A ten-year follow-up of human leptospirosis in Uruguay: an unresolved health problem
Tóm tắt
Leptospira spp. are delicate bacteria that cannot be studied by usual microbiological methods. They cause leptospirosis, a zoonotic disease transmitted to humans through infected urine of wild or domestic animals. We studied the incidence of this disease in the Uruguayan population, its epidemiologic and clinical features, and compared diagnostic techniques. After examining 6,778 suspect cases, we estimated that about 15 infections/100,000 inhabitants occurred yearly, affecting mainly young male rural workers. Awareness about leptospirosis has grown among health professionals, and its lethality has consequently decreased. Bovine infections were probably the principal source of human disease. Rainfall volumes and floods were major factors of varying incidence. Most patients had fever, asthenia, myalgias or cephalalgia, with at least one additional abnormal clinical feature. 30-40% of confirmed cases presented abdominal signs and symptoms, conjunctival suffusion and altered renal or urinary function. Jaundice was more frequent in patients aged > 40 years. Clinical infections followed an acute pattern and their usual outcome was complete recovery. Laboratory diagnosis was based on indirect micro-agglutination standard technique (MAT). Second serum samples were difficult to obtain, often impairing completion of diagnosis. Immunofluorescence was useful as a screening test and for early detection of probable infections.
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Tài liệu tham khảo
Adler B, 1980, Detection of specific anti-leptospiral immunoglobulins M and G in human serum by solid-phase enzyme-linked immunosorbent assay, J Clin Microbiol, 11, 452, 10.1128/JCM.11.5.452-457.1980
Appassakij H, 1995, Evaluation of the immunofluorescent antibody test for the diagnosis of human leptospirosis, Am J Trop Med Hyg, 52, 340, 10.4269/ajtmh.1995.52.340
Bal AM, 2005, Unusual clinical manifestations of leptospirosis, J Postgrad Med, 51, 179
Barcellos C, 2001, The place behind the case: leptospirosis risks and associated environmental conditions in a flood-related outbreak in Rio de Janeiro, Cad Saúde Pública, 17, 59, 10.1590/S0102-311X2001000700014
Bharti AR, 2003, Leptospirosis: a zoonotic disease of global importance, Lancet Infect Dis, 3, 757, 10.1016/S1473-3099(03)00830-2
Breijo M, 2006, Leptospirosis con compromiso respiratorio predominante: Presentación de cinco casos clínicos, Rev Med Urug, 22, 220
Caffarena RM, 1971, Avances en leptospirosis en el Uruguay, Rev Urug Pat Clín Microbiol, 9, 186
Caffarena RM, 1966, Comprobaciones serológicas de brucelosis y leptospirosis en suinos de la República Oriental del Uruguay, An Fac Vet, 11, 93
Cullen PA, 2005, Surfaceome of Leptospira spp, Infect Immun, 73, 4853, 10.1128/IAI.73.8.4853-4863.2005
Eshghi A, 2009, Global proteome analysis of Leptospira interrogans, J Proteome Res, 8, 4564, 10.1021/pr9004597
Euzéby JP
Faine S, 1999, 2
Feng CY, 2009, Immune strategies using single-component LipL32 and multi-component recombinant LipL32-41-OmpL1 vaccines against Leptospira, Braz J Med Biol Res, 42, 796, 10.1590/S0100-879X2009005000013
Figueiredo AO, 2009, Prevalência e fatores de risco para a leptospirose em bovinos de Mato Grosso do Sul, Pesq Vet Bras, 29, 375, 10.1590/S0100-736X2009000500003
Gamage CD, 2011, Prevalence and carrier status of leptospirosis in smallholder dairy cattle and peridomestic rodents in Kandy, Sri Lanka, Vector Borne Zoonotic Dis, 11, 1041, 10.1089/vbz.2010.0153
García Rodríguez E, 2001, Factores de riesgo de la leptospirosis humana en el municipio Ciego de Ávila, Rev Cuba Hig Epidemiol, 39, 207
Gautam R, 2010, Detection of antibodies against Leptospira serovars via microscopic agglutination tests in dogs in the United States, 2000-2007, J Am Vet Med Assoc, 237, 293, 10.2460/javma.237.3.293
Giatti-Rodrigues C, 1999, Leptospirose bovina: sorologia na bacia leiteira da região de Londrina, Paraná, Brasil, Ciênc Rural, 29, 309, 10.1590/S0103-84781999000200020
