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PubMedDate not supplied

[Leptospirosis-clinico-biological and therapeutical aspects-study of 256 cases].

Leptospirosis is a zooantroponosis manifested as an infectious disease with a severe evolution, with liver and renal failure and hemorrhagic manifestation. The aim of this study was to present the clinico-biological investigation and the therapeutical aspects of 256 cases of leptospirosis admitted in the Infectious Diseases Hospital Iasi during 4 years (1998-2001). The diagnosis was based on the study of clinico-biological and therapeutical parameters (risk factors, fever, mialgia, headache, algic, eruptive, meningeal, hepatorenal, hemorrhagic syndromes with the serological evidence of the serotypes of leptospirosis); most of the cases were registered in 1998 (23% cases), in adults (31.2%) and male (75.22%). All the patients were serologic confirmed with leptospirosis (RAL and RFC), and L. icterohaemorhagiae was isolated most frequently. The standard anti-leptospirosis treatment was administered with favorable evolution; 6 deaths were registered from the severe forms of the disease. The leptospirosis is an emergent disease with the possibility of severe evolution in some forms, with liver and renal failure.

Adolescent↗
PubMed2004

Frequency of leptospirosis in patients of acute febrile illness in Uttar Pradesh.

OBJECTIVE: This study was performed to asses the disease burden of leptospirosis in and around Lucknow among patients presenting with acute febrile illness and conforming to the case definition of leptospirosis. METHODS: A total of 346 serum samples (mostly paired) and an equal number of urine samples were collected from patients presenting with acute febrile illness and fulfilling the criteria of clinical diagnosis of leptospirosis from January 2001 to December 2001. Patients attending a tertiary care hospital as well as from various communities in and around Lucknow were included in this study. All sera and urine samples were tested for the presence of IgM antibody by Leptodipstick test and by dark-field microscopy (DFM) respectively. All positive and 10% negative sera were tested at national leptospirosis reference centre at Andaman and Nicobar Islands for microagglutination test (MAT). RESULTS: IgM antibody was detected in 25/346 (7%) patients ranging in age from 9-65 years. DFM was positive in only in one case. MAT was positive in 4/17 cases tested and the prevalent serogroups were L. grippotyphosa and L. pomona in two each. Common presenting features in these patients were fever (25/25) and jaundice (17/25). History of contact with animal or water contaminated with animal urine was present in 96% cases. CONCLUSION: Leptospirosis is not uncommon in Uttar Pradesh. However larger epidemiological studies are required to know the actual disease burden. Dark-field microscopy is an insensitive method for the diagnosis of leptospirosis and is not suitable for surveillance.

Acute Disease↗
PubMedDate not supplied

A global research agenda for leptospirosis.

Leptospirosis is a zoonotic spirochetal disease of global importance. This disease continues to have a major impact on people living in urban and rural areas of developing countries with inestimable morbidity and mortality. Funding for research and control efforts is currently haphazard, not organized and not effective for public health efforts, primarily because there are no concerted, ongoing international efforts to assess the impact of leptospirosis on human health. Major issues in the field need to be addressed to develop strategies of control, amelioration and treatment. These include the following: mechanisms of naturally acquired and vaccine-induced protective immunity against clinical leptospirosis; mechanisms of severe leptospirosis pathogenesis; standardized, precise and simplified taxonomy of Leptospira relevant to disease manifestations, transmission and control; effective adjunct treatments in addition to antimicrobials; and environmental assessment for risk of leptospirosis transmission and relevant mammalian reservoirs. Once effective ongoing, collaborative international efforts to assess the impact of leptospirosis on human and veterinary health are underway, appropriate mobilization of clinical and public health research funding will follow.

Humans↗
PubMed2006

A note from a survey of some knowledge aspects of leptospirosis among a sample of rural villagers in the highly endemic area, Thailand.

