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Epidemiology of Human Leptospirosis in Malaysia, 2004–2012
... Human infections occurred through the exposure of abraded skin and mucous membrane to leptospires-contaminated environments and through direct transmission. The local burden of human leptospirosis was deliberated by a previous study [3], emphasizing the endemicity of this disease in the tropical and subtropical regions, with prominently high incidence in Southeast Asia [4,5,6,7]. ...
... The average incidence rate of leptospirosis during the study period was 104 cases per 100,000 population, slightly higher than reported by Benacer et al. [3] for the incidence rate in Sarawak. The variation in incidence rate reported was due to the different data time frame used in the studies where Benacer and colleague [3] analysed data from 2004 to 2012, and this study included data from 2012 to 2016. ...
... The average incidence rate of leptospirosis during the study period was 104 cases per 100,000 population, slightly higher than reported by Benacer et al. [3] for the incidence rate in Sarawak. The variation in incidence rate reported was due to the different data time frame used in the studies where Benacer and colleague [3] analysed data from 2004 to 2012, and this study included data from 2012 to 2016. The present study showed a low incidence rate in 2016 with a mean of 24 cases per 100,000 population) due to incomplete monthly data reported for that particular year. ...
Background Leptospirosis is a zoonotic disease caused by spirochete bacteria in the genus Leptospira, and it has become a significant public health challenge in Malaysia. Environmental survival and persistence of this pathogen are highly dependent on environmental conditions such as moisture content, pH and temperature. These conditions are further adapted by the natural climate system including precipitation and humidity which is highly heterogeneous at a geographical scale. This paper described the spatial and temporal distribution of leptospirosis incidence with climate factors using Geographical Information System and stratified the climate factors based on their association with the disease incidence rate. Methods Leptospirosis surveillance data from 2012-2016 were integrated into this study along with seven geo-spatial climate variables for the state of Sarawak, Malaysia. High and low clustering of incidence rate was explored by Getis Ord Gi* statistics. Geographical Weighted Regression model was utilized to study the relationship between the incidence rate and selected climate variables. Results Spatial analysis revealed seven districts in the state of Sarawak as hot spot areas, and six cold spot areas with GiZ score varies between (-3.092 to 3.203). The cumulative incidence rate demonstrated an increasing trend towards the South-East region of Sarawak with an average of 162 cases per 100,000 population. The univariate analysis reported a significant relationship (p
... Human infections occurred through the exposure of abraded skin and mucous membrane to leptospires-contaminated environments and through direct transmission. The local burden of human leptospirosis was deliberated by a previous study [3], emphasizing the endemicity of this disease in the tropical and subtropical regions, with prominently high incidence in Southeast Asia [4,5,6,7]. ...
... The average incidence rate of leptospirosis during the study period was 104 cases per 100,000 population, slightly higher than reported by Benacer et al. [3] for the incidence rate in Sarawak. The variation in incidence rate reported was due to the different data time frame used in the studies where Benacer and colleague [3] analysed data from 2004 to 2012, and this study included data from 2012 to 2016. ...
... The average incidence rate of leptospirosis during the study period was 104 cases per 100,000 population, slightly higher than reported by Benacer et al. [3] for the incidence rate in Sarawak. The variation in incidence rate reported was due to the different data time frame used in the studies where Benacer and colleague [3] analysed data from 2004 to 2012, and this study included data from 2012 to 2016. The present study showed a low incidence rate in 2016 with a mean of 24 cases per 100,000 population) due to incomplete monthly data reported for that particular year. ...
Background Leptospirosis is a zoonotic disease caused by spirochete bacteria in the genus Leptospira, and it has become a significant public health challenge in Malaysia. Environmental survival and persistence of this pathogen are highly dependent on environmental conditions such as moisture content, pH and temperature. These conditions are further adapted by the natural climate system including precipitation and humidity which is highly heterogeneous at a geographical scale. This paper described the spatial and temporal distribution of leptospirosis incidence with climate factors using Geographical Information System and stratified the climate factors based on their association with the disease incidence rate. Methods Leptospirosis surveillance data from 2012-2016 were integrated into this study along with seven geo-spatial climate variables for the state of Sarawak, Malaysia. High and low clustering of incidence rate was explored by Getis Ord Gi* statistics. Geographical Weighted Regression model was utilized to study the relationship between the incidence rate and selected climate variables. Results Spatial analysis revealed seven districts in the state of Sarawak as hot spot areas, and six cold spot areas with GiZ score varies between (-3.092 to 3.203). The cumulative incidence rate demonstrated an increasing trend towards the South-East region of Sarawak with an average of 162 cases per 100,000 population. The univariate analysis reported a significant relationship (p
... (Albuquerque et al., 2021;SESPA, 2012;Brasil, 2001). (Lara et al., 2019;Benacer et al., 2016;Costa et al., 2015;Vasconcelos et al., 2012;Pelissari et al., 2011). ...
... No que diz respeito ao perfil dos pacientes, observamos que existe grande similaridade entre as três regiões de saúde, pois houve maior ocorrência em pessoas do sexo masculino, com ensino fundamental completo e incompleto, residentes na área urbana tendo o ambiente domiciliar como de o provável ambiente de infecção(Lara et al., 2019;Benacer et al, 2016;Costa et al, 2015;Vasconcelos et al, 2012;Pelissari et al., 2011).Em relação ao epidemiológico dos pacientes e situações de risco, observou-se semelhança entre as três regiões de saúde. A maioria dos casos ocorreu em pessoas do sexo masculino, com ensino fundamental completo ou incompleto, residentes em áreas urbanas, sendo o ambiente domiciliar o provável local de infecção ...
Objetivo: Neste trabalho foram avaliadas características epidemiológicas e as principais situações de risco associadas aos casos confirmados nas três Regiões de Saúde com maior ocorrência da doença no estado do Pará, no período de 2007 a 2022. Métodos: Estudo epidemiológico retrospectivo e descritivo, utilizando dados secundários do Sistema de Informação de Agravos de Notificação sobre a ocorrência da doença. As variáveis analisadas foram: critério de diagnóstico da doença, sexo, idade (categorizada a cada 10 anos de idade), escolaridade (considerando o nível de estudo completo e incompleto da mesma categoria), zona de residência do paciente, ambiente de infecção, situações de risco e ocupação dos pacientes. Realizou-se estatística descritiva através do software Jamovi. Resultados: Dos 10.608 casos suspeitos, 17,08% (n=1.812) foram confirmados com leptospirose. Entre as 13 Regiões de saúde do estado, destacaram-se as regiões Metropolitana I com 57,28% dos casos, Metropolitana III com 11,15% e Baixo Amazonas com 8,61%. Conclusão: Nas três Regiões de Saúde com maior ocorrência da doença, a leptospirose acometeu principalmente, homens com ensino fundamental, residentes em áreas urbanas, com o domicílio como local provável de infecção, e o contato com local com sinais de roedores, que foi a principal situação de risco. É necessária a implementação de políticas públicas sociais e de saúde mais eficazes contra a leptospirose humana, assim como destacamos a importância do correto preenchimento das informações para garantir análises mais representativas da realidade da doença no estado.
... The first case of human leptospirosis was reported in 1925 (El Jalii & Bahaman, 2004). Since then, recorded cases have risen rapidly amongst vulnerable animal species as well as humans (Benacer et al., 2016a;Tan et al., 2016), making it the preeminent zoonosis that causes morbidity and fatality in Malaysia (Garba et al., 2017). The World Health Organization (WHO) reported that it is considered the most widely spread zoonotic disease that has emerged (Wong et al., 2012). ...
... Since 2010, when the Ministry of Health Malaysia (MOH) declared leptospirosis as a notifiable disease (Ministry of Health, 2015), the number of cases has risen rapidly, beginning with 284 cases in 2004 and becoming worse in 2012, with 3604 cases (Benacer et al., 2016b). As a result, there were 461 confirmed cases between 2004 and 2012, with an incidence rate of 8.00 per 100,000 people (Benacer et al., 2016a). In Malaysia, Terengganu is one of the five states with the highest incidence of leptospirosis cases (Ministry of Health, 2015). ...
Leptospirosis is a zoonotic disease caused by Leptospira, which is transmitted through infected mammalian species, including small mammals. However, the prevalence of pathogenic Leptospira spp. in small mammals, particularly between different site categories in the eastern part of Peninsular Malaysia, is still underexplored. Therefore, in this study, we aimed to determine the species composition of small mammals and the prevalence of pathogenic Leptospira spp. between different site categories from Dungun, Terengganu. We selected five case sites (leptospirosis cases were recorded) and five control sites (no leptospirosis cases were recorded) in Dungun, Terengganu, based on previous reports by the Ministry of Health (MOH) Malaysia (2016-2020). For three consecutive nights, 100 cage traps were used for each trapping session. In addition, kidney samples from captured individuals were extracted for the Polymerase Chain Reaction (PCR) detection of pathogenic Leptospira spp. Overall, 89 individuals from five species were captured (6.43% trapping success), consisting of Rattus norvegicus (n = 39), Rattus rattus (n = 27), Suncus murinus (n = 11), Rattus exulans (n = 10) and Tupaia glis (n = 2). Out of 89 individuals captured, 14 tested positive with a 15.7% (n = 14/89) prevalence rate. R. norvegicus was the most dominant captured species and had the highest number of infected individuals with pathogenic Leptospira (20.5%, n = 8/39). The statistical analysis revealed that there is a significant difference in pathogenic Leptospira spp. between case and control sites (P < 0.05), with control sites recording higher positive individuals (78.6%, n = 11/14) compared to case sites (21.4%, n = 3/14). However, no significant differences were observed between species and sex (P > 0.05). The results show that the monitoring of leptospirosis cases should not only focus on case areas but also control areas in order to prevent the outbreak of this disease in the future.
... This contributes to the dramatic increase in the number of reported cases in Malaysia. According to the Ministry of Health Malaysia, there was a marked increase of leptospirosis cases from 12.5 per 100,000 population in 2012 to 15.0 per 100,000 population in 2013 (Benacer et al., 2016). ...
... Furthermore, there is a lack of data on the genetic characteristics of Leptospira strains isolated from cattle in Malaysia. Molecular detection tools such as the polymerase chain reaction (PCR) assays have been widely used to detect Leptospira spp. in various species worldwide (Benacer et al., 2016;Sabri et al., 2019) and has been regarded as the most convenient method employed for the surveillance of BL. Molecular techniques can provide valuable information on the genetic diversity, population structure, and transmission dynamics of Leptospira strains. ...
Leptospirosis is a zoonotic bacterial disease affecting both humans and animals. This is the first study aiming to detect the Leptospira spp. in bovine kidneys collected from selected wet markets in Kota Bharu, Kelantan and subsequently determine the predominant Leptospira species. Additionally, the pathological alterations to the bovine kidneys as a result of leptospirosis were also analyzed. A total of fifty bovine kidney samples (n=50) were collected from four wet markets within Kota Bharu town and the samples were tested using a polymerase chain reaction (PCR) assay. From the results, thirteen samples (n=13; 26%) were found to be positive for the 16S rRNA gene. DNA sequencing of the positive samples revealed the presence of Leptospira borgpetersenii (n=11) and Leptospira interrogans (n=1), which are known to be pathogenic Leptospira species in cattle and humans. One sample cannot be sequenced due to poor yield and quality. Furthermore, the kidneys that were PCR-positive showed significant histopathological lesions of bovine leptospirosis, consisting of interstitial nephritis, glomerular atrophy and tubular necrosis. In conclusion, the present study demonstrated the presence of L. borgpetersenii and L. interrogans in local cattle and this is an indisputable public health risk to the public considering that the samples were obtained from the local wet markets.
... The most recent retrospective study conducted between 2005-2015, focused on patients presenting at a tertiary referral hospital in WCP, and a seroprevalence of 20% was reported [22]. Studies outside Africa have highlighted the influence of season, gender and age on the distribution and occurrence of human leptospirosis [23][24][25]. Such associations have scarcely been studied in Africa despite changes in climatic factors, demographic shifts, urbanization, and globalization [4,9,[26][27][28]. ...
... The overall incidence was significantly higher in males as compared to females during the study period. Similar results have been reported in both seroprevalence studies in Africa and in incidence studies conducted using surveillance data globally [23,35,36]. The higher incidence among males has been largely attributed to occupational or environmental exposure, whereby males engage in activities that may put them at higher risk of contracting the infection [33,37]. ...
Introduction:
leptospirosis is an emerging zoonosis of global importance. In South Africa, the infection is an underreported public health concern, with limited information on its incidence and distribution. This study investigated the incidence of human leptospirosis in Western Cape Province (WCP) between 2010 and 2019, and compared the incidence based on seasonal and demographic factors.
Methods:
a retrospective study was conducted with data on leptospirosis diagnoses in WCP obtained from the National Health Laboratory Services. With the provincial population sizes as the denominator, incidence of leptospirosis was estimated and expressed as cases per 100,000 population. Negative binomial regression was used to estimate the effect of sex, season, and year on the incidence of leptospirosis.
Results:
two hundred and fifty-four (254) cases of leptospirosis were reported between 2010 and 2019, with the highest number of cases being in 2015 and the annual incidence ranged between 0.15 and 0.66/100,000 population. Males had a higher incidence compared to females (0.55 vs. 0.25/ 100,000 population; incidence rate ratio (IRR) 2.2, 95% CI: 1.66,3.03). The 18-44 age cohort had the highest average incidence (0.56/100,000 population), while the ≤17 age cohort had the lowest incidence (0.07/100,000 population). The 18-44 (IRR 8.0, 95% CI: 4.65,15.15) and ≥45 (IRR 7.4, 95% CI: 4.17,14.17) age cohorts were more at risk of infection compared to ≤17 age cohort.
Conclusion:
leptospirosis is an important zoonosis in WCP disproportionately affecting males and the productive age demographic groups. These findings should enhance targeted prevention and provoke further investigation on the importance of environmental and socioeconomic factors on leptospirosis burden.
... Early with antibiotics such as penicillin, doxycycline, tetracycline, ampicillin or amoxicillin is essential (Disease Control Division, 2011). The burden of human leptospirosis was prevailing in the tropical and subtropical regions, with a prominently high incidence in Southeast Asia such as India, Bangladesh, Nepal, Thailand, Sri Lanka and Indonesia (Bahaman & Ibrahim, 1988;Kawaguchi et al., 2008;Benacer et al., 2016;Hinjoy, 2016). In addition, factors including poor environmental hygiene, the proliferation of reservoir hosts, socio-economic status, contact with infected animals, and recreational activities have compounded the predisposition of humans and susceptible animals to the risk of contracting leptospirosis (Garba et al., 2018). ...
... For instance, socioeconomic factor such as occupational types could discriminate the predisposition of the susceptible population in different districts (Mohd Radi et al., 2018). The significance of occupational exposures as an essential risk factor for leptospirosis has been documented in previous studies (Chou et al., 2008;Goris et al., 2013;Benacer et al., 2016;Tan et al., 2016). A study in China reported that counties with a higher risk of leptospirosis predominantly observed on younger population, more males and farmers, compared to the lowrisk counties (Dhewantara et al., 2019). ...
