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Sample records for diagnose leptospirosis disease

  1. Leptospirosis disease mapping with standardized morbidity ratio and Poisson-Gamma model: An analysis of Leptospirosis disease in Kelantan, Malaysia

    Science.gov (United States)

    Che Awang, Aznida; Azah Samat, Nor

    2017-09-01

    Leptospirosis is a disease caused by the infection of pathogenic species from the genus of Leptospira. Human can be infected by the leptospirosis from direct or indirect exposure to the urine of infected animals. The excretion of urine from the animal host that carries pathogenic Leptospira causes the soil or water to be contaminated. Therefore, people can become infected when they are exposed to contaminated soil and water by cut on the skin as well as open wound. It also can enter the human body by mucous membrane such nose, eyes and mouth, for example by splashing contaminated water or urine into the eyes or swallowing contaminated water or food. Currently, there is no vaccine available for the prevention or treatment of leptospirosis disease but this disease can be treated if it is diagnosed early to avoid any complication. The disease risk mapping is important in a way to control and prevention of disease. Using a good choice of statistical model will produce a good disease risk map. Therefore, the aim of this study is to estimate the relative risk for leptospirosis disease based initially on the most common statistic used in disease mapping called Standardized Morbidity Ratio (SMR) and Poisson-gamma model. This paper begins by providing a review of the SMR method and Poisson-gamma model, which we then applied to leptospirosis data of Kelantan, Malaysia. Both results are displayed and compared using graph, tables and maps. The result shows that the second method Poisson-gamma model produces better relative risk estimates compared to the SMR method. This is because the Poisson-gamma model can overcome the drawback of SMR where the relative risk will become zero when there is no observed leptospirosis case in certain regions. However, the Poisson-gamma model also faced problems where the covariate adjustment for this model is difficult and no possibility for allowing spatial correlation between risks in neighbouring areas. The problems of this model have

  2. A review of human leptospirosis in Malaysia.

    Science.gov (United States)

    El Jalii, I M; Bahaman, A R

    2004-12-01

    This paper reviews the literature on human leptospirosis in Malaysia from its first description in 1925 until the present day. Fletcher diagnosed the first case of human leptospirosis in Malaysia in 1925. Following Fletcher, many investigations on human leptospirosis in Malaysia disclosed a high prevalence of infection. These investigations indicated that the disease was endemic in the country. Examination of 1993 suspected human cases of leptospirosis by Tan indicated 28 % of the cases were positive. In a recent survey, 2190 serum samples from patients with different clinical manifestations in the country disclosed 12.6% were positive for antibodies to leptospires. The risk to leptospiral infection with respect to occupation, location, sex, race and age groups was demonstrated. Both civilians and military personnel were affected. Thirty-seven serovars from thirteen serogroups have been identified in the country. Recent studies on animal leptospirosis showed that the disease was highly endemic in the animal population. It is considered that the majority of leptospirosis cases in humans were due to association of man with animals and disease-infected environment.

  3. Standardized morbidity ratio for leptospirosis mapping in Malaysia

    Science.gov (United States)

    Awang, Aznida Che; Samat, Nor Azah

    2017-05-01

    Leptospirosis is a worldwide zoonotic disease that affects human health in many parts of the world including Malaysia. Leptospirosis is a disease caused by the infection of pathogenic Leptospira genus called Spirochaetes. Leptospirosis can be transmitted directly or indirectly from rats to human. The human infection is usually caused by human contact with urine or tissues of infected animal. This disease can be spread through mucus membrane such as mouth, nose and eyes, ingestion of contaminated food and water and also exposed injured skin to contaminated water or soil. There is still no vaccine currently available for the prevention or treatment of leptospirosis disease but this disease can be treated if it is diagnosed early. Therefore, the aim of this study is to estimate the relative risk for leptospirosis disease based initially on the most common statistic used in the study of disease mapping called Standardized Morbidity Ratio (SMR). We then apply SMR to leptospirosis data obtained in Malaysia. The results show that the states of Melaka have very high risk areas. The states of Kedah, Terengganu and Kelantan are identified as high risk areas. The states of Perak, Perlis, Sabah and Sarawak showed medium risk areas. This is followed by low risk by other states except Pahang, Johor and Labuan with very low risk areas. In conclusion, SMR method is the best method for mapping leptospirosis because by referring to the relative risk maps, the states that deserve closer look and disease prevention can be identified.

  4. Emerging tropical diseases in Australia. Part 1. Leptospirosis

    DEFF Research Database (Denmark)

    Tulsiani, Suhella; Lau, C L; Graham, G C

    2010-01-01

    Human leptospirosis is a zoonotic disease of global importance that causes significant morbidity and mortality, particularly in developing nations. In this review, the history, epidemiology, transmission, clinical presentation and treatment of this disease, and its impact in Australia, are discus......Human leptospirosis is a zoonotic disease of global importance that causes significant morbidity and mortality, particularly in developing nations. In this review, the history, epidemiology, transmission, clinical presentation and treatment of this disease, and its impact in Australia...

  5. Cavernous sinus thrombosis syndrome and brainstem involvement in patient with leptospirosis: Two rare complications of leptospirosis

    Directory of Open Access Journals (Sweden)

    Shahriyar Alian

    2014-01-01

    Full Text Available Leptospirosis is a bacterial disease that is caused by pathogenic spirochetes of the genus Leptospira. It can affect humans and animals. In humans, it can lead to a wide spectrum of symptoms. It is known as the most common zoonosis in the world. The typical presentation of the disease is an acute biphasic febrile illness with or without jaundice. Less common clinical manifestations may result from involvement of different human body systems. In many places, this disease may be under-diagnosed, especially when associated with neurological complications. Moreover, without treatment, leptospirosis can lead to organ damages, and even death. Neurological complications are uncommon and are reported in a few cases. Cavernous sinus thrombosis syndrome and brainstem involvement are rare complications of leptospirosis and are associated with a high mortality risk. To our knowledge, no such cases have been reported in the literature.

  6. Leptospirosis: a globally increasing zoonotic disease.

    LENUS (Irish Health Repository)

    Rock, Clare

    2010-01-01

    A 27-year-old previously healthy man was admitted to the intensive care unit with severe jaundice, dyspnoea with haemoptysis, anaemia, thrombocytopenia and acute renal injury. He had no recent history of foreign travel but had been building a shed in his back garden in Cork, Ireland, for the preceding week. The patient\\'s history, clinical observations, haematological and radiological results were all consistent with icteric leptospirosis or Weil\\'s disease. This was confirmed on serological testing. He completed 7 days intravenous ceftriaxone and made a complete recovery. While endemic in tropical climates, leptospirosis incidence is increasing in temperate climates. Recent cases seen in temperate climates can be severe, particularly with pulmonary manifestations. The report of this case serves to increase awareness of this re-emerging potentially fatal infectious disease.

  7. Leptospirosis in Spanish travelers returning from Chiang Mai: A case series.

    Science.gov (United States)

    Rodriguez-Valero, Natalia; Moriñigo, Helena Moza; Martínez, Miguel J; Peiró, Aida; Oliveira, Ines; Bodro, Marta; Gómez-Junyent, Joan; Gascon, Joaquim; Muñoz, Jose

    Leptospirosis is an important zoonosis worldwide, nevertheless is often poor recognized in non tropical settings. In Thailand is becoming an emerging disease and Chiang Mai could become a popular spot to acquire the disease amongst travelers. We describe three cases of imported leptospirosis undifferentiated fever after travelling to Thailand during the summer of 2015 diagnosed at two Spanish hospitals. Our three patients probably acquired leptospirosis while swimming in freshwater around Chiang Mai, a Thailand's northern region with moderate incidence of leptopirosis. Travelers had normal white blood cell counts and low platelets, suggesting leptospirosis after ruling out other imported diseases such as malaria, dengue or typhoid. As recent findings point out, low platelets and normal white blood cell counts are clinical features that could help the clinician to suspect Leptospirosis infection. It should be always considered as a cause of fever, particularly if travelers come from a tropical country and have had contact with water or flooding, especially during rainy season. Copyright © 2018 Elsevier Ltd. All rights reserved.

  8. An outbreak of leptospirosis among Peruvian military recruits.

    Science.gov (United States)

    Russell, Kevin L; Montiel Gonzalez, Marco A; Watts, Douglas M; Lagos-Figueroa, Roberto C; Chauca, Gloria; Ore, Marianela; Gonzalez, Jose E; Moron, Cecilia; Tesh, Robert B; Vinetz, Joseph M

    2003-07-01

    Acute undifferentiated febrile illnesses are common in tropical developing countries but are difficult to diagnose on clinical grounds alone. Leptospirosis is rarely diagnosed, despite evidence that sporadic cases and epidemics continue to occur worldwide. The purpose of this study was to diagnose an outbreak of acute undifferentiated febrile illness among Peruvian military recruits that developed after a training exercise in the high jungle rainforest of Peru. Of 193 military recruits, 78 developed an acute febrile illness with varied manifestations. Of these, 72 were found to have acute leptospirosis by a microscopic agglutination test (MAT). An enzyme-linked immunosorbent assay using Leptospira biflexa antigen was insensitive for the detection of anti-leptospiral IgM antibodies compared with the MAT (20 of 72, 28%). This outbreak of acute undifferentiated febrile illness among Peruvian military recruits was due to leptospirosis. High clinical suspicion, initiation of preventative measures, and performance of appropriate diagnostic testing is warranted in similar settings to identify, treat, and prevent leptospirosis.

  9. Ovine leptospirosis in Brazil

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    SB Lucheis

    2011-01-01

    Full Text Available Leptospirosis is a zoonosis distributed worldwide, endemic mainly in humid subtropical and tropical countries, with epidemic potential. It affects a range of both wild and domestic animals, including sheep, which transport leptospires in their urine and, therefore, can infect other animals and humans who deal with them. Therefore, leptospirosis is characterized as an occupational zoonosis. In individual herds leptospirosis can cause severe economic loss due to miscarriages and outbreaks of mastitis with a significant reduction of milk production. The disease is caused by Leptospira interrogans, which was reclassified into 13 pathogenic species, and distributed into more than 260 serovars classified into 23 serogroups. The clinical signs of infection may vary depending on the serovar and host. In maintenance hosts, antibody production is generally low; there are relatively mild signs of the disease, and a prolonged carrier state with organisms in the kidneys. In incidental hosts, the disease may be more severe, with high titers of circulating antibodies and a very short or nonexistent renal carrier state. In general, young animals with renal and hepatic failure have more serious infections than adults. Several diseases may produce symptoms similar to those of leptospirosis, so that laboratory confirmation, through microscopic agglutination test, for example, is required. The effectiveness of treatment depends on early diagnosis and appropriate therapy, depending on clinical features, since leptospirosis can develop into chronic liver disease and nephropathy, progressing towards death. Improvements in habitation and sanitary conditions, rodent control, vaccination, isolation and treatment of affected animals are the main measures for the control of leptospirosis.

  10. A global, multi-disciplinary, multi-sectorial initiative to combat leptospirosis: Global Leptospirosis Environmental Action Network (GLEAN).

    Science.gov (United States)

    Durski, Kara N; Jancloes, Michel; Chowdhary, Tej; Bertherat, Eric

    2014-06-05

    Leptospirosis has emerged as a major public health problem in both animals and humans. The true burden of this epidemic and endemic disease is likely to be grossly under-estimated due to the non-specific clinical presentations of the disease and the difficulty of laboratory confirmation. The complexity that surrounds the transmission dynamics, particularly in epidemic situations, requires a coordinated, multi-disciplinary effort. Therefore, the Global Leptospirosis Environmental Action Network (GLEAN) was developed to improve global and local strategies of how to predict, prevent, detect, and intervene in leptospirosis outbreaks in order to prevent and control leptospirosis in high-risk populations.

  11. Risk factors of leptospirosis among febrile hospital admissions in northeastern Malaysia.

    Science.gov (United States)

    Rafizah, A A Noor; Aziah, B D; Azwany, Y N; Imran, M Kamarul; Rusli, A Mohamed; Nazri, S Mohd; Nikman, A Mohd; Nabilah, I; Asma', H Siti; Zahiruddin, W M; Zaliha, I

    2013-01-01

    Leptospirosis is a worldwide zoonotic disease. Risk factors for the disease may vary among countries. This study was conducted to determine the risk factors of leptospirosis among febrile cases. A hospital-based cross-sectional study was conducted among 999 febrile patients admitted to 10 hospitals in northeastern Malaysia, from August 2010 to February 2011. An interviewer-guided proforma sheet on sociodemography, type of occupation and social history data was distributed to all adult patients with fever on admission. Serum sample for leptospirosis was screened by IgM Enzyme-linked Immunosorbent Assay (IgM ELISA) test and confirmed by Microscopic Agglutination Test (MAT). The cut-off point for positive MAT was ≥ 1:400 titer in single acute specimens. Seroprevalence of leptospirosis was 8.4% (95% CI: 6.8, 10.3) (n=84/999) by MAT. Multiple logistic regression analysis showed that the high risk occupation group (OR: 1.95, 95% CI: 1.22, 3.13) (p=0.005) and history of recent recreational activity (OR: 2.36, 95% CI: 1.46, 3.85) (pMalaysia. Identification of high risk occupational group and history of recent recreational activity will help to increase the index of suspicion to diagnose leptospirosis among febrile inpatients due to its mimicking other common febrile illnesses in Malaysia. Copyright © 2013 Elsevier Inc. All rights reserved.

  12. MAT FOR LEPTOSPIROSIS DIAGNOSIS

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    Esti Rahardianingtyas.

    2014-06-01

    Full Text Available Leptospirosis is a disease caused by bacterial infection leptospira interrogans.Leptospira bacteria is a spiral bacterium with solid strands with two flagella periplasmik.Septicaemic phase patient samples taken from the blood and cerebrospinal fluid, whereassamples taken at phase immune extracted from urine. The diagnosis of leptospirosis occurdirectly or indirectly. Diagnosis is done by directly isolate and identify the causative agents ofthe agent. Diagnosis is done indirectly by detecting specific antibodies from the patient's body.Gold Standard of the diagnosis of leptospirosis is MAT. Mat made by reacting antibodies toleptospira antigen. Positive results seen with clump formed.Key words: Leptospirosis, Leptospirosis Diagnostic, MAT (Microscopic Agglutination Test Leptospirosis merupakan penyakit yang disebabkan karena infeksi bakteri leptospirainterrogans. Bakteri leptospira merupakan bakteri spiral dengan untaian yang padat dengan duaflagella periplasmik. Sampel pasien pada fase septicaemic diambil dari darah dan cairanserebrospinal, sedangkan sampel yang diambil pada fase immune diambil dari urine. Diagnosisleptospirosis dilakukan secara langsung maupun tidak langsung. Diagnosis secara langsungdilakukan dengan cara mengisolasi agen penyebab dan mengidentifikasi agen tersebut. Diagnosissecara tidak langsung dilakukan dengan cara mendeteksi antibodi spesiflk dari dalam tubuhpasien. Gold Standart dari diagnosis leptospirosis adalah MAT. Mat dilakukan dengan caramereaksikan antibodi dengan antigen leptospira. Hasil positif dilihat dengan terbentuk gumpalanagglutinasiKata kunci: Leptospirosis, Leptospira, Leptospirosis Diagnosis.

  13. Increasing Incidence of Canine Leptospirosis in Switzerland

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    Andrea Major

    2014-07-01

    Full Text Available A marked increase in canine leptospirosis was observed in Switzerland over 10 years with a peak incidence of 28.1 diagnosed cases/100,000 dogs/year in the most affected canton. With 95% affected dogs living at altitudes <800 m, the disease presented a seasonal pattern associated with temperature (r2 0.73 and rainfall (r2 0.39, >90% cases being diagnosed between May and October. The increasing yearly incidence however was only weakly correlated with climatic data including number of summer (r2 0.25 or rainy days (r2 0.38. Serovars Australis and Bratislava showed the highest seropositivity rates with 70.5% and 69.1%, respectively. Main clinical manifestations included renal (99.6%, pulmonary (76.7%, hepatic (26.0%, and hemorrhagic syndromes (18.2%, leading to a high mortality rate (43.3%. Similar to the human disease, liver involvement had the strongest association with negative outcome (OR 16.3. Based on these data, canine leptospirosis presents similar features and severity as the human infection for which it therefore can be considered a model. Its re-emergence in a temperate country with very high incidence rates in canines should thus be viewed as a warning and emphasize the need for increased awareness in other species.

  14. Leptospirosis among Hospitalized Febrile Patients in Northern Tanzania

    Science.gov (United States)

    Biggs, Holly M.; Bui, Duy M.; Galloway, Renee L.; Stoddard, Robyn A.; Shadomy, Sean V.; Morrissey, Anne B.; Bartlett, John A.; Onyango, Jecinta J.; Maro, Venance P.; Kinabo, Grace D.; Saganda, Wilbrod; Crump, John A.

    2011-01-01

    We enrolled consecutive febrile admissions to two hospitals in Moshi, Tanzania. Confirmed leptospirosis was defined as a ≥ 4-fold increase in microscopic agglutination test (MAT) titer; probable leptospirosis as reciprocal MAT titer ≥ 800; and exposure to pathogenic leptospires as titer ≥ 100. Among 870 patients enrolled in the study, 453 (52.1%) had paired sera available, and 40 (8.8%) of these met the definition for confirmed leptospirosis. Of 832 patients with ≥ 1 serum sample available, 30 (3.6%) had probable leptospirosis and an additional 277 (33.3%) had evidence of exposure to pathogenic leptospires. Among those with leptospirosis the most common clinical diagnoses were malaria in 31 (44.3%) and pneumonia in 18 (25.7%). Leptospirosis was associated with living in a rural area (odds ratio [OR] 3.4, P < 0.001). Among those with confirmed leptospirosis, the predominant reactive serogroups were Mini and Australis. Leptospirosis is a major yet underdiagnosed cause of febrile illness in northern Tanzania, where it appears to be endemic. PMID:21813847

  15. Environmental risk of leptospirosis infections in the Netherlands: Spatial modelling of environmental risk factors of leptospirosis in the Netherlands.

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    Ente J J Rood

    Full Text Available Leptospirosis is a globally emerging zoonotic disease, associated with various climatic, biotic and abiotic factors. Mapping and quantifying geographical variations in the occurrence of leptospirosis and the surrounding environment offer innovative methods to study disease transmission and to identify associations between the disease and the environment. This study aims to investigate geographic variations in leptospirosis incidence in the Netherlands and to identify associations with environmental factors driving the emergence of the disease. Individual case data derived over the period 1995-2012 in the Netherlands were geocoded and aggregated by municipality. Environmental covariate data were extracted for each municipality and stored in a spatial database. Spatial clusters were identified using kernel density estimations and quantified using local autocorrelation statistics. Associations between the incidence of leptospirosis and the local environment were determined using Simultaneous Autoregressive Models (SAR explicitly modelling spatial dependence of the model residuals. Leptospirosis incidence rates were found to be spatially clustered, showing a marked spatial pattern. Fitting a spatial autoregressive model significantly improved model fit and revealed significant association between leptospirosis and the coverage of arable land, built up area, grassland and sabulous clay soils. The incidence of leptospirosis in the Netherlands could effectively be modelled using a combination of soil and land-use variables accounting for spatial dependence of incidence rates per municipality. The resulting spatially explicit risk predictions provide an important source of information which will benefit clinical awareness on potential leptospirosis infections in endemic areas.

  16. Leptospirosis

    Science.gov (United States)

    ... It occurs when you come in contact with leptospira bacteria. ... Haake DA, Levett PN. Leptospira species (leptospirosis). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, ...

  17. Approximate analytical modeling of leptospirosis infection

    Science.gov (United States)

    Ismail, Nur Atikah; Azmi, Amirah; Yusof, Fauzi Mohamed; Ismail, Ahmad Izani

    2017-11-01

    Leptospirosis is an infectious disease carried by rodents which can cause death in humans. The disease spreads directly through contact with feces, urine or through bites of infected rodents and indirectly via water contaminated with urine and droppings from them. Significant increase in the number of leptospirosis cases in Malaysia caused by the recent severe floods were recorded during heavy rainfall season. Therefore, to understand the dynamics of leptospirosis infection, a mathematical model based on fractional differential equations have been developed and analyzed. In this paper an approximate analytical method, the multi-step Laplace Adomian decomposition method, has been used to conduct numerical simulations so as to gain insight on the spread of leptospirosis infection.

  18. Seasonality of human leptospirosis in Reunion Island (Indian Ocean and its association with meteorological data.

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    Amélie Desvars

    Full Text Available BACKGROUND: Leptospirosis is a disease which occurs worldwide but particularly affects tropical areas. Transmission of the disease is dependent on its excretion by reservoir animals and the presence of moist environment which allows the survival of the bacteria. METHODS AND FINDINGS: A retrospective study was undertaken to describe seasonal patterns of human leptospirosis cases reported by the Centre National de Références des Leptospiroses (CNRL, Pasteur Institute, Paris between 1998 and 2008, to determine if there was an association between the occurrence of diagnosed cases and rainfall, temperature and global solar radiation (GSR. Meteorological data were recorded in the town of Saint-Benoît (Météo France "Beaufonds-Miria" station, located on the windward (East coast. Time-series analysis was used to identify the variables that best described and predicted the occurrence of cases of leptospirosis on the island. Six hundred and thirteen cases were reported during the 11-year study period, and 359 cases (58.56% were diagnosed between February and May. A significant correlation was identified between the number of cases in a given month and the associated cumulated rainfall as well as the mean monthly temperature recorded 2 months prior to diagnosis (r = 0.28 and r = 0.23 respectively. The predictive model includes the number of cases of leptospirosis recorded 1 month prior to diagnosis (b = 0.193, the cumulated monthly rainfall recorded 2 months prior to diagnosis (b = 0.145, the average monthly temperature recorded 0 month prior to diagnosis (b = 3.836, and the average monthly GSR recorded 0 month prior to diagnosis (b = -1.293. CONCLUSIONS: Leptospirosis has a seasonal distribution in Reunion Island. Meteorological data can be used to predict the occurrence of the disease and our statistical model can help to implement seasonal prevention measures.

  19. Leptospirosis in New Orleans.

    Science.gov (United States)

    Toliver, Herman L; Krane, N Kevin

    2014-02-01

    Leptospirosis is an unusual but reemerging zoonotic infectious disease in the United States where the diagnosis may not be suspected when patients initially present. The case report of a patient from New Orleans who presented with jaundice, hypotension and acute kidney injury is presented. In this patient, a broad differential diagnosis was considered on presentation and serologic testing for leptospirosis eventually confirmed the diagnosis. A review of the clinical manifestations, diagnostic studies and treatment are discussed so that leptospirosis will be considered more carefully in the initial evaluation and management of similar patients.

  20. Pulmonary manifestations of leptospirosis

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    Sameer Gulati

    2012-01-01

    Full Text Available Leptospirosis has a spectrum of presentation which ranges from mild disease to a severe form comprising of jaundice and renal failure. Involvement of the lung can vary from subtle clinical features to deadly pulmonary hemorrhage and acute respiratory distress syndrome. Of late, it has been identified that leptospirosis can present atypically with predominant pulmonary manifestations. This can delay diagnosis making and hence optimum treatment. The purpose of this review is to bring together all the reported pulmonary manifestations of leptospirosis and the recent trends in the management.

  1. Globalization of leptospirosis through travel and migration.

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    Bandara, Medhani; Ananda, Mahesha; Wickramage, Kolitha; Berger, Elisabeth; Agampodi, Suneth

    2014-08-12

    Leptospirosis remains the most widespread zoonotic disease in the world, commonly found in tropical or temperate climates. While previous studies have offered insight into intra-national and intra-regional transmission, few have analyzed transmission across international borders. Our review aimed at examining the impact of human travel and migration on the re-emergence of Leptospirosis. Results suggest that alongside regional environmental and occupational exposure, international travel now constitute a major independent risk factor for disease acquisition. Contribution of travel associated leptospirosis to total caseload is as high as 41.7% in some countries. In countries where longitudinal data is available, a clear increase of proportion of travel-associated leptospirosis over the time is noted. Reporting patterns is clearly showing a gross underestimation of this disease due to lack of diagnostic facilities. The rise in global travel and eco-tourism has led to dramatic changes in the epidemiology of Leptospirosis. We explore the obstacles to prevention, screening and diagnosis of Leptopirosis in health systems of endemic countries and of the returning migrant or traveler. We highlight the need for developing guidelines and preventive strategies of Leptospirosis related to travel and migration, including enhancing awareness of the disease among health professionals in high-income countries.

  2. Pulmonary hemorrhage resulting from leptospirosis

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    Mauro Razuk Filho

    2016-07-01

    Full Text Available Leptospirosis is one of the most widespread zoonoses in the world, although the mechanisms responsible for the pathogenesis of spirochetes of the genus Leptospira are largely unknown. Human infection occurs either by direct contact with infected animals or indirectly, through contact with water or soil contaminated with urine, as the spirochetes easily penetrate human skin. The present report exposes the case of a female patient, diagnosed with leptospirosis after having had contact with a dog infected by Leptospira sp. that developed pulmonary hemorrhage, acute respiratory distress syndrome and acute renal failure.

  3. Kejadian Leptospirosis pada Anjing di Daerah Istimewa Yogyakarta (CASE OF CANINE LEPTOSPIROSIS IN THE CITY OF YOGYAKARTA

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    Guntari Titik Mulyani

    2017-09-01

    Full Text Available Leptospirosis is a zoonotic disease, which is caused by Leptospira interrogans. The incidence of leptospirosis in dogs varies according to region and season, and is considered as emerging infectious diseases in humans. Clinical symptoms of leptospirosis in dogs vary greatly, some dogs are asymptomatic, with mild symptoms, and others progress to severe illness until death. The study aims to determine cases of canine leptospirosis in Yogyakarta, and identify the serovar that infect them. A total of 20 dogs without symptoms, with mild symptoms, to severe symptoms of leptospirosis were collected their serum and further tested using Microscopic Agglutination Test (MAT conducted at the Center for Veterinary Research (BBLitvet Bogor. History of vaccination is recorded as a consideration in interpreting the MAT results. The results showed that three out of the 20 samples were positive leptospirosis. Of the three positive samples, one was identified as serovar bataviae, another one as serovar bataviae and tarrasovi, and the last as serovar bataviae, tarrasovi, ichterohaemorrhagiae, canicola, celledoni, pyrogenes, cynopteri, and rachmati, respectively. The three dogs with leptospirosis showed similar clinical symptoms i.e. Anorexia, lethargy, and fever. It can be concluded that there are cases of canine leptospirosis in Yogyakarta which is predominantly caused by Leptospira interrogans serovar bataviae. ABSTRAK Leptospirosis adalah penyakit zoonosis, yang disebabkan oleh Leptospira interrogans. Kejadian leptospirosis pada anjing bervariasi menurut wilayah dan musim, dan dianggap sebagai penyakit menular yang muncul pada manusia. Gejala klinis leptospirosis pada anjing sangat bervariasi, beberapa anjing tanpa menunjukkan gejala, dengan gejala ringan, dan yang lain melanjut menjadi penyakit yang parah sampai kematian. Penelitian ini bertujuan untuk mengetahui kasus leptospirosis pada anjing di Propinsi Daerah Istimewa Yogyakarta, dan mengidentifikasi

  4. Analisis Karakteristik Lingkungan Pada Kejadian Leptospirosis di Kabupaten Demak Jawa Tengah Tahun 2009

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    Bina Ikawati

    2015-11-01

    Full Text Available ABSTRACT Background: Leptospirosis is a zoonosis disease caused by Leptospira bacteria and transmitted to human by contact with contaminated animal urin or contaminated environment. Leptospirosis cases in Demak district increased for 4 year later. Until April 15th 2008, there were 62 leptospirosis cases with CFR=9,67%. The aim of this research was to determine environmental characteristic related to leptospirosis incidence in Demak district. Method: It was an observational research using a case control design with 44 cases and 44 controls. Cases were leptospirosis diagnosed by leptotek dri dot in Demak Health District Agency. Controls were neighbour of leptospirosis cases who didn’t have clinically symptom of leptospirosis, with age and sex appropiate to inclusion criteria. Laboratory diagnosis with leptotek dri dot had done for controls who agreed to sign inform consent. Data were analyzed using chi square test at α=5%. Variable with p value<0,25 would be continued with multivariat test using Regressi Logistic - Backward Likehood Ratio method. Result: The result of this research showed that there were 10 controls with no clinical diagnosis but positive at leptotek dri dot diagnosis. At statistical analysis 10 cases and 10 controls dropped. Univariat analysis showed controls and cases have environmental risk factor and knowledge, attitude, practice about leptospirosis similarly. Bivariat analysis showed there was no relationship between environmental characteristic and knowledge, attitude, practice with leptospirosis. Test of  water sample had been done at 8 location. One of them of creek showed positif contain Leptospira sp. Rat trapped had been done at four location, showed trap succes about 8,7%-29,8%. Eventhough environment factor and knowledge, attitude, practice showed there were no but water from ditch that positif Leptospira sp, significant association and highly succes at rat trapped were concidered to be the risk of  leptospirosis

  5. Diagnostic approach in leptospirosis patients

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    Sembiring, E.

    2018-03-01

    Leptospirosis is as a worldwide zoonotic disease, spread by pathogenic species of the bacterial genus Leptospira that occurs most commonly in tropical and subtropical regions which are one of endemic diseases in some places in Indonesia. The leptospira serovars are naturally carried in the renal tubules of rodents, wild and domestic animals. Human can be infected either through direct contact with urine of infected animals or indirect contact through with contaminated water and soil. Clinical manifestation is highly variable. The most cases are with a mild flu-like illness which may mimic many other diseases. Weil’s disease is the name given to severe illness and is characterized by a severe febrile illness with bleeding, jaundice and renal failure with high mortality rate. Leptospirosis has been frequently underdiagnosed and underreported. The diagnosis of leptospirosis is difficult to confirm and laboratory test is rarely available even in endemic areas.

  6. Autochthonous leptospirosis in South-East Austria, 2004-2012.

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    Hoenigl, Martin; Wallner, Carina; Allerberger, Franz; Schmoll, Friedrich; Seeber, Katharina; Wagner, Jasmin; Valentin, Thomas; Zollner-Schwetz, Ines; Flick, Holger; Krause, Robert

    2014-01-01

    Leptospirosis is one of the world's mostly spread zoonoses causing acute fever. Over years, leptospirosis has been reported to occur rarely in Austria and Germany (annual incidence of 0.06/100,000 in Germany). Only imported cases have been on the increase. Objectives of this case-series study were to retrospectively assess epidemiologic and clinical characteristics of leptospirosis illnesses in South-East Austria, to describe risk exposures for autochthonous infections, and to compare patients with imported versus autochthonous infection. During the 9-year period between 2004 and 2012, 127 adult patients (49 females, 78 males) who tested positive by rapid point-of-care test for Leptospira-specific IgM (Leptocheck®) were identified through electronic hospital databases. Follow-up telephone interviews were conducted with 82 patients. A total of 114 (89.8%) of the 127 patients enrolled had acquired leptospirosis within Austria and 13 (10.2%) had potentially imported infections. Most autochthonous cases were diagnosed during the months of June and July, whereas fewest were diagnosed during the winter months. Exposure to rodents, recreational activities in woods or wet areas, gardening, cleaning of basements or huts were the most common risk exposures found in autochthonous infection. Serogroups Australis (n = 23), Sejroe (n = 22), and Icterohaemorrhagiae (n = 11) were identified most frequently by MAT testing in autochthonous infections. Patients with imported leptospirosis were significantly younger, less likely to be icteric and had significantly lower liver transaminase levels (p = 0.004) than those with autochthonous infections. Leptospirosis is endemic in South-East Austria. In contrast to reports from other countries we found a relatively high proportion of leptospirosis cases to be female (39% vs. ∼ 10%), likely the result of differing risk exposures for South-East Austria.

  7. Zoonotic occupational diseases in forestry workers – Lyme borreliosis, tularemia and leptospirosis in Europe

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    Stéphanie Richard

    2015-02-01

    Full Text Available [b]Introduction[/b]. Forestry workers and other people who come into close contact with wild animals, such as hunters, natural science researchers, game managers or mushroom/berry pickers, are at risk of contracting bacterial, parasitological or viral zoonotic diseases. Synthetic data on the incidence and prevalence of zoonotic diseases in both animals and humans in European forests do not exist. It is therefore difficult to promote appropriate preventive measures among workers or people who come into direct or indirect contact with forest animals. [b]Objectives.[/b] The objectives of this review are to synthesise existing knowledge on the prevalence of the three predominant bacterial zoonotic diseases in Europe, i.e. Lyme borreliosis, tularemia and leptospirosis, in order to draw up recommendations for occupational or public health. [b]Methods[/b]. 88 papers published between 1995–2013 (33 on Lyme borreliosis, 30 on tularemia and 25 on leptospirosis were analyzed. [b]Conclusions[/b]. The prevalences of these three zoonotic diseases are not negligible and information targeting the public is needed. Moreover, the results highlight the lack of standardised surveys among different European countries. It was also noted that epidemiological data on leptospirosis are very scarce

  8. Leptospirosis; AND#8220;Fever Aftermath of DelugeAND#8221;

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    Ahmet Karakas

    2010-12-01

    Full Text Available Flooding provides an opportunity for epidemics of waterborne viral, protozoan, or bacterial diseases to develop in affected areas. May be, the only epidemic-prone infection which can be transmitted directly from contaminated water is leptospirosis, a zoonotic bacterial disease. Leptospirosis is commonly founded in bodies of water, moist soil, or vegetation contaminated by the urine or tissues of infected animals. Outbreaks of leptospirosis have occurred many times following flood events in different part of the world especially in India, Latin America and South-East Asia. Leptospirosis should be kept in mind of health workers and local administrators in every where even also developed regios and countries especially during the water associated nature events. Many of the leptospirosis symptoms can be mistaken for other epidemic prone diseases. So, spesific laboratuary methods are needed for accurate diagnosis. Both of medical facilities and medical personnels might be affected by natural disasters. Beyond of these, reason of a lot of leptospirosis cases and other water based contagious diseases, running of the complicated and time consuming or expensive tests could be impossible. So, preferring of the rapid tests like slide agglutination test or urine dipstick tests for leptospirosis diagnosis could be reasonable. Concisely, due to Leptospirosis is a water-borne disease and can often be overlooked, it should be kept in mind especially for patients presenting with fever and multi-organ involvement just after natural disasters like tsunami, land sliding, flooding, sudden or heavy reains. This fact is extremely important nowadays and in the future, because of ingreasingly aggravated global climatic change. [TAF Prev Med Bull 2010; 9(6.000: 651-654

  9. Towards the burden of human leptospirosis: duration of acute illness and occurrence of post-leptospirosis symptoms of patients in the Netherlands.

