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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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Acute leptospirosis and rainfall by month, Nicaragua 2008–9.
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pntd-0002941-g003: Acute leptospirosis and rainfall by month, Nicaragua 2008–9.

Mentions: Epidemiologic and clinical characteristics of patients with and without acute leptospirosis are detailed in Tables 1 and 2, respectively. Those with and without acute leptospirosis had similar durations of illness (median 3.5 [IQR 2–6] vs. 3 [IQR 1–5] days, p = 0.10) and times to convalescent follow-up (14 days [IQR 14–31] versus 15 days [IQR 14–28], p = 0.73). Patients with acute leptospirosis were older (median 18 years, IQR 10–37) than febrile patients without acute leptospirosis (median 9 years, IQR 2–27), p = 0.0009 (Table 1 and Figure 2). The proportion of patients with leptospirosis that were male vs. female was similar (55% vs. 53%, respectively, p = 0.82). Acute leptospirosis was a more common cause of fever in rural than in urban residents (12.6% vs. 3.8%, p<0.001). Patients reporting pig exposure were both more likely to report rural residence (60% vs. 40%, p<0.001) and more likely to have confirmed acute leptospirosis (45% vs. 23%, p = 0.001). However, rural residence was associated with a statistically significant increased risk of acute leptospirosis even in the absence of reported pig exposure (10.2% vs. 3.2%, p = 0.003). Patients with acute leptospirosis were more likely to report fresh water exposure than were others (36.4 vs. 10.3%, p<0.001), which was predominantly river exposure (34.1% vs. 9.7%, p<0.001). Acute leptospirosis occurred throughout the year, but 11.3% of the febrile cohort had acute leptospirosis in rainy May to October (median rainfall 364.6 cm, IQR 145.0–539.8 cm) versus 4.8% of the cohort in drier November to April (median 0 cm, IQR 0–1.2 cm), p = 0.003. The largest number of acute leptospirosis cases occurred in October and November, when leptospirosis accounted for 20% (13/66) and 14% (10/70) cases of acute febrile illness, respectively (Figure 3). Fresh water exposure was also associated with acute leptospirosis (reported in 36.4% with leptospirosis vs. 10.33% without leptospirosis, p<0.001), and fresh water exposure was reported as commonly (by 11.4% of patients) in the wet season as in the dry season.


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)

Acute leptospirosis and rainfall by month, Nicaragua 2008–9.
© Copyright Policy
Related In: Results  -  Collection

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

pntd-0002941-g003: Acute leptospirosis and rainfall by month, Nicaragua 2008–9.
Mentions: Epidemiologic and clinical characteristics of patients with and without acute leptospirosis are detailed in Tables 1 and 2, respectively. Those with and without acute leptospirosis had similar durations of illness (median 3.5 [IQR 2–6] vs. 3 [IQR 1–5] days, p = 0.10) and times to convalescent follow-up (14 days [IQR 14–31] versus 15 days [IQR 14–28], p = 0.73). Patients with acute leptospirosis were older (median 18 years, IQR 10–37) than febrile patients without acute leptospirosis (median 9 years, IQR 2–27), p = 0.0009 (Table 1 and Figure 2). The proportion of patients with leptospirosis that were male vs. female was similar (55% vs. 53%, respectively, p = 0.82). Acute leptospirosis was a more common cause of fever in rural than in urban residents (12.6% vs. 3.8%, p<0.001). Patients reporting pig exposure were both more likely to report rural residence (60% vs. 40%, p<0.001) and more likely to have confirmed acute leptospirosis (45% vs. 23%, p = 0.001). However, rural residence was associated with a statistically significant increased risk of acute leptospirosis even in the absence of reported pig exposure (10.2% vs. 3.2%, p = 0.003). Patients with acute leptospirosis were more likely to report fresh water exposure than were others (36.4 vs. 10.3%, p<0.001), which was predominantly river exposure (34.1% vs. 9.7%, p<0.001). Acute leptospirosis occurred throughout the year, but 11.3% of the febrile cohort had acute leptospirosis in rainy May to October (median rainfall 364.6 cm, IQR 145.0–539.8 cm) versus 4.8% of the cohort in drier November to April (median 0 cm, IQR 0–1.2 cm), p = 0.003. The largest number of acute leptospirosis cases occurred in October and November, when leptospirosis accounted for 20% (13/66) and 14% (10/70) cases of acute febrile illness, respectively (Figure 3). Fresh water exposure was also associated with acute leptospirosis (reported in 36.4% with leptospirosis vs. 10.33% without leptospirosis, p<0.001), and fresh water exposure was reported as commonly (by 11.4% of patients) in the wet season as in the dry season.

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