LEPTOSPIROSIS
Diagnosis, Diagnostics, Immunodiagnosis &
Immunodiagnostics:
ABSTRACTS
3346.
Guarner J. Shieh WJ. Morgan J.
Bragg SL. Bajani MD. Tappero JW.
Zaki SR. Leptospirosis mimicking
acute cholecystitis among athletes participating in a triathlon. Human Pathology. 32(7):750-2, 2001 Jul.
Abstract
Leptospirosis, a disease acquired by
exposure to contaminated water, is characterized by fever accompanied by
various symptoms, including abdominal pain. An acute febrile illness occurred
in athletes who participated in an Illinois triathlon in which the swimming
event took place in a freshwater lake. Of 876 athletes, 120 sought medical care
and 22 were hospitalized. Two of the athletes had their gallbladders removed
because of abdominal pain and clinical suspicion of acute cholecystitis. We
applied an immunohistochemical test for leptospirosis to these gallbladders and
demonstrated bacterial antigens staining (granular and filamentous patterns)
around blood vessels of the serosa and muscle layer. Rare intact bacteria were
seen in 1 case. These results show that leptospirosis can mimic the clinical
symptoms of acute cholecystitis. If a cholecystectomy is performed in febrile
patients with suspicious environmental or animal exposure, pathologic studies
for leptospirosis on formalin-fixed, paraffin-embedded tissues may be of great
value.
3347.
Guerreiro H. Croda J. Flannery B.
Mazel M. Matsunaga J. Galvao Reis M. Levett PN. Ko AI. Haake DA. Leptospiral proteins recognized
during the humoral immune response to leptospirosis in humans. Infection &
Immunity. 69(8):4958-68, 2001 Aug.
Abstract
Leptospirosis is an emerging zoonosis caused
by pathogenic spirochetes belonging to the genus Leptospira. An understanding
of leptospiral protein expression regulation is needed to develop new
immunoprotective and serodiagnostic strategies. We used the humoral immune
response during human leptospirosis as a reporter of protein antigens expressed
during infection. Qualitative and quantitative immunoblot analysis was
performed using sera from 105 patients from Brazil and Barbados. Sera from
patients with other diseases and healthy individuals were evaluated as
controls. Seven proteins, p76, p62, p48, p45, p41, p37, and p32, were
identified as targets of the humoral response during natural infection. In both
acute and convalescent phases of illness, antibodies to lipopolysaccharide were
predominantly immunoglobulin M (IgM) while antibodies to proteins were
exclusively IgG. Anti-p32 reactivity had the greatest sensitivity and
specificity: positive reactions were observed in 37 and 84% of acute- and
convalescent-phase sera, respectively, while only 5% of community control
individuals demonstrated positive reactions. Six immunodominant antigens were
expressed by all pathogenic leptospiral strains tested; only p37 was
inconsistently expressed. Two-dimensional immunoblots identified four of the
seven infection-associated antigens as being previously characterized proteins:
LipL32 (the major outer membrane lipoprotein), LipL41 (a surface-exposed outer
membrane lipoprotein), and heat shock proteins GroEL and DnaK. Fractionation
studies demonstrated LipL32 and LipL41 reactivity in the outer membrane
fraction and GroEL and DnaK in the cytoplasmic fraction, while p37 appeared to
be a soluble periplasmic protein. Most of the other immunodominant proteins,
including p48 and p45, were localized to the inner membrane. These findings
indicate that leptospiral proteins recognized during natural infection are
potentially useful for serodiagnosis and may serve as targets for vaccine
design.
3348.
Kobayashi Y. Clinical
observation and treatment of leptospirosis. [Review] [39 refs] Journal of Infection &
Chemotherapy. 7(2):59-68, 2001 Jun.
Abstract
The epidemiological and clinical
observations of 240 patients with Weil's disease and 10 patients with canicola
fever, and these observations in two epidemics of canicola fever, are presented.
