Leptospirosis

Harrison, N. A.; Fitzgerald, William

doi:10.1136/pgmj.64.748.163

Cited by 35 publications

(19 citation statements)

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“…However, it is worth noting that transient leptospiral shedding does occur during human infection and human-to-human infection, although extremely rare, has occurred through sexual intercourse (Doeleman 1932; Harrison and Fitzgerald 1988) and during lactation (Bolin and Koellner 1988). Transplacental transmission may occur if infection occurs during pregnancy, resulting in abortion (Chung et al 1963) or still birth (Coghlan and Bain 1969; Faine et al 1984).…”

Section: Epidemiology and Surveillancementioning

confidence: 99%

Leptospirosis in Humans

Haake

Levett

2014

Current Topics in Microbiology and Immunology

765

974

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Leptospirosis is a widespread and potentially fatal zoonosis that is endemic in many tropical regions and causes large epidemics after heavy rainfall and flooding. Infection results from direct or indirect exposure to infected reservoir host animals that carry the pathogen in their renal tubules and shed pathogenic leptospires in their urine. Although many wild and domestic animals can serve as reservoir hosts, the brown rat (Rattus norvegicus) is the most important source of human infections. Individuals living in urban slum environments characterized by inadequate sanitation and poor housing are at high risk of rat exposure and leptospirosis. The global burden of leptospirosis is expected to rise with demographic shifts that favor increases in the number of urban poor in tropical regions subject to worsening storms and urban flooding due to climate change. Data emerging from prospective surveillance studies suggest that most human leptospiral infections in endemic areas are mild or asymptomatic. Development of more severe outcomes likely depends on three factors: epidemiological conditions, host susceptibility, and pathogen virulence (Fig. 1). Mortality increases with age, particularly in patients older than 60 years of age. High levels of bacteremia are associated with poor clinical outcomes and, based on animal model and in vitro studies, are related in part to poor recognition of leptospiral LPS by human TLR4. Patients with severe leptospirosis experience a cytokine storm characterized by high levels of IL-6, TNF-alpha, and IL-10. Patients with the HLA DQ6 allele are at higher risk of disease, suggesting a role for lymphocyte stimulation by a leptospiral superantigen. Leptospirosis typically presents as a nonspecific, acute febrile illness characterized by fever, myalgia, and headache and may be confused with other entities such as influenza and dengue fever. Newer diagnostic methods facilitate early diagnosis and antibiotic treatment. Patients progressing to multisystem organ failure have widespread hematogenous dissemination of pathogens. Nonoliguric (high output) renal dysfunction should be supported with fluids and electrolytes. When oliguric renal failure occurs, prompt initiation of dialysis can be life saving. Elevated bilirubin levels are due to hepatocellular damage and disruption of intercellular junctions between hepatocytes, resulting in leaking of bilirubin out of bile caniliculi. Hemorrhagic complications are common and are associated with coagulation abnormalities. Severe pulmonary hemorrhage syndrome due to extensive alveolar hemorrhage has a fatality rate of >50 %. Readers are referred to earlier, excellent summaries related to this subject (Adler and de la Peña-Moctezuma 2010; Bharti et al. 2003; Hartskeerl et al. 2011; Ko et al. 2009; Levett 2001; McBride et al. 2005).

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Section: Epidemiology and Surveillancementioning

confidence: 99%

Leptospirosis in Humans

Haake

Levett

2014

Current Topics in Microbiology and Immunology

765

974

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“…It is thought that the low pH of human urine limits survival of leptospires after excretion. Transmission by sexual intercourse during convalescence has been reported (167,262).…”

Section: Epidemiologymentioning

confidence: 99%

2001

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Leptospirosis is a worldwide zoonotic infection with a much greater incidence in tropical regions and has now been identified as one of the emerging infectious diseases. The epidemiology of leptospirosis has been modified by changes in animal husbandry, climate, and human behavior. Resurgent interest in leptospirosis has resulted from large outbreaks that have received significant publicity. The development of simpler, rapid assays for diagnosis has been based largely on the recognition that early initiation of antibiotic therapy is important in acute disease but also on the need for assays which can be used more widely. In this review, the complex taxonomy of leptospires, previously based on serology and recently modified by a genotypic classification, is discussed, and the clinical and epidemiological value of molecular diagnosis and typing is also evaluated

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“…A positive result was confirmed by the microscopic agglutination test (MAT). In another report detailing possible human-to-human transmission, Harrison and Fitzgerald (1988) discussed the advent of possible sexual transmission of L. interrogans serovar Icterohaemorrhagie. The diagnosis of this condition was also confirmed serologically by MAT.…”

Section: Evidence Of Human-to-human Transmissionmentioning

confidence: 98%

Leptospirosis and Leptospires—The Silent Assassins

Craig

Wynwood

Collet

et al. 2014

Zoonoses - Infections Affecting Humans and Animals

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Leptospirosis is one of the most common yet under reported zoonoses. Leptospires, the etiological agents of leptospirosis are ubiquitous pathogens, with a world-wide distribution, causing a spectrum of disease ranging from a mild influenza-like illness to Weil's disease, which manifests itself in multi-organ failure. The following chapter reports on the epidemiology and transmission of the disease in humans and animals. The chapter will also delineate the symptoms observed in humans and animals and in concluding outline unresolved and evolving issues for microbiologists, epidemiologists and public health officials.

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Leptospirosis — can it be a sexually transmitted disease?

Abstract: Summary:Person to person spread of leptospirosis has not been previously reported. We describe two cases occurring in a man and wife which tantalisingly raise this possibility.

Cited by 35 publications

References 1 publication

Leptospirosis in Humans

Leptospirosis in Humans

Leptospirosis

Leptospirosis and Leptospires—The Silent Assassins

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