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The aim of this systematic review was to identify articles on prevalence of leptospirosis in stray and sheltered dogs worldwide and access the methodological quality of the recovered papers. Six databases (CABI, Cochrane, Pubmed, Scielo, Scopus and Web of Science) were searched, without restriction on year or location where the studies were performed. The search recovered 476 articles and 60 were selected for analysis according to quality criteria. None of the selected articles showed a complete explanation for the sample size adopted (probabilistic sampling), leading to the impossibility of recalculation of leptospirosis prevalence for stray or sheltered dogs. Among the analyzed papers 43.33% (26/60) showed five of the ten quality criteria analyzed, 16.67% (10/60) three, 15.00% (9/60) four, 10.00% (6/60) six, 6.67% (4/60) eight, only 5.00% (3/60) showed nine of the ten criteria analyzed, whereas two papers showed two [1.67% (1/60)] and seven [1.67% (1/60)] of the ten criteria assessed. The majority of the papers were published in the Americas [45.00% (27/60)] and in the last sixteen years (2003 to 2019) [81.67% (49/60)], and most of the sampled dogs were stray dogs [65.00% (39/60)]. The leptospirosis diagnostic test used more frequently was Micro Agglutination Test (MAT) [78.33% (47/60)] followed by polymerase Chain Reaction (PCR) [23.33% (14/60)], whereas the most common serovars identified were Canicola [71.43% (35/49)], Icterohaemohrragiae [65.31% (32/49)], Grippotyphosa [40.82% (20/49)] and Pomona [40.82% (20/49)]. In conclusion, our results showed that Leptospira spp. is present in stray and sheltered dogs worldwide, but the complete comprehension of the prevalence of leptospirosis in these populations could not be achieved due to the low methodologic quality of the recovered studies about leptospirosis in stray and sheltered dogs.

This 18-year-old boy presented to the hospital with symptoms of cerebellar dysfunction preceded by an acute febrile illness with rash. Examination showed evidence of left-sided cerebellar dysfunction and polyneuropathy. Empirical treatment for leptospirosis and scrub typhus was initiated. MRI was normal. Other organ dysfunctions in the form of thrombocytopenia and transaminitis were also observed. He recovered without sequelae. A diagnosis of acute cerebellar ataxia and polyneuropathy due to scrub typhus was made.

Leptospira interrogans is one of the causative agents of human leptospirosis, a zoonotic disease with worldwide distribution. Nowadays, this zoonosis is considered one of the biggest in terms of morbidity and mortality (even considering Dengue, the major arbovirosis affecting humans), having in Brazil 3,800 human cases per year. Currently, difficulties imposed by the absence of a rapid, sensitive diagnostic test that can be used as a routine test for the detection of leptospirosis lead to misdiagnosis and underreported cases. The gold standard diagnostic test for leptospirosis is the microscopic agglutination test (MAT), which presents difficulties in execution and interpretation. Therefore, this review proposes a general view of the epidemiologic situation of the disease in Brazil, in addition to the current contributions in the literature for the development of new diagnostic methods. Amongst them, the gene sequences polymorphism analysis, which presents potential for phylogenetic and populational analysis and genotyping of Leptospira spp. Leptospira interrogans é uma das bactérias causadoras da leptospirose, uma zoonose de ampla distribuição mundial. Atualmente, essa zoonose é considerada uma das que apresenta maiores taxas de morbidade e mortalidade no Brasil (mesmo considerando a Dengue, a maior arbovirose em humanos), com cerca de 3.800 casos humanos por ano documentados. Porém, devido às dificuldades impostas pela ausência de um ensaio de diagnóstico rápido, sensível e que possa ser empregado como teste de rotina para a detecção da leptospirose, essa doença é comumente subnotificada e diagnosticada erroneamente. O teste diagnóstico padrão ouro para a leptospirose é a aglutinação microscópica, o qual apresenta dificuldade de execução e interpretação. Dessa forma, propomos nesta revisão uma visão geral da situação epidemiológica da doença no Brasil, além das contribuições presentes na literatura para o desenvolvimento de novas abordagens diagnósticas. Dentre elas, a análise de polimorfismos de sequências gênicas a qual apresenta potencial para análises filogenéticas, populacionais e de genotipagem de Leptospira spp.

Background Acute febrile illnesses (AFIs), including dengue, scrub typhus and leptospirosis, cause significant morbidity and mortality in Southeast Asia. Serological surveillance can be used to investigate the force and distribution of infections. Dried blood spot (DBS) samples are an attractive alternative to serum because they are easier to collect and transport and require less cold storage. We conducted a pilot study to determine the feasibility of integrating serological surveillance for dengue, scrub typhus and leptospirosis into a population-representative lymphatic filariasis seroprevalence survey in Timor-Leste using DBSs. Methods A total of 272 DBSs were collected from healthy community participants. DBSs were analysed at the National Health Laboratory using commercially available enzyme-linked immunosorbent assays. To validate assays for DBSs, 20 anonymised serum samples of unknown serostatus were used to create dried serum spots (DSSs). These were analysed with optical densities compared with those of serum. Where low variance was observed (dengue assay) the published kit cut-offs for serum were applied to the analysis of DBSs. For the other assays (scrub typhus and leptospirosis), index values (IVs) were calculated and cut-offs were determined to be at 2 standard deviations (SDs) above the mean. Results Of the 272 samples analysed, 19 (7.0% [95% confidence interval {CI} 4.3 to 10.7]) were positive for dengue immunoglobulin G (IgG), 11 (4.0% [95% CI 2.1 to 7.1]) were positive for scrub typhus IgG and 16 (5.9% [95% CI 3.4 to 9.4%]) were positive for leptospira IgG. Conclusions While dengue seroprevalence was lower than in nearby countries, results represent the first evidence of scrub typhus and leptospirosis transmission in Timor-Leste. Integrated programmes of serological surveillance could greatly improve our understanding of infectious disease epidemiology in remote areas and would incur minimal additional fieldwork costs. However, when planning such studies, the choice of assays, their validation for DBSs and the laboratory infrastructure and technical expertise at the proposed location of analysis must be considered.

Spirochaetes comprise a heterogenous group of gram negative, motile, spiral shaped bacteria. Some of these pathogens are known to cause numerous human diseases such as Lyme disease, relapsing fever, syphilis and leptospirosis. However, intestinal spirochetosis is a rare condition. Patients frequently present with long-term complaints of loose stools, abdominal pain and weight loss and rectal bleeding. Hence to establish a diagnosis an endoscopy with biopsy is required. In this article, we describe four such cases, having different ages and socio- economic background, successfully treated with a short course of metronidazole.

Leptospirosis is known to determine reproductive disorders on livestock, and Leptospira interrogans and Leptospira borgpetersenii are the most frequently reported species. Leptospira noguchii is an emerging pathogen, but its association with reproductive disease is unclear. We have detected L. noguchii as the agent of an outbreak with reproductive disorders in a Brazilian dairy goat flock. In the kidding season, five out of 10 Saanen had abortions in the final month of pregnancy and two newborn kids had acute clinical signs. After necropsy of three foetuses and one newborn kid, fragments of liver, lung and kidney were submitted to lipL32-PCR. It yielded positive results in at least one fragment from each animal. After, a nested secY-PCR, followed by sequencing, could identify L. noguchii, with 99-100% of identity with sequences obtained from cattle in the same region. For the first time, L. noguchii was detected in goats and, most importantly, the association of this leptospiral species with reproductive failures in ruminants has been demonstrated.

