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Fulltext Emerging Infectious Disease Implications of Invasive Mammalian Species: The Greater White-Toothed Shrew (Crocidura russula) Is Associated With a Novel Serovar of Pathogenic Leptospira in Ireland

Nally JE, Arent Z, Bayles DO, Hornsby RL, Gilmore C, Regan S, et al.

PLoS Negl Trop Dis, 2016 12;10(12):e0005174.
PMID: 27935961 DOI: 10.1371/journal.pntd.0005174

The greater white-toothed shrew (Crocidura russula) is an invasive mammalian species that was first recorded in Ireland in 2007. It currently occupies an area of approximately 7,600 km2 on the island. C. russula is normally distributed in Northern Africa and Western Europe, and was previously absent from the British Isles. Whilst invasive species can have dramatic and rapid impacts on faunal and floral communities, they may also be carriers of pathogens facilitating disease transmission in potentially naive populations. Pathogenic leptospires are endemic in Ireland and a significant cause of human and animal disease. From 18 trapped C. russula, 3 isolates of Leptospira were cultured. However, typing of these isolates by standard serological reference methods was negative, and suggested an, as yet, unidentified serovar. Sequence analysis of 16S ribosomal RNA and secY indicated that these novel isolates belong to Leptospira alstonii, a unique pathogenic species of which only 7 isolates have been described to date. Earlier isolations were limited geographically to China, Japan and Malaysia, and this leptospiral species had not previously been cultured from mammals. Restriction enzyme analysis (REA) further confirms the novelty of these strains since no similar patterns were observed with a reference database of leptospires. As with other pathogenic Leptospira species, these isolates contain lipL32 and do not grow in the presence of 8-azagunaine; however no evidence of disease was apparent after experimental infection of hamsters. These isolates are genetically related to L. alstonii but have a novel REA pattern; they represent a new serovar which we designate as serovar Room22. This study demonstrates that invasive mammalian species act as bridge vectors of novel zoonotic pathogens such as Leptospira.

Matched MeSH terms: Leptospira/classification; Leptospira/drug effects; Leptospira/isolation & purification*; Leptospira/pathogenicity
Antigenic potential of a recombinant polyvalent DNA vaccine against pathogenic leptospiral infection

Garba B, Bahaman AR, Zakaria Z, Bejo SK, Mutalib AR, Bande F, et al.

Microb Pathog, 2018 Nov;124:136-144.
PMID: 30138761 DOI: 10.1016/j.micpath.2018.08.028

Leptospirosis is a serious epidemic disease caused by pathogenic Leptospira species. The disease is endemic in most tropical and sub-tropical regions of the world. Currently, there is no effective polyvalent vaccine for prevention against most of the circulating serovars. Moreover, development of an efficient leptospiral vaccine capable of stimulating cross-protective immune responses against a wide range of serovars remains a daunting challenge. This, in part, is associated with the extensive diversity and variation of leptospiral serovars from region to region. In this study, a multi-epitope DNA vaccine encoding highly immunogenic epitopes from LipL32 and LipL41 was designed using in-silico approach. The DNA encoding antigenic epitopes was constructed from conserved pathogenic Leptospira genes (LipL32 and LipL41). Immunization of golden Syrian hamsters with the multi-epitope chimeric DNA vaccine resulted in the production of both agglutinating and neutralizing antibodies as evidence by MAT and in-vitro growth inhibition tests respectively. The antibodies produced reacted against eight different serovars and significantly reduced renal colonization following in vivo challenge. The vaccine was also able to significantly reduce renal colonization which is a very important factor responsible for persistence of leptospires among susceptible and reservoir animal hosts. In conclusion, the leptospiral multi-epitope chimeric DNA vaccine can serve as a potentially effective and safe vaccine against infection with different pathogenic leptospiral serovars.

