Cluster of Leptospirosis Cases Among Children in France (original) (raw)
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An observational study to detect leptospirosis in Mumbai, India, 2000
Archives of Disease in Childhood, 2003
Background: Leptospirosis is relatively uncommon in children. Following torrential rains and flooding an outbreak of leptospirosis was suspected in Mumbai. Aims: To investigate the possibility of an outbreak of leptospirosis and describe the clinical illness. Methods: From 24 July to 14 September 2000, children with a history of abrupt onset of high fever (.39˚C), who presented to our hospital, were admitted and tested serologically for anti-Leptospira antibodies by a quantitative enzyme linked immunosorbent assay (ELISA) test. An IgM titre of more than 20U/ml confirmed the diagnosis of leptospirosis. Clinical features in the confirmed leptospirosis and leptospirosis negative groups were analysed. Results: Of 53 children screened, 18 (34%) had leptospirosis. In all 18, the disease was anicteric and responded well to intravenous penicillin. Four clinical features present at the time of admission were significantly associated with leptospirosis: a history of contact with flood water (18/18 v 16/35), conjunctival suffusion (5/18 v 1/35), abdominal pain (9/18 v 5/35), and skin rash (5/18 v 1/35). As the number of these four features concomitantly present increased, the chances of the child having leptospirosis also increased significantly. A history of contact with flood water had a sensitivity of 100%, and the presence of conjunctival suffusion, abdominal pain, and skin rash had a specificity of 97%, 86%, and 97%, respectively, for identifying children with leptospirosis. Conclusion: Leptospirosis should be suspected in febrile children with contact with flood water.
REVIEW LEPTOSPIROSIS, A CLINICAL UPDATE REGARDING A NEGLECTED INFECTIOUS DISEASE
2021
Leptospirosis is one of the neglected infectious diseases locally widespread and extremely significant in tropical areas due to its great epidemic potential. It is a worldwide public health problem in view of the emergence and reemergence of the disease due to lack of sanitation and negligence, among other factors. In fact, leptospirosis infects more than 1 million people per year, resulting in almost 60,000 deaths. Human infection generally takes place after skin exposure to soil and/or water contaminated with urine of chronically infected mammals. The clinical presentations of the disease vary from a slight fever, goosebumps and flu-like symptoms to the acute forms of the disease. Understanding the main aspects of the disease is paramount due to the many unspecific signs and symptoms as well as frequently mistaken diagnosis. In this article, we discuss the epidemiological, immunopathogenic, clinical and prophylactic aspects of this condition with the purpose of clarifying an up to date panorama of the subject.
LEPTOSPIROSIS, A CLINICAL UPDATE REGARDING A NEGLECTED INFECTIOUS DISEASE
Leptospirosis is one of the neglected infectious diseases locally widespread and extremely significant in tropical areas due to its great epidemic potential. It is a worldwide public health problem in view of the emergence and reemergence of the disease due to lack of sanitation and negligence, among other factors. In fact, leptospirosis infects more than 1 million people per year, resulting in almost 60,000 deaths. Human infection generally takes place after skin exposure to soil and/or water contaminated with urine of chronically infected mammals. The clinical presentations of the disease vary from a slight fever, goosebumps and flu-like symptoms to the acute forms of the disease. Understanding the main aspects of the disease is paramount due to the many unspecific signs and symptoms as well as frequently mistaken diagnosis. In this article, we discuss the epidemiological, immunopathogenic, clinical and prophylactic aspects of this condition with the purpose of clarifying an up to date panorama of the subject.
Clustered cases of leptospirosis in Rochefort, France, June 2001
Euro surveillance : bulletin Européen sur les maladies transmissibles = European communicable disease bulletin, 2002
Five clustered cases of leptospirosis were diagnosed in the area of Rochefort, France, in June 2001, among teenagers who had swum in the Genouillé canal. The symptoms included fever, headache, abdominal pain and vomiting, chills and myalgia. Three cases were confirmed by PCR and serology. The mean cumulative duration of bathing was significantly higher in cases (23.8 hours) compared to controls (14.4 hours). No other particular risk factor was observed. The environmental investigation revealed the presence of rodents excreting of leptospires near the bathing area. For all antigens considered, the occurence of seropositive rodents was 30.8%, L. icterohaemorrhagiae being the predominant serogroup (23,1%).