La importancia de las cabras en México radica en que su producción se concentra en zonas áridas y semiáridas del norte y el centro del país, y particularmente en la región de la Mixteca en los estados de Oaxaca, Guerrero y Puebla, donde prevalece la pobreza y donde la especie, es capaz de sobrevivir y producir leche y cabritos. El estudio de las enfermedades de las cabras en México es escaso; el INIFAP se ha caracterizado por nunca haber dejado de lado la investigación en esta especie. En esta revisión, se abordan las principales enfermedades que afectan a las cabras en México y se describen las investigaciones que sobre ellas ha desarrollado el INIFAP. Los problemas de salud que enfrentan la mayoría de los rebaños caprinos en los que se ha realizado investigación, demuestran que algunos trastornos reproductivos son causados por enfermedades como brucelosis, leptospirosis y clamidiasis, todas éstas consideradas endémicas y con potencial zoonótico. Por otra parte, los problemas de tipo respiratorio y digestivo son los principales padecimientos que afectan a los cabritos. En las cabras en etapa productiva del territorio nacional, se ha demostrado una frecuencia elevada de animales con artritis encefalitis, enfermedad causada por la infección de Lentivirus de los pequeños rumiantes, paratuberculosis y linfadenitis caseosa, estas últimas de origen bacteriano; una particularidad de estas tres enfermedades es su característica de cronicidad, lo que hace pensar de manera equívoca al productor que su presencia no tiene mayor impacto dentro de los rebaños. Finalmente, se ha logrado detectar la presencia de la fiebre Q, una enfermedad zoonotica actualmente considerada exótica en México, y que en otros países es frecuentemente asociada con trastornos reproductivos, abortos y ocasionalmente, problemas respiratorios en los animales. En las aportaciones del INIFAP hay que destacar el diagnóstico y el control de la brucelosis, que es la principal zoonosis bacteriana en nuestro país; además de haber contribuido a que enfermedades consideradas exóticas en México, se determine que ya son endémicas, y se cuente con las herramientas para su diagnóstico, siendo un reto para nuestro instituto realizar la transferencia de estas tecnologías a los laboratorios de diagnóstico de nuestro país.

A leptospirose é causada por bactérias que pertencem ao gênero Leptospira, afetando diversas espécies animais e os seres humanos. Os cães por conviverem em proximidade com os seres humanos, participam ativamente da cadeia epidemiológica da doença. Para tanto, objetivou-se denotar a leptospirose subclínica em cães de Bom Jesus, Piauí. Foram coletadas amostras de sangue de 125 cães para realização da técnica de Soroaglutinação Microscópica (SAM). Dos 125 cães, 15 (12%) foram soropositivos, onde, 8 (oito) foram reagentes para o sorovar Icterohaemorrhagiae, 3 (três) para o sorovar Autumnalis, 2 (dois) para Copenhageni e 2 (dois) para o Canícola. Os resultados mostram que os cães podem atuar na transmissão da enfermidade para os humanos, e que, mesmo sororeagentes para sorovares não adaptados a esta espécie, não manifestaram sinais clínicos característicos da leptospirose.

Background Refugees in Malaysia, who are afflicted by poverty, conflict and poor health, are vulnerable to a range of zoonotic infections in the deprived environmental and social conditions under which they live. Exposure to infections such as leptospirosis, for which rodents are primary hosts, is of particular concern. Methods A wellness program was conducted to determine the presence of antibodies against Leptospira (seroprevalence) in 11 refugee community schools and centers in the Klang Valley, Malaysia. A total of 433 samples were assessed for IgG and IgM antibodies against Leptospira, using enzyme-linked immunosorbent assays (ELISA). Results Overall Leptospira seroprevalence was 24.7%, with 3.0% being seropositive for anti-Leptospira IgG and 21.7% for anti-Leptospira IgM. Factors significantly associated with overall Leptospira seroprevalence included: age, ethnicity, pet ownership, knowledge of disease and awareness of disease fatality. For IgM seroprevalence, significant risk factors included sex, ethnicity, eating habits with hands, pet ownership, the presence of rats, walking in bare feet and water recreation visits. Conclusions These findings highlight the need for improvements in health and well-being among the refugee community through disease awareness programs and provision of healthy behavior programs, particularly in hygiene and sanitation through community engagement activities.

Background Leptospirosis diagnoses have increased in Sarawak, Malaysia in recent years. Methods To better understand the burden of disease and associated risk factors, we evaluated 147 patients presenting with clinical leptospirosis to local hospitals in Sarawak, Malaysia for the presence of Leptospira and associated antibodies. Sera and urine specimens collected during the acute illness phase were assessed via a commercially available rapid diagnostic test (Leptorapide, Linnodee Ltd., Antrim, Northern Ireland), an ELISA IgM assay (Leptospira IgM ELISA, PanBio, Queensland, Australia) and a pan-Leptospira real-time PCR (qPCR) assay to estimate disease prevalence and diagnostic accuracy of each method. Microagglutination testing was performed on a subset of samples. Results Overall, 45 out of 147 patients (30.6%) showed evidence of leptospires through qPCR in either one or both sera (20 patients) or urine (33 patients), and an additional ten (6.8%) were considered positive through serological testing, for an overall prevalence of 37.4% within the study population. However, each diagnostic method individually yielded disparate prevalence estimates: rapid test 42.2% for sera and 30.5% for urine, ELISA 15.0% for sera, qPCR 13.8% for sera and 23.4% for urine. Molecular characterization of a subset of positive samples by conventional PCR identified the bacterial species as Leptospira interrogans in 4 specimens. A multivariate risk factor analysis for the outcome of leptospirosis identified having completed primary school (OR = 2.5; 95 CI% 1.0–6.4) and weekly clothes-washing in local rivers (OR = 10.6; 95 CI% 1.4–214.8) with increased likelihood of leptospirosis when compared with those who had not. Conclusion Overall, the data suggest a relatively high prevalence of leptospirosis in the study population. The low sensitivities of the rapid diagnostic test and ELISA assay against qPCR highlight a need for better screening tools.

Background Persistent leptospiruria in naturally infected dogs occurs despite appropriate antibiotic treatment. Hypothesis/Objectives To determine the frequency of persistent leptospiruria in naturally infected dogs and the association of persistent leptospiruria with different antibiotic treatments. Animals Thirty‐two dogs of varying age and breed diagnosed with leptospirosis via urine polymerase chain reaction assay (PCR). Methods A prospective observational study of dogs diagnosed with leptospirosis was undertaken to determine the frequency of persistent leptospiruria as determined by PCR. Clinical presentation of leptospirosis, antibiotic treatment, serum creatinine concentration, and outcome were recorded. Results Fifteen of 32 dogs had a negative urine PCR on the first submission in the study, 5 of 15 received only an aminopenicillin. The remaining 17 dogs had a negative urine PCR on the second (n = 6 dogs), third (n = 5), fourth (n = 5), and eighth (n = 1) submissions. Acute kidney injury was reported in 32/32 dogs. Two of 32 dogs developed chronic kidney disease. Conclusions and Clinical Importance Persistent leptospiruria is common despite treatment with antibiotics frequently recommended for treatment. Follow‐up urine PCR to confirm clearance of the organism is recommended in all dogs. In dogs with persistent leptospiruria, chronic kidney disease can develop after acute kidney injury.

The purpose of the research to create a concept for diagnostics and therapy of hemostasis disorders of patients with severe leptospirosis.Patients and Methods. The study included 474 patients with severe serologically confirmed leptospirosis with a favorable outcome of the disease and 31 patients with fatal outcome (total 505 people). Variant of coagulopathy was determined by using a set of special methods for studying hemostasis. The influence of platelet concentrate transfusion, plasma exchange and various tactics of glucocorticoid therapy on patient survival and correction of hemostasis disorders was evaluated. Survival analysis was made using Kaplan-Meyer method with a Cox proportional intensity model. Relative risk (RR) was calculated with a 95% confidence interval (CI).Results: the use of early diagnosis of coagulopathy variants and the use of a differentiated therapy regimen in the choice of the variant of hemostasis disorder led to a decrease of mortality from 16.45% to 11.5% and decrease in the consumption of platelet concentrate and fresh frozen plasma.Conclusion: patients with severe leptospirosis develop a multivariate hemostatic pathology: isolated thrombocytopenia (38%) with thrombotic microangiopathy (20,5%), disseminated intravascular coagulopathy (37,1%), uremic coagulopathy (4,9%), hepatic coagulopathy (3,4%). Plasma exchange in thrombotic microangiopathy is pathogenetically justified. Also, plasma exchange is pathogenetically justified in order to reduce plasma volume in DIC syndrome with consumption coagulopathy and hepatic coagulopathy. The use of GCS in isolated thrombocytopenia can be effective and safe in both “medium doses” and in the form of “pulse therapy” if the following conditions are met: acute renal injury (AKI) III stage according to AKIN and the absence of renal replacement therapy (RRT). The main indication for platelet concentrate transfusion in severe leptospirosis is extremely severe thrombocytopenia (grade 4) with active life-threatening bleeding at the time of transfusion.

