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PubMed2004

Epidemic of leptospirosis: an ICU experience.

AIMS: To study the clinical profile and outcome of critically ill patients suffering from leptospirosis with organ dysfunction and correlate mortality with individual risk factors. METHODS: A study of critically ill patients suffering from leptospirosis was carried out in the Medical Intensive Care Unit of a tertiary centre of a metropolitan city between 1st June 2002 and 31st May 2003. All the patients in whom diagnosis was confirmed by ELISA IgM antibody testing underwent thorough clinical examination and necessary biochemical investigations. They received standard antimicrobial therapy and extensive supportive therapy as required. Mortality was correlated with individual risk factors. RESULTS: Out of 834 total admissions in this period, 60 (7.2%) patients suffered from leptospirosis. There were 48 males and 12 females with age ranging from 12 to 60 years, mean age being 40 years. The clinical manifestations varied from fever (58 patients), jaundice (38), subconjunctival haemorrhages (24), to altered sensorium (22). All the patients had evidence of severe sepsis. Forty six patients had multiple organ dysfunction syndrome (MODS) and 26 required ventilatory support. The total mortality in leptospirosis patients was 52% which was much higher compared to the total MICU mortality (31.4%) in the same period. CONCLUSION: Leptospirosis is an important infection associated with high mortality when associated with organ dysfunction. The poor prognostic factors are preponderance of male sex, alcohol dependence, age group > 50 years, MODS, acute respiratory distress syndrome (ARDS), presence of acidosis and need for mechanical ventilation. However, timelyintervention and intensive therapy can save many young lives.

Adolescent↗
PubMedDate not supplied

The prevention and control of human leptospirosis.

Human leptospirosis is prevalent in several states in India, sporadically or as outbreaks, especially during rainy seasons. It affects predominantly male adults who work in agriculture, causing severe morbidity and unnecessary mortality. Yet, there is no systematic leptospirosis prevention and control programme in the country, as it is not identified as priority under the national health policy. Therefore states with leptospirosis ought to establish public health programme for its prevention and control, as part of building a comprehensive initiative for the control of all-important infectious diseases. After establishing disease surveillance and laboratory support service, the disease burden must be monitored before and during interventions for control. The District is the ideal unit of activity, with full participation of the State Government and Local Panchayati raj. The public health staff must give technical leadership and the risk factors of human leptospirosis must be identified and specific interventions targeted against them. Action must be local-area-specific and coordinated between the Departments of Health, Agriculture, Animal Husbandry, Environment and Forestry. A model leptospirosis control programme has been formulated in Kerala State and is awaiting implementation. A state level Diagnostic and Epidemiology centre has been established to provide technical leadership. This model must be implemented and also replicated in other states. The most important ingredient for the control of infectious diseases is the 'political will'.

Communicable Disease Control↗
PubMed2005

[Clinical and epidemiological features of leptospirosis in Bolívar state, Venezuela. Comparison of diagnostic methods: LEPTO-Dipstick and plaque macroscopic agglutination test].

Leptospirosis is caused by numerous serovars of Leptospira interrogans. The infection is acquired through the contact of softened skin, mucous and conjunctive with the urine of animals and humans infected by animal carriers. The aim of this study was to determine the clinical and epidemiological features of leptospirosis in Bolívar state Venezuela and to compare the sensibility and specificity of the LEPTO-Dipstick, with the test of macroscopic agglutination in plate with the termorresistent antigen (TR). Thirty one sample of serums were processed of patients with leptospirosis clinic, admitted in the Hospital Universitario "Ruiz y Páez" of Ciudad Bolívar during 12 months. Detection IgM antibodies of anti-Leptospiras was carried out by means of LEPTO-Dipstick and antigen TR. The Microscopic Agglutination Test (MAT) was also, carried out. The general prevalence of leptospirosis in patients who attended the "Ruiz y Paez" Hospital was of 80.6% (n = 25) by means of the determination of the termorresistent antigen. The most frequent serovars identified in Bolívar State, were the serovars: icterohaemorrhagiae, copenhageni (21.3%), autummalis and australis (12.8%). TR antigen and LEPTO Dipstick had a sensibility of 80% and a specificity of 25%. The agreement between both methods was null (Kappa: -0.2). Bolívar state has a high leptospirosis prevalence and the infection should be discarded in those patients with long-term fever and risk factors for the illness.