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    Marga G A Goris

    Full Text Available BACKGROUND: Leptospirosis is a global zoonotic disease. Although important for the assessment of the burden of leptospirosis, data on the duration of the illness and the occurrence of post-leptospirosis complaints are not well documented. Hence the main objective of this study was to estimate the occurrence of persistent complaints and duration of hospital stay in laboratory confirmed leptospirosis patients in the Netherlands during 1985 to 2010. Additionally, several risk factors potentially impacting on the occurrence of post-leptospirosis complaints were investigated. METHODS/PRINCIPAL FINDINGS: The duration of the acute phase of leptospirosis was 16 days (IQR 12-23; 10 days (IQR 7-16 were spent hospitalized. Eighteen fatal cases were excluded from this analysis. Complaints of leptospirosis patients by passive case investigations (CPC derived from files on ambulant consultations occurring one month after hospital discharge, revealed persistent complaints in 108 of 236 (45.8% laboratory confirmed cases. Data on persistent complaints after acute leptospirosis (PCAC, assessed in 225 laboratory confirmed leptospirosis cases collected through questionnaires during 1985-1993, indicated 68 (30.2% PCAC cases. Frequently reported complaints included (extreme fatigue, myalgia, malaise, headache, and a weak physical condition. These complaints prolonged in 21.1% of the cases beyond 24 months after onset of disease. There was no association between post-leptospirosis complaints and hospitalization. However, individuals admitted at the intensive care unit (ICU were twice as likely to have continuing complaints after discharge adjusting for age and dialysis (OR 2.0 95% CI 0.8-4.8. No significant association could be found between prolongation of complaints and infecting serogroup, although subgroup analysis suggest that infection with serogroups Sejroe (OR 4.8, 95%CI 0.9-27.0 and icterohaemorrhagiae (OR 2.0, 95%CI 0.9-4.3 CI are more likely to result in

  10. Leptospirosis in sheep and goats under tropical conditions.

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    Martins, Gabriel; Lilenbaum, Walter

    2014-01-01

    Inadequate management practices and poor reproductive performance have been reported as fundamental factors on reducing the levels of productivity in livestock. Different pathogens have been reported in small ruminants' herds/flocks with reproductive failures. The aim of the present study was to review aspects of leptospirosis in small ruminants, mainly its impact on reproduction and consequently on productivity of the herds/flocks under tropical conditions. Leptospiral infection in goats and sheep is common in several countries, and those species can also act as carriers of leptospires. Severe disease is often associated to young animals and is frequently associated to incidental serovars. In contrast, subclinical infection is mainly characterized by reproductive problems, such as infertility, abortion, occurrence of stillbirths, and weak lambs/goat kids. Moreover, laboratorial tests are essential to achieve an accurate diagnosis of the infection. Microscopic agglutination test is the most common indirect test of leptospirosis, being used worldwide. In small ruminants, PCR consists on a recommendable method for diagnosing animals that carry leptospires. Control of leptospirosis in small ruminants involves measures such as the identification and treatment of the carriers and other sources of infection, quarantine in acquired animals, and systematic immunization with commercial vaccines containing the circulating serovars in the herd/flock. Productivity of small ruminant breeding can dramatically increase with adequate sanitary conditions and control of leptospirosis. Immunization of all the animals combined to the treatment of carriers may successfully control the infection and importantly reduce the economic reproductive hazards that are observed under tropical conditions.

  11. Studying risk factors associated with Human Leptospirosis

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    Ramachandra Kamath

    2014-01-01

    Full Text Available Background: Leptospirosis is one of the most under diagnosed and underreported disease in both developed and developing countries including India. It is established that environmental conditions and occupational habit of the individuals put them at risk of acquiring disease, which varies from community to community. Various seroprevalence studies across the world have documented emerging situation of this neglected tropical disease, but limited have probed to identify the risk factors, especially in India. Objectives: The objective of this study was to identify the environmental and occupational risk factors associated with the disease in Udupi District. Materials and Methods: This population-based case-control study was carried out in Udupi, a District in Southern India from April 2012 until August 2012. Udupi is considered to be endemic for Leptospirosis and reported 116 confirmed cases in the year 2011. Seventy of 116 laboratory confirmed cases and 140 sex matched neighborhood healthy controls participated in the study. A predesigned, semi-structured and validated questionnaire was used for data collection through house to house visit and observations were noted about environmental conditions. Univariate analysis followed by multivariate analysis (back ward conditional logistic regression was performed by using STATA version 9.2 (StataCorp, College Station, TX, USA to identify potential risk factors. Results: Occupational factors such as outdoor activities (matched odds ratio [OR] of 3.95, 95% confidence interval [CI]: 1.19-13.0, presence of cut or wound at body parts during work (matched OR: 4.88, CI: 1.83-13.02 and environmental factors such as contact with rodents through using the food materials ate by rat (matched OR: 4.29, CI: 1.45-12.73 and contact with soil or water contaminated with urine of rat (matched OR: 4.58, CI: 1.43-14.67 were the risk factors identified to be associated with disease. Conclusion: Leptospirosis is still

  12. Leptospirosis in dogs and cats: epidemiology, clinical disease, zoonotic implications and prevention

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    Azocar-Aedo, L.; Smits, H. L.; Monti, G.

    2014-01-01

    Leptospirosis is a zoonotic disease of worldwide distribution caused by spirochetes of the genus Leptospira. The genus includes a large number of serovars that may be sheed in the urine of infected animals creating a highly infectious source of transmission. Numerous species of wild and domestic

  13. Cathelicidin Insufficiency in Patients with Fatal Leptospirosis.

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    Lindow, Janet C; Wunder, Elsio A; Popper, Stephen J; Min, Jin-Na; Mannam, Praveen; Srivastava, Anup; Yao, Yi; Hacker, Kathryn P; Raddassi, Khadir; Lee, Patty J; Montgomery, Ruth R; Shaw, Albert C; Hagan, Jose E; Araújo, Guilherme C; Nery, Nivison; Relman, David A; Kim, Charles C; Reis, Mitermayer G; Ko, Albert I

    2016-11-01

    Leptospirosis causes significant morbidity and mortality worldwide; however, the role of the host immune response in disease progression and high case fatality (>10-50%) is poorly understood. We conducted a multi-parameter investigation of patients with acute leptospirosis to identify mechanisms associated with case fatality. Whole blood transcriptional profiling of 16 hospitalized Brazilian patients with acute leptospirosis (13 survivors, 3 deceased) revealed fatal cases had lower expression of the antimicrobial peptide, cathelicidin, and chemokines, but more abundant pro-inflammatory cytokine receptors. In contrast, survivors generated strong adaptive immune signatures, including transcripts relevant to antigen presentation and immunoglobulin production. In an independent cohort (23 survivors, 22 deceased), fatal cases had higher bacterial loads (P = 0.0004) and lower anti-Leptospira antibody titers (P = 0.02) at the time of hospitalization, independent of the duration of illness. Low serum cathelicidin and RANTES levels during acute illness were independent risk factors for higher bacterial loads (P = 0.005) and death (P = 0.04), respectively. To investigate the mechanism of cathelicidin in patients surviving acute disease, we administered LL-37, the active peptide of cathelicidin, in a hamster model of lethal leptospirosis and found it significantly decreased bacterial loads and increased survival. Our findings indicate that the host immune response plays a central role in severe leptospirosis disease progression. While drawn from a limited study size, significant conclusions include that poor clinical outcomes are associated with high systemic bacterial loads, and a decreased antibody response. Furthermore, our data identified a key role for the antimicrobial peptide, cathelicidin, in mounting an effective bactericidal response against the pathogen, which represents a valuable new therapeutic approach for leptospirosis.

  14. Cathelicidin Insufficiency in Patients with Fatal Leptospirosis.

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    Janet C Lindow

    2016-11-01

    Full Text Available Leptospirosis causes significant morbidity and mortality worldwide; however, the role of the host immune response in disease progression and high case fatality (>10-50% is poorly understood. We conducted a multi-parameter investigation of patients with acute leptospirosis to identify mechanisms associated with case fatality. Whole blood transcriptional profiling of 16 hospitalized Brazilian patients with acute leptospirosis (13 survivors, 3 deceased revealed fatal cases had lower expression of the antimicrobial peptide, cathelicidin, and chemokines, but more abundant pro-inflammatory cytokine receptors. In contrast, survivors generated strong adaptive immune signatures, including transcripts relevant to antigen presentation and immunoglobulin production. In an independent cohort (23 survivors, 22 deceased, fatal cases had higher bacterial loads (P = 0.0004 and lower anti-Leptospira antibody titers (P = 0.02 at the time of hospitalization, independent of the duration of illness. Low serum cathelicidin and RANTES levels during acute illness were independent risk factors for higher bacterial loads (P = 0.005 and death (P = 0.04, respectively. To investigate the mechanism of cathelicidin in patients surviving acute disease, we administered LL-37, the active peptide of cathelicidin, in a hamster model of lethal leptospirosis and found it significantly decreased bacterial loads and increased survival. Our findings indicate that the host immune response plays a central role in severe leptospirosis disease progression. While drawn from a limited study size, significant conclusions include that poor clinical outcomes are associated with high systemic bacterial loads, and a decreased antibody response. Furthermore, our data identified a key role for the antimicrobial peptide, cathelicidin, in mounting an effective bactericidal response against the pathogen, which represents a valuable new therapeutic approach for leptospirosis.

  15. Clinical predictors of dengue fever co-infected with leptospirosis among patients admitted for dengue fever - a pilot study.

    Science.gov (United States)

    Suppiah, Jeyanthi; Chan, Shie-Yien; Ng, Min-Wern; Khaw, Yam-Sim; Ching, Siew-Mooi; Mat-Nor, Lailatul Akmar; Ahmad-Najimudin, Naematul Ain; Chee, Hui-Yee

    2017-06-28

    Dengue and leptospirosis infections are currently two major endemics in Malaysia. Owing to the overlapping clinical symptoms between both the diseases, frequent misdiagnosis and confusion of treatment occurs. As a solution, the present work initiated a pilot study to investigate the incidence related to co-infection of leptospirosis among dengue patients. This enables the identification of more parameters to predict the occurrence of co-infection. Two hundred sixty eight serum specimens collected from patients that were diagnosed for dengue fever were confirmed for dengue virus serotyping by real-time polymerase chain reaction. Clinical, laboratory and demographic data were extracted from the hospital database to identify patients with confirmed leptospirosis infection among the dengue patients. Thus, frequency of co-infection was calculated and association of the dataset with dengue-leptospirosis co-infection was statistically determined. The frequency of dengue co-infection with leptospirosis was 4.1%. Male has higher preponderance of developing the co-infection and end result of shock as clinical symptom is more likely present among co-infected cases. It is also noteworthy that, DENV 1 is the common dengue serotype among all cases identified as dengue-leptospirosis co-infection in this study. The increasing incidence of leptospirosis among dengue infected patients has posed the need to precisely identify the presence of co-infection for the betterment of treatment without mistakenly ruling out either one of them. Thus, anticipating the possible clinical symptoms and laboratory results of dengue-leptospirosis co-infection is essential.

  16. Unusual clinical manifestations of leptospirosis

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    Bal A

    2005-01-01

    Full Text Available Leptospirosis has protean clinical manifestations. The classical presentation of the disease is an acute biphasic febrile illness with or without jaundice. Unusual clinical manifestations may result from involvement of pulmonary, cardiovascular, neural, gastrointestinal, ocular and other systems. Immunological phenomena secondary to antigenic mimicry may also be an important component of many clinical features and may be responsible for reactive arthritis. Leptospirosis in early pregnancy may lead to fetal loss. There are a few reports of leptospirosis in HIV- infected individuals but no generalisation can be made due to paucity of data. It is important to bear in mind that leptospiral illness may be a significant component in cases of dual infections or in simultaneous infections with more than two pathogens.

  17. LEPTOSPIROSIS PADA MANUSIA DI KABUPATEN BANYUMAS, PROVINSI JAWA TENGAH

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    Bina Ikawati

    2013-09-01

    Full Text Available ABSTRACT. Leptospirosis is one of infected diseases that caused by bacteria pathogen called Leptospira Sp,transmitted direct or indirect from infected animal to human, also known as zoonotic deseases. Indonesia includein middle category for leptospirosis incidence with 1-10 per 100.000 population.Leptospirosis in Central Java at2011 reported in Demak, Purworejo, Klaten, Pati, Wonogiri, Cilacap, Jepara District, Semarang District andSemarang City. Clinical leptospirosis in Banyumas District found but underreported. Aimed of this research wasto confirm leptospirosis at human in Banyumas district. Cross sectional design by case screening in 3 hospital and2 Primary Health Care at Juni-November 2012. Sera from patient examine by leptotec IgG IgM and MAT(Microscopic Aglutination Test, risk factor tracer had been done in patient from Banyumas. As much 25 clinicalleptospirosis examinated with laboratory test showed 6 serra positive by leptotec IgG IgM and with MAT(Microscopic Aglutination Test. MAT test showed 4 sera clinical leptospirosis that reactive with Leptospira Spand 1 negative but reactive at low titre 1:80. Risk factor of leptospirosis was flood and poor housing, bad hygienesanitation, bad waste management. Leptospirosis case confirmed in BanyumasKey words: leptospirosis, Banyumas

  18. The Jarisch-Herxheimer reaction in leptospirosis: a systematic review.

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    Gilles Guerrier

    Full Text Available BACKGROUND: Leptospirosis is an endemo-epidemic zoonotic disease associated with potentially fatal renal, cardiovascular or pulmonary failure. Recommended treatment includes antibiotics, which may induce a Jarisch-Herxheimer reaction (JHR. Since little information on the importance of this adverse event is available, we performed this review to quantify frequency and impact of JHR in leptospirosis management. METHODOLOGY/PRINCIPAL FINDINGS: This review systematically summarizes the literature on the JHR in leptospirosis. To approach the broader aspects of the subject, articles considering the treatment of leptospirosis, national leptospirosis guidelines and textbook and technical reports of the World Health Organisation were reviewed. Publications describing JHR in leptospirosis are very limited and consist mainly of single case reports and small case series. A single randomized control trial specifically assessed the JHR occurrence, but it has never been systematically investigated in large trials. Not all guidelines and not all literature on leptospirosis mention this reaction which can be fatal. CONCLUSIONS/SIGNIFICANCE: Although generally assumed to be a rare event, the true prevalence of JHR in leptospirosis is unknown and the awareness of this event is insufficient. All leptospirosis guidelines and local leptospirosis protocols should stress on systematic monitoring for clinical status early after antibiotic administration. Large well designed studies are required to precise the incidence and the impact of JHR as well as the severity and rates between various antibiotics.

  19. Mapping Of Leptospirosis Environmental Risk Factors and Determining the Level of Leptospirosis Vulnerable Zone In Demak District Using Remote Sensing Image

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    Rahayu, Siti; Sakundarno Adi, Mateus; Saraswati, Lintang Dian

    2018-02-01

    Leptospirosis, a zoonotic disease, transmitted to human trough contact with contaminated animal urine and contaminated environment. Demak District is an endemic area where cases increased in the past 2 years. The aim of the study was to map environmental risk factor of Leptospirosis and to determine Leptospirosis vulnerable zone using cross-sectional study design. There were 42 cases mapped by GPS and overlaid using remote sensing (Quickbird image) by using ArcView program then interpreted by Spatial Feature and Spatial Analyses. Leptospirosis cases were spread out and grouped in Demak Sub District area. More cases were males (61.9%), 21-50 years old age group (59.3%) and farmers (40.4%). Spatial analyses showed that all the leptospirosis cases took place in the area with low plain profile (28.6%), tidal inundation's profile (7.1%), vegetation (59.5%). Leptospirosis high-risk zone was in 37,801.8 ha (41.32%), moderate risk zone was 43,570.23 ha (48.55%), and low-risk zone was 9,090.96 ha (10.13%). Densely populated housing, bad environment condition, and the presence of rat and puddles that were contaminated by rat's urine were risk factors of Leptospirosis cases in Demak District.

  20. CASE REPORT OF PATIENTS WITH LEPTOSPIROSIS HOSPITALIZED IN THE DEPARTMENT OF INFECTIOUS DISEASES AT GENERAL HOSPITAL MURSKA SOBOTA IN THE YEAR 2002 – THE SIGNIFICANCE OF BLOOD CULTURE

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    Emil Pal

    2003-05-01

    Full Text Available Background. Leptospirosis is a zoonosis with worldwide distribution. In Slovenia, Pomurje is an endemic area. Manifestations of leptospirosis may be observed as different types of disease. The range from a short-lived febrile state to a severe disease with renal failure, liver impairment, hemorrhage and fulminant course.Patients and methods. Until year 2001 in the Department of infectious diseases at General Hospital Murska Sobota, only serological methods in diagnosis of leptospirosis had been used. Only in 2002 isolation of leptospires from blood was used. Four cases of confirmed leptospirosis hospitalized in our Department in 2002 were presented with broad spectrum of clinical courses and the significance of cultivation of leptospires from blood in the diagnosis.Conclusions. Because of the protean manifestations of leptospirosis, microbiological tests are essential for confirmatory diagnosis. In case of epidemiological data, clinical course and laboratory markers suggesting the diagnosis of leptospirosis, it is advisible to obtain blood cultures.

  1. Pancreatitis and myocarditis followed by pulmonary hemorrhage, a rare presentation of leptospirosis- A case report and literature survey

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    Ranawaka Nuwan

    2013-01-01

    Full Text Available Abstract Background Leptospirosis is a potentially fatal disease which can cause multi-organ dysfunction. It can rarely present as acute pancreatitis. This is the first ever report of leptospirosis presenting with acute pancreatitis and myocarditis followed by diffuse pulmonary hemorrhages to the best of our knowledge. Case presentation A 15-year-old South Asian boy presented with high grade fever, epigastric discomfort and was anicteric on admission. He developed tachycardia, transient hypotension, changes of electro-cardiogram and positive troponin I suggestive of myocarditis. Acute pancreatitis was diagnosed with 12 fold high serum amylase and with the evidence of computerized tomography. Then he developed diffuse pulmonary hemorrhages and later acute renal failure. Leptospirosis was confirmed by positive leptospira IgM, negative IgG and strongly positive Microscopic Agglutination Test. Other possible infective and autoimmune causes were excluded. Patient recovered completely with antibiotics and the supportive care. Conclusion This case illustrates diagnostic difficulties especially in resource poor settings where leptospirosis is common. Additionally it highlights the fact that leptospirosis should be considered in patients presenting with pancreatitis which can be complicated with myocarditis and diffuse pulmonary hemorrhages. We hypothesize that Toll like receptors may play a role in such systemic involvement.

  2. PEMERIKSAAN BAKTERI LEPTOSPIRA PADA SAMPEL DARAH MANUSIA SUSPECT LEPTOSPIROSIS MENGGUNAKAN METODE PCR (POLYMERASE CHAIN REACTION

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    Sefrita Tri Utami

    2014-01-01

    Full Text Available ABSTRACTLeptospirosis is a zoonotic disease, which is caused by leptospira. Leptospirosis cases often show no specificclinical symptoms and is difficult to diagnose without testing samples in the laboratory. Testing using PCR(Polymerase Chain Reaction is considered more accurate than the other methods. Components required in theexamination Leptospira bacteria in human blood samples using PCR method is DNA template, DNA polymeraseenzyme, forward primer (PU1 and SU1 and reverse primer (Lep R1, nuclease free water, Mg 2 +, and dNTPs.Examination of Leptospira bacteria in human blood samples include sampling, DNA isolation, examination byPCR, and electrophoresis running.Key words: leptospirosis, Leptospira, PCR methodsABSTRAKLeptospirosis adalah penyakit zoonosis yang disebabkan oleh bakteri Leptospira. Kasus leptospirosis seringtidak menunjukkan gejala klinis yang spesifik dan sulit didiagnosis tanpa pengujian sampel di laboratorium.Pengujian dengan menggunakan metode PCR (Polymerase Chain Reaction dinilai lebih akurat dibandingkandengan metode yang lain. Komponen-komponen yang dibutuhkan dalam pemeriksaan bakteri Leptospira padasampel darah manusia menggunakan metode PCR adalah DNA template, enzim polymerase, Primer PU 1 danPrimer SU 1, Primer Lep R1, air, Mg2+ , dan dNTP. Pemeriksaan bakteri Leptospira pada sampel darah manusiameliputi pengambilan sampel, isolasi DNA, pemeriksaan dengan metode PCR, dan running elektroforesis.Kata kunci: leptospirosis, Leptospira, metode PCR

  3. Validation of a case definition for leptospirosis diagnosis in patients with acute severe febrile disease admitted in reference hospitals at the State of Pernambuco, Brazil.

    Science.gov (United States)

    Albuquerque Filho, Alfredo Pereira Leite de; Araújo, Jéssica Guido de; Souza, Inacelli Queiroz de; Martins, Luciana Cardoso; Oliveira, Marta Iglis de; Silva, Maria Jesuíta Bezerra da; Montarroyos, Ulisses Ramos; Miranda Filho, Demócrito de Barros

    2011-01-01

    Leptospirosis is often mistaken for other acute febrile illnesses because of its nonspecific presentation. Bacteriologic, serologic, and molecular methods have several limitations for early diagnosis: technical complexity, low availability, low sensitivity in early disease, or high cost. This study aimed to validate a case definition, based on simple clinical and laboratory tests, that is intended for bedside diagnosis of leptospirosis among hospitalized patients. Adult patients, admitted to two reference hospitals in Recife, Brazil, with a febrile illness of less than 21 days and with a clinical suspicion of leptospirosis, were included to test a case definition comprising ten clinical and laboratory criteria. Leptospirosis was confirmed or excluded by a composite reference standard (microscopic agglutination test, ELISA, and blood culture). Test properties were determined for each cutoff number of the criteria from the case definition. Ninety seven patients were included; 75 had confirmed leptospirosis and 22 did not. Mean number of criteria from the case definition that were fulfilled was 7.8±1.2 for confirmed leptospirosis and 5.9±1.5 for non-leptospirosis patients (pcase definition, for a cutoff of at least 7 criteria, reached average sensitivity and specificity, but with a high positive predictive value. Its simplicity and low cost make it useful for rapid bedside leptospirosis diagnosis in Brazilian hospitalized patients with acute severe febrile disease.

  4. Global Burden of Leptospirosis: Estimated in Terms of Disability Adjusted Life Years

    NARCIS (Netherlands)

    Torgerson, Paul R.; Hagan, José E.; Costa, Federico; Calcagno, Juan; Kane, Michael; Martinez-Silveira, Martha S.; Goris, Marga G. A.; Stein, Claudia; Ko, Albert I.; Abela-Ridder, Bernadette

    2015-01-01

    Background Leptospirosis, a spirochaetal zoonosis, occurs in diverse epidemiological settings and affects vulnerable populations, such as rural subsistence farmers and urban slum dwellers. Although leptospirosis can cause life-threatening disease, there is no global burden of disease estimate in

  5. Recent advances in canine leptospirosis: focus on vaccine development

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    Klaasen HLBM

    2015-06-01

    Full Text Available Henricus LBM (Eric Klaasen,1 Ben Adler2 1Global Companion Animals Research and Development, Merck Sharp and Dohme Animal Health, Boxmeer, the Netherlands; 2Department of Microbiology, Monash University, Clayton, VIC, Australia Abstract: Leptospirosis is a global infection of humans and animals caused by pathogenic Leptospira spp. Leptospirosis is a major zoonosis, with infection acquired from wild and domestic animals. It is also a significant cause of morbidity, mortality, and economic loss in production and companion animals. Leptospirosis in dogs is prevalent worldwide and as well as a cause of canine disease, it presents a zoonotic risk to human contacts. Canine leptospirosis does not differ greatly from the syndromes seen in other animal species, with hepatic, renal, and pulmonary involvement being the main manifestations. While the pathogenesis of disease is well documented at the whole animal level, the cellular and molecular basis remains obscure. Killed, whole-cell bacterin vaccines are licensed worldwide and have not changed greatly over the past several decades. Vaccine-induced immunity is restricted to serologically related serovars and is generally short-lived, necessitating annual revaccination. The appearance of new serovars as causes of canine leptospirosis requires constant epidemiological surveillance and tailoring of vaccines to cover emerging serovars. At the present time, there is no realistic prospect of alternative, non-bacterin vaccines in the foreseeable future. Keywords: canine leptospirosis, vaccines, diagnosis, epidemiology, pathogenesis

  6. Leptospirosis complicating with acute large bowel gangrene: a case report.

    Science.gov (United States)

    Zamri, Z; Shaker, A H; Razman, J

    2012-01-01

    Leptospirosis is a zoonosis with worldwide distribution. It is often referred to as swineherd's disease, swamp fever or mud fever. In recent years there is increase incidence in leptospirosis in human. The incidence varies from sporadic in temperate zones to endemic in the tropical countries. Leptospirosis generally present with features of bacterial infection in acute phase following with multi organs complications. Acute bowel ischaemia with perforation following leptospirosis is a rare presentation . To the best of our knowledge, this is the first case report of such condition. The surgical management of this rare incidence will be discussed.

  7. Brote de leptospirosis en terneros en recría en la provincia de Corrientes, Argentina Leptospirosis outbreak in calves from Corrientes Province, Argentina

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    María G. Draghi

    2011-03-01

    Full Text Available La leptospirosis es una enfermedad infecciosa que produce importantes pérdidas económicas en la producción ganadera. Los signos característicos de la enfermedad son aborto, muerte embrionaria, muerte de terneros de pocos días de vida y mastitis. Se describe un brote de leptospirosis en terneros en actividad de recría. Se realizaron estudios histopatológicos, de hemoparásitos, inmunofluorescencia y cultivos bacterianos. Se aisló Leptospira interrogans serovar Pomona a partir de muestras de los terneros muertos.Leptospirosis is an infectious disease resulting in significant economic losses in livestock production. This disease causes abortion, embryo death, death of calves within the first few days of life and mastitis. We report a leptospirosis outbreak in calf growing and fattening. Histopathological and hemoparasite studies, immunofluorescence, and bacterial cultures were performed. A strain of Leptospira interrogans serovar Pomona was isolated from samples collected from dead calves.

  8. European consensus statement on leptospirosis in dogs and cats

    Science.gov (United States)

    Leptospirosis is a zoonotic disease of worldwide distribution affecting most mammalian species. Clinical leptospirosis is common in dogs but seems to be rare in cats. Both dogs and cats however, can shed leptospires in the urine. This is problematic as it can lead to exposure of humans. The control ...

  9. Portrait of leptospirosis in the State of Acre, Brazil

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    Eloizy Mariana Dias de Medeiros Cirilo Costa

    2017-03-01

    Full Text Available Introduction: Leptospirosis is an acute bacterial disease, that has global distribution and manifests itself in subclinical or asymptomatic way, having mild or severe conditions that can lead to the death of the patient. Objective: To identify, among the municipalities of the state of Acre, Brazil, those with the highest incidence of leptospirosis between 2010 and 2015, and in addition, to determine the prevalence of this disease between the sexes. Methods: Descriptive study, of documentary character, with epidemiological base and quantitative approach. It was made by available documents through the Department of Informatics of the Unified Health System of Brazil (DATASUS and also by the Health Secretary of State of Acre (SESACRE. Variables were selected as sex, age and year of notification. Regarding the analysis, it is emphasized that it was quantitative and descriptive and the results were presented in tables built in Microsoft Word. Results: It was found that the capital of the state of Acre, Rio Branco, led every year, contributing to the higher proportion of notifications related to leptospirosis. Regarding gender, there was a predilection for males and among age groups, the period of 20 to 39 years contributes to the greater number of cases of the disease. Conclusion: Leptospirosis is a worldwide public health problem and in the state of Acre, the high rainfall, the agglomeration of low income combined with inadequate sanitation, collaborate to infestation of transmitters animals, providing high rates of the disease. Thus, it appears that these high numbers can probably be attributed to the ineffectiveness of preventive activities, as well as insufficient investment directed to social policies and infrastructure sectors. Keywords: Infectious Disease. Leptospirosis. Prevalence. Incidence.

  10. Human leptospirosis in the Federal District, Brazil, 2011-2015: eco-epidemiological characterization

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    Ivanildo de Oliveira Correia Santos

    Full Text Available Abstract INTRODUCTION: Leptospirosis is an infectious disease that affects more than 5,000 people per year in Brazil. The Federal District (FD lacks epidemiological studies of human leptospirosis and presents concerning rates of this disease, especially considering its lethality. METHODS: Seventy-nine autochthonous human cases of leptospirosis between 2011 and 2015 were analyzed, with the probable infection location serving as a basis for the collection and analysis of the environmental and epidemiological variables. RESULTS: The incidence of the disease ranged from 0.68-13.39 per 100,000 inhabitants in 21 of the 31 administrative regions that compose the FD. The local profile of human leptospirosis was predominantly associated with urban areas during the rainy season, population access to the sewage network, the treated water network, and the public garbage collection service. The vast majority of cases had a strong association with synanthropic rodents at the infection sites. CONCLUSIONS: In order to prevent and control potentially lethal human leptospirosis infection, the eco-epidemiological characterization of this disease is a valuable tool for public policies of prevention, control, and surveillance. In addition to population awareness, the systematized control of synanthropic rodents could be the main health action to reduce the incidence of this disease in the FD.

  11. Global Morbidity and Mortality of Leptospirosis: A Systematic Review.

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    Federico Costa

    Full Text Available Leptospirosis, a spirochaetal zoonosis, occurs in diverse epidemiological settings and affects vulnerable populations, such as rural subsistence farmers and urban slum dwellers. Although leptospirosis is a life-threatening disease and recognized as an important cause of pulmonary haemorrhage syndrome, the lack of global estimates for morbidity and mortality has contributed to its neglected disease status.We conducted a systematic review of published morbidity and mortality studies and databases to extract information on disease incidence and case fatality ratios. Linear regression and Monte Carlo modelling were used to obtain age and gender-adjusted estimates of disease morbidity for countries and Global Burden of Disease (GBD and WHO regions. We estimated mortality using models that incorporated age and gender-adjusted disease morbidity and case fatality ratios. The review identified 80 studies on disease incidence from 34 countries that met quality criteria. In certain regions, such as Africa, few quality assured studies were identified. The regression model, which incorporated country-specific variables of population structure, life expectancy at birth, distance from the equator, tropical island, and urbanization, accounted for a significant proportion (R(2 = 0.60 of the variation in observed disease incidence. We estimate that there were annually 1.03 million cases (95% CI 434,000-1,750,000 and 58,900 deaths (95% CI 23,800-95,900 due to leptospirosis worldwide. A large proportion of cases (48%, 95% CI 40-61% and deaths (42%, 95% CI 34-53% were estimated to occur in adult males with age of 20-49 years. Highest estimates of disease morbidity and mortality were observed in GBD regions of South and Southeast Asia, Oceania, Caribbean, Andean, Central, and Tropical Latin America, and East Sub-Saharan Africa.Leptospirosis is among the leading zoonotic causes of morbidity worldwide and accounts for numbers of deaths, which approach or exceed those

  12. DISTRIBUSI SPASIAL LEPTOSPIROSIS DI KABUPATEN GRESIK, JAWA TIMUR

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    Sunaryo Sunaryo

    2015-01-01

    Full Text Available AbstractLeptospirosis is a rodent borne disease, the agent is Leptospira sp bacteria and transmitted to human through rodent urine. Gresik district is endemic for leptospirosis. The case fatality rate in 2009, 2010 and 2011 was 28,13%, 33,33% and 45%. respectively. The objective of this study was to determine the distibution of leptospirosis cases, by using Geografhical Information System (GIS and epidemiology spatial analysis based on the environmental risk factors in Gresik district. The study was conducted in march to November 2012, using spatial analysis in a cross sectional design. The results showed that leptospirosis cases were fluctuated between 2009 and 2011, in 2012 a number of 26 cases were found and 3 cases was a results of screening. The predoninat cases was found among the males, mosly fishermen and farmers. In Gresik district there were three endemic sub-districts, Duduk Sampeyan, Bungah and Gresik sub-districts. The cases fluctuation pattern showed the increased of the cases in january up to April, corresponding with the rain pattern. Enviraonmental variables that  influenced  the  occurence  of  leptospirosis  in  Gresik  were  the  presence  of  fishponds, farming areas, medium rain fall, lowland, medium vegetation population, alluvial type of soil and mostly the abundant of rats in the area. And the most risky leptospirosis transmission was found in the cener of Gresik district. It was concluded that GIS can be used as a part of leptospirosis surveillance and temporal spatial monitoring.Keywords : GIS, leptospirosis, GresikAbstrakLeptospirosis merupakan penyakit bersumber rodensia, disebabkan oleh bakteri Leptospira sp, menular melalui luka kulit atau mukosa dengan air/tanah tercemar leptospira dari urine binatang. Kabupaten Gresik merupakan daerah endemis leptospirosis, dengan case fatality ratetahun 2009 sampai dengan 2011 berturut-turut sebesar 28,13%, 33,33% dan 45%. Penelitian ini bertujuan untuk mengetahui

  13. [Seroprevalence of leptospirosis in Puente Piedra, Lima, in 2006].

    Science.gov (United States)

    Platts-Mills, James A; LaRochelle, Patrick; Campos, Kalina; Vinetz, Joseph M; Gotuzzo, Eduardo; Ricaldi, Jessica N

    2011-06-01

    Leptospirosis is a disease widely prevalent in tropical areas, but may also be present in urban areas. The present study aims to determine the seroprevalence of Leptospira in the district of Puente Piedra, where there have been cases of severe leptospirosis in recent years. We collected data related to risk factors associated with leptospirosis and blood samples from 250 participants, selected by random sampling. We found a high prevalence of risk factors in the population and using the microscopic agglutination test, antibodies were found in only 3 participants (1.2%).

  14. Global Burden of Leptospirosis: Estimated in Terms of Disability Adjusted Life Years.

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    Paul R Torgerson

    Full Text Available Leptospirosis, a spirochaetal zoonosis, occurs in diverse epidemiological settings and affects vulnerable populations, such as rural subsistence farmers and urban slum dwellers. Although leptospirosis can cause life-threatening disease, there is no global burden of disease estimate in terms of Disability Adjusted Life Years (DALYs available.We utilised the results of a parallel publication that reported global estimates of morbidity and mortality due to leptospirosis. We estimated Years of Life Lost (YLLs from age and gender stratified mortality rates. Years of Life with Disability (YLDs were developed from a simple disease model indicating likely sequelae. DALYs were estimated from the sum of YLLs and YLDs. The study suggested that globally approximately 2.90 million DALYs are lost per annum (UIs 1.25-4.54 million from the approximately annual 1.03 million cases reported previously. Males are predominantly affected with an estimated 2.33 million DALYs (UIs 0.98-3.69 or approximately 80% of the total burden. For comparison, this is over 70% of the global burden of cholera estimated by GBD 2010. Tropical regions of South and South-east Asia, Western Pacific, Central and South America, and Africa had the highest estimated leptospirosis disease burden.Leptospirosis imparts a significant health burden worldwide, which approach or exceed those encountered for a number of other zoonotic and neglected tropical diseases. The study findings indicate that highest burden estimates occur in resource-poor tropical countries, which include regions of Africa where the burden of leptospirosis has been under-appreciated and possibly misallocated to other febrile illnesses such as malaria.

