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Unsuspected leptospirosis is a cause of acute febrile illness in Nicaragua.

Reller ME, Wunder EA, Miles JJ, Flom JE, Mayorga O, Woods CW, Ko AI, Dumler JS, Matute AJ - PLoS Negl Trop Dis (2014)

Bottom Line: The sensitivity of clinical impression and acute-phase IgM detected by ELISA were poor.Leptospirosis is a common (6.3%) but unrecognized cause of acute febrile illness in Nicaragua.Rapid point-of-care tests to support early diagnosis and treatment as well as tests to support population-based studies to delineate the epidemiology, incidence, and clinical spectrum of leptospirosis, both ideally pathogen-based, are needed.

View Article: PubMed Central - PubMed

Affiliation: Division of Medical Microbiology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America; Hubert-Yeargan Center for Global Health, Durham, North Carolina, United States of America.

ABSTRACT

Background: Epidemic severe leptospirosis was recognized in Nicaragua in 1995, but unrecognized epidemic and endemic disease remains unstudied.

Methodology/principal findings: To determine the burden of and risk factors associated with symptomatic leptospirosis in Nicaragua, we prospectively studied patients presenting with fever at a large teaching hospital. Epidemiologic and clinical features were systematically recorded, and paired sera tested by IgM-ELISA to identify patients with probable and possible acute leptospirosis. Microscopic Agglutination Test and PCR were used to confirm acute leptospirosis. Among 704 patients with paired sera tested by MAT, 44 had acute leptospirosis. Patients with acute leptospirosis were more likely to present during rainy months and to report rural residence and fresh water exposure. The sensitivity of clinical impression and acute-phase IgM detected by ELISA were poor.

Conclusions/significance: Leptospirosis is a common (6.3%) but unrecognized cause of acute febrile illness in Nicaragua. Rapid point-of-care tests to support early diagnosis and treatment as well as tests to support population-based studies to delineate the epidemiology, incidence, and clinical spectrum of leptospirosis, both ideally pathogen-based, are needed.

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Study participants with a diagnosis of confirmed acute leptospirosis, Nicaragua 2008–9.
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pntd-0002941-g001: Study participants with a diagnosis of confirmed acute leptospirosis, Nicaragua 2008–9.

Mentions: We tested paired sera by IgM ELISA to identify a subset of patients with probable and possible acute leptospirosis to be confirmed by MAT and/or PCR (Figure 1). In those with probable acute leptospirosis (IgM seroconversion by ELISA and/or the equivalent of a 4-fold rise in IgM titer), paired sera were tested by both MAT and PCR to confirm acute leptospirosis. In those with possible acute leptospirosis (stable, decreasing, or less than 4-fold rise in titer), paired sera were tested by MAT only if the convalescent-phase sera screened positive (titer 200 for a pathogenic serogroup) by MAT. In this latter group with possible acute leptospirosis, PCR was performed only for MAT-confirmed acute leptospirosis. Finally, PCR was performed in a subset of patients with unlikely acute leptospirosis (convalescent serum positive by ELISA but negative by MAT).


Unsuspected leptospirosis is a cause of acute febrile illness in Nicaragua.

Reller ME, Wunder EA, Miles JJ, Flom JE, Mayorga O, Woods CW, Ko AI, Dumler JS, Matute AJ - PLoS Negl Trop Dis (2014)

Study participants with a diagnosis of confirmed acute leptospirosis, Nicaragua 2008–9.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4109853&req=5

pntd-0002941-g001: Study participants with a diagnosis of confirmed acute leptospirosis, Nicaragua 2008–9.
Mentions: We tested paired sera by IgM ELISA to identify a subset of patients with probable and possible acute leptospirosis to be confirmed by MAT and/or PCR (Figure 1). In those with probable acute leptospirosis (IgM seroconversion by ELISA and/or the equivalent of a 4-fold rise in IgM titer), paired sera were tested by both MAT and PCR to confirm acute leptospirosis. In those with possible acute leptospirosis (stable, decreasing, or less than 4-fold rise in titer), paired sera were tested by MAT only if the convalescent-phase sera screened positive (titer 200 for a pathogenic serogroup) by MAT. In this latter group with possible acute leptospirosis, PCR was performed only for MAT-confirmed acute leptospirosis. Finally, PCR was performed in a subset of patients with unlikely acute leptospirosis (convalescent serum positive by ELISA but negative by MAT).

Bottom Line: The sensitivity of clinical impression and acute-phase IgM detected by ELISA were poor.Leptospirosis is a common (6.3%) but unrecognized cause of acute febrile illness in Nicaragua.Rapid point-of-care tests to support early diagnosis and treatment as well as tests to support population-based studies to delineate the epidemiology, incidence, and clinical spectrum of leptospirosis, both ideally pathogen-based, are needed.

View Article: PubMed Central - PubMed

Affiliation: Division of Medical Microbiology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America; Hubert-Yeargan Center for Global Health, Durham, North Carolina, United States of America.

ABSTRACT

Background: Epidemic severe leptospirosis was recognized in Nicaragua in 1995, but unrecognized epidemic and endemic disease remains unstudied.

Methodology/principal findings: To determine the burden of and risk factors associated with symptomatic leptospirosis in Nicaragua, we prospectively studied patients presenting with fever at a large teaching hospital. Epidemiologic and clinical features were systematically recorded, and paired sera tested by IgM-ELISA to identify patients with probable and possible acute leptospirosis. Microscopic Agglutination Test and PCR were used to confirm acute leptospirosis. Among 704 patients with paired sera tested by MAT, 44 had acute leptospirosis. Patients with acute leptospirosis were more likely to present during rainy months and to report rural residence and fresh water exposure. The sensitivity of clinical impression and acute-phase IgM detected by ELISA were poor.

Conclusions/significance: Leptospirosis is a common (6.3%) but unrecognized cause of acute febrile illness in Nicaragua. Rapid point-of-care tests to support early diagnosis and treatment as well as tests to support population-based studies to delineate the epidemiology, incidence, and clinical spectrum of leptospirosis, both ideally pathogen-based, are needed.

Show MeSH
Related in: MedlinePlus