Leptospirosis is a zoonotic disease, it arises worldwide but it is most frequent in tropical and subtropical zone. It is one of the notifiable and treatable disease. Leptospirosis is a plague caused by species of bacteria called Leptospira the bacteria shed into the nature via urine of infected animals. Rats are the most recurrent source of human sepsis. Rivers are the assumption to be a predominant risk factor for transmission of disease to humans. It possesses an extensive variation of mechanisms that allow them to avoid the host immune system and cause infection. The infection is extremely vast ranging from subclinical to multi organ infection with elevated mortality. It is frequently mild but can be terminal, it is likely to be serious and the serious alignment form known as Weils disease and can easily steer to death. The mingling of renal failure, hemorrhage and jaundice is known as Weils disease. It is the most affection pattern associated with critical leptospirosis. It is accumulating as a serious problem worldwide and superficially existing as co-infections with various unrelated diseases, including malaria and dengue. Laboratory diagnostic tests are not always accessible and usually diagnosis is executed by enzyme linked immunosorbent assay (ELISA) serology and microscopic agglutination test, rapid test are also feasible. The MAT (microscopic agglutination test) is known as Gold standard. Serological tests are most frequently used for the diagnosis of leptospirois. The carcinogenesis of human disease and mechanism of cell membrane injuries which take place mainly due to the occupancy of leptospirosis along with their antigen in host tissues many molecules hand out to the ability of leptospira to invade, colonize and to adhere. In most of the cases antibiotics are preferred to reduce the symptoms of leptospirosis.

Приведен клинический случай лептоспироза у юноши, жителя Тернопольской области, который был госпитализирован в инфекционно-диагностическое отделение Тернопольской областной детской клинической больницы. Особенностью данного клинического случая является то, что у пациента была безжелтушная форма, которая сопровождалась лихорадкой с литическим снижением температуры, острой почечной недостаточностью, болями в икроножных мышцах, гепатоспленомегалией, тромбоцитопенией. У мальчика развился характерный геморрагический синдром, сопровождавшийся петехиальной сыпью на груди. При наличии острой почечной недостаточности, которая сопровождается тромбоцитопенией, гипертрансаминаземией, следует исключить лептоспироз.

Introduction: Leptospirosis is an international zoonotic condition relay and rising prevalencethe causes of the infection Leptospira spirochete with popular exhibition of polluted clean water.Most asymptomatic diseases, but the symptoms are moderate, autonomous, specific febrile and respiratory non-specific disorder high mortality rates of renal failure. Case: A 33-years-old woman from rural area came to the hospital in casualty with a history of high grade fever (40 degree Celsius), with chilling, headache, stiff neck. Urinary retention along with productive cough for three days. Intervention: The patient underwent inpatient management, which included tablet Ceftriaxone 1gm twice a day, Tablet Doxycycline 100 mg bd given and intravenous fluids 5% dextrose and dextrose/sodium chloride solution, Injection Furosemide20 mg intravenously twice a day were given to the patients. Nursing management: monitoring the vital sign, maintain the O2 levels as well as the consumption and output. All basic nursing care has been provided. Her symptoms cured after two weeks of treatment, she was discharged. Results: Fever has been minimized. The therapy is reacted to and restored. Conclusion: Management was mainly aimed at protecting patient wellbeing, preventing complications and improving the quality of life. The patient received all medical therapy and the results show that the therapy and care was effective.

Leptospirosis in pregnancy is often underdiagnosed and not commonly reported due to its unusual appearance and rarity. It looks like HELLP syndrome, obstetric cholestasis, viral hepatitis & pregnancy-related acute fatty liver. Miscarriages in the first trimester, stillbirths, and neonatal leptospirosis are serious complications that necessitate a high degree of concern, heightened sensitivity, and prompt diagnosis and treatment. We have one such incidence of leptospirosis in a COVID-19 positive pregnant female. A 21-year-old Primigravida with a predisposition of serious anaemia & thrombocytopenia, presented with fever, haematemesis, malena and sore throat at 38 weeks and 2 days gestation, during the COVID-19 pandemic. She had pallor, oedema, and haematuria on catheterization, rest all investigations were within normal limits. Proteinuria, haemolysis, low platelets, and elevated bilirubin were discovered during the investigation. Due to the lack of hypertension and elevated transaminases, the working diagnosis was atypical haemolysis, low platelets (HELLP) syndrome. The patient was tested for COVID-19 RT-PCR, came out to be positive and the fever spikes continued, leading to further investigations for Dengue, Malaria, Scrub Typhus, and Leptospirosis due to the ongoing Covid-19 pandemic. After the EIA (Enzyme Immunoassay) IgM antibody (confirmatory for Leptospirosis) tested positive for Leptospirosis, the decision to start Doxycycline was made. Meanwhile, the patient's CTG (Cardio tocograph) revealed signs of foetal distress, and a decision for an emergency LSCS was taken (Lower Segment Caesarean Section). The histology of the placenta after the section revealed normal findings. Doxycycline was initiated with a neonatal feeding regimen that was acceptable. On day two of life, the newborn had no indications of inherited leptospirosis and was removed from Neonatal Intensive Care. Within one week, the patient's symptoms had disappeared, and her biochemistry had went back to normal within 2 weeks.

The present article addresses issues related to feline leptospirosis. The causative agent of the infection is reviewed, alongside its morphology and up-to-date taxonomic classification including the concepts of serogroup and serovar. The fact that leptospirae can infect cats is confirmed. Reservoirs and sources of the infection are listed, as well as transmission routes represented as schemes courtesy of the world’s leading institutions specialising in research into human and animal leptospirosis. Taking into account current statutory regulations and scientific knowledge on leptospirosis, the present article offers an analysis of common myths and misconceptions regarding leptospirae, clinical manifestation of the infection in cats and pertinent issues related to the diagnosis of leptospirosis, including differential diagnosis. Cats’ resistance to leptospirosis on the level of the species is reviewed, and data are presented substantiating that treating leptospirosis in cats is unnecessary and might have detrimental impact on their welfare. Additionally, the absence of tools for the specific prophylaxis of feline leptospirosis worldwide is highlighted.

This study attempts to summarize epidemiological characteristics of human leptospirosis and to determine the seroprevalence of this disease among domestic animals in the Autonomous Province of Vojvodina, for the period 2009-2018. Chronological, demographic and topographic characteristics of human cases were analyzed. Pearson's correlation was used to explore correlations between different meteorological factors and trends in time-series of human cases. Overall 87 human cases of leptospirosis and five subsequent deaths (CFR: 5.75%) were recorded in the ten-year period. The average annual incidence rate was 0.45/100,000 (range: 0.16-1.50/100,000). The disease was more prevalent in males (M/F=16.40:1), with the majority of cases reported in August (N=23; 26.44%), September (N=20; 23.00%) and October (N=15; 17,24%). A statistically significant weak positive correlation was observed between the mean monthly air temperature and the number of human cases of leptospirosis of the same month (r=0.30, p

Introduction: During the year 2019, Kerala state experienced flooding during August. Following this mass chemoprophylaxis with doxycycline was given in the flood in affected areas. In this context, the study was conducted with the objectives to identify the risk factors of leptospirosis and to know the usefulness of chemoprophylaxis with doxycycline in an endemic area. Methodology: It was conducted at a public sector tertiary care hospital setting. Cases were adult patients admitted in medical ward with confirmed diagnosis of leptospirosis and the controls were selected from the bystanders of the selected cases. Collected data were entered into MS Excel and analyzed using PASW’18 software. Results: Among cases (n=38), 84.2% were males and the age was 43.87 (15.5) years. Among controls (n=47), 85.1% were males with age of 45.83 (14.17) years. Out of this, occupational exposure (OR 4.22, 95% CI 1.61 – 11.09, p=0.003) and any wound during past one month (OR 27.6, 95% CI 3.49.17 – 217.75,p=0.001) were significantly associated with incidence of leptospirosis. Intake of doxycycline within 2 weeks of flood was found to be protective (95% OR 0.09, 95% CI 0.01-0.72, p=0.023). Conclusion: Our study found that occupational factors, and any wound or injury are important risk factors of leptospirosis and prophylaxis with doxycycline immediately after flood can reduce the risk of leptospirosis.

