Factors Associated with Severe Leptospirosis, Martinique, 2010–2013

Hochedez, Patrick; Théodose, R.; Olive, Claude; Bourhy, Pascale; Hurtrel, G.; Vignier, Nicolas; Mehdaoui, Hossein; Valentino, Ruddy; Martinez, Roland; Delord, Jean-Marie; Herrmann, Cécile; Lamaury, I.; Césaire, Raymond; Picardeau, Mathieu; Cabie, André

doi:10.3201/eid2112.141099

Cited by 43 publications

(54 citation statements)

References 14 publications

(16 reference statements)

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“…2). Although our calculated threshold for lethality was as high as 10 6 leptospires/ml in blood and 10 7 leptospires/g in kidney, liver, and spleen, our findings corroborate those of previous studies in human patients with clinical leptospirosis (16,20,43), which showed that a threshold burden of 10 4 to 10 6 leptospires/ml in the blood was associated with poor outcomes.…”

Section: Discussionsupporting

confidence: 82%

“…Regardless of the inoculum dose and the challenge route, the burden in target tissues is more important for pathogenesis than the ability of the pathogen to disseminate. However, the burden of infection is correlated with disease outcomes, as has been shown in humans (16,20,43). The quantitative real-time PCR assay, which we have standardized and described here, may be useful in tracking mutant strains during the infection process to identify genes involved in penetration, dissemination, and multiplication in the host.…”

Section: Discussionmentioning

confidence: 99%

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Real-Time PCR Reveals Rapid Dissemination of Leptospira interrogans after Intraperitoneal and Conjunctival Inoculation of Hamsters

et al. 2016

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eThe pathogen Leptospira interrogans is a highly motile spirochete that causes acute and fulminant infections in humans and other accidental hosts. Hematogenous dissemination is important for infection by the pathogen but remains poorly understood because few animal model studies have used sensitive tools to quantify the bacteria. We evaluated the kinetics of leptospiral infection in Golden Syrian hamsters by a sensitive quantitative real-time PCR (TaqMan) with lipl32 as the target gene. The dissemination and bacterial burden were measured after intraperitoneal infection with a high dose (10 8 ) or low dose (2.5 ؋ 10 2 ) of leptospires. We also examined the conjunctival challenge route to mimic the natural history of infection. Quantification of leptospires in perfused animals revealed that pathogens were detected in all organs of intraperitoneally infected hamsters, including the eye and brain, within 1 h after inoculation of 10 8 virulent L. interrogans bacteria. Peaks of 10 5 to 10 8 leptospires per gram or per milliliter were achieved in blood and all tissues between day 4 and day 8 after intraperitoneal inoculation of highand low-dose challenges, respectively, coinciding with macroscopic and histological changes. The conjunctival route resulted in a delay in the time to peak organ burden in comparison to intraperitoneal infection, indicating that although infection could be established, penetration efficiency was low across this epithelial barrier. Surprisingly, infection with a large inoculum of highpassage-number attenuated L. interrogans strains resulted in dissemination to all organs in the first 4 days postinfection, albeit with a lower burden, followed by clearance from the blood and organs 7 days postinfection and survival of all animals. These results demonstrate that leptospiral dissemination and tissue invasion occur. In contrast, development of a critical level of tissue burden and pathology are dependent on the virulence of the infecting strain.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Real-Time PCR Reveals Rapid Dissemination of Leptospira interrogans after Intraperitoneal and Conjunctival Inoculation of Hamsters

et al. 2016

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“…Severe forms of leptospirosis were defined by the use of vasopressor agents for hemodynamic support and/or dialysis for acute kidney injury and/or mechanical ventilation for respiratory distress and/or death. 10,11 Climatic data of the study period (2007-2014) of the meteorological station of the Félix Eboué airport, provided by Météo France, such as cumulative daily rainfall, daily average temperature under shelter (24 observations), and daily and average humidity, were obtained.…”