  15. Epidemiology of human leptospirosis in Malaysia, 2004-2012.

    Science.gov (United States)

    Benacer, Douadi; Thong, Kwai Lin; Min, Ng Choung; Bin Verasahib, Khebir; Galloway, Renee L; Hartskeerl, Rudy A; Souris, Marc; Mohd Zain, Siti Nursheena

    2016-05-01

    Leptospirosis is an emerging disease, especially in countries with a tropical climate such as Malaysia. A dramatic increase in the number of cases has been reported over the last decade; however, information on the epidemiological trends of this disease is lacking. The objective of this study is to provide an epidemiological description of human leptospirosis cases over a 9-year period (2004-2012) and disease relationship with meteorological, geographical, and demographical information. A retrospective study was undertaken to describe the patterns of human leptospirosis cases and their association with intrinsic (sex, age, and ethnicity) and extrinsic (location, rainfall, and temperature) factors. Data was grouped according to age, sex, ethnicity, seasonality and geographical distribution, and analyzed using statistical tools to understand the influence of all the different factors on disease incidence. A total of 12,325 cases of leptospirosis were reported between 2004 and 2012 with an upward trend in disease incidence, with the highest in 2012. Three hundred thirty-eight deaths were reported with an overall case fatality rate of 2.74%, with higher incidence in males (9696; 78.7%) compared with female patients (2629; 21.3%), and overall male to female ratio of 3.69:1. Patients aged cohorts between 30-39 years old (16.22 per 100,000 population) had the highest disease incidence while the lowest incidence occurred between cases (1.80 per 100,000 population). Positive relationships were recorded between the number of reported cases with the number of raining days per month and monthly average temperature (p-valuecases. This collaborative efforts between medical, academic and governmental institutions has enabled the construction of this comprehensive database that is essential to understand the disease trends in Malaysia and add insights into the prevention and control of this disease. Copyright © 2016 Elsevier B.V. All rights reserved.

  16. Cyclical changes in seroprevalence of leptospirosis in California sea lions: endemic and epidemic disease in one host species?

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    St Leger Judy

    2007-11-01

    Full Text Available Abstract Background Leptospirosis is a zoonotic disease infecting a broad range of mammalian hosts, and is re-emerging globally. California sea lions (Zalophus californianus have experienced recurrent outbreaks of leptospirosis since 1970, but it is unknown whether the pathogen persists in the sea lion population or is introduced repeatedly from external reservoirs. Methods We analyzed serum samples collected over an 11-year period from 1344 California sea lions that stranded alive on the California coast, using the microscopic agglutination test (MAT for antibodies to Leptospira interrogans serovar Pomona. We evaluated seroprevalence among yearlings as a measure of incidence in the population, and characterized antibody persistence times based on temporal changes in the distribution of titer scores. We conducted multinomial logistic regression to determine individual risk factors for seropositivity with high and low titers. Results The serosurvey revealed cyclical patterns in seroprevalence to L. interrogans serovar Pomona, with 4–5 year periodicity and peak seroprevalence above 50%. Seroprevalence in yearling sea lions was an accurate index of exposure among all age classses, and indicated on-going exposure to leptospires in non-outbreak years. Analysis of titer decay rates showed that some individuals probably maintain high titers for more than a year following exposure. Conclusion This study presents results of an unprecedented long-term serosurveillance program in marine mammals. Our results suggest that leptospirosis is endemic in California sea lions, but also causes periodic epidemics of acute disease. The findings call into question the classical dichotomy between maintenance hosts of leptospirosis, which experience chronic but largely asymptomatic infections, and accidental hosts, which suffer acute illness or death as a result of disease spillover from reservoir species.

  17. Urine Levels of Defensin α1 Reflect Kidney Injury in Leptospirosis Patients

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    Haorile Chagan-Yasutan

    2016-09-01

    Full Text Available Leptospirosis is a zoonotic disease whose severe forms are often accompanied by kidney dysfunction. In the present study, urinary markers were studied for potential prediction of disease severity. Urine samples from 135 patients with or without leptospirosis at San Lazaro Hospital, the Philippines, were analyzed. Urine levels of defensin α1 (uDA1 were compared with those of neutrophil gelatinase-associated lipocalin (uNGAL and N-acetyl-β-d-glucosidase (uNAG. Serum creatinine (Cr was used as a marker of kidney injury. The levels of uDA1/Cr, uNGAL/Cr, and uNAG/Cr were positive in 46%, 90%, and 80% of leptospirosis patients, and 69%, 70%, and 70% of non-leptospirosis patients, respectively. In leptospirosis patients, the correlation of uDA1/Cr, uNGAL/Cr and uNAG/Cr levels with serum Cr were r = 0.3 (p < 0.01, r = 0.29 (p < 0.01, and r = 0.02 (p = 0.81, respectively. uDA1/Cr levels were correlated with uNGAL/Cr levels (r = 0.49, p < 0.01 and uNAG/Cr levels (r = 0.47, p < 0.0001 in leptospirosis patients. These findings suggest that uDA1, uNGAL, and uNAG were elevated in leptospirosis patients and reflected various types of kidney damage. uDA1 and uNGAL can be used to track kidney injury in leptospirosis patients because of their correlation with the serum Cr level.

  18. [Leptospirosis in French Guiana and the Guiana shield: Current knowledge in 2016].

    Science.gov (United States)

    Epelboin, L; Bourhy, P; Le Turnier, P; Schaub, R; Mosnier, E; Berlioz-Arthaud, A; Reynaud, Y; Nacher, M; De Thoisy, B; Carles, G; Richard-Hansen, C; Demar, M; Picardeau, M; Djossou, F

    2017-08-01

    Leptospirosis is a cosmopolitan zoonosis caused by bacteria of the genus Leptospira. Whether the distribution is worldwide, the hot and humid climate of the tropics is particularly conducive to its expansion. In most French overseas departments and territories, leptospirosis is considered as a public health problem. In French Guiana, a French department located in the northeastern part of the Amazon rainforest, it is supposed to be rare. The objective of this review was to make an inventory of the knowledge on human and animal leptospirosis in French Guiana and neighboring countries. A comprehensive search was conducted through the indexed and informal medical literature in English, French, Spanish and Portuguese. Thus, respectively ten and four publications were identified on human and animal leptospirosis in French Guiana, published between 1940 and 1995 in the form of case reports or case series. The publications concerning this disease in the other countries of the Guiana Shield, eastern Venezuela, Guyana, Suriname, and Brazilian state of Amapá, also scarce or nonexistent. However recent data from the French National Centre of leptospirosis showed a recent and sudden increase in the number of cases in the department, probably partly due to the development of diagnostic tools such as Elisa IgM serology. It is likely that leptospirosis is a neglected disease in the region, due to the lack of diagnostic tools readily available, the lack of knowledge of the local clinicians on this disease and the existence of many other pathogens with similar clinical presentation such as malaria, arboviruses and Q fever and Amazonian toxoplasmosis. The establishment of more large-scale studies on animal and human leptospirosis is necessary and urgent to know the true burden of this disease in our region.

  19. Human Leptospirosis in Malaysia: Reviewing the Challenges After 8 Decades (1925-2012).

    Science.gov (United States)

    Benacer, Douadi; Thong, Kwai Lin; Verasahib, Khebir Bin; Galloway, Renee L; Hartskeerl, Rudy A; Lewis, John W; Mohd Zain, Siti Nursheena

    2016-05-01

    The history and epidemiology of human leptospirosis in Malaysia from 1925 to 2012 are described. Previous studies have demonstrated that leptospirosis is an endemic disease in Malaysia occurring in both urban and rural locations. The number of cases has risen dramatically since the Ministry of Health Malaysia highlighted leptospirosis as a notifiable disease in 2010, with reported cases increasing from 248 cases in 2004 to 3604 in 2012. The incidence of infection among the population suggests that occupation, sex, age, ethnic background, water recreational activities, and sporting events are risk factors. A robust surveillance system is now in place to monitor temporal and spatial changes in the incidence and prevalence of infection and to identify risk areas and disease behavior. Despite extensive studies over the past decade, there is a still a need to describe local serovars in host carriers and the human population, with the view to develop an effective vaccine against leptospirosis. © 2016 APJPH.

  20. Large-scale application of highly-diluted bacteria for Leptospirosis epidemic control.

    Science.gov (United States)

    Bracho, Gustavo; Varela, Enrique; Fernández, Rolando; Ordaz, Barbara; Marzoa, Natalia; Menéndez, Jorge; García, Luis; Gilling, Esperanza; Leyva, Richard; Rufín, Reynaldo; de la Torre, Rubén; Solis, Rosa L; Batista, Niurka; Borrero, Reinier; Campa, Concepción

    2010-07-01

    Leptospirosis is a zoonotic disease of major importance in the tropics where the incidence peaks in rainy seasons. Natural disasters represent a big challenge to Leptospirosis prevention strategies especially in endemic regions. Vaccination is an effective option but of reduced effectiveness in emergency situations. Homeoprophylactic interventions might help to control epidemics by using highly-diluted pathogens to induce protection in a short time scale. We report the results of a very large-scale homeoprophylaxis (HP) intervention against Leptospirosis in a dangerous epidemic situation in three provinces of Cuba in 2007. Forecast models were used to estimate possible trends of disease incidence. A homeoprophylactic formulation was prepared from dilutions of four circulating strains of Leptospirosis. This formulation was administered orally to 2.3 million persons at high risk in an epidemic in a region affected by natural disasters. The data from surveillance were used to measure the impact of the intervention by comparing with historical trends and non-intervention regions. After the homeoprophylactic intervention a significant decrease of the disease incidence was observed in the intervention regions. No such modifications were observed in non-intervention regions. In the intervention region the incidence of Leptospirosis fell below the historic median. This observation was independent of rainfall. The homeoprophylactic approach was associated with a large reduction of disease incidence and control of the epidemic. The results suggest the use of HP as a feasible tool for epidemic control, further research is warranted. 2010 Elsevier Ltd. All rights reserved.

  1. Validation of a case definition for leptospirosis diagnosis in patients with acute severe febrile disease admitted in reference hospitals at the State of Pernambuco, Brazil

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    Alfredo Pereira Leite de Albuquerque Filho

    2011-12-01

    Full Text Available INTRODUCTION: Leptospirosis is often mistaken for other acute febrile illnesses because of its nonspecific presentation. Bacteriologic, serologic, and molecular methods have several limitations for early diagnosis: technical complexity, low availability, low sensitivity in early disease, or high cost. This study aimed to validate a case definition, based on simple clinical and laboratory tests, that is intended for bedside diagnosis of leptospirosis among hospitalized patients. METHODS: Adult patients, admitted to two reference hospitals in Recife, Brazil, with a febrile illness of less than 21 days and with a clinical suspicion of leptospirosis, were included to test a case definition comprising ten clinical and laboratory criteria. Leptospirosis was confirmed or excluded by a composite reference standard (microscopic agglutination test, ELISA, and blood culture. Test properties were determined for each cutoff number of the criteria from the case definition. RESULTS: Ninety seven patients were included; 75 had confirmed leptospirosis and 22 did not. Mean number of criteria from the case definition that were fulfilled was 7.8±1.2 for confirmed leptospirosis and 5.9±1.5 for non-leptospirosis patients (p<0.0001. Best sensitivity (85.3% and specificity (68.2% combination was found with a cutoff of 7 or more criteria, reaching positive and negative predictive values of 90.1% and 57.7%, respectively; accuracy was 81.4%. CONCLUSIONS: The case definition, for a cutoff of at least 7 criteria, reached average sensitivity and specificity, but with a high positive predictive value. Its simplicity and low cost make it useful for rapid bedside leptospirosis diagnosis in Brazilian hospitalized patients with acute severe febrile disease.

  2. Diagnostic accuracy of an in-house ELISA using the intermediate species Leptospira fainei as antigen for diagnosis of acute leptospirosis in dogs.

    Science.gov (United States)

    Penna, Bruno; Marassi, Carla D; Libonati, Hugo; Narduche, Lorena; Lilenbaum, Walter; Bourhy, Pascale

    2017-02-01

    Diagnosis of animal leptospirosis is still challenging. The microscopic agglutination test, is the current method for diagnosing leptospirosis. However, this technique requires specific equipment, highly trained staff and the maintenance of live cultures of several reference strains of Leptospira for use as antigens. Recently, an ELISA (enzyme-linked immunosorbent assay) employing a Leptospira fainei serovar Hurstbridge based antigen for the early diagnostic of human leptospirosis was developed. In this study we estimate the diagnostic sensitivity and specificity of this test in identifying acute canine leptospirosis. A total of 271 serum samples divided into five panels and tested by MAT as a reference test, were used to evaluate the ELISA. Comparing acutely and non-acutely infected dogs, ELISA-Hb showed 95.6% sensitivity and 93% specificity. L. fainei-based ELISA is adequate for diagnosing acute canine leptospirosis, with high sensitivity and specificity and presenting practical advantages when compared to current techniques. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. Leptospirose pulmonar Pulmonary leptospirosis

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    João Cláudio Barroso Pereira

    2007-12-01

    Full Text Available No presente artigo, os autores discutem brevemente sobre a leptospirose, realçando a forma pulmonar da doença. Revê-se a patologia, achados clínicos, diagnóstico por métodos de imagem e broncoscopia e tratamento da leptospirose pulmonar. É também lembrado o diagnóstico clínico e radiológico precoces, para que se possa iniciar terapêutica adequada. Os autores concluem que a forma pulmonar da leptospirose deve ser sempre considerada como causa e diagnóstico diferencial da hemorragia alveolar difusa e síndroma de dificuldade respiratória do adulto.In this article, the authors discuss briefly the leptospirosis, emphasizing mainly the pulmonary form of disease. The authors review pathology, clinical findings, imaging and broncoscopy diagnosis, treatment of pulmonary leptospirosis. It is also remembered about early clinics and radiology diagnosis to start therapeutics. The authors conclude that pulmonary form of disease must always be remembered and considered as cause and differential diagnosis of Diffuse Alveolar Hemorrhage and Adult Respiratory Distress Syndrome.

  4. FAKTOR LINGKUNGAN BIOTIK PADA KEJADIAN LEPTOSPIROSIS

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    Asyhar Tunissea

    2012-11-01

    Full Text Available Beberapa penelitian tentang kejadian leptospirosis menunjukkan bahwa kejadian leptospirosis berkaitan dengan faktor lingkungan, baik lingkungan abiotik maupun biotik. Komponen lingkungan biotik yang diduga merupakan faktor risiko kejadian leptospirosis di Indonesia antara lain adalah vegetasi, keberhasilan penangkapan tikus (trap succes dan prevalensi leptospirosis pada tikus.

  5. Changes in leptospirosis etiology in animals and humans.

    Science.gov (United States)

    Vasylieva, Natalia; Andreychyn, Mykhaylo; Kravchuk, Yulia; Chervinska, Оlena; Iosyk, Iaryna

    2017-12-23

    Leptospirosis is endemic in Ternopil region. In Ukraine, the disease is registered in almost all regions, including the Ternopil region. The aim of the research is to study the regularities of epidemic and epizootic processes of leptospirosis, and the circulation of its pathogens among different sources (small mammals, animals) and humans. Etiologic spectrum of leptospirosis registered in Ternopil region in 1972-2016 among small mammals, farm animals and sick people was studied. Due to the analysis of pathogens circulation among different sources (small mammals, animals), as well as the annual morbidity in humans, it was proved that new leptospira serovars are endemic and brought into the regions mostly by farm animals. Farm animals introduce the infection to humans through the environment, sometimes within 3-5-years. The spread was observed of pathogen serovars, which are new in certain areas, among all types of mouse-like small mammals and rats. It was established that livestock and small mammals are parallel reservoirs. In the regions with endemic species, the structural modification in the etiology of leptospirosis in humans is caused by additional reservoirs among animals, as well as the circulation of other pathogen serovars that were absent in the main natural reservoir, i.e. mouse-like small mammals and rats. The constant monitoring of the population, contamination and carrier state of mouse-like small mammals, rats and farm animals, is required In order to predict the future epidemiological situation on leptospirosis among the population and to improve leptospirosis diagnosis.

  6. Human leptospirosis in Seychelles: A prospective study confirms the heavy burden of the disease but suggests that rats are not the main reservoir.

    Science.gov (United States)

    Biscornet, Leon; Dellagi, Koussay; Pagès, Frédéric; Bibi, Jastin; de Comarmond, Jeanine; Mélade, Julien; Govinden, Graham; Tirant, Maria; Gomard, Yann; Guernier, Vanina; Lagadec, Erwan; Mélanie, Jimmy; Rocamora, Gérard; Le Minter, Gildas; Jaubert, Julien; Mavingui, Patrick; Tortosa, Pablo

    2017-08-01

    Leptospirosis is a bacterial zoonosis caused by pathogenic Leptospira for which rats are considered as the main reservoir. Disease incidence is higher in tropical countries, especially in insular ecosystems. Our objectives were to determine the current burden of leptospirosis in Seychelles, a country ranking first worldwide according to historical data, to establish epidemiological links between animal reservoirs and human disease, and to identify drivers of transmission. A total of 223 patients with acute febrile symptoms of unknown origin were enrolled in a 12-months prospective study and tested for leptospirosis through real-time PCR, IgM ELISA and MAT. In addition, 739 rats trapped throughout the main island were investigated for Leptospira renal carriage. All molecularly confirmed positive samples were further genotyped. A total of 51 patients fulfilled the biological criteria of acute leptospirosis, corresponding to an annual incidence of 54.6 (95% CI 40.7-71.8) per 100,000 inhabitants. Leptospira carriage in Rattus spp. was overall low (7.7%) but dramatically higher in Rattus norvegicus (52.9%) than in Rattus rattus (4.4%). Leptospira interrogans was the only detected species in both humans and rats, and was represented by three distinct Sequence Types (STs). Two were novel STs identified in two thirds of acute human cases while noteworthily absent from rats. This study shows that human leptospirosis still represents a heavy disease burden in Seychelles. Genotype data suggests that rats are actually not the main reservoir for human disease. We highlight a rather limited efficacy of preventive measures so far implemented in Seychelles. This could result from ineffective control measures of excreting animal populations, possibly due to a misidentification of the main contaminating reservoir(s). Altogether, presented data stimulate the exploration of alternative reservoir animal hosts.

  7. Human leptospirosis in Seychelles: A prospective study confirms the heavy burden of the disease but suggests that rats are not the main reservoir.

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    Leon Biscornet

    2017-08-01

    Full Text Available Leptospirosis is a bacterial zoonosis caused by pathogenic Leptospira for which rats are considered as the main reservoir. Disease incidence is higher in tropical countries, especially in insular ecosystems. Our objectives were to determine the current burden of leptospirosis in Seychelles, a country ranking first worldwide according to historical data, to establish epidemiological links between animal reservoirs and human disease, and to identify drivers of transmission.A total of 223 patients with acute febrile symptoms of unknown origin were enrolled in a 12-months prospective study and tested for leptospirosis through real-time PCR, IgM ELISA and MAT. In addition, 739 rats trapped throughout the main island were investigated for Leptospira renal carriage. All molecularly confirmed positive samples were further genotyped.A total of 51 patients fulfilled the biological criteria of acute leptospirosis, corresponding to an annual incidence of 54.6 (95% CI 40.7-71.8 per 100,000 inhabitants. Leptospira carriage in Rattus spp. was overall low (7.7% but dramatically higher in Rattus norvegicus (52.9% than in Rattus rattus (4.4%. Leptospira interrogans was the only detected species in both humans and rats, and was represented by three distinct Sequence Types (STs. Two were novel STs identified in two thirds of acute human cases while noteworthily absent from rats.This study shows that human leptospirosis still represents a heavy disease burden in Seychelles. Genotype data suggests that rats are actually not the main reservoir for human disease. We highlight a rather limited efficacy of preventive measures so far implemented in Seychelles. This could result from ineffective control measures of excreting animal populations, possibly due to a misidentification of the main contaminating reservoir(s. Altogether, presented data stimulate the exploration of alternative reservoir animal hosts.

  8. Human leptospirosis: seroreactivity and genetic susceptibility in the population of São Miguel Island (Azores, Portugal.

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    Lisa M Esteves

    Full Text Available Leptospirosis is a worldwide zoonotic and recognized neglected infectious disease. It has been observed that only a proportion of individuals exposed to pathogenic species of Leptospira become infected and develop clinically evident disease. Moreover, little information is available in subsequent reinfections. In the present study, we determine if a first infection with leptospirosis protects against subsequent reinfection, and investigate which of the host genetic factors are involved in the susceptibility and resistance to leptospirosis.We conducted, in 2011, a retrospective hospital-based case-control study in the São Miguel Island population (Azores archipelago. In order to determine the seropositivity against pathogenic Leptospira after the first episode of leptospirosis, we performed a serological evaluation in 97 unrelated participants diagnosed with leptospirosis between 1992 and 2011. The results revealed that 46.4% of the 97 participants have circulating anti-Leptospira antibodies, and from these participants 35.6% maintained the seroprevalence for the same serogroup. Moreover, three of them were reinfected with unrelated Leptospira serovars. The genetic study was carried out by adding a control group composed of 470 unrelated healthy blood donors, also from São Miguel Island. Twenty five SNPs among twelve innate immune genes - IL1α, IL1β, IL6, IL10, IL12RB1, TLR2, TLR4, TLR9, CD14, CISH, LTA and TNF - were genotyped, as well as HLA class I (-A and -B genes. Association analysis indicates that genotypes -511GG (OR=1.6, 95%CI 1.01-2.56, p=0.04 in IL1β, +1196CG (OR=2.0, 95%CI 1.26-3.27, p=0.003 in IL12RB1, -292TA (OR=1.8, 95% CI 1.06-2.1, p=0.03 and +3415CG (OR=1.8, 95% CI 1.08-3.08, p=0.02, both in CISH confer susceptibility to pathogenic Leptospira.The present study suggests some degree of long-term protection against leptospires with an attenuation of symptoms in case of reinfection. Moreover, our data supports the genetic

  9. FAKTOR-FAKTOR YANG BERHUBUNGAN DENGAN PERILAKU PENCEGAHAN PENYAKIT LEPTOSPIROSIS (STUDI KASUS DI KELURAHAN TANDANG KECAMATAN TEMBALANG KOTA SEMARANG

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    Ayu Nur Illahi

    2015-10-01

    Full Text Available Leptospirosis merupakan salah satu penyakit infeksi yang berbahaya yang disebabkan oleh bakteri leptospira. Pelaksanaan pencegahan penyakit leptospirosis masih mengalami hambatan. Penelitian ini adalah  explanatory research dengan  rancangan cross sectional. Sampel berjumlah 80 dengan responden ibu rumah tangga. Analisis data dilakukan secara univariat dan bivariat. Berdasarkan hasil penelitian didapatkan bahwa variabel yang berhubungan dengan perilaku pencegahan penyakit leptospirosis adalah pengetahuan  (p value=0,023, umur (p value=0,005, pendidikan (p value=0,000, pendapatan keluarga (p value=0,014, sumber informasi (p value=0,001, dan dukungan keluarga (p value=0,017. Variabel yang tidak berhubungan dengan perilaku pencegahan penyakit leptospirosis adalah sikap, pekerjaan, akses pelayanan kesehatan, dan pengalaman. Leptospirosis is an emerging infectious diseases caused by Leptospira bacteria. Implementation for  prevention behavior of Leptospirosis diseases is barrier. This research was an explanatory research with cross sectional design. Samples numbered 80 and the respondents were housewife. Data analysis was performed by univariate and bivariate. Based on the results of this study found that variables related with prevention behavior Leptospirosis diseases were knowledge (p value= 0.023, age (p value= 0.005, education (p value= 0.000, family income (p value= 0.014, information resources (p value= 0.001, and family support (p value= 0.017. Variables that were not related with prevention behavior Leptospirosis diseases were attitude, occupation, health service access, and experience.

  10. Spectrum of Radiological Findings in Leptospirosis on Chest Radiograph and Ultrasonography-Study during Epidemics in South Gujarat Region of India

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    Mona Shastri

    2017-10-01

    Full Text Available Introduction: Leptospirosis is an acute generalised infectious disease caused by any of the group of spirochetes of the genus Leptospira. The disease can involve many organs mainly liver, central nervous system, kidneys, skeletal muscle, and lungs. Diagnosis can be done on the basis of epidemiological, clinical and laboratory features. As the disease has varied manifestations, it is frequently misdiagnosed even in areas of high prevalence. A delay in diagnosis can leads to severe form of disease and development of its complications. Aim: To find out involvement of thoracic and abdominal organs in each and every patient with the help of chest radiographs and Ultrasonography (USG of abdomen and thorax. Also, to put together the radiological spectrum of pulmonary manifestations, and other system involvement in leptospirosis during epidemics in south Gujarat region and their role in early diagnosis and follow up of patients. Materials and Methods: Study was carried out for 3 years. Total 380 patients of suspected leptospirosis were referred during epidemic during months of July to October in year 2008, 2009 and 2010 for confirmation of diagnosis and management. Total 275 patients were confirmed for leptospirosis by serological test (ELISA during first and second week of illness which was included in our study. All 275 patients were evaluated with chest radiographs and ultrasound of chest and abdomen. Those patients which are clinically suspected for leptospirosis but were serologically negative were excluded. Results: Out of 275 confirmed patients of leptospirosis, 54 patients had signs of pulmonary haemorrhage on chest radiograph (19.65%. Out of these 54 patients 50 (which accounts 92% of pulmonary hemorrhage patients and 18% of total 275 patients died due to severe pulmonary haemorrhage and respiratory distress. Pleural effusion was diagnosed on X-ray chest in 10 patients but it was found in 68 patients on USG. Signs of acute renal disease were

  11. Evaluation of surveillance case definition in the diagnosis of leptospirosis, using the Microscopic Agglutination Test: a validation study.

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    Dassanayake, Dinesh L B; Wimalaratna, Harith; Agampodi, Suneth B; Liyanapathirana, Veranja C; Piyarathna, Thibbotumunuwe A C L; Goonapienuwala, Bimba L

    2009-04-22

    Leptospirosis is endemic in both urban and rural areas of Sri Lanka and there had been many out breaks in the recent past. This study was aimed at validating the leptospirosis surveillance case definition, using the Microscopic Agglutination Test (MAT). The study population consisted of patients with undiagnosed acute febrile illness who were admitted to the medical wards of the Teaching Hospital Kandy, from 1st July 2007 to 31st July 2008. The subjects were screened to diagnose leptospirosis according to the leptospirosis case definition. MAT was performed on blood samples taken from each patient on the 7th day of fever. Leptospirosis case definition was evaluated in regard to sensitivity, specificity and predictive values, using a MAT titre >or= 1:800 for confirming leptospirosis. A total of 123 patients were initially recruited of which 73 had clinical features compatible with the surveillance case definition. Out of the 73 only 57 had a positive MAT result (true positives) leaving 16 as false positives. Out of the 50 who didn't have clinical features compatible with the case definition 45 had a negative MAT as well (true negatives), therefore 5 were false negatives. Total number of MAT positives was 62 out of 123. According to these results the test sensitivity was 91.94%, specificity 73.77%, positive predictive value and negative predictive values were 78.08% and 90% respectively. Diagnostic accuracy of the test was 82.93%. This study confirms that the surveillance case definition has a very high sensitivity and negative predictive value with an average specificity in diagnosing leptospirosis, based on a MAT titre of >or= 1: 800.

  12. Leptospira Serovars for Diagnosis of Leptospirosis in Humans and Animals in Africa: Common Leptospira Isolates and Reservoir Hosts.

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    Mgode, Georgies F; Machang'u, Robert S; Mhamphi, Ginethon G; Katakweba, Abdul; Mulungu, Loth S; Durnez, Lies; Leirs, Herwig; Hartskeerl, Rudy A; Belmain, Steven R

    2015-12-01

    The burden of leptospirosis in humans and animals in Africa is higher than that reported from other parts of the world. However, the disease is not routinely diagnosed in the continent. One of major factors limiting diagnosis is the poor availability of live isolates of locally circulating Leptospira serovars for inclusion in the antigen panel of the gold standard microscopic agglutination test (MAT) for detecting antibodies against leptospirosis. To gain insight in Leptospira serovars and their natural hosts occurring in Tanzania, concomitantly enabling the improvement of the MAT by inclusion of fresh local isolates, a total of 52 Leptospira isolates were obtained from fresh urine and kidney homogenates, collected between 1996 and 2006 from small mammals, cattle and pigs. Isolates were identified by serogrouping, cross agglutination absorption test (CAAT), and molecular typing. Common Leptospira serovars with their respective animal hosts were: Sokoine (cattle and rodents); Kenya (rodents and shrews); Mwogolo (rodents); Lora (rodents); Qunjian (rodent); serogroup Grippotyphosa (cattle); and an unknown serogroup from pigs. Inclusion of local serovars particularly serovar Sokoine in MAT revealed a 10-fold increase in leptospirosis prevalence in Tanzania from 1.9% to 16.9% in rodents and 0.26% to 10.75% in humans. This indicates that local serovars are useful for diagnosis of human and animal leptospirosis in Tanzania and other African countries.

  13. Seroprevalence of Leptospirosis in Working Dogs.

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    Lau, S F; Wong, J Y; Khor, K H; Roslan, M A; Abdul Rahman, M S; Bejo, S K; Radzi, R; Bahaman, A R

    2017-12-01

    Working dogs are canine animals that have been trained to assist human beings in carrying out various tasks. They help in guarding property, performing rescues, assisting the visually impaired or physically handicapped, searching for drugs, explosives, and others. Leptospirosis is one of the most widespread zoonotic diseases in the world and a commonly occurring disease of the tropics and subtropics. In Malaysia, all working dogs are normally vaccinated with serovars, Pomona, Icterohaemorrhagiae, Canicola, and Grippotyphosa based on protocols recommended from other countries. The duration of immunity in vaccinated dogs for Leptospira can last up to 13 months; however, there is no full crossprotection between the different serovars. Five representative canine units from different government agencies in Malaysia (n = 96 dogs) were recruited in this study. For detection, the microscopic agglutination test was performed by incubating the serum from dogs with various serovars of leptospires, namely, Icterohaemorrhagiae, Canicola, Pomona, Grippotyphosa, Australis, Bataviae, Javanica, Tarassovi, Hebdomadis, Lai, and Pyrogenes. The plasma obtained was used for polymerase chain reaction (PCR) analysis, for the detection of 16S rRNA, and lipL 32 genes of Leptospira. Out of the 96 dogs sampled, only 3 dogs were positive toward serovars, Australis, Bataviae, and Javanica, based on the cutoff point at 1:80. The seroprevalence of canine leptospirosis in this population was 3.1% (n = 3/96). However, all 96 blood samples of working dogs tested negative for both pathogenic and nonpathogenic Leptospira genes. The results revealed that, by vaccination alone, working dogs were not fully protected against leptospirosis and could pose a risk to dog handlers. A preventative and control protocol for leptospirosis is warranted, and its implementation should be monitored and improved accordingly from time to time, in order to maintain a healthy condition in both working dogs and their

  14. Estimating leptospirosis incidence using hospital-based surveillance and a population-based health care utilization survey in Tanzania.

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    Holly M Biggs

    Full Text Available The incidence of leptospirosis, a neglected zoonotic disease, is uncertain in Tanzania and much of sub-Saharan Africa, resulting in scarce data on which to prioritize resources for public health interventions and disease control. In this study, we estimate the incidence of leptospirosis in two districts in the Kilimanjaro Region of Tanzania.We conducted a population-based household health care utilization survey in two districts in the Kilimanjaro Region of Tanzania and identified leptospirosis cases at two hospital-based fever sentinel surveillance sites in the Kilimanjaro Region. We used multipliers derived from the health care utilization survey and case numbers from hospital-based surveillance to calculate the incidence of leptospirosis. A total of 810 households were enrolled in the health care utilization survey and multipliers were derived based on responses to questions about health care seeking in the event of febrile illness. Of patients enrolled in fever surveillance over a 1 year period and residing in the 2 districts, 42 (7.14% of 588 met the case definition for confirmed or probable leptospirosis. After applying multipliers to account for hospital selection, test sensitivity, and study enrollment, we estimated the overall incidence of leptospirosis ranges from 75-102 cases per 100,000 persons annually.We calculated a high incidence of leptospirosis in two districts in the Kilimanjaro Region of Tanzania, where leptospirosis incidence was previously unknown. Multiplier methods, such as used in this study, may be a feasible method of improving availability of incidence estimates for neglected diseases, such as leptospirosis, in resource constrained settings.

  15. Estimating Leptospirosis Incidence Using Hospital-Based Surveillance and a Population-Based Health Care Utilization Survey in Tanzania

    Science.gov (United States)

    Biggs, Holly M.; Hertz, Julian T.; Munishi, O. Michael; Galloway, Renee L.; Marks, Florian; Saganda, Wilbrod; Maro, Venance P.; Crump, John A.

    2013-01-01

    Background The incidence of leptospirosis, a neglected zoonotic disease, is uncertain in Tanzania and much of sub-Saharan Africa, resulting in scarce data on which to prioritize resources for public health interventions and disease control. In this study, we estimate the incidence of leptospirosis in two districts in the Kilimanjaro Region of Tanzania. Methodology/Principal Findings We conducted a population-based household health care utilization survey in two districts in the Kilimanjaro Region of Tanzania and identified leptospirosis cases at two hospital-based fever sentinel surveillance sites in the Kilimanjaro Region. We used multipliers derived from the health care utilization survey and case numbers from hospital-based surveillance to calculate the incidence of leptospirosis. A total of 810 households were enrolled in the health care utilization survey and multipliers were derived based on responses to questions about health care seeking in the event of febrile illness. Of patients enrolled in fever surveillance over a 1 year period and residing in the 2 districts, 42 (7.14%) of 588 met the case definition for confirmed or probable leptospirosis. After applying multipliers to account for hospital selection, test sensitivity, and study enrollment, we estimated the overall incidence of leptospirosis ranges from 75–102 cases per 100,000 persons annually. Conclusions/Significance We calculated a high incidence of leptospirosis in two districts in the Kilimanjaro Region of Tanzania, where leptospirosis incidence was previously unknown. Multiplier methods, such as used in this study, may be a feasible method of improving availability of incidence estimates for neglected diseases, such as leptospirosis, in resource constrained settings. PMID:24340122

  16. KAJIAN EPIDEMIOLOGI KEJADIAN LEPTOSPIROSIS DI KOTA SEMARANG DAN KABUPATEN DEMAK TAHUN 2008

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    Bambang Yuniarto

    2013-09-01

    Full Text Available Leptospirosis is one of rodent borne neglected diseases, but health problem in day. Transmision of Leptospirosis occurs by contact with water or humid soil contaminated with urine from rodent infected with Leptospira. The aim of this research was to know epidemiology Leptospirosis in Semarang City and Demak District, in April-November 2008. The design of this research was cross sectional. The activity included Leptospirosis diagnosis with Rapid Diagostic Test (Leptotek Dri Dot and rat trappings. Data were analysed descriptively by using tables, graphics and maps. The result showed that in 2008, Leptospirosis incidence in the both areas was higher compared to the previous year. The Leptospirosis cases tended to increase in the rainy season. In Semarang City, Leptospirosis cases were mostly found in the age group of 0-19 years (44,1% and 51% of the total cases were female. In Demak District, the cases were mostly found in the age group of 40-49 years (25,7% and 75,7% from the total cases were male. The spesies rats found in this research were Rattus tanezumi, R.norvegicus, B.indica, Mus musculus, R.exculan and Suncus murinus. Kidney test of the rats caught in Semarang City showed Rattus tanezumi, R.norwegicus, B.indica, and R.exculan were infected with Leptospira sp.