Early diagnosis is most important for the prognosis of patients with the severe
form of leptospirosis. It depends on the clinical features, clinical laboratory
findings, and the epidemiological situation. The most characteristic clinical
signs for early diagnosis were febrile illness of sudden onset, severe general
malaise, muscular pain, and conjunctival congestion. Proteinuria, leukocytosis
with neutrophilia, and raised erythrocyte sedimentation rate were the most
indicative clinical laboratory findings for early diagnosis. Although jaundice
and hemorrhage are the most important signs of the severe form of
leptospirosis, Weil's disease, these are rarely useful in early diagnosis. Of a
variety of antibiotics used, penicillins and cephems had the lowest minimal
inhibitory concentration against leptospires. However, it became apparent from
basic studies in vitro and in vivo that streptomycin showed the best
bactericidal action against leptospires and that it was the most effective
anti-leptospiral antibiotic. Gentamicin, tobramycin, and isepamicin are also
effective as alternatives to streptomycin. Although penicillins, cephems,
tetracyclines, and macrolides are also effective for the treatment of
leptospirosis, when these antibiotics with inadequate bactericidal activity are
used for the treatment of the disease, long-term therapy with sufficiently
large doses may be required from an early stage of the disease until the
appearance of antibodies. [References: 39]
3349.
Kobayashi Y. Discovery of the
causative organism of Weil's disease: historical view. Journal of Infection
& Chemotherapy. 7(1):10-5, 2001
Mar.
Abstract
On January 20, 1915, Inada and Ido announced
the discovery of the causative agent of Weil's disease. Subsequently, on
February 13, 1915, they published the first paper on the discovery of the
causative organism (a new species of Spirochaeta) of Weil's disease. Besides
discovering the causative organism of the disease, Inada and colleagues
clarified the pure culture in medium, and determined the source and route of
the infection, its pathology and morbid anatomy; the distribution of the
organism in various organs and tissues; the excretion of the spirochete, and
its division, filterability, and morphological characteristics; and the
clinical picture, laboratory findings, diagnosis, prophylaxis, and treatment of
the disease. These studies were conducted by Inada, Ido, Kaneko, Hoki, and Ito,
in the years 1914 to 1915. In the early investigation of leptospirosis, Inada
and colleagues played a prominent part. We would like to remember these
remarkably complete and definitive original achievements on leptospirosis made
by Inada and colleagues.
3350.
Levett PN. Leptospirosis.
[Review] [677 refs] Clinical Microbiology Reviews. 14(2):296-326, 2001 Apr.
Abstract
Leptospirosis is a worldwide zoonotic
infection with a much greater incidence in tropical regions and has now been
identified as one of the emerging infectious diseases. The epidemiology of
leptospirosis has been modified by changes in animal husbandry, climate, and
human behavior. Resurgent interest in leptospirosis has resulted from large
outbreaks that have received significant publicity. The development of simpler,
rapid assays for diagnosis has been based largely on the recognition that early
initiation of antibiotic therapy is important in acute disease but also on the
need for assays which can be used more widely. In this review, the complex
taxonomy of leptospires, previously based on serology and recently modified by
a genotypic classification, is discussed, and the clinical and epidemiological
value of molecular diagnosis and typing is also evaluated. [References: 677]
3351.
Panicker JN. Mammachan R. Jayakumar RV. Primary
neuroleptospirosis. Postgraduate
Medical Journal. 77(911):589-90, 2001
Sep.
Abstract
Leptospirosis is an important zoonosis of
worldwide distribution. It is uncommon for leptospirosis to present as a
primary neurological disease. In this study of patients who presented with an
acute neurological disease, and who were subsequently found to have
leptospirosis, aseptic meningitis was the commonest manifestation. The other
presentations were myeloradiculopathy, myelopathy, Guillain-Barré
syndrome-like presentation, meningoencephalitis, intracerebral bleed,
cerebellar dysfunction, iridocyclitis, and tremor/rigidity. Treatment consists
of antibiotics, crystalline penicillin being the drug of choice, which reduces
the course of illness if given early. The role of steroids is controversial.
The prognosis after primary neuroleptospirosis is generally good but altered
sensorium and seizures herald a worse prognosis.
3352.
3353.