Adolescent↗
PubMed2006

[Evaluation of indirect immunofluorescence assay for diagnosis of human leptospirosis].

INTRODUCTION: The diagnosis of leptospirosis is difficult because it presents an extremely broad spectrum of symptoms. A number of diagnostic serological assays have been developed, but their performance and utility have not been evaluated in Colombia. OBJECTIVES: To evaluate the IgM-IgG-indirect inmunofluorescence assay to detect antibodies against Leptospira in human serum samples and to diagnose leptospirosis. MATERIALS AND METHODS: A panel of 19 sera from leptospirosis cases with clinical diagnosis and positive microscopic agglutination test, 40 samples from individuals without history of leptospirosis and negative microscopic agglutination test, and 96 samples from patients with other infectious diseases were evaluated. RESULTS: The sensitivity of the indirect inmunofluorescence assay was 89.47%, its specificity was 100%, the negative predictive value was 95.2% (CI 95% 82.6-99.2), and its positive predictive value was 100%. At the same time an exploratory study of 27 samples from different febrile syndromes, 11% were positive by IgM-indirect inmunofluorescence assay against Leptospira. CONCLUSIONS: The data indicate that indirect inmunofluorescence assay is useful as a diagnostic adjunct to clinical diagnosis and for seroepidemiologic studies. The presence of IgM antibodies against Leptospira in sera from cases of febrile syndrome indicate that leptospirosis is one of the causes of this syndrome and should be considered by the clinician.

Colombia↗
PubMed2006

Leptospirosis presenting to an intensive care unit in provincial New Zealand: a case series and review.

BACKGROUND: Leptospirosis is a disease associated with meat and agricultural workers which is endemic in New Zealand and Australia. During 2003-2005, it resulted in 207 hospitalisations in New Zealand. Hawke's Bay had the highest regional incidence in 2004 and 2005. While admission to intensive care units with leptospirosis is not infrequent, no such cases have been described in the literature from New Zealand, and only five from Australia. METHODS: A chart review of all patients admitted to the intensive care/high dependency unit of a regional hospital in New Zealand with a diagnosis of leptospirosis from June 1999 to May 2005. Admission features, progress and diagnostic tests were collated, and APACHE II score on admission and daily Sequential Organ Failure Assessment (SOFA) score were calculated. RESULTS: 15 cases were identified; median age was 44 years (range, 27-62), and 13 were men. Myalgia, headache, nausea and vomiting were common; nine had conjunctival suffusion. Ten had hypotension and 14 had renal failure before ICU admission. Eleven received vasoactive support, and three received renal replacement therapy. Median length of ICU stay was 4 days (range, 2- 11; mean, 4 days). Median hospital stay was 6 days (range, 2-13; mean, 7.6 days). All patients survived and were discharged free of dialysis. CONCLUSION: Leptospirosis presents to the ICU with a variety of signs and symptoms. Renal failure is the most common organ dysfunction requiring intensive care, and its severity is disproportionate to other signs of severe sepsis. Leptospirosis has a good prognosis with early management in an ICU.

Acute Kidney Injury↗
PubMed2006

Leptospirosis: an unusual presentation.

Leptospirosis is a common zoonosis that is endemic in the tropical Top End of the Northern Territory. Disease ranges from mild to very severe. We report a patient with anicteric leptospirosis who became critically ill, challenging the view that anicteric leptospirosis is less severe than the icteric form. Despite a typical but non-specific presentation and recreational high-risk activities, diagnosis of leptospirosis was delayed. The patient developed respiratory failure, resulting from pulmonary haemorrhage, and acute renal failure. This case highlights the multiple factors that should prompt health care workers to consider the diagnosis of leptospirosis in non-classical presentations.

Adult↗
PubMed1991

[Seroepidemiological study of human leptospirosis at Reunion Island].

In order to evaluate the prevalence of human leptospirosis in Reunion island and to identify possible risk factors, a study was realised on a representative population sample of 3.338 persons. The prevalence of leptospirosis, diagnosed by ELISA and confirmed by Micro Agglutination Test, was 1.1%. Male predominance and higher prevalence in rainy parts of the island, were confirmed. It has not been possible to display risk factors such as housing conditions or professional exercise. The serological repartition showed not only icterohaemorrhagiae serovar, but also canicola, panama and sejroe, especially in women. These results, compared with clinical studies (showing nearly exclusive male repartition, in agricultural workers, due to icterohaemorrhagiae serovar), confirm the double look of human leptospirosis in Reunion island: clinical leptospirosis, severe, concerning males, often countrymen, due to icterohaemorrhagiae serovar, and infraclinical leptospirosis, concerning principally females, which is a domestic illness, due to other serovars.