  17. DECIPHERING LEPTOSPIROSIS-A DIAGNOSTIC MYSTERY: AN INSIGHT

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    Mohit Bhatia, B L Umapathy

    2015-07-01

    Full Text Available Leptospirosis is an emerging infectious disease which has been recognized as the most common zoonotic infection in the world. It affects human beings and many other species of vertebrates .Most commonly, the infection is acquired by direct or indirect exposure to urine of reservoir animals through contaminated soil, mud & water entering via small abrasions or breaches in the skin & mucous membranes during occupational, recreational or vocational activities. The signs & symptoms resemble a wide range of bacterial & viral diseases & sometimes can present as food poisoning, chemical poisoning & snake bite also due to which the diagnosis is often missed. This review article aims to focus on the role of Dark Field Microscopy (DFM, culture, Enzyme Linked Immuno Sorbent Assay (ELISA, Macroscopic Slide Agglutination test (MSAT, Microscopic Agglutination Test (MAT and Faine’s criteria in the diagnosis of leptospirosis.

  18. Diagnóstico de leptospirosis: evaluación de un enzimoinmunoensayo en fase sólida en diferentes etapas de la enfermedad Diagnosis of leptospirosis: evaluation of a solid-phase enzyme immunoassay in different stages of the disease

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    Norma B. Vanasco

    2007-06-01

    solid-phase enzyme immunoassay (ELISA for genus-specific immunoglobulin G (IgG determination with leptospirosis and to evaluate the ELISA in different stages of the disease. METHODS: A total of 1 077 serum samples from 812 patients with suspected leptospirosis were analyzed. The samples had come from diagnoses done in the laboratory of the National Institute of Respiratory Diseases (Instituto Nacional de Enfermedades Respiratorias, in the city of Santa Fe, Argentina, between 1999 and 2005. Included in the study were 182 confirmed cases (267 samples, 167 negative cases (293 samples, and 40 probable cases (60 samples (based on case definitions based on the results from the microscopic agglutination test (MAT, leukocyte counts, and neutrophilia values. Each sample was classified, according to the days of the natural history of disease, into one of three stages: first ( 25 days. The antigen used in the ELISA was an extract of a mixture of pyrogenes and tarassovi serovars cultivated in a liquid medium, treated with ultrasound, and immobilized by adsorption on polystyrene plates. As a secondary antibody, a peroxidase-conjugated goat anti-human IgG monoclonal antibody was used. The cutoff value, sensitivity, and specificity of the ELISA were determined using the definitions of confirmed cases and of negatives cases as the standard. In order to determine the optimal cutoff value, the area under the receiver operating characteristic curve was calculated. RESULTS: The sensitivity of the evaluated test was much higher in the second stage (93.2% than in either the first stage (68.1% or the third stage (78.8%. The specificity increased gradually from 96.3% in the first stage to 100% in the third stage. CONCLUSIONS: Our results indicate that this ELISA test can be a very useful complement to the MAT for the diagnosis of leptospirosis in all the stages and, in particular, in order to diagnose acute disease sooner.

  19. Leptospirosis risk around a potential source of infection

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    Loaiza-Echeverry, Erica; Hincapié-Palacio, Doracelly; Ochoa Acosta, Jesús; Ospina Giraldo, Juan

    2015-05-01

    Leptospirosis is a bacterial zoonosis with world distribution and multiform clinical spectrum in men and animals. The etiology of this disease is the pathogenic species of Leptospira, which cause diverse manifestations of the disease, from mild to serious, such as the Weil disease and the lung hemorrhagic syndrome with lethal proportions of 10% - 50%. This is an emerging problem of urban health due to the growth of marginal neighborhoods without basic sanitary conditions and an increased number of rodents. The presence of rodents and the probability of having contact with their urine determine the likelihood for humans to get infected. In this paper, we simulate the spatial distribution of risk infection of human leptospirosis according to the proximity to rodent burrows considered as potential source of infection. The Bessel function K0 with an r distance from the potential point source, and the scale parameter α in meters was used. Simulation inputs were published data of leptospirosis incidence rate (range of 5 to 79 x 10 000), and a distance of 100 to 5000 meters from the source of infection. We obtained an adequate adjustment between the function and the simulated data. The risk of infection increases with the proximity of the potential source. This estimation can become a guide to propose effective measures of control and prevention.

  20. Modeling Leptospirosis in Trinidad, West Indies: A Waterborne Zoonosis of Increasing Public Health Importance

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    Vega, M. C.; Opadeyi, J.

    2012-12-01

    Leptospirosis is a waterborne disease which is considered one of the most common and widely spread bacterial zoonosis and a growing global public health problem. Transmission in humans is caused by direct or indirect contact with contaminated water, soil or infected urine, blood or tissue of carrier animals. Because of the similarity with influenza, dengue and viral hepatitis symptoms it is often misdiagnosed with these diseases, but as the leptospirosis progresses, internal organs can be compromised, causing severe syndromes (e.g. Weil's disease), and potentially can cause death. In less developed countries, leptospirosis is often poorly recognized. In humid tropics and subtropics, where this disease has a high impact, climatic and environmental factors, such as rainfall, floods, land cover and their modifications have been frequently related to the occurrence of leptospirosis. In these regions one of the main problems for the study of the role of environmental factors on disease dynamics is the lack of accurate data since, in many cases, data are either unavailable or do not exist at all. Between 1980 and 2005 a total of 12,475 cases of leptospirosis were reported from all Caribbean countries, with 2,370 (19%) of these corresponding to Trinidad and Tobago, where the current average annual incidence rate is 1.84 per 100,000 population based on confirmed cases. In order to explore the underlying spatial variability of leptospirosis occurrence as related to environmental and socio-economic factors, a series of Geographically Weighted Regression (GWR) models were developed. GWR was used to examine the determinants of leptospirosis in the communities of Trinidad using a total of 1,549 reported cases and 250 confirmed cases from 1998 to 2008. MODIS satellite imagery and GIS analysis were used to develop a series of covariables for each community including land cover, vegetation indices, wetness index (ln (α/tanβ)), river length per Ha, topography, percentage of free

  1. Knowledge, attitudes and practices (KAP) regarding leptospirosis among residents of riverside settlements of Santa Fe, Argentina.

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    Ricardo, Tamara; Bergero, Laura C; Bulgarella, Esteban P; Previtali, M Andrea

    2018-05-01

    Leptospirosis is a global and re-emerging zoonotic disease caused by Leptospira spirochetes that are shed into the environment by infected animals. Humans can get infected via contact with animal hosts or contaminated environment. In Argentina, the highest annual incidences were reported in the province of Santa Fe, where epidemic outbreaks occurred during flooding events. This study examined the knowledge, attitudes and practices (KAP) regarding leptospirosis among residents of riverside slum settlements from Santa Fe after a major flood. A cross-sectional questionnaire was administered to 113 residents of 3 riverside settlements from Santa Fe. The influence of knowledge and attitudes regarding leptospirosis on the likelihood that an individual will use preventive practices were evaluated using linear mixed-effects models. The majority of respondents (83.2%) had previously heard about leptospirosis; however specific knowledge about leptospirosis was limited. The results of the modeling efforts, show that the likelihood of using preventive practices was associated with having greater knowledge score, but not with more positive attitudes. We also found that females were more likely to use safer practices than males. Even though the majority of respondents had heard about leptospirosis, a high percentage of them had limited knowledge regarding the severity of the disease and its prevalence in the region. Our results suggest that public health interventions in these riverside communities should focus on educating the public on the multiple dimensions of leptospirosis in order to attain greater adherence to preventive practices instead of intending to change the perceptions or attitudes towards the disease, which did not have a significant influence. The key challenge lies in identifying effective strategies to reach the high risk group for leptospirosis here that is male fishermen, who spend most of the time in precarious campsites on the river islands.

  2. A Case of Anicteric Leptospirosis Presenting with Rectal Bleeding and Hyperpyrexia

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    Handan Ilhan

    2016-06-01

    Full Text Available Leptospirosis is a globally widespread zoonotic infection caused by leptospira-type spirochetes. In humans the infection generally occurs by way of direct or indirect contact with infected animal urine. The main clinical symptoms are fever, septicemia, headache, fatigue and myalgia. The disease usually begins with a high fever. The largest risk factor for leptospirosis is occupational and it includes farmers, ranchers, military personnel and, sewer workers. There is also a risk through recreational exposure such as freshwater swimming and kayaking. This report describes a case of leptospirosis following a course with hyper-pyrexia, for the first time in the medical literature. [Dis Mol Med 2016; 4(2.000: 18-20

  3. Penicillin at the late stage of leptospirosis: a randomized controlled trial

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    Costa Everaldo

    2003-01-01

    Full Text Available There is evidence that an early start of penicillin reduces the case-fatality rate of leptospirosis and that chemoprophylaxis is efficacious in persons exposed to the sources of leptospira. The existent data, however, are inconsistent regarding the benefit of introducing penicillin at a late stage of leptospirosis. The present study was developed to assess whether the introduction of penicillin after more than four days of symptoms reduces the in-hospital case-fatality rate of leptospirosis. A total of 253 patients aged 15 to 76 years with advanced leptospirosis, i.e., more than four days of symptoms, admitted to an infectious disease hospital located in Salvador, Brazil, were selected for the study. The patients were randomized to one of two treatment groups: with intravenous penicillin, 6 million units day (one million unit every four hours for seven days (n = 125 and without (n = 128 penicillin. The main outcome was death during hospitalization. The case-fatality rate was approximately twice as high in the group treated with penicillin (12%; 15/125 than in the comparison group (6.3%; 8/128. This difference pointed in the opposite direction of the study hypothesis, but was not statistically significant (p = 0.112. Length of hospital stay was similar between the treatment groups. According to the results of the present randomized clinical trial initiation of penicillin in patients with severe forms of leptospirosis after at least four days of symptomatic leptospirosis is not beneficial. Therefore, more attention should be directed to prevention and earlier initiation of the treatment of leptospirosis.

  4. Strategies for diagnosis and treatment of suspected leptospirosis: a cost-benefit analysis.

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    Yupin Suputtamongkol

    Full Text Available BACKGROUND: Symptoms and signs of leptospirosis are non-specific. Several diagnostic tests for leptospirosis are available and in some instances are being used prior to treatment of leptospirosis-suspected patients. There is therefore a need to evaluate the cost-effectiveness of the different treatment strategies in order to avoid misuse of scarce resources and ensure best possible health outcomes for patients. METHODS: The study population was adult patients, presented with uncomplicated acute febrile illness, without an obvious focus of infection or malaria or typical dengue infection. We compared the cost and effectiveness of 5 management strategies: 1 no patients tested or given antibiotic treatment; 2 all patients given empirical doxycycline treatment; patients given doxycycline when a patient is tested positive for leptospirosis using: 3 lateral flow; 4 MCAT; 5 latex test. The framework used is a cost-benefit analysis, accounting for all direct medical costs in diagnosing and treating patients suspected of leptospirosis. Outcomes are measured in length of fever after treatment which is then converted to productivity losses to capture the full economic costs. FINDINGS: Empirical doxycycline treatment was the most efficient strategy, being both the least costly alternative and the one that resulted in the shortest duration of fever. The limited sensitivity of all three diagnostic tests implied that their use to guide treatment was not cost-effective. The most influential parameter driving these results was the cost of treating patients with complications for patients who did not receive adequate treatment as a result of incorrect diagnosis or a strategy of no-antibiotic-treatment. CONCLUSIONS: Clinicians should continue treating suspected cases of leptospirosis on an empirical basis. This conclusion holds true as long as policy makers are not prioritizing the reduction of use of antibiotics, in which case the use of the latex test would be

  5. INFEKSI LEPTOSPIROSIS DENGAN GEJALA JAUNDICE DAN ACUTE KIDNEY INJURY: SEBUAH LAPORAN KASUS

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    I Made Ade Sukma Gautama

    2015-01-01

    Full Text Available Infeksi leptospirosis adalah penyakit zoonosis yang disebabkan oleh mikro organisme dari genus Leptospira. Penularan penyakit ini melalui kontak langsung ataupun tidak langsung dari urin hewan yang terinfeksi. Angka perkiraan kejadian infeksi leptospirosis di dunia antara 100 per 100.000 populasi pada grup yang berisiko tinggi, dengan proporsi angka kematian mencapai 22%, tepatnya penanganan yang diberikan akan menurunkan angka kematian akibat infeksi ini dan komplikasi yang lebih berat yang dapat terjadi seperti Weil disease. Laporan kasus ini membahas tentang infeksi leptospirosis pada seorang laki-laki berusia 21 tahun disertai pemeriksaan serologi antibodi leptospira menunjukkan hasil positif. Pada pasien ini dilakukan penanganan berupa hemodialisa cito dan pemberian antibiotik ceftriaxone.

  6. Leptospirosis in Mexico: Epidemiology and Potential Distribution of Human Cases

    Science.gov (United States)

    Sánchez-Montes, Sokani; Espinosa-Martínez, Deborah V.; Ríos-Muñoz, César A.; Berzunza-Cruz, Miriam; Becker, Ingeborg

    2015-01-01

    Background Leptospirosis is widespread in Mexico, yet the potential distribution and risk of the disease remain unknown. Methodology/Principal Findings We analysed morbidity and mortality according to age and gender based on three sources of data reported by the Ministry of Health and the National Institute of Geography and Statics of Mexico, for the decade 2000–2010. A total of 1,547 cases were reported in 27 states, the majority of which were registered during the rainy season, and the most affected age group was 25–44 years old. Although leptospirosis has been reported as an occupational disease of males, analysis of morbidity in Mexico showed no male preference. A total number of 198 deaths were registered in 21 states, mainly in urban settings. Mortality was higher in males (61.1%) as compared to females (38.9%), and the case fatality ratio was also increased in males. The overall case fatality ratio in Mexico was elevated (12.8%), as compared to other countries. We additionally determined the potential disease distribution by examining the spatial epidemiology combined with spatial modeling using ecological niche modeling techniques. We identified regions where leptospirosis could be present and created a potential distribution map using bioclimatic variables derived from temperature and precipitation. Our data show that the distribution of the cases was more related to temperature (75%) than to precipitation variables. Ecological niche modeling showed predictive areas that were widely distributed in central and southern Mexico, excluding areas characterized by extreme climates. Conclusions/Significance In conclusion, an epidemiological surveillance of leptospirosis is recommended in Mexico, since 55.7% of the country has environmental conditions fulfilling the criteria that favor the presence of the disease. PMID:26207827

  7. Sero-epidemiology and hemato-biochemical study of bovine leptospirosis in flood affected zone of Pakistan.

    Science.gov (United States)

    Ijaz, Muhammad; Abbas, Syed Nazar; Farooqi, Shahid Hussain; Aqib, Amjad Islam; Anwar, Ghulam Ali; Rehman, Abdul; Ali, Muhammad Muddassir; Mehmood, Khalid; Khan, Amjad

    2018-01-01

    The bovine leptospirosis is an economically important zoonotic disease of flood affected areas worldwide, but scarce information is available about its epidemiology in Pakistan. This is a first study on sero-epidemiology of bovine leptospirosis in Pakistan. The objectives of this study were to investigate the sero-prevalence and associated risk factors of bovine leptospirosis in flood affected zone of Punjab, Pakistan. A total of 385 serum samples were randomly collected from four tehsils of district Muzaffargarh, Pakistan. The serum samples were subjected to indirect ELISA for the detection of anti-leptospira antibodies. The overall sero-prevalence of leptospirosis was 30.39%. The prevalence was significantly higher (p0.05) difference among TLC values among sero-positive and sero-negative animals. The serum biochemical profile revealed significant differences (pPakistan, and the disease needs to be explored comprehensively in other parts of the country to sort out solid strategies for its control and eradication. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. Leptospirosis, water sports, and chemoprophylaxis

    NARCIS (Netherlands)

    Haake, David A.; Dundoo, Manjula; Cader, Rumi; Kubak, Bernard M.; Hartskeerl, Rudy A.; Sejvar, James J.; Ashford, David A.

    2002-01-01

    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

  9. Human Leptospirosis Trends: Northeast Thailand, 2001–2012

    Directory of Open Access Journals (Sweden)

    Wilawan Thipmontree

    2014-08-01

    Full Text Available The objective of this study was to determine the changing trend of leptospirosis over time in Thailand using two prospective hospital-based studies conducted amongst adult patients with acute undifferentiated fever (AUFI admitted to Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima Province, Thailand between July 2001 to December 2002 and between July 2011 to December 2012. During the first period, leptospirosis (98 patients, 40% and scrub typhus (59 patients, 24.1% were the two major causes of AUFI. In the second period, scrub typhus (137 patients, 28.3% was found to be more common than leptospirosis (61 patients, 12.7%. Amongst patients with leptospirosis, the proportion of male patients and the median age were similar. Leptospira interrogans serogroup Autumnalis was the major infecting serogroup in both study periods. The case fatality rate of leptospirosis was significantly higher in 2011–2012 as compared with the case fatality rate in 2001–2002 (19.7% vs. 6.3%, p < 0.001. In summary, we found that number of leptospirosis cases had decreased over time. This trend is similar to reportable data for leptospirosis complied from passive surveillance by the Ministry of Public Health, Thailand. However, the case fatality rate of severe leptospirosis has increased. Severe lung hemorrhage associated with leptospirosis remained the major cause of death.

  10. Perceptions and risky behaviors associated with Leptospirosis in an ...

    African Journals Online (AJOL)

    Background: Leptospirosis, a disease caused by Leptospira species, a spirochaete bacterium that can develop in an appropriate ... can exist in human and animal hosts and in soil, water, ... Infection can be transmitted from animals to humans.

  11. Hypoxemic Respiratory Failure from Acute Respiratory Distress Syndrome Secondary to Leptospirosis

    Directory of Open Access Journals (Sweden)

    Shannon M. Fernando

    2017-01-01

    Full Text Available Acute respiratory distress syndrome (ARDS, characterized by hypoxemic respiratory failure, is associated with a mortality of 30–50% and is precipitated by both direct and indirect pulmonary insults. Treatment is largely supportive, consisting of lung protective ventilation and thereby necessitating Intensive Care Unit (ICU admission. The most common precipitant is community-acquired bacterial pneumonia, but other putative pathogens include viruses and fungi. On rare occasions, ARDS can be secondary to tropical disease. Accordingly, a history should include travel to endemic regions. Leptospirosis is a zoonotic disease most common in the tropics and typically associated with mild pulmonary complications. We describe a case of a 25-year-old male with undiagnosed leptospirosis, presenting with fever and severe hypoxemic respiratory failure, returning from a Costa Rican holiday. There was no other organ failure. He was intubated and received lung protective ventilation. His condition improved after ampicillin and penicillin G were added empirically. This case illustrates the rare complication of ARDS from leptospirosis, the importance of taking a travel history, and the need for empiric therapy because of diagnostic delay.

  12. Pembelian Ternak dan Kelembaban Tinggi Merupakan Faktor Risiko Leptospirosis pada Sapi di Girimulyo, Kulon Progo, Jogjakarta (PURCHASE OF CATTLE AND HIGH HUMIDITY WERE RISK FACTORS OF BOVINE LEPTOSPIROSIS IN GIRIMULYO, KULON PROGO DISTRICT

    Directory of Open Access Journals (Sweden)

    Guntari Titik Mulyani

    2014-08-01

    Full Text Available Leptospirosis is an acute infectious disease could to attack humans and animals such as dogs, cats,cows, pigs, and wild animals such as rats, weasels and squirrels. The death rate of human leptospirosis inIndonesia reached 2.5 to 16.5%. Leptospirosis attacked approximately 274 residents, 18 fatalities atKulonprogo disctrict, and designated as Extraordinary Events in 2011. The purpose of this reasearch is todetermine risk factors affecting the prevalence of leptospirosis in cattle in the area of human leptospirosisin Girimulyo, Kulon Progo. This study used 132 samples of cattle blood. Methods of examination withMicro Aglutination Test (MAT conducted at the Center for Veterinary Research, Bogor. Micro AglutinationTest is done by creating a serum dilution with PBS in stages then added antigen in the form of various cultures leptospira serovar. Subsequently incubated at 28-30 ° C for 2 hours, and was reading the resultsunder a microscope dark field / phase contrast. Endpoint reading was 50% agglutination, highest finalserum dilution in serum-antigen mixtures that showed 50% agglutination is called the titer. Serum witha titer of 1:100 or more against one or more tested positive for serovar. Micro Aglutination Test result wasthe dependent variable (Y, while the independent variables (X were factors of farmers, animal factors,enclosure factors, and feed factors. Univariate analysis was done to see descriptively each variable studied.Association between the prevalence of leptospirosis and risk factors was analyzed by Chi Square.Multivariate Logistic Regression Analysis was used to build models of leptospirosis disease to investigatethe risk factors associated with leptospirosis. Variables that influence the prevalence of leptospirosiswere measured magnitude of association by Odd Ratio. The results of study that the prevalence of bovineleptospirosis in Girimulyo subdistrict, Kulonprogo district was 7.6%. Risk factors for the prevalence ofleptospirosis

  13. Influence of Topographic and Hydrographic Factors on the Spatial Distribution of Leptospirosis Disease in São Paulo County, Brazil: An Approach Using Geospatial Techniques and GIS Analysis

    Science.gov (United States)

    Ferreira, M. C.; Ferreira, M. F. M.

    2016-06-01

    Leptospirosis is a zoonosis caused by Leptospira genus bacteria. Rodents, especially Rattus norvegicus, are the most frequent hosts of this microorganism in the cities. The human transmission occurs by contact with urine, blood or tissues of the rodent and contacting water or mud contaminated by rodent urine. Spatial patterns of concentration of leptospirosis are related to the multiple environmental and socioeconomic factors, like housing near flooding areas, domestic garbage disposal sites and high-density of peoples living in slums located near river channels. We used geospatial techniques and geographical information system (GIS) to analysing spatial relationship between the distribution of leptospirosis cases and distance from rivers, river density in the census sector and terrain slope factors, in Sao Paulo County, Brazil. To test this methodology we used a sample of 183 geocoded leptospirosis cases confirmed in 2007, ASTER GDEM2 data, hydrography and census sectors shapefiles. Our results showed that GIS and geospatial analysis techniques improved the mapping of the disease and permitted identify the spatial pattern of association between location of cases and spatial distribution of the environmental variables analyzed. This study showed also that leptospirosis cases might be more related to the census sectors located on higher river density areas and households situated at shorter distances from rivers. In the other hand, it was not possible to assert that slope terrain contributes significantly to the location of leptospirosis cases.

  14. Knowledge, Attitudes, and Practices Related to Leptospirosis among Urban Slum Residents in Brazil

    Science.gov (United States)

    Navegantes de Araújo, Wildo; Finkmoore, Brooke; Ribeiro, Guilherme S.; Reis, Renato B.; Felzemburgh, Ridalva D. M.; Hagan, José E.; Reis, Mitermayer G.; Ko, Albert I.; Costa, Federico

    2013-01-01

    Leptospirosis disproportionately affects residents of urban slums. To understand the knowledge, attitudes, and practices regarding leptospirosis, we conducted a cross-sectional study among residents of an urban slum community in Salvador, Brazil. Of the 257 residents who were interviewed, 225 (90%) were aware of leptospirosis and more than two-thirds of respondents correctly identified the modes of disease transmission and ways to reduce exposure. However, study participants who performed risk activities such as cleaning open sewers had limited access to protective clothing such as boots (33%) or gloves (35%). Almost all respondents performed at least one activity to prevent household rat infestation, which often included use of an illegal poison. Our findings support the need for interventions targeted at the individual and household levels to reduce risk of leptospirosis until large-scale structural interventions are available to residents of urban slum communities. PMID:23269657

  15. PEMETAAN MODEL KERAWANAN LEPTOSPIROSIS BERDASARKAN FAKTOR RISIKO LINGKUNGAN DAN TRAP SUCCESS DI BANTUL, YOGYAKARTA

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    Sunaryo Sunaryo

    2016-09-01

    Full Text Available ABSTRACTLeptospirosis is zoonotic disease, which is caused by leptospira bacteria and transmitted to human bycontact with contaminated animal urine. Bantul District is endemic area of leptospirosis, case fatality rateas much 11% in 2010. The aim of this research was to study distribution of spatial epidemiologyleptospirosis, and mapping of vulnerable leptospirosis model by using Geographical Information Systembased on environmental risk factor and trap success in Bantul.This research done in March until November2011, and applied spatial analysis by using cross sectional design. Result of this research• showedleptospirosis cases in 2011 reaching 135 cases, and group of adult men was dominant, mostly as farmer andveteriner worker. There were three claster with average distance between cases: 0 km and furthermost 30km. Leptospirosis pattern increased in March and April when high rainfall. Medium rainfall spatial,lowland, vegetation index medium, alluvial type of soil, existence of rat and landuse of ricefield wereenvironmental variable influence leptospirosis cases. High vulnerable leptospirosis zone located in Centerand West Bantul.Keyword : Mapping, leptospirosis, vulnerable model. ABSTRAK Leptospirosis merupakan penyakit bersumber rodensia, disebabkan oleh bakteri leptospira, menular melalui kulit luka atau mukosa dengan air/tanah tercemar leptospira dariurine binatang. Kabupaten Bantul merupakan daerah endemis leptospirosis,case fatality rate mencapai11% pada tahun2010. Penelitian ini bertujuan ingin mengetahui persebaran epidemiologi spasial leptospirosis, dan pemetaanmodel daerah rawan Leptospirosisdi Kabupaten Bantul berdasarkan faktor risiko lingkungan dan trap success tikus dengan aplikasi Sistem Informasi Geografis. Penelitian ini dilakukanpada Bulan Maret sampaiNovember 2011, menggunakan metode analisis spasial deskriptif dengan pendekatan potong lintang. Hasil: Kasus leptospirosispada tahun2011 mencapai135 kasusyang didominasi oleh

  16. Clinical manifestation, serology marker & microscopic agglutination test (MAT) to mortality in human leptospirosis

    Science.gov (United States)

    Perdhana, S. A. P.; Susilo, R. S. B.; Arifin; Redhono, D.; Sumandjar, T.

    2018-03-01

    Leptospirosis is a potentially fatal zoonosis that is endemic in many tropical regions and causes large epidemics after heavy rainfall and flooding. Severe disease is estimated 5–15% of all human infections. Its mortality rate is 5-40%. MAT, isolation of the organism, or leptospiral DNA in PCR are used to confirm Leptospirosis. This cross-sectional analytic study recruited 26 hospitalized leptospirosis patients admitted to Dr. Moewardi Hospital Surakarta. The diagnosis was based on clinical, laboratory and epidemiological findings. The onset of the disease was the date when the first symptom started, and the end of the analysis was the date when the patient died or discharged. Modified Faine’s score ≥ 25 tend to die (45.5%) while modified Faine’s score 20 – 24 tend to heal (60%) (OR 1.250; CI 0.259-6.029; p=1.0). Seropositive IgM predicts mortality 7.8 times higher than seronegative IgM (OR 7.800; CI 1.162-52.353; p=0.038). MAT positive predict mortality 10.667 times higher than MAT negative (OR 10.667; CI 1.705-66.720; p=0.015). Clinical manifestation, MAT, and serologic marker are all correlated with mortality in Leptospirosis. However, statistically, clinical manifestation has an insignificant correlation.

  17. Leptospirosis in American Samoa 2010: epidemiology, environmental drivers, and the management of emergence.

    Science.gov (United States)

    Lau, Colleen L; Dobson, Annette J; Smythe, Lee D; Fearnley, Emily J; Skelly, Chris; Clements, Archie C A; Craig, Scott B; Fuimaono, Saipale D; Weinstein, Philip

    2012-02-01

    Leptospirosis has recently been reported as an emerging disease worldwide, and a seroprevalence study was undertaken in American Samoa to better understand the drivers of transmission. Antibodies indicative of previous exposure to leptospirosis were found in 15.5% of 807 participants, predominantly against three serovars that were not previously known to occur in American Samoa. Questionnaires and geographic information systems data were used to assess behavioral factors and environmental determinants of disease transmission, and logistic regression was used to identify factors associated with infection. Many statistically significant factors were consistent with previous studies, but we also showed a significant association with living at lower altitudes (odds ratio [OR] = 1.53, 95% confidence interval [CI]: 1.03-2.28), and having higher numbers of piggeries around the home (OR = 2.63, 95% CI: 1.52-4.40). Our findings support a multifaceted approach to combating the emergence of leptospirosis, including modification of individual behavior, but importantly also managing the evolving environmental drivers of risk.

  18. Retrospective Study of Leptospirosis in Malaysia.

    Science.gov (United States)

    Garba, Bashiru; Bahaman, Abdul Rani; Khairani-Bejo, Siti; Zakaria, Zunita; Mutalib, Abdul Rahim

    2017-06-01

    Leptospirosis is a bacterial disease transmitted to humans and animals by direct or indirect contact with urine or body fluids from infected animals especially rodents. Infection can be associated with wide clinical spectrum varying from asymptomatic to severe multi-organ syndrome with life-threatening consequences. We conducted a review of published studies on incidences, case reports, sero-epidemiological surveys from year 2000 to 2015 using different electronic data bases. Our study revealed that majority of the studies were conducted in Peninsular Malaysia and predominantly among high-risk human groups. Most of the studies on domestic animals were conducted in the 1980s; hence, the current status of leptospirosis among domestic animal population remains largely unknown. There tend to be a sharp rise in incidence rate among human population in the year 2014 which was attributed to flooding and heavy rainfall experienced as well as recreational activities. Several gaps in epidemiological knowledge were also disclosed.

  19. Pathology and pathophysiology of pulmonary manifestations in leptospirosis

    Directory of Open Access Journals (Sweden)

    Marisa Dolhnikoff

    Full Text Available Leptospirosis is a re-emerging zoonosis occurring as large outbreaks throughout the world caused by Leptospira interrogans. The incidence of pulmonary involvement in leptospirosis has been reported to be increasing in the last years, affecting up to 70% of the patients. Alveolar hemorrhage presented as dyspnea and hemoptysis is the main pulmonary manifestation. The emergence of massive hemoptysis and acute respiratory distress syndrome has characterized the recent changes reported in the clinical patterns of leptospirosis. The pulmonary involvement has been emerged as a serious life threat, becoming the main cause of death due to leptospirosis in some countries. In this review we present the main clinical and pathological manifestations of pulmonary involvement in leptospirosis, with special focus on recent data concerning the pathophysiological mechanisms underlying lung injury.

  20. Exploring governance for a One Health collaboration for leptospirosis prevention and control in Fiji: Stakeholder perceptions, evidence, and processes.

    Science.gov (United States)

    McPherson, Anna; Hill, Peter S; Kama, Mike; Reid, Simon

    2018-03-30

    Fiji has a high burden of leptospirosis, with endemic infection and epidemic outbreaks with high mortality, often associated with flooding and cyclones. As a zoonosis, leptospirosis control requires interventions in sectors beyond the usual control of health-in Fiji, the dairy and sugar industries, and water and sanitation and rodent control in communities. This paper presents the findings of qualitative research to inform policy around governance for a One Health multisectoral approach to leptospirosis control. Key informants from relevant government agencies and industry organizations were interviewed in late 2014, and the interviews analyzed and triangulated with documentary analysis. The analysis identified 5 themes: perceptions of the impact of leptospirosis, governance processes, models for collaboration, leptospirosis control, and preferred leadership for leptospirosis management. Data were limited, with poor communication between ministries, and limited awareness of leptospirosis outside outbreaks. Collaboration during outbreaks was positive but not sustained in endemic periods. Mechanism for enhanced collaboration was developed for endemic and outbreak situations. The findings informed a One Health governance approach to leptospirosis, framed within a National Strategic Plan, with a specific National Action Plan for Leptospirosis. The process provides a research based One Health template for application to other zoonotic diseases. Copyright © 2018 John Wiley & Sons, Ltd.

  1. Differential cytokine gene expression according to outcome in a hamster model of leptospirosis.

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    Frédérique Vernel-Pauillac

    Full Text Available BACKGROUND: Parameters predicting the evolution of leptospirosis would be useful for clinicians, as well as to better understand severe leptospirosis, but are scarce and rarely validated. Because severe leptospirosis includes septic shock, similarities with predictors evidenced for sepsis and septic shock were studied in a hamster model. METHODOLOGY/PRINCIPAL FINDINGS: Using an LD50 model of leptospirosis in hamsters, we first determined that 3 days post-infection was a time-point that allowed studying the regulation of immune gene expression and represented the onset of the clinical signs of the disease. In the absence of tools to assess serum concentrations of immune effectors in hamsters, we determined mRNA levels of various immune genes, especially cytokines, together with leptospiraemia at this particular time-point. We found differential expression of both pro- and anti-inflammatory mediators, with significantly higher expression levels of tumor necrosis factor alpha, interleukin 1alpha, cyclo-oxygenase 2 and interleukin 10 genes in nonsurvivors compared to survivors. Higher leptospiraemia was also observed in nonsurvivors. Lastly, we demonstrated the relevance of these results by comparing their respective expression levels using a LD100 model or an isogenic high-passage nonvirulent variant. CONCLUSIONS/SIGNIFICANCE: Up-regulated gene expression of both pro- and anti-inflammatory immune effectors in hamsters with fatal outcome in an LD50 model of leptospirosis, together with a higher Leptospira burden, suggest that these gene expression levels could be predictors of adverse outcome in leptospirosis.