Ray S. Gragoudas E. Neuroretinitis. [Review] [46
refs] International Ophthalmology
Clinics. 41(1):83-102, 2001 Winter.
Abstract
Despite the growing list of agents that can
present as neuroretinitis, nearly one-half remain idiopathic. However, many of
the candidate etiologies are treatable conditions, and accurate diagnosis can
result in visual rehabilitation. A complete workup in patients presenting with
acute neuroretinitis should include a thorough history and general medical
evaluation. Exposure history should be thoroughly explored, including recent
travel, unpasteurized and uncooked foods, sexual experience, and animal
contacts. A detailed physical examination should be performed to note hidden
rashes and inoculation sites and should include routine measurements of blood
pressure and heart rate. Laboratory tests should be tailored to the history and
may include complete blood count; erythrocyte sedimentation rate; bacterial,
fungal, and viral blood cultures; antinuclear antibody test;
angiotensin-converting enzyme; anti-double-stranded DNA; and C3. Serological
evaluation should look for syphilis, Lyme disease, histoplasmosis, brucellosis,
chlamydia, HIV, toxoplasmosis, Epstein-Barr virus, viral hepatitis B and C, and
tuberculin skin test. Neuroretinitis is a clinical entity in which there is
inflammation of the retinal architecture and optic nerve. There are numerous
entities that can cause a picture of neuroretinitis ranging from vascular to
infectious to autoimmune. With regards to the infectious etiologies, it is
interesting to note that many of these organisms are obligate intracellular
pathogens. The microorganisms B. henselae, T. gondii, R. typhi, T. pallidum, Mycobacterium
tuberculosis, Histoplasma capsulatum, and various viruses, such as HIV, mumps,
and HSV, are known intracellular agents. Other major infectious agents, such as
B. burgdorferi and Leptospirosis spp. are known to remain sequestered within
the circulatory system. It is possible that in this way these agents are able
to breach the delicate blood-brain barrier. The implication of such findings on
the treatment and management of neuroretinitis remains to be explored.
Interestingly, the vast majority of infected patients do not develop
neuroretinitis or demonstrate CNS involvement. Detailed examination of this
variability may provide further insight into the pathogenic properties of these
infectious agents, host tissue susceptibility, and mechanisms of blood-retina
barrier integrity. A detailed retinal examination can provide an unobstructed
view of the CNS. Careful inspection of this delicate interface may reveal
subtle findings critical for accurate and rapid diagnosis of underlying
systemic pathology. The varied visual and neurological symptoms of
neuroretinitis attest to the fact that this is a disease of both the retina and
contiguous neuronal elements. Such involvement significantly elevates the risk
to the patient and emphasizes the need for early detection and prompt
treatment. [References: 46]
Oct 02
4120.
Agunloye C A, Alabio F O, Odemuyiwa S O, Olaleye
O D: Leptospirosis in Nigerians: a seroepidemiological survey. Indian Vet J
2001, 78(5), 371-5. (015572). Aug 1, 2001.
Five hundred and
thirty eight sera collected from various parts of Nigeria were tested for the
presence of antibodiesto leptospires. Out of these 223 (41.5% reacted with
leptospira antigen using the Passive Haemagglutination test (PHA). For the
ELASA (33.5%) were seropositive. Only 110(20.5%) were positive by the
Microscopic Agglutination Test. The prevalence of individual serovars were L.
icterohae morrhagiae 21 (18.3%), L. hardjo 18 (15.7%), L. grippotyposa 15
(13.0%), L. hamptoni 15 (13.0%), L. pomona 14 (12.2%), and L. ballum 12(10.4%)
among others. The seropositivity was higher (P<0.05, X2 ) in adults than in
children and young adults (< 18 years). There is need for the consideration
of leptospirosis-like illnesses in Nigerians. 16 ref.
4121.
Flannery B, Pereira MM, Velloso L de F, Carvalho
C de C, De Codes LG, Orrico G de S, Dourado CM, Riley LW, Reis MG, Ko AI.