This study is to analyse the spatial distribution of leptospirosis and identify its high and low incidence clusters in Sarawak. The annual incidence rate at the district level was calculated using confirmed report of leptospirosis cases from year 2011 to 2018. Empirical Bayes estimation smoothing of relative risks was used to display the spatial distribution of leptospirosis across the study region. Moran's Global Index and Local Indicators of Spatial Association (LISA) were used to analyse the existence of global and local spatial autocorrelation. Data were analysed using ArcGIS and Geoda software at the district level. The annualised average incidence reported during the study period was 20.83 per 100,000 population, with the highest cases reported in year 2018 (n = 870). The Global Moran's Index revealed spatial clustering of leptospirosis incidence in 2012 (Moran's I: 0.23), 2013 (Moran's I: 0.33), and 2014 (Moran's I: 0.45), while 2011 (Moran's I: -0.01), 2015 and 2016 (Moran's I: 0.09), 2017 (Moran's I: 0.13), and 2018 (Moran's I: 0.04) showed random patterns. High incidence clusters of leptospirosis were primarily congested in the Southeast of Sarawak, involving districts such as Kapit, Belaga, Song, Tatau and Lubok Antu. Spatial and temporal patterns of leptospirosis incidence were heterogeneous across Sarawak. This study facilitates the implementation of targeted interventions and control measures for leptospirosis in Sarawak by identifying spatial cluster and outliers.
... Giardiasis can result in malnutrition from chronic diarrhea (13,14) while toxoplasmosis symptoms can vary from asymptomatic to severe clinical manifestations that occur typically in immunocompromised patients (15). In Malaysia, bacterial diseases include leptospirosis (16,17), trachoma (18), and yaws (19) that can impact the skin, eyes, joints, and other parts of the body. ...
... The IgG responses to 12 antigens from six pathogens were assayed (Table 1; Supplementary Table 1). Merozoite surface protein [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] and apical membrane antigen-1 (AMA-1) antigens from Plasmodium falciparum and P. vivax were also included with appropriate control sera as internal positive controls. Excluding the malaria proteins, all antigen-coupled microspheres were provided by the Centers for Disease Control and Prevention (Atlanta, GA, USA) and coupled according to standard Luminex protocols to minimize the signal-to-noise ratio (29). ...
Background
Infectious diseases continue to burden populations in Malaysia, especially among rural communities where resources are limited and access to health care is difficult. Current epidemiological trends of several neglected tropical diseases in these populations are at present absent due to the lack of habitual and efficient surveillance. To date, various studies have explored the utility of serological multiplex beads to monitor numerous diseases simultaneously. We therefore applied this platform to assess population level exposure to six infectious diseases in Sabah, Malaysia. Furthermore, we concurrently investigated demographic and spatial risk factors that may be associated with exposure for each disease.
Methods
This study was conducted in four districts of Northern Sabah in Malaysian Borneo, using an environmentally stratified, population-based cross-sectional serological survey targeted to determine risk factors for malaria. Samples were collected between September to December 2015, from 919 villages totaling 10,100 persons. IgG responses to twelve antigens of six diseases (lymphatic filariasis- Bm33, Bm14, BmR1, Wb123; strongyloides- NIE; toxoplasmosis-SAG2A; yaws- Rp17 and TmpA; trachoma- Pgp3, Ct694; and giardiasis- VSP3, VSP5) were measured using serological multiplex bead assays. Eight demographic risk factors and twelve environmental covariates were included in this study to better understand transmission in this community.
Results
Seroprevalence of LF antigens included Bm33 (10.9%), Bm14+ BmR1 (3.5%), and Wb123 (1.7%). Seroprevalence of Strongyloides antigen NIE was 16.8%, for Toxoplasma antigen SAG2A was 29.9%, and Giardia antigens GVSP3 + GVSP5 was 23.2%. Seroprevalence estimates for yaws Rp17 was 4.91%, for TmpA was 4.81%, and for combined seropositivity to both antigens was 1.2%. Seroprevalence estimates for trachoma Pgp3 + Ct694 were 4.5%. Age was a significant risk factors consistent among all antigens assessed, while other risk factors varied among the different antigens. Spatial heterogeneity of seroprevalence was observed more prominently in lymphatic filariasis and toxoplasmosis.
Conclusions
Multiplex bead assays can be used to assess serological responses to numerous pathogens simultaneously to support infectious disease surveillance in rural communities, especially where prevalences estimates are lacking for neglected tropical diseases. Demographic and spatial data collected alongside serosurveys can prove useful in identifying risk factors associated with exposure and geographic distribution of transmission.
... Leptospires has been reported to survive longer in river water in comparison to acidic sea water (Khairani-Bejo et al., 2004). Higher frequency of leptospirosis cases in Malaysia were recorded between 27°C to 28°C (Benacer et al., 2016). Previous studies also discussed leptospirosis outbreaks following the occurrence of extreme weather in tropical countries such as Philippines, Laos, India and Malaysia (Pappachan et al., 2004;Kawaguchi et al., 2008;Al-shere et al., 2012;Radi et al., 2018). ...
... Conventionally, the amount of precipitation has a positive relationship with leptospirosis (V ictoriano et al., 2009;Chadsuthi et al., 2012;Benacer et al., 2016). However, the results of this study found that the spatial density of leptospirosis cases were concentrated in areas with lower precipitation in the driest month (PDM) and the wettest quarter (PWQ). ...
The spatial distribution of environmental conditions may influence the dynamics of vectorborne diseases like leptospirosis. This study aims to investigate the global and localised relationships between leptospirosis with selected environmental variables. The association between environmental variables and the spatial density of geocoded leptospirosis cases was determined using global Poisson regression (GPR) and geographically weighted Poisson regression (GWPR). A higher prevalence of leptospirosis was detected in areas with higher water vapour pressure (exp(â): 1.12; 95% CI: 1.02 - 1.25) and annual precipitation (exp(â): 1.15; 95% CI: 1.02 - 1.31), with lower precipitation in the driest month (exp(â): 0.85; 95% CI: 0.75 - 0.96) and the wettest quarter (exp(â): 0.88; 95% CI: 0.77 - 1.00). Water vapor pressure (WVP) varied the most in the hotspot regions with a standard deviation of 0.62 (LQ: 0.15; UQ; 0.99) while the least variation was observed in annual precipitation (ANNP) with a standard deviation of 0.14 (LQ: 0.11; UQ; 0.30). The reduction in AICc value from 519.73 to 443.49 indicates that the GWPR model is able to identify the spatially varying correlation between leptospirosis and selected environmental variables. The results of the localised relationships in this study could be used to formulate spatially targeted interventions. This would be particularly useful in localities with a strong environmental or socio-demographical determinants for the transmission of leptospirosis.
... The main factor that leads to the floods is the Northeast Monsoon wind that brings heavy rain from November to March. The floods often affect flood victims, especially in terms of water supply resources in which flood victims usually face problem with contaminated water resources (Benacer et al. 2016;Kumar et al. 2016;Molla et al. 2016) and lack of water supply (Hossain et al. 2014) at the Temporary Evacuation Centres (TECs). This situation causes the flood victims to resort to using water resources of unknown hygienic status for cooking, drinking, and washing at the TECs. ...
... However, the use of water resources with unknown quality status will expose flood victims to the risk of spreading various waterborne diseases. Leptospirosis is a common disease experienced in Malaysia when floods hit (Benacer et al. 2016) as happened in Johor before (Badrul Hashim et al. 2010). The problem is also faced by flood-prone countries like Bangladesh (Shimi et al. 2010), Nigeria (Ubachukwu & Emeribe 2017), India (Sharad et al. 2007) and Sudan (Abbas & Routray 2014). ...
Quality assessment of water resources is important to ensure the well-being of residents, especially the victims who are affected by floods and having difficulties in obtaining clean water supply when the floods hit. This paper seeks to discuss the quality assessment of water resources in the district of Kuala Krai, Kelantan. Field methods were used to collect water samples during the northeast monsoon season in the month of December 2016/January 2017 involving six well stations, four flood water stations and four rainfall stations. The quality assessment of water resources involved six key parameters, namely DO, pH, BOD, COD, NH3N and SS using the Water Quality Index (WQI) analysis. The results of the analysis showed that the WQI percentage of well and flood water stations accounted for 61.31 to 75.95% which is Class III of moderately contaminated status, except the T6 station that recorded 80.99% of WQI value which is Class II of good status. The findings also showed that all WQI values from the rainwater stations were at 87.85 to 89.10%, which is Class II of good status. This condition explains that the rainwater resources have better quality than the well and flood water resources. With the help of this research, the flood manager’s party can take systematic management measures in ensuring that flood victims receive water supplies during flood events. In this regard, infectious diseases resulted from the consumption of contaminated water among flood victims can be reduced.
... In Malaysia, reported human cases have always been associated with exposure to contaminated soil and water. Outbreaks occur with flooding during the monsoon season (Benacer et al., 2016). ...
... This study aimed to detect anti-leptospiral antibody in working and shelter dogs and their handlers. Serological surveillance provides much needed preliminary assessment of leptospirosis in managing its endemicity (MOH, 2015;Benacer et al., 2016). ...
The incidence of leptospirosis seems to be on the rise and could be an alarming indirect indication of a global re-emergence. It is a potential public health threat when dogs are speculated to be involved in the transmission of leptospirosis through possible subclinical harbouring of Leptospira spp. and subsequent shedding into the environment. This study aimed to detect anti-leptospiral antibodies among dogs and their handlers using the microscopic agglutination test (MAT). Blood samples from 266 apparently healthy dogs and 194 dog handlers were collected at four working dog organisations and four dog shelters. Serum samples were tested using MAT against 20 leptospiral serovars with a cut-off titre >=1:100 (dog) and >=1:50 (dog handlers). Seventy dogs (70/266; 26.3%) were seropositive mainly against serovars Icterohaemorrhagiae, Ballum, Bataviae and Javanica (titres ranged: 1:100-1:800). Sixty-seven dog handlers (67/194; 34.5%) were seropositive mainly against serovars Grippotyphosa, Icterohaemorrhagiae and Malaysia (titres ranged: 1:50-1:200). Dogs were seropositive due to exposure, vaccination or active infection. Seropositive dog handlers could indicate exposure or active infection. This shows the potential of dogs in maintaining and spreading the infection in Malaysia. Due to the occupational risk as a result of frequent contact with dogs and exposure to contaminated environments, dog handlers should be made aware of the presence of this zoonotic disease.
... Local ethnic people were predisposed to illness from leptospirosis. Dense population with inadequate local infra-structure and poor flash-flood management could be contributing factors for infection (Benacer et al, 2016a). In addition, climatic conditions may assist in disease transmission: high rainfall, high humidity and warmer environment increase incidence of leptospirosis (Reis et al, 2008;Storck et al, 2008;WHO, 2010). ...
... Over half of infected patients present with anicteric febrile illness (Forbes et al, 2012). However, other signs and symptoms observed are insufficient to distinguish leptospirosis from other acute febrile illnesses (Kishimoto et al, 2004;Pappas et al, 2008;Benacer et al, 2016a). In the present study, leukocytosis was the most frequently noted laboratory finding, followed by anemia, elevated liver function tests, azotemia, and thrombocytopenia, similar to a previous report (Pamar et al, 2013). ...
Leptospirosis is a widespread zoonotic disease caused by pathogenic Leptospira mostly affecting people in tropical and subtropical countries where environmental and socio-cultural conditions favor disease transmissions. Borneo, Malaysia is endemic for leptospirosis and a survey was conducted to analyze profiles of leptospirosis patients in Borneo obtained from records of confirmed cases admitted to Queen Elizabeth Hospital and Sibu Hospital from 2011-2014. Among 268 patients, 76% were males, age ranging from <1 to 89 years with 19% in 30-39 age bracket and 79% detected in the indigenous population. Fever with chills and rigor, nausea and vomiting were predominant symptoms, with abnormal liver and renal profiles. Mortality (5%) was due to complications from the disease. As leptospirosis continues to be an important public health concern, more work is needed to evaluate risk factors and improve awareness to improve strategies for control and prevention.
... Our study is in accordance with the literature showing that the most cases of leptospirosis occurred in individuals aged from 20-39 years old, followed by those aged 40-59 years old (18,26). Adults in these age groups are at increased risk due to occupational exposure such as miners, farmers, and abattoir and sewer workers (27). ...
... There was an increased incidence in the North region of the country between the years 2012 and 2014. Leptospirosis is known to be seasonal, and associated with rainfall in other countries (22,26) and Brazil (3,28). According to Research Company of Mineral Resources (CPRM), the agency responsible for monitoring rainfall, in 2012 there was an exceptional level of flooding recorded in the state of Acre, in the North of Brazil. ...
... Despite rapid modernization, leptospirosis remains an endemic disease in Malaysia with the emergence of more data for the past few years, since it was labelled a notifiable disease in 2010 [6][7][8][9]. The incidence of leptospirosis in Malaysia showed a progressively increasing trend from 2004 to 2014, with mortality rate ranging between 1-5% [7,8,10]. ...
... Despite rapid modernization, leptospirosis remains an endemic disease in Malaysia with the emergence of more data for the past few years, since it was labelled a notifiable disease in 2010 [6][7][8][9]. The incidence of leptospirosis in Malaysia showed a progressively increasing trend from 2004 to 2014, with mortality rate ranging between 1-5% [7,8,10]. The recent data from Ministry of Health of Malaysia show an increase from 3,665 cases in 2012 to 5,284 in 2016 [5]. ...
Typically, doctors consider a diagnosis of probable leptospirosis when there is a history of fever with kidney or liver involvement and an elevated serum creatine phosphokinase level. However, there are increasing numbers of cases with atypical presentation, which renders the diagnosis challenging. Objectives. The aim of this study is to determine the presentation patterns of leptospirosis during an outbreak, in order to increase the understanding of this potentially complex disease. Material and methods. This is a retrospective, observational study of an outbreak that occurred in an army camp in 2012. The data were collected by retrieving the patients' medical records, including signs and symptoms, laboratory findings, and outcomes. Results. There were 47 cases of leptospirosis confirmed by a microscopic agglutination test (MAT). Of these, only 50% had a positive point-of-care serology test result at initial encounter in the emergency department. The majority (58%) presented with mild upper respiratory tract and gastrointestinal symptoms and 64% had no fever on presentation. Only five patients had leukocytosis (12%); 86% were within the normal range. Half of the patients (50%) had a normal platelet count and 60% had normal renal function. However, 74% had a creatine phosphokinase level over 200. Conclusions. Leptospirosis is difficult to diagnose due to its ambiguous clinical presentation. Most of the laboratory findings can be unhelpful in excluding the diagnosis. The point-of-care serology test done in the primary setting should not be relied on in highly suspicious cases. In a cluster where leptospirosis is endemic, the MAT might be warranted; otherwise, empirical antibiotics may be considered, even for mild symptoms.
