on a rope, and the tank was usually left open. PCR tests confirmed the presence of leptospires from this water. Other control measures included cleaning the large backyard with its many stray dogs and rats, chlorinating water supplies, boiling drinking water and health education. No further cases occurred twelve days after implementing control measures. Access to clean water, not only for drinking but also for bathing, brushing and washing is essential to prevent water-borne outbreaks.
Acute disseminated encephalomyelitis is very rare following leptospirosis. Here we describe a patient who developed the condition after leptospiral infection, which responded to intravenous immunoglobulin only.
A multi-test strip dotblot immunoassay for the diagnosis of typhoid fever, scrub typhus, murine typhus, dengue virus infection and leptospirosis was evaluated in Thai adults presenting to hospital with acute, undifferentiated fever. The kit gave multiple positive test results in 33 of 36 patients with defined infections and was therefore not a useful admission diagnostic tool.
From October 13 to October 21, 1999, a total of 46 males, aged 8 to 19 years, were admitted to Beaufort Hospital after swimming in the creek near an oil palm plantation in Kampung (Kg) Kebatu, Beaufort. Thirty (30) presented with symptoms including fever, vomiting, bodyache, giddiness, headache, chest pain and cough, while 16 others, were asymptomatic. One, a 15 year old boy, died from haemorrhagic shock secondary to pulmonary haemorrhage. The onset of the illness was from 11 October to 19 October 1999. A case-control study found that the outbreak was associated with swimming in the creek (p<0.0001). A total of 44 paired sera samples were sent for microscopic agglutination test (MAT), 5 pairs showed sero-conversion, 3 pairs had 4 fold rise in titre and 18 pairs were positive at >320. The findings indicated that Leptospirosis was the cause of the outbreak of this illness and the contaminated creek water was the source of the infection. The occurrence of flooding and stagnation in the creek following the heavy rainfall during the first week of October 1999 could have contributed to the timing of the outbreak.
The results of 4 043 bovine sera samples from various Mexican regions, which were sent to a diagnosis lab, were analyzed. The method was the agglutination technique, taking the dilution rate 1:1000 or higher as positive. The analysis revealed 31,1% of seroprevalence and the most frequent serovarietes were hardjo (strain H 89 isolated in Mexico), wolffi and tarassovi. There is coincidence with early data obtained in Mexico on a 34% of prevalence found in a similar study performed in 1994, and with the scientific literature from other countries. The former study also indicated that tarassovi and wolffi were the most common leptospira, so there is coincidence with the figures in the reviewed literature. It was concluded that there was no significant variation in the prevalence rate between the 1994 study and the present one; therefore, it is recommended that this study be promoted so as to increase the bovine vaccination and achieve a reduction in leptospirosis in Mexico.
Two simple enzyme immunoassays, a conventional microplate and dot-ELISA, were developed to detect specific IgM antibodies using pool sonicated antigen prepared from three of the most reactive serovars of Leptospira associated with disease in Thailand. Both assays were evaluated and compared with the standard microscopic agglutination test (MAT) performed with 343 serum samples. A battery of 16 pathogenic serovars of L. interrogans were used as antigens in the MAT assay. The result of MAT at serum titers > or = 1:400 showed three pathogenic serovars of leptospira, Bratislava (71.88%), Sejroe (63.54%) and Pyrogenes (36.46%), were among the most commonly reacted serovars and they were selected for preparation of pool sonicated antigen for both IgM ELISA tests. The microplate IgM-ELISA, performed with sera at 1:80 dilution using the cutoff OD of 0.60, demonstrated sensitivity, specificity and efficiency of 87.50, 97.57, and 94.75%, respectively. The same values for IgM dot-ELISA performed with sera at 1:160 dilution were 98.96, 93.93, and 95.33%, respectively. Both ELISA methods showed results with statistically significant differences from MAT (p < 0.05). The agreement rate of IgM dot-ELISA compared with microplate IgM-ELISA was 0.85 by Kappa analysis. Both assays offered relatively high negative predictive values (95.26-99.57%), thus making the assays ideally suited for rapid screening. Future applications of the IgM dot-ELISA as a test kit would be suitable for use at the peripheral level as a rapid screening test for human leptospirosis.