Referral pattern of leptospirosis cases during a large urban epidemic of
dengue. Am J Trop Med Hyg 2001 Nov;65(5):657-63
During heavy
seasonal rainfall in 1996, concurrent epidemics of dengue and leptospirosis
occurred in an urban center in northeastern Brazil. We interviewed 110 cases of
leptospirosis hospitalized a median of seven days after the onset of illness to
evaluate the impact of the dengue epidemic on the triage of suspected
leptospirosis from ambulatory clinics to the infectious disease reference
hospital. Within the first three days of illness, 46 (42%) cases sought their
first medical evaluation, and 28 (61% of 46) received a diagnosis of dengue.
Dengue diagnoses were associated with a median of five days delay in referral
to the infectious disease hospital. Patients who reported initial diagnoses of
dengue were more likely than other patients to have required admission to the
intensive care unit (odds ratio [OR] = 2.7, 95% confidence interval [CI] =
0.8-9.5) and to have died during hospitalization (OR = 5.1, 95% CI = 0.8-55.0).
These findings indicate that diagnostic confusion between the early symptoms of
leptospirosis and dengue may have contributed to the high mortality observed
during the leptospirosis epidemic.
4122.
Kakkilaya BS, Balasaraswathy P, Motha B.
Leptospirosis and ground itch. Trop Doct
2001 Oct;31(4):252 No Abstract.
4123.
Katz AR, 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 Dec 1;33(11):1834-41
Leptospirosis is frequently misdiagnosed as a result of its protean and nonspecific presentation. Leptospirosis, a zoonosis with global distribution, commonly occurs in tropical and subtropical regions; most reported cases in the United States occur in Hawaii. All laboratory-confirmed leptospirosis cases in the State of Hawaii from 1974 through 1998 (n=353) were clinically evaluated. The most common presentation involved nonspecific signs or symptoms, including fever, myalgia, and headache. Jaundice occurred in 39% of cases; conjunctival suffusion was described in 28% of these cases. Initiation of antibiotics before the seventh day of symptoms was associated with a significantly shortened duration of illness. Because early recognition and initiation of antibiotic therapy are important, clinicians should familiarize themselves with the clinical presentation of leptospirosis, and when evaluating a patient with a febrile illness, they should obtain exposure and travel histories and entertain the possibility of leptospirosis in the differential diagnosis.
4124.
Truccolo J, Serais O, Merien F, Perolat P.
Following the course of human leptospirosis: evidence of a critical threshold
for the vital prognosis using a quantitative PCR assay. FEMS Microbiol
Lett 2001 Nov 13;204(2):317-21
In order to follow the course of acute human leptospirosis, an ELISA microtiter plate hybridization method was developed for the quantitative determination of Leptospira spp. in biological samples after PCR. The biotin-labelled amplified product (331 bp from the rrs gene) was hybridized with a complementary capture probe covalently linked onto aminated polystyrene wells, and detected using a colorimetric reaction. The mean detection limit was 50 copies per 10 microl. In a prospective study of human leptospirosis cases, we obtained evidence that a density of 10(4) leptospires per ml of blood is a critical threshold for the vital prognosis of the patients. The practicability of the method makes it suitable for use in tropical areas for multicentric studies. Such studies could lead to a better knowledge of the natural history of the human disease. The method is also suitable for experimental evaluation of improved antibiotic treatments for leptospirosis.
July 02
4702.
Lee
SH, Kim S, Park SC, Kim MJ. Cytotoxic
activities of Leptospira interrogans hemolysin SphH as a pore-forming protein
on mammalian cells. Infect Immun. 2002 Jan;70(1):315-22.
Leptospirosis
is a spirochetal zoonosis that causes an acute febrile systemic illness in
humans. Leptospira sp. hemolysins have been shown to be virulence factors for
the pathogenesis of leptospirosis. Previously, we cloned a hemolysin SphH of
Leptospira interrogans serovar lai, a homologue of L. borgpetersenii
sphingomyelinase (SphA), from a genomic library (S. H. Lee, K. A. Kim, Y. K.
