Clinical Diagnosis and Geographic Distribution of Leptospirosis, Thailand

Wuthiekanun, Vanaporn; Sirisukkarn, Nisa; Daengsupa, Prayad; Sakaraserane, Prangyong; Sangkakam, Amornwadee; Chierakul, Wirongrong; Smythe, Lee D.; Symonds, Meegan L.; Dohnt, Michael F.; Slack, Andrew T.; Day, Nicholas P. J.; Peacock, Sharon J.

doi:10.3201/eid1301.060718

Cited by 64 publications

(63 citation statements)

References 2 publications

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“…28 However, in several studies reporting serologic surveys in local populations in Southeast Asia, serogroup Icterohaemorrhagiae was not shown to be the dominant serogroup. [29][30][31][32] Leptospirosis was seen as multi-organ failure and a potentially life-threatening disease in many of our patients. This type of manifestation was significantly more common in patients presumptively infected with serogroup Icterohaemorrhagiae.…”

Section: Discussionmentioning

confidence: 99%

Travel-Related Leptospirosis in Israel: A Nationwide Study

Leshem¹,

Segal²,

Barnea³

et al. 2010

The American Society of Tropical Medicine and Hygiene

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Abstract. Leptospirosis is re-emerging in developed countries as a travel-related infection. In this nationwide study of travel-related leptospirosis in Israel, all cases diagnosed at the Central Reference Laboratory for Leptospirosis, during 2002Leptospirosis, during -2008 were retrospectively reviewed and only travel-related cases were included. During the study years, 20 (42%) of 48 leptospirosis cases in Israel were travel-related. Exposure occurred in Southeast Asia in 15 (75%) of 20 cases. The estimated yearly incidence of travel-related leptospirosis was 1.78/100,000 travelers compared with an incidence of endemic cases of 0.06/100,000 inhabitants (risk ratio = 29.6, 95% confidence interval = 16.7-52.4). Most patients (89%) were infected during water-related activities. Severe disease was present in 10 (55%) of 18 patients; 7 of them were presumptively infected with the Icterohaemorrhagiae serogroup. Thus, travel-related leptospirosis is becoming increasingly important in the epidemiology of leptospirosis in Israel. Leptospirosis should be suspected in any traveler with undifferentiated febrile illness, especially when water exposure is reported.

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Section: Discussionmentioning

confidence: 99%

Travel-Related Leptospirosis in Israel: A Nationwide Study

Leshem¹,

Segal²,

Barnea³

et al. 2010

The American Society of Tropical Medicine and Hygiene

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“…In one study in Thailand, the positive predictive accuracy of a hospital-based diagnosis of leptospirosis in nine provinces was low, with only 143 out of 700 (20%) suspected cases being confirmed by laboratory testing. The causes of illness in the remaining 80% of cases were not found 5 . Furthermore, routine laboratory data are generally nonspecific; either a normal differential white blood cell count or a predominance of polymorphonuclear leucocytes is generally seen in leptospirosis cases.…”

Section: Introductionmentioning

confidence: 97%

“…A diagnosis may be made on the basis of the clinical presentation and symptoms that show characteristics of the severe disease form together with a suggestive epidemiological history 3,4 . However, a clinical diagnosis of leptospirosis is often inaccurate because the disease shares clinical features with a range of other infectious diseases [5][6][7][8] . Some of these other viral and bacterial infections, including some arboviruses (e.g., dengue fever, Oropouche fever and yellow fever), Brazilian spotted fever, viral hepatitis and hantaviruses, are matters of public health concern in tropical countries and may be related to the misdiagnosis of leptospirosis 9,10 .…”

Section: Introductionmentioning

confidence: 99%

Atypical lymphocytosis in leptospirosis: a cohort of hospitalized cases between 1996 and 2009 in State of Rio de Janeiro, Brazil

Damasco

Ávila

Barbosa

et al. 2011

Rev. Soc. Bras. Med. Trop.