Matched MeSH terms: Leptospira/genetics; Leptospira/immunology*
Development of multiplex loop mediated isothermal amplification (m-LAMP) label-based gold nanoparticles lateral flow dipstick biosensor for detection of pathogenic Leptospira

Nurul Najian AB, Engku Nur Syafirah EA, Ismail N, Mohamed M, Yean CY

Anal Chim Acta, 2016 Jan 15;903:142-8.
PMID: 26709307 DOI: 10.1016/j.aca.2015.11.015

In recent years extensive numbers of molecular diagnostic methods have been developed to meet the need of point-of-care devices. Efforts have been made towards producing rapid, simple and inexpensive DNA tests, especially in the diagnostics field. We report on the development of a label-based lateral flow dipstick for the rapid and simple detection of multiplex loop-mediated isothermal amplification (m-LAMP) amplicons. A label-based m-LAMP lateral flow dipstick assay was developed for the simultaneous detection of target DNA template and a LAMP internal control. This biosensor operates through a label based system, in which probe-hybridization and the additional incubation step are eliminated. We demonstrated this m-LAMP assay by detecting pathogenic Leptospira, which causes the re-emerging disease Leptospirosis. The lateral flow dipstick was developed to detect of three targets, the LAMP target amplicon, the LAMP internal control amplicon and a chromatography control. Three lines appeared on the dipstick, indicating positive results for all representative pathogenic Leptospira species, whereas two lines appeared, indicating negative results, for other bacterial species. The specificity of this biosensor assay was 100% when it was tested with 13 representative pathogenic Leptospira species, 2 intermediate Leptospira species, 1 non-pathogenic Leptospira species and 28 other bacteria species. This study found that this DNA biosensor was able to detect DNA at concentrations as low as 3.95 × 10(-1) genomic equivalent ml(-1). An integrated m-LAMP and label-based lateral flow dipstick was successfully developed, promising simple and rapid visual detection in clinical diagnostics and serving as a point-of-care device.

Matched MeSH terms: Leptospira
Fulltext Leptospirosis: recent incidents and available diagnostics - a review

Yuszniahyati Y, Kenneth FR, Daisy Vanitha J

Med J Malaysia, 2015 Dec;70(6):351-5.
PMID: 26988208

OBJECTIVE: The aim of this article was to review published research articles on leptospirosis, in particular the recent incidence of leptospirosis in Malaysia and the currently available diagnostic methods for the detection of leptospirosis.

METHODS: PubMed, Google Scholar and Google Search databases were searched using the key words Leptospira and leptospirosis. A total of seventy-six references were reviewed including sixty-seven research articles, three annual reports from Ministry of Health and six online newspaper articles. This review includes the following five sub-headings: introduction, leptospirosis transmission, leptospirosis incidents, laboratory diagnosis of leptospirosis and treatment and prevention of leptospirosis.

RESULTS: An increase in incidents of leptospirosis cases has been seen in recent years in Malaysia. The recent floods have contributed to the rise in the number of reported cases. Current diagnostic approaches such as dark field microscopy, microscopic agglutination test (MAT), Polymerase chain reaction and serological tests are inadequate as the organism is a slow grower.

CONCLUSION: There is an urgent need to develop newer techniques for rapid detection of leptospirosis. The combination of PCR and ELISA are suggested for rapid and accurate diagnosis of leptospirosis. Studies on the mechanism of pathogenesis of Leptospira are needed for the development of vaccines that are safe for human use.

Matched MeSH terms: Leptospira
Fulltext Circulating interleukins in leptospirosis with pulmonary involvement patients

Wan Shahriman Yushdie Wan Yusoff, Maha Abdullah, Fairuz Amran, Zamberi Sekawi, Muhammad Yazli Yuhana, Syafinaz Amin Nordin