INTRODUCTION: The main purpose of this pilot study was to assess knowledge of leptospirosis among a sample of rural villagers in the highly endemic area, Thailand. METHOD: This cross-sectional descriptive study was conducted among a sample of 300 rural villagers in the highly endemic area of leptospirosis, Buriram Province in Thailand. A self-administered questionnaire on some knowledge aspects of leptospirosis was used. RESULTS: The response rate was 100%. Most participants (80%) had a poor knowledge of leptospirosis. There was no significant correlation of sex and age of the subjects as to the level of knowledge (chi2, p > 0.05); however, there was significant correlation of level of education and occupation of the subjects to the level of their knowledge (chi2, p < 0.05). CONCLUSIONS: Although this was a limited pilot study, the results imply that the present leptospirosis control program is not successful, and that the main problem is the knowledge level of people in endemic areas. A program to improve the basic knowledge of leptospirosis of rural villagers in endemic areas must be initiated.

Adult↗
PubMed2006

[Clinical features and current laboratory diagnosis of leptospirosis of grippotyphosa serogroup].

AIM: To characterize persistence of the causative agent in the blood of patients with leptospirosis, to evaluate significance of the results of polymerase chain reaction (PCR) with isolation of ribosomal RNA (rRNA) and microagglutination reaction (MAR) in diagnosis of leptospirosis at different stages of the disease. MATERIAL AND METHODS: The study included 94 patients with leptospirosis: 51 (54.2%) males, 43 (45.8%) females, 74 (78. 7%) urban and 20 (21.3%) rural citizens in acute leptospirosis, early and late convalescence. Leptospirosis was diagnosed on the basis of clinico-epidemiological, laboratory-device data. All the patients were divided into 2 groups: with leptospiral jaundice (n = 33, 35.1%) and without leptospiral jaundice (n = 61, 64.9%). The disease of moderate severity was in 64 (68%) patients. Verification of the diagnosis was based on determination of specific antibodies titer in MAR using standard set of diagnostic cultures. PCR determined rRNA of leptospira in the blood on the disease day 5, 10 and 15, 1, 2, 3, 6 and 12 months after the disease onset. The results were processed with methods of parametric and non-parametric statistics. CONCLUSION: PCR demonstrated diagnostic value in early leptospirosis (sensitivity of the method in the disease week 1 was 86%). Diagnostic significance of MAR reached 81.8% later - in 3 weeks. Detection of leptospiral rRNA by PCR in the autopsy material allows one to recommend this method for additional verification of the diagnosis including as an alternative to bacterioscopic test.

Agglutination Tests↗
PubMed1991

Hyperamylasemia and pancreatitis in leptospirosis.

Hyperamylasemia has been documented in up to 65% of our patients with leptospirosis and jaundice. However, pancreatitis is an uncommon complication of leptospirosis. Three patients with leptospirosis and pancreatitis are described and compared with two leptospirosis patients who had hyperamylasemia but in whom the diagnosis of pancreatitis could not be substantiated. The cause of the hyperamylasemia in the latter patients was nonpancreatic. The elevation of the amylase in these latter two patients could not be explained by renal insufficiency, because the level of the amylase was greater than three to four times the normal value, the upper limit to which amylase rises in renal failure. Thus, hyperamylasemia in patients with leptospirosis can be from pancreatic and nonpancreatic sources. Leptospirosis should be considered in the differential diagnosis of hyperamylasemia and pancreatitis.

Adult↗
PubMed1992

An investigation of some risk factors for severe leptospirosis on Barbados.

Between November 1979 and the end of December 1986 (7.17 years), 248 cases of leptospirosis were confirmed among hospital patients on Barbados (mean 35 per year; range 25-57). Considering the 235 who were greater than or equal to 15 years of age, the annual incidence of leptospirosis was 19.2/100,000 population (14.0 for all age groups). There were 173 males and 62 females, and for cases aged 15-34 leptospirosis was 9.6 times more common in men than women. Among men, incidence increased fairly steadily with age, and an even steadier increase was apparent in women up to age 64, with some decline in later years. The incidence of disease was much higher among agricultural than other workers and the non-employed. Highest case numbers were recorded in the parishes of St Michael (65 or 28%) and Christ Church (36 or 15%), though the incidence was lowest in these two parishes (13.1/100,000 and 17.4/100,000, respectively). The highest incidence rates were in St Andrew and St Joseph (50.2 and 36.1/100,000, respectively). The incidence in areas with rainfall greater than or equal to 1600 mm (32.6/100,000) was nearly twice that in areas with rainfall less than 1600 mm (17.3/100,000). There is a clear link between cases of severe disease and recent rainfall. Using 134 patients greater than or equal to 15 years of age with fever due to other illnesses as controls, a higher proportion of cases than controls came from rural areas. The risk of contracting leptospirosis was increased for all categories of manual workers relative to the group at lowest risk (non-manual indoor workers). Sugar-cane workers were five times more likely to contract leptospirosis than were non-manual indoor workers, while those whose families minded livestock were 2.5 times more likely, and those with rodents in their garden/yard were 1.8 times more likely to do so. Other risk factors examined did not show significant associations with the disease. Despite increasing mechanization and the use of more protective clothing, agricultural workers are still at high risk from leptospirosis. The annual range of cases is likely to stay much as it is in the foreseeable future.

