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PubMed1988

Recent trends in human leptospirosis in Italy.

The recent epidemiological trends of human leptospirosis in Italy were investigated using data collected for the years 1981-1985. A total of 626 hospitalized patients with clinical diagnoses of suspected leptospirosis were reported by hospital centers from several Italian regions. Epidemiological, clinical and seroimmunological data were collected in 517 of these cases and examined by the National Center for Leptospirosis. Serological findings in 33.5% of these subjects met the criteria for confirmation of the disease. In 21.8% of the subjects, low titer antibodies were detected, which possibly reflected previous leptospiral infections. An early antibiotic treatment of the current infection may also have lowered the seroimmunological response in some of these patients. In 59.3% of the confirmed cases, modes of transmission were allotted equally between accidental events and recreational or occupational activities. Drinking water from an open air fountain emerged as an uncommon mode of transmission; it was responsible for an outbreak of 33 cases of leptospirosis. In another 37.07% of the subjects, it was impossible to establish the mode of transmission. Respiratory or influenza-like symptoms were the only clinical signs of illness in 21.2% of the patients with confirmed leptospirosis. In comparison to the sixties and seventies, the prevalence of infecting serovars showed increasing incidence of infections due to serovars of the Javanica (11.0%) and Australis (11.0%) serogroups and an important decrease in the Bataviae serogroup infections (from 58.8% in rice-field workers in the forties to 0.6% in the years 1981-1985). Sejroe serogroup infections accounted for 4.5 per cent of confirmed cases of leptospirosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed2002

Pediatric presentations of leptospirosis.

OBJECTIVE: Leptospirosis in children is an often under diagnosed condition due to the non specificity of the presentations except for the classical Weil's disease. METHODS: Children presenting with symptoms and signs suggestive of Leptospirosis were included in the study. Diagnostic criteria were fever, myalgia, conjunctival suffusion, Jaundice, headache, altered sensorium, seizures, bleeding manifestation and oliguria. Their clinical profile, lab parameters (general and specific), response to treatment and outcome were analysed. RESULT: One hundred and thirty nine cases were diagnosed during a 4-year period. The commonest symptoms were fever 133 (96%), headache and myalgia 34 (24%). Jaundice was present in only 25 (18%) of cases with renal failure in 2 cases. The frequently encountered clinical signs were hepatomegaly in 100 (72%), myalgia in 34 (24%) with icterus in 25 (18%), 12 (9%) of children presented with shock and 10 (7%) had meningitis. CPK estimated was a useful index of myositis. The diagnosis was confirmed by Dark field microscopy and paired or single high serological tests (MAT, ELISA IgM). Overlapping infections such as culture positive Salmonella typhi with leptospirosis (Serology positive) or Dengue Hemorrhagic fever with Leptospirosis presented with complications such as a myocarditis, shock and ARDS. CONCLUSION: Presentation of non-icteric forms of Leptospirosis are often non-specific and may be missed unless there is a high index of suspicion. This study emphasizes the myositis and meningitis forms of leptospirosis. Delayed diagnosis leads to increased mortality and morbidity.

Child↗

PubMed1986

Clinical, pathological and serological features of spontaneous canine leptospirosis. An evaluation of the IgM- and IgG-specific ELISA.

The clinical, pathomorphological and serological features of acute canine leptospirosis are evaluated and the IgM- and IgG-specific ELISA for leptospirosis serology in dogs is assessed. The clinical syndrome of acute canine leptospirosis was characterized by depression, anorexia, vomiting and often haemorrhagic diarrhoea. In addition, jaundice, uraemia, elevated creatinine and alkaline phosphatase were observed in the majority of the dogs. In pups invagination of the intestines was a noteworthy finding. The clinical signs and the post-mortem findings were rather non-specific so that the clinical and post-mortem diagnosis had to be confirmed serologically. In acute clinical cases of canine leptospirosis a high anti-leptospiral IgM titre, ranging from 160 in pups to 10240 in adults, was always present, whereas the anti-leptospiral IgG titre and the agglutination titre usually were negative or low. Dogs died from leptospirosis in spite of a high anti-leptospiral IgM titre. Only two dogs having, at the first examination, a high IgM titre in conjunction with a high IgG titre survived an acute infection. The possible role of IgM and IgG in the pathogenesis of an acute leptospiral infection is discussed. Different serological patterns in reference dogs, which were not suffering from acute leptospirosis, are presented.

