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PubMed1969

Sensitized-erythrocyte-lysis (SEL) test as an epidemiological tool for human leptospirosis serological surveys.

Epidemiological studies of human leptospirosis have generally been limited to countries with specialized laboratories employing the microscopic-agglutination (MA) test. The sensitized-erythrocyte-lysis (SEL) test is much simpler for routine hospital laboratories to carry out and it has been found valuable in the diagnosis of human leptospirosis. This paper reports the results of studies of the SEL test as an epidemiological tool in serological surveys.The results showed that the significant SEL titre was 1:80 and that the sensitivity of the test depended possibly on the antigen preparation and the amount of complement used. Most of the SEL antibodies were found to persist at significant titres for about 1 year after active infection, but less than half persisted longer than that. The SEL test is therefore useful for detecting recent infections and for indicating that stability of leptospirosis in an area.The endemicity of leptospirosis in West Malaysia was confirmed by the SEL test, based on the employment of 1:80 as the significant titre.

Antibodies↗
PubMed1997

Demonstration of leptospiral antigens on tissues using monoclonal antibodies and avidin-biotin peroxidase staining.

Glycolipoprotein (GLP) cytotoxin was extracted from Leptospira interrogans serovar canicola. The silver staining profile of GLP subjected to SDS-PAGE under denaturing conditions showed a number of bands in the mol. weight range of 14-66 kDa. Mouse Monoclonal Antibodies (MAbs) IgG3 recognizing a band near to 24 kDa of leptospiral GLP were produced (clone number MGLP-01). The agglutinating property of MAbs was established by microscopic agglutination test (MAT) using 25 different serovars as antigens. Only the homologous serovar was agglutinated by MAbs suggesting that the recognized epitope is a specific surface-exposed antigen. The MAbs were applied to demonstration of leptospiral antigens in tissue damage by avidin-biotin immunoperoxidase staining. Golden hamsters were experimentally infected with a virulent strain of L. interrogans serovar canicola. Histologically kidneys stained by routine hematoxylin and eosin showed changes characterized by injury of tubular epithelial cells leading to acute tubular necrosis (ATN). Typical, well-defined morphologic leptospires or finely granular deposits were found by immunoperoxidase staining near to blood vessels, within inflammatory infiltrates and intraluminal in proximal and distal parts of the nephron. Binding of leptospiral antigens to capillary endothelial cells, tubular epithelial cells and macrophages were also demonstrated. This entails a basis for further studies either in research or in diagnostic histopathology.

Animals↗
PubMed2005

Human leptospirosis in eastern Croatia, 1969-2003: epidemiological, clinical, and serological features.

This survey presents epidemiological, serological and clinical features of 270 patients (85% males, 18% children) treated for leptospirosis from 1969 to 2003 at the Clinic for Infective Diseases, University Hospital Osijek, Osijek, eastern Croatia. 75% of the admissions were between July and October. The route of transmission was mostly by indirect contact with domestic animals, less frequently by direct contact with urine or tissue of infected animals. Clinical presentation included signs and symptoms with expected and common frequency, with the exception of jaundice (62%) and aseptic meningitis (60%), which occurred with higher incidence than previously reported. Acute renal failure ensued in 53% of patients, 7% of whom required haemodialysis. No deaths were observed. Therapy consisted of antimicrobials (penicillin and doxycycline) and symptomatic measures. Diagnosis was confirmed by microscopic agglutination test (MAT). There were in total 18 serological types of Leptospira detected, and types L. sejroe, L.pomona, L. australis and L. icterohaemorrhagiae prevailed. During the last 10 y some new types were observed. Leptospirosis was not rare in the region of eastern Croatia, and its course could be life-threatening if not recognized and adequately treated.

Adolescent↗
PubMed1982

Leptospirosis in Israel: epidemiological features and laboratory findings in 13 human cases due to Leptospira ballum.