Aims. To record demographics, symptoms, signs, and laboratory features of confirmed leptospirosis cases in the Hawke’s Bay area of New Zealand to aid clinicians in diagnosis and recognition of severity. Methods. Review of suspected leptospirosis cases referred to the reference laboratory from hospitals in the Hawke’s Bay region between March 2003 and March 2012. Inclusion criteria were IgM positivity and diagnosis confirmed with either polymerase chain reaction (PCR) or microscopic agglutination test (MAT). A retrospective systematic review of case notes was completed for demographic and laboratory data. Results. Forty-three cases were included. Most common presenting symptoms were pyrexia (93%), myalgia, and headache (both 86%). 93% of patients worked in the farming or meat industries. The most common biochemical abnormalities were elevated CRP (100%) and abnormal urinalysis (93%). There was no difference in disease severity between icteric and anicteric patients. Compared to other studies, patients in New Zealand have less severe disease. Conclusion. Contrary to popular understanding, this study has not found icteric leptospirosis to be related to more severe disease. Anicteric leptospirosis should be a differential diagnosis in patients presenting with pyrexia, myalgia, and headache who have elevated CRP and abnormal urinalysis.

The goal is to identify the epidemiological, territorial-epidemiological, environmental, clinical and features of hemorrhagic fever with renal syndrome in order to improve epidemiological surveillance in a large metropolis of the Northwestern Federal District.Materials and methods. An epidemiological analysis of cases of hemorrhagic fever with renal syndrome in St. Petersburg for 2005–2019 was carried out and the clinical and epidemiological characteristics of 135 patients hospitalized in the S.P. Botkin Clinical Infectious Disease Hospital were studied. 70 patients identified combined HFRS diseases associated with other pathogens of viral and bacterial nature. An epidemiological analysis of cases of hemorrhagic fever with renal syndrome in St. Petersburg for 2005–2018 and long-term monitoring of the zoological, epizootological state of small mammals in several districts of St. Petersburg and its suburbs were carried out. The clinical and epidemiological characteristics of 135 patients were studied, of which 70 patients identified combined hemorrhagic fever with renal syndrome diseases associated with other pathogens of a viral and bacterial nature. To assess the epizootological situation, trapped rodents were examined for the presence of viral antigen and antibodies using the method of indirect immunofluorescence with the Xantagnost diagnosticum and enzymelinked immunosorbent assay.Results. The long-term dynamics of the incidence rate in St. Petersburg had a fluctuant rising character with two peaks. The proportion of diseases during the first rise was 11,5%, the second – 44,2% of the long-term incidence. Men prevailed in the age groups of 20-49 years without changes in periods. The proportion of women 20–49 years old was 20,7%, increased to 52,8 % in age groups over 50 years old. When distributed by month in a period of high incidence, the seasonal rise began in September with a peak in October. Infection with hemorrhagic fever with renal syndrome patients – residents of the city occurred mainly (with 35.5%), in the nearby territories of the Northwestern Federal District with 8.9% - in remote areas and with 5,9% in the countries of near and far abroad. The epidemiological situation in places of temporary residence and infection of people was characterized by an increase in the number of small mammals (redbacked voles) and, in particular, infection from 2,9 to 4,4%. Hemorrhagic fever with renal syndrome diseases occurred in the form of moderate severity in 94,4% cases. Severe forms were found in only 5,6% of cases. In the structure of combined infection in 25,9–22,3%, there was a combination of hemorrhagic fever with renal syndrome with gastroenterocolitis and influenza, serologically confirmed. In 17,6% of cases, hemorrhagic fever with renal syndrome was combined with other zoonoses (Lyme disease, tick-borne encephalitis, pseudotuberculosis, leptospirosis, tularemia), in 17,6% with of various etiologies. The presence of combinations of hemorrhagic fever with renal syndrome with other infections complicates the clinical diagnosis.

Zoonoses are primarily recognized as animal diseases that are transmitted to human beings through various routes. These diseases have a serious impact on public health as well as economy throughout the world. Leptospirosis is an emerging and re-emerging infectious zoonotic disease with global public health implications in terms of morbidity and mortality of humans and livestock. The disease can occur in sporadic as well as in epidemic forms. The source of infection is exogenous. Leptospirosis is a life threatening disease that causes 10.3 million cases and 58900 deaths each year worldwide. Rodents are considered the main reservoir of Leptospira. The contact of the skin with moist soil, water, and vegetation contaminated with urine of the infected animals and penetration of the organism to the skin, mucous membrane through abrasion, cut, and injury help in the transmission of the infection. Leptospirosis presents most important public health crisis that exists at the animals-humans-ecosystem interface. A strategic break in the relationship between the host-pathogen and their ecosystem could provide effective control of several possible zoonoses including leptospirosis. Global strategy to broaden interdisciplinary partnerships and coordination in all areas of health care for humans, livestock and the community is required.

BACKGROUND Endothelial dysfunction might contribute to the development of leptospiral pulmonary hemorrhage syndrome (LPHS). HYPOTHESIS Serum concentrations of markers of endothelial activation and dysfunction are higher in dogs with leptospirosis and correlate with the occurrence of LPHS and a higher case fatality rate. ANIMALS Clinically healthy dogs (n = 31; 10/31 dogs confirmed healthy based on no detected abnormalities on blood work), dogs with leptospirosis with LPHS (n = 17) and without LPHS (n = 15), dogs with acute kidney injury not due to leptospirosis (AKI-nL, n = 34). METHODS Observational study. Serum concentrations of soluble intercellular adhesion molecule 1 (sICAM-1), vascular endothelial growth factor (VEGF), and angiopoietin-2 (Ang-2) at admission were compared between groups. Correlations with outcome and the accuracy to predict LPHS were examined. RESULTS Soluble intercellular adhesion molecule (sICAM-1), VEGF, and Ang-2 concentrations were higher in dogs with AKI-nL (sICAM-1 34.7 ng/mL, interquartile range [IQR] = 24.4-75.5; VEGF 43.1 pg/mL, IQR = 12.3-79.2; Ang-2 8.5 ng/mL, IQR = 6.2-12.3), leptospirosis without LPHS (sICAM-1 45.1 ng/mL, IQR = 30.6-59.0; VEGF 32.4 pg/mL, IQR = 12.5-62.6; Ang-2 9.6 ng/mL, IQR = 6.9-19.3), and LPHS (sICAM-1 69.7 ng/mL, IQR = 42.1-89.1; VEGF 51.8 pg/mL, IQR = 26.3-96.7; Ang-2 8.0 ng/mL, IQR = 5.6-12.2) compared to controls (P

BackgroundLeptospirosis is the most common anthropozoonosis worldwide and imposes a major public health problem in many tropical countries. It is a leading cause of disease burden in form of mortality, morbidity and hospital admission. Identifying patients at high risk for mortality or for prolonged hospitalization may save lives and preserve economy. The aim of the current study is to identify significant factors associated with disease mortality and prolonged hospitalization.DesignCress-sectional retrospective study.SettingsTertiary care teaching hospitals in Kelantan, Peninsular Malaysia.ParticipantsAdult patients proven to have leptospirosis depending on IgM ELISA were classified into two classes depending on prolonged hospitalization (>7 days or ≤ 7 days) and mortality (fatal cases or non-fatal cases). Patients' clinico-laboratory data were compared according to these two outcomes using the appropriate statistical test.ResultsOf the 525 patients enrolled, 136 (25.9%) had prolonged hospitalization. The mean length of stay was 6.77 ± 5.68 days. Logistic regression analysis identified acute kidney injury (AKI) (OR 2.3), Jaundice (OR 2.7), elevated alanine aminotransferase (ALT) (OR 2), and prolonged prothrombin time (PT) (OR 1.9) independently associated with prolonged hospitalization. Case fatality rate was 6.48% and around one third of fatal cases had prolonged hospitalization of more than seven days. Factors associated with leptospirosis mortality included age >40 years (p < 0.001), patients presented with tachypnea (p = 0.002), pulmonary infiltrate (p < 0.001), T-wave changes (p < 0.001), atrial fibrillation (p = 0.013), conducting abnormality (p < 0.001), chronic kidney diseases (p < 0.001), multiple organ dysfunctions (p < 0.0010), respiratory failure (p < 0.001), pneumonia (p < 0.001), sepsis (p = 0.004), low venous PH (p = 0.042), AKI (P < 0.001), elevated AST (p < 0.001) or ALT (p = 0.004), hypoalbuminemia (p < 0.001), rhabdomyolysis (p < 0.001), severe thrombocytopenia (p = 0.042), prolonged PT (p < 0.001) or prolonged aPTT (p < 0.017).ConclusionsSignificant proportion of leptospirosis patients (25.9%) had prolonged hospital stay and less proportion died (6.48%). Early identifying patients with factors associated with prolonged hospitalization and death will positively impact practitioners' decisions regarding the proper and fast course of management including ICU admission.