Animals↗

PubMed2005

[Acute leptospirosis in children in Reunion Island: a retrospective review of 16 cases].

INTRODUCTION: Leptospirosis is a worldwide zoonosis caused by pathogenic species of the genus Leptospira. This infectious disease known with a high incidence in Reunion island (French overseas territories in Indian Ocean) is in state of endemia especially during rains season. OBJECTIVES: The aim of our work was to identify the mains epidemiologic, clinical, biological, and therapeutic features of leptospirosis in children. POPULATION AND METHODS: We conducted a retrospective analysis of children hospitalized in pediatric unit with the diagnosis of leptospirosis from January 2001 to June 2004 in general hospital of Saint-Denis. We found out 16 cases (mean age 14 years, range 9-17), mainly boys (ratio 7:1). RESULTS: The patient sera reacted most strongly with Leptospira interrogans serovars canicola (66%), icterohaemorrhagiae (17%), and sejroe (17%). Epidemiologic data indicated contact with contaminated water in most cases (68%). Jaundice was present in 43% of the patients, increased transaminase levels in 56%, renal failure in 50%, meningitis in 25%, ECG abnormalities in 6%, respiratory manifestations in 6%, systemic manifestations in 12% and thrombocytopenia in 56%. Death rate was zero, but renal failure is likely to induce life prognosis. DISCUSSION: The diagnosis' traps are numerous, leading to an underestimation and underdiagnosis of the leptospirosis, more over there is a lack in specific, reliable, and quick biological test to make the diagnosis. A negative polymerase chain reaction analysis (PCR) do not exclude the diagnosis, and the microagglutination test (MAT) remains the reference of the undoubtly diagnosis of leptospirosis. It appears that it is more often the conjunction of epidemiologic data (young boy, swimming or fishing in river, rains season), with clinical and biological data that lead to the diagnosis. Diagnosis was not evoked at the emergency room in 37% of the patients. CONCLUSION: Leptospirosis should be considered face to an influenza like illness especially during rains season.

Acute Kidney Injury↗

PubMed2006

Human leptospirosis in Portugal: A retrospective study of eighteen years.

INTRODUCTION: Leptospirosis, an under-recognized public health problem, needs to be confirmed through specific laboratory diagnosis. DESIGN: We describe herein a series of 4618 symptomatic patients for whom a microagglutination test (MAT) serology was available, representing a unique picture of human leptospirosis in central mainland Portugal and the Azores islands of São Miguel and Terceira, over eighteen- and twelve-year periods, respectively. RESULTS: The distribution of the 1024 (22%) cases identified was an average 57 cases per year, with higher frequency in males (67%). These represent the majority of leptospirosis notifications in Portugal, with a higher annual incidence rate in the islands, compared to the central mainland (11.1 and 1.7/100,000 population, respectively). Middle-aged adults (25-54 years) were most frequently infected (45%). Cases occurred mainly in December and January. Serovars from nine presumptive serogroups caused infection, with a predominance of Icterohaemorrhagiae, Pomona, and Ballum, accounting for 66% of cases. CONCLUSIONS: Seropositivity was associated with both anicteric and icteric leptospirosis. Several risk factors and a higher transmission risk in certain areas were emphasized. Leptospirosis was confirmed as a steadily increasing public health problem; good surveillance, communication, and laboratory support are thus necessary to reduce the impact of leptospirosis in areas at risk.

Adolescent↗

PubMed2026

A systematic review and meta-analysis to estimate the global prevalence of leptospirosis in sheep.