Thirteen sporadic cases of human leptospirosis due to Leptospira ballum were laboratory confirmed during a period of 11 yr. In four cases the diagnosis was proved retrospectively. All but three were residents of the Sharon plain region, living 10 to 15 km apart. All were engaged in some form of agriculture, especially in irrigated fields or groves, or in chicken farming. It was suspected that wet soil contaminated with the urine of rodents, carriers of L. ballum, was the main source of infection. Two types of immunological response were observed: 1) high microscopic agglutination (MA) titers with L. ballum serovar only (nine cases); and 2) considerable coagglutination titers with heterologous serovars as well (four cases). The serological follow-up of these cases for several years revealed that in some, a relatively high MA titer (1:200 to 1:400) against L. ballum serovars persisted for 4 to 9 yr. Sera from 10 patients were tested for IgM and IgG anti-bodies by the MA test. In eight cases the IgM responded to a higher titer and persisted for many years, regardless of whether or not any IgG agglutinins were detected. The importance of blood cultures is emphasized and the possibility of misinterpretation of MA results is discussed.

Adult↗
PubMed1978

Serological and protective-antibody responses of rabbits to leptospiral antigens.

The rabbit antibody response to leptospiral F4 antigen extracted from serovar pomona depended on the method of immunisation. Intravenous injection of whole leptospires stimulated F4 antibodies that were confined to the IgM class, but leptospires injected intramuscularly with adjuvant stimulated F4 antibodies in both the IgM and the IgM and the IgG classes. Both methods of immunisation stimulated agglutinins in both the IgM and IgG classes. F4 antigen in soluble form was immunogenci when injected intradermally with adjuvant, but not when given alone. The F4 antibodies were distinct from the agglutinins in that they did not protect hamsters from acute infection with homologous leptospires, nor did they kill leptospires in vitro although they reacted with leptospires. The hamster-protective capacity of rabbit sera depended on the level of agglutinin.

Animals↗
PubMed1982

Canine leptospirosis in Puerto Rico.

Among 116 stray dogs in Puerto Rico surveyed for leptospiral agglutinins, 73 (62.9%) has significant titers to one or more leptospiral serotypes. The most common serogroup identified serologically was icterohaemorrhagiae accounting for 53 (72.6%) of the infections. Although the infection rates were comparable for male and female dogs the older were found to be more frequently infected. The significance of the canine in the epidemiology of leptospirosis in Puerto Rico is probably of paramount importance due to the extensive direct and indirect contact dogs have with rats and the human population.

Agglutination Tests↗
PubMed2003

Leptospirosis in "Eco-Challenge" athletes, Malaysian Borneo, 2000.

Adventure travel is becoming more popular, increasing the likelihood of contact with unusual pathogens. We investigated an outbreak of leptospirosis in "Eco-Challenge" multisport race athletes to determine illness etiology and implement public health measures. Of 304 athletes, we contacted 189 (62%) from the United States and 26 other countries. Eighty (42%) athletes met our case definition. Twenty-nine (36%) case-patients were hospitalized; none died. Logistic regression showed swimming in the Segama River (relative risk [RR]=2.0; 95% confidence interval [CI]=1.3 to 3.1) to be an independent risk factor. Twenty-six (68%) of 38 case-patients tested positive for leptospiral antibodies. Taking doxycycline before or during the race was protective (RR=0.4, 95% CI=0.2 to 1.2) for the 20 athletes who reported using it. Increased adventure travel may lead to more frequent exposure to leptospires, and preexposure chemoprophylaxis for leptospirosis (200 mg oral doxycycline/week) may decrease illness risk. Efforts are needed to inform adventure travel participants of unique infections such as leptospirosis.

Adult↗
PubMedDate not supplied

The hemorrhagic syndrome of leptospirosis: an experimental study in guinea pigs.

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.

Animals↗
PubMed1988

A review of leptospirosis in Malaysia.