... Leptospirosis is a globally emerging, zoonotic disease caused by the pathogenic spirochete Leptospira. Rodents are the most common host reservoirs for this transmission taking place through contaminated mammalian blood or urine or indirectly through contaminated water or soil (Benacer et al., 2016). Leptospirosis is endemic in Malaysia, but surprisingly this was only regarded as a notifiable disease from 2010 onwards (Tan et al., 2016). ...
The mass movement of migrants to Malaysia for employment is one of the factors contributing to the emergence and re-emergence of infectious diseases in this country. Despite mandatory health screening for migrants seeking employment, prevalence records of infectious diseases amongst migrant populations in Malaysia are still within negligible proportions. Therefore, the present review highlights the incidence, mortality and overall status of infectious diseases amongst migrants' populations in Malaysia, which maybe be useful for impeding exacerbation of inequalities among them and improving our national health system thru robust and effective emergency responses in controlling the prevalent diseases found among these populations and maybe, Malaysian citizens too. Peer-reviewed articles from January 2016 to December 2020 were searched through online platform including SCOPUS, PubMed, Science Direct, and Google Scholar. Non-peer-reviewed reports and publications from ministry and government websites including data from related agencies were also scoured from in order to ensure that there are no cases being overlooked, as most published articles did not have migrants as the research subjects. A total of 29 studies had been selected in the final analysis. Migrants in Malaysia were at higher risk for tuberculosis, malaria, lymphatic filariasis, cholera, leprosy and leptospirosis. Lymphatic filariasis was still endemic among this population while thousand cases of TB and cholera had been reported among them due to cramp living conditions and poor sanitation in their settlements respectively. While malaria had gradually decreased and become sporadic, the influx of migrant workers had led to the rising of imported malaria cases. Low cases of leprosy had been recorded in Malaysia but a significant proportion of it was contributed by migrant workers. As for leptospirosis, studies found that there are prominent cases among migrant workers, which particularly highest within workers with lower educational attainment. Infectious diseases are still prevalent among migrants in Malaysia due to various interplay factors including their working sectors, country of origin, immunization status, type of settlement, impoverished living conditions, and language and cultural barriers that impeding access to health facilities.
... Hence, this disease is a relevant public health concern in Brazil, with social, health, and economic impact; high hospital cost; loss of productivity; and high lethality [5,6]. Leptospirosis is caused by Leptospira interrogans, a bacterial species that survives in varied environments for prolonged periods and affects humans and wild, domestic, and synanthropic animals, which then become carriers of this species and contribute to its spread in nature [7]. ...
Although leptospirosis is endemic in most Brazilian regions, South Brazil shows the highest morbidity and mortality rates in the country. The present study aimed to analyze the spatial and temporal dynamics of leptospirosis cases in South Brazil to identify the temporal trends and high-risk areas for transmission and to propose a model to predict the disease incidence. An ecological study of leptospirosis cases in the 497 municipalities of the state of Rio Grande do Sul, Brazil, was conducted from 2007 to 2019. The spatial distribution of disease incidence in southern Rio Grande do Sul municipalities was evaluated, and a high incidence of the disease was identified using the hotspot density technique. The trend of leptospirosis over the study period was evaluated by time series analyses using a generalized additive model and a seasonal autoregressive integrated moving average model to predict its future incidence. The highest incidence was recorded in the Centro Oriental Rio Grandense and metropolitan of Porto Alegre mesoregions, which were also identified as clusters with a high incidence and high risk of contagion. The analysis of the incidence temporal series identified peaks in the years 2011, 2014, and 2019. The SARIMA model predicted a decline in incidence in the first half of 2020, followed by an increase in the second half. Thus, the developed model proved to be adequate for predicting leptospirosis incidence and can be used as a tool for epidemiological analyses and healthcare services.Temporal and spatial clustering of leptospirosis cases highlights the demand for intersectorial surveillance and community control policies, with a focus on reducing the disparity among municipalities in Brazil.
... Penelitian yang dilakukan oleh Benacer (2016) yang dilakukan di Malaysia tahun 2004-2012 menemukan bahwa ada hubungan positif antara suhu dan leptospirosis. 12 Penelitian tersebut menemukan bahwa kasus leptospirosis sering terjadi pada suhu 27 o C hingga 28 o C. Penelitian lainnya juga menerangkan bahwa iklim yang hangat berhubungan dengan leptospirosis dimana daya bertahan hidup patogen dan tumbuh subur pada suhu rata-rata sekitar 23.5 o C. 13,14 Peningkatan kelembaban di Kota Semarang berhubungan dengan kenaikan kasus Leptospirosis di Kota Semarang. Penelitian yang dilakukan di Cartagena de Indias, Colombia menemukan bahwa faktor iklim lokal seperti kelembaban relatif berhubungan dengan kasus leptospirosis khususnya kelembaban pada lag 1 atau kelembaban 1 bulan sebelumnya. ...
Latar belakang: Perubahan cuaca yang terjadi saat ini disebabkan oleh meningkatnya konsentrasi Gas Rumah Kaca dan dapat merubah elemen suhu, kelembaban, dan curah hujan. Meningkatnya iklim ekstrim basah menyebabkan beberapa daerah menjadi rawan banjir dan menjadi penyebab penyakit bawaan air seperti Leptospirosis. Tujuan penelitian ini yakni melihat hubungan temporal dan spasial faktor cuaca (suhu, kelembaban, curah hujan), kejadian banjir dengan kasus leptospirosis di Kota Semarang serta melihat prediksinya.Metode: Data cuaca, kejadian banjir dan kasus leptospirosis selama 10 tahun (2012-2021) di dapatkan dari Stasiun Klimatologi Kelas 1 Semarang, Badan Pengendali Bencana Daerah Kota Semarang, dan Dinas Kesehatan Kota Semarang. Data temporal maupun spasial diolah menggunakan program R. Analisis menggunakan time lag 1 bulan – 3 bulan.Hasil: Analisis statistik menunjukkan bahwa suhu lag 1 bulan, kelembaban lag 1 bulan, curah hujan lag 2 bulan, kejadian banjir lag 1 bulan berhubungan dengan kasus leptospirosis di Kota Semarang. Pola temporal menunjukkan pola yang simetris yakni apabila kasus naik maka kelembaban lag 1, curah hujan lag 2, kejadian banjir lag 1 mengalami kenaikan sedangkan untuk suhu mengalami pola terbalik. Sedangkan pola spasial menunjukkan ada hubungan yang konsisten pada tingkat kecamatan di Kota Semarang selama 10 tahun. Faktor cuaca dan kejadian banjir juga bisa menjadi prediktor kasus leptospirosis 1 bulan kedepan dengan tingkat RMSE 5.36%.Simpulan: Faktor Cuaca dan Kejadian Banjir memiliki hubungan dengan adanya Kasus Leptospirosis di Kota Semarang dan dapat menjadi prediktor selama 1 bulan kedepan.Kata kunci: cuaca, banjir, leptospirosis, spasial, temporal ABSTRACTTitle: Temporal and Spatial Analysis of Weather Factors with Cases of Leptospirosis in Semarang City 2012-2021Background: Current weather changes are caused by increased concentrations of greenhouse gases and can change the elements of temperature, humidity, and rainfall, The increasing extreme wet climate causes some areas to become prone to flooding and becomes the cause of water borne diseases such as Leptospirosis. The purpose of this study is to analyze the temporal and spatial relationship of weather factors (temperature, humidity, rainfall), flooding with cases of leptospirosis in Semarang City and see the predictions.Method: Weather data, flooding and leptospirosis cases for 10 years (2012-2021) obtained from Semarang Class 1 Climatology Station, Semarang City Regional Disaster Control Agency and Semarang City Health Office. Temporal and spatial data are processed using the R program. Analysis uses a time lag of 1 month – 3 months.Result: Statistical analysis shows that temperature lag 1 month, humidity lag 1,rainfall lag 2 month, flood lag 1 month associated with cases of leptospirosis in Semarang City. Temporal patterns show a symmetrical pattern that is if the case rises then humidity lag 1, precipitation lag 2, the incidence of flooding lag 1 increase while for temperature experiences an inverse pattern. Meanwhile, spatial patterns shows that there is a consistent relationship at the sub-district level in Semarang City for 10 years. Weather factors and the incident of flooding can also be predictors of leptospirosis cases in the next 1 month with a RMSE rate of 4.92%.Conclusion: Weather Factors and Flood Events have a relationship with the existence of Leptospirosis Cases in Semarang City and can be a predictor for the next 1 month.Keywords: weather, flood, leptospirosis, spatial, temporal
... According to Nasir et al. (2016), heavy metal exposure on humans can cause serious health effects including disrupting the human growth system, cancer, organ damage, nervous system damage and in severe cases, can be fatal or causes death. In Malaysia, leptospirosis is a common disease experienced by the victims whenever floods hit (Benacer et al., 2016) like what previously happened in Johor (Badrul Hashim et al., 2010). While in other countries such as Bangladesh which was reported to have frequent diarrhea, dysentery, fever, eye and skin infections, and abdominal ulcer when floods hit (Shimi et al., 2010), as well as Nigeria where most flood victims suffered from health problems such as malaria and diarrhea (Ubachukwu & Emeribe, 2017). ...
... Between 2004 and 2012, approximately 12,325 leptospirosis cases were documented with a case fatality rate of 2.7%. 2 The clinical manifestations of leptospirosis vary from self-limiting febrile disease to multiple organ failure that eventually leads to death. 3 Leptospirosis-afflicted patients also exhibit nonspecific symptoms, including fever, headache, and myalgia, that resemble dengue fever (DF). ...
In recent years, the number of leptospirosis cases, including the number of deaths, has exponentially increased in Malaysia. From June 2016 to February 2018, blood samples of 321 febrile patients with the presumptive diagnosis of dengue-like illness were examined for possible exposure to Leptospira . Two hundred fifty-five blood samples were tested as negative for dengue. Seminested polymerase chain reaction (PCR) and IgM ELISA for leptospirosis were performed. From the samples, an overall prevalence for leptospirosis based on PCR of 4.7% (12/255) was obtained. Eighteen percent (46/255) were positive for anti- Leptospira IgM antibodies. The genome sequences of six of 12 Leptospira PCR-positive samples showed > 97.0% similarity to Leptospira interrogans . One patient’s sample consisted of Leptospira and chikungunya virus, suggesting a coinfection. Findings from the study suggest that leptospirosis is prevalent among dengue-negative febrile patients in Malaysia.
... Malaysia is divided geographically into the more urbanized Peninsular Malaysia and more rural Malaysian Borneo, with differing regional endemic disease profiles. For example, malaria is prevalent in Borneo [11][12][13][14], while leptospirosis and dengue are more commonly reported in rural and urban areas of Peninsular Malaysia, respectively [15][16][17][18][19][20][21][22]. Although a strong emphasis on scrub typhus was seen in Malaysian history dating back to the early 1900s (then known as the Federated Malay States), when Dowden first described a 26-year-old plantation worker in Kuala Lumpur with what he described as "kedani fever" (kedani is Japanese for "hairy mite") [23]. ...
Rickettsial infections are among the leading etiologies of acute febrile illness in Southeast Asia. However, recent data from Malaysia are limited. This prospective study was conducted in Teluk Intan, Peninsular Malaysia, during January to December 2016. We recruited 309 hospitalized adult patients with acute febrile illness. Clinical and biochemistry data were obtained, and patients were stratified into mild and severe infections based on the sepsis-related organ failure (qSOFA) scoring system. Diagnostic assays including blood cultures, real-time PCR, and serology (IFA and MAT) were performed. In this study, pathogens were identified in 214 (69%) patients, of which 199 (93%) patients had a single etiology, and 15 (5%) patients had >1 etiologies. The top three causes of febrile illness requiring hospitalization in this Malaysian study were leptospirosis (68 (32%)), dengue (58 (27%)), and rickettsioses (42 (19%)). Fifty-five (18%) patients presented with severe disease with a qSOFA score of >2. Mortality was documented in 38 (12%) patients, with the highest seen in leptospirosis (16 (42%)) followed by rickettsiosis (4 (11%)). While the significance of leptospirosis and dengue are recognized, the impact of rickettsial infections in Peninsular Malaysia remains under appreciated. Management guidelines for in-patient care with acute febrile illness in Peninsular Malaysia are needed.
... The average annual incidence was 4.83 cases per 100,000 population. More cases are observed during the wet season between October and March in Peninsular Malaysia which is, and from October to February in East Malaysia (Benacer et al. 2016). ...
Leptospirosis is a zoonotic disease caused by the Leptospira spirochete. These microorganisms are transmitted through stagnant water or soil via urine of wild and domestic animals which act as reservoir hosts. During flooding incidents, Leptospira spirochetes are dispersed in flood waters and may infect humans who come in contact with the water. The aim of this study is to assess the risk factors for leptospirosis during a major flood disaster in Kelantan at the end of December 2014 until early January 2015. A hospital-based case-control study was conducted from 12-30 January 2015 in the state of Kelantan, Malaysia. Leptospirosis cases were confirmed by microscopic agglutination test (MAT) or polymerase chain reaction (PCR). A standardized questionnaire was used to collect demographic and exposure information from both cases and controls. We recruited 54 confirmed leptospirosis cases and 119 controls. Multivariable logistic regression showed staying in flood relief centres (AOR: 4.23; 95% CI: 1.02, 17.53) and history of walking in floodwaters (6.16; 1.40, 27.21) were significantly associated with leptospirosis. Our findings suggest that risk of leptospirosis infection during major floods may be reduced by avoiding walking in floodwaters and ensuring high standards of hygiene and cleanliness in flood relief centers.
... This is particularly relevant, because unlike these other diseases, leptospirosis is treatable with easily available antibiotics such as doxycycline or penicillin. Further research is needed to differentiate febrile illness caused by leptospirosis from other tropical illnesses in Rwanda [22,23]. ...
Background
Leptospirosis is a zoonotic disease transmitted through the urine of wild and domestic animals, and is responsible for over 50,000 deaths each year. In East Africa, prevalence varies greatly, from as low as 7% in Kenya to 37% in Somalia. Transmission epidemiology also varies around the world, with research in Nicaragua showing that rodents are the most clinically important, while studies in Egypt and Chile suggest that dogs may play a more important role. There are no published studies of leptospirosis in Rwanda.
Methods & findings
We performed a cross-sectional survey of asymptomatic adults recruited from five occupational categories. Serum samples were tested using ELISA and Microscopic Agglutination Test (MAT). We found that 40.1% (151/377) of asymptomatic adults had been exposed to Leptospira spp. Almost 36.3% of positive subjects reported contact with rats (137/377) which represent 90.7% among positive leptospira serology compared with 48.2% of negative subjects (182/377) which represent 80.5% among negative leptospira serology (OR 2.37, CI 1.25–4.49) and 1.7 fold on prevalence ratio and 2.37 of odd ratio. Furthermore, being a crop farmer was significantly associated with leptospirosis (OR 2.06, CI 1.29–3.28). We identified 6 asymptomatic subjects (1.6%) who met criteria for acute infection.