Leptospirosis in sheep is a zoonotic concern considering sheep may act as potential reservoirs for Leptospira spp. infection to humans. This study aimed to estimate the pooled prevalence of leptospirosis in sheep worldwide. A comprehensive literature search was conducted across databases following PRISMA guidelines. Meta-analyses were performed using a random effect model in R software (version 4.3.1) to calculate pooled prevalence with 95% confidence intervals (CI). Subgroup analyses were performed based on prevalence types, diagnostic methods and continental regions to explore sources of heterogeneity. A total of 138 studies comprising 54,174 samples and 10,299 positive detections were included in this study. The global pooled prevalence of leptospirosis in sheep was 15.69% (95% CI: 12.69-19.25) with overall heterogeneity (I2) 98%. The prediction interval ranged from 1.09% to 75.91%, indicating wide inter-study variability. The seroprevalence was 16.16% (95% CI: 12.91-20.04) and infection prevalence was 12.98% (95% CI: 8.07-20.22), showing no significant difference (P = 0.40). In addition, the prevalence of leptospirosis in sheep differed significantly across diagnostic methods and continents (P < 0.01), indicating substantial variation influenced by both methodological and geographical factors. The funnel plot revealed marked asymmetry, suggesting potential publication bias which was confirmed by Egger's regression test (P < 0.01). In conclusion, leptospirosis is widely prevalent in sheep globally, with marked geographical and methodological heterogeneity. These findings highlight the epidemiological importance of sheep in leptospirosis transmission and underscore the need for improved surveillance, standardized diagnostic approaches, and targeted control strategies within a One Health framework.

Animals↗

PubMedDate not supplied

Characterization of renal damage in canine leptospirosis by sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) and Western blotting of the urinary proteins.

Canine leptospirosis is a zoonotic disease that can cause interstitial nephritis. As a consequence of the renal damage, proteinuria may occur. To determine the urine protein pattern in the disease we performed sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) on the urine from 10 dogs with leptospirosis and 20 healthy dogs. Western blotting analysis of the urine samples with antibodies against canine IgG and IgA was also performed to identify these immunoglobulins in the urine. Urine electrophoresis showed three new bands in the dogs suffering from leptospirosis. Only two of the dogs with leptospirosis showed detectable concentrations of IgG and IgA in urine, while a third animal showed IgG alone. The study showed a 36.7% increase in the excretion of low molecular weight proteins in dogs with leptospirosis but almost no change in the high molecular weight protein pattern. These results, together with the low number of animal with detectable concentrations of IgG and IgA in the urine, support the view that canine leptospirosis is characterized by interstitial nephritis.

Animals↗

PubMed2002

Clustering of reported cases of leptospirosis among dogs in the United States and Canada.

A retrospective study was conducted to determine whether cases of leptospirosis diagnosed among dogs in the United States and Canada were clustered in time, space, or time-and-space. The study population was estimated--based on first examination of each dog--to consist of 1,035,366 dogs examined at 22 veterinary teaching hospitals between 1983 and 1998. The veterinary medicine database was searched for records of dogs in which a diagnosis of leptospirosis was made during the study period. The scan statistic (Poisson model) was used to examine for clustering of cases, using recorded date of diagnosis and the location of the veterinary teaching hospital at which the diagnosis was made. Three-hundred and forty dogs diagnosed with leptospirosis were identified. Cases were clustered in the period of 1992-1998. A cluster of dogs diagnosed at three veterinary teaching hospitals located in the midwest of the United States was identified. The composition of this spatial cluster was influenced by the age and gender distribution of the population at-risk. A cluster of cases involving 143 dogs diagnosed with leptospirosis between 9 April 1993 and 14 December 1998 at six veterinary teaching hospitals located in the midwest of the United States was identified. This time-space cluster was not influenced by the age, gender or breed distribution of the population of dogs presented at veterinary teaching hospitals during the study period. Leptospirosis was clustered during the 1990s in the midwest of the United States. Dog risk factors (age, gender, breed) do not explain the clustering that was observed. Leptospira serovar or environmental factors might be responsible for the clustering of canine leptospirosis in the United States and Canada.

Age Distribution↗

PubMed2004

HLA-DQ6 and ingestion of contaminated water: possible gene-environment interaction in an outbreak of Leptospirosis.

