Leptospirosis in Human Pregnancy followed by Death of the Foetus

Coghlan, Joyce D.; Bain, A. D.

doi:10.1136/bmj.1.5638.228

Cited by 38 publications

(13 citation statements)

References 3 publications

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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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“…Fatality rates vary depending upon bacterial strain characteristics, geographic region, patient age and levels of support given to patients, but may be upwards of 20% (Dupont et al., 1997; Vinetz, 1997; Dahler et al., 1999; Faine et al., 1999; Kobayashi, 2001; Levett, 2001; Plank and Dean, 2002; Theilen et al., 2002; Bharti et al., 2003; Lopes et al., 2004; Cachay and Vinetz, 2005). Leptospira can also be transmitted from mother to foetus, which may result in spontaneous abortion or neonatal death (Coghlan and Bain, 1969; Feigin and Anderson, 1975; Shaked et al., 1993; Vinetz, 1997; Faine et al., 1999; Levett, 2001; Plank and Dean, 2002; Bharti et al., 2003). In fact, one of the most common features of leptospirosis in animals is reproductive failure, which includes abortions, stillbirths and infertility.…”

Section: Leptospirosismentioning

confidence: 99%

Leptospiral Uveitis – There Is More to It Than Meets the Eye!

Verma

Stevenson

2012

Zoonoses and Public Health

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Summary Leptospirosis, caused by pathogenic species of genus Leptospira, is a highly prevalent zoonotic disease throughout many parts of the world, and an important emerging disease within the United States. Uveitis is a common complication of systemic infection in humans. A similar condition in horses is characterized by recurrent bouts of inflammation. In this article, we review advances in our understanding of leptospiral uveitis and its pathogenic mechanisms.

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“…Leptospirosis, still another spirochetal disease, has also been associated with transplacental infection and stillbirth. 40,41 Although not a spirochetal disease, trypanosomiasis, better known as African sleeping sickness and transmitted by the tsetse fly, has been associated with stillbirth. 42 The parasites, Trypanosoma brucei, have been demonstrated in the placentas of dead fetuses.…”

Section: Infection and Stillbirthmentioning

confidence: 99%