Introduction: ILeptospirosis is an important zoonotic disease commonly found in tropical or sub-tropical countries. The most severe form is Weil's syndrome which presents with jaundice, renal failure, and bleeding diatheses. Although jaundice occurs in 38% of patients with leptospirosis, no studies in Asia have focused on the liver biochemical profile of these patients. Characterization of liver biochemical profile and ultrasonographic findings may shed more light on the disease process. Identification of liver biochemical parameters that portend a poor prognosis may also allow for early aggressive intervention. Objective: To describe the liver biochemical profile and liver ultrasonographic findings in adult patients with laboratoryconfirmed leptospirosis, admitted at a tertiary hospital in Manila, Philippines. The association of clinical and laboratory features with clinical outcomes (i.e., severe liver injury, Weil’s syndrome, and mortality) was also investigated. Methods: This retrospective cross-sectional study reviewed all available cases of adult patients with laboratoryconfirmed leptospirosis admitted in the Philippine General Hospital from January 2009 to August 2018. The clinical features, liver biochemical profiles, and ultrasound findings were recorded and analyzed. Comparison between the means of each group based on clinical outcome (i.e., mortality, Weil’s syndrome) was done via Students’ t-test for continuous variables, and calculation of the Odds Ratio for categorical variables. Results: Total and direct bilirubin levels were elevated in patients with leptospirosis compared to serum aminotransferases and alkaline phosphatase levels which were only mildly elevated. Abdominal ultrasound showed typically un-enlarged livers with normal parenchymal echogenicity, normal spleens, and non-dilated biliary trees. Dyspnea was associated with an increased odds for mortality. Although jaundice was present in 39.5% of patients and significantly associated with severe liver injury, this was not associated with mortality. Liver biochemical test values did not differ among patients who expired and those who survived to discharge. The presence of myalgia and abdominal pain increased the odds for Weil's syndrome. Conclusion To date, no local studies have fully described the liver biochemical profile of patients with leptospirosis. Our findings are compatible with previous studies showing that leptospirosis typically presents with predominantly elevated direct bilirubin from cholestasis and systemic infection. Contrary to previous literature, however, our study found no association between jaundice and mortality.
Leptospirosis

Objective: To analyze the incidence of leptospirosis in Fujian province from 2015 to 2020 and provide the scientific evidences for the risk assessment, prevention and control of leptospirosis. Methods: The incidence data of leptospirosis in Fujian during 2015-2020 were collected from China Information System for Disease Control and Prevention for a descriptive analysis, and software ArcGIS 10.3.1 was used for spatial autocorrelation analysis, and rats were captured in 17 surveillance areas during the same period, and the rat organs were collected for pathogen culture, the level of Leptospira antibody was detected in serum samples of rats, healthy population and the serum samples of patients sent by the hospitals. The infection status of Leptospira in human and rats were analyzed. Results: The incidence of leptospirosis in Fujian showed a downward trend from 2015 to 2020. A total of 176 cases of leptospirosis were reported. There were obvious seasonality and bimodal distribution. The majority of cases were farmers, accounting for 49.43% (87/176). Most cases were aged 30-69 years (85.80%, 151/176). The male to female ratio of the cases was 3.51∶1 (137∶39). Spatial autocorrelation analysis showed that leptospirosis had high or low clustering areas. From 2015 to 2020, the average capture rate of rats in 17 surveillance areas was 6.96% (1 519/21 838), Rattus losea, Rattus flavipectus and Niviventer fulvescens were the main species. The average positive rate of Leptospira antibody in rats was 28.64% (252/880). Java and Autumnalis were the predominant serogroups, accounting for 56.75% (143/252) and 17.46% (44/252), respectively. The average positive rate of Leptospira antibody in healthy population was 16.13% (254/1 575), and Autumnalis and Australis were the predominant serogroups, accounting for 71.65% (182/254). The confirmation rate of leptospirosis in patient serum samples sent by the hospitals was 2.23% (188/8 431), Autumnalis (56.38%, 106/188) and Hebdomadis (19.68%, 37/188) were the major serogroups. Conclusions: The incidence of leptospirosis in Fujian showed a downward trend from 2015 to 2020, there were obvious area clustering and seasonality. The high clustering areas were mainly distributed in northern, western and central Fujian. Java and Autumnalis were the predominant serogroups in rats. The infection rate in healthy population decreased year by year. Autumnalis and Hebdomadis were the main serogroups in population in Fujian.
Animals ; Antibodies, Bacterial ; Female ; Humans ; Incidence ; Leptospira ; Leptospirosis/epidemiology* ; Male ; Rats ; Serogroup