Malaysian Journal of Medicine and Health Sciences, 2019;15(108):48-48.
MyJurnal

Introduction: Leptospirosis is a re-emerging zoonotic disease caused by Leptospira bacteria. The clinical manifes-tations of leptospirosis include mild-fever to a severe or even fatal. Increased levels of inflammatory cytokines pro-duced in response to the Leptospira infection by the host immune system were hypothesized as among the causes of severity in leptospirosis. Besides the classical presentation with the triad of febrile, jaundice, and renal failure, patients with leptospirosis also can pose with predominant sign and symptoms of pulmonary involvement. This study aimed to compare the levels of TNF-α, IL-1b, IL-4, IL-6, IL-8, IL-10, IL-12, IL-13, IL-17A, IL-18, and IL-22 In the plasma of samples of leptospirosis patients with and without pneumonia. Methods: Circulating cytokine levels in plasma were measured in seventeen patients hospitalized and diagnosed with leptospirosis in Malaysia (January 2016 – December 2017) and nineteen healthy individuals as controls. Patients were categorized into leptospirosis without pneumonia (n=12) and with pneumonia (n=5). Cytokine was measured using SimplePlexTM assays (San Jose, CA, USA). Measurement was performed in triplicate and statistical analysis was conducted using Graphpad® Prism v6 (San Diego, CA, USA). Results: Elevation of plasma TNF-α, IL-6, IL-8, IL-10, IL-18, and IL-22 levels were observed among leptospirosis patients with pneumonia compared to without, although no statistical differences were observed between these two groups. Conclusion: There are no significant differences observed between the levels of plasma TNF-α, IL-6, IL-8, IL-10, IL-18, and IL-22 in patients with pneumonia compared to without.

Matched MeSH terms: Leptospira
Fulltext Combined PCR and MAT improves the early diagnosis of the biphasic illness leptospirosis

Philip N, Affendy NB, Masri SN, Yuhana MY, Than LTL, Sekawi Z, et al.

PLoS One, 2020;15(9):e0239069.
PMID: 32915919 DOI: 10.1371/journal.pone.0239069

The diagnosis of leptospirosis remains a challenge due to its non-specific symptoms and the biphasic nature of the illness. A comprehensive diagnosis that includes both molecular (polymerase chain reaction (PCR)) and serology is vital for early detection of leptospirosis and to avoid misdiagnosis. However, not all samples could be subjected to both tests (serology and molecular) due to budget limitation, infrastructure, and technical expertise at least in resource-limited countries. We evaluated the usefulness of testing the clinically suspected leptospirosis cases with both techniques on all samples collected from the patients on the day of admission. Among the 165 patient's blood/serum samples tested (from three hospitals in Central Malaysia), 43 (26%) showed positivity by microscopic agglutination test (MAT), 63 (38%) by PCR, while 14 (8%) were positive by both MAT and PCR. For PCR, we tested two molecular targets (lipL32 by qPCR and 16S rDNA or rrs by nested PCR) and detected lipL32 in 47 (29%) and rrs gene in 63 (38%) patients. The use of more than one target gene for PCR increased the detection rates. Hence, a highly sensitive multiplex PCR targeting more than one diagnostic marker is recommended for the early detection of Leptospira in suspected patients. When the frequencies for positivity detected either by MAT or PCR combined, leptospirosis was diagnosed in a total of 92 (56%) patients, a higher frequency compared to when samples were only tested by a single method (MAT or PCR). The results from this study suggest the inclusion of both serology and molecular methods for every first sample irrespective of the days post-onset of symptoms (DPO) collected from patients for early diagnosis of leptospirosis.

Matched MeSH terms: Leptospira
Fulltext Linkages between Chiropteran diversity and ecosystem services for sustainable fragmented forest conservation