Haake DA, 1993, Molecular cloning and sequence analysis of the gene encoding OmpL1, a transmembrane outer membrane protein of pathogenic Leptospira spp, J Bacteriol, 175, 4225, 10.1128/jb.175.13.4225-4234.1993
Jansen A, 2005, Leptospirosis in Germany, 1962-2003, Emerg Infect Dis, 11, 1048, 10.3201/eid1107.041172
Juliano RS, 2000, Prevalência e aspectos epidemiológicos da leptospirose bovina em rebanhos leiteiros na microrregião de Goiânia-GO, Ciênc Rural, 30, 857, 10.1590/S0103-84782000000500020
León LL, 2008, Prevalence of leptospirosis in dairy cattle from small rural production units in Toluca Valley, State of Mexico, Ann NY Acad Sci, 1149, 292, 10.1196/annals.1428.002
Levett PN, 2007, Leptospira, 9, 963
Lombardi R, 1972, Insuficiencia renal aguda en la Leptospirosis, Rev Urug Patol Clin Microbiol, 10, 28
Lombardi R, 1997, Acute renal failure in leptospirosis in Uruguay, Renal Fail, 19, 315, 10.3109/08860229709026295
Marotto PC, 1999, Acute lung injury in leptospirosis: clinical and laboratory features, outcome and factors associated with mortality, Clin Infect Dis, 29, 1561, 10.1086/313501
Mazzonelli J, 1975, Recherches sur les antigènes des leptospires, Tropenmed Parasitol, 26, 35
Mederos R, 1959, Leptospirosis en el perro (Su comprobación en el Uruguay), An Fac Vet, 9, 171
Oliveira FCS, 2010, Fatores de risco para a leptospirose em fêmeas bovinas em idade reprodutiva no Estado da Bahia, Nordeste do Brasil, Pesq Vet Bras, 30, 398, 10.1590/S0100-736X2010000500004
Panaphut T, 2002, Prognostic factors of death in leptospirosis: a prospective cohort study in Khon Kaen, Thailand, Int J Infect Dis, 6, 52, 10.1016/S1201-9712(02)90137-2
Pereira MM, 2000, A clonal subpopulation of Leptospira interrogans sensu stricto is the major cause of leptospirosis outbreaks in Brazil, J Clin Microbiol, 38, 450, 10.1128/JCM.38.1.450-452.2000
Pisano I, 1997, Leptospirosis con compromiso miocárdico, Cuad Med Interna, 1, 51
Rajapakse S, 2010, Developing a clinically relevant classification to predict mortality in severe leptospirosis, J Emerg Trauma Shock, 3, 213, 10.4103/0974-2700.66519
Repiso MV, 2005, Prevalencia de las principales enfermedades infecciosas que afectan el comportamiento reproductivo en la ganadería de carne y caracterización de los establecimientos de cría del Uruguay, Veterinaria, 40, 5
Rosetti C, 1999
Schoonman L, 2010, Herd-and animal-level risk factors for bovine leptospirosis in Tanga region of Tanzania, Trop Anim Health Prod, 42, 1565, 10.1007/s11250-010-9607-1
Scialfa E, 2010, Isolation of Leptospira interrogans from suburban rats in Tandil, Buenos Aires, Argentina, Rev Argent Microbiol, 42, 126
Shang ES, 1996, Molecular cloning and sequence analysis of the gene encoding LipL41, a surface-exposed lipoprotein of pathogenic Leptospira species, Infect Immun, 64, 2322, 10.1128/IAI.64.6.2322-2330.1996
Shuang-Xi Ren, 2003, Unique physiological and pathogenic features of Leptospira interrogans revealed by whole-genome sequencing, Nature, 422, 888, 10.1038/nature01597
Silva EF, 2009, Leptospira noguchii and human and animal leptospirosis, Southern Brazil, Emerg Infect Dis, 15, 621, 10.3201/eid1504.071669
Silva MV, 1995, Behaviour of specific IgM, IgG and IgA class antibodies in human leptospirosis during the acute phase of the disease and during convalescence, J Trop Med Hyg, 98, 268
Smythe LD, 2002, A quantitative PCR (Taq Man) assay for pathogenic Leptospira spp, BMC Infect Dis, 2, 13, 10.1186/1471-2334-2-13
Tealdo MS, 2007, Serología positiva a Leptospira interrogans, serovar cynopteri en caninos de la Ciudad de Buenos Aires, Argentina, InVet, 9, 59
Torten M, 1966, The use of immunofluorescence in the diagnosis of human leptospirosis by a genus-specific antigen, J Infect Dis, 166, 537, 10.1093/infdis/116.5.537
Turk N, 2009, Molecular analysis of Leptospira spp. isolated from humans by restriction fragment length polymorphism, real-time PCR and pulsed-field gel electrophoresis, FEMS Microbiol Lett, 300, 174, 10.1111/j.1574-6968.2009.01776.x
Ursu M, 1993, Insuficiencia renal aguda en la leptospirosis: análisis de 20 casos, Paciente Crít, 6, 129
Vieira ML, 2006, Human leptospirosis in Portugal: A retrospective study of eighteen years, Int J Infect Dis, 10, 378, 10.1016/j.ijid.2005.07.006
Terpstra WJ, 2003