Conclusions
This study demonstrates a high prevalence of leptospiral antibodies infection among asymptomatic adults in rural Rwanda, particularly relative to neighboring countries. Although positive subjects were more likely to report rat contact, we found no independent association between rats and leptospirosis infection. Nonetheless, exposure was high among crop farmers, which is supportive of the hypothesis that rats together with domestic livestock might contribute to the transmission.
Further studies are needed to understand infecting Leptospira servers and elucidate the transmission epidemiology in Rwanda and identify means of host transmitters.
... Prevention and control of leptospirosis needs to be supported by complex scientific knowledge and health policy development. There are complex leptospirosis risk factors such as socioeconomics [24,25], environment [26], livestock [27,28] and community involvement. Departments in districts cooperate to develop plans to prevent and control leptospirosis that mainly focus on patients and not the whole population. ...
Leptospirosis is an endemic disease with moderate to high incidence in Mahasarakham province, Thailand. The present study was designed to assess the policy implementation mission regarding leptospirosis prevention and control from the national level to the local administrative levels, through a One Health perspective. A qualitative study was conducted, using documentation review, individual in-depth interviews with public health officers, local government officers, livestock officers who developed policy implementation tools or have responsibilities in leptospirosis prevention and control. The results show that Thailand has progressively developed a leptospirosis prevention and control policy framework at the national level, transferring the responsibility of its implementation to the local level. The province of Mahasarakham has decided to foster cooperation in leptospirosis prevention and control at the local level. However, there are insufficient linkages between provincial, district and sub-district departments to ensure comprehensive disease prevention activities at the local level concerning leptospirosis patients and the whole population.
... During the flood times, normally the access for a clean water, especially at the evacuation centers are very limited, simply because they're not available. A normal clean water distribution pipe is simply not working for this time, due to disruption in the water supply system infrastructure following the rise in flood water levels [1,2,3]. McCluskey [4] has stated that floods will always lead to damage of the water pumps and water treatment equipment. ...
Clean water supply has an important role among flood victims at evacuation centers during the flood. However, the water supply from various unknown and unverified sources such as hygiene status can affect the flood victims health. Therefore, the purpose of this study is to evaluate the flood water quality in the Kuala Krai flooding areas. The methodology of data collection in this study are fieldwork methods. It has been used to collect flood water samples during the northeast monsoon season in December 2016 and January 2017. A total of four flood water stations have been select based on the four flood evacuation centers based on the number of flood victims. A total of 13 water quality parameters were analyzed: pH, DO, BOD, COD, SS, NH3N, turbidity, NO3, Fe, Mg, Ca, Cu and E. coli bacteria. Flood water quality assessment in this study is based on the Malaysian National Water Quality Standards by the Malaysia Department of Environment (DOE). The results showed that flood water quality was in class III which was considered as moderate pollution. This situation explains that flood water needs to be fully treated for drinking water. To ensure the safe water supply for flood victims, a water supply risk management during floods has to be developed to ensure flood victims will have a good clean water supply and reduce the spread of flood-related diseases.
... Terengganu, a state situated in the east coast of Peninsular Malaysia has been listed as one of the five states with high leptospirosis cases in 2015. A total number of 461 documented reports, were reported and 8.00 per 100,000 population incidence rates was documented between the years 2004 -2012 [3]. Leptospirosis cases are more likely to occur among occupational workers in the agricultural field, including farm workers, forestry-related workers as well as palm oil plantation workers, rice fields planter and rubber tapper compared to recreational exposure. ...
Leptospirosis is a re-emerging infectious disease of public health importance. Infection can occur through occupational and environmental exposure of the causative agent through contaminated water in the agricultural field. In this study, soil and water samples were screened for the presence of Leptospira sp. In addition, the study aimed to explore the knowledge, attitudes and practice (KAP) on leptospirosis among agricultural communities in Setiu, Terengganu. A total of 40 environmental samples were randomly collected from rice fields, rubber plantation and oil palm plantation. All samples were examined for the presence of Leptospira sp by quantitative Real Time Polymerase Chain Reaction (qPCR) assay. KAP survey was carried out among 248 respondents using standardized modified translated questionnaires. Findings from this study revealed that only 5% of water collected from rice field area showed the presence of Leptospira sp. Similarly, only 5% of soil collected from oil palm plantation showed the presence of Leptospira sp DNA. Majority of respondents (52.58%) had moderate knowledge and unsatisfactory practice score (72.51%) but showed 75.21% of satisfactory attitude score. The findings also showed there is a significant difference in knowledge with regards to the signs and symptoms of leptospirosis (0.004). Furthermore, the practice score on rat control measures estimated 0.011 between three groups of respondents. The presence of Leptospira sp in the agricultural area and medium knowledge and practice among agricultural communities possesses environmental risks of contracting to leptospirosis. Hence, necessary interventions should be implemented by relevant authorities to prevent future transmission of leptospirosis in agricultural areas.
... According to Nasir et al. (2016), heavy metal exposure on humans can cause serious health effects including disrupting the human growth system, cancer, organ damage, nervous system damage and in severe cases, can be fatal or causes death. In Malaysia, leptospirosis is a common disease experienced by the victims whenever floods hit (Benacer et al., 2016) like what previously happened in Johor (Badrul Hashim et al., 2010). While in other countries such as Bangladesh which was reported to have frequent diarrhea, dysentery, fever, eye and skin infections, and abdominal ulcer when floods hit (Shimi et al., 2010), as well as Nigeria where most flood victims suffered from health problems such as malaria and diarrhea (Ubachukwu & Emeribe, 2017). ...
... Adult stage (>1 year) was significantly associated with leptospiruria (odds ratio 6.8, CI 90% 1.08- 40,4). Previous studies already reported older age as a risk factor for Leptospira spp. ...
Shedding of DNA of pathogenic Leptospira spp. has been documented in naturally infected cats in several countries, but urinary shedding of infectious Leptospira spp. has only recently been proven. The climate in Southern Chile is temperate rainy with high annual precipitations which represents ideal preconditions for survival of Leptospira spp., especially during spring and summer. The aims of this study were to investigate shedding of pathogenic Leptospira spp. in outdoor cats in Southern Chile, to perform molecular characterization of isolates growing in culture, and to assess potential risk factors associated with shedding. Urine samples of 231 outdoor cats from rural and urban areas in southern Chile were collected. Urine samples were investigated for pathogenic Leptospira spp. by 4 techniques: qPCR targeting the lipL32 gene, immunomagnetic separation (IMS)-coupled qPCR (IMS-qPCR), direct culture and IMS-coupled culture. Positive urine cultures were additionally confirmed by PCR. Multilocus sequence typing (MLST) was used to molecularly characterize isolates obtained from positive cultures. Overall, 36 urine samples (15.6%, 95% confidence interval (CI) 11.4–20.9) showed positive results. Eighteen (7.8%, 95% CI 4.9–12.1), 30 (13%, 95% CI 9.2–18), 3 (1.3%, 0.3–3.9) and 4 cats (1.7%; 95% CI 0.5–4.5) were positive in qPCR, IMS-qPCR, conventional culture, and IMS-coupled culture, respectively. MLST results of 7 culture-positive cats revealed sequences that could be assigned to sequence type 17 (6 cats) and sequence type 27 (1 cat) corresponding to L. interrogans (Pathogenic Leptospira Subgroup 1). Shedding of pathogenic Leptospira spp. by cats might be an underestimated source of infection for other species including humans. The present study is the first one reporting growth of leptospires from feline urine in culture in naturally infected cats in South-America and characterisation of culture-derived isolates. So far, very few cases of successful attempts to culture leptospires from naturally infected cats are described worldwide.
... According to Nasir et al. (2016), heavy metal exposure on humans can cause serious health effects including disrupting the human growth system, cancer, organ damage, nervous system damage and in severe cases, can be fatal or causes death. In Malaysia, leptospirosis is a common disease experienced by the victims whenever floods hit (Benacer et al., 2016) like what previously happened in Johor (Badrul Hashim et al., 2010). While in other countries such as Bangladesh which was reported to have frequent diarrhea, dysentery, fever, eye and skin infections, and abdominal ulcer when floods hit (Shimi et al., 2010), as well as Nigeria where most flood victims suffered from health problems such as malaria and diarrhea (Ubachukwu & Emeribe, 2017). ...
Mathematics is an important subject for every pupil. We learn mathematics since early childhood education, primary school, secondary school, and even in higher education. It is needed in our everyday life, yet there are many pupils who afraid of this mathematics subject. This is happening especially among the dyscalculic pupils. Dyscalculia is a type of learning disabilities as the same categories as dyslexia. However, dyscalculia remains behind dyslexia in terms of research and understanding. Dyscalculic pupils are a group of pupils with special educational needs. More researches in this field are very crucial to be developed. Hence, the purpose of this study is to introduce the symptoms, instruments, diagnosis and interventions of dyscalculia. This introduction of dyscalculia will be explained based on the previous literature reviews dan previous studies. The impact of this study is it will provide a fundamental knowledge for researchers in future researches as well as special education teachers or mainstream teachers to understand about their pupils who might have symptoms of dyscalculia. By this knowledge, they can also learn about some instruments, diagnosis, and interventions to improve the mathematics learning and even reduce the impact of dyscalculia on the pupils. Keywords:
... Leptospirosis is caused by Leptospira spirochaetes, is an important zoonotic disease that annually infects 1.03 million people worldwide (Costa et al., 2015). Leptospirosis is considered to be an endemic disease in Malaysia, with the number of reported cases and outbreaks increasing significantly over the years (Benacer et al., 2016). The mortality rate of leptospirosis ranges broadly between 5% and 83.3% and depends on several factors, including sociodemographic status, disease manifestation, and age (Edilane et al., 2008;Victoriano et al., 2009;Costa et al., 2015;Widiastuti et al., 2016). ...
Aims: Leptospirosis is an infectious disease that is endemic to many tropical regions. Large epidemics usually happen after heavy rainfall and flooding. This potentially fatal zoonosis is caused by pathogenic bacteria belonging to the genus Leptospira. Leptospirosis can be diagnosed using specific biomarkers such as target genes and virulence indicators that are well preserved across various Leptospira spp., including those that are prevalent in clinical samples and in the environment. To date, several pathogenicity-determinant genes, including lipL32 and lipL41, have been described and used for diagnosing leptospirosis. However, prevalence of these genes in leptospiral strains is unclear. Methodology and results: In the present study, we assessed the distribution of eight pathogenicity-determinant genes in reference Leptospira strains and environmental isolates in Malaysia, by polymerase chain reaction (PCR). We found that only lipL32 and ligB were consistently expressed in all pathogenic Leptospira strains compared with the other tested genes. Moreover, our results suggested that the use of lipL41, lipL21, ompL1, lfb1, ligA, and ligC as biomarkers could incorrectly misdetect pathogenic Leptospira strains present in the environment. Conclusion: Thus, our results suggest that the pathogenicity-determinant genes lipL32 and ligB can be used as biomarkers for detection pathogenic Leptospira.
... It is estimated that there are one million cases of leptospirosis worldwide each year, with an estimated death toll of about 58,900 [2]. Malaysia is known to be an endemic country for human leptospirosis [3]. The number of reported cases has risen dramatically since the Ministry of Health Malaysia highlighted leptospirosis as a notifiable disease in 2010, with reported cases increasing from 263 to 7806 in the duration of 10 years. ...
This study was carried out to determine the risk factors of leptospirosis infection among local urban service workers in Sabah. This is a cross-sectional study involving 394 workers in Kota Kinabalu City, Sabah, conducted from February to March 2017. Information on demography, occupational exposures and environmental factors was obtained by a modified validated questionnaire. Polymerase Chain Reaction (PCR) was used to determine the prevalence of positive leptospirae. The overall figure for positive leptospirae was 9.4% (95% CI: 6.8-12.8). Urban sweepers and lorry drivers made up the highest proportion of positive leptospirae respondents, contributing 15.5% and 9.4%, respectively. The significant risk factors for positive leptospirae were older age (p-value = 0.001), higher monthly salary (p-value = 0.039), longer duration of employment (p-value = 0.011) and working as an urban sweeper (p-value = 0.021). Leptospirae was prevalent among healthy urban service workers and relates to their working activities.
... This disease is reemerging [3] affecting approximately 1 million people all over the world each year [4,5]. Over the last few years, the number of cases has increased in tropical regions [6]. Leptospirosis ranges in severity from benign in most cases to sometimes fatal with a mortality rate of around 10 percent and raises a real public health issue [7]. ...
Leptospirosis is a reemerging zoonosis and ranges in severity from benign to sometimes fatal. In cattle, infection may be responsible for abortion and infertility cases causing economic losses. Humans may be contaminated through direct contact with urine of infected animals or indirectly though interaction with urine-contaminated environment. Many wildlife species living close to cattle, especially commensal rodents may play a role in the transmission of leptospires. Because little is known on the epidemiology of nonmaintenance Leptospira serovars, appropriate management is still limited. On a French farm where human and cattle leptospirosis were detected, the transmission cycle was explored to propose appropriate mitigation measures. For that, commensal rodents present on the farm were trapped and their leptospires carriage was studied by molecular methods. Trapped mice were shown to carry two pathogenic Leptospira species ( L. interrogans and L. kirschneri ). Since these 2 serogroups were simultaneously detected in the trapped mice and in the cows of this farm, we suspected an initial Leptospira transmission from mice to cows requiring an effective management of mice on this farm. Because resistance to anticoagulant rodenticides due to Vkorc1 mutations has been largely described in rodents and first-generation anticoagulant rodenticides seemed to be inefficient in controlling mice on this farm, susceptibility of these mice to anticoagulants has been characterized by Vkorc1 sequencing. 50% of the trapped mice carried mutations in the Vkorc1 gene leading to severe resistance to first-generation anticoagulants. The management of such mice that are a real sanitary threat can be achieved only by using the most toxic second-generation anticoagulants or nonanticoagulant solutions.
... Furthermore, the demographic characteristics revealed that most of the students lived in terrace houses, which are considered urban houses in well-managed towns with proper sanitary conditions. This may also have contributed to the high percentage of knowledge regarding the disease, as a high risk of infection can be observed among people living in urban slums and unsanitary environments [51]. The location of the university (considered as an urban area) can also be attributed to the higher percentage of students who had leptospirosis knowledge, as they had easy access to different media and sources from the internet. ...
Leptospirosis is a zoonotic disease that has been reported in Malaysia and has been associated with a recent trend of recreational activities among the youth. Thus, efforts such as educational interventions among high-risk populations, especially the youth, are key to increasing public awareness regarding leptospirosis. This paper presents the findings of a pilot study wherein an educational intervention using a gamification intervention method was used to determine changes in leptospirosis knowledge among youth. On this note, students from a public university in Seremban district, Malaysia, were recruited and were asked to complete questionnaires before and after gamification activities. Baseline and immediate post-intervention data on leptospirosis knowledge were obtained. The total knowledge score was calculated, and differences in the mean pre- and post-intervention knowledge score were determined. Of the total 185 questionnaires that were completed at baseline and immediately post-intervention, only 168 that belonged to respondents who had heard of leptospirosis were analysed in this paper. A significant increase in leptospirosis knowledge was observed for the students following health education by gamification (p < 0.01). The results demonstrate the effectiveness of an educational intervention using gamification in improving leptospirosis knowledge among youth and suggest that gamification could become an efficient tool to prevent the disease within university-age demographics.