Background: In the Philippines, Leptospirosis is a seasonal but common and prevalent disease with an average of 680 cases and 40 deaths annually. Cases result from exposure to contaminated flood, water, or soil. Several studies showed that males are more commonly affected, who are believed to be more exposed to the outdoor environment. In terms of pediatric population, early diagnosis is based mainly on clinical and epidemiological factors. Objective: This study was conducted to determine the clinical features and outcomes of pediatric leptospirosis, as well as determine the prognostic factors associated with mortality. Methodology: A descriptive retrospective study was done in a tertiary hospital from January 2007 – December 2019. Review of all cases that satisfy the diagnosis of Leptospirosis by WHO Criteria (2003) was done. The data extracted from the chart were encoded using Microsoft Excel; processed and analyzed using STATA SE 15 to generate the required output. Results & Conclusion In this 12-year study, a total of 85 cases of leptospirosis in children, aged 0-18 years, were reported. Leptospirosis predominates in males in the adolescent age group. It is noted all year round but noted mostly during the rainy months which increases the risk to exposure to contaminated water through wading, especially in the cities of Navotas, Malabon and Tondo. The mean duration of symptoms was 3.6 days. The most common clinical findings noted in this study were fever, gastrointestinal symptoms, conjunctival suffusion, oliguria, calf tenderness and headache. Abnormal laboratory findings were leukocytosis, neutrophilia, thrombocytosis, elevated BUN and creatinine, hypokalemia and hyponatremia. Significant correlation with poor outcome was found in patients who have had pulmonary hemorrhage.
Leptospirosis

We described a case of positive molecular detection of leptospirosis in urine sample following prolonged hospitalization. Relevant clinical history had raised suspicion to leptospirosis infection. A significantly high level of creatinine kinase suggested possibility of rhabdomyolysis. Blood and urine samples collected on 4th day of admission were negative for leptospires culture and serological method showed no significant evidences of positive infection. Molecular detection of Leptospira spp. in blood sample was positive but not in urine sample. After seven weeks of infection, leptospiral DNA was detected in urine sample using molecular method
Leptospirosis

OBJECTIVES: This study aimed to assess the status of Scrub typhus, Leptospirosis and HFRS(hemorrhagic fever with renal syndrome) among farmers with febrile illness. METHODS: We involved a total of 841 farmers who had febrile illness(508 and 333 village residents were, respectively, three and four district of Gyeongju city) selected during autumn of 2014 and 2015. Data were collected by survey questionnaires and blood sample examination. RESULTS: Serum response rate for Scrub typhus and Leptospirosis was 1.5% each and 1.9% for HFRS. Serum response rate for Scrub typhus was significantly higher for tick-bite cases(38.5%), while Leptospirosis was significantly higher for those who were in fruit–planting work(23.1%). Similarly, serum response rate was significantly higher for HFRS who were working in venyl green house work(25.0%). CONCLUSIONS: Government authority should develop effective and efficient preventive strategies to create awareness of infectious diseases among farmers. Extending information, education and communication be reached to farmers that could change their perception and help early diagnosis and treatment and reduce the disease burden and its complication.
Communicable Diseases ; Early Diagnosis ; Education ; Farmers ; Fever ; Gyeongsangbuk-do ; Hemorrhagic Fever with Renal Syndrome ; Leptospirosis ; Risk Factors ; Scrub Typhus

Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder of an unknown origin. The role of leptospirosis as a triggering factor for SLE is unknown. This paper reports an uncommon case of SLE following a leptospira infection. A 29-year-old female was referred due to fevers, myalgia, and facial edema with rash. Laboratory investigations revealed a hepatic dysfunction, significantly raised lactate dehydrogenase with marked leukopenia and thrombocytopenia. A diagnosis of leptospirosis was confirmed. The patient was treated with antibiotic therapy for leptospirosis. She developed dyspnea after one week. The echocardiogram revealed global hypokinesia with a decreased ejection fraction. A positivity of antinuclear, anti-DNA, and anti-Smith antibodies, together with clinical and laboratory improvement by steroid therapy, led to the diagnosis of SLE. This case highlights the presence of concurrent SLE and leptospirosis. As the symptoms of SLE are similar to leptospirosis, accurate diagnosis through high suspicion is essential for appropriate treatment.
Adult ; Antibodies ; Diagnosis ; Dyspnea ; Edema ; Exanthema ; Female ; Fever ; Humans ; Hypokinesia ; L-Lactate Dehydrogenase ; Leptospira ; Leptospirosis* ; Leukopenia ; Lupus Erythematosus, Systemic* ; Myalgia ; Myocarditis ; Thrombocytopenia

BACKGROUND: Domestic animals are known to be either maintenance or accidental hosts of Leptospira. Determination of seroprevalence of leptospirosis among these animals is of great importance due to their close association with humans, economic loss as well as the public and veterinary health problems caused by the said zoonosis.

OBJECTIVE: This study aimed to determine the seroprevalence of leptospirosis among water buffaloes, pigs, and dogs in selected areas in the Philippines.

METHODS: Microscopic agglutination test (MAT) was used to test for leptospirosis. Testing was done from January 2007 to August 2008.