  2. Faktor Risiko Kejadian Luar Biasa (KLB Leptospirosis Paska Banjir di Kabupaten Pati Tahun 2014

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    Nova Pramestuti

    2015-09-01

    Full Text Available Leptospirosis is a disease caused by Leptospira which transmitted by reservoir. Flood can increase risk of the transmission. There had been flood in Pati District in January 2014 and then outbreaks occured afterwards. The objective of this study was to identify risk factors for leptospirosis outbreaks after flood in Pati district 2014. The research was conducted in Pati in March 2014, with cross sectional design. Data were collected by interviews of 35 persons using a structured questionnaire. The results showed that cases of leptospirosis mostly in flood areas (75.7%, dominant in male sex (74.4% and 15-44 years age group (41.9%. The most significant risk factor were contact with water/irrigation canal in rice fields (RP = 4.81 and cuts and abrasions in the skin (RP = 4.57. Another risk factor were cleaning drains/sewers which stagnant, contact with stagnant water around the house/ floodwater, contact with rats, and job at risk such as farmers, cattleman, fishermen, fishpond workers, looking for stone in river. The risk factors were important epidemiological in transmission of leptospirosis outbreaks which associated with flood in Pati District.Key words: risk factor, outbreak, leptospirosis, flood

  3. Incidence of Leptospirosis infection in the East Zone of Sao Paulo City, Brazil

    Science.gov (United States)

    2013-01-01

    Background Leptospirosis is a zoonosis which is spread through contamined running water. This contaminations is seriously affected by the flooding which occurs in the area surrounding the Aricanduva river. The transmission of the disease results mainly from the contact of water with soil contaminated by the urine of infected animals. We aimed to conduct an epidemiological survey on Leptospirosis cases in Sao Paulo East Zone area. Method The analysis conducted in this study was based on data collected from the health authorities of that region close the Aricanduva river between 2007 and 2008 years, which give the rates of confirmed cases, mortality and death from human Leptospirosis. Other information concerned with the relationships among rainfall index, points of flooding and incidence of Leptospirosis. Results We observed a direct and important water contamination. Records of flooding points and dates of the reported cases in the region showed a direct relationship from which the period of higher rainfall also recorded an increase in cases. The annual record of the city and the region and rainfall regions also presented correlation. Conclusion The association between the indices of flooding and Leptospirosis cases indicates that preventive measures are necessary to avoid exposing the community. PMID:23672682

  4. Travel-related leptospirosis: a series of 15 imported cases.

    Science.gov (United States)

    van de Werve, Charlotte; Perignon, Alice; Jauréguiberry, Stéphane; Bricaire, François; Bourhy, Pascal; Caumes, Eric

    2013-01-01

    Leptospirosis belongs to the spectrum of travel-related infections. We retrospectively studied all the consecutive cases of travel-related leptospirosis seen in our department between January 2008 and September 2011. Patients were included with a clinical picture compatible with the disease within 21 days after return, the presence of a thermoresistant antigen or IgM antibodies, Elisa ≥ 1 /400, and a positive microagglutination test (MAT) ≥ 1/100. Fifteen leptospirosis cases were evaluated. Exposure occurred in Asia (47%), Africa (20%), the Caribbean (20%), and Indian Ocean (13%). Fourteen patients were infected during water-related activities. On admission the most frequent symptoms were fever (100%), headache (80%), and digestive disorders (67%). Relevant laboratory findings included impaired liver function tests (100%), lymphocytopenia (80%), thrombocytopenia (67%), and elevated C-reactive protein (CRP) (67%). Our cases were confirmed by MAT that found antibodies against nine different serovars. Seven patients were cured with amoxicillin, four with doxycycline, two with ceftriaxone, one with ceftriaxone, doxycycline, and spiramycin, whereas one recovered spontaneously (retrospective diagnosis). Eight patients were hospitalized. All patients recovered. Our cases involved nine different serovars. They were related to travel in Asia, Africa, and the Caribbean. Bathing or other fresh-water leisure activities (canoeing, kayaking, rafting) are the most likely at-risk exposure. Any traveler with fever and at-risk exposure should be investigated for leptospirosis. © 2013 International Society of Travel Medicine.

  5. Perceptions and risky behaviors associated with Leptospirosis in an ...

    African Journals Online (AJOL)

    Background: Leptospirosis, a disease caused by Leptospira species, a spirochaete bacterium that can develop in an appropriate environment and/or grow in human and/or animal hosts, is a serious problem for the Ministry of Public Health, Thailand. Objective: To investigate people's perceptions and behavioral risks ...

  6. Leptospirosis in Rio Grande do Sul, Brazil: An Ecosystem Approach in the Animal-Human Interface

    Science.gov (United States)

    Schneider, Maria Cristina; Najera, Patricia; Pereira, Martha M.; Machado, Gustavo; dos Anjos, Celso B.; Rodrigues, Rogério O.; Cavagni, Gabriela M.; Muñoz-Zanzi, Claudia; Corbellini, Luis G.; Leone, Mariana; Buss, Daniel F.; Aldighieri, Sylvain; Espinal, Marcos A.

    2015-01-01

    Background Leptospirosis is an epidemic-prone neglected disease that affects humans and animals, mostly in vulnerable populations. The One Health approach is a recommended strategy to identify drivers of the disease and plan for its prevention and control. In that context, the aim of this study was to analyze the distribution of human cases of leptospirosis in the State of Rio Grande do Sul, Brazil, and to explore possible drivers. Additionally, it sought to provide further evidence to support interventions and to identify hypotheses for new research at the human-animal-ecosystem interface. Methodology and findings The risk for human infection was described in relation to environmental, socioeconomic, and livestock variables. This ecological study used aggregated data by municipality (all 496). Data were extracted from secondary, publicly available sources. Thematic maps were constructed and univariate analysis performed for all variables. Negative binomial regression was used for multivariable statistical analysis of leptospirosis cases. An annual average of 428 human cases of leptospirosis was reported in the state from 2008 to 2012. The cumulative incidence in rural populations was eight times higher than in urban populations. Variables significantly associated with leptospirosis cases in the final model were: Parana/Paraiba ecoregion (RR: 2.25; CI95%: 2.03–2.49); Neossolo Litolítico soil (RR: 1.93; CI95%: 1.26–2.96); and, to a lesser extent, the production of tobacco (RR: 1.10; CI95%: 1.09–1.11) and rice (RR: 1.003; CI95%: 1.002–1.04). Conclusion Urban cases were concentrated in the capital and rural cases in a specific ecoregion. The major drivers identified in this study were related to environmental and production processes that are permanent features of the state. This study contributes to the basic knowledge on leptospirosis distribution and drivers in the state and encourages a comprehensive approach to address the disease in the animal

  7. FLOWCYTOMETRY IN LEPTOSPIROSIS

    Directory of Open Access Journals (Sweden)

    Galya I. Gancheva

    2008-05-01

    Full Text Available Differential count of leucocytes and six lymphocyte populations and subpopulations were investigated by flow cytometry in fourteen cases with leptospirosis. Marked granulocytosis and lymphopenia were found in 100%. The percentage of the monocytes was significantly decreased (mean 6,65%; 0,7 to 14,0%; sd 5,49. Immunophenotypization of lymphocyte populations and subpopulations by flow cytometry was revealed prevalent tendencies for decreasing of the number of total T-lymphocytes, T-helpers, T-suppressors, T-helpers/T-suppressors index; increasing of the number of the activated T-lymphocytes, subpopulation of NK cells (CD3-/ CD16+56+, and B-lymphocyte. These data are suggested that cell-mediated immunity plays a role in later stages of the diseases.

  8. Serological Prevalence of Leptospirosis Among Rural Communities in the Rejang Basin, Sarawak, Malaysia.

    Science.gov (United States)

    Suut, Lela; Mazlan, Mohamad Nur-Azim; Arif, Mohamad Taha; Yusoff, Haironi; Abdul Rahim, Nor-Aliza; Safii, Razitasham; Suhaili, Mohamad Raili

    2016-07-01

    Leptospirosis is an important zoonotic disease globally and is endemic in Malaysia. A study was conducted in the Rejang basin of Sarawak from June 2011 to May 2013 to determine the seroprevalence of leptospirosis among the communities and dominant infecting Leptospira serovars. A total of 508 human sera were analyzed using ELISA and the microscopic agglutination test (MAT). The seroprevalence of leptospirosis in the study area was 37.4%, with the highest prevalence in Kapit division. More women were positive for leptospirosis (59.5%), and the mean age of seropositive individuals was 42.2 (SD = 18.7) years. Antibody titers between 1:50 and 1:1600 were reported, and serovars djasiman (22.1%), shermani (13.2%), and pomona (7.9%) predominated, with varied distribution between geographical locations. This study highlighted the endemicity and diversity of existing Leptospira serovars within the community. This information should be communicated to local health personnel and communities at risk, and rapid diagnostic capability should be made available to local health facilities. © 2016 APJPH.

  9. Leptospirosis in Cattle From Markets of Almaty Province, Kazakhstan

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    Kirkimbayeva Zhumagul

    2015-04-01

    Full Text Available This paper is the first study of the prevalence of leptospirosis in the cattle at slaughter from a rural area of Kazakhstan. Five hundred and seventy three samples of serum, urine, and kidneys from cattle of Alatau, Kazakh white and Auliyekol breed, aged from 2 to 5 years (unknown vaccination status, from the province of Almaty in the South-Eastern region were collected during four years (March 2010 to October 2013. The serological, bacteriological, and molecular analyses were performed. Serum samples were tested with 14 reference Leptospira serovars by microscopic agglutination test (MAT. MAT results showed that 89 (15.53% serum samples had detectable antibodies against seven serovars of L. interrogans at a dilution of ≥1:100. Serovars: Pomona (38.2%, Tarassovi (27.2%, and Kabula (18.8% were the most prevalent and their titres ranged from 100 to 1200. The spirochetes were detected in 11 samples of urine and nine samples of kidneys under dark-field microscope observation. The pure cultures were obtained from three samples. PCR technique confirmed leptospirosis in 23 out of 89 urine samples from cows, which showed the presence of leptospiral antibodies in microagglutination test. The high disease prevalence in cows indicates the high Leptospira contamination in this area. It was concluded that the bovine leptospirosis is an endemic and locally widespread disease in Kazakhstan, and that it may play a role in zoonotic transmission to humans.

  10. A Reevaluation of the Effectiveness of Homoeoprophylaxis Against Leptospirosis in Cuba in 2007 and 2008.

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    Golden, Isaac; Bracho, Gustavo

    2014-07-01

    In 2007 and 2008, Cuban health officials conducted large homoeoprophylaxis interventions against rising rates of leptospirosis caused by extensive hurricane damage. Published results showed that the interventions were highly successful, but some questions regarding possible confounders were raised. The objective of this research was to assess the influence of potential confounders on initial results. Weekly leptospirosis reporting data entries for 9 years were checked to ensure data consistency. Some errors in weekly reports for 2000-2008 were discovered, and corrected, and the changes incorporated in this analysis. The corrected data was reanalyzed to investigate the impact of potential confounders. New analyses of the timing and extent of vaccination and chemoprophylaxis in 2007 and 2008 and changes in leptospirosis notifications were presented. The results support the previous conclusions that homoeoprophylaxis can be used to effectively immunize people against targeted infectious diseases such as leptospirosis. © The Author(s) 2014.

  11. Leptospirosis following a major flood in Central Queensland, Australia.

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    Smith, J K G; Young, M M; Wilson, K L; Craig, S B

    2013-03-01

    Throughout December 2010 and January 2011, Queensland experienced widespread flooding due to unusually protracted and heavy rainfalls. In mid-January 2011, four individuals from a small community in Central Queensland were hospitalized with leptospirosis. A further five cases were subsequently identified from around Central Queensland, bringing the total to nine. Microscopic agglutination testing found that serovar Arborea (Leptospira borgpetersenii serovar Arborea) was presumptively responsible for leptospirosis in seven of nine confirmed cases. Serovars Hardjo and Australis were identified in samples from two remaining cases. All cases had exposure to flood water. No single exposure source was identified. This is the first reported outbreak of leptospirosis in Central Queensland and the first report of leptospirosis cases associated with flood water inundation in Queensland. Public health authorities should continue to promote awareness of leptospirosis in flood-affected populations. Healthcare providers must maintain a high level of suspicion for leptospirosis during and after flood events.

  12. Cross-protection between experimental anti-leptospirosis bacterins

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    Cristina Corsi Dib

    2014-09-01

    Full Text Available We investigated the existence of cross-protection between two anti-leptospirosis monovalent experimental bacterins produced with two strains of Leptospira serogroup Pomona: Fromm strain of serovar Kennewicky, isolated from pigs in the United States, and strain GR6 of serovar Pomona isolated from pigs in Brazil. Both were added of aluminum hydroxide as an adjuvant. Experimental bacterins were tested with the hamster potency test in order to assess protection provided against the disease and against the establishment of kidney infection. Controls were polyvalent commercial vaccine produced with Leptospira strains isolated outside Brazil, which included a representative of Pomona serovar, or Sorensen solution added of aluminum hydroxide adjuvant. The challenge was performed with cross-strains of serogroup Pomona tested in accordance with international standards established for the potency test. After 21 days of the challenge, survivors were killed to evaluate the condition of Leptospira renal carrier. Experimental bacterins protected hamsters against homologous and heterologous strains, demonstrating the existence of cross-protection. The commercial vaccine protected the hamsters challenged with both strains, but there was a high proportion of animals diagnosed as renal carriers when the challenge was performed with strain GR6, isolated from pigs in Brazil.

  13. Cross-protection between experimental anti-leptospirosis bacterins

    Science.gov (United States)

    Dib, Cristina Corsi; Gonçales, Amane Paldês; de Morais, Zenaide Maria; de Souza, Gisele Oliveira; Miraglia, Fabiana; Abreu, Patricia Antonia Estima; Vasconcellos, Silvio Arruda

    2014-01-01

    We investigated the existence of cross-protection between two anti-leptospirosis monovalent experimental bacterins produced with two strains of Leptospira serogroup Pomona: Fromm strain of serovar Kennewicky, isolated from pigs in the United States, and strain GR6 of serovar Pomona isolated from pigs in Brazil. Both were added of aluminum hydroxide as an adjuvant. Experimental bacterins were tested with the hamster potency test in order to assess protection provided against the disease and against the establishment of kidney infection. Controls were polyvalent commercial vaccine produced with Leptospira strains isolated outside Brazil, which included a representative of Pomona serovar, or Sorensen solution added of aluminum hydroxide adjuvant. The challenge was performed with cross-strains of serogroup Pomona tested in accordance with international standards established for the potency test. After 21 days of the challenge, survivors were killed to evaluate the condition of Leptospira renal carrier. Experimental bacterins protected hamsters against homologous and heterologous strains, demonstrating the existence of cross-protection. The commercial vaccine protected the hamsters challenged with both strains, but there was a high proportion of animals diagnosed as renal carriers when the challenge was performed with strain GR6, isolated from pigs in Brazil. PMID:25477946

  14. ANALYSIS OF ENVIRONMENTAL FACTORS FOR LEPTOSPIROSIS CASES IN TULUNGAGUNG DISTRICT

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    Arief Nugroho

    2016-01-01

    Full Text Available Leptospirosis merupakan penyakit zoonosis. Pada tahun 2012 ditetapkan Kejadian Luar Biasa (KLB dengan ditemukannya dua kasus leptospirosis di dua kecamatan dengan satu kasus meninggal. Tujuan penelitian untuk menganalisis hubungan faktor lingkungan terhadap kejadian leptospirosis di Kabupaten Tulungagung. Rancangan penelitian yaitu cross sectional dilakukan melalui observasi lokasi, pengukuran lingkungan abiotik dan observasi kondisi rumah penduduk. Lokasi penelitian di Dusun Banjar, Desa Picisan RT 3 RW 1 Kecamatan Sendang, Kabupaten Tulungagung. Besar sampel sebanyak 50 rumah. Analisis data berupa analisis deskriptif dan statistik dengan uji Chi square. Hasil penelitian menunjukkan bahwa adanya sampah terbuka di depan atau belakang rumah berhubungan dengan kejadian leptospirosis dan mempunyai resiko 16,3 kali lebih besar dalam penyebaran leptospirosis. pH, salinitas dan kelembaban udara menunjang pertumbuhan bakteri Leptospira sp. pada badan air alami. Kata kunci: leptospirosis, Tulungagung, lingkungan

  15. Mapping of leptospirosis risk factor based on remote sensing image in Tembalang, Semarang City, Central Java

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    Sunaryo Sunaryo

    2012-09-01

    Full Text Available AbstrakLatar belakang: Leptospirosis merupakan penyakit zoonosis yang disebabkan oleh bakteri leptospira dan menular kepada manusia melalui kontak dengan urine hewan dan lingkungan yang terkontaminasi bakteri leptospira. Kecamatan Tembalang merupakan daerah endemis leptospirosis selama tiga tahun terakhir. Tujuan penelitian ini mengkaji kegunaan citra penginderaan jauh untuk pemetaan faktor risiko lingkungan leptospirosis.Metode: Penelitian ini menggunakan cara potong lintang, subyek sebanyak 246 dipetakan dengan GPS. Dengan program ArcGis 9.2 kasus leptospirosis ditumpang susun dengan citra Quickbird, kemudian dilakukan interpretasi kenampakan visual, dan dilakukan digitasi layar untuk identifi kasi faktor risiko secara visual.Hasil: Berdasarkan visualisasi digital diperoleh data bahwa kasus leptospirosis tahun 2009 terbanyak tersebar membentuk klaster di wilayah Tembalang dengan indeks jarak terdekat 0,009 km, sedangkan indeks jarak terjauh 18 km. Kasus lebih banyak ditemukan pada anak-anak dan remaja laki-laki, secara temporal kasus meningkat pada musim kemarau, antara bulan Juli dan Agustus. Hasil interpretasi visual dan digitasi diperoleh peta penggunaan lahan, badan air, pemukiman, area luasan banjir, kerapatan vegetasi dan ketinggian tempat.Kesimpulan: Citra penginderaan jauh resolusi spasial tinggi sangat baik untuk pemetaan faktor risiko leptospirosis. Sebaran kasus leptospirosis membentuk klaster di wilayah Tembalang, kasus didominasi anakanakdan remaja laki-laki. (Health Science Indones 2012;1:45-50Kata kunci: citra penginderaan jauh, leptospirosis, Tembalang AbstractBackground: Leptospirosis is a zoonotic disease, caused by leptospira bacteria and transmitted to human by contact though contaminated animal urine and environment. Tembalang Sub District is endemic area ofleptospirosis and increased at last three years. The aim of this research was to study the ability and usefulness of image remote sensing for mapping as distribution

  16. Spatial epidemiology of suspected clinical leptospirosis in Sri Lanka.

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    Robertson, C; Nelson, T A; Stephen, C

    2012-04-01

    Leptospirosis is one of the most widespread zoonoses in the world. A large outbreak of suspected human leptospirosis began in Sri Lanka during 2008. This study investigated spatial variables associated with suspected leptospirosis risk during endemic and outbreak periods. Data were obtained for monthly numbers of reported cases of suspected clinical leptospirosis for 2005-2009 for all of Sri Lanka. Space-time scan statistics were combined with regression modelling to test associations during endemic and outbreak periods. The cross-correlation function was used to test association between rainfall and leptospirosis at four locations. During the endemic period (2005-2007), leptospirosis risk was positively associated with shorter average distance to rivers and with higher percentage of agriculture made up of farms <0·20 hectares. Temporal correlation analysis of suspected leptospirosis cases and rainfall revealed a 2-month lag in rainfall-case association during the baseline period. Outbreak locations in 2008 were characterized by shorter distance to rivers and higher population density. The analysis suggests the possibility of household transmission in densely populated semi-urban villages as a defining characteristic of the outbreak. The role of rainfall in the outbreak remains to be investigated, although analysis here suggests a more complex relationship than simple correlation.

  17. Accuracy of a dual path platform (DPP assay for the rapid point-of-care diagnosis of human leptospirosis.

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    Scott A Nabity

    Full Text Available Diagnosis of leptospirosis by the gold standard serologic assay, the microscopic agglutination test (MAT, requires paired sera and is not widely available. We developed a rapid assay using immunodominant Leptospira immunoglobulin-like (Lig proteins in a Dual Path Platform (DPP. This study aimed to evaluate the assay's diagnostic performance in the setting of urban transmission.We determined test sensitivity using 446 acute and convalescent sera from MAT-confirmed case-patients with severe or mild leptospirosis in Brazil. We assessed test specificity using 677 sera from the following groups: healthy residents of a Brazilian slum with endemic transmission, febrile outpatients from the same slum, healthy blood donors, and patients with dengue, hepatitis A, and syphilis. Three operators independently interpreted visual results without knowing specimen status.The overall sensitivity for paired sera was 100% and 73% for severe and mild disease, respectively. In the acute phase, the assay achieved a sensitivity of 85% and 64% for severe and mild leptospirosis, respectively. Within seven days of illness onset, the assay achieved a sensitivity of 77% for severe disease and 60% for mild leptospirosis. Sensitivity of the DPP assay was similar to that for IgM-ELISA and increased with both duration of symptoms (chi-square regression P = 0.002 and agglutinating titer (Spearman ρ = 0.24, P<0.001. Specificity was ≥93% for dengue, hepatitis A, syphilis, febrile outpatients, and blood donors, while it was 86% for healthy slum residents. Inter-operator agreement ranged from very good to excellent (kappa: 0.82-0.94 and test-to-test reproducibility was also high (kappa: 0.89.The DPP assay performed acceptably well for diagnosis of severe acute clinical leptospirosis and can be easily implemented in hospitals and health posts where leptospirosis is a major public health problem. However, test accuracy may need improvement for mild disease and early stage

  18. Neumonía aguda de la comunidad y hemorragia pulmonar por leptospirosis en el área metropolitana Buenos Aires Community acquired pneumonia and pulmonary hemorrhage in leptospirosis in the Buenos Aires metropolitan area

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    Alfredo Seijo

    2011-04-01

    Full Text Available El objetivo del trabajo es comunicar los hallazgos epidemiológicos, clínicos y de diagnóstico de la neumonía y hemorragia pulmonar por leptospirosis, en el período enero 2007 a octubre 2009. Un 64% (20/31 de pacientes con diagnóstico de leptospirosis tuvieron neumonía. Quince de ellos (75% presentaron neumonía grave, de los cuales siete (35% desarrollaron hemorragia pulmonar. En diez enfermos (32% el motivo de consulta e inicio del cuadro clínico fue una gastroenteritis secretoria con fiebre y dolor abdominal. La ictericia sólo se manifestó en once pacientes (35%. La técnica de reacción en cadena de la polimerasa (PCR fue útil para el diagnóstico en muestra obtenida post mortem. De un hemocultivo se aisló una cepa clasificada dentro del serogrupo canicola. Se clasificaron las neumonías en tres tipos: neumonías de curso no grave con escasa repercusión general; neumonías graves asociadas a formas clínicas sistémicas con ictericia, insuficiencia renal, trombocitopenia y hemorragia pulmonar; también de curso grave, no asociada a ictericia, insuficiencia renal o trombocitopenia grave. El tratamiento antibiótico iniciado en los primeros días de enfermedad (promedio 3.2 días no tuvo influencia en la evolución de las neumonías graves. Se plantea además considerar tres formas clínicas de leptospirosis: anictérica, ictérica (con sus variantes evolutivas y hemorragia pulmonar.The aim of this paper is to report the epidemiological, clinical and diagnosis findings of pneumonia and pulmonary hemorrhage observed in patients with leptospirosis in the period January 2007 to October 2009. A 64% (20/31 of patients diagnosed with leptospirosis presented pneumonia. Fifteen of them (75% had severe pneumonia, of which seven (35% were pulmonary hemorrhage. In ten patients (32% reason for consultation and clinical early stage was a secretory gastroenteritis with fever and abdominal pain. Jaundice was only expressed in eleven patients (35

  19. Comparison of the Estimated Incidence of Acute Leptospirosis in the Kilimanjaro Region of Tanzania between 2007-08 and 2012-14.

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    Michael J Maze

    2016-12-01

    Full Text Available The sole report of annual leptospirosis incidence in continental Africa of 75-102 cases per 100,000 population is from a study performed in August 2007 through September 2008 in the Kilimanjaro Region of Tanzania. To evaluate the stability of this estimate over time, we estimated the incidence of acute leptospirosis in Kilimanjaro Region, northern Tanzania for the time period 2012-2014.Leptospirosis cases were identified among febrile patients at two sentinel hospitals in the Kilimanjaro Region. Leptospirosis was diagnosed by serum microscopic agglutination testing using a panel of 20 Leptospira serovars belonging to 17 separate serogroups. Serum was taken at enrolment and patients were asked to return 4-6 weeks later to provide convalescent serum. Confirmed cases required a 4-fold rise in titre and probable cases required a single titre of ≥800. Findings from a healthcare utilisation survey were used to estimate multipliers to adjust for cases not seen at sentinel hospitals. We identified 19 (1.7% confirmed or probable cases among 1,115 patients who presented with a febrile illness. Of cases, the predominant reactive serogroups were Australis 8 (42.1%, Sejroe 3 (15.8%, Grippotyphosa 2 (10.5%, Icterohaemorrhagiae 2 (10.5%, Pyrogenes 2 (10.5%, Djasiman 1 (5.3%, Tarassovi 1 (5.3%. We estimated that the annual incidence of leptospirosis was 11-18 cases per 100,000 population. This was a significantly lower incidence than 2007-08 (p<0.001.We estimated a much lower incidence of acute leptospirosis than previously, with a notable absence of cases due to the previously predominant serogroup Mini. Our findings indicate a dynamic epidemiology of leptospirosis in this area and highlight the value of multi-year surveillance to understand leptospirosis epidemiology.

  20. Major epidemiological factors associated with leptospirosis in Malaysia.

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    Garba, Bashiru; Bahaman, Abdul Rani; Bejo, Siti Khairani; Zakaria, Zunita; Mutalib, Abdul Rahim; Bande, Faruku

    2018-02-01

    Leptospirosis is a zoonotic disease caused by a diverse pathogenic leptospira species and serovars. The disease is transmitted directly following contact with infected urine and other body fluids or indirectly after contact with water or soil contaminated with infected urine. While a wide range of domestic and wild animals are known to be reservoirs of the disease, occupation, international travel and recreation are beginning to assume a center stage in the transmission of the disease. The objective of this study is to review available literatures to determine the extent to which these aforementioned risk factors aid the transmission, increase incidence and outbreak of leptospirosis in Malaysia. The review was conducted based on prevalence, incidence, and outbreak cases of leptospirosis among human and susceptible animals predisposed to several of the risk factors identified in Malaysia. Literature searchers and reviews were conducted based on articles published in citation index journals, Malaysian ministry of health reports, periodicals as well as reliable newspapers articles and online media platforms. In each case, the newspapers and online media reports were supported by press briefings by officials of the ministry of health and other agencies responsible. The disease is endemic in Malaysia, and this was attributed to the large number of reservoir animals, suitable humid and moist environment for proliferation as well as abundant forest resources. Over 30 different serovars have been detected in Malaysia in different domestic and wild animal species. This, in addition to the frequency of flooding which has increased in recent years, and has helped increase the risk of human exposure. Occupation, recreation, flooding and rodent population were all identified as an important source and cause of the disease within the study population. There is an urgent need for the government and other stakeholders to intensify efforts to control the spread of the disease

  1. Has Madagascar lost its exceptional leptospirosis free-like status?

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    Ratsitorahina, Maherisoa; Rahelinirina, Soanandrasana; Michault, Alain; Rajerison, Minoarisoa; Rajatonirina, Soatiana; Richard, Vincent

    2015-01-01

    Leptospirosis is a widespread but underreported cause of morbidity and mortality. It has rarely been reported in either humans or animals in Madagascar. We conducted a cross-sectional survey of the inhabitants in Moramanga, Madagascar, in June 2011, to estimate the prevalence of human infection using the microscopic agglutination test (MAT). This activity was carried out as part of a workshop implemented by the Pasteur Institute of Madagascar, focusing on surveillance with a one week field study and targeting the health staff of the district level. In total, we sampled 678 inhabitants from 263 households. The sex ratio (M/F) was 0.65 and the mean age 26.7 years. We obtained a value of 2.9% for the first recorded seroprevalence of this disease in the human community of Moramanga. Questionnaire responses revealed frequent contacts between humans and rodents in Moramanga. However, activities involving cattle were identified as a risk factor significantly associated with seropositivity (OR=3). Leptospirosis remains a neglected disease in Madagascar. This study highlights the need to quantify the public health impact of this neglected disease in a more large scale, in all the country and to establish point-of-care laboratories in remote areas.

  2. The Use of Chemoprophylaxis after Floods to Reduce the Occurrence and Impact of Leptospirosis Outbreaks

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    Maria Cristina Schneider

    2017-06-01

    Full Text Available Record-breaking and devastating rainfall events have occurred in the past decade. Rain and floods are considered the main risk factors for leptospirosis and several outbreaks have been reported following extreme weather events. In such situations, one possible intervention to prevent leptospirosis cases in high-risk groups is the use of chemoprophylaxis. However, not enough evidence of its effect is available. The objectives of this study were to review the literature on the current practices of chemoprophylaxis for leptospirosis and to explore, using a mathematical model, how various chemoprophylaxis scenarios may affect the progression of a leptospirosis outbreak. Twenty-six peer-reviewed publications were selected (10 quantitative studies, two systematic reviews and 14 articles of other types. Oral doxycycline was the most used antibiotic for chemoprophylaxis of leptospirosis. Post-exposure prophylaxis was assessed in four studies following a natural disaster. Although evidence of the effectiveness of post-exposure prophylaxis is inconsistent, the direction of association supported a protective effect for morbidity and mortality. The theoretical model showed how the assumed benefit of chemoprophylaxis was influenced by the time and rate of administration. Future models should consider the heterogeneity of affected communities, improved estimates of the effect of chemoprophylaxis on leptospirosis infection and disease, as well as potential detrimental impacts. Additional research is critical to provide clear evidence-based recommendations for leptospirosis control during an outbreak. The results of this study suggest that chemoprophylaxis may provide some protection in reducing the number of leptospirosis cases after a high-risk exposure; however, the effective benefit may depend on a variety of factors such as the timing and coverage of prophylaxis. The information summarized can be used to support decision-making during a high-risk event.

  3. The Use of Chemoprophylaxis after Floods to Reduce the Occurrence and Impact of Leptospirosis Outbreaks.

    Science.gov (United States)

    Schneider, Maria Cristina; Velasco-Hernandez, Jorge; Min, Kyung-Duk; Leonel, Deise Galan; Baca-Carrasco, David; Gompper, Matthew E; Hartskeerl, Rudy; Munoz-Zanzi, Claudia

    2017-06-03

    Record-breaking and devastating rainfall events have occurred in the past decade. Rain and floods are considered the main risk factors for leptospirosis and several outbreaks have been reported following extreme weather events. In such situations, one possible intervention to prevent leptospirosis cases in high-risk groups is the use of chemoprophylaxis. However, not enough evidence of its effect is available. The objectives of this study were to review the literature on the current practices of chemoprophylaxis for leptospirosis and to explore, using a mathematical model, how various chemoprophylaxis scenarios may affect the progression of a leptospirosis outbreak. Twenty-six peer-reviewed publications were selected (10 quantitative studies, two systematic reviews and 14 articles of other types). Oral doxycycline was the most used antibiotic for chemoprophylaxis of leptospirosis. Post-exposure prophylaxis was assessed in four studies following a natural disaster. Although evidence of the effectiveness of post-exposure prophylaxis is inconsistent, the direction of association supported a protective effect for morbidity and mortality. The theoretical model showed how the assumed benefit of chemoprophylaxis was influenced by the time and rate of administration. Future models should consider the heterogeneity of affected communities, improved estimates of the effect of chemoprophylaxis on leptospirosis infection and disease, as well as potential detrimental impacts. Additional research is critical to provide clear evidence-based recommendations for leptospirosis control during an outbreak. The results of this study suggest that chemoprophylaxis may provide some protection in reducing the number of leptospirosis cases after a high-risk exposure; however, the effective benefit may depend on a variety of factors such as the timing and coverage of prophylaxis. The information summarized can be used to support decision-making during a high-risk event.

  4. Commonly used severity scores are not good predictors of mortality in sepsis from severe leptospirosis: a series of ten patients.

    Science.gov (United States)

    Velissaris, Dimitrios; Karanikolas, Menelaos; Flaris, Nikolaos; Fligou, Fotini; Marangos, Markos; Filos, Kriton S

    2012-01-01

    Introduction. Severe leptospirosis, also known as Weil's disease, can cause multiorgan failure with high mortality. Scoring systems for disease severity have not been validated for leptospirosis, and there is no documented method to predict mortality. Methods. This is a case series on 10 patients admitted to ICU for multiorgan failure from severe leptospirosis. Data were collected retrospectively, with approval from the Institution Ethics Committee. Results. Ten patients with severe leptospirosis were admitted in the Patras University Hospital ICU in a four-year period. Although, based on SOFA scores, predicted mortality was over 80%, seven of 10 patients survived and were discharged from the hospital in good condition. There was no association between SAPS II or SOFA scores and mortality, but survivors had significantly lower APACHE II scores compared to nonsurvivors. Conclusion. Commonly used severity scores do not seem to be useful in predicting mortality in severe leptospirosis. Early ICU admission and resuscitation based on a goal-directed therapy protocol are recommended and may reduce mortality. However, this study is limited by retrospective data collection and small sample size. Data from large prospective studies are needed to validate our findings.

  5. Study on the Prevalence of Leptospirosis among Fever Cases Reported from Private Clinics in the Urban areas of Villupuram District, Tamil Nadu, India

    Science.gov (United States)

    Basker, Parasuraman; Kannan, Pichai; Kolandaswamy, Karumana Gounder

    2014-01-01

    Objectives To know the prevalence of leptospirosis cases reported in private clinics among fever cases in Villupuram District, Tamil Nadu, India to know its real magnitude of the problem and to diagnose Leptospirosis among fever cases from differential diagnosis. Methods 1502 Blood serum samples collected from three urban towns namely Kallakurichi (Latitude: 11° 73′ N; Longitude: 78° 97′ E), Villupuram (Latitude: 11° 75′ N; Longitude: 79° 92′ E) and Thindivanam (Latitude: 12° 25′ N; Longitude: 79° 65′ E) in fifteen clinics based on case definition of leptospirosis delineated by the National Vector Borne Disease Control Programme (NVBDCP), Government of India. Samples were tested in the laboratory of the Zonal Entomological Team (ZET), Cuddalore with Macroscopic Slide Agglutination Test (MSAT) and Ig-M ELISA. Result There were 65 positive cases detected from 1502 blood serum samples in both MSAT and Ig-M ELISA. It could be known that there was 4% cases contributed from private clinics among fever cases. From this study, further it was known that all age groups of people affected irrespective of sexes based on their living condition associated with the environment prevailed of the disease. Conclusion From this study, it was quantified that 4% of cases reported in private clinics among fever cases and its findings ascertained both the importance of differential diagnosis as well as reports that should be included to the Government for knowing its real magnitude for planning. PMID:24955313

  6. A process for developing multisectoral strategies for zoonoses: the case of leptospirosis in Fiji.

    Science.gov (United States)

    Reid, Simon A; Rodney, Anna; Kama, Mike; Hill, Peter S

    2017-08-22

    Zoonotic diseases such as leptospirosis occur as a result of the often complex interactions that exist at the human-animal-environment interface. The most obvious consequence of this complexity is the need for the health sector to partner with institutions in other sectors of society such as agriculture, labour and local government. This multisectoral engagement is complicated by the different agendas and cultures of the various institutions and their ability to "see" their role and ant benefits in a collaborative response. The research used a realist review methodology combined with systems thinking frameworks to determine the optimal strategy and governance for the prevention and control of leptospirosis in Fiji. The process included facilitated workshops with multiple stakeholders to determine the needs, issues and potential interventions that was guided by a synthesis of locally available data and information on the impact of leptospirosis. This process was informed by interviews with bureaucrats from different government ministries. Stakeholders concurred that leptospirosis generally only received wide-spread attention in outbreaks, when there is media coverage of deaths or a large number of hospitalisations. In general, all ministries expressed support for a multisectoral strategy but saw the Ministry of Health and Medical Services as the lead agency with overall responsibility. The final consultation workshop yielded a clearly articulated goal to reduce the case fatality rate attributable to leptospirosis by 50% by 2020 and 4 overarching strategies: 1) improved clinical management of leptospirosis, 2) improved surveillance for leptospirosis, 3) enhanced communication to minimise risk and improve health seeking behaviours, and 4) strengthening coordination and governance structures. Human mortality and morbidity remained the primary drive for government action, defining leptospirosis as a human health problem. The process of deliberative consultation, and the

  7. Leptospirosis in Sub-Saharan Africa: a systematic review.

    Science.gov (United States)

    de Vries, Sophia G; Visser, Benjamin J; Nagel, Ingeborg M; Goris, Marga G A; Hartskeerl, Rudy A; Grobusch, Martin P

    2014-11-01

    Leptospirosis is an emerging zoonotic infection worldwide, possibly due to climate change and demographic shifts. It is regarded as endemic in Sub-Saharan Africa; however, for most countries scarce epidemiological data, if any, exist. The primary objectives were to describe the prevalence of leptospirosis in countries in Sub-Saharan Africa, and to develop options for prevention and control in the future. A systematic review was conducted to determine the prevalence of leptospirosis in Sub-Saharan Africa; the PRISMA guidelines were followed. Medline/PubMed, Embase, The Cochrane Library, Web of Science, BIOSIS Previews, the African Index Medicus, AJOL, and Google Scholar were searched. Information about the prevalence and incidence of leptospirosis in humans is available, but remains scarce for many countries. Data are unavailable or outdated for many countries, particularly those in Central Africa. Most data are available from animals, probably due to the economic losses caused by leptospirosis in livestock. In humans, leptospirosis is an important cause of febrile illness in Sub-Saharan Africa. It concerns numerous serogroups, harboured by many different animal carriers. A wide variety of data was identified. Prevalence rates vary throughout the continent and more research, especially in humans, is needed to reliably gauge the extent of the problem. Preventive measures need to be reconsidered to control outbreaks in the future.

