Abstract. A leptospirosis surveillance program was carried out for 12 months on the entire population of the Seychelles. Diagnosis was assessed by both microagglutination test and polymerase chain reaction (PCR) assay. In this population of 74,331, leptospirosis was clinically suspected in 125 subjects and confirmed in 75 patients (incidence of 101 per 100,000; 95% confidence interval ϭ 79-126). Leptospirosis was more frequent in middle-aged males with environmental exposure. Eight serogroups were identified and Icterohaemorrhagiae (31%) and Hurstbridge (20%) were the most frequent. Hurstbridge, a recently identified new serogroup, was implicated in severe cases and death. Influenza-like forms accounted for 37% of the cases while jaundice, acute renal failure, and pulmonary hemorrhage occurred in 52%, 28%, and 19%, respectively. Death occurred in six patients and was related to pulmonary hemorrhage. The PCR result was positive after completion of treatment in eight patients, suggesting that the administered five-day course of penicillin may be inadequate to eradicate the bacteria.

An assay device for the rapid detection of Leptospira-specific immunoglobulin M (IgM) antibodies in human sera is presented. The sensitivity (85.8%) and specificity (93.6%) of the assay compared well (91.9% agreement) with those of an IgM enzyme-linked immunosorbent assay routinely used in the serodiagnosis of leptospirosis. The sensitivity of the assay varied with the stage of the disease. The assay uses stabilized components and is simply performed by the addition of serum and sample fluid to the sample well of the assay device. The assay is read after 10 min, and a positive result is obtained when staining of the test line is observed.As the clinical symptoms and signs of leptospirosis often are nonspecific, the disease is easily mistaken for other major infectious diseases. Manifestations of leptospirosis may vary, and different types of disease may be observed, from relatively mild influenza-like symptoms to severe disease with renal failure, liver impairment, and haemorrhage (Weil's syndrome). Meningismus and (aseptic) meningitis can be observed as well. Because of the wide variety of symptoms, leptospirosis is easily confused with many other fibril illnesses including haemorrhagic fevers, e.g., dengue fever (7). Laboratory testing to confirm the clinical diagnosis thus is essential for optimal treatment and patient management. The laboratory diagnosis of leptospirosis mainly depends on serology (8). The microscopic agglutination test (MAT) (5, 31) is considered the reference test for leptospirosis, but the enzyme-linked immunosorbent assay (ELISA) (2, 15-17, 19, 32, 34, 36) and a number of other tests including the immunofluorescent-antibody test (IFAT) (3), the slide agglutination test (9), the macrocapsule agglutination test (4), and the hemagglutination test (13,28,29) can be used as well. Drawbacks of the standard diagnostic assays like MAT, ELISA, and IFAT are that they are not very easy to perform, require special and expensive equipment, depend on the availability of electricity and refrigeration, or can be applied only by trained personnel. Hence, these assays are available only in a few specialized laboratories. MAT, which is considered the reference test for leptospirosis, is rarely performed by routine diagnostic laboratories.Leptospirosis has been reported from countries all over the world (1). Sporadic cases of leptospirosis may occur in countries with moderate climates. The disease, however, can be endemic in countries with wet and warm climates. People living under poor socioeconomical and hygienic conditions are at particular risk of getting the disease. Outbreaks have been reported (6, 11, 12, 14, 20-23, 27, 30, 33). Most people at risk cannot depend on health care facilities supported by laboratories capable of performing the more complicated standard laboratory assays. We previously developed a dipstick assay for the detection of Leptospira-specific immunoglobulin M (IgM) antibodies in human sera (10,20,(24)(25)(26)35). This assay can be used outside the specialized laboratory and may e...

These data indicate a high incidence of leptospirosis in Seychelles. This suggests that leptospires are likely to be ubiquitous and that effective leptospirosis control in tropical countries needs a multifactorial approach including major behaviour change by large segments of the general public.

We examined the cause of death during a 12-month period (1995196) in all consecutive patients admitted to hospital with leptospiral infection in Seychelles (Indian Ocean), where the disease is endemic. Leptospirosis was diagnosed by use of the microscopic agglutination test and a specific polymerase chain reaction assay on serum samples. Seventy-five cases were diagnosed and 6 patients died, a case fatality of 8%. All 6 patients died within 9 days of onset of symptoms and within 2 days of admission for 5 of them (5 days for the 6th). On autopsy, diffuse bilateral pulmonary haemorrhage (PH) was found in all fatalities. Renal, cardiac, digestive and cerebral haemorrhages were also found in 5,3,3 and 1 case(s), respectively. Incidentally, haemoptysis and lung infiltrate on chest radiographs, which suggest PH, were found in 8 of the 69 non-fatal cases. Dengue and hantavirus infections were ruled out. In conclusion, PH appeared to be a main cause of death in leptospirosis in this population, although haemorrhage in other organs may also have contributed to fatal outcomes. This cause of death contrasts with the findings generally reported in endemic settings.

Leptospirosis is an often severe disease which requires prompt treatment. Laboratory testing is required to reach a valid diagnosis. An agglutination assay for the detection of Leptospira‐specific antibodies consisting of individually wrapped agglutination cards containing a stable, dried detection reagent is evaluated. The assay is simply performed by suspending the dried reagent with a drop of serum. The result is obtained within 30 s. The sensitivity of the assay varied with the stage of the disease and was 72.3% for samples collected during the first 10 days of the illness and 88.2% for samples collected at a later stage. The specificity was 93.9% and 89.8%, respectively. These characteristics make the test ideal for use in areas where the disease is common and where laboratory support is not routinely available.