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Epidemiology, microbiology, clinical manifestations, and diagnosis of leptospirosis

INTRODUCTION

Leptospirosis is a zoonosis with protean clinical manifestations caused by pathogenic spirochetes of the genus Leptospira. Synonyms for the disease include Weil's disease, Weil-Vasilyev disease, Swineherd's disease, rice-field fever, waterborne fever, nanukayami fever, cane-cutter fever, swamp fever, mud fever, Stuttgart disease, and Canicola fever.

The epidemiology, microbiology, clinical manifestations, and diagnosis of leptospirosis will be presented here. The treatment and prevention of this disease are discussed separately. (See "Treatment and prevention of leptospirosis".)

EPIDEMIOLOGY

Leptospirosis is a widespread and prevalent zoonotic disease. It occurs in both temperate and tropical regions; the incidence in the tropics is approximately 10 times higher than in temperate regions [1]. Leptospirosis is an under-reported disease, and there are no reliable global incidence figures. A modeling exercise by the World Health Organization's (WHO's) Leptospirosis Burden Epidemiology Group estimated that there were 873,000 cases worldwide annually with 48,600 deaths [2].

Various mammals are natural hosts; humans are infected incidentally after animal or environmental exposure.

Animal infection — The organism infects a variety of both wild and domestic mammals, especially rodents, cattle, swine, dogs, horses, sheep, and goats. The disease rarely occurs in cats. Animals can be asymptomatic or develop clinical infection, which can be fatal. Mortality in dogs is estimated at approximately 10 percent. Spontaneous abortion is a common outcome of leptospirosis in cattle, swine, sheep, and goats.

               