Fakhrul-Hatta SNN, Nelson BR, Shafie NJ, Zahidin MA, Abdullah MT

Data Brief, 2018 Dec;21:2089-2094.
PMID: 30533456 DOI: 10.1016/j.dib.2018.11.058

This data article informs about Chiropteran diversity, new records, ecosystem services and possible pathogen carriers in fragmented forests (sub-divided by utility corridors, man-made structures, untouched and secondary plantations) within districts Setiu (Setiu Research Station), Hulu Terengganu (Saok and Lasir waterfalls) and Besut (Gunung Tebu Forest Reserve) of state Terengganu, Peninsular Malaysia. These bats were captured using harp traps and mist nets that were set 10 m apart across flyways, streams and less cluttered trees in the 50 m × 50 m transect zones (identified at each site). All animals were distinguished by morphology and gender before their release at the site of capture. The data comprise of five bat family groups Hipposideridae, Megadermatidae, Pteropodidae, Rhinolophidae and Vespertilionidae. It is interesting to note that untouched Saok Waterfalls is home to wide variety of bats listed (68.8%), followed by secondary forests of Gunung Tebu Forest Reserve (24.8%), untouched Lasir Waterfalls (4.8%) and lastly, Setiu Research Station as least favored (1.6%). Chiroptera like Cynopterus brachyotis (n = 23, 37.7%), Hipposideros bicolor (n = 6, 9.8%) and Scotophilus kuhli (n = 6, 9.8%) were most dominant in the checklist whereas Hipposideros armiger, Murina suilla and Scotophilus kuhlii are new data records in the fragmented forests of Terengganu. The data were interpret into Shannon, Simpson, Margalef, Menhinik and Evenness indices to individually or collectively distinguish chiropteran variety in Terengganu State whereas weight-forearm length (W/FA) informs about chiropteran Body Condition Index (-0.25 to 0.25). The function of bats were also identified to distinguish service providers (pollination and forests regeneration) and zoonotic pathogen carriers (in particular to Leptospira bacteria, Nipah virus and Sindbis virus).

Matched MeSH terms: Leptospira
Fulltext Leptospiral Infection, Pathogenesis and Its Diagnosis-A Review

Samrot AV, Sean TC, Bhavya KS, Sahithya CS, Chan-Drasekaran S, Palanisamy R, et al.

Pathogens, 2021 Feb 01;10(2).
PMID: 33535649 DOI: 10.3390/pathogens10020145

Leptospirosis is a perplexing conundrum for many. In the existing literature, the pathophysiological mechanisms pertaining to leptospirosis is still not understood in full. Considered as a neglected tropical zoonotic disease, leptospirosis is culminating as a serious problem worldwide, seemingly existing as co-infections with various other unrelated diseases, including dengue and malaria. Misdiagnosis is also common as non-specific symptoms are documented extensively in the literature. This can easily lead to death, as the severe form of leptospirosis (Weil's disease) manifests as a complex of systemic complications, especially renal failure. The virulence of Leptospira sp. is usually attributed to the outer membrane proteins, including LipL32. With an armament of virulence factors at their disposal, their ability to easily adhere, invade and replicate within cells calls for a swift refinement in research progress to establish their exact pathophysiological framework. As an effort to reconstitute the current knowledge on leptospirosis, the basis of leptospiral infection, including its risk factors, classification, morphology, transmission, pathogenesis, co-infections and clinical manifestations are highlighted in this review. The various diagnostic techniques are also outlined with emphasis on their respective pros and cons.

Matched MeSH terms: Leptospira
Fulltext In vitro antileptospiral activity of trigona thoracia propolis and its synergistic effects with commonly prescribed antibiotics