Kim, I. W. Seong, M. J. Kim, and Y. J. Lee, Gene 254:19-28, 2000). Escherichia
coli lysate harboring the sphH showed high hemolytic activities on sheep
erythrocytes. However, it neither showed sphingomyelinase nor phospholipase
activities, in contrast to SphA which was known to have sphingomyelinase
activity. Interestingly, the SphH-mediated hemolysis on erythrocytes was
osmotically protected by PEG 5000, suggesting that the SphH might have caused
pore formation on the erythrocyte membrane. In the present study, we have
prepared the Leptospira hemolysin SphH and investigated its hemolytic and
cytotoxic activities on mammalian cells. SphH was shown to be a pore-forming
protein on several mammalian cells: When treated with the SphH, the sheep
erythrocyte membranes formed pores, which were morphologically confirmed by
transmission electron microscopy. Furthermore, the SphH-mediated cytotoxicities
on mammalian cells were demonstrated by the release of LDH and by inverted
microscopic examinations. Finally, the immune serum against the full-length
hemolysin could effectively neutralize the SphH-mediated hemolytic and
cytotoxic activities. In conclusion, these results suggest that the virulence
of Leptospira SphH was due to the pore formation on mammalian cell membranes.
4703.
Mehta
M N, Kakkad N H, Gohel D R, Shah JS :
Leptospirosis. Gujarat med J 2000, 57(2), 15-18. No Abstract.
4704.
Ramadass P; Latha D; Senthil kumar A; Srinivasan P; Saranya N.
Arbitrarily primed PCR : a rapid and simple method for typing of leptospiral
serovars Indian Journal of Medical Microbiology 2002 Jan; 20(1): 25-8
ABSTRACT: Purpose : To investigate
the use of arbitrarily primed polymerase chain reaction (AP-PCR) for typing of
leptospiral serovars. Methods : AP-PCR was adopted for identification of
laboratory strains of leptospires and leptospiral cultures at serovar level. A
primer of 12 bp was used for amplifying DNA of 13 laboratory strains of
leptospires as well as culture pellets of leptospires. Results : Each serovar
produced distinct DNA fingerprint which was characteristic for each serovar.
These patterns were used for typing of 81 serum culture samples obtained from
human leptospiral cases. Of these samples, 39 could be typed based on AP-PCR
fingerprints belonging to serovars autumnalis, pomona, canicola, javanica,
icterohaemorrhagiae, patoc and pyrogenes. These results were confirmed by RAPD
fingerprinting of the DNA samples of the respective leptospiral serovars after
culturing them in EMJH media. One of the important findings of this work was
that straight culture sample could be used for AP-PCR assay, without
purification of DNA. By having more number of AP-PCR reference fingerprints,
more serovars could be typed. Conclusions : AP-PCR technique provides great
potential for simple and rapid identification of leptospires at serovar level,
which could be useful in molecular epidemiological studies of leptospirosis.
4705.
Tunbridge
AJ, Dockrell DH, Channer KS, McKendrick MW.
A breathless triathlete. Lancet. 2002 Jan 12;359(9301):130. No Abstract.
Oct 2002
5473.
Abb J. Acute
leptospirosis in a triathlete. Wilderness Environ Med 2002 Spring;13(1):45-7
We report the case of a 38-year-old male
patient with acute leptospirosis. The most probable cause of infection was
repeated and prolonged exposure to contaminated river water (Neckar and Enz
rivers) while preparing for participation in long-distance triathlon (swimming,
biking, and running) competitions.
5474.
Eapen CK,
Sugathan S, Kuriakose M, Abdoel T, Smits HL. Evaluation of the clinical utility
of a rapid blood test for human leptospirosis. Diagn Microbiol Infect Dis 2002 Apr;42(4):221-5
A rapid assay device for the detection of
Leptospira-specific immunoglobulin M (IgM) antibodies was applied on whole
blood samples collected from a group of consecutive patients admitted with
clinical suspicion of leptospirosis to a district hospital in Kerala, India.
The hospital is located in an area that is endemic for leptospirosis. The
results of the rapid assay showed an agreement of 94.3% with those of an IgM
ELISA routinely used for the serodiagnosis of leptospirosis. The rapid assay
was simply performed by the addition of 10 microL blood to the sample well of a
plastic assay device followed by the addition of 130 microL sample fluid. The
assay was read after 10 min by visual inspection and was scored positive when
staining of the antigen line in the test zone was observed. The assay utilizes
stabilised components and can be stored without the need for refrigeration.