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Literature review current through: Jun 2014. | This topic last updated: Jul 10, 2014.
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References
Top
  1. Hartskeerl RA, Collares-Pereira M, Ellis WA. Emergence, control and re-emerging leptospirosis: dynamics of infection in the changing world. Clin Microbiol Infect 2011; 17:494.
  2. http://www.pmaconference.mahidol.ac.th/dmdocuments/2013-PMAC-Poster-P9-Bernadette%20Abela-Ridder.pdf (Accessed on August 13, 2013).
  3. Ko AI, Goarant C, Picardeau M. Leptospira: the dawn of the molecular genetics era for an emerging zoonotic pathogen. Nat Rev Microbiol 2009; 7:736.
  4. Stern EJ, Galloway R, Shadomy SV, et al. Outbreak of leptospirosis among Adventure Race participants in Florida, 2005. Clin Infect Dis 2010; 50:843.
  5. Jesus MS, Silva LA, Lima KM, Fernandes OC. Cases distribution of leptospirosis in City of Manaus, State of Amazonas, Brazil, 2000-2010. Rev Soc Bras Med Trop 2012; 45:713.
  6. Reis RB, Ribeiro GS, Felzemburgh RD, et al. Impact of environment and social gradient on Leptospira infection in urban slums. PLoS Negl Trop Dis 2008; 2:e228.
  7. Kawaguchi L, Sengkeopraseuth B, Tsuyuoka R, et al. Seroprevalence of leptospirosis and risk factor analysis in flood-prone rural areas in Lao PDR. Am J Trop Med Hyg 2008; 78:957.
  8. Miyazato KE, Fonseca AL, Caputto LZ, et al. Incidence of Leptospirosis infection in the East Zone of Sao Paulo City, Brazil. Int Arch Med 2013; 6:23.
  9. Dechet AM, Parsons M, Rambaran M, et al. Leptospirosis outbreak following severe flooding: a rapid assessment and mass prophylaxis campaign; Guyana, January-February 2005. PLoS One 2012; 7:e39672.
  10. Smith JK, Young MM, Wilson KL, Craig SB. Leptospirosis following a major flood in Central Queensland, Australia. Epidemiol Infect 2013; 141:585.
  11. Thaipadungpanit J, Wuthiekanun V, Chierakul W, et al. A dominant clone of Leptospira interrogans associated with an outbreak of human leptospirosis in Thailand. PLoS Negl Trop Dis 2007; 1:e56.
  12. Nardone A, Capek I, Baranton G, et al. Risk factors for leptospirosis in metropolitan France: results of a national case-control study, 1999-2000. Clin Infect Dis 2004; 39:751.
  13. Sugunan AP, Natarajaseenivasan K, Vijayachari P, Sehgal SC. Percutaneous exposure resulting in laboratory-acquired leptospirosis -- a case report. J Med Microbiol 2004; 53:1259.
  14. Wasiński B, Dutkiewicz J. Leptospirosis--current risk factors connected with human activity and the environment. Ann Agric Environ Med 2013; 20:239.
  15. Sugunan AP, Vijayachari P, Sharma S, et al. Risk factors associated with leptospirosis during an outbreak in Middle Andaman, India. Indian J Med Res 2009; 130:67.
  16. Lupi O, Netto MA, Avelar K, et al. Cluster of leptospirosis cases among military personnel in Rio de Janeiro, Brazil. Int J Infect Dis 2013; 17:e129.
  17. Morgan J, Bornstein SL, Karpati AM, et al. Outbreak of leptospirosis among triathlon participants and community residents in Springfield, Illinois, 1998. Clin Infect Dis 2002; 34:1593.
  18. Stone SC, McNutt E. Update: Outbreak of acute febrile illness among athletes participating in Eco-Challenge-Sabah 2000--Borneo, Malaysia, 2000. Ann Emerg Med 2001; 38:83.
  19. Radl C, Müller M, Revilla-Fernandez S, et al. Outbreak of leptospirosis among triathlon participants in Langau, Austria, 2010. Wien Klin Wochenschr 2011; 123:751.
  20. Brockmann S, Piechotowski I, Bock-Hensley O, et al. Outbreak of leptospirosis among triathlon participants in Germany, 2006. BMC Infect Dis 2010; 10:91.
  21. Shaked Y, Shpilberg O, Samra D, Samra Y. Leptospirosis in pregnancy and its effect on the fetus: case report and review. Clin Infect Dis 1993; 17:241.
  22. Carles G, Montoya E, Joly F, Peneau C. [Leptospirosis and pregnancy. Eleven cases in French Guyana]. J Gynecol Obstet Biol Reprod (Paris) 1995; 24:418.
  23. Puliyath G, Singh S. Leptospirosis in pregnancy. Eur J Clin Microbiol Infect Dis 2012; 31:2491.
  24. Brenner DJ, Kaufmann AF, Sulzer KR, et al. Further determination of DNA relatedness between serogroups and serovars in the family Leptospiraceae with a proposal for Leptospira alexanderi sp. nov. and four new Leptospira genomospecies. Int J Syst Bacteriol 1999; 49 Pt 2:839.