In 2017 leptospirosis cases occur in new areas in Bantul where cases have never been previously reported. Cases still occur in 2018 with an interval of two months after the first case. Preventive and curative efforts in the context of controlling cases have been carried out by the local health office, in addition to these control efforts, it is also necessary to know the presence of Leptospira in rats and water bodies in the area as well as the history of patients transmission. This study was conducted to provide epidemiological data, especially the status of Leptospira in rats as reservoir animal and water bodies as well as a history of patient activity as basic data for leptospirosis control in Gilangharjo Village. This cross-sectional study was conducted at the case location in RT 03 Jodog, Gilangharjo Village, Pandak District, Bantul Regency, which was conducted in April 2018. Leptospira infection status was carried out on rats and water bodies by molecular examination, while the history of transmission based on interviews with patients and the result of the examination of Leptospira status. Rat species caught were dominated by R.tanezumi, R. norvegicus and B. indica. Positive rat infected with Leptospira were found in B. indica while in water bodies Leptospira contamination was not found. Infected rat can be a source of transmission for humans and other animals. Most of the patient's activities were carried out in the fields and at home, all of the patients had wounds that were not treated, and had a history of contact with rats that might transmit Leptospira to humans.

Leptospirosis is a serious bacterial disease that affects both humans and animals. A wide range of symptoms have been described in humans; the disease in dogs is commonly associated with kidney and/or liver disease. In Malaysia, information about the common serovars infecting dogs is limited. Therefore, we investigated the occurrences of leptospirosis in 124 pet dogs diagnosed with kidney and/or liver disease. Blood, urine, abdominal effusion, and/or kidney and liver were collected from the dogs. Based on microscopic agglutination testing, 53 of 124 (42.7%) dogs were seropositive for leptospiral exposure. Sera were frequently positive to serovars Bataviae ( n = 12), Javanica ( n = 10), and Icterohaemorrhagiae ( n = 10). Direct detection using PCR showed that 42 of 124 (33.9%) of the whole blood and 36 of 113 (31.9%) urine samples were positive for pathogenic Leptospira spp. By PCR, 2 of 23 (9.1%) kidney and 2 of 23 (9.1%) liver were positive for pathogenic Leptospira spp. Abdominal effusion from 4 dogs were PCR-positive for pathogenic Leptospira spp. The species detected were L. interrogans, L. borgpetersenii, L. kirschneri, and L. kmetyi by partial 16S rRNA sequencing. We further identified and characterized 11 Leptospira spp. isolates from 8 dogs as serovars Bataviae, Javanica, and Australis. The mortality rate of the Leptospira-infected dogs was high (18 of 53; 34%).

Background:Chengannur, a town in the south Indian state of Kerala, was 1 of the worst affected towns during the floods of 2018. Post-flood, Kerala state was under the threat of many infectious diseases including leptospirosis, but did not report any leptospirosis infections.Objectives:This study was conducted with the following objectives: (1) Assess the knowledge, attitude and practices regarding the prevention of leptospirosis among the flood affected population and Accredited Social Health Activists (ASHAs) of Chengannur; and (2) Analyze the factors responsible for and contributing to leptospirosis control in the area post flood.Methodology:A cross-sectional questionnaire based observational study was conducted among 2 groups: the flood affected population, and ASHA. The questionnaire was divided into 3 parts. Part A contained the socio-demographic information. Part B contained questions on assessment of knowledge, attitude, and practices regarding the prevention, and control of leptospirosis. Part C was only for the ASHA involved.Results:The final sample size was 331 (244 from the general population and 87 ASHAs). With respect to knowledge, attitude, and practice, the responses were dichotomized into correct and wrong responses. The mean knowledge score was 9.01 ± 1.08 (maximum score of 10), mean attitude score was of 3.61 ± 0.55 (maximum score of 4) and the mean practice score was 4.12 ± 1.05 (maximum score of 5).Conclusion:Knowledge and attitude scores did not significantly differ between the general population and ASHA, but the practice score showed a higher score among the ASHA, all of which could have probably contributed to the prevention of a leptospirosis outbreak in the region.

The immune response is hypothesized as an important factor in the disease outcome of leptospirosis. Exaggerated immune response may promote tissue damage that lead to severe disease outcome. In this study TNF, IL-10, sTNFR1 levels were measured among sixty-two hospitalized leptospirosis confirmed patients in Sri Lanka. Thirty-one serum samples from healthy individuals were obtained as controls. PCR–RFLP method was used to identify TNF gene polymorphisms and to determine their association with TNF expression and disease severity in leptospirosis. TNF (p = 0.0022) and IL-10 (p

Coronavirus disease 2019 (COVID-19) is a zoonotic disease caused by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). Its symptoms range from mild fever, cough, pharyngitis to severe acute respiratory syndrome. Since its first outbreak in Wuhan province of China, the disease has spread worldwide and emerged as pandemic. The infection is mainly spread by droplets and through contacts. Initially SARS-CoV-2 was thought to cause viral pneumonia only, but now it is evident that the virus can spread through the bloodstream and can cause systemic lesions as well. Though most of the time patients recovered spontaneously for immune-compromised patients, it is detrimental. Lack of effective therapy in conventional medicine has made host immune response as the only option to focus on this battle against COVID-19. First-world countries such as the USA, Italy, England and Spain have witnessed a massive number of deaths, and India is not an exception to that. The whole world is searching for effective treatment in the form of antiviral drugs, vaccines and hydroxychloroquine, but none has proven effective. Homeopathy has always put a mark during epidemics and in recent past during the elimination of leptospirosis in Cuba (2009–2014), homeopathy was very effective. In this scenario, we think homeopathy has a decisive role to play to fight this pandemic as it can enhance the host immune response and reduce the severity of the infection to a great extent. In this review, we will discuss the scopes of homeopathic medicines in the treatment of coronavirus disease.

Introduction Presentation of febrile illness with nonspecific features, overlapping manifestations of dengue and leptospirosis, limited laboratory diagnostic tests, make the clinical diagnosis of pyrexia a challenge. The present study aimed to determine the prevalence of Leptospira and dengue IgM co-infection among acute febrile illness patients. Methods This is a retrospective hospital-based study which included patient data collected from June 2016 to May 2017. Inpatients' samples (n=2139) were tested for dengue and/or Leptospira IgM at the Microbiology Laboratory. Data like duration of fever, platelet count, hemoglobin, white blood cell count, erythrocyte sedimentation rate, results of liver and renal function tests, mode of treatment, were collected from medical records of laboratory-confirmed co-infection cases. Results Among 1612 serum samples tested for dengue IgM by ELISA, 382 (23.7%) were positive, 17 equivocal and 1213 were negative. Of the 811 Leptospira IgM ELISA done, 119 (14.7%) were positive, 17 equivocal and 675 negative. Two hundred eighty-four samples were tested for both infections and nine (3.2%) were positive for both and 275 were negative. These nine patients positive for dual infections showed elevated transaminases, alkaline phosphatase, serum bilirubin, creatinine, and blood urea, thrombocytopenia and leukocytosis. They received effective antibiotics along with supportive treatment and were cured of the infection. Conclusions The study emphasizes the possibility of leptospirosis and dengue co-infection (3.2%) and need for confirmation by a highly specific test like PCR. If co-infection is suspected, treatment with specific antibiotics for leptospirosis and supportive treatment for dengue is mandatory, with due attention to complexity of organ involvement.