RESULTS: With the cut-off titer set at 1:80, the MAT-positivity rates were 82%, 67%, and 79% for 190 water buffaloes, 45 pigs, and 106 dogs, respectively. The most common prevailing serovars detected were Hardjo, Tarassovi, and Hebdomadis for water buffaloes; Semaranga, Grippotyphosa, and Patoc for pigs; and, Manilae, Patoc, and Autumnalis for dogs. MAT-positivity rates among these animals in terms of age (except for water buffaloes), sex and sample collection sites were not statistically significant. No Leptospira was isolated from the blood, urine, and kidney samples of these animals.

CONCLUSION: Results indicate a high seroprevalence of leptospirosis among the animals studied and that several pathogenic leptospires are causing infection in these animals.

Abstracts: Leptospirosis is endemic worldwide. Based on the 2016 Philippine Pediatric Society Disease Registry, there were 800 cases of leptospirosis from May 2006 to August 2016, making it a significant public health concern. Case fatality rate is about 8-9%, with increased prevalence of the disease among adults and adolescents. Objective: This study was conducted to evaluate the effectiveness of public health education through a lecture on improving the knowledge, attitude, and practice scores on leptospirosis among adolescents from grades 7-10 in a public school in Manila. Methodology: This was a cross-sectional analytical study. A pre-tested, self administered questionnaire was given among 357 students in a public school in Intramuros, Manila. A lecture regarding leptospirosis was conducted and a post-test was given afterwards. Data was analyzed using paired t-test. Results: A total of 357 students were included, with an 88.37% response rate. Total mean pre-test knowledge score was 88.64%, and total mean pre-test attitude score was 80.97%. For practices related to leptospirosis, the total mean pre-test score was 72.12%. Pre-test knowledge scores were compared with post-test scores. After the lecture, there was a significant increase in their knowledge on leptospirosis (p=<0.0001). There was also an improvement on post-test scores on attitude and practices regarding leptospirosis (p=<0.0001). Conclusion Public health education through a lecture was effective in increasing the knowledge, attitude, and practice scores on leptospirosis among adolescents. This may help in the prevention of the disease in the adolescent population.
Leptospirosis ; Adolescent

Introduction: Leptospirosis is a zoonotic disease caused by spirochaete of the genus Leptospira. Human infection occurs after exposure to water or soil contaminated by urine from an infected animal. Most patients manifest as self-limited systemic illness. However 10% of patients manifest as severe disease associated with high fatality. The disease affects mostly men, cases involving pregnant women are uncommon. We presented a case of leptospirosis in a pregnant woman leading to mortality of both mother and foetus. Case Report: A 28-year-old woman at 18 weeks of gestation, had shortness of breath and collapsed. She was brought unconscious to the emergency department and died shortly after arrival. A week prior to this, she had presented to the same hospital with pain on both thighs. Examination of the patient and ultrasound of the foetus revealed normal findings. Post mortem examination revealed hepatosplenomegaly and congested lungs; no jaundice, meningeal inflammation or cardiac abnormalities was evident. Histopathology examination of the lungs revealed pulmonary haemorrhages and oedema. Multiple infarcts were seen in the spleen and the kidneys showed foci of acute tubular necrosis. Laboratory investigations revealed Leptospira IgM antibody and PCR for leptospira were positive. This case illustrates the subtleness of clinical presentation of leptospirosis. The diagnosis was obscure even at post-mortem and was only suspected following histopathological examination, leading to further investigations. Conclusion: Leptospirosis may have a subtle presentation and a high index of suspicion for this infection is required for early identification of the disease.
Leptospirosis

Introduction: Leptospirosis is a preventable zoonosis of public health importance. Due to increasing incidence of leptospirosis and seasonal floods affecting Kuantan community, a study was conducted to identify the determinants of leptospirosis preventive practices. Methods: A cross-sectional study was carried out in Perkampungan Sungai Isap, Kuantan, Pahang, Malaysia, which obtained 568 respondents by stratified proportionate random sampling technique. Data was collected using a modified guided questionnaire and analysed using IBM SPSS version 22.0. Results: Majority of the respondents were females (52.6%), Malay ethnicity (98.8%), attended up to secondary school (57.2%), worked in low-risk occupational group (96.0%) and reside in moderate-risk stratum (55.6%). Overall, majority (68%) of the respondents had good knowledge. However, only 38% of the respondents had satisfactory attitude and 18% had satisfactory practice. There were significant associations between stratum and leptospirosis preventive practices (χ2=11.84, df=2, p=0.003), age group and leptospirosis preventive practices (χ2=7.41, df=2, p=0.03) and personal income and leptospirosis preventive practices (χ2=6.32, df=1, p=0.01). Multivariate logistic regression showed that the predictors of satisfactory leptospirosis preventive practices were high-risk stratum (aOR: 3.69, 95% CI: 1.71-8.00, p=0.001) and monthly personal income of less than RM1000 (aOR: 1.65, 95% CI: 1.05-2.59, p=0.03). Conclusions: Leptospirosis can be prevented by having adequate awareness regarding the disease through health promotional activities especially before, during and after flooding, targeting more on those in low to moderate risk areas and higher income group to prevent potential outbreaks.
Leptospirosis