Clinical and laboratory aspect of leptospirosis in humans

Main Article Content

I Made Setiawan

Abstract

Leptospirosis is a world-wide zoonotic disease, especially in tropical and subtropical regions. The disease is found in rural and urban areas with poor environmental conditions. The spectrum of human disease ranges from subclinical infection to severe clinical disease with multi-organ failure (Weil’s disease) and high mortality rate, and depends both on the host and the infecting serovar. Leptospirosis may occur either sporadically or in the context of an outbreak and is commonly related to occupational or recreational activities that involve direct or indirect contact with the urine of animal species that are reservoirs of the disease. The disease infects man through contact with contaminated environments or direct contact with carrier animals such as rats, dogs, cattle, pigs, etc. Leptospirosis has clinical symptoms similar to such diseases as dengue, malaria, typhoid, influenza, thus laboratory methods are required for early detection to facilitate appropriate treatment of patients. The diagnosis of leptospirosis should be considered in any patient presenting with an abrupt onset of fever, chills, conjunctival suffusion, headache, myalgia, and jaundice. Suspicion is further increased if there is a history of occupational or recreational exposure to infected animals or to an environment potentially contaminated with animal urine. Treatment commonly consists of administration of antibiotics such as penicillin, ampicillin, amoxicillin, tetracycline and doxycycline. Prevention by immunization is uncommon, as the available vaccines are ineffective in preventing the disease. In general, prevention is by avoiding environmental exposure.

Article Details

How to Cite
Setiawan, I. M. (2008). Clinical and laboratory aspect of leptospirosis in humans. Universa Medicina, 27(2), 87–97. https://doi.org/10.18051/UnivMed.2008.v27.87-97
Section
Review Article

References

Nardone A, Capek I, Baranton G, Campese C, Postic D, Vaillant V, et al. Risk factors for leptospirosis in metropolitan France: Results of a national case-control study, 1999-2000. Clin Infect Dis 2004; 39: 751-3.

Smythe L, Dohnt M, Symonds M, Bernett L, Moore M, Brookes D, et al. Review of leptospirosis notifications in Queensland and Australia: January 1998-June 1999. Commun Dis Intell 2000; 24: 153-7.

Morgan J, Bornstein SL, Karpati AM, Bruce M, Bolin CA, Austin CC, et al. Outbreak of leptospirosis among triathlon participants and community residents in Springfield, Illinois, 1998. Clin Infect Dis 2002; 34: 1593-9.

Levett PN. Leptospirosis. In: Mandel GL, Bennett JE, Dolin R, editors. Principle and Practice of Infectious Diseases. 6th ed. Vol.2. Philadelphia, Pennsylvania, Elsevier Churchill Livingstone; 2005. p. 2789-94.

Karande S, Kulkarni H, Kulkarni M, De A, Varaiya A. Leptospirosis in children in Mumbai slums. Indian J Pediatr 2002; 69: 855-8.

Levett PN. Usefulness of serologic analysis as a predictor of the infecting serovar in patients with severe leptospirosis. Clin Infect Dis 2003; 36: 447-52.

Myint KSA, Gibbons RV, Murray CK, Rungsimanphaiboon K, Supornpun W, Sithiprasasna R, et al. Leptospirosis in Kamphaeng Phet, Thailand. Am J Trop Med Hyg 2007; 76: 135-8.

Trevejo RT, Rigau Perez JG, Ashford DA, McClure M, Gonzalez CJG, Amador JJ, et al. Epidemic leptospirosis associated with pulmonary haemorrhage-Nicaragua 1995. J Infect Dis 1998; 178: 1457-63.

Ismail TF, Wasfi M, Abdul-Rahman B, Murray CK, Hospenthal DR, Abdel-Fadeel M, et al. Retrospective serosurvey of leptospirosis among patients with acute febrile illness and hepatitis in Egypt. Am J Trop Med Hyg 2006; 75: 1085-9.

Collins RA. Leptospirosis. Biomed Scientist 2006; 116-21.

Plank R, Dean D. Overview of the epidemiology, microbiology, and pathogenesis of leptospira spp. in humans. Microb Infect 2000; 2: 1265-76.

Katz AL, Ansdell VE, Effler PV, Middleton CR, Sasaki DM. Assessment of the clinical presentation and treatment of 353 cases of laboratory-confirmed leptospirosis in Hawaii, 1974-1998. Clin Infect Dis 2001; 33: 1834-41.