  8. Leptospirosis: a report on a series of five autochthonous cases in a Greek region.

    Science.gov (United States)

    Panagopoulos, Periklis; Ganitis, Anestis; Papanas, Nikolaos; Iosifidou, Georgia; Maltsan, Tzelal; Kioutsouk, Serif; Christakidou, Evi; Maltezos, Efstratios

    2016-10-01

    Leptospirosis is a worldwide zoonotic disease difficult to diagnose both to the clinic and the laboratory. Many risk factors have been involved, such as planting, hunting, harvesting and butchering or sports, such as rafting. We reported our experience through a period of 20  months and we tried to investigate prognostic factors predicting clinical outcomes. Five male patients were admitted to our Department with a median age of 40  years. Overall, three out of five patients presented to other hospital and were transferred to ours with a wrong or delayed diagnosis. In terms of clinical signs and symptoms, all presented with fever, myalgia, headache and jaundice, whereas conjunctival suffusion was present in 80% of them. Acute renal injury and liver deficiency were diagnosed in all subjects. Acute renal failure management required dialysis in 3/5 patients, whereas renal recovery was achieved soon after clinical improvement. However, clinical awareness and serology are the most important tools for accurate and quick diagnosis in order to administer the appropriate therapy.

  9. Outbreak of Leptospirosis after a Race in the Tropical Forest of Martinique

    Science.gov (United States)

    Hochedez, Patrick; Rosine, Jacques; Théodose, Rafaelle; Abel, Sylvie; Bourhy, Pascale; Picardeau, Mathieu; Quénel, Philippe; Cabié, André

    2011-01-01

    Three athletes who participated in a race in the tropical forest of the Caribbean island of Martinique were subsequently diagnosed with leptospirosis using polymerase chain reaction (PCR). We investigated an outbreak to evaluate possible risk factors, and to determine the appropriate public health recommendations. Of 230 athletes, we contacted 148 (64%) and 20 (13.5%) met our case definition. Five were hospitalized and none were fatal. Ten (91%) of the 11 ill athletes who were tested were confirmed by PCR or serology. Serogroup Pyrogenes was commonly found. Cutaneous cuts, reported by 14 (73.7%), was the only potential risk factor using univariate analysis. Sporting event participants in tropical areas should be made aware of specific warnings and recommendations concerning the risk of leptospirosis, especially after periods of heavy rainfall or flooding. Rapid diagnostic assays such as PCR are particularly appropriate in this setting for early diagnosis and for formulating public health recommendations. PMID:21460020

  10. Gaucher's disease diagnosed by splenectomy.

    Science.gov (United States)

    Adas, Mine; Adas, Gokhan; Karatepe, Oguzhan; Altiok, Merih; Ozcan, Deniz

    2009-08-01

    Splenectomy continues to find common therapeutic indications for hematologic disorders. In addition, recently it is also performed in surgical clinics to assist diagnose of some illnesses. Gaucher's disease, especially Type I, is the most frequently encountered lysosomal storage disorder in man. Manifestations of it are highly variable. The most frequently found symptoms include splenomegaly with anaemia and thrombocytopenia, mostly due to hypersplenism, hepatomegaly and bone disease. Four patients were reported in the present study. Three of them were easily diagnosed with Gaucher's disease via bone marrow cytology, and one with Gaucher's disease was detected by pathological examination following the splenectomy. For the pouse of diagnosis of the Gaucher's disease, performing surgery is generally not necessary. However, for the cases of difficult to diagnose by classical methods, the corect diagnosis of Gaucher's disease can only be made by a special operation.

  11. Prevalence of and risk factors for leptospirosis among dogs in the United States and Canada: 677 cases (1970-1998).

    Science.gov (United States)

    Ward, Michael P; Glickman, Lawrence T; Guptill, Lynn E

    2002-01-01

    To determine whether there was a temporal trend in prevalence of leptospirosis among dogs in the United States and Canada and to determine whether age, sex, and breed were risk factors for the disease. Retrospective study. 1,819,792 dogs examined at 22 veterinary teaching hospitals between 1970 and 1998. The Veterinary Medical Data Base was searched for records of dogs in which a diagnosis of leptospirosis was made, and hospital prevalence was calculated. Logistic regression was used to examine the association between leptospirosis and age, sex, and breed. 677 dogs with leptospirosis were identified. Thus, hospital prevalence was 37 cases/100,000 dogs examined. A significant increase in leptospirosis prevalence between 1983 and 1998 was identified. Male dogs were at significantly greater risk of leptospirosis than were female dogs; dogs between 4 and 6.9 years old and between 7 and 10 years old were at significantly greater risk than dogs dogs, hounds, working dogs, and mixed-breed dogs were at significantly greater risk than companion dogs. The prevalence of leptospirosis among dogs examined at veterinary teaching hospitals in the United States and Canada has increased significantly since 1983. Male dogs of working and herding breeds were at greater risk.

  12. Deteksi Leptospira Patogen Pada Tersangka Penderita Leptospirosis Di Kabupaten Ponorogo

    Directory of Open Access Journals (Sweden)

    Dyah Widiastuti

    2017-02-01

    Full Text Available AbstractUp to March 2012, there were increasing leptospirosis cases in Ponorogo. A total of 11 cases of leptospirosis were reported by the Ponorogo District Health Center. This study aims to detect pathogenic Leptospira bacteria using Polymerase Chain Reaction (PCR in suspected leptospirosis in Ponorogo. Collection of blood samples carried out by the local health care medical personnel (doctor, midwife or nurse was accompanied by a team of researchers. Subjects were people with fever (temperature >380C or fever accompanied by headache, muscle aches, and rash conjunctivitis. Blood and urine samples were taken purposively. Active case detection was also conducted in communities around the previous patients who had a history of infection risk and relationship of leptospirosis. Further blood samples examined by two different methods, Lepto Tek Lateral Flow and Polymerase Chain Reaction (PCR. Ninety blood and urine samples was collected. Four samples were positive for pathogenic Leptospira DNA consisted of two samples of blood (whole blood and two samples of urine. PCR-positive samples in the blood has negative results of Lepto Tek examination. While the PCR-positive samples in the urine, Lepto Tek was positive. Lepto tek showed lower sensitivity in early detection of leptospirosis. Examination of blood and urine samples using PCR can support the early discovery of leptospirosis cases.Keywords: Leptospirosis, Ponorogo, PCRAbstrakSampai dengan bulan Maret 2012 terjadi peningkatan kasus leptospirosis di Ponorogo. Sebanyak 11 kasus leptospirosis dilaporkan oleh Dinas Kesehatan Kabupaten Ponorogo. Penelitian ini bertujuan untuk mendeteksi bakteri Leptospira patogen menggunakan teknik Polimerase Chain Reaction (PCR pada tersangka penderita leptospirosis di Kabupaten Ponorogo. Pengumpulan sampel darah dilakukan oleh tenaga medis Puskesmas setempat (dokter, bidan atau perawat didampingi oleh tim peneliti terhadap penduduk yang mengalami demam (suhu badan

  13. LigB subunit vaccine confers sterile immunity against challenge in the hamster model of leptospirosis.

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    Neida L Conrad

    2017-03-01

    Full Text Available Neglected tropical diseases, including zoonoses such as leptospirosis, have a major impact on rural and poor urban communities, particularly in developing countries. This has led to major investment in antipoverty vaccines that focus on diseases that influence public health and thereby productivity. While the true, global, impact of leptospirosis is unknown due to the lack of adequate laboratory diagnosis, the WHO estimates that incidence has doubled over the last 15 years to over 1 million cases that require hospitalization every year. Leptospirosis is caused by pathogenic Leptospira spp. and is spread through direct contact with infected animals, their urine or contaminated water and soil. Inactivated leptospirosis vaccines, or bacterins, are approved in only a handful of countries due to the lack of heterologous protection (there are > 250 pathogenic Leptospira serovars and the serious side-effects associated with vaccination. Currently, research has focused on recombinant vaccines, a possible solution to these problems. However, due to a lack of standardised animal models, rigorous statistical analysis and poor reproducibility, this approach has met with limited success. We evaluated a subunit vaccine preparation, based on a conserved region of the leptospiral immunoglobulin-like B protein (LigB(131-645 and aluminium hydroxide (AH, in the hamster model of leptospirosis. The vaccine conferred significant protection (80.0-100%, P < 0.05 against mortality in vaccinated animals in seven independent experiments. The efficacy of the LigB(131-645/AH vaccine ranged from 87.5-100% and we observed sterile immunity (87.5-100% among the vaccinated survivors. Significant levels of IgM and IgG were induced among vaccinated animals, although they did not correlate with immunity. A mixed IgG1/IgG2 subclass profile was associated with the subunit vaccine, compared to the predominant IgG2 profile seen in bacterin vaccinated hamsters. These findings suggest

  14. Challenge in Clinical Diagnosis and Treatment of Leptospirosis

    Directory of Open Access Journals (Sweden)

    Dora I. Ríos

    2015-01-01

    Full Text Available Abstract: Introduction: Leptospirosis is an acute febrile disease caused by the leptospira. It is considered a zoonosis that affects a variety of animals, both wild and domestic (mainly rodents. Humans become infected accidentally by contact with urine or tissues from infected animals. This pathology has variable clinical manifestations, ranging from inapparent infections and aseptic meningitis, to severe forms such as the Weil syndrome. Development: We present the case of a young patient of 22 years old with fever quantified peaks of 40° C, chills, profuse sweating, headache, muscle and joint pain in knees and malleoli, retroorbital and retrosternal pain; and appetite loss. The symptoms occurred after 20 days of having practiced extreme water sports. Conclusion: The late diagnosis of the patient and hospital readmission are the result of several factors; First, the homology with other infectious diseases that present acute febrile illness with similar symptoms as dengue , malaria, influenza , yellow fever , brucellosis; and secondly the lack of expertise and poor contact with patients who present this disease by the medical staff. Correct antibiotic treatment and proper support reduce morbidity and mortality. The objective of this article is to describe a case of human leptospirosis and make a review of the literature in order to analyze the epidemiological characteristics and relevant clinical manifestations.

  15. Evaluation of nested polymerase chain reaction for the early detection of Leptospira spp. DNA in serum samples from patients with leptospirosis.

    Science.gov (United States)

    Blanco, Roberta Morozetti; Romero, Eliete Caló

    2014-04-01

    The aim of this study was to analyse the nested polymerase chain reaction (nested PCR) in human serum samples of patients with clinical manifestations of leptospirosis. The cases of leptospirosis were defined by the microagglutination test (MAT). The samples were collected in 2010. Of 1042 serum samples collected from 521 patients, 28 (5.4%) were considered positive cases of leptospirosis, and 493 (94.6%) were negative. Twenty-three confirmed cases had no MAT-detectable antibodies in the acute sample (mean of 5.6 days after onset). Nested PCR was positive in 22/23 (95.7%) patients during the acute phase of the disease, with negative results by MAT. Nested PCR was negative in all convalescent serum samples with positive results by MAT. All negative cases of leptospirosis were negative by nested PCR. The nested PCR is an alternative diagnostic tool for early detection of leptospires in sera during the first 7 days of the disease. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. Comparison of the Estimated Incidence of Acute Leptospirosis in the Kilimanjaro Region of Tanzania between 2007–08 and 2012–14

    Science.gov (United States)

    Maze, Michael J.; Biggs, Holly M.; Rubach, Matthew P.; Galloway, Renee L.; Cash-Goldwasser, Shama; Allan, Kathryn J.; Halliday, Jo E. B.; Hertz, Julian T.; Saganda, Wilbrod; Lwezaula, Bingileki F.; Cleaveland, Sarah; Mmbaga, Blandina T.; Maro, Venance P.; Crump, John A.

    2016-01-01

    Background The sole report of annual leptospirosis incidence in continental Africa of 75–102 cases per 100,000 population is from a study performed in August 2007 through September 2008 in the Kilimanjaro Region of Tanzania. To evaluate the stability of this estimate over time, we estimated the incidence of acute leptospirosis in Kilimanjaro Region, northern Tanzania for the time period 2012–2014. Methodology and Principal Findings Leptospirosis cases were identified among febrile patients at two sentinel hospitals in the Kilimanjaro Region. Leptospirosis was diagnosed by serum microscopic agglutination testing using a panel of 20 Leptospira serovars belonging to 17 separate serogroups. Serum was taken at enrolment and patients were asked to return 4–6 weeks later to provide convalescent serum. Confirmed cases required a 4-fold rise in titre and probable cases required a single titre of ≥800. Findings from a healthcare utilisation survey were used to estimate multipliers to adjust for cases not seen at sentinel hospitals. We identified 19 (1.7%) confirmed or probable cases among 1,115 patients who presented with a febrile illness. Of cases, the predominant reactive serogroups were Australis 8 (42.1%), Sejroe 3 (15.8%), Grippotyphosa 2 (10.5%), Icterohaemorrhagiae 2 (10.5%), Pyrogenes 2 (10.5%), Djasiman 1 (5.3%), Tarassovi 1 (5.3%). We estimated that the annual incidence of leptospirosis was 11–18 cases per 100,000 population. This was a significantly lower incidence than 2007–08 (p<0.001). Conclusions We estimated a much lower incidence of acute leptospirosis than previously, with a notable absence of cases due to the previously predominant serogroup Mini. Our findings indicate a dynamic epidemiology of leptospirosis in this area and highlight the value of multi-year surveillance to understand leptospirosis epidemiology. PMID:27911902

  17. Social cost of leptospirosis cases attributed to the 2011 disaster striking Nova Friburgo, Brazil.

    Science.gov (United States)

    Pereira, Carlos; Barata, Martha; Trigo, Aline

    2014-04-15

    The aim of this study was to estimate the social cost of the leptospirosis cases that were attributed to the natural disaster of January 2011 in Nova Friburgo (State of Rio de Janeiro, Brazil) through a partial economic assessment. This study utilized secondary data supplied by the Municipal Health Foundation of Nova Friburgo. Income scenarios based on the national and state minimum wages and on average income of the local population were employed. The total social cost of leptospirosis cases attributed to the 2011 disaster may range between US$21,500 and US$66,000 for the lower income scenario and between US$23,900 and US$100,800 for that of higher income. Empirical therapy represented a total avoided cost of US$14,800, in addition to a reduction in lethality. An estimated 31 deaths were avoided among confirmed cases of the disease, and no deaths resulted from the leptospirosis cases attributed to the natural disaster. There has been a significant post-disaster rise in leptospirosis incidence in the municipality, which illustrates the potential for increased cases--and hence costs--of this illness following natural disasters, which justifies the adoption of preventive measures in environmental health.

  18. Human Leptospirosis and risk factors.

    Directory of Open Access Journals (Sweden)

    Yanelis Emilia Tabío Henry

    2010-09-01

    Full Text Available The human leptospirosis is a zoonosis of world distribution, were risk factors exist that have favored the wild and domestic animal propagation and so man. A descpitive investigation was made with the objective of determining the behavior of risk factors in outpatients by human leptospirosis in “Camilo Cienfuegos“ University General Hospital from Sncti Spíritus In the comprised time period betwen december 1 st and 3 st , 2008.The sample of this study was conformed by 54 risk persons that keep inclusion criteria. Some variables were used:age, sex, risk factors and number of ill persons, according to the month. Some patients of masculine sex prevailed (61,9%, group of ages between 15-29 and 45-59 years (27,7%, patients treated since october to december (53,7%, the direct and indirect contact with animals (46,2 %. The risk factors cassually associated to human leptospirosis turned to be: the masculine sex, the contac with animals, the occupational exposition and the inmersion on sources of sweet water.

  19. Hubungan Kebersihan Pribadi dan Riwayat Luka dengan Kejadian Leptospirosis

    OpenAIRE

    Cahyati, Widya Hary; Lestari, Feriyanti

    2009-01-01

    There were 65 cases of  leptospirosis with four deaths in Sunan Kalijaga Hospital during January to April, 2008.The research aims to determine the relationship bet-ween personal hygiene and a history of injury with the incidence of leptospirosis. The research design was observational analytic with case control approach. Their population are the case of public hospital inpatients who suffer leptospirosis and control populations hospital inpatients who do not. The 45 samples consist of 15 samp...

  20. Spatial and Statistical Analysis of Leptospirosis in Guilan Province, Iran

    Science.gov (United States)

    Nia, A. Mohammadi; Alimohammadi, A.; Habibi, R.; Shirzadi, M. R.

    2015-12-01

    The most underdiagnosed water-borne bacterial zoonosis in the world is Leptospirosis which especially impacts tropical and humid regions. According to World Health Organization (WHO), the number of human cases is not known precisely. Available reports showed that worldwide incidences vary from 0.1-1 per 100 000 per year in temperate climates to 10-100 per 100 000 in the humid tropics. Pathogenic bacteria that is spread by the urines of rats is the main reason of water and soil infections. Rice field farmers who are in contact with infected water or soil, contain the most burden of leptospirosis prevalence. In recent years, this zoonotic disease have been occurred in north of Iran endemically. Guilan as the second rice production province (average=750 000 000 Kg, 40% of country production) after Mazandaran, has one of the most rural population (Male=487 679, Female=496 022) and rice workers (47 621 insured workers) among Iran provinces. The main objectives of this study were to analyse yearly spatial distribution and the possible spatial clusters of leptospirosis to better understand epidemiological aspects of them in the province. Survey was performed during the period of 2009-2013 at rural district level throughout the study area. Global clustering methods including the average nearest neighbour distance, Moran's I and General G indices were utilized to investigate the annual spatial distribution of diseases. At the end, significant spatial clusters have been detected with the objective of informing priority areas for public health planning and resource allocation.

  1. EVALUASI PELAKSANAAN SURVEILANS KASUS LEPTOSPIROSIS DI DINAS KESEHATAN KABUPATEN BOYOLALI

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    Lintang Dian Saraswati

    2017-04-01

    Full Text Available Kabupaten Boyolali merupakan salah satu kabupaten di Indonesia yang telah terjadi peningkatan kasus Leptospirosis selama 4 tahun terakhir. Salah satu upaya untuk mengatasinya adalah dengan melakukan surveilans epidemiologi. Tujuan penelitian ini yaitu untuk mengevaluasi pelaksanaan dan hasil surveilans kasus leptospirosis di Kabupaten Boyolali. Penelitian ini merupakan penelitian deskriptif dengan desain penelitian observasional. Sampel penelitian berjumlah 12 tenaga surveilans puskesmas dan 2 orang tenaga surveilans di Dinas Kesehatan Kabupaten Boyolali yang dipilih dengan metode purposive sampling dan dilakukan wawancara, telaah data sekunder, dan observasi. Hasil penelitian menunjukkan bahwa kasus leptospirosis di Kabupaten Boyolali tahun 2012-2015 paling banyak terjadi pada kelompok umur 26-45 tahun (38,3%, berjenis kelamin laki-laki (70%, dan pekerjaan sebagai petani (44,7%. Kasus paling banyak terjadi pada bulan Maret tahun 2014 dan 2015 dengan angka insiden kumulatif sebesar 0,6. Sebagian besar kasus leptospirosis terjadi di Kecamatan Nogosari (34%. Pelaksanaan surveilans epidemiologi leptospirosis di Kabupaten Boyolali belum berjalan dengan baik, pengumpulan data sudah dilakukan oleh semua responden, kompilasi data hanya dilakukan di 3 dari 12 puskesmas dan di dinas kesehatan, analisis data hanya dilakukan di dinas kesehatan berupa analisis sederhana kecenderungan leptospirosis, dan sudah dilakukan diseminasi informasi dalam bentuk pelaporan dan umpan balik. Boyolali is one of the regency in Indonesia that has been an increase of Leptospirosis cases for the last 4 years. One effort to overcome this problem is conduct epidemiological surveillance. The purpose of this study was to evaluate the implementation and results of leptospirosis case surveillance in Boyolali. This research was descriptive study with observational research design. Samples of this research were 12 puskesmas surveillance officers and 2 health office surveillance

  2. Seroprevalence of Brucellosis, Leptospirosis, and Q Fever among Butchers and Slaughterhouse Workers in South-Eastern Iran.

    Science.gov (United States)

    Esmaeili, Saber; Naddaf, Saied Reza; Pourhossein, Behzad; Hashemi Shahraki, Abdolrazagh; Bagheri Amiri, Fahimeh; Gouya, Mohammad Mehdi; Mostafavi, Ehsan

    2016-01-01

    Zoonotic diseases can be occupational hazards to people who work in close contact with animals or their carcasses. In this cross-sectional study, 190 sera were collected from butchers and slaughterhouse workers in different regions of the Sistan va Baluchestan province, in Iran in 2011. A questionnaire was filled for each participant to document personal and behavioural information. The sera were tested for detection of specific IgG antibodies against brucellosis, leptospirosis, and Q fever (phase I and II) using commercial enzyme-linked immunosorbent assays (ELISA). The seroprevalence of brucellosis was 7.9%, leptospirosis 23.4%, and phase I and II of Q fever were 18.1% and 14.4%, respectively. The seroprevalence of Q fever and leptospirosis, but not brucellosis, varied among regions within the province (p = 0.01). Additionally, a significant relationship was found between seropositivity of Q fever and camel slaughtering (p = 0.04). Reduced seropositivity rate of brucellosis was associated with use of personal protective equipment (PPE) (p = 0.004). This study shows that brucellosis, leptospirosis and Q fever occur among butchers and slaughterhouse workers in this area.

  3. Leptospirosis in Ireland: annual incidence and exposures associated with infection.

    LENUS (Irish Health Repository)

    Garvey, P

    2013-08-05

    SUMMARY Human leptospirosis is found throughout the world, albeit with a higher incidence in tropical regions. In temperate regions it is associated with certain occupational and recreational activities. This paper reports both on the incidence of human leptospirosis in Ireland and on possible associated exposures, using leptospirosis case notification, enhanced surveillance, hospital discharge data and death registrations. Based on official notification data, there was a threefold increase in the reported incidence of leptospirosis in Ireland between 1995-1999 and 2004-2009, which appears partially to be due to improved reporting. The exposures most associated with infection were those involving contact with livestock or water-based recreational sports, in particular kayaking. Advice on prevention should continue to be targeted in the first instance at these groups. The variety of potential transmission routes reported should inform clinicians to consider leptospirosis in individuals with a compatible clinical profile who were not from occupational groups historically considered at risk.

  4. Social Cost of Leptospirosis Cases Attributed to the 2011 Disaster Striking Nova Friburgo, Brazil

    Directory of Open Access Journals (Sweden)

    Carlos Pereira

    2014-04-01

    Full Text Available The aim of this study was to estimate the social cost of the leptospirosis cases that were attributed to the natural disaster of January 2011 in Nova Friburgo (State of Rio de Janeiro, Brazil through a partial economic assessment. This study utilized secondary data supplied by the Municipal Health Foundation of Nova Friburgo. Income scenarios based on the national and state minimum wages and on average income of the local population were employed. The total social cost of leptospirosis cases attributed to the 2011 disaster may range between US$21,500 and US$66,000 for the lower income scenario and between US$23,900 and US$100,800 for that of higher income. Empirical therapy represented a total avoided cost of US$14,800, in addition to a reduction in lethality. An estimated 31 deaths were avoided among confirmed cases of the disease, and no deaths resulted from the leptospirosis cases attributed to the natural disaster. There has been a significant post-disaster rise in leptospirosis incidence in the municipality, which illustrates the potential for increased cases—and hence costs—of this illness following natural disasters, which justifies the adoption of preventive measures in environmental health.

  5. A road map for leptospirosis research and health policies based on country needs in Latin America.

    Science.gov (United States)

    Pereira, Martha Maria; Schneider, Maria Cristina; Munoz-Zanzi, Claudia; Costa, Federico; Benschop, Jackie; Hartskeerl, Rudy; Martinez, Julio; Jancloes, Michel; Bertherat, Eric

    2018-02-19

    This report summarizes the presentations, discussions and the recommendations coming from the Oswaldo Cruz Institute/FIOCRUZ International Workshop for Leptospirosis Research Based on Country Needs and the 5th Global Leptospirosis Environmental Action Network meeting, which was held in the city of Rio de Janeiro, Brazil, 10-12 November 2015. The event focused on health policy and worked to develop a road map as a consensus document to help guide decision-making by policymakers, funding bodies, and health care professionals. The direction that leptospirosis research should take in the coming years was emphasized, taking into account the needs of countries of Latin America, as well as experiences from other world regions, as provided by international experts. The operational concepts of "One Health" and translational research underlaid the discussions and the resulting recommendations. Despite the wide geographic distribution of leptospirosis and its impact in terms of incidence, morbidity, and mortality, leptospirosis is not yet considered a "tool-ready" disease for global initiatives. Surveillance programs need new tools and strategies for early detection, prevention, and follow-up. The major recommendations developed at the Rio meeting cover both health policy and research. The health policy recommendations should be taken into account by decisionmakers, government officials, and the Pan American Health Organization. The priorities for research, technological development, and innovation should be considered by research institutions, universities, and stakeholders.

  6. Discovery of a leptospirosis cluster amidst a pneumonic plague outbreak in a miners' camp in the Democratic Republic of the Congo.

    Science.gov (United States)

    Bertherat, Eric; Mueller, Melissa J; Shako, Jean-Christophe; Picardeau, Mathieu

    2014-02-07

    Conditions in the Democratic Republic of the Congo provide an ideal environment for leptospirosis and plague, both of which can cause severe pulmonary manifestations. In December 2004, an outbreak of lethal pneumonia occurred in a local mining camp, affecting 130 persons and killing 57 of them. Clinical signs, fast disease spread, and initial laboratory investigations suggested pneumonic plague. While leptospirosis had not recently been described in the region, it was considered as a differential diagnosis. Anti-Leptospira antibodies were detected by microscopic agglutination test (MAT). A confirmed case of leptospirosis was defined as having consistent clinical signs and any one of the following: seroconversion or four-fold increase in MAT titre for paired serum samples, or a MAT titre ≥ 1:400 for acute-phase serum samples. Twenty-nine of the 54 patients or convalescents tested for leptospirosis were seropositive. Two cases showed a confirmed infection for both plague and leptospirosis. While evidence supports the plague nature of this outbreak, the results suggest that some of the suspected plague cases might be due to leptospirosis. In any case, this diagnosis will have to be evoked in the future if a similar outbreak occurs in this region of Africa.

  7. Seroprevalence of Brucellosis, Leptospirosis, and Q Fever among Butchers and Slaughterhouse Workers in South-Eastern Iran.

    Directory of Open Access Journals (Sweden)

    Saber Esmaeili

    Full Text Available Zoonotic diseases can be occupational hazards to people who work in close contact with animals or their carcasses. In this cross-sectional study, 190 sera were collected from butchers and slaughterhouse workers in different regions of the Sistan va Baluchestan province, in Iran in 2011. A questionnaire was filled for each participant to document personal and behavioural information. The sera were tested for detection of specific IgG antibodies against brucellosis, leptospirosis, and Q fever (phase I and II using commercial enzyme-linked immunosorbent assays (ELISA. The seroprevalence of brucellosis was 7.9%, leptospirosis 23.4%, and phase I and II of Q fever were 18.1% and 14.4%, respectively. The seroprevalence of Q fever and leptospirosis, but not brucellosis, varied among regions within the province (p = 0.01. Additionally, a significant relationship was found between seropositivity of Q fever and camel slaughtering (p = 0.04. Reduced seropositivity rate of brucellosis was associated with use of personal protective equipment (PPE (p = 0.004. This study shows that brucellosis, leptospirosis and Q fever occur among butchers and slaughterhouse workers in this area.

  8. Establishment of Valid Laboratory Case Definition for Human Leptospirosis

    NARCIS (Netherlands)

    M.G.A. Goris (Marga); M.M.G. Leeflang (Mariska); K.R. Boer (Kimberly); M. Goeijenbier (Marco); E.C.M. van Gorp (Eric); J.F.P. Wagenaar (Jiri); R.A. Hartskeerl (Rudy)

    2011-01-01

    textabstractLaboratory case definition of leptospirosis is scarcely de ned by a solid evaluation that determines cut-off values in the tests that are applied. This study describes the process of determining optimal cut-off titers of laboratory tests for leptospirosis for a valid case definition of

  9. A case–control study of epidemiological factors associated with leptospirosis in South Gujarat region

    Directory of Open Access Journals (Sweden)

    K T Desai

    2016-01-01

    Full Text Available Background: The current study was planned to identify the epidemiological factors associated with leptospirosis in South Gujarat region using neighborhood controls. Methods: A total of 100 cases of leptospirosis occurred in South Gujarat region during the year 2012 were selected using simple random sampling. Three neighbors of the selected cases formed the controls (n = 300. A pretested structured questionnaire was used for data collection and data were analyzed using Epi Info 2007. Results: There was significant association of illiteracy (odds ratio [OR] =1.82, 95% confidence interval [CI] =1.14–2.89, working in waterlogged fields during the reference season (OR = 4.6, 95% CI = 1.6–17.9, swimming/bathing in canals, open air defecation practices, storage of cow dung in or surrounding house, residence in the house made up of cow dung walls, households with access of food to rodents, injuries over hands/foot during the endemic season (OR = 3, 95% CI = 1.8–4.8, and history of skin disease during the endemic season (OR = 4.2, 95% CI = 2–8.5, with leptospirosis. Only 10% of individuals had gumboots for protection. A total of 83 (83% cases and 240 (80% controls had taken oral doxycycline chemoprophylaxis (P > 0.05. Cases had taken chemoprophylaxis for a median 4 weeks (range: 1–8 while controls had taken the same for median 8 weeks (range = 1–8 (P < 0.002. Conclusions: Although the commonly established factors appear to be associated with leptospirosis, the role of host factors seems to play a more important role in determining susceptibility to leptospirosis in exposed individuals.

  10. Discovery of a Leptospirosis Cluster Amidst a Pneumonic Plague Outbreak in a Miners’ Camp in the Democratic Republic of the Congo

    Science.gov (United States)

    Bertherat, Eric; Mueller, Melissa J.; Shako, Jean-Christophe; Picardeau, Mathieu

    2014-01-01

    Conditions in the Democratic Republic of the Congo provide an ideal environment for leptospirosis and plague, both of which can cause severe pulmonary manifestations. In December 2004, an outbreak of lethal pneumonia occurred in a local mining camp, affecting 130 persons and killing 57 of them. Clinical signs, fast disease spread, and initial laboratory investigations suggested pneumonic plague. While leptospirosis had not recently been described in the region, it was considered as a differential diagnosis. Anti-Leptospira antibodies were detected by microscopic agglutination test (MAT). A confirmed case of leptospirosis was defined as having consistent clinical signs and any one of the following: seroconversion or four-fold increase in MAT titre for paired serum samples, or a MAT titre ≥ 1:400 for acute-phase serum samples. Twenty-nine of the 54 patients or convalescents tested for leptospirosis were seropositive. Two cases showed a confirmed infection for both plague and leptospirosis. While evidence supports the plague nature of this outbreak, the results suggest that some of the suspected plague cases might be due to leptospirosis. In any case, this diagnosis will have to be evoked in the future if a similar outbreak occurs in this region of Africa. PMID:24514425

  11. Knowledge, Attitude and Practices towards Leptospirosis among Lakeshore Communities of Calamba and Los Baños, Laguna, Philippines

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    Joseph Arbiol

    2016-04-01

    Full Text Available Leptospirosis is a serious and potentially fatal zoonotic disease, but often neglected owing to lack of awareness. This study examined the knowledge, attitudes, and practices concerning leptospirosis among agricultural (n = 152 and non-agricultural (n = 115 workers in the lakeshore communities of Calamba and Los Baños, Laguna, Philippines. The findings showed no significant differences for the knowledge and attitude scores between agricultural and non-agricultural workers. However, agricultural workers had significantly lower prevention practice scores than non-agricultural workers. The ordinary least squares regression model identified gender, use of broadcast media as a source of health information, and knowledge and attitudes about leptospirosis as significant predictors of prevention practices common to both workers. Higher educational attainment was significantly associated with prevention practices among agricultural workers, while higher age and income level were significantly associated with prevention practices among non-agricultural workers. Public health interventions to improve leptospirosis knowledge and prevention practices should include health education and promotion programs, along with the strengthening of occupational health and safety programs in the agricultural sector.

  12. Leptospirosis and Extensive Urbanization in West Africa: A Neglected and Underestimated Threat?

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    Gauthier Dobigny

    2018-03-01

    Full Text Available Leptospirosis affects 1 million and kills 60,000 people annually, but it remains poorly documented in Africa. We aim to describe the large West African Conurbation Corridor where the omnipresence of slums, water and close animal/human interactions may result in high leptospiral risk. Though scarce, data from this region point towards the wide circulation of pathogenic leptospires in the urban environment as well as in humans. However, because of the absence of reliable surveillance systems together with lack of awareness, the absence of reference laboratory and/or a high number of infected people showing only mild manifestations, it is likely that the burden is much higher. We believe raising awareness of leptospirosis may have a positive impact on many vulnerable African city dwellers, as the disease is a preventable and treatable.

  13. Leptospirosis en la provincia de Cienfuegos

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    Rubén Bembibre Taboada

    2000-08-01

    Full Text Available La leptospirosis es una enfermedad infecciosa que constituye un problema de salud no erradicado. Se realizó un estudio descriptivo retrospectivo de la totalidad de los pacientes afectados por leptospirosis en el año 1998 en la provincia de Cienfuegos. Los datos primarios se obtuvieron del registro del Centro Provincial de Higiene y Epidemiología (CPHE procediéndose a la aplicación de encuesta para obtener datos de interés como: sexo, edad, municipio de residencia, ocupación, fuente de infección, vacunación previa, evolución, necesidad de ingreso, y seguimiento por el Médico de la Familia, teniendo como objetivo determinar el comportamiento de la entidad en el período estudiado y el rol del Médico de la Familia. Los datos fueron procesados por sistema EXCEL de Windows y los principales resultados se exponen en figuras diseñadas por Power Point. Se constató la disminución de la morbilidad por esta afección en la provincia respecto al año 1997 en 33,3 %, la letalidad fue de 0 y existió un predominio del sexo masculino con 40 casos, y del grupo etáreo de 25 a 44 años con el 70 %. La mayor incidencia correspondió al municipio Palmira. Ninguno de los enfermos había sido inmunizado con la vacuna cubana antileptospírica. Los ingresos domiciliarios se realizaron en el 77 % de los casos con evolución favorable, demostrándose la efectividad en la atención a nivel primario y el papel del Médico de la Familia tanto en la labor preventiva como curativa. La seroconversión y el aumento del título fueron las principales pruebas de confirmación de 45 y 41 % respectivamente, aún existen índices de roedores no despreciables en el territorio provincial. La labor del Médico y Enfermera de la Familia puede ser eficaz en el control de la leptospirosis con la minimización de sus perjudiciales consecuenciasLeptospirosis is an infectious disease and a health problem that has not been erradicated yet. A descriptive and retrospective study

  14. Pilot Cross-Sectional Study of Three Zoonoses (Lyme Disease, Tularaemia, Leptospirosis) among Healthy Blood Donors in Eastern Slovakia.