Siti Radziah Ismail

IIUM Medical Journal Malaysia, 2020;19(1):13-22.
MyJurnal

Introduction: Trigona thoracica propolis is known to have antimicrobial properties, however its
antileptospiral properties and its synergistic effects with commonly prescribed antibiotics are scarcely
documented. This study aimed to evaluate the antileptospiral properties of Trigona thoracica against
pathogenic Leptospira species (spp.) and to study its synergistic effects with commonly prescribed
antibiotics. Materials and Methods: The tested Leptospira serovars were Australis, Bataviae, Canicola and
Javanica. Aqueous extract propolis (AEP) and ethanolic extracts propolis (EEP) were used. Broth dilution
methods were used to determine the Minimum Inhibitory Concentration (MIC), Minimum Bactericidal
Concentration (MBC) and the synergistic effects between the propolis and the tested antibiotics. The
synergistic effects was evaluated by using the fractional inhibitory concentration (FIC) index. Morphological
changes of the treated Leptospira were observed under a Scanning Electron Microscope (SEM). Results: The
AEP and EEP were found to have antileptospiral properties against the tested Leptospira spp. The synergy
result showed that only combination of AEP and penicillin G against serovar Australis has demonstrated
synergistic effect with the FIC index of 0.38. Morphological study using SEM showed significant structural
changes of the treated Leptospira spp. Conclusions: The result suggests that Trigona thoracica propolis could
potentially be used as either a complimentary or an alternative therapeutic agent against pathogenic
Leptospira spp.

Matched MeSH terms: Leptospira
Fulltext A review of human leptospirosis in Malaysia

El Jalii IM, Bahaman AR

Trop Biomed, 2004 Dec;21(2):113-9.
PMID: 16493403 MyJurnal

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.

Matched MeSH terms: Leptospira
Fulltext Serological prevalance of leptospiral infection in captive Malayan porcupiness (Hystrix brachyura)

Siti-Nurdyana, A.K., Bahaman, A.R., Sharma, R.S.K., Azlan, C.M., Abdul Razak, M.F.A.

Jurnal Veterinar Malaysia, 2016;28(2):1-3.
MyJurnal

Leptospirosis is recognised as one of the leading zoonotic diseases and rodents have been implicated as one of the natural reservoirs of the disease. The Malayan porcupines (Hystrix brachyura) which are also a rodent could possibly be a carrier of leptospiral organisms. This study was conducted to determine the serological prevalence of leptospiral infection among captive Malayan porcupines and to disclose the possibility of porcupines as a reservoir for leptospiral infection. Fifty serum samples were obtained from the Malayan porcupines kept in captivity at the Wildlife Conservation Centre, Sungai Dusun, Malaysia. The microscopic agglutination test (MAT) was performed on the serum samples to detect the presence of agglutinating antibodies to a panel of 16 Leptospira serovars (Australis, Autumnalis, Ballum, Bataviae, Canicola, Celledoni, Djasiman, Hardjobovis, Hardjopratjino, Hebdomadis, Hurstbridge, Icterohaemorrhagiae, Javanica, Pomona, Pyrogenes and Sejroe). From the serological test, 18% (n=9/50) of the Malayan porcupines tested had leptospiral antibodies to serovars Javanica (8%), Hurstbridge (4%), Ballum (2%), Celledoni (2%) and Hardjoprajitno (2%). It is seen that this study disclosed a high prevalence of leptospiral infection in the Malayan porcupines tested and indicated that the Malayan porcupines could possibly be a source of leptospirosis to other animals including humans and that they might play an important role in the epidemiology of leptospiral infection in the country.

Matched MeSH terms: Leptospira
Fulltext Diversity of Leptospira spp. in Rats and Environment from Urban Areas of Sarawak, Malaysia

Pui CF, Bilung LM, Apun K, Su'ut L

J Trop Med, 2017;2017:3760674.
PMID: 28348601 DOI: 10.1155/2017/3760674

Various prevalence studies on Leptospira in animals and humans, as well as environmental samples, had been conducted worldwide, including Malaysia. However, limited studies have been documented on the presence of pathogenic, intermediate, and saprophytic Leptospira in selected animals and environments. This study was therefore conducted to detect Leptospira spp. in rats, soil, and water from urban areas of Sarawak using the polymerase chain reaction (PCR) method. A total of 107 rats, 292 soil samples, and 324 water samples were collected from April 2014 to February 2015. Pathogenic Leptospira was present in 5.6% (6/107) of rats, 11.6% (34/292) of soil samples, and 1.9% (6/324) of water samples. Intermediate Leptospira was present in 2.7% (8/292) of soil samples and 1.9% (6/324) of water samples. Saprophytic Leptospira was present in 10.3% (11/107) of rats, 1.4% (4/292) of soil samples, and 0.3% (1/324) of water samples. From this study, 76 Leptospira spp. were isolated. Based on DNA sequencing, the dominant Leptospira spp. circulating in urban areas of Sarawak are pathogenic Leptospira noguchii, intermediate Leptospira wolffii serovar Khorat, and saprophytic Leptospira meyeri, respectively. Overall, this study provided important surveillance data on the prevalence of Leptospira spp. from rats and the environment, with dominant local serovars in urban areas of Sarawak.

