(Diagnosis, Diagnostics, Immunodiagnosis, Immunodiagnostics, Pathogenesis, Vaccines & Drugs)



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1753. Guidugli F.  Castro AA.  Atallah AN.  Systematic reviews on leptospirosis.  Revista do Instituto de Medicina Tropical de Sao Paulo.  42(1):47-9, 2000   Jan-Feb.


  OBJECTIVES: To find the existing clinical evidence on interventions for leptospirosis. The objective is to evaluate the effectiveness and safety   of any intervention on leptospirosis through systematic reviews of   randomized controlled trials (RCTs). DATA SOURCE: The sources of studies   used (where there were no limitations concerning language, date, or other   restrictions) were: EMBASE, LILACS, MEDLINE, the Cochrane Controlled   Clinical Trials Database, and the Cochrane Hepato-Biliary Group Randomized   Trials register. SELECTION OF STUDIES: Type of Study: All systematic   reviews of randomized controlled trials. Participants: patients with   clinical and/or laboratorial  diagnosis of leptospirosis, and subjects   potencially exposed to leptospirosis as defined by the authors   Interventions: any intervention for leptospirosis (as antibiotics or   vaccines for prevention or treatment). DATA COLLECTION: The assessment   will be independently made by the reviewers and cross-checked. The   external validity was assessed by analysis of: studies, interventions, and   outcomes. DATA SYNTHESIS: Located 163 studies using the search strategy   described above, at the electronic databases above. Only 2 hits were   selected, which are protocols of systematic reviews of Cochrane   Collaboration, and not full reviews. One of the protocols evaluates   antibiotics for treatment, and the other evaluates antibiotics for   prevention of leptospirosis. CONCLUSIONS: There were not complete   systematic reviews on interventions for leptospirosis. Any interventions  for leptospirosis, such as prevention and treatment remains unclear for   guidelines and practice.


1754.  Smythe L.  Dohnt M.  Symonds M.  Barnett L.  Moore M.  Brookes D.  Vallanjon M. Review of leptospirosis notifications in Queensland and Australia: January   1998-June 1999.


  Communicable Diseases Intelligence.  24(6):153-7, 2000 Jun.


  The World Health Organization/Food and Agricultural Organization   Collaborating Centre for Reference and Research on Leptospirosis, Western   Pacific Region, accredited since 1958, is part of Queensland Health   Scientific Services, which provide tertiary level support in epidemiology,   surveillance, training and diagnosis for hospitals and pathology   laboratories across the State. Databases for leptospirosis on a global,   Australian and State-wide basis are maintained on site and support public   health authorities in Australia, WHO and the International Leptospirosis   Society. Queensland data collated and analysed from leptospirosis   questionnaires, and a brief overview of Australian data based on   questionnaire responses for notified cases from 1998 to June 1999, are   summarised. The increase in leptospirosis notifications (77%) during 1998  possibly signalled greater awareness of the disease by clinicians. There   was a significant increase in leptospirosis notifications for children and   students and a high rate of hospitalisation of cases. An outbreak in North   Queensland during the first half of 1999 resulted in 184 notifications   with over 50% of cases hospitalised. Polymorphic presentation of the   disease with severe pulmonary haemorrhage is associated in particular with   the serovar australis. Serovar zanoni continues to be a major cause of   severe clinical leptospirosis. Several cases were diagnosed in tourists.   One of these cases presented with severe respiratory distress and required

  14 days in hospital. 


1755. Authors

  Sonrier C.  Branger C.  Michel V.  Ruvoen-Clouet N.  Ganiere JP.

  Andre-Fontaine G.


  Evidence of cross-protection within Leptospira interrogans in an

  experimental model.


  Vaccine.  19(1):86-94, 2000 Aug 15.


  Killed whole-cell preparations were used as bacterins against   leptospirosis. As this type of protection is considered to be   serogroup-specific, several serogroups were added to the usual vaccines,   and the most pathogenic serovar was chosen for each group. Different   leptospire extracts were evaluated for their protective capacity against   acute lethal leptospirosis in gerbils (Meriones unguiculatus). Total   extracts induced complete protection against homologous challenges and   partial protection against heterologous challenges. LPS fractions    protected against homologous but not heterologous challenges, whereas   protein extract induced significant protection against both types of   challenge. Thus, cross-protection within L. interrogans was related to the   protein extract.  


2235. Anonymous. From the Centers for Disease Control and Prevention. Update: outbreak of acute febrile illness among athletes participating in Eco-Challenge-Sabah 2000--Borneo, Malaysia, 2000. JAMA.  285(6):728-30, 2001 Feb 14.  


2236. No abstract


2237. No abstract


2238. No abstract


2239. No abstract


2240. Sorabjee JS. The liver in enteric fever and leptospirosis. [Review] [13 refs] Indian Journal of Gastroenterology.  20 Suppl 1:C44-6, 2001 Mar.