This was a prospective evaluation of four immunodiagnostic assays for human leptospirosis, including the indirect immunofluorescence test (IFA), the microscopic agglutination test (MAT), the LEPTO dipstick, and the latex agglutination (LA) test. Four hundred ninety-two serum samples were collected from 348 patients who presented with acute fever without localizing signs. The sensitivities of the IFA, MAT, Dipstick, and LA were 91.9, 76.6, 77.4, and 83.1%, respectively. The specificities of these assays were 100.0, 100.0, 89.3, and 83.5, respectively. Even though IFA showed the highest overall sensitivity and specificity, when acute sera were considered, the LA was the most sensitive (28.7%). All 3 genus specific antibody assays had broad reactivity against various serogroups. The MAT is best suited for the reference laboratory, where it can be maintained with the battery of live antigens; the IFA is suited for a laboratory with sophisticated equipment and technical expertise; the Dipstick and LA are suitable for peripheral laboratories which lack expensive equipment and expertise.
215 cases diagnosed of human leptospirosis in the Camagüey Province, Cuba, are studied, for the period between 1986 and 1990. The clinical and epidemiological features are studied, together with the anatomopathological study of the decreased. The most frequent complications and the treatment employed, including prophylactic measures, are analyzed. It is concluded that the disease is more frequent in young males, from a rural origin and with a farming job. Acute kidney failure was the main complication, and as for the therapeutic approach, penicillin was the antibiotic of election, prophylactic measures are important, specifically vaccination.
As leptospirosis is a treatable disease, early diagnosis and prompt treatment are important for better prognosis. Early diagnosis depends on the knowledge of epidemiological factors, presenting features and use of appropriate laboratory tests. Early institution of appropriate antimicrobial therapy in combination with supportive therapy reduces the mortality from this disease. Leptospires are sensitive to a variety of antimicrobial agents, including penicillin, cephems, aminoglycosides, tetracyclines and macrolides. Of these antimicrobial agents, short-term treatment with streptomycin exterminates, leptospires. When penicillin, cephems, tetracylines and macrolides are used, long-term therapy with large doses may be required from the early stage of the disease until the appearance of antibodies.
Out of 571 serologically investigated dogs from Bratislava and all regions of Slovakia and Moravia, 26.1% presented antibodies reacting with leptospiral antigens. The lowing seropositivity in dogs from Bratislava was found in lap dogs--11.1%, the highest one in farm dogs--35.3% (Tab. I). The seropositivity of police dogs from different regions of Slovakia and Moravia varied from 24.0% to 47.6% (Tab. II). The age of dogs progressing, their seropositivity rose from 3.1% in animals younger than one year to 33.3% in those aged seven years and in older ones (Tab. III). The predominant serovars causing infections of dogs were L. grippotyphosa (58.9% of infections) and serovars of both Sejroe (21.0%) and Icterohaemorrhagiae groups (15.3%). The serovars bratislava/jalna, pomond/mozdok and tarassovi were only rarely involved in these infections, canicola and arborea only exceptionally (Tab. IV). At present, in the Czechoslovak conditions the dogs do not play a significant role as reservoirs of human leptospirosis, and the predominant serovars may only cause irregular and short-time lasting leptospiruria. This is why the reasonableness of actual vaccination of dogs, possibly with the exception of the vaccination against Weil's disease, is doubtful. Dog is a good indicator of the distribution of different leptospiral serovars in its environment. It seems reasonable to practice occasionally serological investigations of these animals in order to detect possible changes in infecting leptospiral serovars. Consequently, adequate epizootological measures could be taken (e. g. modification of the composition of a leptospiral vaccine for dogs).
We retrospectively reviewed the medical records and chest radiographs of 118 patients who presented during January 1998 to October 2002 at Songklanagarin Hospital in Hat Yai, Songkhla Province, Thailand who had a high serum immunofluorescent assay titer for leptospirosis. Twenty-nine of 118 (24%) patients had abnormal chest films. Nearly all of these patients had respiratory symptoms and needed oxygen therapy (93% and 90%, respectively). Forty-eight of the 118 (40%) had respiratory symptoms, but only 27/48 (56%) had abnormal radiographs. Twenty-one of the 28 (75%) and 18/27 (67%) who had abnormal chest radiographs had coexisting impaired renal function or jaundice, respectively, whereas 21/69 (30%) of the patients who had impaired renal function and 18/55 (33%) of the patients with jaundice had abnormal radiographs. There were 6/27 (22%) patients who had abnormal chest radiographs without renal or liver impairment. The most common finding on the abnormal chest radiograph was bilateral diffuse air space disease, which resolved within 7 days. No permanent lung damage was seen. The patients who had an abnormal chest radiograph needed longer hospitalization, than those without an abnormal chest radiograph (average 12 days and 5 days, respectively).