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INTRODUCTION: Leptospirosis is a zoonotic disease found in tropical and temperate countries, and its clinical diagnostic confusion with arboviruses (dengue fever, oropouche fever and yellow fever), Brazilian spotted fever, viral hepatitis and hantaviruses has been an ongoing public health concern. The aim of this observational study was to demonstrate an association between findings of atypical lymphocytosis and the progression of endemic leptospirosis. METHODS: A retrospective analysis was performed on the demographic, epidemiological, clinical and laboratory aspects of 27 human leptospirosis cases that occurred over a period of 13 years (1996-2009) with no reported epidemic outbreaks in Rio de Janeiro, Brazil. RESULTS: The overall mortality rate was 11.1% in our cohort of hospitalized cases. However, there was no mortality among patients with atypical lymphocytosis (OR = 11.1; 95% CI = 1.12-110.9; p = 0.04). Two patients who were in the septicemic phase showed signs of expansion of γδ T cell responses in peripheral blood. CONCLUSIONS: Atypical lymphocytosis may be observed in patients with leptospirosis. Our observations suggest that these atypical leukocyte subsets are associated with partial protection during the disease course of leptospirosis.

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“…For this reason, we evaluated the analytic validity of an immunoglobulin M immunoblot (IgM-IB) assay for the diagnosis of acute leptospirosis. Using a mixture of local blood culture isolates (34,40,46), we identified several low-molecular-weight antigens that were recognized by antibodies in a high percentage of sera from patients with early disease. Inclusion of these low-molecular-weight antigens in the diagnostic criteria resulted in an IgM-IB test with superior sensitivity for diagnosis of acute leptospirosis.…”

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confidence: 99%

Early Diagnosis of Leptospirosis by Immunoglobulin M Immunoblot Testing

Doungchawee

Kositanont

Niwetpathomwat

et al. 2008

Clin Vaccine Immunol

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There is an urgent need for the development of serodiagnostic approaches with improved sensitivity for patients with acute leptospirosis. Immunoblots were performed on 188 sera collected from 74 patients with laboratory-confirmed early leptospiral infection to detect immunoglobulin M (IgM) antibodies to antigens pooled from 10 leptospiral strains prevalent in Thailand. Sera from patients with other febrile diseases served as controls. IgM reactivity to seven distinct antigens, with apparent molecular masses of 14 to 18, 19 to 23, 24 to 30, 32, 35/36, 37, and 41/42 kDa, was observed. The low-molecular-mass 14-to 18-kDa band was the most frequently detected antigen, being recognized in sera from 82.4% of patients during the first 3 days after the onset of symptoms. We evaluated the accuracy of the IgM immunoblot (IgM-IB) test by using reactivity to the 14-to 18-kDa band and/or at least two bands among the 19-to 23-, 24-to 30-, 32-, 35/36-, 37-, and 41/42-kDa antigens as the diagnostic criterion. The sensitivities of the IgM-IB test and the microscopic agglutination test (MAT) were 88.2% and 2.0%, respectively, with sera from patients 1 to 3 days after the onset of symptoms. In contrast, the IgM-IB test was positive with only 2/48 (4.2%) sera from patients with other febrile illnesses. The high sensitivity and specificity of the IgM-IB test for acute leptospirosis would provide greatly improved diagnostic accuracy for identification of patients who would benefit from early antibiotic intervention. In addition, the antigens identified by the IgM-IB test may serve as components of a rapid, accurate, point-of-care diagnostic test for early leptospirosis.

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Clinical Diagnosis and Geographic Distribution of Leptospirosis, Thailand

Cited by 64 publications

References 2 publications

Travel-Related Leptospirosis in Israel: A Nationwide Study

Travel-Related Leptospirosis in Israel: A Nationwide Study

Atypical lymphocytosis in leptospirosis: a cohort of hospitalized cases between 1996 and 2009 in State of Rio de Janeiro, Brazil

Early Diagnosis of Leptospirosis by Immunoglobulin M Immunoblot Testing

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