Leptospirosis-Associated Hospitalizations, United States, 1998–2009

Traxler, Rita M.; Callinan, Laura S.; Holman, Robert C.; Steiner, Claudia; Guerra, Marta

doi:10.3201/eid2008.130450

Cited by 37 publications

(42 citation statements)

References 21 publications

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“…The majority of these patients appear to have had negative PCR results from whole blood, but individual test results are not specifically reported [15]. Although lumbar puncture cannot be recommended for all suspected cases of leptospirosis, this procedure is frequently performed in hospitalized patients in the United States (20.5% of patients in a review of 1,994 cases) [44]. If CSF is obtained, this specimen should be considered for molecular testing in suspected leptospirosis cases.…”

Section: Specimen Typesmentioning

confidence: 99%

Molecular diagnostics for human leptospirosis

Waggoner

Pinsky²

2016

Current Opinion in Infectious Diseases

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Purpose of Review The definitive diagnosis of leptospirosis, which results from infection with spirochetes of the genus Leptospira, currently relies on the use of culture, serological testing (microscopic agglutination testing, MAT), and molecular detection. The purpose of this review is to describe new molecular diagnostics for Leptospira and discuss advancements in the use of available methods. Recent Findings Efforts have been focused on improving the clinical sensitivity of Leptospira detection using molecular methods. In this review, we describe a re-optimized pathogenic species-specific real-time PCR (targeting lipL32) that has demonstrated improved sensitivity; findings by two groups that real-time RT-PCRs targeting the 16S rrs gene can improve detection; and two new loop-mediated amplification techniques. Quantitation of leptospiremia, detection in different specimen types, and the complementary roles played by molecular detection and MAT will be discussed. Finally, a protocol for Leptospira strain subtyping using variable number tandem repeat targets and high-resolution melting will be described. Summary Molecular diagnostics have an established role for the diagnosis of leptospirosis and provide an actionable diagnosis in the acute setting. The use of real-time RT-PCR for testing serum/plasma and cerebrospinal fluid, when available, may improve the detection of Leptospira without decreasing clinical specificity.

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Section: Specimen Typesmentioning

confidence: 99%

Molecular diagnostics for human leptospirosis

Waggoner

Pinsky²

2016

Current Opinion in Infectious Diseases

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“…Leptospirosis mimics many other tropical diseases and diagnosis requires a high degree of clinical suspicion [14, 17, 33]. The average annual hospitalization rate for leptospirosis in the U.S. from 1998 to 2009 was 0.6/1,000,000 population and the average length of stay and hospital charges were higher in comparison to non-leptospirosis associated hospitalizations [34]. In Brazil, untreated leptospirosis results in significant social costs in years of potential life lost and partial hospitalization costs when compared to early treatment and prevention [35].…”

Section: Leptospirosismentioning

confidence: 99%

Neglected bacterial zoonoses

Chikeka

Dumler

2015

Clinical Microbiology and Infection

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Bacterial zoonoses comprise a group of diseases in humans or animals acquired by direct contact with or by oral consumption of contaminated animal materials, or via arthropod vectors. Among neglected infections, bacterial zoonoses are among the most neglected given emerging data on incidence and prevalence as causes of acute febrile illness, even in areas where recognized neglected tropical diseases occur frequently. While many other bacterial infections could also be considered in this neglected category, five distinct infections stand out because they are globally distributed, are acute febrile diseases, have high rates of morbidity and case fatality, and are reported as commonly as malaria, typhoid or dengue virus infections in carefully designed studies in which a broad spectrum diagnoses are actively sought. Thus, this review will focus attention on leptospirosis, relapsing fever borreliosis, and rickettsioses, including scrub typhus, murine typhus and spotted fever group rickettsiosis. Of greatest interest is the lack of distinguishing clinical features among these infections when in humans, which confounds diagnosis where laboratory confirmation is lacking, and in regions where clinical diagnosis is often attributed to one of several perceived more common threats. As diseases such as malaria come under improved control, the real impact of these common and under-recognized infections will become evident, as will the requirement for the strategies and allocation of resources for their control.

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“…Although evidence that women are more susceptible to leptospirosis was reported in the past (7), more recent clinical and sero-epidemiological evidence suggests that incidence of human Leptospirosis is higher in males than in female adults and children (8), (9), (10), (11). Furthermore, its severe clinical signs requiring hospitalization are also more frequently observed in men (12), (13). Most studies focused on identification of motility factors, LPS biosynthesis and outer membrane proteins using animal models of acute Leptospirosis have been done using male hamsters (14), (15), (16), (17), (18), (19), (20); few used females and one investigator reports the use of both sexes (21), (22), (23).…”

Section: Introductionmentioning

confidence: 99%

Lethality of leptospirosis depends on sex: male hamsters succumb to infection with lower doses of pathogenic Leptospira

Guedes

Potula

et al. 2018

Preprint

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Leptospirosis is a widespread zoonotic disease caused by pathogenic spirochetes of the genus Leptospira which affect both humans and animals. A somewhat contradictory published body of evidence suggests that sex impacts severity outcomes of human Leptospirosis. In this study, we used an acute animal model of disease to analyze how male and female hamsters infected side-by-side with low but increasing doses of L. interrogans under the same exposure conditions develop Leptospirosis. We found that female hamsters were considerably more resistant to Leptospirosis given that 87.5% survived infection; male hamsters did not gain weight and 93.7% succumbed to infection with the same infectious doses. Analysis of bacterial burden in kidney of male hamsters showed that infection with the lowest dose (103) resulted in a 4Log increase of L. interrogans, whereas females infected with the same dose had a reduction of ~1Log, after 28 days of infection. Non-surviving hamsters had signs of compromised renal function (higher levels of creatinine in blood), as well as increased levels of anti-inflammatory IL-10 and innate response pro-inflammatory CCL3, CxCL10 and TNF-α in kidney, as well as ColA1 which is a marker of kidney fibrosis. In endemic areas, humans are more often exposed to the lower infection doses which were lethal to males, than the higher doses which were lethal to males and females. It is possible that the frequency of lower infectious doses in nature and increased biological susceptibility both contribute for aggravated outcomes of leptospirosis in males.

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Leptospirosis-Associated Hospitalizations, United States, 1998–2009

Abstract: Average cost and duration of hospitalizations were significantly greater than for other infectious diseases.

Cited by 37 publications

References 21 publications

Molecular diagnostics for human leptospirosis

Molecular diagnostics for human leptospirosis

Neglected bacterial zoonoses

Lethality of leptospirosis depends on sex: male hamsters succumb to infection with lower doses of pathogenic Leptospira

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