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Microbiology, epidemiology, clinical manifestations, and diagnosis of leptospirosis

INTRODUCTION

Leptospirosis is a zoonosis with protean manifestations caused by the spirochete, Leptospira interrogans. Synonyms for the disease include Weil's disease, Swineherd's disease, rice-field fever, cane-cutter fever, swamp fever, mud fever, hemorrhagic jaundice, Stuttgart disease, and Canicola fever.

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

MICROBIOLOGY

The genus Leptospira consists of two species, L. interrogans and L. biflexia, only the former of which is known to cause human disease. More than 200 serovars of L. interrogans have been identified. Leptospira are spiral-shaped aerobic spirochetes with 18 or more coils per cell. They tend to stain poorly with common laboratory stains and are best visualized by dark field microscopy, silver stain or fluorescent microscopy.

Unlike the clinically important spirochete Treponema pallidum, L. interrogans can be grown in vitro from clinical specimens including blood, urine, and cerebrospinal fluid (CSF). Special media are required for isolation such as Fletcher's, Ellinghausen's, or polysorbate 80 media. Therefore, the laboratory needs to be notified if an attempt to isolate leptospira is desired. Growth is usually observed in one to two weeks but may take up to three months [1].

Whole genome-sequencing of a representative virulent strain of L. interrogans has identified a series of genes possibly related to adhesion, invasion, and the hematological changes that characterize leptospirosis, allowing in depth studies of virulence and pathogenesis [2].
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References Top
  1. Kaufmann, AF, Weyant, RS. Leptospiraceae. In: Manual of Clinical Microbiology, 6th ed, ASM Press, Washington, DC, 1995, p. 621.
  2. Ren, SX, Fu, G, Jiang, XG, et al. Unique physiological and pathogenic features of Leptospira interrogans revealed by whole-genome sequencing. Nature 2003; 422:888.
  3. Desai, S, van Treeck, U, Lierz, M, et al. Resurgence of field fever in a temperate country: an epidemic of leptospirosis among seasonal strawberry harvesters in Germany in 2007. Clin Infect Dis 2009; 48:691.
  4. Acha, PN, Szyfres, B. Leptospirosis. In: Zoonoses and Communicable Disease Common to Man and Animals, 3rd Pan American Health Organization, Washington, DC, 2001, p. 157.
  5. Bovet, P, Yersin, C, Merien, F, et al. Factors associated with clinical leptospirosis: A population-based case-control study in the Seychelles (Indian Ocean). Int J Epidemiol 1999; 28:583.
  6. Van, CT, Thuy, NT, San, NH, et al. Human leptospirosis in the Mekong delta, Viet Nam. Trans R Soc Trop Med Hyg 1998; 92:625.
  7. Bertherat, E, Renaut, A, Nabias, R, et al. Leptospirosis and Ebola virus infection in five gold-panning villages in northeastern Gabon. Am J Trop Med Hyg 1999; 60:610.
  8. Segura, ER, Ganoza, CA, Campos, K, et al. Clinical spectrum of pulmonary involvement in leptospirosis in a region of endemicity, with quantification of leptospiral burden. Clin Infect Dis 2005; 40:343.
  9. Sejvar, J, Tangkanakul, W, Ratanasang, P, et al. An outbreak of leptospirosis, Thailand--the importance of the laboratory. Southeast Asian J Trop Med Public Health 2005; 36:289.
  10. Yang, HY, Hsu, PY, Pan, MJ, et al. Clinical distinction and evaluation of leptospirosis in Taiwan--a case-control study. J Nephrol 2005; 18:45.
  11. Jena, AB, Mohanty, KC, Devadasan, N. An outbreak of leptospirosis in Orissa, India: the importance of surveillance. Trop Med Int Health 2004; 9:1016.
  12. Morgan, J, Bornstein, SL, Karpati, AM, et al. Outbreak of leptospirosis among triathlon participants and community residents in Springfield, Illinois, 1998. Clin Infect Dis 2002; 34:1593.
  13. Update: outbreak of acute febrile illness among athletes participating in Eco-Challenge-Sabah 2000--Borneo, Malaysia, 2000. MMWR Morb Mortal Wkly Rep 2001; 50:21.
  14. Farr, RW. Leptospirosis. Clin Infect Dis 1995; 21:1.
  15. Nardone, A, Capek, I, Baranton, G, et al. Risk factors for leptospirosis in metropolitan France: results of a national case-control study, 1999-2000. Clin Infect Dis 2004; 39:751.
  16. Sugunan, AP, Natarajaseenivasan, K, Vijayachari, P, Sehgal, SC. Percutaneous exposure resulting in laboratory-acquired leptospirosis -- a case report. J Med Microbiol 2004; 53:1259.