... Living nearby rubber tree plantations and bathing in natural bodies of water two weeks before the onset of illness are activities associated with agricultural and outdoor occupations, which are typically associated with the transmission and infection of leptospirosis [19]. These two behaviors have previously been shown to be associated with human leptospirosis infections [20,21]. The reason for why they are associated with severe leptospirosis in our study was probably due to the high concentration of the specific Leptospira serovars found in rubber tree plantations and natural bodies of water. ...
A nationwide prevention and control campaign for leptospirosis in Thailand has led to a decreased incidence rate, but the mortality and case fatality rates have remained stable. Regarding the limited knowledge of risk factors, a case-control study of the association between environmental and behavioral exposure with severe leptospirosis was implemented to identify the risk factors among adults in Thailand. The study was conducted in 12 hospital-based sites. Hospitalized patients with suspected clinical symptoms of leptospirosis were tested for leptospirosis by culture, loop mediated isothermal amplification (LAMP), real-time PCR, and the microscopic agglutination test (MAT). All participants answered a standardized questionnaire about potential risk factors. Risk factors were identified by univariable and multivariable logistic regression. Of the 44 confirmed cases, 33 (75.0%) presented with severe illness, as determined by clinical criteria, and were categorized as severe cases. Non-severe cases were defined as patients with non-severe symptoms of leptospirosis. Living nearby a rubber tree plantation (adjusted OR 11.65, 95% CI 1.08–125.53) and bathing in natural bodies of water (adjusted OR 10.45, 95% CI 1.17–93.35) were both significantly associated with an increased risk of severe leptospirosis. We recommend designating rubber plantations in Thailand as high-risk zones and closely monitoring hospitalized patients in those areas.
Foram avaliados os dados relacionados à ocorrência de leptospirose humana no período de 2007-2017 no estado do Pará/Brasil, com o objetivo de avaliar a ocorrência de leptospirose, os aspectos epidemiológicos, sociais e fatores de risco que podem favorecer a ocorrência da doença em humanos. Os dados secundários do Sinan foram analisados estatisticamente quanto às frequências das variáveis, teste qui-quadrado, razão de ODDS e regressão múltipla. O primeiro semestre apresentou maior incidência de casos, sendo mais frequentes em homens entre 20 e 39 anos. O fator de risco contato/limpeza de local com sinais de roedores (n=839; 63,61%) foi o preditor mais frequente e variável de casos (Beta = 0,27, F(499) = 7,5); bem como sexo (Beta = 0,13, F(499) = 4,18); e contato com água e lama (Beta = 0,12, F(499) = 3,57). Concluímos que a ocorrência da leptospirose foi mais frequente em pessoas domiciliadas na área urbana, do sexo masculino e está relacionada à deficiência de infraestrutura de saneamento básico, haja vista que foram indicados pela regressão linear como fatores preditores para a infecção humana. Além disso, indicamos a adoção de políticas que garantam a completude do preenchimento das informações na base de dados do Sinan.
Leptospirosis is a bacteria infection prevalent in many tropical regions, caused by the genus Leptospira. Humans contract the disease by coming in contact with contaminated environments. This study proposes a deterministic mathematical model that links the within-host and between-host dynamics of leptospirosis and investigates its properties. The model's parameters were estimated by fitting it to real-life data using the "lsqcurvefit" package in MATLAB. The study employs global sensitivity analysis using Latin hypercube sampling with a partial rank correlation coefficient index and uses Pon-tryagin's maximum principle to identify cost-effective solutions for time-dependent intervention strategies to suppress the bacteria transmission within a specific period. The results of the study showed that bacteria replication within human and rodent hosts is the major driver of the overall dynamics of leptospirosis and therefore controlling the prevalence of the disease by focusing on the epidemiology components is necessary but will not be effective if the intra-host dynamics of the bacteria within rodent hosts and human hosts are not attentively considered. MSC 2020: 92B05; 92C37; 92D30
Background
Leptospirosis, caused by the Leptospira bacteria, is an acute infectious disease that is mainly transmitted by exposure to contaminated soil or water, thereby presenting a wide range of subsequent clinical conditions. This study aimed to assess the distribution of cases and deaths from leptospirosis and its association with social vulnerability in the state of Rio Grande do Sul, Brazil, between 2010 and 2019.
Methods
The lethality rates and incidence of leptospirosis and their association with gender, age, education, and skin color were analyzed using chi-square tests. The spatial relationship between the environmental determinants, social vulnerability, and the incidence rate of leptospirosis in the different municipalities of Rio Grande do Sul was analyzed through spatial regression analysis.
Results
During the study period, a total of 4,760 cases of leptospirosis, along with 238 deaths, were confirmed. The mean incidence rate was 4.06 cases/100,000 inhabitants, while the mean fatality rate was 5%. Although the entire population was susceptible, white-colored individuals, males, people of the working-age group, along with less-educated individuals, were more affected by the disease. Lethality was higher in people with dark skin, and the prime risk factor associated with death was the direct contact of the patients with rodents, sewage, and garbage. The social vulnerability was positively associated with the incidence of leptospirosis in the Rio Grande do Sul, especially in municipalities located in the center of the state.
Conclusions
It is evident that the incidence of the disease is significantly related to the vulnerability of the population. The use of the health vulnerability index showed great relevance in the evaluation of leptospirosis cases and can be used further as a tool to help municipalities identify disease-prone areas for intervention and resource allocation.
Resumo A leptospirose é uma zoonose que apresenta potencial epidêmico, principalmente após fortes chuvas que acarretam inundações, alagamentos e enxurradas. Algumas características da região costeira de Santa Catarina, localizada no Sul do Brasil, influenciam nesses processos. Portanto, a partir do estudo da leptospirose nos seis municípios do estado com as maiores incidências e picos epidêmicos de 2000 a 2015, buscou-se conhecer a tendência dessa doença e as variáveis climáticas e ambientais associadas à sua ocorrência, ajustando dois modelos com resposta binomial negativa. As maiores incidências foram encontradas em 2008 e 2011, com picos no mesmo mês ou no posterior aos eventos de desastres. A incidência apresentou forte comportamento sazonal, sendo maior nos meses do verão. Observou-se tendência de queda na incidência dos municípios estudados, estimada em 3,21% ao ano. Os fatores climáticos e ambientais mais fortemente associados foram o número de dias de chuva, a temperatura máxima e a presença de enxurrada e de inundação, com diferentes impactos entre os municípios. Houve interações significativas, indicando que o efeito de inundações na incidência não é o mesmo em todos os municípios e que as diferenças nas incidências entre os municípios dependem da ocorrência ou não de inundações.
Background:
Leptospirosis is emerging as one of the growing public health problems in many parts of India. It can occur in both rural and urban areas with varied risk factors. This study was taken up in three districts of Maharashtra namely-Mumbai, Ratnagiri, and Sindhudurg to understand the determinants of leptospirosis in both the urban and rural areas and look for differences if any.
Materials and methods:
This cross-sectional study was carried out during the year 2017. A pretested validated questionnaire was used to collect data. Field observations were made. Eighty-seven cases from Sindhudurg and 14 from Ratnagiri and 307 cases from Mumbai were included in the study.
Results:
A total of 408 cases were included in the study. A total of 63 (62.4%) were males and 38 (37.6%) were females. Most cases belonged to the 20-35 year age group (37%). In rural areas, 32.7% of them visited government facilities first, whereas, in the urban areas, it was 73.9% (P = 0.006). Headache, myalgia, and prostration were more common in cases from rural areas (P = <0.05). Skin rash was found to be associated with urban cases of leptospirosis. The presence of rodents, cattle sheds, pets, and working in paddy fields were common environmental risks in rural areas, and using water for recreational activities were common in urban areas (P < 0.001).
Conclusions:
Context-specific risk factors were found significantly associated with the cases. No important difference was found in the epidemiology of leptospirosis in the urban and rural areas except the source of infection.
Leptospirosis is an endemic zoonoses of global proportions. Stray dogs have been postulated to play a role in disease transmission; however, supporting information are still limited. Roaming behaviour may not only predispose the dogs to infection, but could also contribute to disease spread. In this study, the susceptibility of urban stray dogs in shedding Leptospira spp. was determined. Blood, urine, and tissue samples of kidney and liver were collected from 100 dogs from 2 animal control facilities. Serological testing using microscopic agglutination test (MAT) were performed on blood against 20 leptospiral serovars with a cut-off titre of ≥ 1:100. Samples were cultured onto semi-solid Ellinghausen and McCullough modified by Johnson and Harris (EMJH) media. Isolates were identified using molecular polymerase chain reaction (PCR) using two primers (16s rRNA and LipL32) and hyperimmune serum (HIS) MAT. The seroprevalence for the dogs positive for leptospirosis was 32% (n=32/100) with the following detected serovars: Javanica (n=13), Bataviae (n=10), Icterohaemorrhagiae (n=3), Autumnalis (n=2), Canicola (n=1), Pyrogenes (n=1), Copenhageni (n=1), and Australis (n=1). Six Leptospira spp. isolated were procured from urine (n=2), kidney (n=2) and liver (n=2). All 6 isolates belonged to L. interrogans, a pathogenic variant of Leptospira spp. Serotyping and phylogenetic analysis suggested serovar Bataviae (n=5) and serovar Canicola (n=1). Presence of vaccinal serovars (Icterohaemorrhagiae and Canicola) suggested potential post-vaccination antibodies but the predominance of non-vaccinal serovars (Javanica and Bataviae) indicate the possibility of current infection or post-exposure. Isolation of Leptospira spp. directly from urine sample not only suggested an active infection but highlighted the potential shedding capability among these stray dogs. These findings further strengthen speculations that urban stray dogs could play a role in transmission and dissemination of leptospirosis through their constant movement. The urine of infected dogs may contaminate the environment, posing a major public health threat.
Leptospirosis has been recognized as a major public health concern in Thailand following dramatic outbreaks. We analyzed human leptospirosis incidence between 2004 and 2014 in Mahasarakham province, Northeastern Thailand, in order to identify the agronomical and environmental factors likely to explain incidence at the level of 133 sub-districts and 1,982 villages of the province. We performed general additive modeling (GAM) in order to take the spatial-temporal epidemiological dynamics into account. The results of GAM analyses showed that the average slope, population size, pig density, cow density and flood cover were significantly associated with leptospirosis occurrence in a district. Our results stress the importance of livestock favoring leptospirosis transmission to humans and suggest that prevention and control of leptospirosis need strong intersectoral collaboration between the public health, the livestock department and local communities. More specifically, such collaboration should integrate leptospirosis surveillance in both public and animal health for a better control of diseases in livestock while promoting public health prevention as encouraged by the One Health approach.
Introduction
Leptospirosis is a bacterial disease that affects both humans and animals, the occurrence of which increases markedly during and after heavy rainfall and flooding. The aim of this study was to determine the serological prevalence of leptospiral infection in livestock after a voluminous flood in 10 districts of the Malaysian state of Kelantan.
Material and Methods
In December 2014, Kelantan was hit by an extensive flood. A total of 1,728 serum samples were collected from livestock from the state, comprised of 1,024 from cattle, 366 from goats and 338 from sheep, and they were tested using the microscopic agglutination test (MAT).
Results
Altogether, 203 (11.75%; 203/1728; 95% CI: 10.20%–13.30%) of the tested sera were found to be positive serologically. Cattle had the highest prevalence of 14.16% (145/1024), while goats and sheep had 11.20% (41/366) and 5.03% (17/338) respectively. The most frequent serovars detected were Hardjo-bovis (3.70%; 64/1728), Hebdomadis (2.08%; 36/1728) and Pomona (1.04%; 18/1728). There was a statistically significant association (P < 0.05) between livestock that were exposed to the flood and seropositivity.
Conclusion
This study showed that flood is a risk factor that can play a role in the epidemiology of leptospiral infection in livestock.
Leptospirosis is a zoonotic disease and a worldwide public health problem that affects mainly high-risk groups. Characterizing knowledge, attitude, and practice (KAP) among high-risk groups is important to develop appropriate prevention programs. Here, we performed a cross-sectional study among 300 visitors of a recreational forest in Malaysia to examine leptospirosis KAP and demographics. These variables were integrated to create knowledge and practice scores for each respondent. All respondents had heard about leptospirosis, and 87% of them correctly identified it as a disease. The majority of respondents had high knowledge (63%), positive attitude, and good practice (68%) toward prevention of the disease. However, there were gaps in knowledge, with 78% of the respondents indicating eating without washing hands as the major cause of leptospirosis transmission. Our final model identified that higher knowledge score was associated with higher practice score. Our results indicate that it is important to increase knowledge, especially on transmission routes of leptospirosis, among visitors in recreational areas. Moreover, more attention needs to be paid to promote good practice habits among visitors, targeting those at higher risk of being infected by leptospirosis to prevent potential outbreaks in the recreational areas.
Land use change can elevate disease risk by creating conditions beneficial to species that carry zoonotic pathogens. Observations of concordant global trends in increased pathogen prevalence or disease incidence and landscape change have generated concerns that urbanization could increase transmission risk of some pathogens. Yet host‐pathogen relationships underlying transmission risk have not been well characterized within cities, even where contact between humans and species capable of transmitting pathogens of concern occur. We addressed this deficit by testing the hypothesis that areas in cities experiencing greater population loss and infrastructure decline (i.e., counter‐urbanization) can support a greater diversity of host species and a larger and more diverse pool of pathogens. We did so by characterizing pathogenic Leptospira infection relative to rodent host richness and abundance across a mosaic of abandonment in post‐Katrina New Orleans (Louisiana, USA). We found that Leptospira infection loads were highest in areas that harbored higher rodent species richness (which ranged from 1 – 4 rodent species detected). Areas with greater host co‐occurrence also harbored a greater abundance of hosts, including the host species most likely to carry high infection loads, indicating that Leptospira infection can be amplified by increases in overall and relative host abundance. Evidence of shared infection among rodent host species indicates that cross‐species transmission of Leptospira likely increases infection at sites with greater host richness. Additionally, evidence that rodent co‐occurrence and abundance and Leptospira infection load parallel abandonment suggests that counter‐urbanization can elevate zoonotic disease risk within cities, particularly in underserved communities that are burdened with disproportionate concentrations of derelict properties.
The prevalence of leptospirosis in humans is highly variable, being influenced by climatic factors, the presence of reservoirs, occupational exposure, recreational activity, and socioeconomic conditions. The objective of this study was to estimate the prevalence of Leptospira spp. and identify the predominant human serovars on the island of Fernando de Noronha, Brazil, based on a microscopic agglutination test. The prevalence of anti-Leptospira antibodies was 1.17% (4/341; I.C. 0.46%–2.98%), with the predominance of serovars Icterohaemorrhagiae, Javanica, Mini and Louisiana. This is the first study on the occurrence of antibodies against Leptospira spp. in humans in Fernando de Noronha and highlights the need to implement control and prevention strategies in this island environment.