This paper reviews the literature on leptospirosis in Malaysia from its first description in 1928 until the present day. Most of the early reports were on investigations of leptospirosis in wildlife and man and up-to-date, thirty-seven leptospiral serovars from thirteen serogroups have been bacteriologically identified. The thirteen serogroups are: Australis, Autumnalis Bataviae, Canicola, Celledoni, Grippotyphosa, Hebdomadis, Icterohaemorrhagiae, Javanica, Pomona, Pyrogenes, Sejroe and Tarassovi. Rats have been ascribed as the principal maintenance host of leptospires in Malaysia. However, serovars from the Pomona, Pyrogenes and Sejroe serogroups have yet to be isolated from rats. It is considered that the majority of leptospirosis cases in man were due to association of man with an environment where rats were plentiful. Recent investigations on domestic animals disclosed a high prevalence of infection in cattle and pigs and they were suspected as being the maintenance host for serovar hardjo and pomona respectively. There is ample scope for research in leptospirosis, particularly in the epidemiology and control of the disease in domestic animals. The strategy to control the infection in domestic animals and man in Malaysia is bound to be different from that of the temperate countries, basically due to the presence of a large number of leptospiral serovars in wildlife, further confounded by geographical and financial constraints.

Animals↗
PubMed1987

Human leptospirosis in New South Wales, 1975-1985.

From July 1975 to June 1985, 14,630 sera from patients in New South Wales were tested for serological evidence of leptospirosis. Among these, 361 sera contained evidence of past infections and 150 of these 361 specimens had evidence of recent or current infections. Serologically-diagnosed cases of leptospirosis were distributed mainly in the central and eastern parts of the State. Pomona, hardjo and icterohaemorrhagiae were the most common serovars to be detected; male abattoir workers and farmers were the most common occupational groups that were infected. An increase in seropositive cases occurred from 1981, largely due to hardjo and to a lesser extent pomona infections among farmers. Clinical histories indicated that most cases presented as pyrexias of unknown origin or as febrile illnesses; however, four patients were reported to have presented with renal failure; three patients were reported to have presented with meningitis; and 10 patients were jaundiced at presentation.

Australia↗
PubMed1998

[Patent and occult intra-alveolar hemorrhage in leptospirosis].

PURPOSE: Pulmonary involvement (PI) is common in leptospiral infection, usually characterized by hemoptysis and diffuse bilateral infiltrates on chest radiographs. Alveolar haemorrhage (AH) has already been proved by autopsy and some case-reports with fiberoptic bronchoscopy (FB) and bronchoalveolar lavage (BAL). The purpose of this study was 1/to evaluate the incidence of AH in leptospirosis 2/to define the impact of BAL on the early diagnosis of the infection. PATIENTS AND METHODS: FB with BAL were performed in 23 consecutive patients with leptospirosis (13 patients with patent signs of PI: group 1, 10 patients without: group 2). AH was defined by a percentage of siderophages > or = 20% and/or a Golde score > 100 and/or an haemorrhagic aspect of BAL fluid. Culture tests were performed on specific medium. RESULTS: We diagnosed AH in all patients of group 1 and in 7 patients of group 2. Filaments were seen in 6 specimens of BAL fluid, initially thought to be leptospires, but culture tests were negative. CONCLUSION: AH is identified in all cases of leptospirosis with PI. Occult AH often occurs to patients without any respiratory symptom. Physicians should consider leptospiral infection in the differential diagnosis of AH. Culture-tests for leptospirosis in BAL do no help in diagnosing leptospirosis.

Adult↗
PubMed2000

Evaluation of the indirect hemagglutination assay for diagnosis of acute leptospirosis in Hawaii.

Timely diagnosis of leptospirosis is important to ensure a favorable clinical outcome. The definitive serologic assay, the microscopic agglutination test (MAT), requires paired sera and is not useful for guiding early clinical management. The only screening test approved for use in the United States, the indirect hemagglutination assay (IHA), has not undergone extensive field evaluation. To assess the performance of the leptospirosis IHA in Hawaii, serum from patients evaluated for leptospirosis between 1992 and 1997 were tested with the IHA at the Hawaii State Laboratories Division and with the MAT at the Centers for Disease Control and Prevention. Leptospirosis was considered confirmed by a fourfold rise in MAT titer and/or a positive culture. A total of 92 (41%) of 226 specimens from 114 persons with confirmed leptospirosis were found positive by IHA. Only 18 (15%) of 119 specimens obtained within 14 days of onset were IHA positive, compared to 74 (69%) of 107 specimens collected more than 14 days after onset (P <0.001). Repeat testing ultimately resulted in 78 (68%) of the confirmed cases having at least one specimen found positive by IHA. Thirteen different presumptive infecting serogroups were identified among 251 specimens with an MAT titer of >/=200 and obtained from persons with confirmed or probable leptospirosis. Fifty (68%) of 73 specimens with Icterohaemorrhagiae as the presumptive infecting serogroup were found positive by IHA, compared to 44 (47%) of 93 specimens with Australis as the presumptive infecting serogroup (P, 0.01). The IHA test was positive for 3 (1%) of 236 specimens from 154 persons without leptospirosis. The sensitivity of the leptospirosis IHA in Hawaii was substantially below figures reported previously, particularly early in the course of illness, limiting its usefulness for diagnosing acute infection. Since the presumptive infecting serogroup affected IHA results and the prevalence of serovars varies with geography, the performance of the IHA should be assessed locally. More sensitive leptospirosis screening tests are needed in Hawaii.

