Leptospiral renal colonization status in asymptomatic rural population of Tiruchirapalli district, Tamilnadu, India

Sivasankari, Karikalacholan; Shanmughapriya, Santhanam; Natarajaseenivasan, Kalimuthusamy

doi:10.1080/20477724.2016.1222054

Cited by 11 publications

(9 citation statements)

References 22 publications

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“…We considered it worthwhile to conduct PCR to complement the MAT, in view of the fact that at least two studies had presented evidence of urinary shedding of Leptospira by asymptomatic, MAT-negative individuals, using PCR to identify leptospiral DNA in urine samples. 43,44 Analyses were conducted using the method, including the primer/probe sequences, described by Stoddard et al 45 and modified to increase sensitivity as described by Galloway and Hoffmaster. 46…”

Section: Methodsmentioning

confidence: 99%

Investigating Possible Infectious Causes of Chronic Kidney Disease of Unknown Etiology in a Nicaraguan Mining Community

Kulldorff

Friedman

et al. 2019

The American Journal of Tropical Medicine and Hygiene

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. A chronic kidney disease of unknown etiology (CKDu) has been killing workers in Central America. Occupational heat stress is thought to play an important role. Leptospirosis and hantavirus have been suggested as additional possible risk factors. In a case–control study in a Nicaraguan mining community, a structured survey was administered to adults, and biological measurements and specimens were taken. Serum was analyzed for antibodies to Leptospira and hantavirus. Before statistical analysis, a board-certified nephrologist determined final case and control status based on serum creatinine and other laboratory values. Multivariable analysis was by logistic regression. In sensitivity analyses, cases were restricted to those diagnosed with CKDu in the previous 3 years. Of 320 eligible participants, 112 were classified as presumptive cases, 176 as controls and 32 as indeterminant. The risk of CKDu in those ever having worked in mining or construction was 4.4 times higher than in other participants (odds ratio = 4.44, 95% CI: 1.96–10.0, P = 0.0003). Eighty-three (26%) of the 320 participants were seropositive for at least one tested strain of Leptospira . No evidence of a causal link between leptospirosis or hantavirus and CKDu was found. The sensitivity analyses provide some evidence against the hypotheses that leptospirosis or hantavirus leads to CKDu within a few years . A major limitation was the impossibility of determining the absolute or relative timing of infection and CKDu onset. A prospective cohort design, with repeated collection of specimens over several years, could yield clearer answers about infections as potential etiologic agents in CKDu.

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Section: Methodsmentioning

confidence: 99%

Investigating Possible Infectious Causes of Chronic Kidney Disease of Unknown Etiology in a Nicaraguan Mining Community

Kulldorff

Friedman

et al. 2019

The American Journal of Tropical Medicine and Hygiene

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“…In Tamil Nadu, India, positive urine leptospira DNA was identified from 52.7% (129 of 245) asymptomatic participants. Serological results showed that 20.4% (50 of 245) of persons with urine DNA positivity were even negative for MAT indicating that deficient immunity may allow the persistence of carrier status [33]. In Nicaragua, after a major outbreak of leptospirosis in 1995, 85 out of 566 (15.0%) persons were found to be seropositive by immunoglobulin M enzyme-linked immunosorbent assay, in which only 25 (29.4%) reported having a febrile illness during the preceding 2 months; the remaining 60 (70.6%) had asymptomatic infection [34].…”

Section: Leptospirosis Chronic Carrier and Ckdmentioning

confidence: 99%

Leptospirosis Renal Disease: Emerging Culprit of Chronic Kidney Disease Unknown Etiology