Adolescent↗
PubMed1990

[Immunologic monitoring of leptospirosis in the Maritime Territory].

The epidemiological and epizootic situation in Leptospira infections at the Maritime [correction of Primorski] Territory is evaluated on the basis of complex studies carried out in 1984-1989. As revealed in these studies, cases of leptospirosis among humans have a sporadic character and are mainly registered among professional high risk groups of the population. In the immunological structure of persons covered by the survey L. hebdomadis, L. pomona and L. javanica prevail. The anthropourgic foci of leptospirosis caused by L. pomona are of the leading epidemiological importance. Swine serves as the main source of infection in these foci. The study revealed the epidemic danger of the natural foci of leptospirosis caused by L. grippotyphosa and L. javanica in rice fields where the decisive factors of leptospirosis proved to be reed voles and striped field mice serving as reservoirs of this infection, as well as the synanthropic foci of leptospirosis caused by L. hebdomadis with house mice serving as the main carriers.

Animals↗
PubMed1990

Evaluation of two screening tests for human leptospirosis.

Leptospirosis is prevalent in Thailand but its diagnosis depends primarily on clinical awareness. Serodiagnosis is of great assistance in the diagnosis of leptospirosis but in Thailand microagglutination (MA) is the only serodiagnosis available. MA is not rapid and it is used mainly in the referent laboratory. In addition, its roles in early diagnosis are rarely available. Rapid screening serological test which is sensitive early in the infection is needed. Latex agglutination (LA), indirect hemagglutination (IHA) were developed and evaluated in 100 MA positive sera and 200 blood donors. Later on, IHA and LA were compared with MA in 30 patients with a clinical picture compatible with leptospirosis. IHA and LA had sensitivities of 94 and 98 per cent respectively in MA positive sera. The specificity of IHA and LA in 200 blood donors was 99 and 100 per cent respectively. The study in 30 patients showed that LA and IHA were definitely more sensitive than MA test in sera collected within two weeks after the onset of fever. LA is also one of the most rapid tests for leptospirosis. With either LA or IHA human leptospirosis will be diagnosed more readily and more accurately.

Hemagglutination Tests↗
PubMed1997

Leptospirosis on Oahu: an outbreak among military personnel associated with recreational exposure.

In December 1992, a common-source waterborne outbreak of leptospirosis occurred on the island of Oahu in the state of Hawaii. Two male service persons were hospitalized with culture-confirmed leptospirosis. Eighteen others had similar histories of exposure to the same freshwater swimming site. Although six men developed signs and symptoms comparable to those of the two confirmed cases, none manifested culture or serologic evidence of leptospirosis. The increased incidence of leptospirosis in Hawaii coupled with an increased risk in young males characterize the military population in Hawaii as a high-risk population with respect to leptospirosis.

Disease Outbreaks↗
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↗
PubMed1976

[Meaning of serotype Patoc (biflexa complex) for the diagnosis of leptospirosis by microscopic agglutination test (author's transl)].

Agglutination with serotype patoc (Patoc 1) was found in 72 of 125 cases of leptospirosis. Patoc-agglutination occured frequently in leptospirosis icterohaemorrhagiae, less frequently in leptospirosis grippotyphosa and rarely in leptospirosis tarassovi. 53 cases of leptospirosis were not diagnosed when using Patoc 1 as single antigen. So we cannot recommend to use serotype patoc as the sole antigen for microscopic agglutination test. We observed 1 case in which the reaction with Patoc 1 happened earlier than the reaction with the pathogen serotypes. For this reason the battery of antigens for carrying out microscopic agglutination test should include serotype patoc, too.

Agglutination Tests↗
PubMed2003

Re: Fifty years of leptospirosis research in New Zealand: a perspective.