These characteristics make the assay ideal in areas where the disease is common
and where laboratory support is not routinely available.
5475.
Haake DA,
Dundoo M, Cader R, Kubak BM, Hartskeerl RA, Sejvar JJ, Ashford DA.
Leptospirosis, water sports, and chemoprophylaxis. Clin Infect Dis 2002 May 1;34(9):e40-3
Recreational activities, such as water
sports and adventure travel, are emerging as an important risk factor for
leptospirosis, a potentially fatal zoonosis. We report the clinical course of 2
patients who acquired leptospirosis through participation in water sports.
Physicians caring for patients who participate in adventure travel involving
water sports should be familiar with the risk factors for and diagnosis,
prevention, and treatment of leptospirosis.
5476.
Rodriguez I,
Alvarez EL, Fernandez C, Miranda A. Comparison of a recombinant-antigen enzyme
immunoassay with Treponema pallidum hemagglutination test for serological
confirmation of syphilis. Mem Inst Oswaldo Cruz 2002 Apr;97(3):347-9 . Abstract: A recombinant-antigen enzyme
immunoassay (EIA), BioSCREEN anti-Treponema pallidum, was compared favorably
with the T. pallidum hemagglutination test, in the detection of specific
antibodies in different groups of sera from patients with primary (n = 38),
secondary (n = 10), early latent (n = 28) and congenital syphilis (n = 2),
patients with leptospirosis ( n= 8), infectious mononucleosis (n = 7),
hepatitis (n = 9), diabetes mellitus (n = 11), rheumatoid arthritis (n = 13),
leprosy (n = 11), tuberculosis (n = 9), HIV/Aids ( n= 12), systemic lupus
erythematosus (n = 4), rheumatic fever (n = 3), old-persons (n = 9), pregnant
women (n = 29) and blood donors (n = 164). The coincidence between them was
95.1%. The sensitivity and specificity of the EIA were 93.3% and 95.5%,
respectively. Fifteen serum specimens belonging to old-persons, pregnant women,
blood donors, and patients with human leptospirosis, hepatitis, diabetes
mellitus, tuberculosis and rheumatic fever gave false-positive results by
Venereal Disease Research Laboratory and/or Rapid Plasma Reagin. The EIA can be
used as alternative method for the serological confirmation of syphilis.
5477.
Senthil
Kumar, Ramadass P, Nachimuthu K. Use of
polymerase chain reaction for the detection of leptospires in clinical samples.
Indian Vet J. 2001; 78(12), 1087-90. Abstract: Usefulness of polymerase chain
reaction (PCR) has been evaluated for rapid diagnosis of leptospirosis in
animals and man. Clinical samples like urine, serum, mastitis milk samples and
cerebrospinal fluid were tested by dark field microscopy (DFM) and polymerase
chain reaction (PCR) assay of Clinical samples is potentially useful, quick and
specific diagnostic method for confirming active infection with leptospires.
5478.
Singh SS,
Vijayachari P, Sinha A, Sugunan AP, Raheed MA, Sehgal SC.
Clinicoepidemiological study of hospitalized cases of severe leptospirosis.
Indian J med Res. 1999; 109(March), 94-9. Abstract: In an attempt to understand the clinical spectrum and
pathological and biochemical abnormalities and their prognostic importance in
leptospirosis, a prospective study was carried out in Port Blair during
September 1996 to August 1997. Out of 80 patients suspected to have
leptospirosis, 58 were proved to have current leptospiral infection using
serological tests and among these, 14 died giving a case fatality rate of 24.1
per cent. The incidence of the disease showed two separate peaks roughly
coinciding with the paddy sowing and harvesting season and the majority of the
patients had history of exposure to wet and water logged environment prior to
the attack of the disease. The disease presented as two separate clinical
syndromes – the hepato-renal form and the pulmonary form though some degree of
overlap was present. Hepatic and renal complications occurred in 30 patients each
with 26 of them having both. These generally occurred late in the course of the
disease and the mortality rate in those patients was very high (6.7% vs 42.9%).