Leptospirosis is a neglected tropical disease that affects mostly rural people in Thailand. This study aims to identify the factors explaining leptospirosis epidemiology, to describe the health policy implemented for leptospirosis prevention and control and its implementation in the rural province of Mahasarakham (Thailand), and to analyse the representations, practices, and attitudes of patients, people, health volunteers and health officers toward the disease and its prevention.The analysis of health policies showed that Thailand has progressively developed a national prevention and control policy framework and transferred its implementation to local administrative levels. However, leptospirosis prevention and control still need enhanced collaboration between public health, livestock, and agriculture departments with an important local community involvement under the One Health approach.The analysis of the spatiotemporal distribution of human leptospirosis cases showed that the factors associated with leptospirosis infection are complex and multifactorial, including human population density, livestock density, rainfall, flood cover and physical geography, i.e. average slope. The results stressed the importance of livestock that may contribute to leptospirosis transmission to humans. Targeting areas prone at risk, i.e. with high livestock or in flooded areas, should be complemented by improving communication to people at risk, i.e. farmers.The cross sectional study conducted to assess knowledge, attitudes, and practices showed that patients, neighbors, village health volunteers and community leaders did not have a clear comprehension of the disease and its transmission to really improve the prevention of infections. People need to have access to a complex and up-to-date scientific knowledge in order to improve their awareness about leptospirosis.Finally, taking results of above issues allowed “Guidelines for developing cooperation between departments for prevention and control leptospirosis of Mahasarakham Province, Thailand” to be produced.
Background:
Leptospirosis (LS) is a neglected tropical zoonosis of global importance. A nationwide investigation of characteristics, epidemiology, risk factors and outbreak is crucial for awareness of this disease.
Methods:
A nationwide database of reported LS cases from October 2007 to December 2014 obtained from the Centers for Disease Control, Taiwan, was analysed. Geographic information system software was used to map the distribution of confirmed LS cases and pigs. Cross-matching with the databases of Q fever, scrub typhus and murine typhus was conducted to identify possible coinfections.
Results:
A total of 10,917 reported cases of LS were recorded in the database, which included 665 (6.1%) confirmed LS and 10,252 (93.9%) non-confirmed LS cases. The major residences of confirmed LS were the Kaohsiung-Pingtung (248, 37.3%) and Taipei (174, 26.2%) regions. The average annual incidence was 0.4/100,000 people. Compared with non-confirmed LS cases, confirmed LS cases had significantly higher percentages of male gender (83.6% vs. 67.9%, p < .001), high-risk occupations (farmer, animal husbandry or veterinarian) (24.8% vs. 13.7%, p < .001), residence in the Kaohsiung-Pingtung region (37.3% vs. 19.6%, p < .001) and exposure to rats (8.6% vs. 4.9%, p = .001) or pigs (9.4% vs. 1.9%, p < .001) but a lower mean age (47.8 ± 15.1 vs. 51.±18.5 years old). Rat and pig exposure trends were found in the northern and southern regions, respectively. Distribution of LS was consistent with pigs, and one outbreak associated with flooding and pigs occurred in the Pingtung region in 2009. Twenty-three and four patients with LS were coinfected with scrub typhus and Q fever, respectively.
Conclusions:
LS is an endemic disease in Taiwan, particularly in the Kaohsiung-Pingtung and Taipei regions. High-risk occupations and animal exposure history are important for the clinical presumptive diagnosis of LS, particularly for rats in northern Taiwan and pigs in southern Taiwan. Although uncommon, clinicians should be aware of coinfection of LS with endemic rickettsial diseases.
Leptospirosis is probably the most widespread zoonotic disease in the world especially in tropical countries. There has been an increase in individual studies, which assessed the frequency of leptospirosis in flood conditions. Some studies showed contact with floods was significantly associated with the occurrence of leptospirosis while other studies reported differently. The objective of this meta-analysis was to synthesize the evidence on the risk factors which are associated with human leptospirosis following flooding. We set up the inclusion criteria and searched for the original studies, addressing leptospirosis in human with related to flood in health-related electronic databases including PubMed, Embase, Ovid Medline, google scholar and Scopus sources. We used the terms 'leptospirosis', 'flood', 'risk factor' and terms from the categories were connected with "OR" within each category and by "AND" between categories. The initial search yielded 557 citations. After the title and abstract screening, 49 full-text papers were reviewed and a final of 18 observational studies met the pre-specified inclusion criteria. Overall, the pooled estimates of 14 studies showed that the contact with flooding was a significant factor for the occurrence of leptospirosis (pooled OR: 2.19, 95%CI: 1.48-3.24, I 2 :86%). On stratification, the strength of association was greater in the case-control studies (pooled OR: 4.01, 95%CI: 1.26-12.72, I 2 :82%) than other designs (pooled OR:1.77,95%CI:1.18-2.65, I 2 :87%). Three factors such as 'being male'(pooled OR:2.06, 95%CI:1.29-2.83), the exposure to livestock animals (pooled OR: 1.95, 95%CI:1.26-2.64), the lacerated wound (pooled OR:4.35, 95%CI:3.07-5.64) were the risk factors significantly associated with the incidence of leptospirosis following flooding in the absence of within-study heterogeneity (I 2 : 0%). We acknowledge study limitations such as publication bias and type 2 statistical errors. We recommended flood control and other environmental modifications that are expected to reduce the risk of leptospiral infection, and a multi-sectoral effort to this aspect would have long-term benefits.
Leptospirosis is probably the most widespread zoonotic disease in the world especially in tropical countries. There has been an increase in individual studies, which assessed the frequency of leptospirosis in flood conditions. Some studies showed contact with floods was significantly associated with the occurrence of leptospirosis while other studies reported differently. The objective of this meta-analysis was to synthesize the evidence on the risk factors which are associated with human leptospirosis following flooding. We set up the inclusion criteria and searched for the original studies, addressing leptospirosis in human with related to flood in health-related electronic databases including PubMed, Embase, Ovid Medline, google scholar and Scopus sources. We used the terms ‘leptospirosis’, ‘flood’, ‘risk factor’ and terms from the categories were connected with “OR” within each category and by “AND” between categories. The initial search yielded 557 citations. After the title and abstract screening, 49 full-text papers were reviewed and a final of 18 observational studies met the pre-specified inclusion criteria. Overall, the pooled estimates of 14 studies showed that the contact with flooding was a significant factor for the occurrence of leptospirosis (pooled OR: 2.19, 95%CI: 1.48–3.24, I²:86%). On stratification, the strength of association was greater in the case-control studies (pooled OR: 4.01, 95%CI: 1.26–12.72, I²:82%) than other designs (pooled OR:1.77,95%CI:1.18–2.65, I²:87%). Three factors such as ‘being male’(pooled OR:2.06, 95%CI:1.29–2.83), the exposure to livestock animals (pooled OR: 1.95, 95%CI:1.26–2.64), the lacerated wound (pooled OR:4.35, 95%CI:3.07–5.64) were the risk factors significantly associated with the incidence of leptospirosis following flooding in the absence of within-study heterogeneity (I²: 0%). We acknowledge study limitations such as publication bias and type 2 statistical errors. We recommended flood control and other environmental modifications that are expected to reduce the risk of leptospiral infection, and a multi-sectoral effort to this aspect would have long-term benefits.
In the past decade, leptospirosis has emerged as a globally important infectious disease. It occurs in urban environments of industrialised and developing countries, as well as in rural regions worldwide. Mortality remains significant, related both to delays in diagnosis due to lack of infrastructure and adequate clinical suspicion, and to other poorly understood reasons that may include inherent pathogenicity of some leptospiral strains or genetically determined host immunopathological responses. Pulmonary haemorrhage is recognised increasingly as a major, often lethal, manifestation of leptospirosis, the pathogenesis of which remains unclear. The completion of the genome sequence of Leptospira interrogans serovar lai, and other continuing leptospiral genome sequencing projects, promise to guide future work on the disease. Mainstays of treatment are still tetracyclines and beta-lactam/cephalosporins. No vaccine is available. Prevention is largely dependent on sanitation measures that may be difficult to implement, especially in developing countries.
A group of Leptospira strains which were isolated from patients with leptospirosis in Mayotte (Indian Ocean) were previously found considerably divergent from other known Leptospira species by sequence analysis of rrs (16S rRNA) and other genetic loci, suggesting they belong to a new species. Two strains from each of the currently identified serogroup within this new species were studied. Spirochete, aerobic, motile, helix-shaped strains grew well at 30-37°C, but not at 13°C or in the presence of 8-azaguanine. Draft genomes of the strains were also analyzed to study the DNA relatedness with other Leptospira species. The new isolates formed a distinct clade, which was most closely related to L. borgpetersenii, in multilocus sequence analysis using concatenated sequences of the genes rpoB, recA, fusA, gyrB, leuS and sucA. The analysis of average nucleotide identity (ANI) and genome-to-genome distances (GGD), which have recently been proposed as reliable substitutes for classical DNA-DNA hybridization, further confirmed that these isolates should be classified as a new species. The G+C content of the genomic DNA was 39.5 mol%. These isolates represent a novel species, for which the name Leptospira mayottensis sp. nov. is proposed, with 200901116T (=CIP110703 T = DSM28999 T) as the type strain.
ABSTRAK Kajian secara rentas ini telah dilakukan di sepanjang tahun 2000 untuk menentukan persepsi penduduk bandar terhadap urbanisasi dalam sektor kesihatan dan kesannya terhadap kehidupan mereka. Seramai 627 orang responden telah ditemuduga menggunakan borang soal-selidik secara berpandu di 6 lokasi yang dipilih menurut keselesaan. Kuala Lumpur dan Johor Bahru dipilih mewakili Bandaraya, Kota Bahru dan Langkawi mewakili Majlis Perbandaran dan Bentong dan Kuala Selangor mewakili Majlis Daerah. Kajian mendapati seramai 90.7 peratus responden pernah mendengar tentang pengkorporatan sektor kesihatan. Namun, hanya 38.3 peratus bersetuju tentang kebaikan pengkorporatan itu dan 23.0 peratus bersetuju sektor kesihatan dikorporatkan masa ini. Majoriti berpendapat (75.9 peratus) pengkorporatan akan meningkatkan bayaran perkhidmatan dan hanya 1.4 peratus yang merasakan ia akan dapat memberi imbuhan kepada pekerja. Sekiranya perkhidmatan kesihatan terpaksa dikorporatkan, 35.9 peratus responden mencadangkan agar skim pembayaran ansuran diperkenalkan. Hanya 8 peratus responden telah mencadangkan skim insurans kesihatan. Penduduk bandar juga merasakan bahawa perkembangan prasarana di Bandar, yang secara tidak langsung merupakan kesan urbanisasi adalah memuaskan. Walau bagaimanapun, kecanggihan sistem perhubungan dan kemasukan warga asing dikatakan dapat mempercepatkan penularan penyakit. Sejumlah 48.3 peratus responden merasakan penggunaan perubatan alternatif perlu digalakkan. Walau bagaimanapun, kemasukan ubatan alternatif secara berleluasa tanpa sekatan perlu disekat secara tegas. Usaha bersungguh-sungguh pelbagai pihak sangat diperlukan untuk meningkatkan pengetahuan dan amalan penduduk bandar tentang urbanisasi demi menjayakan wawasan negara. 112 Akademika 65 ABSTRACT This cross-sectional study was conducted throughout the year 2000 to determine the perception of urban residents towards urbanisation in health sector and its effect on their lives. A total of 627 respondents were interviewed using guided questionnaires at 6 locations selected by convenient sampling. Kuala Lumpur and Johor Bahru represented the cities, Kota Bahru and Langkawi represented the Municipal Council, and Bentong and Kuala Selangor represented the District Council. The study showed that a total of 90.7 percent respondents have heard of health sector corporatisation. However, only 38.3 percent agreed with the benefits of corporatisation, while only 23percent agreed that the health sector should be corporatised now. Majority of the respondents (75.9 percent) were of the opinion that corporatisation will increase the service cost and only 1.4 percent felt that it would benefit the workers. If health services have to be corporatised, 35.9 percent respondents suggested that the installment payment scheme be introduced. Only eight percent respondents suggested health insurance scheme. The urban residents also felt that the development of urban facilities that is indirectly due to the effect of urbanisation are satisfactory. However, the advancement of the communication system and the entry of foreigners were perceived to have speeded up the spread of disease. A total of 48.3 percent respondents felt that the use of alternative medicine should be encouraged, while, the wide entry of alternative medicine without restrictions must be strictly prevented. Serious efforts from various parties are needed to increase the knowledge and practice of the urban residents regarding urbanisation in order to achieve the country's vision to create a knowledgeable society.
Background
Leptospirosis is the most common bacterial zoonoses and has been identified as an important emerging global public health problem in Southeast Asia. Rodents are important reservoirs for human leptospirosis, but epidemiological data is lacking.
Methodology/Principal Findings
We sampled rodents living in different habitats from seven localities distributed across Southeast Asia (Thailand, Lao PDR and Cambodia), between 2009 to 2010. Human isolates were also obtained from localities close to where rodents were sampled. The prevalence of Leptospira infection was assessed by real-time PCR using DNA extracted from rodent kidneys, targeting the lipL32 gene. Sequencing rrs and secY genes, and Multi Locus Variable-number Tandem Repeat (VNTR) analyses were performed on DNA extracted from rat kidneys for Leptospira isolates molecular typing. Four species were detected in rodents, L. borgpetersenii (56% of positive samples), L. interrogans (36%), L. kirschneri (3%) and L. weilli (2%), which were identical to human isolates. Mean prevalence in rodents was approximately 7%, and largely varied across localities and habitats, but not between rodent species. The two most abundant Leptospira species displayed different habitat requirements: L. interrogans was linked to humid habitats (rice fields and forests) while L. borgpetersenii was abundant in both humid and dry habitats (non-floodable lands).
Conclusion/Significance
L. interrogans and L. borgpetersenii species are widely distributed amongst rodent populations, and strain typing confirmed rodents as reservoirs for human leptospirosis. Differences in habitat requirements for L. interrogans and L. borgpetersenii supported differential transmission modes. In Southeast Asia, human infection risk is not only restricted to activities taking place in wetlands and rice fields as is commonly accepted, but should also include tasks such as forestry work, as well as the hunting and preparation of rodents for consumption, which deserve more attention in future epidemiological studies.