The article which appeared in the Jubilee Issue of the New Zealand Veterinary Journal (Marshall and Manktelow 2002) reviewed one of this country's most important zoonotic diseases. I wish to add three important references concerning its first recognition in livestock and humans in New Zealand. The first field cases of leptospirosis in calves due to Leptospira pomona (now L. interrogans serovar pomona) were confirmed in November 1951 on farms in Westland, not in Northland in 1953 as stated in the review. The seminal year for leptospirosis research was 1951 not 1953. Simultaneously, the association with human disease in New Zealand was also recognized and confirmed (Bruere 1952; Kirschner et al 1952). In that year there was a mini-epidemic of cases in Westland involving both calves and humans. It was fortuitous at the time that Kirschner had established methods for the diagnosis of leptospirosis at Otago Medical School. Despite obvious clinical signs, laboratory diagnosis of leptospirosis was not confirmed at Wallaceville (New Zealand's only animal diagnostic station available to veterinarians in 1951) because of logistic impossibilities in both transport and sample preservation. From calf sera collected in Koiterangi (now renamed Kowhitirangi) in Westland in November 1951, Kirschner confirmed my diagnosis of leptospirosis ...

Journal Article↗
PubMedDate not supplied

[Prognostic significance of the NBT test in patients with ichterohaemorrhagic leptospirosis].

The values of spontaneous NBT test significantly rise at the peak of leptospirosis in patients with an uncomplicated course of the disease (p < 0.05). Low values of the spontaneous NBT test with stimulation with Staphylococcus in patients with grave leptospirosis predict the development of life-threatening complications. Leptospirosis vaccine reduced the elevated values of the NBT in leptospirosis. The depressing effect of leptospirosis vaccine is indicative of a high risk of development of late complications.

Adolescent↗
PubMed1964

THE USE OF LEPTOSPIRA BIFLEXA PATOC ANTIGEN IN FIELD INVESTIGATIONS OF LEPTOSPIROSIS.

Hitherto the laboriousness of serological procedures for the laboratory diagnosis of leptospirosis has somewhat limited their usefulness. The authors of this paper report on a simple and sensitive genus-specific serological test for this disease that is within the capabilities of ordinary diagnostic laboratories. They describe the organization and results of a trial carried out in Romania in 1962 of a complement-fixation (CF) test in leptospirosis in which an antigen derived from the Patoc I strain of Leptospira biflexa is used. Human sera examined with this test in nine field laboratories were re-examined at the Cantacuzino Institute in Bucharest with both CF and agglutination tests.Of 152 sera found CF-positive in the field laboratories, 138 were found positive by the agglutination test in Bucharest-representing 90% agreement. There was 88% agreement between the field laboratory and central laboratory results in the CF test.The test makes possible the early detection of human leptospirosis and gives positive reactions with sera from leptospirosis patients irrespective of the causative serotype.

Agglutination Tests↗
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↗
PubMed1993

Evaluation of a passive microcapsule agglutination test for the screening of human leptospirosis.

Microcapsules, absorbed with two mixed antigens--each composed of 3 sonicated leptospira serovars--were developed in the past as a microcapsule agglutination test (MCA-LS) for the screening of clinical leptospirosis. For this study, fifty serum samples, taken at an earlier and at a later stage of illness from 25 Italian in-patients with clinical symptoms of leptospirosis, were tested with both the MCA-LS one-dilution test and the microscopic agglutination (MA) test, the confirmatory test for leptospirosis, with 18 leptospira strains circulating in Italy. Compared with MA, MCA-LS showed a sensitivity of 91.7%, and a specificity of 92.3%, including leptospirosis not sustained by the diagnostic strains used in the MCA-LS kit.

Agglutination Tests↗
PubMed1992

Epidemiology of an outbreak of leptospirosis in man and dog.

An outbreak of leptospirosis in man and dog occurred during the monsoon in Madras city, India. 48 (50.5%) of the 95 human sera tested were positive for leptospirosis. Of these, 32 showed the presence of agglutinin to serovar icterohaemorrhagiae. 20 (21.3%) of the 94 canine sera tested were positive for leptospirosis. Of these, 10 had agglutinins to serovar icterohaemorrhagiae and 9 to serovar canicola. Among murine reservoirs, 8 (25%) of 32 rat sera and 10 (41.6%) of 24 bandicoot sera were positive. Bandicoot and rat sera contained 70 and 50% of agglutinins to serovar icterohaemorrhagiae, respectively. Urine culture lead to isolate a icterohaemorrhagiae strain from a patient and a canicola one from a dog. The changing trends of epidemiology in the transmission of leptospirosis to man and dog has been discussed.

Animals↗