  17. Katz, AR, Ansdell, VE, Effler, PV, et al. Assessment of the clinical presentation and treatment of 353 cases of laboratory-confirmed leptospirosis in Hawaii, 1974-1998. Clin Infect Dis 2001; 33:1834.
  18. Wong, ML, Kaplan, S, Dunkle, LM, et al. Leptospirosis: a childhood disease. J Pediatr 1977; 90:532.
  19. Sanford, JP. Leptospirosis--time for a booster. N Engl J Med 1984; 310:524.
  20. Berman, SJ, Tsai, C, Holmes, K, et al. Sporadic anicteric leptospirosis in South Vietnam. Ann Intern Med, 1973; 79:167.
  21. Wu, MS, Yang, CW, Pan, MJ, et al. Reduced renal Na+-K+-Cl- co-transporter activity and inhibited NKCC2 mRNA expression by Leptospira shermani: from bed-side to bench. Nephrol Dial Transplant 2004; 19:2472.
  22. Krishnan, A, Karnad, DR, Medhekar, TP. Paralysis due to renal potassium wasting: an unusual presentation of leptospirosis. Nephrol Dial Transplant 2003; 18:2454.
  23. Karande, S, Gandhi, D, Kulkarni, M, et al. Concurrent outbreak of leptospirosis and dengue in Mumbai, India, 2002. J Trop Pediatr 2005; 51:174.
  24. Ganoza, CA, Segura, ER, Swancutt, MA, et al. Mild, self-resolving acute leptospirosis in an HIV-infected patient in the Peruvian Amazon. Am J Trop Med Hyg 2005; 73:67.
  25. Neves Ede, S, Pereira, MM, Galhardo, MC, et al. Leptospirosis patient with AIDS: the first case reported. Rev Soc Bras Med Trop 1994; 27:39.
  26. Jones, S, Kim, T. Fulminant leptospirosis in a patient with human immunodeficiency virus infection: case report and review of the literature. Clin Infect Dis 2001; 33:E31.
  27. Dupont, H, Dupont-Perdrizet, D, Pere, JL, et al. Leptospirosis: Prognostic factors associated with mortality. Clin Infect Dis 1997; 25:720.
  28. Rathinam, SR, Rathnam, S, Selvaraj, S, et al. Uveitis associated with an epidemic outbreak of leptospirosis. Am J Ophthalmol 1997; 124:71.
  29. Cetin, BD, Harmankaya, O, Hasman, H, et al. Acute renal failure: a common manifestation of leptospirosis. Ren Fail 2004; 26:655.
  30. Chawla, V, Trivedi, TH, Yeolekar, ME. Epidemic of leptospirosis: an ICU experience. J Assoc Physicians India 2004; 52:619.
  31. Johnson, WD Jr, Silva, IC, Rocha, H. Serum creatine phosphokinase in leptospirosis. JAMA 1975; 233:981.
  32. Chierakul, W, Tientadakul, P, Suputtamongkol, Y, et al. Activation of the coagulation cascade in patients with leptospirosis. Clin Infect Dis 2008; 46:254.
  33. Stefos, A, Georgiadou, SP, Gioti, C, et al. Leptospirosis and pancytopenia: two case reports and review of the literature. J Infect 2005; 51:e277.
  34. Helmer, RE 3d, Millsaps, RD. Hypoglycorrachia in leptospirosis (Letter). Ann Intern Med 1973; 79:912.
  35. Im, JG, Yeon, KM, Han, MC, et al. Leptospirosis of the lung: radiographic findings in 58 patients. AJR Am J Roentgenol 1989; 152:955.
  36. Carvalho, CR, Bethlem, EP. Pulmonary complications of leptospirosis. Clin Chest Med 2002; 23:469.
  37. Winslow, WE, Merry, DJ, Pirc, ML, Devine, PL. Evaluation of a commercial enzyme-linked immunosorbent assay for detection of immunoglobulin M antibody in human leptospiral infection. J Clin Microbiol 1997; 35:1938.
  38. Levett, PN, Whittington, CU. Evaluation of the indirect hemagglutination assay for diagnosis of acute leptospirosis. J Clin Microbiol 1998; 36:11.
  39. Levett, PN. Usfulness of serologic analysis as a predictor of the infecting serovar in patients with severe leptospirosis. Clin Infect Dis 2003; 36:447.
  40. Bajani, MD, Ashford, DA, Bragg, SL, et al. Evaluation of four commercially available rapid serologic tests for diagnosis of leptospirosis. J Clin Microbiol 2003; 41:803.
  41. Tansuphasiri, U, Deepradit, S, Phulsuksombati, D, Tangkanakul, W. Two simple immunoassays using endemic leptospiral antigens for serodiagnosis of human leptospirosis. Southeast Asian J Trop Med Public Health 2005; 36:302.
  42. Merien, F, Portnoi, D, Bourhy, P, et al. A rapid and quantitative method for the detection of Leptospira species in human leptospirosis. FEMS Microbiol Lett 2005; 249:139.
  43. Zuerner, RL, Bolin, CA. Differentiation of leptospira interrogans isolates by IS 1500 hybridization and PCR assays. J Clin Microbiol 1997; 35:2612.
  44. Woo, TH, Patel, BK, Smythe, LD, et al. Identification of pathogenic leptospira genospecies by continuous monitoring of fluorogenic hybridization probes during rapid-cycle PCR. J Clin Microbiol 1997; 35:3140.
  45. Romero, EC, Billerbeck, AE, Lando, VS, et al. Detection of leptospira DNA in patients with aseptic meningitis by PCR. J Clin Microbiol 1998; 36:1453.
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