  25. Smythe L, Adler B, Hartskeerl RA, et al. Classification of Leptospira genomospecies 1, 3, 4 and 5 as Leptospira alstonii sp. nov., Leptospira vanthielii sp. nov., Leptospira terpstrae sp. nov. and Leptospira yanagawae sp. nov., respectively. Int J Syst Evol Microbiol 2013; 63:1859.
  26. Boonsilp S, Thaipadungpanit J, Amornchai P, et al. A single multilocus sequence typing (MLST) scheme for seven pathogenic Leptospira species. PLoS Negl Trop Dis 2013; 7:e1954.
  27. Slack AT, Dohnt MF, Symonds ML, Smythe LD. Development of a Multiple-Locus Variable Number of Tandem Repeat Analysis (MLVA) for Leptospira interrogans and its application to Leptospira interrogans serovar Australis isolates from Far North Queensland, Australia. Ann Clin Microbiol Antimicrob 2005; 4:10.
  28. Wuthiekanun V, Amornchai P, Paris DH, et al. Rapid isolation and susceptibility testing of Leptospira spp. using a new solid medium, LVW agar. Antimicrob Agents Chemother 2013; 57:297.
  29. Ren SX, Fu G, Jiang XG, et al. Unique physiological and pathogenic features of Leptospira interrogans revealed by whole-genome sequencing. Nature 2003; 422:888.
  30. Katz AR, Ansdell VE, Effler PV, et al. Assessment of the clinical presentation and treatment of 353 cases of laboratory-confirmed leptospirosis in Hawaii, 1974-1998. Clin Infect Dis 2001; 33:1834.
  31. Vilaichone RK, Mahachai V, Wilde H. Acute acalculous cholecystitis in leptospirosis. J Clin Gastroenterol 1999; 29:280.
  32. Vanasco NB, Schmeling MF, Lottersberger J, et al. Clinical characteristics and risk factors of human leptospirosis in Argentina (1999-2005). Acta Trop 2008; 107:255.
  33. Sanford JP. Leptospirosis--time for a booster. N Engl J Med 1984; 310:524.
  34. Berman, SJ, Tsai, C, Holmes, K, et al. Sporadic anicteric leptospirosis in South Vietnam. Ann Intern Med, 1973; 79:167.
  35. Karande S, Gandhi D, Kulkarni M, et al. Concurrent outbreak of leptospirosis and dengue in Mumbai, India, 2002. J Trop Pediatr 2005; 51:174.
  36. Romero EC, Blanco RM, Yasuda PH. Aseptic meningitis caused by Leptospira spp diagnosed by polymerase chain reaction. Mem Inst Oswaldo Cruz 2010; 105:988.
  37. Yang HY, Hsu PY, Pan MJ, et al. Clinical distinction and evaluation of leptospirosis in Taiwan--a case-control study. J Nephrol 2005; 18:45.
  38. von Ranke FM, Zanetti G, Hochhegger B, Marchiori E. Infectious diseases causing diffuse alveolar hemorrhage in immunocompetent patients: a state-of-the-art review. Lung 2013; 191:9.
  39. Dupont H, Dupont-Perdrizet D, Perie JL, et al. Leptospirosis: prognostic factors associated with mortality. Clin Infect Dis 1997; 25:720.
  40. Chawla V, Trivedi TH, Yeolekar ME. Epidemic of leptospirosis: an ICU experience. J Assoc Physicians India 2004; 52:619.
  41. LaRocque RC, Breiman RF, Ari MD, et al. Leptospirosis during dengue outbreak, Bangladesh. Emerg Infect Dis 2005; 11:766.
  42. Pappachan MJ, Mathew S, Aravindan KP, et al. Risk factors for mortality in patients with leptospirosis during an epidemic in northern Kerala. Natl Med J India 2004; 17:240.
  43. Amilasan AS, Ujiie M, Suzuki M, et al. Outbreak of leptospirosis after flood, the Philippines, 2009. Emerg Infect Dis 2012; 18:91.
  44. Rathinam SR, Rathnam S, Selvaraj S, et al. Uveitis associated with an epidemic outbreak of leptospirosis. Am J Ophthalmol 1997; 124:71.
  45. Cetin BD, Harmankaya O, Hasman H, et al. Acute renal failure: a common manifestation of leptospirosis. Ren Fail 2004; 26:655.
  46. Hurst FP, Neff RT, Katz AR, et al. Acute kidney injury requiring hemodialysis in patients with anicteric leptospirosis. Clin Nephrol 2009; 72:186.
  47. Daher Ede F, Zanetta DM, Abdulkader RC. Pattern of renal function recovery after leptospirosis acute renal failure. Nephron Clin Pract 2004; 98:c8.
  48. Wong ML, Kaplan S, Dunkle LM, et al. Leptospirosis: a childhood disease. J Pediatr 1977; 90:532.
  49. Tubiana S, Mikulski M, Becam J, et al. Risk factors and predictors of severe leptospirosis in New Caledonia. PLoS Negl Trop Dis 2013; 7:e1991.
  50. Assimakopoulos SF, Fligou F, Marangos M, et al. Anicteric leptospirosis-associated severe pulmonary hemorrhagic syndrome: a case series study. Am J Med Sci 2012; 344:326.
  51. Segura ER, Ganoza CA, Campos K, et al. Clinical spectrum of pulmonary involvement in leptospirosis in a region of endemicity, with quantification of leptospiral burden. Clin Infect Dis 2005; 40:343.