Matched MeSH terms: Leptospira
Fulltext The effect of pH on the survival of leptospires in water

Smith CE, Turner LH

Bull World Health Organ, 1961;24(1):35-43.
PMID: 20604084

One of the factors on which the incidence of leptospirosis is dependent is the survival time of shed leptospires in surface water or soil water, and this time is in turn affected by the acidity or alkalinity of the water. The authors have therefore studied the survival of four leptospiral serotypes in buffered distilled water at pH's ranging from 5.3 to 8.0. All survived longer in alkaline than in acid water, and significant differences between the serotypes were found in response to pH. Survival at pH's under 7.0 ranged from 10 to 117 days and at pH's over 7.0 from 21 to 152 days. Survival was also studied in aqueous extracts of soil samples from different areas in Malaya; no correlation was found between pH and survival time.It was also noted that in a group of Malayan ricefields a low incidence of leptospirosis in man was accompanied by a high infection rate among rodents, and when it was found that this phenomenon could not be explained by pH or salinity, attention was turned to the soil. Bentonite clay, similar to the montmorrillonite clay of the ricefields, was found to adsorb about half the leptospires in suspension. The authors recommend that field study of this laboratory observation be undertaken.

Matched MeSH terms: Leptospira
Recombinant LipL32 Protein Developed Using a Synthetic Gene Detects Leptospira-specific Antibodies in Human Serum Samples

Yaakob Y, Rodrigues KF, Opook F, William T, John DV

Malays J Med Sci, 2017 Oct;24(5):44-51.
PMID: 29386971 DOI: 10.21315/mjms2017.24.5.5

Background: Synthetic biology is emerging as a viable alternative for the production of recombinant antigens for diagnostic applications. It offers a safe alternative for the synthesis of antigenic principles derived from organisms that pose a high biological risk.
Methods: Here, we describe an enzyme-linked immunosorbent assay (ELISA) using the synthetic recombinant LipL32 (rLipL32) protein expressed in Escherichia coli for the detection of Leptospira-specific antibodies in human serum samples. The rLipL32-based ELISA was compared with a microscopic agglutination test (MAT), which is currently used as the gold standard for the diagnosis of leptospirosis.
Results: Our results showed that all the MAT-positive serum samples were positive for Leptospira-specific IgG in an ELISA, while 65% (n = 13) of these samples were also positive for Leptospira-specific IgM. In the MAT-negative serum samples, 80% and 55% of the samples were detected as negative by an ELISA for Leptospira-specific IgM and IgG, respectively.
Conclusion: An ELISA using the synthetic rLipL32 antigen was able to distinguish Leptospira-specific IgM (sensitivity 65% and specificity 80%) and IgG (sensitivity 100% and specificity 55%) in human serum samples and has the potential to serve as a rapid diagnostic test for leptospirosis.