The results of ten-year observations of the natural foci of leptospirosis on the territory of Moscow are presented. Information on the foci, the main species of small mammals (the reservours of the infection), the etiological structure of leptospires, circulating among rodents and insectivores, is given.
Leptospirosis is the most common zoonosis worldwide, although most cases occur in tropical countries. Leptospira interrogans, a spirochete, is the causative agent. Rats are the main reservoir. Most patients present a mild clinical form of the disease, which consists of a self-limited febrile process, without jaundice. Nevertheless, about 10% of patients suffer severe infections, with intense jaundice. Typically the disease manifests in two phases: acute or leptospiremic and immune or leptospiuric, although in many patients the two phases are indistinguishable, and in mild cases the second one is frequently absent. Diagnosis is carried out by serology or culture of the microorganism. Treatment consists of antibiotics such as penicillin G, ceftriaxone, doxycycline or amoxicillin.
This paper deals with 254 monosera of patients with leptospirosis verified by macroagglutination test with thermoresistant antigen (TR antigen) and passive hemaglutination (HA), as reference technique. The TR antigen was elaborated according to the method described by Mailloux and coworkers, 1974, with modifications, and it showed a wide generic reactivity. It was specific when serologic test were performed with hyperimmune sera obtained from febrile disease producing bacteria and the causal agent of syphilis. The results obtained by both serologic tests were compared and it was observed that 106 sera (41.73%) were reactive to HA, which showed a highly significant statistical difference between the two techniques; so a lower sensibility of TR macroagglutination test was determined.
Leptospirosis is a major pig-associated zoonosis worldwide. There are also human occupational disease exposure risks. For better public health and sanitation, the prevalence of this disease was investigated. Four hundred sera were obtained from sows in central Thailand during August 2004 to January 2005 and examined with 20 reference leptospira serovars by a microscopic agglutination test (MAT). The results showed that 10% of samples gave a positive reaction. The most prevalent serovar was grippotyphosa which accounted for 55% of all positive cases. Other minor serovars were canicola and a non-pathogenic strain (patoc). It follows that, the sow may be one of the disease transmitting sources for humans in this area. The disease correlation between pigs, humans and the environments should be evaluated.
A description is made of a leptospirosis outbreak in children who bathed in the Cimarron Channel in Morón. Ciego de Avila. The outbreak started on September 25 and ended on October 20, 1986. Six cases were reported, of which four had meningoencephalic appearance. Ages ranged from 8 to 13 years. Fever, cephalalgia, arthralgia and myalgia were the most common signs and symptoms in the confirmed cases. All the patients were positive to Canicola serogroup. The results of a survey on 12 dogs in the zone surrounding the Cimarron Channel suggest that they were the reservoir which contaminated the Channel waters.
In a serological examination of 710 serum samples collected from human volunteers in Plateau State, Nigeria, 128 (18.0pc) had leptospiral antibody titres of 1:100 and above. The prevalence of antibodies to individual serovars were: hardjo 28 (21.9pc), pomona 18 (14.1pc), canicola 17 (13.3pc), grippotyphosa 15 (11.7pc), pyrogenes 13 (10.2pc), icterohaemorrhagiae 12 (0.4pc) and autumnalis 8 (6.3pc). There was no statistical difference in the prevalence rate of leptospirosis in the different local government areas (p greater than 0.05; X2). Among the occupational groups examined, the abattoir workers were particularly at risk with a prevalence rate of 29.5pc. A leptospiral variant of strain Hardjoprajitno was also isolated from the midstream urine of an abattoir worker who was apparently healthy. The isolation of Leptospira interrogans serovar hardjo in man is the first such report in Nigeria.