Leptospirosis has emerged as an urban health problem as slum settlements have rapidly spread worldwide and created conditions for rat-borne transmission. Prospective studies have not been performed to determine the disease burden, identify risk factors for infection and provide information needed to guide interventions in these marginalized communities.We enrolled and followed a cohort of 2,003 residents from a slum community in the city of Salvador, Brazil. Baseline and one-year serosurveys were performed to identify primary and secondary Leptospira infections, defined as respectively, seroconversion and four-fold rise in microscopic agglutination titers. We used multinomial logistic regression models to evaluate risk exposures for acquiring primary and secondary infection. A total of 51 Leptospira infections were identified among 1,585 (79%) participants who completed the one-year follow-up protocol. The crude infection rate was 37.8 per 1,000 person-years. The secondary infection rate was 2.3 times higher than that of primary infection rate (71.7 and 31.1 infections per 1,000 person-years, respectively). Male gender (OR 2.88; 95% CI 1.40-5.91) and lower per capita household income (OR 0.54; 95% CI, 0.30-0.98 for an increase of $1 per person per day) were independent risk factors for primary infection. In contrast, the 15-34 year age group (OR 10.82, 95% CI 1.38-85.08), and proximity of residence to an open sewer (OR 0.95; 0.91-0.99 for an increase of 1 m distance) were significant risk factors for secondary infection.This study found that slum residents had high risk (>3% per year) for acquiring a Leptospira infection. Re-infection is a frequent event and occurs in regions of slum settlements that are in proximity to open sewers. Effective prevention of leptospirosis will therefore require interventions that address the infrastructure deficiencies that contribute to repeated exposures among slum inhabitants.
Leptospirosis, a worldwide distributed zoononis caused by bacteria of the genus Leptospira (antigenically classified into serovars), may be direct or indirectly transmitted through infected urine or environment. Several domestic and wild animals are leptospirosis reservoirs. The disease presents occupational character since it is widely reported in professionals that work in humid environments – such as sewage workers and fishermen – and in places where rodents or susceptible animals are found, like slaughterhouses and veterinary clinics. In developing countries, outbreaks are related to lack of sanitation, overcrowding in inadequate housing and climatic conditions. In developed countries, sporadic cases occur in aquatic recreational activities including swimming and triathlon. The diagnosis of leptospirosis is complex due to the variety of symptoms, disease severity and the lack of techniques that are able to early detect the infection. Thus, leptospirosis causes numerous public health problems and educational activities are very important to its control.
Leptospirosis is an endemic disease in Malaysia and recently has received increasing attention mainly due to several recent incidents that have resulted in human mortality which have alarmed health professionals in Malaysia. The increasing incidence of leptospirosis in forested regions is associated with the bacteria infecting small wild mammals other than rats. Infection in wildlife could result in the introduction of new serovars to humans and domesticated animals. More research on leptospirosis and the screening of wildlife and humans near wildlife habitats is required to have a better understanding of the involvement of wildlife in the disease.
To increase knowledge of leptospirosis in the Netherlands and identify changing trends of this disease over time, we analyzed historical passive surveillance reports for an 84-year period (1925-2008). We found that 2,553 mainly severe leptospirosis cases were diagnosed (average annual incidence rate 0.25 cases/100,000 population). The overall case-fatality rate for patients with reported leptospirosis was 6.5% but decreased over the period, probably because of improved treatment. Ninety percent of reported leptospirosis cases were in male patients. Most autochthonous leptospirosis infections were associated with recreational exposures, but 15.5% of the cases were attributed to accidents that resulted in injury and to concomitant water contact. Since the end of the 1950s, the proportion of imported infections gradually increased, reaching 53.1% of the total during 2005-2008. Most (80.1%) imported infections were associated with sporting and adventurous vacation activities.
Introduction: Town service workers are likely to be exposed to the leptospiral infection as a result of their occupational activities. All activities in solid waste management involve risk of the infection at every step in the process from the point where residents handle wastes in the home for collection or recycling, to the point of ultimate disposal. Aim and Objectives: The purpose of this study was to determine the seroprevalence of leptospirosis among town service workers as there was very little publication on the issue in Malaysia. Methods: A cross sectional study was conducted among 296 town service workers in northeastern state of Malaysia. The town service workers consisted of four main job categories namely garbage collector, town cleaner, landscaper and lorry driver. Seroprevalence for leptospirosis was determined by microscopic agglutination test (MAT). Results: All respondents were Malay males with mean age of 42.1 (SD 8.38) years old with mean duration of employment of 15.6 (SD 8.62) years. The overall seroprevalence of leptospirosis was 24.7% (95%CI: 19.7, 29.6). The predominant pathogenic serovar was Bataviae (12.3%). Garbage collectors and town cleaners were shown to have higher prevalence which were 27.4% (95% CI: 16.9, 37.9) and 26.0% (95% CI: 17.4, 34.5) respectively. Conclusion: Town service workers are occupational risk group for leptospirosis as indicated by the high seroprevalence.
Leptospira species were studied in water and soils from selected urban sites in Malaysia. A total of 151 water (n=121) and soil (n=30) samples were collected from 12 recreational lakes and wet markets. All samples were filtered and inoculated into semi-solid Ellinghausen and McCullough modified by Johnson and Harris (EMJH) media supplemented with additional 5-fluorouracil. The cultures were then incubated at 30°C and observed under a dark field microscope with intervals of 10 days. A PCR assay targeting the rrs gene was used to confirm the genus Leptospira among the isolates. Subsequently, the pathogenic status of the isolates was determined using primer sets G1/G2 and Sapro1/Sapro2, which target the secY and rrs genes, respectively. The isolates were identified at serogroup level using the microscopic agglutination test (MAT) while their genetic diversity was assessed by pulsed field gel electrophoresis (PFGE). Based on dark field microscopy, 23.1% (28/121) water and 23.3% (7/30) soil cultures were positive for Leptospira spp. Of the 35 positive cultures, only 8 were pure and confirmed as Leptospira genus by PCR assay. Two out of 8 isolates were confirmed as pathogenic, 5 were saprophytic and one was intermediate. These 8 isolates were negative for the 25 reference hyperimmune rabbit sera tested in the MAT. PFGE showed that all 8 of these environmental Leptospira spp. were genetically diverse. In conclusion, the presence of pathogenic Leptospira spp. in the urban Malaysian environment may indicate and highlight the importance of water screening, especially in recreational lakes, in order to minimize any chance of Leptospira infection.
Rats are considered the principle maintenance hosts of Leptospira. The objectives of this study were isolation and identification of Leptospira serovars circulating among urban rat populations in Kuala Lumpur. Three hundred urban rats (73% Rattus rattus and 27% R. norvegicus) from three different sites were trapped. Twenty cultures were positive for Leptospira using dark-field microscopy. R. rattus was the dominant carrier (70%). Polymerase chain reaction (PCR) confirmed that all isolates were pathogenic Leptospira species. Two Leptospira serogroups, Javanica and Bataviae, were identified using microscopic agglutination test (MAT). Pulsed-field gel electrophoresis (PFGE) identified two serovars in the urban rat populations: L. borgpetersenii serovar Javanica (85%) and L. interrogans serovar Bataviae (15%). We conclude that these two serovars are the major serovars circulating among the urban rat populations in Kuala Lumpur. Despite the low infection rate reported, the high pathogenicity of these serovars raises concern of public health risks caused by rodent transmission of leptospirosis.
Leptospira strain Eri-1(T) was isolated from a water sample in the campus of Kyushu University, Fukuoka, Japan. The motility and morphology of the isolate were similar to those of the genus Leptospira but spiral structure of the isolates was more sharp under dark-field microscopy. Cells were 10.6±1.3 µm long and 0.2 µm in diameter, with a wavelength of 0.9 µm and an amplitude of 0.4 µm. Strain Eri-1T grew in Korthof's medium at both 13 and 30 °C, and also in the presence of 8-azaguanine. 16S rRNA gene-based phylogenetic analysis placed strain Eri-1(T) within the radiation of the genus Leptospira, and formed a unique lineage within the clade of the known saprophytic Leptospira species. The strain was not pathogenic to hamsters. Strain Eri-1(T) exibited low levels (11.2-12.6%) of relative similarity by DNA-DNA hybridization to the three most closely related Leptospira species. The G+C content of the genome of strain Eri-1(T) was 42.5±0.1 mol%. These results suggested that strain Eri-1(T) is a novel species of genus Leptospira, for which the name Leptospira idonii sp. nov. is proposed. The type strain is Eri-1(T) (= DSM 26084(T) = JCM 18486(T)).
Leptospirosis is an epidemic-prone zoonotic disease that occurs worldwide. In Central America, leptospirosis outbreaks have been reported in almost all countries; Nicaragua in particular has faced several outbreaks. The objective of this study was to stratify the risk and identify "critical areas" for leptospirosis outbreaks in Nicaragua, and to perform an exploratory analysis of potential "drivers". This ecological study includes the entire country (153 municipalities). Cases from 2004 to 2010 were obtained from the country's health information system, demographic and socioeconomic variables from its Census, and environmental data from external sources. Criteria for risk stratification of leptospirosis were defined. Nicaragua reported 1,980 cases of leptospirosis during this period, with the highest percentage of cases (26.36%) in León, followed by Chinandega (15.35%). Among the 153 municipalities, 48 were considered critical areas, 85 were endemic and 20 silent. Using spatial and statistical analysis, the variable presenting the most evident pattern of association with critical areas defined by top quintile of incidence rate is the percentage of municipal surface occupied by the soil combination of cambisol (over pyroclastic and lava bedrock) and andosol (over a volcanic ashes foundation). Precipitation and percentage of rural population are also associated with critical areas. This methodology and findings could be used for Nicaragua's Leptospirosis Intersectoral Plan, and to identify possible risk areas in other countries with similar drivers.
To characterize current leptospirosis reporting practices in the Americas.
Information was collected from the official websites of national ministries of health from the Americas region and two international organizations; personal communications; and three international morbidity databases. For all sources other than the morbidity databases, the review was limited to official reports citing clinically suspected and laboratory confirmed leptospirosis cases or deaths during the period 1996-2005.
A total of 73 out of 1 644 reports met the selection criteria and were included in the analysis. Published leptospirosis data were available from half of the countries/sovereign territories (24 out of 48), and 18 of them had mandatory notification policies for leptospirosis. The sum of the median number of leptospirosis cases notified annually by the 24 countries/territories was 4 713.5, but just three countries (Brazil, Costa Rica, and Cuba) accounted for 83.1% (3 9cas20 es) of the notifications. Eight (16.7%) countries reported deaths due to leptospirosis. The sum of the median number of deaths reported annually for the eight countries was 380, but 349 (91.8%) were reported by Brazil.
Notification practices in the Americas for leptospirosis are limited. Therefore, the numbers of cases and deaths reported are not representative for the region. The lack of leptospirosis data for many countries/territories may reflect weaknesses in certain aspects of national surveillance systems, including mandatory reporting policies, clinical laboratory infrastructure for performing case confirmation, and capacity to collect reported cases. Improved surveillance of leptospirosis cases and deaths in the Americas is needed to allow monitoring of regional epidemiological patterns and to estimate the burden of this important disease.
We analyzed the epidemiological data of all people who were involved in the search and rescue operation in Lubuk Yu, a natural recreational forest with waterfall and stream. The hospital admission records of the cases who fulfilled the case definition and the environmental samples result taken at Lubuk Yu recreational area were studied. 153 people were exposed to this outbreak, 85 (55.5%) were professional rescuers from various government agencies and 68 (44.5%) were villagers. 21 fulfilled the case definition. Ten cases were confirmed melioidosis, six melioidosis alone and four coinfected with leptospirosis. There were eight deaths in this outbreak, seven were villagers and one professional rescuer. Overall case fatality was 70%. All confirmed melioidosis cases and seven who died had diabetes mellitus. The morbidity rate were higher among the villagers, 23.5% compared to professional rescuers, 5.9%. The case fatality rate were also higher in this group which was 100% compared to 33.3% in professional rescuers. The soil and water samples in Lubuk Yu recreational area were positive for leptospira and Burkholderia pseudomallei. The presence of co-infection and co-morbidities especially diabetes mellitus among the exposed led to the high mortality in this outbreak hence a high index of suspicion is important among the healthcare professionals in the management of melioidosis cases. To avoid similar incident in future, search and rescue operation should be only conducted by professional rescuers with appropriate personal protective equipment. A register of rescuers should be maintained for surveillance and follow up if necessary.
To study the number of leptospirosis cases in relations to the seasonal pattern, and its association with climate factors.
Time series analysis was used to study the time variations in the number of leptospirosis cases. The Autoregressive Integrated Moving Average (ARIMA) model was used in data curve fitting and predicting the next leptospirosis cases.
We found that the amount of rainfall was correlated to leptospirosis cases in both regions of interest, namely the northern and northeastern region of Thailand, while the temperature played a role in the northeastern region only. The use of multivariate ARIMA (ARIMAX) model showed that factoring in rainfall (with an 8 months lag) yields the best model for the northern region while the model, which factors in rainfall (with a 10 months lag) and temperature (with an 8 months lag) was the best for the northeastern region.
The models are able to show the trend in leptospirosis cases and closely fit the recorded data in both regions. The models can also be used to predict the next seasonal peak quite accurately.
After a typhoon in September 2009, an outbreak of leptospirosis occurred in Metro Manila, the Philippines; 471 patients were hospitalized and 51 (10.8%) died. A hospital-based investigation found risk factors associated with fatal infection to be older age, hemoptysis, anuria, jaundice, and delayed treatment with antimicrobial drugs.
Leptospirosis is a disease which occurs worldwide but particularly affects tropical areas. Transmission of the disease is dependent on its excretion by reservoir animals and the presence of moist environment which allows the survival of the bacteria.
A retrospective study was undertaken to describe seasonal patterns of human leptospirosis cases reported by the Centre National de Références des Leptospiroses (CNRL, Pasteur Institute, Paris) between 1998 and 2008, to determine if there was an association between the occurrence of diagnosed cases and rainfall, temperature and global solar radiation (GSR). Meteorological data were recorded in the town of Saint-Benoît (Météo France "Beaufonds-Miria" station), located on the windward (East) coast. Time-series analysis was used to identify the variables that best described and predicted the occurrence of cases of leptospirosis on the island. Six hundred and thirteen cases were reported during the 11-year study period, and 359 cases (58.56%) were diagnosed between February and May. A significant correlation was identified between the number of cases in a given month and the associated cumulated rainfall as well as the mean monthly temperature recorded 2 months prior to diagnosis (r = 0.28 and r = 0.23 respectively). The predictive model includes the number of cases of leptospirosis recorded 1 month prior to diagnosis (b = 0.193), the cumulated monthly rainfall recorded 2 months prior to diagnosis (b = 0.145), the average monthly temperature recorded 0 month prior to diagnosis (b = 3.836), and the average monthly GSR recorded 0 month prior to diagnosis (b = -1.293).
Leptospirosis has a seasonal distribution in Reunion Island. Meteorological data can be used to predict the occurrence of the disease and our statistical model can help to implement seasonal prevention measures.
Leptospirosis is a worldwide zoonotic infection that has been recognized for decades, but the problem of the disease has not been fully addressed, particularly in resource-poor, developing countries, where the major burden of the disease occurs. This paper presents an overview of the current situation of leptospirosis in the region. It describes the current trends in the epidemiology of leptospirosis, the existing surveillance systems, and presents the existing prevention and control programs in the Asia Pacific region.