    Science.gov (United States)

    Zákutná, Ľubica; Dorko, Erik; Rimárová, Kvetoslava; Kizeková, Marianna

    2015-06-01

    The aim of the study was to determine the seroprevalence of three zoonotic infections among healthy blood donors/volunteers in Eastern Slovakia. Sera from 124 blood donors were investigated for the presence of antibodies against Borrelia burgdorferi, Francisella tularensis and Leptospira pomona. The participants also completed the questionnaire about demographic, exposure and epidemiological characteristics. Two serological methods were used for the diagnosis: the enzyme linked protein A/G assay (ELPAGA) and the Western blot (WB). First, sera were screened by ELPAGA (except for leptospirosis). The observed seroprevalence was 15% for Lyme borreliosis (LB) and 4% for tularaemia (TUL). The results were confirmed by WB. Positive IgG antibodies (WB method) were detected only in 1.6% of examined for LB and 0.8% for TUL. Our results did not identify any antibodies against Leptospira pomona agent in the examined healthy blood donors group. ELPAGA seroprevalence for TUL was significantly higher in blood donors working in the agricultural area in the direct contact with hay, straw, manure, and agricultural land. Our outputs determine tick bite as a significant risk factor for LB. The study confirms the explosion of tick-borne diseases in the healthy population of people. The exposure risk for leptospirosis seems to be minimal. Copyright© by the National Institute of Public Health, Prague 2015.

  15. Afghanistan and Iraq War Veterans: Mental Health Diagnoses are Associated with Respiratory Disease Diagnoses.

    Science.gov (United States)

    Slatore, Christopher G; Falvo, Michael J; Nugent, Shannon; Carlson, Kathleen

    2018-05-01

    Many veterans of the wars in Afghanistan and Iraq have concomitant respiratory conditions and mental health conditions. We wanted to evaluate the association of mental health diagnoses with respiratory disease diagnoses among post-deployment veterans. We conducted a retrospective cohort study of all Afghanistan and Iraq War veterans who were discharged from the military or otherwise became eligible to receive Veterans Health Administration services. The primary exposure was receipt of a mental health diagnosis and the primary outcome was receipt of a respiratory diagnosis as recorded in the electronic health record. We used multivariable adjusted logistic regression to measure the associations of mental health diagnoses with respiratory diagnoses and conducted several analyses exploring the timing of the diagnoses. Among 182,338 post-deployment veterans, 14% were diagnosed with a respiratory condition, 77% of whom had a concomitant mental health diagnosis. The incidence rates were 5,363/100,000 person-years (p-y), 587/100,000 p-y, 1,450/100,000 p-y, and 233/100,000 p-y for any respiratory disease diagnosis, bronchitis, asthma, and chronic obstructive lung disease diagnoses, respectively, after the date of first Veterans Health Administration utilization. Any mental health diagnosis was associated with increased odds for any respiratory diagnosis (adjusted odds ratio 1.41, 95% confidence interval 1.37-1.46). The association of mental health diagnoses and subsequent respiratory disease diagnoses was stronger and more consistent than the converse. Many Afghanistan and Iraq War veterans are diagnosed with both respiratory and mental illnesses. Comprehensive plans that include care coordination with mental health professionals and treatments for mental illnesses may be important for many veterans with respiratory diseases.

  16. Karakteristik Individu Dan Kondisi Lingkungan Pemukiman di Daerah Endemis Leptospirosis Di Kota Semarang

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    Tri Ramadhani

    2013-02-01

    Full Text Available Abstract: Leptospirosis is an acute febrile illness injecting human and animal (zoonosis and caused by the bacteria leptospira. Semarang city is one endemic leptospirosis with inci­dence rate in 2009 of 13,27/100.000 and case fa ta lity rate 3,5%. This study aimed to know the epidemiological characteristics of leptospirosis cases and the relationship of environ­mental conditions of settlement with the incidence of leptospirosis The study was observational with cross sectional design. Data population are the people who visit the health center with clinical symptoms of leptospirosis and secondary data from the Health Department of Semarang. Sample are people who visited the health center with clinical symptoms ofleptospirosis (mainly:fever (body temperature> 37°C or fever accom­panied by headache, muscle aches, conjunctivitis and rash. Data environmental conditions of settlement had beed observed and interviewed using, and analysed bivariat with chi square. The results show characteristics of respondents most of the age group 10 -19 years (38.1%, male sex (56.2%, education level did not complete primary school (30.5% Distri­bution cases of leptospirosis attack more men (55% with mortality rate (CFR = 3.6, and in the age group 0-19 years that is as much as 32.5% (CFR=14.29Environmental conditions associated with the occurrence of leptospirosis include kitchen wall not a wall, no plavond, open dumping and dirty house. To prevention transmission of leptospirosis, among others, hygiene sanitasi, rat proofing so it does not make to nest rat.Key words: environment, endemic, leptospirosis, individual characteristics, Semarang

  17. Eficacia y seguridad de una vacuna contra la leptospirosis humana en Cuba Efficacy and safety of a vaccine against human leptospirosis in Cuba

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    Raydel Martínez

    2004-04-01

    with leptospirosis more than 21 days after receiving the second dose, with the diagnosis confirmed through serological and microbiological methods. We calculated the efficacy of the vaccine and the relative risk of becoming ill with leptospirosis after the vaccination. For the safety study, two persons were chosen at random from among the individuals vaccinated at the office of each physician participating in the study. Follow-up of local and systemic adverse reactions was carried out by the family physicians during the seven days after the application of each dose. The level of statistical significance was set at 0.05. RESULTS: A total of 101 832 persons were vaccinated, with 50 354 of them (49.4% receiving the leptospirosis vaccine and 51 478 of them (50.6% receiving the control vaccine. The efficacy of the vax-SPIRAL vaccine was 78.1% (95% confidence interval (CI: 59.2% to 88.3%, and the relative risk of becoming ill with leptospirosis after receiving the leptospirosis vaccine was 0.22 (95% CI: 0.12 to 0.41. General discomfort was the most frequent systemic adverse reaction, and mild spontaneous pain at the injection site was the most frequent local effect. The local and systemic adverse reactions were both more frequent in the study group than in the control group (P = 0.003. There were no serious adverse events. CONCLUSION: The vax-SPIRAL vaccine proved to be safe and efficacious for leptospirosis control. The vaccine is recommended for use in preventing this disease among groups at risk of contracting it.

  18. Ionic imbalance and lack of effect of adjuvant treatment with methylene blue in the hamster model of leptospirosis

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    Cleiton Silva Santos

    2013-06-01

    Full Text Available Leptospirosis in humans usually involves hypokalaemia and hypomagnesaemia and the putative mechanism underlying such ionic imbalances may be related to nitric oxide (NO production. We previously demonstrated the correlation between serum levels of NO and the severity of renal disease in patients with severe leptospirosis. Methylene blue inhibits soluble guanylyl cyclase (downstream of the action of any NO synthase isoforms and was recently reported to have beneficial effects on clinical and experimental sepsis. We investigated the occurrence of serum ionic changes in experimental leptospirosis at various time points (4, 8, 16 and 28 days in a hamster model. We also determined the effect of methylene blue treatment when administered as an adjuvant therapy, combined with late initiation of standard antibiotic (ampicillin treatment. Hypokalaemia was not reproduced in this model: all of the groups developed increased levels of serum potassium (K. Furthermore, hypermagnesaemia, rather than magnesium (Mg depletion, was observed in this hamster model of acute infection. These findings may be associated with an accelerated progression to acute renal failure. Adjuvant treatment with methylene blue had no effect on survival or serum Mg and K levels during acute-phase leptospirosis in hamsters.

  19. COMPARISON OF 16S rRNA-PCR-RFLP, LipL32-PCR AND OmpL1-PCR METHODS IN THE DIAGNOSIS OF LEPTOSPIROSIS

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    Tülin GÜVEN GÖKMEN

    Full Text Available SUMMARY Leptospirosis is still one of the most important health problems in developing countries located in humid tropical and subtropical regions. Human infections are generally caused by exposure to water, soil or food contaminated with the urine of infected wild and domestic animals such as rodents and dogs. The clinical course of leptospirosis is variable and may be difficult to distinguish from many other infectious diseases. The dark-field microscopy (DFM, serology and nucleic acid amplification techniques are used to diagnose leptospirosis, however, a distinctive standard reference method is still lacking. Therefore, in this study, we aimed to determine the presence of Leptospira spp., to differentiate the pathogenic L. interrogans and the non-pathogenic L. biflexa, and also to determine the sensitivity and specificity values of molecular methods as an alternative to conventional ones. A total of 133 serum samples, from 47 humans and 86 cattle were evaluated by two conventional tests: the Microagglutination Test (MAT and the DFM, as well as three molecular methods, the 16S rRNA-PCR followed by Restriction Fragment Lenght Polymorphism (RFLP of the amplification products 16S rRNA-PCR-RFLP, LipL32-PCR and OmpL1-PCR. In this study, for L. interrogans, the specificity and sensitivity rates of the 16S rRNA-PCR and the LipL32-PCR were considered similar (100% versus 98.25% and 100% versus 98.68%, respectively. The OmpL1-PCR was able to classify L. interrogans into two intergroups, but this PCR was less sensitive (87.01% than the other two PCR methods. The 16S rRNA-PCR-RFLP could detect L. biflexa DNA, but LipL32-PCR and OmpL1-PCR could not. The 16S rRNA-PCR-RFLP provided an early and accurate diagnosis and was able to distinguish pathogenic and non-pathogenic Leptospira species, hence it may be used as an alternative method to the conventional gold standard techniques for the rapid disgnosis of leptospirosis.

  20. Leptospirosis in Franche-Comté (FRANCE): clinical, biological, and therapeutic data.

    Science.gov (United States)

    Estavoyer, J M; Chirouze, C; Faucher, J F; Floret, N; Couetdic, G; Leroy, J; Hoen, B

    2013-09-01

    We report the patient data in 77 cases of leptospirosis confirmed by PCR and/or serology (micro-agglutination), observed between 1994 and 2008 at the Besançon teaching hospital. Our aim was to compare the epidemiological, clinical, biological, and therapeutic characteristics of leptospirosis in the Franche-Comté region, to those reported in other regions. The median age was 42years and 95% were male patients. Leptospirosis acquisition was likely related to aquatic leisure activities (50.6%), professional exposure (28.6%), building maintenance works (11.7%), or unknown (9.1%). Forty-eight cases were uncomplicated and 29 were severe presentations of leptospirosis. Among severe cases, eight patients had to be managed in an intensive care unit, and one patient died. L. grippotyphosa and L. icterohaemorrhagiae were the main serogroups involved. Age above 50years and serogroup L. icterohaemorrhagiae were positively associated with clinical severity. The outcome was favorable for 15 patients treated with ceftriaxone for less than 7days. We recommended conducting clinical trials aiming at validating short courses of ceftriaxone to treat leptospirosis. Copyright © 2013. Published by Elsevier SAS.

  1. Individual Characteristics of Environmental Conditions of Settlement in Endemic Area of Leptospirosis in Semarang City

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    Tri Ramadhani

    2010-12-01

    Full Text Available Leptospirosis is an acute febrile illness infecting human and animal (zoonosis and caused by the bacteria leptospira. Semarang city is one endemic leptospirosis with incidence rate in 2009 of 13.27/100,000 and case fatality rate 3,5%. This study aimed to know the epidemiological characteristics of leptospirosis cases and the relationship of environmental conditions of settlement with the incidence of leptospirosis. The study was observational with cross sectional design. Data population are the people who visit the health center with clinical symptoms of leptospirosis and secondary data from the Health Department of Semarang. Sample are people who visited the health center with clinical symptoms of leptospirosis (mainly: fever (body temperature > 37C or fever accompanied by headache, muscle aches, conjunctivitis and rash. Data environmental conditions of settlement had beed observed and interviewed using, and analyzed bivariat with chi-square. The results show characteristics of respondents most of the age group 10-19 years (38.1%, male sex (56.2%, education level did not complete primary school (30.5% Distribution cases of leptospirosis attack more men (55% with mortality rate (CFR = 3.6, and in the age group 0-19 years that is as much as 32.5% (CFR=14.29. Environmental conditions associated with the occurrence of leptospirosis include kitchen wall not a wall, no plavond, open dumping and dirty house. To prevention transmission of leptospirosis, among others, hygiene sanitation,rat proofing so it does not make to nest rat.

  2. Leptospirosis in rural Sri Lanka:

    DEFF Research Database (Denmark)

    Hellung Schønning, Marie; Agampodi, Suneth; Phelps, Matthew

    2016-01-01

    Sri Lanka has one of the highest incidences of human leptospirosis worldwide. Outbreaks of this zoonotic infection are related to the monsoons and flooding. The present study investigates risks associated with environmental, animal and occupational exposure. Data was obtained from structured inte...

  3. Leptospira spp. y leptospirosis humana

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    Claudia M. Romero-Vivas

    2016-01-01

    Full Text Available La leptospirosis, la enfermedad bacteriana zoonótica y emergente más importante en el mundo, es causada por las especies patógenas de Leptospira spp. Han sido descritas veinte especies de Leptospira spp.; se ha determinado la secuencia del ADN genómico de algunas cepas patógenas; la función de la mayoría de los genes involucrados en su patogénesis permanece desconocida. La leptospirosis humana presenta un rango de síntomas que van desde una fiebre indiferenciada hasta una ictericia, hemorragia, fallas renales y pulmonares severas. La administración temprana e intravenosa de penicilina G es requerida para reducir las tasas de mortalidad, pero los antibióticos pueden no ser efectivos en la enfermedad pulmonar severa. En las Américas, las áreas de alto riesgo son Brasil, Centroamérica y el Caribe. En Colombia se han realizado pocos estudios. La prueba serológica de oro, la microaglutinación, tiene alta sesibilidad y especificidad cuando se usan baterías de serovariedades locales, pero es serogrupo específica. Las vacunas generan respuestas específicas para la serovariedad usada, pero no previenen la infección o trasmisión. Problemas en el diagnóstico de laboratorio de la leptospirosis conllevan a un subregistro en el número de casos; altas tasas de mortalidad asociadas a fallas renal y pulmonar son resultado de las dificultades en el manejo de los casos.

  4. Diseño de un instrumento para evaluar el nivel de conocimientos, sobre leptospirosis humana, en médicos de la atención primaria de salud Design of a tool to assess the knowledge level on human leptospirosis in primary health care physicians

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    Denis Verdasquera Corcho

    2010-09-01

    Full Text Available INTRODUCCIÓN: el éxito en el tratamiento a un paciente con leptospirosis está vinculado con el diagnóstico temprano y oportuno de los casos. A pesar de que en Cuba esta enfermedad tiene un comportamiento endemo epidémico, deficiencias en el tratamiento clínico de algunos casos han influido en la mortalidad. MÉTODOS: se propone un instrumento diseñado y validado por consulta de expertos y evaluado a través de un estudio piloto desarrollado en las 7 áreas de salud de Boyeros, con el objetivo de evaluar el nivel de conocimientos sobre leptospirosis en médicos asistenciales de la atención primaria. RESULTADOS: el instrumento está compuesto por 3 acápites (datos generales, problemas de atención a pacientes, formas de actualización sobre el tema y evaluación de los conocimientos. A su vez, el acápite destinado a la exploración de conocimientos se subdivide en 3 secciones para explorar de forma independiente, elementos de tratamiento clínico, diagnóstico microbiológico y aspectos epidemiológicos de la enfermedad. Los ítems de cada acápite fueron conformados teniendo en cuenta las normas cubanas para la prevención y control de la leptospirosis, así como los lineamientos para el diagnóstico, vigilancia y control de la leptospirosis humana editado por la Organización Mundial de la Salud y la Sociedad Internacional de Leptospirosis. CONCLUSIONES: el uso de un instrumento estandarizado de este tipo permitirá evaluar el nivel de conocimiento de médicos asistenciales sobre esta zoonosis a nivel comunitario, y contribuir así a trazar estrategias locales y regionales que impacten contra la letalidad causada por esta enfermedad.INTRODUCTION: the treatment success in a patient presenting leptospirosis is linked to the early and timely diagnosis of cases. Despite that in Cuba this disease has an endemic-epidemic behavior, deficiencies in clinical treatment of some cases has influenced on the mortality. METHODS: a tool designed and

  5. Acute leptospirosis in a triathlete.

    Science.gov (United States)

    Abb, Jochen

    2002-01-01

    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.

  6. Utility of loop-mediated isothermal amplification assay, polymerase chain reaction, and elisa for diagnosis of leptospirosis in South Indian patients

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    Mallika Sengupta

    2017-01-01

    Full Text Available Background: Leptospirosis is a zoonotic disease which requires laboratory diagnosis for confirmation. Materials and Methods: In this study serum samples from adults with acute undifferentiated fever (duration ≤15 days were tested for IgM antibodies to Leptospira by ELISA, PCR for rrs gene and loop-mediated isothermal amplification (LAMP assay for LipL32 and LipL41. Results: Among the 150 sera tested, three were positive by PCR, LAMP and IgM ELISA/modified Faines' criteria, two by only PCR; seven only by LAMP assay and forty fulfilled modified Faine's criteria (illness clinically compatible and IgM ELISA positive for leptospirosis. Clinical correlation revealed renal compromise, low platelet count and severe jaundice were significantly related to leptospirosis (P < 0.05. Conclusion: This study suggests that LAMP assay could be useful for diagnosis of leptospirosis during the 1st week of illness whereas IgM ELISA forms the mainstay of diagnosis from the 2nd week onward. Further studies especially community based, comparing ELISA, PCR, LAMP, culture and microscopic agglutination test are required to evaluate the veracity of these findings.

  7. A cross sectional study of leptospirosis and fetal death in Yucatan, Mexico

    OpenAIRE

    Cárdenas-Marrufo, MaríaFidelia; Vado-Solis, Ignacio; Pérez-Osorio, Carlos; Peniche-Lara, Gaspar; Segura-Correa, José

    2016-01-01

    Introduction: Leptospirosis is a zoonotic disease affecting mainly to low income human population. Acute leptospiral infection during pregnancy has been associated with spontaneous abortion and fetal death during the first trimester and the abortion may occur as consequence of systemic failure. Objective: To estimate the frequency of Leptospira interrogans infection in women with spontaneous abortion in the state of Yucatan, Mexico. Methods: A cross sectional study on women with spontaneous a...

  8. Surveillance for leptospirosis in the Americas, 1996-2005: a review of data from ministries of health Vigilancia de la leptospirosis en la Región de las Américas, de 1996 al 2005: análisis de los datos de los ministerios de salud

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    Federico Costa

    2012-09-01

    Full Text Available OBJECTIVE: To characterize current leptospirosis reporting practices in the Americas. METHODS: Information was collected from the official websites of national ministries of health from the Americas region and two international organizations; personal communications; and three international morbidity databases. For all sources other than the morbidity databases, the review was limited to official reports citing clinically suspected and laboratory confirmed leptospirosis cases or deaths during the period 1996-2005. RESULTS: A total of 73 out of 1 644 reports met the selection criteria and were included in the analysis. Published leptospirosis data were available from half of the countries/sovereign territories (24 out of 48, and 18 of them had mandatory notification policies for leptospirosis. The sum of the median number of leptospirosis cases notified annually by the 24 countries/territories was 4 713.5, but just three countries (Brazil, Costa Rica, and Cuba accounted for 83.1% (3 9cas20 es of the notifications. Eight (16.7% countries reported deaths due to leptospirosis. The sum of the median number of deaths reported annually for the eight countries was 380, but 349 (91.8% were reported by Brazil. CONCLUSIONS: Notification practices in the Americas for leptospirosis are limited. Therefore, the numbers of cases and deaths reported are not representative for the region. The lack of leptospirosis data for many countries/territories may reflect weaknesses in certain aspects of national surveillance systems, including mandatory reporting policies, clinical laboratory infrastructure for performing case confirmation, and capacity to collect reported cases. Improved surveillance of leptospirosis cases and deaths in the Americas is needed to allow monitoring of regional epidemiological patterns and to estimate the burden of this important disease.OBJETIVO: Determinar los procedimientos actuales de notificación de la leptospirosis en la Región de las

  9. Early diagnosis of leptospirosis

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    Andrea Babic-Erceg

    2014-06-01

    Full Text Available A 25-years old man from Zagreb, Croatia, was admitted to the University Hospital for Infectious Diseases four days after the onset of symptoms such as fever, intense pain in the calves and anuria. The patient owned a rabbit and, before the onset of the disease, repaired some rubber pipes damaged by rodents. At admission, he had a severe clinical picture with fever, hypotension, jaundice, immobility, and pain in leg muscles. Treatment with ceftriaxone was initiated in combination with volume restitution. Renal failure soon ensued. Consequently continuous venovenous hemodiaphiltration therapy was performed. Due to acute respiratory distress syndrome, the patient was mechanically ventilated. The patient’s condition gradually improved and he recovered fully from multi-organ failure. Diagnosis was confirmed by a microscopic agglutination test (MAT covering 15 leptospira serovars and real-time polymerase-chain reaction (PCR. The first serum sample taken on day 6 tested negative for leptospira, while PCR showed positive results for leptospiral DNA. The second serum sample taken on day 13 tested positive for serovar Canicola serogroup Canicola, serovar Patoc, serovar Grippotyphosa serogroup Grippotyphosa and serovar Tarassovi serogroup Tarassovi (titre 4000, 4000, 1000 and 2000, respectively, while PCR was negative. This report highlights the benefits of combining MAT and PCR methods in early diagnosis of leptospirosis.

  10. Caracterización clinicoepidemiológica de pacientes con leptospirosis Clinical and epidemiological characterization of patients with leptospirosis

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    Abel Tobías Suárez Olivares

    2009-02-01

    Full Text Available Se efectuó un estudio descriptivo y transversal de 145 pacientes con leptospirosis, ingresados en el Hospital General Docente “Dr. Juan Bruno Zayas Alfonso” de Santiago de Cuba durante el 2005. La enfermedad fue más frecuente en el sexo masculino (85,5 % y los grupos etarios de 15 a 54 años. La mayor tasa de incidencia por 100 000 habitantes se registró en el municipio de II Frente (29,0 y el mayor número de casos (64 en el de Santiago de Cuba. Solo 21 pacientes se incluían en las categorías ocupacionales de riesgo (labores agrícolas y pecuarias. Las manifestaciones clínicas consistieron en fiebre, cefalea y artromialgias. Los pacientes graves presentaron complicaciones pulmonares, cardíacas, hepáticas y renales.A descriptive and cross-sectional study of 145 patients with leptospirosis, admitted in "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba during the 2005 was carried out. The disease was more frequent in the male sex (85,5% and the age group from 15 to 54 years. The highest incidence rate for 100 000 inhabitants was registered in II Frente municipality (29,0 and the largest number of cases (64 in Santiago de Cuba municipality. Only 21 patients were included in the risk occupational categories(agricultural and cattle activities.The clinical manifestations consisted in fever, migraine and arthromyalgias. The severely-ill patients had lung, heart, hepatic and renal complications.

  11. Epidemiology of Leptospirosis in Africa: A Systematic Review of a Neglected Zoonosis and a Paradigm for 'One Health' in Africa.

    Science.gov (United States)

    Allan, Kathryn J; Biggs, Holly M; Halliday, Jo E B; Kazwala, Rudovick R; Maro, Venance P; Cleaveland, Sarah; Crump, John A

    2015-01-01

    Leptospirosis is an important but neglected bacterial zoonosis that has been largely overlooked in Africa. In this systematic review, we aimed to summarise and compare current knowledge of: (1) the geographic distribution, prevalence, incidence and diversity of acute human leptospirosis in Africa; and (2) the geographic distribution, host range, prevalence and diversity of Leptospira spp. infection in animal hosts in Africa. Following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, we searched for studies that described (1) acute human leptospirosis and (2) pathogenic Leptospira spp. infection in animals. We performed a literature search using eight international and regional databases for English and non-English articles published between January 1930 to October 2014 that met out pre-defined inclusion criteria and strict case definitions. We identified 97 studies that described acute human leptospirosis (n = 46) or animal Leptospira infection (n = 51) in 26 African countries. The prevalence of acute human leptospirosis ranged from 2 3% to 19 8% (n = 11) in hospital patients with febrile illness. Incidence estimates were largely restricted to the Indian Ocean islands (3 to 101 cases per 100,000 per year (n = 6)). Data from Tanzania indicate that human disease incidence is also high in mainland Africa (75 to 102 cases per 100,000 per year). Three major species (Leptospira borgpetersenii, L. interrogans and L. kirschneri) are predominant in reports from Africa and isolates from a diverse range of serogroups have been reported in human and animal infections. Cattle appear to be important hosts of a large number of Leptospira serogroups in Africa, but few data are available to allow comparison of Leptospira infection in linked human and animal populations. We advocate a 'One Health' approach to promote multidisciplinary research efforts to improve understanding of the animal to human transmission of leptospirosis on the African

  12. Epidemiology of Leptospirosis in Africa: A Systematic Review of a Neglected Zoonosis and a Paradigm for 'One Health' in Africa.

    Directory of Open Access Journals (Sweden)

    Kathryn J Allan

    Full Text Available Leptospirosis is an important but neglected bacterial zoonosis that has been largely overlooked in Africa. In this systematic review, we aimed to summarise and compare current knowledge of: (1 the geographic distribution, prevalence, incidence and diversity of acute human leptospirosis in Africa; and (2 the geographic distribution, host range, prevalence and diversity of Leptospira spp. infection in animal hosts in Africa.Following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA guidelines, we searched for studies that described (1 acute human leptospirosis and (2 pathogenic Leptospira spp. infection in animals. We performed a literature search using eight international and regional databases for English and non-English articles published between January 1930 to October 2014 that met out pre-defined inclusion criteria and strict case definitions.We identified 97 studies that described acute human leptospirosis (n = 46 or animal Leptospira infection (n = 51 in 26 African countries. The prevalence of acute human leptospirosis ranged from 2 3% to 19 8% (n = 11 in hospital patients with febrile illness. Incidence estimates were largely restricted to the Indian Ocean islands (3 to 101 cases per 100,000 per year (n = 6. Data from Tanzania indicate that human disease incidence is also high in mainland Africa (75 to 102 cases per 100,000 per year. Three major species (Leptospira borgpetersenii, L. interrogans and L. kirschneri are predominant in reports from Africa and isolates from a diverse range of serogroups have been reported in human and animal infections. Cattle appear to be important hosts of a large number of Leptospira serogroups in Africa, but few data are available to allow comparison of Leptospira infection in linked human and animal populations. We advocate a 'One Health' approach to promote multidisciplinary research efforts to improve understanding of the animal to human transmission of leptospirosis on the

  13. Faktor Risiko Lingkungan Kejadian Leptospirosis di Jawa Tengah (Studi Kasus di Kota Semarang, Kabupaten Demak dan Pati

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    Riyaningsih Riyaningsih

    2012-11-01

    Full Text Available Background : Leptospirosis is zoonotic disease caused by Leptospira bacteria and transmitted to human through contact with animal urine and contaminated environment.The number of cases increased since 2005, particulary Semarang, Demak, and Pati regency. The purpose of this study is to analyze environmental risk factors related to leptospirosis incidence in Central Java. Method : This research was an explanatory research with  observational method using  case control design. The subjects were 60 cases and 60 controls recruted with  inclusion criteria. Diagnosis  of control was based on  clinical diagnosis and examination of blood sample with  Leptotek Lateral Flow. The data was analyzed in univariate, bivariate and multivariate tests using logistic regression. Result : The results of this research found that  physical environmental factors that influenced the incidence of leptospirosis were stagnant water of the ditch (OR = 3.5; 95% CI: 1,282-9,301; p = 0.014 and habit of taking bath  or washing in the river (OR = 7.5; 95% CI: 1.534- 36.185; p = 0.014. Recomendation: It was sugested for Health Departement to control the risk factors of physical environment by cooperating with relevant agencies, especially PROKASIH (Clean River Program. People need to keep cleaning the house and the neighborhood, especially the existence of  pools of water around the house and do not get a shower and take out the trash / dead mouse in a river. Keywords : Leptospirosis, Environment, Risk Factors

  14. Leptospirosis on captive wild animals in Latin America.

    Science.gov (United States)

    Vieira, Anahi S; Lilenbaum, Walter

    2017-12-01

    Leptospirosis is a worldwide bacterial infection, being more prevalent in tropical regions. Human beings, domestic animals and wildlife species are susceptible to a wide variety of serovars. Zoos have a great importance in keeping endangered species, increasing populations and accumulating knowledge on these species. Although some studies describe the occurrence of leptospirosis in captivity animals, a systematic review regarding the infection in these animals in tropical areas has never been conducted. Thus, the objective of this study was to systematically gather and analyze data regarding leptospirosis among captive wild animals in Latin America. A total of 141 species were studied, 93 genus, 44 families and 15 orders from three classes. Median seroprevalence ranged from 0 to 52% and predominant serogroups were Canicola and Icterohaemorrhagiae for mammalian, and Sejroe for reptiles. One important outcome is that, when kept on zoos, wildlife is more frequently infected by incidental strains instead of adapted strains. Preventive measures should consider periodic serosurvey of all animal species in captivity, as well as the use of commercial vaccines to reduce leptospiral infection and its hazards. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. Development and validation of a new knowledge, attitude, belief and practice questionnaire on leptospirosis in Malaysia.

    Science.gov (United States)

    Zahiruddin, Wan Mohd; Arifin, Wan Nor; Mohd-Nazri, Shafei; Sukeri, Surianti; Zawaha, Idris; Bakar, Rahman Abu; Hamat, Rukman Awang; Malina, Osman; Jamaludin, Tengku Zetty Maztura Tengku; Pathman, Arumugam; Mas-Harithulfadhli-Agus, Ab Rahman; Norazlin, Idris; Suhailah, Binti Samsudin; Saudi, Siti Nor Sakinah; Abdullah, Nurul Munirah; Nozmi, Noramira; Zainuddin, Abdul Wahab; Aziah, Daud

    2018-03-07

    In Malaysia, leptospirosis is considered an endemic disease, with sporadic outbreaks following rainy or flood seasons. The objective of this study was to develop and validate a new knowledge, attitude, belief and practice (KABP) questionnaire on leptospirosis for use in urban and rural populations in Malaysia. The questionnaire comprised development and validation stages. The development phase encompassed a literature review, expert panel review, focus-group testing, and evaluation. The validation phase consisted of exploratory and confirmatory parts to verify the psychometric properties of the questionnaire. A total of 214 and 759 participants were recruited from two Malaysian states, Kelantan and Selangor respectively, for the validation phase. The participants comprised urban and rural communities with a high reported incidence of leptospirosis. The knowledge section of the validation phase utilized item response theory (IRT) analysis. The attitude and belief sections utilized exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The development phase resulted in a questionnaire that included four main sections: knowledge, attitude, belief, and practice. In the exploratory phase, as shown by the IRT analysis of knowledge about leptospirosis, the difficulty and discrimination values of the items were acceptable, with the exception of two items. Based on the EFA, the psychometric properties of the attitude, belief, and practice sections were poor. Thus, these sections were revised, and no further factor analysis of the practice section was conducted. In the confirmatory stage, the difficulty and discrimination values of the items in the knowledge section remained within the acceptable range. The CFA of the attitude section resulted in a good-fitting two-factor model. The CFA of the belief section retained low number of items, although the analysis resulted in a good fit in the final three-factor model. Based on the IRT analysis and factor

  16. Co-infection of scrub typhus and leptospirosis in patients with pyrexia of unknown origin in Longding district of Arunachal Pradesh in 2013.

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    Borkakoty, Biswajyoti; Jakharia, Aniruddha; Biswas, Dipankar; Mahanta, Jagadish

    2016-01-01

    Scrub typhus and leptospirosis are bacterial zoonotic disease causing high morbidity and mortality. The seasonal outbreak of pyrexia is common in Arunachal Pradesh (AP); many times the disease remains undiagnosed. An outbreak of pyrexia of unknown origin (PUO) occurred in Longding district of Arunachal Pradesh in 2013, with 108 deaths, which was investigated to elucidate the cause of illness. Blood samples from the affected region with acute pyrexia were collected, and screened for the malaria parasite, scrub typhus IgM and leptospira IgM. Scrub typhus IgM was reactive in 97% (30/31), and 25% (8/31) cases were co-infected with leptospira. Incidentally, scrub typhus reactive (67%) and leptospira co-infection (62.7%) were higher in females. Record of previous 3 years (2011-2013) from Longding, Community Health Centre showed an increase in indoor pyrexia cases by 2-fold or more during October and November. The present study is the first report of co-infection of scrub typhus with leptospirosis from Northeast India. Medical officers in this region should take scrub typhus and leptospirosis in their differential diagnosis of patients with PUO for early diagnosis and effective treatment.

  17. Reproductive Disorders and Leptospirosis: A Case Study in a Mixed-Species Farm (Cattle and Swine

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    Marcella Mori

    2017-12-01

    Full Text Available Animal leptospirosis, exempt in rodents, manifests as peculiar biology where the animal can function, simultaneously or not, as a susceptible host or reservoir. In the first case, clinical symptoms are likely. In the second case, infection is subclinical and manifestations are mild or absent. Mild clinical symptoms encompass reproductive failure in production animals for host-adapted Leptospira sp. serovars. This work presents a study on Leptospira sp. infection in a mixed-species (bovine and swine farm with documented reproductive disorders in the cattle unit. A long calving interval (above 450 days was the hallmark observed in cows. Some cows (2/26 tested presented a high titre of antibodies against Leptospira sp. serogroup Sejroe, but the overall within-herd prevalence was low (11.5% and 7.7% for cut-off titres of 1:30 and 1:100, respectively. The in-herd prevalence of leptospirosis in the sow unit (determined for 113/140 animals was high when using a lowered cut-off threshold (32.7% vs. 1.8% for cut-off titre of 1:30 and 1:100, respectively. In this unit, the most prevalent serogroup was Autumnalis. The final diagnostic confirmation of Leptospira sp. maintenance within the farm was obtained through detection by PCR of Leptospira sp. DNA in an aborted swine litter. Despite the fact that a common causative infective agent was diagnosed in both species, the direct link between the two animal units was not found. Factors such as drinking from the same water source and the use of manure prepared with the swine slurry might raise suspicion of a possible cross-contamination between the two units. In conclusion, this work suggests that leptospirosis be included in the differential diagnosis of reproductive disorders and spontaneous abortions in production animals and provides data that justify the use of a lowered threshold cut-off for herd diagnosis.