BACKGROUND: Leptospirosis or also commonly called Weil disease is an acute infectious disease that can attack humans and animals and is classified as a zoonotic disease. Leptospirosis is caused by bacteria of the genus Leptospira found in rodents. The difficulty of the diagnosis process causes the case of leptospirosis less reported and is one of the neglected infectious diseases. Patient findings are often not optimal because of underdiagnosis or misdiagnosis. AIM: This study aims to determine the presence of Leptospira serovar bacteria in blood serum of leptospirosis suspect using the microscopic agglutination test (MAT) method. METHODS: This study is a descriptive observational using accidental sampling technique. Sample collection was performed in the Antang Community Health Center, Batua Health Center, and Bangkala Health Center in Manggala District. RESULTS: This study found that there were 31 serum samples. Results of MAT examination on blood serum yielded 11 positive samples of Leptospira (37%) with serovar Hebdomadis, Djasiman, Mini, Icterohaemorrhagiae, Bangkingan, and Bataviae. CONCLUSIONS: The presence of Leptospira bacteria in blood serum of suspected individuals using the MAT method obtained 11 samples of positive blood serum. Special counseling activities are required about leptospirosis and diagnosis enforcement in the community or workers who experience symptoms or leptospirosis suspect.

Despite estimates suggesting Leptospira spp. being endemic in Southeast Asia, evidence remains limited. Diagnostic accuracy evaluations based on Leptospira ELISA mainly rely on hospitalized and severe patients; therefore, studies measuring the pathogen burden may be inaccurate in the community. We evaluated the Panbio Leptospira ELISA IgM among 656 febrile outpatients attending primary care in Chiangrai, Thailand, and Hlaing Tha Yar, Yangon, Myanmar. ELISA demonstrated limited diagnostic accuracy for the detection of acute leptospiral infection using the manufacturer recommended cutoff, with a sensitivity of 71.4% and specificity of 36.4%, and an area under the receiver operator characteristic curve value of 0.65 (95% CI: 0.41–0.89), compared with our reference test, the PCR assay. ELISA also performed poorly as a screening tool for detecting recent exposure to Leptospira spp. compared with the “gold-standard” microscopic agglutination test, with a specificity of 42.7%. We conclude that the utility of the Leptospira IgM ELISA for both serodiagnosis and seroprevalence is limited in our setting.

Background: Leptospirosis is a prevalent zoonotic disease caused by Leptospira interrogans bacterium. Despite the importance of this disease, traditional strategies including attenuated and inactivated vaccines have not been able to prevent leptospirosis. Objective: Hence, this study was designed to develop a novel poly-epitope fusion protein vaccine against Leptospirosis. Methods: To do so, the best epitopes of OmpA, LipL45, OmpL1, LipL41 and LipL21 proteins were predicted. Then, the best-predicted epitopes were applied to assemble IFN-γ, MHC I binding, B cell and MHC II binding fragments, and heparin-binding hemagglutinin adhesion was used as a molecular adjuvant. After designing the vaccine, the most important features of it, including physicochemical parameters, protein structures and protein-protein interaction, were evaluated. Finally, the nucleotide sequence of the designed vaccine was used for codon adaptation. Results: The results showed that the designed vaccine was a stable protein with antigenicity of 0.913, which could dock to its receptor. The results also suggested that the nucleotide sequence of the designed vaccine could be expressed in the prokaryotic system. Conclusion: Based on the results of this study, it can be concluded that the vaccine can be a promising candidate to control Leptospirosis.

Tropical infections constitute 20 – 30% of intensive care unit (ICU) admissions in developing countries. Leptospirosis is a spectrum with mild form presenting as an acute febrile illness with jaundice, complicating in few as acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC), and multi-organ dysfunction syndrome (MODS). The poor prognostic markers are hemorrhagic ARDS, acute renal failure, DIC, severe metabolic acidosis, older age, chronic alcohol abuse, high SOFA score, and septic shock. The confirmatory diagnosis relies on antibody testing, such as microscopic agglutination test (MAT) and IgM ELISA, while the reverse transcription-polymerase chain reaction test being reserved for clinically suspected antibody negative cases. The spectrum of multi-organ involvement necessitates a complete hematological, biochemical workup, including electrocardiogram (ECG), chest X-ray, and two-dimensional echocardiography. Specific antimicrobial therapy consists of the following—benzylpenicillin, ceftriaxone, cefotaxime, and doxycycline. The reported mortality ranges from 6% to as high as 44%. Various ICU scores like SPiRO, THAI LEPTO score, and Faine's criteria have been useful in risk stratification. Optimizing intensive care treatment with appropriate antibiotics, lung protection ventilation strategies, strict fluid management, and if need be timely initiation of renal replacement therapy (RRT) helps in reducing mortality. How to cite this article: Karnik ND, Patankar AS. Leptospirosis in Intensive Care Unit. Indian J Crit Care Med 2021;25(Suppl 2): S134–S137.

Leptospira-infected mice followed by secondary nephrotoxic injury exacerbated immune/inflammatory responses and renal fibrosis. Comparison with the murine model revealed candidates involved in the progression of renal fibrosis in chronic kidney disease (CKD). Comparative transcriptome study suggests that secondary nephrotoxic injury in Leptospira-infected mice recapitulates the gene expression signatures found in CKD patients. This study indicates that secondary nephrotoxic injury may exacerbate CKD in chronic Leptospira infection implicating in the progression of CKD of unknown etiology.

Highlights (1) Blood culture is the gold standard for the diagnosis of bacterial infections. (2) Bone marrow culture is more sensitive than blood culture even in patients with enteric fever receiving antibiotics. (3) Microscopic agglutination test is considered the gold standard for diagnosing leptospirosis; however, now IgM ELISA and polymerase chain reaction (PCR) are more frequently used for diagnosis. (4) Tuberculosis is diagnosed with the help of nucleic acid amplification tests like Xpert MTB/RIF Ultra which also detects rifampicin resistance. Other tests include microscopy, Lowenstein–Jensen and mycobacteria growth indicator tube culture, line probe assay. (5) Tropical rickettsial infections are diagnosed by serological reactions (Weil–Felix, ELISA for antibodies) and PCR. (6) For Brucellosis culture from blood, bone marrow or tissue specimens remain the mainstay in diagnosis. (7) Dengue, Zika, Crimean–Congo hemorrhagic fever, Ebola, hantavirus, rabies are diagnosed with reverse transcriptase-polymerase chain reaction. Serological tests like IgM ELISA or paired sera samples for IgG are also used for diagnosis. How to cite this article Basu S, Shetty A. Laboratory Diagnosis of Tropical Infections. Indian J Crit Care Med 2021;25(Suppl 2):S122–S126.

Background. The importance of timely leptospirosis diagnosis and treatment has increased due to sporadic children morbidity. It is crucial in order to prevent the complications and adverse outcomes development.Clinical Case Description. The data from literature and our own clinical observation of leptospirosis with benign outcome in infant (with kidney damage, purulent meningitis, hemorrhagic syndrome and congenital heart disorder) is presented.Conclusion. The description of leptospirosis symptoms and course in the child is presented in the form of analysis of the clinical setting for further medical education, including differential diagnostics with viral hepatitis.

Hantaviruses are a large family of enveloped viruses with two medically important families Cricetidae and Muridae which are known to cause rodent-borne diseases worldwide. Some strains cause clinical syndromes with multiorgan involvement in humans such as hantavirus haemorrhagic fever with renal syndrome (HFRS) and hantavirus cardiopulmonary syndrome (HCPS), which is also known as hantavirus pulmonary syndrome. Clinical differentiation of this infection from other endemic infections in Sri Lanka such as leptospirosis and rickettsial infections is extremely difficult due to overlapping clinical and epidemiologic features such as exposure to rodents and farming. Here, we report two serologically confirmed cases of hantavirus infection from Sri Lanka with different presentation. The first patient had a combination of HCPS and HFRS. The second patient was treated for HPS complicated with acute respiratory distress syndrome (ARDS). Both had a significant clinical, biochemical, and radiological response with early initiation of corticosteroids. However, further studies are required to assess whether steroids hasten the recovery of severe hantavirus infections. We believe that hantavirus infection is an important emerging disease in the country and should be considered as a differential diagnosis in patients presenting with an acute febrile illness as well as in patients presenting with ARDS. Early diagnosis and prompt treatment improve prognosis.