Levett PN. Leptospirosis. Clin Microbiol Rev 2001; 14: 296-326.

Marotto PCF, Nascimento CMR, Neto JE. Acute lung injury in leptospirosis: clinical and laboratory feature, outcome, and factors associated with mortality. Clin Infect Dis 1999; 29: 1561-3.

Yersin C, Bovet P, Merien F, Wong T, Panowsky J, Perolat P. Human leptospirosis in the Seychelles (Indian Ocean): a population-based study. Am J Trop Hyg 1998; 59: 933-40.

Chu KM, Rathinam R, Namperumalsamy P, Dean D. Identification of Leptospira species in the pathogenesis of uveitis and determination of clinical ocular characteristics in South India. J Infect Dis 1998; 177: 1314-21.

Guarner J, Shieh WJ, Morgan J, Bragg SL, Bajani MD, Tappero JW, et al. Leptospirosis mimicking acute cholecystitis among athletes participating in a triathlon. Human Pathol 2001; 32: 750-2.

Lopes AA, Costa E, Costa YA, Sacramento E, deOliveira Junior ARR, Lopes MB, et al. Comparative study of the in-hospital case-fatality rate of leptospirosis between pediatric and adult patient age groups. Rev Inst Med Trop Sao Paulo 2004; 46: 19-24.

Maciel EAP, Athanazio DA, Reis EAG, Cunha FQ, Queiros A, Almeida D, et al. High serum nitric oxide levels in patients with severe leptospirosis. Acta Tropica 2006; 100: 256-60.

Smythe LD, Smith IL, Smith GA, Dohnt MF, Symond ML, Barnett LJ, et al. A quantitative PCR (TaqMan) assay for pathogenic leptospirosis spp. BMC Infec Dis 2002; 2: 13-9.

Oliveira MAA, Caballero OL, Vago AR, Harskeerl RA, Romanha AJ, Pena SDJ, et al. Diagnostics, typing and identification: low-stringency single specipic primer PCR for identification of Leptospira. J Med Microbiol 2003; 52: 127-35.

Romero EC, Caly CR, Yasuda PH. The persistence of leptospiral agglutinin titres in human sera diagnosed by the microscopic agglutination test. Rev Inst Med Trop Sao Paulo 1998; 40: 183-4.

Croda J, Ramos JG, Matsunaga J, Queiroz A, Homma A, Riley LW, et al. Leptospira immunoglobulin like proteins as a serodiagnostic marker for acute leptospirosis. J Clin Microbiol 2007; 45: 1528-34.

Tansuphasiri U, Deepradit S, Phulsuksombati D, Tangkanakul W. A test strip IgM dot-ELISA assay using leptospiral antigen of endemic strain for serodiagnosis of acute leptospirosis. J Med Thai 2005; 88: 391-8.

Smit HL, Ananyina YV, Cherhsky A, Dancel L, Lai-AFat RFM, Chee HD, et al. International multicenter evaluation of the clinical utility of a dipstick assay for detection of leptospira-specific immunoglobulin M antibodies in human serum specimens. J Clin Microbiol 1999; 37: 2904-9.

Suriptiastuti. Re-emergence of chikungunya: epidemiology and roles of vector in the transmission of the disease. Univ Med 2007; 26: 101-10.

Evander M, Eriksson I, Pettersson L, Juto P, Ahlm C, Olsson GE, et al. Puumala Hantavirus viremia diagnosed by real-time reverse transcriptase PCR using samples from patients with hemoohagic fever and renal syndrome. J Clin Microbiol 2007; 45: 2491-7.

Chu Y, Owen RD, Gonzalez LM, Jonsson CB. The complex ecology of Hantavirus in Paraguay. Am J Trop Med Hyg 2003; 69: 263-8.

Gonsales CR, Casseb J, Monteiro EG, Paula-Neto JB, Fernandez RB, Silva MV, et al. Use of doxycycline for leptospirosis after hight-risk exposure in San Paulo, Brazil. Rev Inst Med Trop 1998; 40: 59-61.

Levett PN. Leptospirosis. Clin Microbiol Rev 2001; 14: 296-326.

Sehgal SC, Suguman AP, Murhekar MV, Sharma S, Vijayachari P. Randomized controlled trial of doxycycline prophylaxis against leptospirosis in an endemic area. Ints J Antimicr Agents 2000; 13: 249-55.