2241. Zochowski WJ.  Palmer MF.  Coleman TJ. An evaluation of three commercial kits for use as screening methods for the detection of leptospiral antibodies in the UK. Journal of Clinical Pathology.  54(1):25-30, 2001 Jan.


  AIMS: To compare three commercial screening tests--the PanBio leptospiral IgM enzyme linked immunosorbent assay (ELISA), the Biolisa leptospiral IgM ELISA, and the indirect haemagglutination assay (IHA)--with the microscopic agglutination test (MAT) and two "in house" ELISAs--urease and horseradish peroxidase (HRP)--for the detection of leptospiral antibodies in a local UK and Eire population. METHOD: Two hundred sera submitted for a differential diagnosis of leptospirosis were tested by all methods. A further 142 sera from patients with antibodies to toxoplasma, Epstein-Barr virus (EBV), hepatitis A virus, rheumatoid factor, Borrelia burgdorferi, Mycoplasma pneumoniae, syphilis, cytomegalovirus, and Q fever were tested for crossreactivity. RESULTS: Compared with the MAT, sensitivity and specificity were found to be: PanBio, 90%/94%; Biolisa with sorbent, 100%/85%; and IHA, 54%/95%. Seven of 200 trial sera gave false negative results with PanBio; 14 of 200 trial sera gave false positive results with Biolisa with sorbent, as did a further 25 of the 142 sera tested for potential crossreactivity. Two of 142 sera gave crossreactions with PanBio and IHA (one each). CONCLUSIONS: The degree of false positivity seen with the Biolisa suggests that the recommended positive value of > or = 26 Eu/ml should be reassessed using pools of sera from local populations. When the cut off value was reassessed, using a value of > or = 40 Eu/ml, a sensitivity and specificity of 96% and 94%, respectively, was achieved. Even the modified Biolisa appears to be over sensitive and to show a high degree of non-specificity. The IHA, although specific (95%), lacked sensitivity in this study. The PanBio appeared to be the most suitable as a screening test for leptospiral IgM in the UK, although it would be advisable for all positive test results to be confirmed by a different enzyme immunoassay and the MAT.



2830.    Levett PN.  Branch SL.  Whittington CU.  Edwards CN.  Paxton H. Two methods for rapid serological diagnosis of acute leptospirosis.  Clinical & Diagnostic Laboratory Immunology.  8(2):349-51, 2001 Mar.


  Leptospirosis is a common and underdiagnosed zoonosis. Two rapid assays for serological diagnosis of acute leptospirosis in diagnostic laboratories, the immunoglobulin M (IgM)-dipstick assay and the indirect hemagglutination assay (IHA), were evaluated and compared with standard assays. Sera were examined from 104 patients admitted to a hospital for investigation in a leptospirosis diagnostic protocol. Specimens for serology were taken on days 1 and 4 of the patients' hospital stay. Antibodies were detected using an IgM-enzyme-linked immunosorbent assay (ELISA), microscopic agglutination test (MAT), an IgM-dipstick assay, and an IHA. Fifty-one patients were found to have leptospirosis. The sensitivity of the IgM-dipstick assay was 98%, its specificity was 90.6%, its positive predictive value was 90.9%, and its negative predictive value was 98%. The sensitivity of the IHA was 92.2%, its specificity was 94.4%, its positive predictive value was 95.9%, and its negative predictive value was 92.7%. The standard IgM-ELISA and MAT, were positive in the first samples tested from 67 and 55% of the cases, respectively, and the rapid IgM-dipstick assay and IHA were positive in 71 and 49%, respectively, in the first sample tested. Both rapid assays are highly sensitive and specific. Neither requires specialized equipment, and both are suitable for use in diagnostic laboratories.


2831.    Werts C.  Tapping RI.  Mathison JC.  Chuang TH.  Kravchenko V.  Saint Girons I.  Haake DA.  Godowski PJ.  Hayashi F.  Ozinsky A.  Underhill DM.  Kirschning CJ.  Wagner H.  Aderem A.  Tobias PS.  Ulevitch RJ. Leptospiral lipopolysaccharide activates cells through a TLR2-dependent mechanism. [see comments]. Nature Immunology.  2(4):346-52, 2001 Apr.


  Leptospira interrogans are zoonotic pathogens that have been linked to a recent increased incidence of morbidity and mortality in highly populated tropical urban centers. They are unique among invasive spirochetes in that they contain outer membrane lipopolysaccharide (LPS) as well as lipoproteins. Here we show that both these leptospiral outer membrane constituents activate macrophages through CD14 and the Toll-like receptor 2 (TLR2). Conversely, it seems that TLR4, a central component for recognition of Gram-negative LPS, is not involved in cellular responses to L. interrogans. We also show that for intact L. interrogans, it is LPS, not lipoprotein, that constitutes the predominant signaling component for macrophages through a TLR2 pathway. These data provide a basis for understanding the innate immune response caused by leptospirosis and demonstrate a new ligand specificity for TLR2.



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