Section: Methodsmentioning

confidence: 99%

Epidemiology of Human Leptospirosis in French Guiana (2007–2014): A Retrospective Study

Turnier

Mosnier

Schaub

et al. 2018

The American Journal of Tropical Medicine and Hygiene

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Leptospirosis is a worldwide zoonotic bacterial infection with a rising incidence. French Guiana is mostly covered by Amazonian rain forest. Despite a potentially favorable environment, leptospirosis has been barely studied in French Guiana. The objective of this study was to describe the current trends of leptospirosis epidemiology in French Guiana. A cross-sectional study was performed in the two main hospitals of French Guiana. Cases of leptospirosis from 2007 to 2014 were retrospectively identified with a systematic screening of serological and polymerase chain reaction results to classify them as confirmed, probable, or excluded cases. Medical files were reviewed to collect epidemiological data. Among the 72 included patients, 55 (76.4%) cases were confirmed and 17 (23.6%) were probable. The median age was 39 years (range: 16-82 years) and the M/F sex ratio 6.2. Sixty-two (86.1%) patients required hospitalization, including 12 (16.7%) in the intensive care unit. Three (4.2%) patients died. The monthly distribution of cases was correlated with rainfall ( = 0.004) and moisture ( = 0.038). Professional exposure was frequently identified (especially gold mining and construction). Among 16 different serogroups identified by microagglutination test, Icterohaemorrhagiae was the most frequent (38.0%). This study revealed an epidemiology close to that observed in Brazilian regions, and professional and climatic risk factors. The high diversity of serogroups may reveal a complex environmental reservoir requiring further investigations. Only 20% of leptospirosis patients were suspected as such on hospital admission, thus emphasizing the need to inform local physicians.

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“…9,14,15 The level of leptospiraemia, quantifi ed by PCR, has been shown to correlate with disease severity. 16 Full laboratory results were available for 10 patients. Creatine kinase was measured in one patient and was within the reference interval.…”

Section: Additional Microbiology and Virology Investigationsmentioning

confidence: 99%

Challenges in the Diagnosis of Leptospirosis Outwith Endemic Settings: A Scottish Single Centre Experience

Russell

Jones²,

O'Shea³

et al. 2018

Journal of the Royal College of Physicians of Edinburgh

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Background Leptospirosis is a zoonotic infection occurring worldwide but endemic in tropical countries. This study describes diagnostic testing for leptospirosis at our institution in Scotland over a 10-year period. Method We identified patients with blood samples referred to the Public Health England reference laboratory for leptospirosis testing between 2006 and 2016. Results A total of 480 samples were sent for IgM ELISA testing with 26 positive results from 14 patients. Two patients met criteria for 'confirmed' leptospirosis (microscopic agglutination test > 1:320 in one case and a positive PCR in the other) and the remaining 12 were 'probable' on the basis of IgM ELISA positivity, though 9 did not have microscopic agglutination testing performed. Nine infections were imported, mostly from Asia and with a history of fresh water exposure. Three co-infections (respiratory syncytial virus, influenza B and Campylobacter sp.) were identified. Conclusions Practical issues with microscopic agglutination testing (insufficient blood sent to reference laboratory) and PCR (travellers returning > 7 days after illness onset) represent challenges to the laboratory confirmation of a clinical diagnosis of leptospirosis. Co-infection and infectious/auto-immune causes of false positive serology should be evaluated.

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Factors Associated with Severe Leptospirosis, Martinique, 2010–2013

Cited by 43 publications

References 14 publications

Real-Time PCR Reveals Rapid Dissemination of Leptospira interrogans after Intraperitoneal and Conjunctival Inoculation of Hamsters

Real-Time PCR Reveals Rapid Dissemination of Leptospira interrogans after Intraperitoneal and Conjunctival Inoculation of Hamsters

Epidemiology of Human Leptospirosis in French Guiana (2007–2014): A Retrospective Study

Challenges in the Diagnosis of Leptospirosis Outwith Endemic Settings: A Scottish Single Centre Experience

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