Acute Disease↗
PubMed1982

Serological survey of leptospiral antibodies in sheep from England and Wales.

A total of 3722 sera was obtained from 188 flocks widely distributed throughout England and Wales; three sera were randomly selected from each flock and tested in the microscopic agglutination test for leptospiral antibodies. Infection with leptospires of the Hebdomadis serogroup was found to the widespread and it is probable that the infecting serovar is hardjo. The prevalence of hardjo titres in the random survey was 6.4 per cent and within-herd prevalences ranged up to 94.4 per cent. Titres to autumnalis antigen were found in 7.3 per cent of sera and evidence is presented that suggests a proportion of these titres are cross-reactions with agglutinins stimulated by infection with leptospires from other serogroups. Titres to bratislava antigen (Australis serogroup) were found in 3.4 per cent of sera. Within-herd prevalences of autumnalis and bratislava titres did not range above 16.7 per cent and 26.3 per cent respectively.

Animals↗
PubMedDate not supplied

[Leptospirosis in children in Rio do Janeiro].

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%).

Age Distribution↗
PubMedDate not supplied

[Natural foci of leptospirosis in Moscow in 1995 - 2004].

The article deals with the results of the 10-year study of the synanthropic urban foci of leptospirosis on the territory of Moscow. Information on the manifestation of the activity of the foci under study, rodents serving as the reservoir of infection in these foci, the etiological structure of the leptospires among these rodents, the state of leptospirosis morbidity among humans is presented.

Agglutination↗
PubMed2005

The use of latex agglutination for the diagnosis of acute human leptospirosis.

The authors evaluated a simple latex agglutination test for the serodiagnosis of acute human leptospirosis. A total of 380 serum samples from 85 confirmed leptospirosis patients and 202 non-leptospirosis patients were selected Using the selected cut-off value of weakly positive, the overall sensitivity and overall specificity of the test were 94.1% and 97.0% respectively. The weighted kappa value for agreement reading between two independent examiners was 0.82. When focused on the first sera obtained from the patients, the sensitivity of the test for acute infection sera was only 17.6%. The latex agglutination test is easy to perform with no need for training and no requirement of special equipment. The assay has a good sensitivity and specificity. This is an interesting alternative assay for serodiagnosis of acute human leptospirosis.

Antibodies, Bacterial↗
PubMed1987

The incidence of severe leptospirosis in Trinidad.

Between February 1977 and September 1982, sera from febrile patients from all areas of Trinidad were examined for leptospiral agglutinins; 158 of 1714 patients (9%) were confirmed as current cases of leptospirosis (annual average 26 or 2.6 per 100,000 population). Of the remaining 1556 patients only 711 provided paired sera; 167 of these (23%) showed evidence of previous leptospiral infection. Of the 845 single samples, 125 were positive. The true incidence of the disease is probably much higher than reported here. Males comprised 74% of the current cases; their highest rate of infection was in the 30-39 year age group, the incidence in late teenage approaching this rate. For females, incidence increased with age up to late middle-age. The presumptive infecting serogroups most commonly recorded among the 158 current cases were Icterohaemorrhagiae (37%), Canicola (16%) and Autumnalis (11%). 13 of the cases died (case fatality rate, 8.2%).

Adolescent↗