  52. Ganoza CA, Segura ER, Swancutt MA, et al. Mild, self-resolving acute leptospirosis in an HIV-infected patient in the Peruvian Amazon. Am J Trop Med Hyg 2005; 73:67.
  53. Neves Ede S, Pereira MM, Galhardo MC, et al. Leptospirosis patient with AIDS: the first case reported. Rev Soc Bras Med Trop 1994; 27:39.
  54. Jones S, Kim T. Fulminant leptospirosis in a patient with human immunodeficiency virus infection: case report and review of the literature. Clin Infect Dis 2001; 33:E31.
  55. Chierakul W, Tientadakul P, Suputtamongkol Y, et al. Activation of the coagulation cascade in patients with leptospirosis. Clin Infect Dis 2008; 46:254.
  56. Stefos A, Georgiadou SP, Gioti C, et al. Leptospirosis and pancytopenia: two case reports and review of the literature. J Infect 2005; 51:e277.
  57. Wu MS, Yang CW, Pan MJ, et al. Reduced renal Na+-K+-Cl- co-transporter activity and inhibited NKCC2 mRNA expression by Leptospira shermani: from bed-side to bench. Nephrol Dial Transplant 2004; 19:2472.
  58. Krishnan A, Karnad DR, Medhekar TP. Paralysis due to renal potassium wasting: an unusual presentation of leptospirosis. Nephrol Dial Transplant 2003; 18:2454.
  59. Johnson WD Jr, Silva IC, Rocha H. Serum creatine phosphokinase in leptospirosis. JAMA 1975; 233:981.
  60. Helmer RE 3rd, Millsaps RD. Letter: Hypoglycorrachia in leptospirosis. Ann Intern Med 1973; 79:912.
  61. Im JG, Yeon KM, Han MC, et al. Leptospirosis of the lung: radiographic findings in 58 patients. AJR Am J Roentgenol 1989; 152:955.
  62. Carvalho CR, Bethlem EP. Pulmonary complications of leptospirosis. Clin Chest Med 2002; 23:469.
  63. Limmathurotsakul D, Turner EL, Wuthiekanun V, et al. Fool's gold: Why imperfect reference tests are undermining the evaluation of novel diagnostics: a reevaluation of 5 diagnostic tests for leptospirosis. Clin Infect Dis 2012; 55:322.
  64. Schreier S, Doungchawee G, Chadsuthi S, et al. Leptospirosis: current situation and trends of specific laboratory tests. Expert Rev Clin Immunol 2013; 9:263.
  65. Levett PN, Whittington CU. Evaluation of the indirect hemagglutination assay for diagnosis of acute leptospirosis. J Clin Microbiol 1998; 36:11.
  66. Vedhagiri K, Velineni S, Timoney JF, et al. Detection of LipL32-specific IgM by ELISA in sera of patients with a clinical diagnosis of leptospirosis. Pathog Glob Health 2013; 107:130.
  67. Desakorn V, Wuthiekanun V, Thanachartwet V, et al. Accuracy of a commercial IgM ELISA for the diagnosis of human leptospirosis in Thailand. Am J Trop Med Hyg 2012; 86:524.
  68. Tanganuchitcharnchai A, Smythe L, Dohnt M, et al. Evaluation of the Standard Diagnostics Leptospira IgM ELISA for diagnosis of acute leptospirosis in Lao PDR. Trans R Soc Trop Med Hyg 2012; 106:563.
  69. Picardeau M, Bertherat E, Jancloes M, et al. Rapid tests for diagnosis of leptospirosis: current tools and emerging technologies. Diagn Microbiol Infect Dis 2014; 78:1.
  70. Levett PN. Usefulness of serologic analysis as a predictor of the infecting serovar in patients with severe leptospirosis. Clin Infect Dis 2003; 36:447.
  71. Smythe LD, Wuthiekanun V, Chierakul W, et al. The microscopic agglutination test (MAT) is an unreliable predictor of infecting Leptospira serovar in Thailand. Am J Trop Med Hyg 2009; 81:695.
  72. Thaipadungpanit J, Chierakul W, Wuthiekanun V, et al. Diagnostic accuracy of real-time PCR assays targeting 16S rRNA and lipL32 genes for human leptospirosis in Thailand: a case-control study. PLoS One 2011; 6:e16236.
  73. Sonthayanon P, Chierakul W, Wuthiekanun V, et al. Accuracy of loop-mediated isothermal amplification for diagnosis of human leptospirosis in Thailand. Am J Trop Med Hyg 2011; 84:614.
  74. Koizumi N, Nakajima C, Harunari T, et al. A new loop-mediated isothermal amplification method for rapid, simple, and sensitive detection of Leptospira spp. in urine. J Clin Microbiol 2012; 50:2072.
  75. Cermakova Z, Kucerova P, Pliskova L, Kubickova P. Real-time PCR method for the detection of the gene encoding surface lipoprotein LipL32 of pathogenic Leptospira: use in the laboratory diagnosis of the acute form of leptospirosis. Scand J Infect Dis 2013; 45:593.
  76. Wilson MR, Naccache SN, Samayoa E, et al. Actionable diagnosis of neuroleptospirosis by next-generation sequencing. N Engl J Med 2014; 370:2408.