Matched MeSH terms: Leptospira
Fulltext Production and characterization of a polyclonal antibody of anti-rLipL21-IgG against leptospira for early detection of acute leptospirosis

Seenichamy A, Bahaman AR, Mutalib AR, Khairani-Bejo S

Biomed Res Int, 2014;2014:592858.
PMID: 24860824 DOI: 10.1155/2014/592858

Leptospirosis is one of the zoonotic diseases in animals and humans throughout the world. LipL21 is one of the important surface-exposed lipoproteins in leptospires and the most effective cross protective immunogenic antigen. It is widely considered as a diagnostic marker for leptospirosis. In this study, we evaluated the serodiagnostic potential of LipL21 protein of Leptospira interrogans serovar Pomona. We have successfully amplified, cloned, and expressed LipL21 in E. coli and evaluated its specificity by immunoblotting. Purified recombinant LipL21 (rLipL21) was inoculated into rabbits for the production of polyclonal antibody. Characterization of the purified IgG antibody against rLipL21 was performed by cross reactivity assay. Only sera from leptospirosis patients and rabbit hyperimmune sera recognized rLipL21 while the nonleptospirosis control sera showed no reaction in immunoblotting. We confirmed that anti-rLipL21-IgG antibody cross reacted with and detected only pathogenic leptospiral species and it did not react with nonpathogenic leptospires and other bacterial species. Results observed showed that anti-rLipL21-IgG antibody has high specificity and sensitivity to leptospires. The findings indicated that the antibody could be used in a diagnostic assay for detection of leptospires or their proteins in the early phase of infection.

Matched MeSH terms: Leptospira/immunology*
Acute renal failure after a holiday in the tropics

Guron G, Holmdahl J, Dotevall L

Clin. Nephrol., 2006 Dec;66(6):468-71.
PMID: 17176921 DOI: 10.5414/cnp66468

A 20-year-old, previously healthy woman, presented with high fever, headache and myalgia 3 days after her return from a holiday in Southeast Asia. Laboratory data on admission demonstrated a pronounced increase in plasma creatinine, marked thrombocytopenia and moderately elevated liver aminotransferases. After having ruled out malaria, dengue fever was primarily suspected and supportive intravenous fluid therapy was initiated. Still, 1 day after admission, platelet counts dropped even further and she became anuric although she did not appear hypovolemic. On day 2 after admission, urine production commenced spontaneously and the patient slowly recovered. All laboratory test results had returned to normal approximately 2 months later. Serological analysis for dengue fever was negative. It turned out that the patient had been trekking in the jungle while in Thailand and we, therefore, analyzed serology for Leptospira spirochetes which was clearly positive. The patient was diagnosed with leptospirosis which is a serious condition associated with a high mortality when complicated by acute renal failure. Differential diagnoses in patients with acute renal failure and tropical infections are reviewed. The importance of early recognition of leptospirosis, and prompt treatment with antibiotics in suspected cases, is emphasized.

Matched MeSH terms: Leptospira/immunology
From the Centers for Disease Control and Prevention. Update: outbreak of acute febrile illness among athletes participating in Eco-Challenge-Sabah 2000--Borneo, Malaysia, 2000

JAMA, 2001 Feb 14;285(6):728-30.
PMID: 11236770
Matched MeSH terms: Leptospira/isolation & purification*
Serological prevalence of leptospiral infection in domestic animals in West Malaysia

Bahaman AR, Ibrahim AL, Adam H

Epidemiol Infect, 1987 Oct;99(2):379-92.
PMID: 3678399

A cross-sectional serological survey of domestic animals in West Malaysia revealed that 25.5% of the animals examined had agglutinating antibodies to one or more antigens belonging to Leptospira interrogans. Significant prevalence of infection was observed in cattle (40.5%), buffaloes (31%) and pigs (16%). The Sejroe serogroup was shown to be the principal one involved in cattle and buffaloes, and to a lesser extent the Tarassovi and Pomona serogroups. Evidence of infection in domestic animals by strains bearing the other seven antigens appeared insignificant and was indicative of sporadic infection. A majority of the large (semi-intensive) cattle and buffalo farms demonstrated a high prevalence of leptospiral infection. In both species of domestic animals mentioned above, the prevalence of infection was significantly higher (P = 0.01) in the semi-intensive farms than in the smallholdings. Amongst cattle, the droughtmasters had the highest prevalence whilst the Kedah-Kelantan (an indigenous breed) had the lowest prevalence of leptospiral infection. In general, the temperate breeds of cattle had a significantly (P = 0.01) higher prevalence of infection than local breeds. Leptospiral infection in goats and sheep was shown to be sporadic, and the Pomona serogroup was the principal leptospiral serogroup involved in these small ruminants. The prevalence of infection in pigs was observed to decline during the study period, and it is suspected that pigs in West Malaysia are the maintenance host for serovar pomona whilst cattle are the maintenance host for serovar hardjo. Overall, it appears that domestic animals in Malaysia will play a bigger role in the epidemiology of leptospiral infection with the advent of sophisticated farming.

