Human leptospirosis in The Federated States of Micronesia: a hospital-based febrile illness survey

Abstract

BackgroundHuman leptospirosis is an emerging infectious disease of global significance, and is endemic to several countries in the Pacific. Zoonotic transmission dynamics combined with diagnostic challenges lead to difficulties in prevention and identification of cases. The Federated States of Micronesia (FSM) lacks surveillance data for human leptospirosis. This hospital-based serologic survey sought to estimate the burden of leptospirosis, collect information relating to associated factors, and assess the leptospirosis point-of-care rapid diagnostic test (RDT) commonly used in FSM.MethodsA four-month hospital-based survey was conducted in Pohnpei State, FSM in 2011. Patients with undifferentiated fevers presenting to hospital were referred for enrolment by physicians. Consenting participants provided paired blood specimens 10–30 days apart, and responded to interview questions regarding demographics, clinical symptoms, exposure to animals, and environmental exposure. Blood samples were subjected to immunochromatographic RDT and confirmed by microscopic agglutination test (MAT).ResultsOf 54 participants tested by MAT, 20.4% (95% confidence interval [CI] 10.1–30.6%) showed serologic evidence of acute infection. Occupation student (odds ratio [OR], 17.5; 95% CI: 1.9–161.1) and recreational gardening (OR, 8.6; 95% CI: 1.0-73.8), identified by univariate logistic regression, were associated with infection. The local rapid diagnostic test (RDT) performed with a sensitivity of 69.2 (42.3-89.3 CI) and specificity of 90.0 (81.6-95.6 CI) compared to MAT.ConclusionsThis study demonstrated a high burden of leptospirosis in Pohnpei. Further work is warranted to identify additional risk factors and opportunities to control leptospirosis in Pohnpei and other Pacific settings.

Determinants of clinical leptospirosis in Nepal

“…Thus, there are large variabilities in the risk factors for human infection from one country to another. Risk factors for human infection are related to occupational exposures such as abattoir workers, veterinarians, agriculture workers (Colt et al, ; Kamath, Swain, Pattanshetty, & Nair, ; Keenan, Ervin, Aung, McGwin, & Jolly, ); direct contact with livestock, dogs or rodents (Keenan et al, ); recreational exposures such as swimming, triathlons, kayaking, or poor personal hygiene; suboptimal sanitation; and flooding (Levett, ).…”

Unravelling infectious disease eco-epidemiology using Bayesian networks and scenario analysis: A case study of leptospirosis in Fiji

“…17,20 The Pacific Islands are particularly vulnerable to the health impacts of climate change because of all of the sociodemographic, geographic, and environmental factors mentioned above, 21,22 and leptospirosis causes significant health impact in the region. [23][24][25][26][27][28] Over the past decades, Fiji has experienced increasing incidence and outbreaks of leptospirosis. 27,[29][30][31] Two post-flooding outbreaks occurred in 2012, resulting in over 500 cases and 40 deaths.…”

In Vivo -Expressed Proteins of Virulent Leptospira interrogans Serovar Autumnalis N2 Elicit Strong IgM Responses of Value in Conclusive Diagnosis

“…Increased economic and recreational activity in pristine areas as well as flooding associated with climatic change has increased human exposure to leptospires. Indeed, several large outbreaks have been reported in Nicaragua (1, 2), Brazil (3), New Caledonia (4), the Federated States of Micronesia (5), Japan (6), and India (7)(8)(9)(10) in recent years. Conventionally, culture positivity, seroconversion, or 4-fold rises in microscopic agglutination test (MAT) titers are demonstrated for confirmation of leptospirosis.…”