Data on leptospirosis in each member country were sought from official national organizations, international public health organizations, online articles and the scientific literature. Papers were reviewed and relevant data were extracted.
Leptospirosis is highly prevalent in the Asia Pacific region. Infections in developed countries arise mainly from occupational exposure, travel to endemic areas, recreational activities, or importation of domestic and wild animals, whereas outbreaks in developing countries are most frequently related to normal daily activities, over-crowding, poor sanitation and climatic conditions.
In the Asia Pacific region, predominantly in developing countries, leptospirosis is largely a water-borne disease. Unless interventions to minimize exposure are aggressively implemented, the current global climate change will further aggravate the extent of the disease problem. Although trends indicate successful control of leptospirosis in some areas, there is no clear evidence that the disease has decreased in the last decade. The efficiency of surveillance systems and data collection varies significantly among the countries and areas within the region, leading to incomplete information in some instances. Thus, an accurate reflection of the true burden of the disease remains unknown.
The environmental and social context in which a leptospirosis outbreak took place during the summer of 1996 in the Rio de Janeiro Western Region was examined by using spatial analysis of leptospirosis cases merged with population and environmental data in a Geographical Information System (GIS). Important differences were observed between places where residences of leptospirosis cases are concentrated and other places in the region. Water supply coverage, solid waste collection, sewerage system coverage and flood risk area were the main determining variables from an initial list of ten. The influence of these unfavorable social and environmental factors is verified hundreds of meters distant from the leptospirosis case residences, demonstrating a necessity to broaden the area of health surveillance practices. The geocoding indicated that some cases did not report contact with flood water, even though they were geographically adjacent to cases who did report this contact. Cases may only report exposures they believe are related to the disease. Geocoding is a useful tool for evaluating such bias in the exposure recall.
The complementary concepts QALYs and DALYs combine years of life and quality of life in a single measure.1–3 In Arnesen and Nord’s words: “QALYs are years of healthy life lived; DALYs are years of healthy life lost. Both approaches multiply the number of years (x axis) by the quality of those years (y axis). QALYs use “utility weights” of health states; DALYs use “disability weights” to reflect the burden of the same states. If the utility of deafness is …
Pathogenic leptospiras (1,424) isolated from natural waters and wet soils in Malaysia comprised 29 different serovars (synonym serotypes). All except two of the serovars had been found previously in Malaysia. The exceptional serovars were werrasingha, an Autumnalis serogroup member originally isolated in Ceylon, and a new serovar designated evansi. Serovar evansi had serological affinities with serovar ranarum which was isolated from the kidney of a frog in Iowa. The large variety of serovars found in jungle areas was consistent with similar previous findings of diverse serovar infections in troops who had operated in Malaysian jungles.
Glaucoma is the name given to a group of diseases characterized by incurable, progressive, multifactorial optic neuropathy. It is the second leading cause of blindness worldwide. Ocular hypertension (OH) is the term used to describe the presence of raised intraocular pressure (the most important risk factor for the development of glaucoma) in the absence of demonstrable glaucomatous optic neuropathy.
The management of glaucoma and OH requires a holistic and rational approach, taking into account a number of factors. Treatment needs to be individualized depending on patient age, the severity and type of glaucoma, associated medical conditions, the condition of the ocular surface, tolerability of topical medication, and patient wishes. An understanding of the mechanism of glaucoma and its etiology in a particular patient is crucial for the initiation of appropriate treatment.
This review article summarizes the existing medical management of glaucoma and OH, including pharmacology, mode of action, and safety profile for each major group of medication, and reviews current advances and future developments in treatment for glaucoma, including experimental medications, together with a summary of their modes of action, pharmacology, and safety profiles. It is hoped that readers will become more aware of the evolution of the next generation glaucoma and OH medications.
The state of Johore, Malaysia had been hit by the worst flood in the Malaysian modern history on the 19th December 2006 (first wave) and the 12th January 2007 (second wave) affecting all the eight districts. A total number of 157,018 and 155,368 Johore population had been displaced by the first and the second wave event respectively. The Johore State Health Department activated the Flood Action Plan which include mobilising medical teams to conduct daily clinical examinations on the flood victims and health teams to inspect flood relief centres, food premises and homes at flood-hit areas with regard to prevent and control communicable diseases. The spreadsheet format was used to collect data on diseases, injury and death throughout the Johore flood disaster period starting from the 19th December 2006 until 19th February 2007. Analyses showed that 19,670 flood victims (36.3%) had communicable diseases and 34,530 (67.0%) had non-communicable diseases. As for the communicable diseases and symptoms/syndromes related to communicable disease, 41.3% were acute respiratory infections (ARI) followed by 25.9% skin infections, 19.1% fever, 10.1% acute gastroenteritis (AGE) and 3.0% acute conjunctivitis. Other infectious diseases include 61 notifiable diseases (46 food poisoning, 14 dengue fever and one tuberculosis), 20 leptospirosis (with two deaths), 20 chicken pox and two melioidosis cases. The Batu Pahat district had the highest incidence for the majority of the communicable diseases because of the prolonged flooding period. No cholera, typhoid, malaria, measles or hand-foot-mouth disease (HFMD) cases were detected among the Johore flood victims. Trends of disease incidence follow the number of evacuees placed in the relief centres corresponding to respective wave. A total of 507 flood victims had physical injuries related to flood mostly due to fall onto wet floor at the relief centres. Fifteen deaths due to drowning were mainly caused by accidental fall into the flood water. The incidence of communicable diseases encountered had been appropriately anticipated and managed attributed to enhanced public health control programmes augmented by syndromic and laboratory surveillance on potentialy fatal infectious diseases. Equal emphasis should be given to the surveillance and control of chronic diseases.
Leptospirosis is a re-emerging zoonotic infection. In developing countries large outbreaks have occurred in urban slums and following floods. Individuals from developed nations are also now more frequently exposed to the infection as a result of international travel and greater participation in certain outdoor recreational activities. Leptospirosis remains a diagnostic challenge since it often presents as a non-specific febrile event and laboratory diagnosis is still currently inadequate. Rapid tests may not be sufficiently sensitive in early disease and culture facilities are not widely available. A severe pulmonary haemorrhagic form of the infection is increasingly being encountered in many countries including Malaysia. The control of leptospirosis is largely dependent on general hygienic measures and rodent control. An effective human vaccine is still not available. There remains much that is unknown about this disease and there is scope and opportunity for good quality research.
Flooding and heavy rainfall have been associated with numerous outbreaks of leptospirosis around the world. With global climate
change, extreme weather events such as cyclones and floods are expected to occur with increasing frequency and greater intensity
and may potentially result in an upsurge in the disease incidence as well as the magnitude of leptospirosis outbreaks. In
this paper, we examine mechanisms by which climate change can affect various ecological factors that are likely to drive an
increase in the overall incidence as well as the frequency of outbreaks of leptospirosis. We will discuss the geographical
areas that are most likely to be at risk of an increase in leptospirosis disease burden owing to the coexistence of climate
change hazard risk, environmental drivers of leptospirosis outbreaks, local socioeconomic circumstances, and social and demographic
trends. To reduce this disease burden, enhanced surveillance and further research is required to understand the environmental
drivers of infection, to build capacity in emergency response and to promote community adaptation to a changing climate.
A recent upsurge in leptospirosis in travellers has prompted the following review of the epidemiology of this infection in humans. The available data from the published literature as well as laboratory surveillance were examined to determine the possible causes of the apparent change in epidemiology.
A retrospective study to describe the epidemiology of human leptospirosis in Trinidad and Tobago during 1996-2007 was conducted. All confirmed cases of leptospirosis was analyzed according to age, sex, seasonality and geographic distribution. A total of 278 cases were recorded, with an average annual incidence rate of 1.84 per 100,000 population. Seventy-five percent of the cases occurred during the wet season, with the highest number of cases recorded in November. A positive correlation was found between number of cases and rainfall. Males constituted 80% of all cases, and the overall male:female ratio was 4.6:1. The total case fatality rate was 5.8%, with deaths among males four times more common than in females. Clinical leptospirosis was greatest in the 10-19 age group and lowest in the 0-9 age group. The total prevalence was 22 per 100,000 population, with the highest prevalence 41 per 100,000 recorded in the regional corporation of Sangre Grande and the lowest (6 per 100,000) in the city of Port of Spain. The lack of important information and active surveillance showed that the level of awareness of the disease is low in the country. The disease is still under-reported, and is considered to be of significant public health importance.
In an ecological study based on the 18 microregions that form the city of Recife, the capital of the Brazilian state of Pernambuco, associations between socio-demographic, environmental and reservoir factors and the incidence of leptospirosis in the city were investigated. Incidence over a 5-year period (2001-2005) and 14 variables were analysed, using central trend and dispersion measurements, Pearson's correlation and multiple linear regression. Variables relating to education, income, housing type, sewage system, rubbish collection and hydrographic factors were found to be significantly correlated with leptospirosis incidence (P<0.05 for each). Just two variables - the proportion of heads of households with incomes less than or equal to the legal minimum (U.S.$83.55/month), and the proportion of households from which rubbish was dumped in skips, lakes, rivers or the sea or on vacant land - explained 60% (P=0.017) of the differences in disease risk observed between the various areas of the city.
Pathogenic leptospiras (1,424) isolated from natural waters and wet soils in Malaysia comprised 29 different serovars (synonym serotypes). All except two of the serovars had been found previously in Malaysia. The exceptional serovars were werrasingha, an Autumnalis serogroup member originally isolated in Ceylon, and a new serovar designated evansi. Serovar evansi had serological affinities with serovar ranarum which was isolated from the kidney of a frog in Iowa. The large variety of serovars found in jungle areas was consistent with similar previous findings of diverse serovar infections in troops who had operated in Malaysian jungles.
This paper reviews the literature on leptospirosis in Malaysia from its first description in 1928 until the present day. Most of the early reports were on investigations of leptospirosis in wildlife and man and up-to-date, thirty-seven leptospiral serovars from thirteen serogroups have been bacteriologically identified. The thirteen serogroups are: Australis, Autumnalis Bataviae, Canicola, Celledoni, Grippotyphosa, Hebdomadis, Icterohaemorrhagiae, Javanica, Pomona, Pyrogenes, Sejroe and Tarassovi. Rats have been ascribed as the principal maintenance host of leptospires in Malaysia. However, serovars from the Pomona, Pyrogenes and Sejroe serogroups have yet to be isolated from rats. It is considered that the majority of leptospirosis cases in man were due to association of man with an environment where rats were plentiful. Recent investigations on domestic animals disclosed a high prevalence of infection in cattle and pigs and they were suspected as being the maintenance host for serovar hardjo and pomona respectively. There is ample scope for research in leptospirosis, particularly in the epidemiology and control of the disease in domestic animals. The strategy to control the infection in domestic animals and man in Malaysia is bound to be different from that of the temperate countries, basically due to the presence of a large number of leptospiral serovars in wildlife, further confounded by geographical and financial constraints.
A survey for leptospiral (SEL) antibodies was conducted throughout West Malaysia from 1961 through 1971 on 18 occupational groups. A total of 4,646 sera was tested of which 592 or 12.7% were positive. The Sensitized Erythrocyte Lysis test was used; the analysis was prepared from the AM strain of Leptospira biflexa. High antibody rates (23.2% to 32.6%) were found among oil palm estate and rubber estate workers and hospital staff. Moderately high rates (13.0% to 17.9%) were observed in laborers, the army, tin miners (of open cast, dredge and gravel pump mines), farmers and padi planters. Moderate rates (11.6% to 12.2%) were found among shop owners, policemen and the veterinary staff and low rates (1.5% to 9.4%), were detected in school teachers, housewives, office workers and tin miners of underground or lode mines.
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.
From October 13 to October 21, 1999, a total of 46 males, aged 8 to 19 years, were admitted to Beaufort Hospital after swimming in the creek near an oil palm plantation in Kampung (Kg) Kebatu, Beaufort. Thirty (30) presented with symptoms including fever, vomiting, bodyache, giddiness, headache, chest pain and cough, while 16 others, were asymptomatic. One, a 15 year old boy, died from haemorrhagic shock secondary to pulmonary haemorrhage. The onset of the illness was from 11 October to 19 October 1999. A case-control study found that the outbreak was associated with swimming in the creek (p<0.0001). A total of 44 paired sera samples were sent for microscopic agglutination test (MAT), 5 pairs showed sero-conversion, 3 pairs had 4 fold rise in titre and 18 pairs were positive at >320. The findings indicated that Leptospirosis was the cause of the outbreak of this illness and the contaminated creek water was the source of the infection. The occurrence of flooding and stagnation in the creek following the heavy rainfall during the first week of October 1999 could have contributed to the timing of the outbreak.
Leptospirosis is an acute febrile illness with a wide variety of clinical manifestations and is encountered throughout the world, prominently in tropical areas with high rainfall. In this paper, we review the current status of leptospirosis in two Asian countries, Japan and Philippines, which have quite different situations in terms of economy, environment, infrastructures and prevailing infectious diseases. In Japan, until 1960, more than 200 deaths due to leptospirosis had been reported yearly. After 1960, the number of reported cases had rapidly decreased. Now, leptospirosis cases notified every year were less than 20. After the early 1960s, modernization of agriculture was introduced, at the same time, inactivated vaccine against Leptospira was applied for humans and there was good maintenance of infrastructures such as water works and sewage systems. In Philippines, on the other hand, leptospirosis patients tend to be frequently found in flood-prone areas of urban setting such as Metro Manila, which was found to be the endemic foci of leptospirosis. Morbidity in a rural area (Cabatuan, Iloilo) was 147 cases per 100,000 populations. From 1998 to 2001, about 70% of 1200 suspected leptospirosis patients in Philippines were serologically positive. The average age of patients was 32 years old where 87% of the cases were males and 70% were outdoor workers. Case fatality rate was found to be 12-14%. The estimated major serovars in Metro Manila and neighboring provinces were Manilae, Losbanos, Tarassovi, Poi and an unknown serovar. Outbreaks of leptospirosis in the Philippines are thought to be associated with heavy rainfall, rapid urbanization (dramatic increase in populations), deforestation, increasing number of flood-prone areas, poor infrastructures and many others.
A cross-sectional seroprevalence study on leptospirosis, using microscopic agglutination test (MAT), was conducted in rural villages in Khammouane Province, Lao People's Democratic Republic, in December 2006. The overall prevalence of leptospiral infection among 406 subjects was 23.9% (95% confidence interval [CI] 19.7-28.0%). Independent risk factors for the infection, identified by multivariate logistic regression, were male sex (odds ratio [OR], 1.92; 95% CI: 1.24-2.98), recent flooding on one's own property (OR, 2.12; 95% CI: 1.25-3.58), and collecting wood in the forest (OR, 1.90; 95% CI: 1.17-3.09). Age, occupation, and animal ownership were not associated with seropositivity. Flooding was associated with the risk of infection particularly for women, whose behaviors or activities involving contact with floodwater were presumed to play an important role. This study showed that leptospirosis is endemic in Khammouane Province and that local flooding plays an important role in the transmission of the disease.
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