Leptospirosis is a zoonosis that can cause severe multisystem disease. While host gene-environment interactions likely modify infectious disease susceptibility, including for leptopsirosis, this has not been documented. In a 1998 leptospirosis outbreak investigation among triathletes in a lake swim, swallowing lake-water was a disease risk-factor. We used genomic DNA from 85 anonymized blood-sample remainders from that investigation to examine the association of laboratory-confirmed leptospirosis with gene polymorphisms (TNF-alpha alleles and serologically defined genotypes for HLA-DRB1 and HLA-DQB1). HLA-DQ6-positive triathletes had increased risk of laboratory-confirmed leptospirosis (OR=2.8, P=0.04) compared to DQ6-negatives. DQ6-positive triathletes swallowing lake-water had greatest risk (OR 8.46, P< or =0.001). This first report of a genetic risk-factor affecting susceptibility to leptospirosis is also the first documented gene-environment interaction (DQ6 and swallowed water) affecting infectious disease susceptibility. Based on these preliminary findings, we hypothesize a role for superantigens in leptospirosis and underscore the importance of outbreak investigations for understanding infectious disease gene-environment interactions.

Adolescent↗

PubMed2003

Human leptospirosis in Bulgaria, 1989-2001: epidemiological, clinical, and serological features.

A total of 455 confirmed and reported to the Bulgarian Ministry of Health leptospirosis cases between 1989 and 2001 were analysed. Overall incidence of the disease was 0.42/100.000 population (range 0.20-0.64/100.000). The overall fatality rate was 6.6%. Infection was acquired through occupational (30.3%), recreational (45.1%), and accidental (4.6%) exposure or was home contracted (5.1%). A tendency towards the main mode of transmission moving from occupational to recreational exposure was noted. Fishing and livestock farming together accounted for more than half of all leptospirosis cases. Leptospirosis was contracted more frequently through indirect contact with animal excreta and less commonly through direct contact with animal urine or tissue. Serovars belonging to 10 different serogroups caused infection during the 13-year study period. Two serogroups, Icterohaemorrhagiae and Pomona, accounted for more than 87% of all leptospirosis cases. The third main cause was serogroup Australis. The significant change in the infecting serovars has to be related to widely performed vaccinations of cattle and pigs but still inefficient measures for rodent control. The most frequently reported symptoms were fever, myalgia, jaundice, and hepatomegaly. Anicteric cases (40.3%) had milder flu-like course. Acute renal failure was reported in 52 (33.8%) of the patients, all of them with icteric leptospirosis. Knowledge of epidemiological, clinical, and serological features of leptospirosis in Bulgaria during the 13-year study period is an appropriate base to outline measures for successful prevention and early diagnosis of the disease.

Adult↗

PubMed1993

Leptospirosis in pregnancy and its effect on the fetus: case report and review.

We report the case of a pregnant woman with leptospirosis who gave birth to a healthy baby. We also review 15 previously reported cases of leptospirosis in pregnancy. Of these 15 cases, eight women had abortions, two delivered healthy babies, and four delivered babies who had signs of active leptospirosis; in one case, the fate of the fetus was not stated. It appears that women are more likely to spontaneously abort if leptospirosis occurs in the early months of pregnancy. Since congenital infection is rare, leptospirosis should not necessarily be considered an indication to terminate pregnancy. Increased awareness of the possibility of leptospirosis for pregnant women who live in areas where the disease is endemic is of utmost importance for early detection and treatment of the disease and, thus, for the safety of the fetus.

Abortion, Spontaneous↗

PubMed2001

Leptospirosis.

Leptospirosis is a globally important zoonotic disease that affects humans on all continents, in both urban and rural contexts, and in temperate and tropical climes. Leptospirosis is a disease of the environment; transmission depends on interactions between humans and mammalian reservoir hosts. A variety of infectious diseases that present as undifferentiated febrile syndromes, such as malaria, dengue and influenza, as well as viral hemorrhagic fevers can mimic leptospirosis. The importance of pulmonary hemorrhage as a lethal complication of leptospirosis has become more widely recognized. In contrast to textbook dogma, population-based studies indicate that there is a poor correlation between infecting leptospiral strain and clinical expression of disease. Genetic transformation of a Leptospira sp. has now been reported, which should allow for detailed analysis of a variety of leptospiral genes. Publication of the whole Leptospira genome is eagerly awaited. Following recent reports of a new, highly effective conjugate typhoid vaccine, new efforts to find leptospirosis vaccines should include the manufacture and testing of conjugate leptospiral lipopolysaccharide vaccines. Recent advances, particularly in epidemiology, molecular genetics and pathogenesis, are placing leptospirosis at the cutting edge of biomedical science.