Yang¹

2017

Nephron

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Leptospirosis is the most prevalent zoonosis affecting more than 1 million populations worldwide. Interestingly, leptospirosis endemic regions coincide with chronic kidney disease (CKD) hotspots largely due to flooding and agricultural overlaps. Acute leptospirosis induces multiple organ dysfunction including acute kidney injury and may predispose to CKD and end-stage renal disease, if not treated timely. Asymptomatic infection may carry the bacteria in the kidney and CKD progresses insidiously. Histologic finding of leptospirosis renal disease includes tubulointerstitial nephritis, interstitial fibrosis, and tubular atrophy. Proximal tubule dysfunction and hypokalemia are observed in adult male workers with leptospirosis, a characteristic similarity to CKD unknown etiology (CKDu). CKDu is a form of CKD that is not attributable to traditional risk factors clustering in agricultural communities affecting young male farmers. Kidney pathology shows a chronic tubulointerstitial disease. CKDu is being reported as an endemic nephropathy across the globe. Recent surveys suggest that asymptomatic leptospira renal colonization is an overlooked risk for renal fibrosis and CKDu. Population with anti-leptospira seropositivity is associated with lower estimated glomerular filtration rate in endemic regions and carrier may progress to CKD. Leptospirosis has been considered as a risk factor for CKDu in Sri Lanka and in Mesoamerican area. Sugarcane workers in Nicaragua showed increased anti-leptospira seropositivity and higher urinary biomarkers for kidney injury. Emerging evidence with signs of infection were reported in these endemic population, indicating that leptospira exposure could play a role in CKDu as a cause of primary kidney disease or a susceptible factor when secondary injury such as heat stress or dehydration aggravates kidney disease. Therefore, leptospirosis as an emerging culprit of CKDu deserves further in-depth investigation.

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“…In general, it is accepted that humans can excrete Leptospira for weeks to months after an infection 30 ; however, a recent study in the Peruvian Amazon found that asymptomatic individuals without serological evidence of recent exposure were shedding either pathogenic or intermediately pathogenic Leptospira in their urine 31 . Another study in India used PCR to find that Leptospira was excreted in the urine by 30.2% of the asymptomatic individuals investigated 32 . It is not known whether the excretion of Leptospira in urine is a characteristic of asymptomatic leptospirosis, and we did not assess the excretion of Leptospira in our subjects.…”

Section: Discussionmentioning

confidence: 99%

High incidence of asymptomatic leptospirosis among urban sanitation workers from Kota Kinabalu, Sabah, Malaysian Borneo

Jeffree

Mori

Yusof

et al. 2020

Sci Rep

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Leptospirosis is a public health challenge in Sabah State of Malaysian Borneo. Rapid urbanization, rural-to-urban migration, and undocumented immigration in Sabah have increased the pressure on the urban garbage disposal system. Rodents and other small animals thrive under these conditions. We hypothesized that urban sanitation workers would be at risk of developing leptospirosis. In total, 303 urban sanitation workers with a mean age of 42.6 years were enrolled in this study. The serum samples collected from these workers were subjected to the microscopic agglutination test (MAT), PCR and nucleotide sequencing of the amplicons to confirm the presence of Leptospira. The phylogenetic analysis using the neighbor joining method was performed to assess whether they were pathogenic. In this study 43.8% (133/303) of the samples were MAT-seropositive and among them, 29 (21.8%) were positive by PCR. Nucleotide sequencing of the amplicons confirmed the presence of Leptospira. Phylogenetic analysis showed that our strains belonged to the pathogenic group of Leptospira. A high proportion of urban sanitation workers were seropositive for leptospirosis, and a considerable number were PCR positive for Leptospira, thereby indicating asymptomatic infections. Further research is needed to confirm whether this is a transient phenomenon or antibiotic therapy is required.

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Leptospiral renal colonization status in asymptomatic rural population of Tiruchirapalli district, Tamilnadu, India

Cited by 11 publications

References 22 publications

Investigating Possible Infectious Causes of Chronic Kidney Disease of Unknown Etiology in a Nicaraguan Mining Community

Investigating Possible Infectious Causes of Chronic Kidney Disease of Unknown Etiology in a Nicaraguan Mining Community

Leptospirosis Renal Disease: Emerging Culprit of Chronic Kidney Disease Unknown Etiology

High incidence of asymptomatic leptospirosis among urban sanitation workers from Kota Kinabalu, Sabah, Malaysian Borneo

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