Introduction Leptospirosis and rickettsial diseases are global zoonotic diseases. In severe infection cases, mortality can range from 10% to 30%. Currently most epidemiological data available are based on outbreak investigations and hospital-based studies from endemic countries. The U.S. soldiers at military bases in these countries are highly vulnerable due to the fact that most of them are immunologically naïve to these pathogens. No risk assessment of leptospirosis and rickettsial diseases among U.S. military personnel in Honduras is currently available. This study was aimed at determining the prevalence of leptospirosis and rickettsial diseases in U.S. military personnel deployed to Honduras using serological assays. Materials and Methods A cohort of pre- and post-deployment sera from the most recent 1,000 military personnel stationed in Honduras for at least 6 months between 2000 and 2016 was identified for this study. Serum specimens from these eligible subjects were retrieved. All post-deployment serum specimens were screened at a dilution of 1:100 for the presence of IgG antibodies to Leptospira and Rickettsia pathogens. The pre-deployment sera from those individuals with post-deployment IgG antibodies above cutoff (i.e., seropositive) were tested to determine seroconversion. Seroconversion was defined as conversion of an optical density value from below the cutoff (i.e., negative) in a pre-deployed specimen to above the cutoff (i.e., positive) in a post-deployed specimen at a titer of 100. Results The seropositive post-deployment specimens for antibodies against Leptospira (causing leptospirosis), Rickettsia typhi (causing murine typhus [MT]), spotted fever group rickettsioses (SFGR, causing SFG Rickettsia), Orientia tsutsugamushi (causing scrub typhus [ST]), and Coxiella burnetii (causing Q fever [QF]) were 11.6%, 11.3%, 6%, 5.6%, and 8.0%, respectively. The seroconverted rate in those assigned to Honduras from 2000 to 2016 was 7.3%, 1.9%, 3.9%, 4.3%, and 2.7% for leptospirosis, MT, SFGR, ST, and QF, respectively. Among the seroconverted specimens, 27 showed seroconversion of at least two antibodies. These seroconverted individuals accounted for 8.8% (3 out of 34) of the personnel who looked for medical attention during their deployment. Conclusions Our results suggest a leptospirosis seroconversion rate of 7.3%, which is higher than the 0.9% and 3.9% seroconversion in Korea and Japan, respectively. The higher rate of seroconversion indicates potential risk of Leptospira exposure. Additional testing of water samples in the pools and pits around the training sites to locate the infected areas is important to eliminate or reduce future exposure to Leptospira during trainings. The rates of seroconversion for ST, MT, spotted fever Rickettsia, and QF were 4.3%, 1.9%, 3.9%, and 2.7%, respectively, indicating the potential exposure to a variety of rickettsial-related pathogens. Testing of vectors for rickettsial pathogens in the areas could inform effective vector control countermeasures to prevent exposure. Proper precaution and protective measures are needed to better protect military personnel deployed to Honduras.

Background: In a highly globalized world, where boundaries are continually crossed due to different international activities, tropical diseases including Leptospirosis have emerged as significant causes of severe illness and death in untreated patients. Aim: To optimize the culture isolation of Leptospira by using different culture methods. Materials and Methods: All suspected cases of Leptospirosis regardless of their age/sex were recruited following informed and written consent. Five different blood culture methods have been tried to see better isolation of Leptospira from patient. Result: Total 326 patients are evaluated over a period of three years. Five different method of blood culture were followed out of that, whole blood culture technique shows better result compaire to other followed technique. Conclusion: The culture methods are gold standard but time consuming. It has an important role in the study of outbreaks. It provides epidemiological data that is helpful in studying pathogenesis of Leptospira. Keywords: Leptospirosis, Blood culture, Isolation, EMJH medium.

Background: Leptospirosis is most often diagnosed clinically, and a laboratory test with high diagnostic accuracy is required. Methods: IgM and IgG ELISAs using Leptospira antigens were established and evaluated in relation to the microscopic agglutination test (MAT). Antigen preparation consisted of saprophytic Leptospira biflexa to detect genus-specific antibodies (genus-specific ELISA) and a pool of the five most prevalent Leptospira interrogans serovars in Sri Lanka to detect serovar-specific antibodies (serovar-specific ELISA). IgM and IgG immune responses were studied in severe and mild leptospirosis patients (n = 100 in each group). Results: The ELISAs showed high repeatability and reproducibility. The serovar-specific IgM-ELISA showed a sensitivity of 80.2% and specificity of 89%; the genus-specific IgM-ELISA showed a sensitivity of 83.3% and specificity of 91%. The serovar- and genus-specific IgG-ELISAs showed sensitivities of 73.3% and 81.7%, respectively, and specificities of 83.3% and 83.3%, respectively. The commercial IgM-ELISA showed a sensitivity of 79.2% and specificity of 93%. The commercial IgG-ELISA showed a sensitivity of 50% and specificity of 96.7%. IgM levels observed in mild and severe leptospirosis patients were significantly higher than in the healthy control group, with mean absorbance values of 0.770, 0.778, and 0.163, respectively. Severe leptospirosis patients had significantly higher mean anti-leptospiral IgG levels compared to both mild leptospirosis patients and healthy control group subjects (0.643, 0.358, and 0.116, respectively; ANOVA, p < 0.001). The presence of anti-leptospiral IgG above an optical density of 0.643 at 1:100 could predict a high risk of severe disease. Conclusion: The serovar-specific in-house ELISA could be used for the laboratory diagnosis of leptospirosis in endemic settings. The high levels of anti-leptospiral IgG observed suggest its value as a predictor of disease severity.

This study aims to evaluate the association between reproductive disorders and the main serogroups of Leptospira spp. in dairy herds. Blood samples from 216 cows from nine herds were collected for a Microscopic Agglutination Test (MAT), and a reproductive follow-up with ultrasonography was carried out monthly for at least 12 months. A total of 75 (16.5%) cows were reactive, while seroreactivity to a herd level ranged from 16.0% to 52.8%. Out of the nine herds, in five (55.0%) Sejroe was found to be the predominant serogroup and in four (45.0%) it was Icterohaemorrhagiae. The major reproductive problems identified were embryonic death (ED) and abortions. All herds presented ED and abortion was observed in three (33.3%). Herds with high seroreactivity (20%) had more reproductive problems. Those with a predominance of Sejroe were associated with ED (P 0.05), while those with Icterohaemorrhagiae were associated with abortion. The results show that different leptospiral strains lead to different reproductive problems, as well as showing that the main problem - ED - is caused by leptospirosis, particularly for those determined by strains of the serogroup Sejroe.

Los casos de la enfermedad de Chagas aguda (ECA) se reportan en forma esporádica en el Perú. En este artículo se describe las características clínicas y epidemiológicas de ocho nuevos casos de ECA detectados por el sistema de vigilancia en la cuenca amazónica, entre 2009 y 2016. La media de la edad fue 12,7 ± 13,7 años, rango de 1 a 44 años y 4/8 casos fueron varones. Un caso se asoció a enfermedad diarreica aguda, otro a leptospirosis y dos a infección del tracto urinario. La tasa de letalidad global fue 12,5% (1/8). La detección tardía es una característica frecuente relacionada a una escasa sospecha diagnóstica en pacientes con historial de fiebre. Se identificó el linaje TcI y TcIV del agente etiológico de la enfermedad de Chagas. Se reporta ocho nuevos casos de ECA, de los cuales siete fueron menores de edad.