… de Salud Pública, 2011
To determine the frequency of human leptospirosis in the sera of suspected clinical cases sent by 14 Caribbean countries for diagnosis to a regional laboratory in 1997-2005. Methods. All serum samples were initially tested using the immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA) for leptospirosis. Demographic data (such as age and sex), month of the year and clinical manifestations that had been observed by the attending physician were related to seropositivity. The microscopic agglutination test (MAT) was used to serotype sera using a panel of 23 international serovars. Results. Of 3 455 samples tested, 452 (13.1%) were seropositive for IgM antibodies to leptospirosis by the ELISA, with frequencies significantly (P < 0.05; χ 2 ) different across countries and years. Among seropositive patients, the frequency of detection of leptospirosis (23.1%) was significantly higher in the age groups 1-20 years and 31-40 years combined compared with other age groups; and in male patients (72.1%) compared with female patients (19.7%) (P < 0.05; χ 2 ). Chills, jaundice, vomiting, weakness, diarrhea, and kidney failure/problems were significantly (P < 0.05; χ 2 ) exhibited at a higher frequency in seropositive, rather than seronegative patients. Using the MAT on 100 sera tested, 98 (98%) were seropositive, of which the serogroup Icterohaemorrhagiae was most prevalent with the detection of serovars Copenhageni (70%), Icterohaemorrhagiae (67%), and Mankarso (29%). Conclusions. Since only 13.1% of the suspected cases of leptospirosis were seropositive for IgM ELISA antibodies, other clinical conditions may have been responsible for the clinical manifestations observed, or the patient may have had chronic leptospirosis (IgG). In the Caribbean, serovars of the serogroup Icterohaemorrhagiae were responsible for most infections in the cases tested.
Diagnosis of Human Leptospirosis by Monoclonal Antibody-Based Antigen Detection in Urine
Journal of Clinical Microbiology, 2002
Hybridomas secreting specific monoclonal antibodies (MAb) to all members of the genus Leptospira (clone LF9) and those that are specific only to the pathogenic species (clones LD5 and LE1) were produced. MAb LF9, which was immunoglobulin G1 (IgG1), reacted to a 38-kDa component of the sodium dodecyl sulfate-polyacrylamide gel electrophoresis-separated whole-cell lysates of all Leptospira spp., while MAb LD5 and MAb LE1, which were IgG1 and IgG2a, respectively, reacted to the 35-to 36-kDa components of all serogroups of the pathogenic species of Leptospira. The MAb LD5 was used in a dot blot-enzyme-linked immunosorbent assay (dot-ELISA) for detecting Leptospira antigen in urine samples serially collected from two groups of patients diagnosed with leptospirosis, i.e., 36 clinically diagnosed patients and 25 Leptospira culture confirmed patients. Their serum samples were tested serologically by IgM Dipstick assay, indirect immunofluorescence assay (IFA), and/or microscopic agglutination test (MAT). Urine samples of 26 patients diagnosed with other illnesses and 120 healthy individuals served as controls. For the first group of patients, who had been ill for an average of 3.4 days before hospitalization, the IgM Dipstick test, IFA, and MAT were positive for 69.4, 70.0, and 85.7% of patients, while the Leptospira antigenuria tested by the MAb-based dot-ELISA was positive for 75.0, 88.9, 97.2, 97.2, and 100% of patients on days 1, 2, 3, 7, and 14 of hospitalization, respectively. All but 1 of 11 patients whose serum samples collected on the first day of hospitalization were IgM seronegative, were positive by urine antigen test on day 1. This is strong evidence that detection of antigen in urine can provide diagnostic information that could be useful in directing early therapeutic intervention. The MAT was positive in 10 of 12 patients (83.3%) of the 25 culture-positive Leptospira patients who had been ill for an average of 5.04 days before hospitalization, and the Leptospira antigen was found in 64.0, 84.0, 96.0, 100, 100, 100, and 100% of the patients' urine samples collected on days 1, 2, 3, 4, 5, 6, and 7 of hospitalization, respectively. Leptospira antigenuria was found in 3 of the 26 patients diagnosed with other illnesses and 1 of the 120 healthy controls. The reasons for this positivity are discussed. The detection of antigen in urine by the monoclonal antibody-based dot-ELISA has high potential for rapid, sensitive, and specific diagnosis of leptospirosis at a low cost.
Immunological and Molecular Diagnostic Techniques for Leptospirosis: An Update
A number of laboratory techniques are employed to establish the diagnosis of microbial diseases that cause significant morbidity as well as mortality in humans and animals throughout the world. Leptospirosis is an emerging and re-emerging enigmatic zoonotic disease of public health and economic importance. Currently, over 600,000 human deaths are attributed due to leptosprirosis annually in the world. However, there is a lack of information on Leptospira strains in remote parts of the world. The diagnosis of leptospirosis is challenging due to non-specific clinical feature. Thus, laboratory tests are necessary to confirm the diagnosis of disease due to its varied symptomatology. The microscopic agglutination test (MAT), which determines agglutinating antibodies in sera for various serovars of Leptospira species is considered the gold standard for the diagnosis of leptospirosis. Enzyme linked immunosorbent assay (ELISA) usually detects only the antibodies reacting with a broadly reactive genus specific antigen and thus gives no indication of the causative serovar or serogroup, which limits its application. Polymerase chain reaction on the other hand is considered sensitive and specific for the rapid detection of Leptospira in clinical samples. It is imperative to employ immunological and molecular techniques in order to make an unequivocal diagnosis of leptospirosis to institute immediate therapy to mitigate the suffering of the patients.