Adolescent↗
PubMed1998

[Leptospirosis in the Netherlands, 1991-1995].

OBJECTIVE: To determine all cases of leptospirosis in the Netherlands in 1991-1995 that were confirmed by serological investigation or culturing. DESIGN: Descriptive, retrospective. SETTING: Department of Biomedical Research, Royal Tropical Institute, Amsterdam, the Netherlands, and Department of Internal Medicine, Academic Medical Centre, Amsterdam, the Netherlands. METHOD: Using data of the Reference Laboratory for Leptospirosis, the number of leptospirosis cases in 1991-1995 was determined and compared with the data of 1986-1990. Additional information was obtained about patients with confirmed leptospirosis or who had been hospitalized because of leptospirosis. RESULTS: The number of confirmed cases dropped from 229 in 1986-1990 to 159 in 1991-1995. This decrease could be attributed mainly to a marked decrease of the number of dairy farm fever (hardjo) cases. There was a clear increase of the number of infections acquired during travel in foreign countries, notably outside Europe. Thus, leptospirosis in the Netherlands shifted from an occupational disease towards a disease due to recreational activities. In about 10% of the patients the disease ran a severe course with Weil's syndrome (icterus, renal failure, and haemorrhages). Eight patients (5%) died. Clinical data of 5 of these 8 patients indicated that they had suffered from Weil's syndrome.

Demography↗
PubMed2004

A review of human leptospirosis in Malaysia.

This paper reviews the literature on human leptospirosis in Malaysia from its first description in 1925 until the present day. Fletcher diagnosed the first case of human leptospirosis in Malaysia in 1925. Following Fletcher, many investigations on human leptospirosis in Malaysia disclosed a high prevalence of infection. These investigations indicated that the disease was endemic in the country. Examination of 1993 suspected human cases of leptospirosis by Tan indicated 28 % of the cases were positive. In a recent survey, 2190 serum samples from patients with different clinical manifestations in the country disclosed 12.6% were positive for antibodies to leptospires. The risk to leptospiral infection with respect to occupation, location, sex, race and age groups was demonstrated. Both civilians and military personnel were affected. Thirty-seven serovars from thirteen serogroups have been identified in the country. Recent studies on animal leptospirosis showed that the disease was highly endemic in the animal population. It is considered that the majority of leptospirosis cases in humans were due to association of man with animals and disease-infected environment.

Journal Article↗
PubMed2002

Outbreak of leptospirosis among triathlon participants and community residents in Springfield, Illinois, 1998.

We investigated an outbreak of leptospirosis among athletes and community residents after a triathlon was held in Springfield, Illinois. A telephone survey was conducted to collect clinical information and data on possible risk factors, community surveillance was established, and animal specimens and lake water samples were collected to determine the source of the leptospiral contamination. A total of 834 of 876 triathletes were contacted; 98 (12%) reported being ill. Serum samples obtained from 474 athletes were tested; 52 of these samples (11%) tested positive for leptospirosis. Fourteen (6%) of 248 symptomatic community residents tested positive for leptospirosis. Heavy rains that preceded the triathlon are likely to have increased leptospiral contamination of Lake Springfield. Among athletes, ingestion of 1 or more swallows of lake water was a predominant risk factor for illness. This is the largest outbreak of leptospirosis that has been reported in the United States. Health care providers and occupational and recreational users of bodies of freshwater in the United States should be aware of the risk of contracting leptospirosis, particularly after heavy rains.

Adult↗
PubMed2005

Clinical spectrum of pulmonary involvement in leptospirosis in a region of endemicity, with quantification of leptospiral burden.