The authors analyzed the main indicators of nosological profile and epizootic manifestations of infectious diseases of pigs in the Krasnodar territory for the period from 1990 to 2019. As a result of the analysis of pig diseases of infectious etiology, 24 nosological forms of diseases were established. During the study period, 3006 disadvantaged areas were registered in the province, where 472.6 thousand heads of pigs of various age and sex groups fell ill, of which 131.3 thousand fell ill. In the nosological structure of infectious diseases of pigs, bacterial, viral and chlamydial infections occupy a significant share: colibacteriosis-34.0 %, salmonellosis-20.3, pseudomonosis-9.9, streptococcosis-7.9, pasteurellosis-5.6, viral gastroenteritis-4.2, erysipelas-3.4, African swine fever-2.3, chlamydia-0.5 %. The largest number of points that were affected by infectious diseases of pigs was registered in 1999 - 354; of these, 4.8% were viral diseases: aujeski disease, viral gastroenteritis; 94.9 - for bacterial: streptococcosis, diplococcosis, colibacteriosis, edema, leptospirosis, pasteurellosis, salmonellosis, erysipelas, pseudomonosis; 0.3 % - for chlamydia. The smallest number of points with problems related to infectious diseases of pigs was registered in 2013: in 1 point with problems related to African swine fever (ASF), 3 heads fell ill. The number of sick animals was the highest in 1994: 66.9 thousand animals fell ill in 80 disadvantaged areas, of which 23.4 thousand died. The greatest economic damage to pig farms was caused by ASF. This infection led to a reduction in the number ofpigs in the Krasnodar territory from 1200.0 to 300.0 thousand heads. In the period from 2008 to 2019, ASF was registered on the territory of the province in 33 out of 44 municipalities, in 79 disadvantaged localities, including 13 among the wild boar population. In total, 7.4 thousand heads of domestic pigs and 157 wild boars fell ill in the centers of ASF, 33 objects infected with the ASF virus were identified.

The most common presentation of animal leptospirosis is the subclinical and silent chronic form, that can lead to important reproductive disorders. The diagnosis of this chronic form remains a challenge. The aim of the present study is to gather and critically analyse the current information about molecular tools applied to animal leptospirosis diagnosis, particularly the silent chronic presentation of the infection. Regarding clinical specimens, samples from urinary tract were the most used (69/102, 67·7%), while few studies (12/102, 11·8%) investigated samples from reproductive tract. Concerning the molecular methods applied, the most used is still the conventional polymerase chain reaction (PCR) (46/102, 45%), followed by real-time PCR (38/102, 37·2%). The lipL32 gene is currently the most common target used for Leptospira detection, with 48% of studies applying this genetic marker. From all the studies, only few (21/102, 20·5%) performed gene sequencing. According to the majority of authors, current evidence suggests that lipL32-PCR is useful for an initial screening for Leptospira DNA detection in animal clinical samples. Posteriorly, if DNA sequencing could be performed on positive lipL32-PCR samples, we encourage the use of secY gene as a genetic marker. The molecular methods appear as the most important tools for the diagnosis of the chronic silent leptospirosis on domestic animals, reinforcing its evident impact not only on animal reproduction but also on a One Health context.

Background Leptospirosis is a zoonotic disease of concern and an investigation of recent spatio-temporal trends of leptospirosis in dogs in the United States is needed. Leptospira PCR testing has become increasingly used in veterinary clinical medicine and these data might provide information on recent trends of disease occurrence. Objectives To identify and describe clusters of PCR-positive Leptospira test results in dogs in the United States. Animals Leptospira real-time PCR test results from dogs (n = 40 118) in the United States from IDEXX Laboratories, Inc., between 2009 and 2016 were included in the analysis. Methods In this retrospective study, spatio-temporal clusters for a real-time PCR-positive test were identified using the space-time permutation scan statistic and the centroid of the zip code reported for each test. A maximum spatial window of 20% of the population at risk, and a maximum temporal window of 6 months were used. Results Seven statistically significant space-time clusters of Leptospira real-time PCR-positive test results were identified across the United States: 1 each located within the states of Arizona (2016), California (2014-2015), Florida (2010), South Carolina (2015), and 1 each located within the south-central region (2015), midwest region (2014), and northeast region (2011). Clusters ranged from 3 to 108 dogs and were identified during all years under study, except 2009, 2012, and 2013. Conclusions and clinical importance The spatial and temporal components of leptospirosis in dogs in this study are similar to those in previous work. However, clusters were identified in new areas, demonstrating the complex epidemiology of this disease.

Introduction: FUO/ PUO (Fever/Pyrexia of Unknown Origin) is referred to when temperature is observed above 38.30C (1010F) on many occasions over a period of > 3 weeks and unable to diagnose despite 1week of thorough investigations. Different studies reported diagnosis of malaria in 5 to 50% cases; leptospirosis in 3 to 10% cases and influenza in 8 to 12% cases Dengue fever and malaria are arthropod born diseases and endemic in many parts of India during the monsoon season. Leptospirosis and scrub typhus are zoonotic infections and are widely prevalent in areas with heavy monsoon and agrarian way of life. Aim: To evaluate the study of various Rickettsia infections in patients suffering from Fever Of Unknown Origin. Objectives: To understand the occurrence of infections caused by rickettsial species in suspected cases of FUO. To increase awareness and clinical suspicion among doctors for these infections. Materials and Methods: The assay was performed using P.vulgaris OX19, OX2, OXK strains according to manufacture’s instructions by tube method. Serum will be diluted from 1/20 to 1/640 titer. A singleWeil Felix titer of >1:160 or fourfold rise in titers on repeat testing starting from 1:40 will be accepted as a positive result. Result: A total 100 cases were including in my study in which 28 cases were positive. Out of 28 positive rickettsial samples, females were 17 and males were 11. Spotted Fever(9), Endemic Fever(8), Epidemic Fever(7), Scrub Typhus Fever(4). Conclusion: With the growing number of cases detected in India, scrub typhus is fast emerging as a public health threat and also due to limited diagnostics leading to underreporting, Weil Felix test could be used in adjunct with Enzyme-linked immunosorbent assay and blood parameters in the diagnosis of rickettsial diseases. Keywords: Fever/Pyrexia of unknown Origin, (FUO/PUO), Spotted fever, Endemic fever, Epidemic fever, Scrub typhus fever, Weil felix.

Introduction Nosodes, the homeopathic preparations sourced from biological materials including clinical samples, cultures of organisms, and diseased tissues have been in use against the source-specific infections as well as other diseases. The nosodes have demonstrated some efficacy in managing epidemics, such as influenza, dengue, and leptospirosis. This article presents the need and process of development of nosodes from the SARS-CoV-2 to explore its prophylactic and therapeutic potentials against certain related viral diseases. MATERIALS AND METHODS A clinical sample of SARS-Cov-2 positive patient, based on the cycle threshold (CT) value of the qRT-PCR, heat-inactivated SARS-CoV-2, and spike glycoprotein all were processed for making nosodes as per the method described in Homoeopathy Pharmacopoeia of India. Molecular tests, such as qRT- PCR and sterility tests were performed to establish the live organisms, RNA material, and the absence of contamination. RESULT Three variants of Coronavirus Nosode were developed using a clinical sample, heat-inactivated SARS-CoV-2, and spike glycoprotein. In potencies 3c and above, no detectable SARS-CoV-2 RNA material was found by PCR. The analytical results for nosodes were reported as compliant for sterility testing as per the IP. CONCLUSION Three variants of Coronavirus nosodes were prepared which need to be evaluated further through pre-clinical and clinical studies.

Dengue and Leptospirosis are endemic metaxenic diseases that affect tropical and subtropical areas, mostly in underdeveloped countries. In addition to this, the COVID-19 pandemic is causing a great deal of damage to both the population and the health level. This is the case of a 13-year-old patient who had fever, gingival and intermenstrual bleeding, abdominal pain and shortness of breath. She had SARS-CoV-2 IgM and IgG positive rapid test, and positive serology NS1 for Dengue and IgM for Leptospira. In addition, non-contrast pulmonary tomography showed areas of consolidated and frosted glass at the base level, as well as cysturitis. Diagnoses of COVID-19 pneumonia, Dengue with warning signs and Leptospirosis were had. Therapeutics were based on fluid therapy according to diuresis and blood pressure, symptomatic, oxygen support, constant monitoring and antibiotic therapy with Ceftriaxone, having a favorable evolution.