Bacterial Typing Techniques↗

PubMed2005

Leptospirosis and its pulmonary complications.

OBJECTIVE: The aim of this study was to assess the incidence and factors associated with pulmonary complications of leptospirosis. METHODOLOGY: In a retrospective study, patients with a definite diagnosis of leptospirosis following a 6-week period of severe flooding in Hadyai city, Thailand, were reviewed. Pulmonary complications of leptospirosis were defined as the occurrence of respiratory symptoms and an abnormal CXR. The clinical and laboratory test results for patients with and without pulmonary complications were compared. RESULTS: Among the 157 patients with leptospirosis, eight patients had pulmonary complications. Three patients had acute renal failure (ARF) and pulmonary oedema. One patient had ARF and adult respiratory distress syndrome (ARDS). Two patients had ARF, congestive heart failure and pulmonary oedema. One patient had congestive heart failure and pulmonary oedema. One patient had only ARF. Factors associated with pulmonary complications were delayed antibiotic treatment and thrombocytopenia (platelet count < 100 x 10(9)/L). Three patients developed adult respiratory distress syndrome and one died from respiratory failure. CONCLUSIONS: Pulmonary complications and death occur in a low percentage of patients with leptospirosis. Delayed antibiotic treatment and thrombocytopenia are risk factors for the development of pulmonary involvement in leptospirosis.

Adolescent↗

PubMed2001

Evaluation of recombinant Leptospira antigen-based enzyme-linked immunosorbent assays for the serodiagnosis of leptospirosis.

There is an urgent need for development of new serodiagnostic strategies for leptospirosis, an emerging zoonosis with worldwide distribution. We have evaluated the diagnostic utility of five recombinant antigens in enzyme-linked immunosorbent assays (ELISAs) for serodiagnosis of leptospirosis. Sera from 50 healthy residents of a high-incidence region were used to determine cutoff values for 96% specificity. In paired sera from 50 cases of leptospirosis confirmed by the microscopic agglutination test, immunoglobulin G (IgG) but not IgM reacted with the recombinant leptospiral proteins. The recombinant LipL32 IgG ELISA had the highest sensitivities in the acute (56%) and convalescent (94%) phases of leptospirosis. ELISAs based on recombinant OmpL1, LipL41, and Hsp58 had sensitivities of 16, 24, and 18% during the acute phase and 72, 44, and 32% during convalescence, respectively. Compared to sera from healthy individuals, patient sera did not react significantly with recombinant LipL36 (P > 0.05). Recombinant LipL32 IgG ELISA demonstrated 95% specificity among 100 healthy individuals, and specificities ranging from 90 to 97% among 30 dengue patients, 30 hepatitis patients, and 16 patients with diseases initially thought to be leptospirosis. Among 39 Venereal Disease Research Laboratory test-positive individuals and 30 Lyme disease patients, 13 and 23% of sera, respectively, reacted positively with the rLipL32 antigen. These findings indicate that rLipL32 may be an useful antigen for the serodiagnosis of leptospirosis.

Antibodies, Bacterial↗

PubMed2003

Report of three children with leptospirosis in rural area of the east of Turkey.

Leptospirosis is a systemic infection usually producing fever with hepatorenal involvement, meningoencephalitis, and hemorrhage. In this article, we present three children between 10 and 13 years of age with leptospirosis. The purpose of this paper is to emphasize that leptospirosis is a problem in our country with farmers/cattle and that leptospirosis should be considered in certain ill children. The main symptoms were headache, fever, fatigue, abdominal pain and unconsciousness. Two patients had hepatic and renal involvement. The other had hepatic, pulmonary and probably pericardial involvement. In all children spirochetes were demonstrated in blood and urine smears by dark-field microscopy and they were also isolated from urine and blood cultures by using Flecher medium. All patients were treated with penicillin; however, one subsequently required additional antibiotics due to Klebsiella pneumoniae septicemia. While one patient was discharged in a good health, the others were taken to their home by parents without completing treatment. In conclusion, we would like to emphasize that leptospirosis is still a public health problem in our region (Eastern Turkey) in where the majority of population are farmers and raise domestic animals such as cattle in rural areas. Additionally, leptospirosis should be considered in children admitted with headache, unconsciousness, fever and abdominal pain.