BACKGROUND: Pulmonary involvement in leptospirosis remains poorly recognized in regions where it is endemic, despite reports of recent outbreaks and epidemic disease. METHODS: A prospective, population-based study was carried out to identify febrile patients exposed to Leptospira in urban and rural contexts in Iquitos, Peru. Evidence of exposure to Leptospira was obtained by serologic testing, and diagnosis of leptospirosis was confirmed in pulmonary cases by culture or quantitative real-time PCR assay. RESULTS: Of 633 consecutively enrolled febrile patients, 321 (50.7%) had antileptospiral IgM antibodies or high titers of antileptospiral antibodies. Seven patients with histories of only urban exposure to leptospires had severe pulmonary manifestations; of these, 5 patients died; 4 of the deaths were caused by pulmonary hemorrhage, and 1 was caused by acute respiratory distress syndrome and multiorgan failure. Real-time, quantitative PCR assay showed high levels of leptospiremia (>or=10(4) leptospires/mL) in most fatal cases; 1 patient, from whom tissue specimens were obtained at autopsy, had >or=10(5) leptospires/g of lung, kidney, and muscle tissue. DISCUSSION. This study demonstrates the underdiagnosis of leptospirosis in a region of high endemicity and the underrecognition of grave pulmonary complications. Pulmonary involvement in leptospirosis was present in urban but not rural areas. Presumptive treatment for leptospirosis should be initiated immediately in the appropriate epidemiological and clinical context.

Adolescent↗
PubMed1987

Prevalence of leptospirosis in man. Pilot survey.

A survey on the prevalence of leptospirosis was performed on the population living in an area of central Italy. The size of the sample was calculated in order to provide significant results in the case of a prevalence of infection in not less than 1% of the population. Results demonstrated an unexpectedly wide circulation of leptospirosis in the surveyed area, showing a prevalence rate of infection of 11.34% for people living in rural areas and 3.08% for people living in the main town. The highest prevalence of infection (17.44%) was found in people between 30 and 44 years of age, living in rural areas. Such a wide circulation of undiagnosed past leptospiral infections was attributed both to the prevalence of mild clinical cases of leptospirosis in humans and the lack of microbiological tests performed to differentiate current leptospirosis from other infectious illnesses. An unexpected persistence in sera of co-agglutinins towards non-pathogenic serovars of L. biflexa was also noticed in healthy people. Criteria were established for the extension of the survey on the prevalence of leptospirosis to cover larger areas by limiting sampling to the more exposed age groups and to areas representative of a larger land belt.

Adolescent↗
PubMedDate not supplied

Respiratory manifestations of leptospirosis: a retrospective study.

We retrospectively reviewed 34 consecutive patients with serologically confirmed leptospirosis admitted during years 1992-2002. Nine patients (26.5%) had respiratory symptoms on admission including cough (n = 4), shortness of breath (n = 4), cyanosis (n = 2), and hemoptysis (n = 1). Six patients had pulmonary radiographic findings including (1) diffuse, ill-defined, ground-glass density (n = 3); (2) diffuse alveolar opacities (n = 2); and (3) small nodular density (n = 1). Male/female ratio was 8/1 and mean age was 47 years. Seven patients reported their exposure source including hunting (n = 2), fishing (n = 2), fresh water swimming (n = 2), and canoeing (n = 1). All patients had fever (mean = 40.1 degrees C). Other common symptoms were headache (n = 4), vomiting (n = 3), and myalgia (n = 3). Biological abnormalities included elevated liver enzymes (n = 8), proteinuria (n = 7), lymphopenia (n = 6), hematuria (n = 5), renal failure (n = 4), anemia (n = 4), and elevated neutrophil count (n = 4). PaO(2 )was measured for 3 patients while they were breathing room air (32, 55, and 66 mmHg). Suspected diagnosis on admission included leptospirosis (n = 2), bacterial pneumonia (n = 2), intoxication, influenza, viral hepatitis, biliary tract lithiasis, and rapidly progressive glomerulonephritis (one patient each). The first serologic testing for leptospirosis was positive for 5 patients (55%). Serovar was presumptively identified for 7 patients: Australis (n = 3), Grippotyphosa (n = 2), and Icterohaemorrhagiae (n = 2). Seven patients were treated with penicillin; two patients received no antibiotics. All patients were cured. In conclusion, patients with leptospirosis may present predominantly with nonspecific pulmonary symptoms. In these patients, leptospirosis must be suspected when there is a potential exposure to rats, especially in case of high-grade fever, myalgia, hepatitis, and renal abnormalities.