Matched MeSH terms: Leptospira interrogans/immunology
Fulltext Hypocalcemia, hypochloremia, and eosinopenia as clinical predictors of leptospirosis: A retrospective study

Fish-Low CY, Balami AD, Than LTL, Ling KH, Mohd Taib N, Md Shah A, et al.

J Infect Public Health, 2020 Feb;13(2):216-220.
PMID: 31455598 DOI: 10.1016/j.jiph.2019.07.021

BACKGROUND: Underestimation of leptospirosis cases is happening in many countries. The most common factor of underreporting is misdiagnosis. Considering the limitations of direct detection of pathogen and serological diagnosis for leptospirosis, clinical features and blood tests though non-specific are usually referred in making presumptive diagnosis to decide disease management.
METHODS: In this single-centre retrospective study, comparative analysis on clinical presentations and laboratory findings was performed between confirmed leptospirosis versus non-leptospirosis cases.
RESULTS: In multivariate logistic regression evidenced by a Hosmer-Lemeshow significance value of 0.979 and Nagelkerke R square of 0.426, the predictors of a leptospirosis case are hypocalcemia (calcium <2.10mmol/L), hypochloremia (chloride <98mmol/L), and eosinopenia (absolute eosinophil count <0.040×109/L). The proposed diagnostic scoring model has a discriminatory power with area under the curve (AUC) 0.761 (p<0.001). A score value of 6 reflected a sensitivity of 0.762, specificity of 0.655, a positive predictive value of 0.38, negative predictive value of 0.91, a positive likelihood ratios of 2.21, and a negative likelihood ratios of 0.36.
CONCLUSION: With further validation in clinical settings, implementation of this diagnostic scoring model is helpful to manage presumed leptospirosis especially in the absence of leptospirosis confirmatory tests.

Matched MeSH terms: Leptospira/isolation & purification
Seroprevalence of leptospiral antibodies among market workers and food handlers in the central state of Malaysia

Samsudin S, Sakinah SNS, Malina O, Norliza BA, Noh MA, Fairuz A, et al.

Trop Med Int Health, 2018 03;23(3):327-333.
PMID: 29356240 DOI: 10.1111/tmi.13033

OBJECTIVE: The high prevalence of leptospirosis in humans is of great public health concern, particularly in tropical and subtropical regions. This study aimed to determine the seroprevalence of leptospiral antibodies and distribution of serovars, and to assess the usefulness of enzyme-linked immunosorbent assay (ELISA) as a screening method for leptospiral antibodies in a high-risk healthy community.
METHODS: Cross-sectional study of 231 market workers and food handlers in wet markets and food premises from two localities in central Malaysia. Respondents' background information was obtained using a questionnaire. Serum samples were tested for leptospiral antibodies using ELISA and microscopic agglutination test (MAT).
RESULTS: Seroprevalence of leptospirosis among healthy workers was 46.3%. Detection of seropositivity was higher by MAT (46%) than ELISA (15%). We observed high seropositivity among local workers (49%), food handlers (49.5%), females (60.8%) and those aged 34 years and older (46.3%). Local strain LEP175 was the predominant serovar, followed by WHO strain Patoc.
CONCLUSION: Overall seroprevalence among healthy food handlers and market workers was high in this study. The workplace places susceptible individuals at risk of leptospirosis.

Matched MeSH terms: Leptospira/isolation & purification*

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