The other complications encountered in the current series of cases were
refractory hypotension probably die to myocarditis in 40 per cent and neck
stiffness and altered sensorium die to central nervous involvement in 12.1 per
cent of the patients. He chances of the patients developing complications were…
5479. Venkatesha MD, Ramadass P. Identification of leptospiral isolates by bacterial restriction endonuclease analysis (BRENDA). Indian J med Microbiol 2001; 19(2): 83-6. DNA samples from 19 references serovars belonging to 19 different serogroups of Leptospira bilexa were examined by bacterial restriction endonuclease analysis using EcoR 1 and Hae III enzymes. All the serovars gave unique restriction patterns that different from each other. DNA from 10 local isolates digested with the standard patterns produced by reference strains could be identified to serovar level.
Pathogenesis:
5480.
Diament D,
Brunialti MK, Romero EC, Kallas EG, Salomao R. Peripheral blood mononuclear
cell activation induced by Leptospira interrogans glycolipoprotein. Infect
Immun 2002 Apr;70(4):1677-83
Leptospira interrogans glycolipoprotein
(GLP) has been implicated in pathological and functional derangement seen in
leptospirosis. The goal of this study was to evaluate GLP's ability to induce
cellular activation, as assessed by cytokine production and expression of
surface activation markers. GLP extracted from either pathogenic L. interrogans
serovar Copenhageni or nonpathogenic Leptospira biflexa serovar Patoc (GLPp)
was used to stimulate peripheral blood mononuclear cell cultures from healthy
donors. Supernatant cytokine levels were measured by enzyme-linked
immunosorbent assay. Expression of CD69 and HLA-DR on lymphocytes and
monocytes, as well as lipopolysaccharide (LPS) binding, were measured by flow
cytometry. At 6 h of incubation, GLP induced a significant rise in tumor necrosis
factor alpha levels, which dropped progressively until 72 h of incubation.
Interleukin-10 peak levels were obtained at between 24 and 48 h, with sustained
levels until 72 h of incubation. The response magnitude was proportional to the
GLP dose. CD69 expression on T lymphocytes and monocytes increased
significantly, as did HLA-DR expression on monocytes. GLPp induced no CD69 or
HLA-DR expression. GLP did not block biotinylated LPS binding to monocytes,
suggesting that different pathways are used to induce cell activation. In
conclusion, GLP induces cellular activation and may play a major role in the
pathogenesis of leptospirosis.
5481.
Morgan J,
Bornstein SL, Karpati AM, Bruce M, Bolin CA, Austin CC, Woods CW, Lingappa J,
Langkop C, Davis B, Graham DR, Proctor M, Ashford DA, Bajani M, Bragg SL, Shutt
K, Perkins BA, Tappero JW;
Leptospirosis Working Group. Outbreak of leptospirosis among triathlon
participants and community residents in Springfield, Illinois, 1998. Clin
Infect Dis 2002 Jun 15;34(12):1593-9.
We investigated an outbreak of
leptospirosis among athletes and community residents after a triathlon was held
in Springfield, Illinois. A telephone survey was conducted to collect clinical
information and data on possible risk factors, community surveillance was
established, and animal specimens and lake water samples were collected to
determine the source of the leptospiral contamination. A total of 834 of 876
triathletes were contacted; 98 (12%) reported being ill. Serum samples obtained
from 474 athletes were tested; 52 of these samples (11%) tested positive for
leptospirosis. Fourteen (6%) of 248 symptomatic community residents tested
positive for leptospirosis. Heavy rains that preceded the triathlon are likely
to have increased leptospiral contamination of Lake Springfield. Among
athletes, ingestion of 1 or more swallows of lake water was a predominant risk
factor for illness. This is the largest outbreak of leptospirosis that has been
reported in the United States. Health care providers and occupational and
recreational users of bodies of freshwater in the United States should be aware
of the risk of contracting leptospirosis, particularly after heavy rains.