Female↗
PubMed2007

High serum nitric oxide levels in patients with severe leptospirosis.

Leptospirosis is a globally distributed zoonosis of major public health importance and is associated with severe disease manifestations such as acute renal failure and pulmonary haemorrhage syndrome. However, the extent to which the pathogenesis of leptospirosis mimics sepsis caused by Gram-negative bacteria remains unknown. The aim of this study was to evaluate serum levels of nitric oxide (NO) in patients diagnosed with severe leptospirosis. Sera from 35 confirmed cases of severe leptospirosis and 13 healthy subjects were analysed. Patients with severe leptospirosis had significantly higher NO levels compared to healthy individuals (30.82+/-10.90 microM versus 3.86+/-1.34 microM, P < 0.001), indicating that this immune mediator plays a role in the underlying systemic inflammatory response.

Adolescent↗
PubMed2006

Use of ceftriaxone in patients with severe leptospirosis.

The optimal treatment of severe and late leptospirosis, and even the need for antibiotic treatment in such clinical settings, remains a subject of debate. Twenty-two patients with severe late leptospirosis were treated with intravenous ceftriaxone 2g daily. Twenty-one patients recovered and one patient passed away due to respiratory complications of the disease. The adverse effect profile and the convenience of the regimen were superior to penicillin regimens reported in other clinical trials. Ceftriaxone may be a reasonable alternative in severe leptospirosis as an efficient, convenient and safe regimen. Large multicentre studies may further define the optimal interventions in severe leptospirosis as well as possible variations in the pathogenic and clinical parameters of respiratory leptospirosis.

Adult↗
PubMed2005

Trends in leptospirosis epidemiology in France. Sixty-six years of passive serological surveillance from 1920 to 2003.

OBJECTIVES: The incidence of leptospirosis, a worldwide zoonosis, has significantly decreased in Western Europe during the last decades. Our aim was to analyse all reliable data collected at the Institut Pasteur from 1920 to 2003 to evaluate more precisely the evolution of the incidence of leptospirosis in France. METHODS: The passive surveillance system used as early as 1920 allows the evaluation of leptospirosis incidence. Serological results inferred from the microagglutination procedure were used to evaluate variation in the incidence of the disease and the evolution of the Leptospira serogroups involved in the human disease. RESULTS: No significant variation either in the number of leptospirosis cases or in the incidence of the disease was observed. However, the period of the 1970s was characterized by a rather low incidence. The weather plays a major role by modifying fresh water abundance, rodent populations and human behaviour. However the weather's influence is not the sole factor involved in the incidence rate. No cyclic variation was evident. CONCLUSION: Although France has the highest incidence of leptospirosis in Europe, the analysis of serological data collected over 66 years has allowed us to conclude that in France, the incidence is slowly decreasing.

Agglutination Tests↗
PubMed2005

Three cases of anicteric leptospirosis from Turkey: mild to severe complications.

Leptospirosis is an acute generalized infectious disease, caused by spirochaetes, Leptospira interrogans. The severity of the disease ranges from an asymptomatic subclinical course to a fatal outcome. The three cases presented here were diagnosed serologically and had thrombocytopenia and acute renal failure as complication of anicteric leptospirosis. Our first case admitted with clinical presentation of pneumonia but clinical progress and laboratory findings made us to consider leptospirosis. The other two cases presented with aseptic meningitis were diagnosed as anicteric leptospirosis by the serological test results. One of the cases had fatal outcome but could not be strictly correlated with leptospirosis.

Acute Kidney Injury↗
PubMed2006

Cerebral venous thrombosis as a complication of leptospirosis.

Leptospirosis is an acute infectious disease caused by a spirochete of the leptospira gender and it is characterized by severe vasculitis. It is not common for leptospirosis to present as a primary neurological disease. On the other hand, no study has been reported on the progression of cerebral venous thrombosis (CVT) in patients with leptospirosis so far. This is the first case reported which shows CVT as a complication after the leptospirosis infection. An acutely developed leptospirosis and post-infectious CVT in a 21-year-old soldier is described here.

Adult↗