Adolescent↗

PubMed1999

[Cardiovascular function in leptospirosis convalescents].

AIM: To study mechanisms of cardiovascular damage in leprospirosis convalescents. MATERIALS AND METHODS: Cardiovascular system was investigated in 121 leptospirosis convalescents at the age 17-58 years clinically, electrocardiographically and measuring troponin-T in blood serum. RESULTS: 6-12 months after leptospirosis 42.1% of patients who had leptospiral jaundice (88.4%) and bovine leptospirosis (21.6%) myocardial damages were revealed. In spite of disappearance of cardiac pain ECG readings did not return to normal. The myocardial damage has developed in the advanced stage of leptospirosis due to rhandomyolis: high concentration of myoglobin and troponin-T in the blood serum confirms this suggestion. CONCLUSION: Clinical ECG readings as well as the level of troponin-T in the blood serum may be considered as the index of rehabilitation level in leptospirosis convalescents. It should be taken into consideration that 19.8% of the convalescents develop hypertension of renal genesis. This should be accounted for when planning prophylaxis and rehabilitation programs for young patients living in the North Caucasus--natural source of leptospirosis.

Adolescent↗

PubMed2000

Introduction of a rapid dipstick assay for the detection of Leptospira-specific immunoglobulin m antibodies in the laboratory diagnosis of leptospirosis in a hospital in Makassar, Indonesia.

An easy, rapid and robust dipstick assay for detection of leptospira-specific immunoglobulin M (IgM) antibodies was evaluated on 403 patients admitted for hospitalization because of fever. The clinical symptoms and signs of 35 patients were consistent with leptospirosis. The final diagnosis for the remaining patients was as follows: 136 with typhoid fever, 82 with hepatitis, 74 with malaria, 48 with infections of the respiratory tract, and 20 with fever of unknown origin. The clinical diagnosis of leptospirosis was confirmed for 24 (68.6%) patients by the combined results of the microscopic agglutination test (MAT), the reference test for leptospirosis, and of IgM ELISA, a standard laboratory test for the serodiagnosis of leptospirosis. In addition, serum specimens from 8 (2.2%) patients with a final clinical diagnosis other than leptospirosis were found to be positive in MAT and/or IgM ELISA. Compared with the results of MAT and IgM ELISA a sensitivity of 91.6% and specificity of 93.6% was calculated for the dipstick assay. Most of the serum samples from the laboratory confirmed patients gave a moderate to strong staining intensity of the antigen band of the dipstick and were easy to read. The results demonstrate that the dipstick assay is convenient to use and allows the rapid and accurate confirmation of patients with clinical suspicion of leptospirosis in areas where the disease is endemic.

Antibodies, Bacterial↗

PubMed2003

Possible scrub typhus coinfections in Thai agricultural workers hospitalized with leptospirosis.

Possible coinfections with Orientia tsutsugamushi the causative agent of scrub typhus, were prospectively evaluated in rice farmers hospitalized with leptospirosis in Northeast Thailand. Of 22 adults with leptospirosis diagnosed by the microscopic agglutination test, 9 also had serologic evidence of scrub typhus. Of 9 individuals with possible coinfections, 5 had signs or symptoms typical of scrub typhus and atypical of leptospirosis. Patients who appeared to have mixed infections had significantly higher median platelet counts and significantly lower median serum bilirubin and creatinine concentrations (P < 0.05, Mann-Whitney U test) than did individuals with leptospirosis alone. One patient with serologic evidence of scrub typhus and leptospirosis was treated only with penicillin, to which scrub typhus is not sensitive. Respiratory distress worsened during therapy, and the patient died of respiratory failure. Physicians should consider the possibility of scrub typhus infection in leptospirosis patients who respond poorly to treatment or who have atypical disease manifestations.

Adult↗