  18. Chronic kidney disease of uncertain etiology in Sri Lanka: Are leptospirosis and Hantaviral infection likely causes?

    Science.gov (United States)

    Gamage, Chandika Damesh; Sarathkumara, Yomani Dilukshi

    2016-06-01

    Chronic kidney disease of uncertain etiology (CKDu) has been a severe burden and a public health crisis in Sri Lanka over the past two decades. Many studies have established hypotheses to identify potential risk factors although causative agents, risk factors and etiology of this disease are still uncertain. Several studies have postulated that fungal and bacterial nephrotoxins are a possible etiological factor; however, the precise link between hypothesized risk factors and the pathogenesis of chronic kidney disease has yet to be proven in prior studies. Leptospirosis and Hantavirus infections are important zoonotic diseases that are naturally maintained and transmitted via infected rodent populations and which present similar clinical and epidemiological features. Both infections are known to be a cause of acute kidney damage that can proceed into chronic renal failure. Several studies have reported presence of both infections in Sri Lanka. Therefore, we hypothesized that pathogenic Leptospira or Hantavirus are possible causative agents of acute kidney damage which eventually progresses to chronic kidney disease in Sri Lanka. The proposed hypothesis will be evaluated by means of an observational study design. Past infection will be assessed by a cross-sectional study to detect the presence of IgG antibodies with further confirmatory testing among chronic kidney disease patients and individuals from the community in selected endemic areas compared to low prevalence areas. Identification of possible risk factors for these infections will be followed by a case-control study and causality will be further determined with a cohort study. If the current hypothesis is true, affected communities will be subjected for medical interventions related to the disease for patient management while considering supportive therapies. Furthermore and possibly enhance their preventive and control measures to improve vector control to decrease the risk of infection. Copyright © 2016

  19. Human Leptospirosis Infection in Fiji: An Eco-epidemiological Approach to Identifying Risk Factors and Environmental Drivers for Transmission.

    Science.gov (United States)

    Lau, Colleen L; Watson, Conall H; Lowry, John H; David, Michael C; Craig, Scott B; Wynwood, Sarah J; Kama, Mike; Nilles, Eric J

    2016-01-01

    Leptospirosis is an important zoonotic disease in the Pacific Islands. In Fiji, two successive cyclones and severe flooding in 2012 resulted in outbreaks with 576 reported cases and 7% case-fatality. We conducted a cross-sectional seroprevalence study and used an eco-epidemiological approach to characterize risk factors and drivers for human leptospirosis infection in Fiji, and aimed to provide an evidence base for improving the effectiveness of public health mitigation and intervention strategies. Antibodies indicative of previous or recent infection were found in 19.4% of 2152 participants (81 communities on the 3 main islands). Questionnaires and geographic information systems data were used to assess variables related to demographics, individual behaviour, contact with animals, socioeconomics, living conditions, land use, and the natural environment. On multivariable logistic regression analysis, variables associated with the presence of Leptospira antibodies included male gender (OR 1.55), iTaukei ethnicity (OR 3.51), living in villages (OR 1.64), lack of treated water at home (OR 1.52), working outdoors (1.64), living in rural areas (OR 1.43), high poverty rate (OR 1.74), living Fiji are complex and multifactorial, with environmental factors playing crucial roles. With global climate change, severe weather events and flooding are expected to intensify in the South Pacific. Population growth could also lead to more intensive livestock farming; and urbanization in developing countries is often associated with urban and peri-urban slums where diseases of poverty proliferate. Climate change, flooding, population growth, urbanization, poverty and agricultural intensification are important drivers of zoonotic disease transmission; these factors may independently, or potentially synergistically, lead to enhanced leptospirosis transmission in Fiji and other similar settings.

  20. Leptospirosis and Workplace Environmental Risk Factors among Cattle Farmers in Northeastern Malaysia

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    Aziah binti Daud

    2018-04-01

    Full Text Available Background: Leptospirosis is an emerging zoonosis and its occurrence has been reported to be rising globally. The environment plays an important role in the survival of Leptospira and determines the risk of infection. Those who were exposed to and had contact with contaminated environment through their occupational, recreational and other activities can be infected with the organism. Objective: To determine the seroprevalence of leptospirosis among cattle farmers, prevalence of pathogenic Leptospira, and the workplace environmental risk factors for leptospirosis among cattle farmers in northeastern Malaysia. Methods: A cross-sectional study involving 120 cattle farmers was conducted. The participants answered an interviewer-guided questionnaire that consisted of sociodemographic and workplace environment characteristics questionnaire, before having their blood sample taken for microscopic agglutination test (MAT. Seropositivity was determined using a cut-off titer of ≥1:100. 248 environmental samples were also collected from the cattle farms for polymerase chain reaction (PCR. Results: The overall seroprevalence of leptospiral antibodies was 72.5% (95% CI 63.5% to 80.1% and the prevalence of pathogenic Leptospira in the cattle farms environment was 12.1% (95% CI 8.4% to 17.0%. The independent factors associated with seropositivity of leptospirosis among cattle farmers were positive pathogenic Leptospira in the environment (Adj OR 5.90, 95% CI 1.34 to 26.01 and presence of garbage dumping in the farm (Adj OR 2.40, 95% CI 1.02 to 5.65. Conclusion: Preventing leptospirosis incidence among cattle farmers necessitates changes in work environment. Identifying modifiable factors may also contribute to the reduction of infection.

  1. High levels of serum mannose-binding lectin are associated with the severity of clinical signs of leptospirosis

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    K.A. Miranda

    2009-04-01

    Full Text Available The clinical heterogeneity observed in leptospirosis may be associated with host factors or bacteria virulence. Human serum mannose-binding lectin (MBL recognizes many pathogens, and low levels of this lectin are associated with susceptibility to infection. MBL is also implicated in the modulation of the inflammatory process. We determined the levels of serum MBL during leptospirosis infection. A double-antibody sandwich ELISA was used to detect the immunoreactive serum MBL. The ELISA plates were coated with monoclonal antibody to MBL and bound MBL or recombinant human MBL were detected by rabbit anti-human MBL serum. HRPO-conjugated goat anti-rabbit antibody was used for detection of the reaction. Two groups of patients seen at referral hospitals in Recife, PE, Brazil, were divided according to the year of infection, 2001 (N = 61 or 2002 (N = 57 and compared in terms of disease severity and levels of serum MBL. A group of healthy volunteers (N = 97 matched by age, gender, and ethnic background was used as control. Patients infected in 2001 had more severe outcomes than those infected in 2002, including jaundice, hemorrhage, respiratory alteration, and renal complication (P = 0.0009; chi-square test. The frequency of patients producing serum MBL >1000 ng/mL was higher in the 2001 group than in the 2002 and control groups (P < 0.01, suggesting an association of MBL level with disease severity. The involvement of MBL and genetic variation of the MBL2 gene should be further evaluated to establish the role of this lectin in the pathogenesis of leptospirosis.

  2. Seroprevalence and risk factor analysis of human leptospirosis in distinct climatic regions of Pakistan.

    Science.gov (United States)

    Sohail, Muhammad Luqman; Khan, Muhammad Sarwar; Ijaz, Muhammad; Naseer, Omer; Fatima, Zahida; Ahmad, Abdullah Saghir; Ahmad, Waqas

    2018-05-01

    Leptospirosis is a worldwide emerging infectious disease of zoonotic importance and large epidemics and epizootics have been reported all over the globe. A cross survey study was conducted to estimate seroprevalence of human leptospirosis in climatically distinct regions of Pakistan and to identify the risk factors associated with the disease. Blood samples from 360 humans were collected through convenient sampling, 120 from each of three study areas. Serological testing was performed using ELISA kit as per manufacturer's recommendations. The results showed an overall prevalence of 40.83% (95% CI; 35.71-46.11). Statistical analysis showed significant (P climatic region (50.83%; 95% CI; 41.55-60.07), followed by semi-arid region (44.16%; 95% CI; 35.11-53.52) and lowest in hot and dry region (27.50%; 95% CI; 19.75-36.40). After multivariate analysis age, gender, exposure to flooding water, source of water usage, disinfection schedule of surroundings and history of cut and wound were found significantly associated with the seropositivity of Leptospira. The present study, first to uncover seroprevalence of human Leptospira in different climatic regions of Pakistan, alarms about effect of climate on prevalence of Leptospira in the region. Copyright © 2018 Elsevier B.V. All rights reserved.

  3. Leptospirosis: an emerging global public health problem

    Indian Academy of Sciences (India)

    PRAKASH KUMAR

    jaundice with heamaturea, meningitis with haemorrhages including sub conjunctival haemorrhage or febrile illness with cardiac arrhythmias with or without haemorrhages are some of the syndromes. Because of the protean manifestations of leptospirosis it is often misdiagnosed and under-reported. Although the basic ...

  4. Severe Leptospirosis with Multiple Organ Failure Successfully Treated by Plasma Exchange and High-Volume Hemofiltration

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    Vincent Bourquin

    2011-01-01

    Full Text Available Background. Leptospirosis is a spirochetal zoonosis with complex clinical features including renal and liver failure. Case report. We report the case of a Swiss fisherman presenting with leptospirosis. After initial improvement, refractory septic shock and severe liver and kidney failure developed. The expected mortality was estimated at 90% with clinical scores. The patient underwent plasma exchanges and high-volume hemofiltration (HVHF with complete recovery of hepatic and kidney functions. Discussion. Plasma exchanges and HVHF may confer survival benefit on patients with severe leptospirosis, refractory septic shock, and multiple-organ failure.

  5. Thrombocytopenia in leptospirosis and role of platelet transfusion

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    Sharma Jayashree

    2007-01-01

    Full Text Available Aim : The study was designed to find out the incidence of thrombocytopenia in leptospirosis and to correlate thrombocytopenia with other parameters like renal failure, hepatic failure and bleeding manifestation like adult respiratory distress syndrome and to assess the role of platelet transfusion. Materials and Methods : 50 cases of leptospirosis during the month of July and August 2005 were retrospectively analyzed. Criteria for selection were Lepto Tek Dri - dot test positive cases of the clinically suspected cases of Leptospirosis. Degree of thrombocytopenia was categorized as severe, moderate and mild. Presence of thrombocytopenia was clinically correlated with parameters like renal dysfunction, hepatic dysfunction and hemorrhagic manifestations (mainly ARDS. Role of platelet transfusion was assessed with reference to presence and degree of thrombcytopenia and hemorrhagic manifestations. Results : Out of total 50 patients 26 were male and 24 were females. Major bleeding manifestation in the form of ARDS was seen in 15 (30% of patients. 28 (56% patients had thrombocytopenia and 22 (44% patients had normal platelet counts. Total number of patients with renal dysfunction was 24 (48%. Only four (18.18% patients with normal platelet counts had renal dysfunction while 20 (71.42% patients with thrombocytopenia had renal dysfunction. Only two (9.09% patients with normal platelet counts and 48 (46.42% patients with thrombocytopenia had hepatorenal dysfunction. Total number of patients with ARDS was 15 (30%. Of these two (13.33% had normal platelet count while 13 (86.6% patients were thrombocytopenic. Total 47 units of platelets were transfused to 12 patients in our study. Of these seven patients with severe thrombocytopenia required total 28 units, two patients with moderate thrombocytopenia required total seven units and patients with mild thrombocytopenia were transfused total 12 units of platelets. Conclusion : It is important to anticipate and

  6. Evidence for Wild Crocodiles as a Risk for Human Leptospirosis, Mexico.

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    Pérez-Flores, Jonathan; Charruau, Pierre; Cedeño-Vázquez, Rogelio; Atilano, Daniel

    2017-03-01

    Sentinel species such as crocodilians are used to monitor the health of ecosystems. However, few studies have documented the presence of zoonotic diseases in wild populations of these reptiles. Herein we analyzed 48 serum samples from Crocodylus acutus (n = 34) and C. moreletii (n = 14) from different sites in the state of Quintana Roo (Mexico) to detect antibodies to Leptospira interrogans by means of a microscopic agglutination test (MAT). Crocodylus acutus and C. moreletii tested positive to 11 and 9 serovars, respectively, with Grippotyphosa being the serovar with the highest prevalence in Cozumel island (100%), Banco Chinchorro Biosphere Reserve (70.6%), and Río Hondo (100%), while in Chichankanab Lake, it was Bratislava (75%). Titers ranged from 1:50 to 1:3200, and the most frequent was 1:50 in all study sites. Leptospira is present in fresh and saltwater individuals due to the resistance of the bacterium in both environments. Cases of infected people involved with crocodile handling and egg collection suggest that these reptiles could play an important role in the transmission of leptospirosis. Preventive medicine programs should consider the monitoring of reptiles, and testing the soil and water, to prevent outbreaks of leptospirosis in facilities containing crocodiles.

  7. Divorce and risk of hospital-diagnosed infectious diseases.

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    Nielsen, Nete Munk; Davidsen, Rie B; Hviid, Anders; Wohlfahrt, Jan

    2014-11-01

    Although, divorce is considered to have a negative impact on morbidity, very little is known concerning exposure to divorce and risk of infectious diseases. We aimed to investigate the association between divorce and subsequent hospital contacts with infectious diseases. We performed a nation-wide cohort study, including all Danish men and women (n≈5.6 million) alive on the 1 January 1982 or later, and followed them for infectious disease diagnosed in hospital settings from 1982 to 2010. The association between divorce and risk of infectious diseases was evaluated through rate ratios (RRs) comparing incidence rates of infectious diseases between divorced and married pesons. Compared with married persons, divorced persons were overall at a 1.48 fold (RR=1.48 (95% CI: 1.47-1.50)) increased risk of hospital-diagnosed infectious diseases (RR adjusted for sex, age, period, income and education). The risk of infectious diseases was slightly more pronounced for divorced women (RR=1.54 (1.52-1.56)) than divorced men ((RR=1.42 (1.41-1.44)). The increased risk remained almost unchanged even more than 15 years after the divorce. Young age at divorce, short duration of marriage and number of divorces further increased the risk of infectious diseases, whereas number of children at time of divorce had no impact on risk of hospital-diagnosed infectious diseases following the divorce. Divorce appears to have a moderate but long lasting impact on the risk of infectious diseases the underlying mechanism is unknown but shared risk factors predicting divorce and infectious diseases could contribute to our findings. © 2014 the Nordic Societies of Public Health.

  8. Randomized controlled trial of pulse methyl prednisolone × placebo in treatment of pulmonary involvement associated with severe leptospirosis. [ISRCTN74625030

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    Leite Alfredo

    2011-06-01

    Full Text Available Abstract Background The lungs are involved in up to 70% of cases of leptospirosis. In the more severe forms-bleeding from the lungs and acute respiratory distress syndrome-the lethality is high. The treatment proposed for leptospirotic pneumonitis includes just care for patients in critical condition. Clinical and experimental studies point to the involvement of immunological mechanisms in the physiopathology of lung damage caused by leptospirosis. The aim of this study is to evaluate pulse treatment with methylprednisolone × placebo for leptospirotic pneumonitis. Study design This is a randomized double-blind clinical trial to test the efficacy of pulse treatment with methylprednisolone in patients with leptospirotic pneumonitis, compared with a placebo. The patients are recruited from three hospitals in the city of Recife, in the Brazilian State of Pernambuco. The exclusion criteria include patients aged under 15 years, a history of hypersensitivity to the use of corticosteroids, the presence of active infection of fungal, tuberculous or bacterial origin apart from the infection by leptospira itself, the presence of hemoconcentration or atypical lymphocyte count on admission to hospital, the presence of co-morbidities that could be responsible for the radiological and gasometric alterations used to diagnose leptospirotic pneumonitis, evidence of recent cranial trauma, neurosurgery, peptic ulcer, and participation in another clinical trial. The patients are followed until they are discharged from hospital or die. The intervention consists of endovenous pulse treatment with 1 g methylprednisolone for three consecutive days in the study group and a placebo in the control group. The primary end-point is mortality from leptospirotic pneumonitis. The secondary end-points are: evolution of lung disease; the occurrence of nosocomial respiratory infection; duration of mechanical ventilation; duration of intensive care unit (ICU stay; duration of

  9. Molecular diagnostics for human leptospirosis.

    Science.gov (United States)

    Waggoner, Jesse J; Pinsky, Benjamin A

    2016-10-01

    The definitive diagnosis of leptospirosis, which results from infection with spirochetes of the genus Leptospira, currently relies on the use of culture, serological testing (microscopic agglutination testing), and molecular detection. The purpose of this review is to describe new molecular diagnostics for Leptospira and discuss advancements in the use of available methods. Efforts have been focused on improving the clinical sensitivity of Leptospira detection using molecular methods. In this review, we describe a reoptimized pathogenic species-specific real-time PCR (targeting lipL32) that has demonstrated improved sensitivity, findings by two groups that real-time reverse-transcription PCR assays targeting the 16S rrs gene can improve detection, and two new loop-mediated amplification techniques. Quantitation of leptospiremia, detection in different specimen types, and the complementary roles played by molecular detection and microscopic agglutination testing will be discussed. Finally, a protocol for Leptospira strain subtyping using variable number tandem repeat targets and high-resolution melting will be described. Molecular diagnostics have an established role for the diagnosis of leptospirosis and provide an actionable diagnosis in the acute setting. The use of real-time reverse-transcription PCR for testing serum/plasma and cerebrospinal fluid, when available, may improve the detection of Leptospira without decreasing clinical specificity.

  10. Seroepidemiology of leptospirosis among febrile patients in a rapidly growing suburban slum and a flood-vulnerable rural district in Mozambique, 2012â2014: Implications for the management of fever

    OpenAIRE

    Policarpo Ribeiro; Nilesh Bhatt; Sádia Ali; Vanessa Monteiro; Edmilson da Silva; Ilana Teruszkin Balassiano; Carolina Aquino; Nilsa de Deus; Onelia Guiliche; Argentina Felisbela Muianga; Pascoal Jorge Alho; Virginia Lara Evaristo; Ivan Manhiça; Marco Medeiros; Eduardo Samo Gudo

    2017-01-01

    Objective: Leptospirosis is one of the most widespread zoonoses in the world and is caused by spirochetes of the genus Leptospira. In Mozambique, the disease is largely ignored and its epidemiology is unknown. The objective of this study was to investigate the occurrence of leptospirosis in febrile patients. Methods: This cross-sectional study was performed between July 2012 and September 2015 among febrile patients. A total of 373 paired serum samples were drawn from febrile patients; 208 we...

  11. Determining risk for severe leptospirosis by molecular analysis of environmental surface waters for pathogenic Leptospira.

    Directory of Open Access Journals (Sweden)

    Christian A Ganoza

    2006-08-01

    . This combined quantitative and molecular taxonomical risk assessment of environmental surface waters is globally applicable for assessing risk for leptospiral infection and severe disease in leptospirosis-endemic regions.

  12. Creutzfeldt-Jakob disease: a case report and differential diagnoses.

    Science.gov (United States)

    Kojima, Gotaro; Tatsuno, Brent K; Inaba, Michiko; Velligas, Stephanie; Masaki, Kamal; Liow, Kore K

    2013-04-01

    Sporadic Creutzfeldt-Jakob disease is a rare neurodegenerative disorder of unknown etiology that causes rapidly progressive dementia. This disease is uniformly fatal and most patients die within 12 months. Clinical findings include myoclonus, visual disturbances, and cerebellar and pyramidal/extrapyramidal signs in addition to rapidly progressive cognitive and functional impairment. These findings are all non-specific and it is often difficult and challenging to diagnose premortem because of low awareness and clinical suspicion. We present a 66-year-old woman with a 5-month history of rapidly progressive dementia. After a series of extensive diagnostic examinations and continuous follow-up, she was diagnosed with probable sporadic Creutzfeldt-Jakob disease based on Centers for Disease Control and Prevention (CDC) criteria, with key findings of rapidly progressive dementia, blurry vision, extrapyramidal signs (cogwheel rigidity), and abnormal hyperintensity signals on diffusion-weighted MRI. Her symptoms progressively worsened and she died 7 months after the onset. The postmortem brain autopsy demonstrated the presence of abnormal protease-resistant prion protein by Western Blot analysis. A literature review was performed on differential diagnoses that present with rapidly progressive dementia and thereby mimic sporadic Creutzfeldt-Jakob disease. These include Alzheimer's disease, dementia with Lewy Bodies, frontotemporal dementia, meningoencephalitis, corticobasal degeneration, progressive supranuclear palsy, CADASIL, and paraneoplastic encephalomyelitis.

  13. Leptospirosis in animals and human contacts in Egypt: broad range surveillance

    Directory of Open Access Journals (Sweden)

    Ahmed Samir

    2015-06-01

    Full Text Available INTRODUCTION: Leptospirosis is a re-emerging zoonotic disease of humans and animals worldwide. The disease is caused by pathogenic species of the genus Leptospira. These organisms are maintained in nature via chronic renal infection of carrier animals, which excrete the organisms in their urine. Humans become infected through direct or indirect exposure to infected animals and their urine or through contact with contaminated water and soil. This study was conducted to investigate Leptospira infections as a re-emerging zoonosis that has been neglected in Egypt. METHODS: Samples from 1,250 animals (270 rats, 168 dogs, 625 cows, 26 buffaloes, 99 sheep, 14 horses, 26 donkeys and 22 camels, 175 human contacts and 45 water sources were collected from different governorates in Egypt. The samples were collected from different body sites and prepared for culture, PCR and the microscopic agglutination test (MAT. RESULTS: The isolation rates of Leptospira serovars were 6.9%, 11.3% and 1.1% for rats, dogs and cows, respectively, whereas the PCR results revealed respective detection rates of 24%, 11.3% and 1.1% for rats, dogs and cows. Neither the other examined animal species nor humans yielded positive results via these two techniques. Only six Leptospira serovars (Icterohaemorrhagiae, Pomona, Canicola, Grippotyphosa, Celledoni and Pyrogenes could be isolated from rats, dogs and cows. Moreover, the seroprevalence of leptospiral antibodies among the examined humans determined using MAT was 49.7%. CONCLUSIONS: The obtained results revealed that rats, dogs and cows were the most important animal reservoirs for leptospirosis in Egypt, and the high seroprevalence among human contacts highlights the public health implications of this neglected zoonosis.

  14. SEROPOSITIVITY TO LEPTOSPIROSIS IN DOMESTIC RESERVOIRS AND DETECTION OF Leptospira spp. IN WATER SOURCES, IN FARMS OF YUCATAN, MEXICO.

    Directory of Open Access Journals (Sweden)

    Maria Fidelia Cardenas-Marrufo

    2010-11-01

    Full Text Available Leptospirosis is a zoonotic infectious disease with a worldwide distribution. WHO classifies this disease as reemergent and it represents risk to human health with economical repercussion to animal reproduction. Leptospirosis occurs with higher frequency in countries with tropical weather. A transversal study was conducted to determine the frequency of infection of L. interrogans in 476 reservoir animals -212 bovines, 203 pigs, and 61 dogs in 34 animal production units. Positivity frequency the reservoirs was 30.5%. 31 out of 34 animal units had positive reservoirs. The most frequent serovars were tarassovi (53.6%, and hardjo (31.6% in cattle; bratislava (66% and icterohaemorragiae (18.7% in pigs; and canicola (79.8% and icterohaemorragiae (9.8% in dogs. 68 pools of water samples from water tanks were analyzed by DNA amplification of a 16S rRNA fragment for L. interrogans detection using Lepat1-Lepat2 primers. It is recommended to use preventive measures such as vaccination to domestic animals to reduce the risk of transmission to the human population.

  15. Leptospirosis in Sub-Saharan Africa: a systematic review

    NARCIS (Netherlands)

    de Vries, Sophia G.; Visser, Benjamin J.; Nagel, Ingeborg M.; Goris, Marga G. A.; Hartskeerl, Rudy A.; Grobusch, Martin P.

    2014-01-01

    Leptospirosis is an emerging zoonotic infection worldwide, possibly due to climate change and demographic shifts. It is regarded as endemic in Sub-Saharan Africa; however, for most countries scarce epidemiological data, if any, exist. The primary objectives were to describe the prevalence of

  16. Susceptibility, likelihood to be diagnosed, worry and fear for contracting Lyme disease.

    Science.gov (United States)

    Fogel, Joshua; Chawla, Gurasees S

    Risk perception and psychological concerns are relevant for understanding how people view Lyme disease. This study investigates the four separate outcomes of susceptibility, likelihood to be diagnosed, worry, and fear for contracting Lyme disease. University students (n=713) were surveyed about demographics, perceived health, Lyme disease knowledge, Lyme disease preventive behaviors, Lyme disease history, and Lyme disease miscellaneous variables. We found that women were associated with increased susceptibility and fear. Asian/Asian-American race/ethnicity was associated with increased worry and fear. Perceived good health was associated with increased likelihood to be diagnosed, worry, and fear. Correct knowledge was associated with increased susceptibility and likelihood to be diagnosed. Those who typically spend a lot of time outdoors were associated with increased susceptibility, likelihood to be diagnosed, worry, and fear. In conclusion, healthcare providers and public health campaigns should address susceptibility, likelihood to be diagnosed, worry, and fear about Lyme disease, and should particularly target women and Asians/Asian-Americans to address any possible misconceptions and/or offer effective coping strategies. Copyright © 2016 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

  17. Are Pathogenic Leptospira Species Agents of Community-Acquired Pneumonia? Case Reports of Leptospirosis Presenting as Pneumonia

    NARCIS (Netherlands)

    Gasem, M. Hussein; Farida, Helmia; Ahmed, Ahmed; Severin, Juliţte A.; Suryanto, Agus; Isbandrio, Bambang; Verbrugh, Henri A.; Hartskeerl, Rudy A.; van den Broek, Peterhans J.

    2016-01-01

    We report four Indonesian cases meeting the clinical and radiological criteria for community-acquired pneumonia and other findings suggestive of leptospirosis. Quantitative PCR (qPCR) analyses of serum and urine samples and serology confirmed the diagnosis of leptospirosis in each. Results of qPCR

  18. Anti-leptospirosis agglutinins in Brazilian capybaras (hydrochoerus hydrochaeris).

    Science.gov (United States)

    Langoni, Helio; Kuribara, Ivone Yumi; Ferreira Lopes Correa, Ana Paula; Ullmann, Leila Sabrina; Sánchez, Gabriela Pacheco; Lucheis, Simone Baldini

    2016-01-01

    The interest in commercial use of wild animals is increasing, especially regarding raising of capybaras. Although this wild species is potentially lucrative for the production of meat, oil and leather, it is suggested as a probable reservoir of leptospires. Due to the economic importance of this species and the lack of studies concerning leptospirosis, the presence of anti-leptospirosis agglutinins was assayed in 55 serum samples of capybaras (Hydrochoerus hydrochaeris) from commercial and experimental breeding flocks located in São Paulo state, Paraná state, and Rio Grande do Sul state, Brazil. Samples were obtained through cephalic or femoral venipunction (5 to 10 mL). Microscopic agglutination test was used according to the Brazilian Health Ministry considering as cut-off titer of 100. Out of the 55 samples analyzed, 23 (41.82 %) tested positive. The most prevalent serovar was Icterohaemorrhagiae (56.52 %) in 13 samples, followed by Copenhageni in nine samples (39.13 %), Pomona in four samples (17.39 %), Djasiman and Castellonis in three samples each (13.04 %), Grippotyphosa, Hardjo, Canicola, and Cynopteri in two samples each (8.7 %), and Andamana and Bratislava in one sample each (4.34 %). These results suggest the evidence of exposure to Leptospira spp. and the need of new studies to evaluate a higher number of capybaras from different regions to better understand the importance of leptospirosis infection in these animals and verify the zoonotic role of this species as a possible source of infection to humans and other animals.

  19. Transbronchial biopsies safely diagnose amyloid lung disease

    Science.gov (United States)

    Govender, Praveen; Keyes, Colleen M.; Hankinson, Elizabeth A.; O’Hara, Carl J.; Sanchorawala, Vaishali; Berk, John L.

    2018-01-01

    Background Autopsy identifies lung involvement in 58–92% of patients with the most prevalent forms of systemic amyloidoses. In the absence of lung biopsies, amyloid lung disease often goes unrecognized. Report of a death following transbronchial biopsies in a patient with systemic amyloidosis cautioned against the procedure in this patient cohort. We reviewed our experience with transbronchial biopsies in patients with amyloidosis to determine the safety and utility of bronchoscopic lung biopsies. Methods We identified patients referred to the Amyloidosis Center at Boston Medical Center with lung amyloidosis diagnosed by transbronchial lung biopsies (TBBX). Amyloid typing was determined by immunohistochemistry or mass spectrometry. Standard end organ assessments, including pulmonary function test (PFT) and chest tomography (CT) imaging, and extra-thoracic biopsies established the extent of disease. Results Twenty-five (21.7%) of 115 patients with lung amyloidosis were diagnosed by TBBX. PFT classified 33.3% with restrictive physiology, 28.6% with obstructive disease, and 9.5% mixed physiology; 9.5% exhibited isolated diffusion defects while 19% had normal pulmonary testing. Two view chest or CT imaging identified focal opacities in 52% of cases and diffuse interstitial disease in 48%. Amyloid type and disease extent included 68% systemic AL disease, 16% localized (lung limited) AL disease, 12% ATTR disease, and 4% AA amyloidosis. Fluoroscopy was not used during biopsy. No procedure complications were reported. Conclusions Our case series of 25 patients supports the use of bronchoscopic transbronchial biopsies for diagnosis of parenchymal lung amyloidosis. Normal PFTs do not rule out the histologic presence of amyloid lung disease. PMID:28393574

  20. Evaluación de la prueba de inmunofluorescencia indirecta para el diagnóstico de leptospirosis humana.

    Directory of Open Access Journals (Sweden)

    Piedad Agudelo Flórez

    2006-06-01

    Full Text Available Introducción. El diagnóstico de la leptospirosis es difícil debido al amplio espectro de síntomas clínicos que presenta. Varias pruebas diagnósticas serológicas se han desarrollado, pero su aplicación y utilidad en Colombia no han sido determinadas. Objetivos. Evaluar la prueba de inmunofluorescencia indirecta para el diagnóstico de leptospirosis humana y determinar así los anticuerpos de las clases inmunoglobulina G y M producidos contra Leptospira. Materiales y métodos. Se establecieron tres grupos de estudio. El primero incluyó 19 muestras positivas para leptospirosis de pacientes con diagnóstico clínico y prueba de microaglutinación positiva; el segundo, 40 muestras de personas sin antecedentes de leptospirosis y con microaglutinación negativa, y el tercero con 96 muestras de pacientes con otras enfermedades diferentes a leptospirosis. Todas las muestras fueron procesadas por inmunofluorescencia indirecta. Resultados. Se determinó que la inmunofluorescencia indirecta tiene sensibilidad de 89,47%, especificidad de 100%, valor predictivo negativo de 95,2% (IC95%82,6 a 99,2 y valor predictivo positivo de 100%. En forma paralela, un estudio exploratorio en 27 muestras de suero que habían sido remitidas para diagnóstico de diferentes síndromes febriles encontró que 11% de ellas fueron positivas por inmunofluorescencia indirecta para anticuerpos IgM contra Leptospira. Conclusiones. La inmunofluorescencia indirecta es una alternativa que complementa el diagnóstico de leptospirosis y los estudios seroepidemiológicos. La presencia de anticuerpos dirigidos contra Leptospira en las muestras de síndrome febril del estudio indica que la leptospirosis es una de las causas de este síndrome que el clínico debe explorar.

  1. Rapid, actionable diagnosis of urban epidemic leptospirosis using a pathogenic Leptospira lipL32-based real-time PCR assay.

    Science.gov (United States)

    Riediger, Irina N; Stoddard, Robyn A; Ribeiro, Guilherme S; Nakatani, Sueli M; Moreira, Suzana D R; Skraba, Irene; Biondo, Alexander W; Reis, Mitermayer G; Hoffmaster, Alex R; Vinetz, Joseph M; Ko, Albert I; Wunder, Elsio A

    2017-09-01

    With a conservatively estimated 1 million cases of leptospirosis worldwide and a 5-10% fatality rate, the rapid diagnosis of leptospirosis leading to effective clinical and public health decision making is of high importance, and yet remains a challenge. Based on parallel, population-based studies in two leptospirosis-endemic regions in Brazil, a real-time PCR assay which detects lipL32, a gene specifically present in pathogenic Leptospira, was assessed for the diagnostic effectiveness and accuracy. Patients identified by active hospital-based surveillance in Salvador and Curitiba during large urban leptospirosis epidemics were tested. Real-time PCR reactions were performed with DNA-extracted samples obtained from 127 confirmed and 23 unconfirmed cases suspected of leptospirosis, 122 patients with an acute febrile illness other than leptospirosis, and 60 healthy blood donors. The PCR assay had a limit of detection of 280 Leptospira genomic equivalents/mL. Sensitivity for confirmed cases was 61% for whole blood and 29% for serum samples. Sensitivity was higher (86%) for samples collected within the first 6 days after onset of illness compared to those collected after 7 days (34%). The real-time PCR assay was able to detect leptospiral DNA in blood from 56% of serological non-confirmed cases. The overall specificity of the assay was 99%. These findings indicate that real-time PCR may be a reliable tool for early diagnosis of leptospirosis, which is decisive for clinical management of severe and life-threatening cases and for public health decision making.

  2. Genetic diversity of Leptospira in northwestern Colombia: first report of Leptospira santarosai as a recognised leptospirosis agent

    Directory of Open Access Journals (Sweden)

    Ronald Guillermo Peláez Sanchez

    Full Text Available The region of Antioquia in northeastern Colombia has the highest number of reported leptospirosis cases in the country. It also shows high seroprevalence indexes in the general population and socio-environmental conditions favourable for the transmission of the disease between humans and animals. In this study, 25 Leptospira isolates from Colombia’s Antioquia department were identified to the species level as L. santarosai (12, L. interrogans (9 and L. meyeri (4 using phylogenetic analysis of the Amidohydrolase gene. Typing at the serovar level was performed using multilocus sequence typing (MLST and monoclonal antibodies. The serovars Canalzonae, Babudieri, Alice, Beye, and Copenhageni have been identified as causing human or animal infections in Antioquia, Colombia. The four environmental isolates were not identified to the serovar level. L. santarosai serovar Canalzonae and Alice were identified as new etiologic agents of human leptospirosis in Antioquia, Colombia. This paper reports species and serovars that were previously unknown in the region.

  3. Leptospirosis acquired by tourists in Venice, Italy.

    Science.gov (United States)

    Lagi, Filippo; Corti, Giampaolo; Meli, Massimo; Pinto, Antonella; Bartoloni, Alessandro

    2013-01-01

    We present the case of two Australian tourists aged 25 and 26  years who, after immersion in a canal in Venice, developed severe leptospirosis. After a 1-week history of fever, headache, myalgia, and vomiting they developed jaundice and renal failure. Complete remission was achieved by antibiotic therapy and hemodialysis. © 2012 International Society of Travel Medicine.

  4. Are we diagnosing too many people with coeliac disease?

    Science.gov (United States)

    Aziz, Imran; Sanders, David S

    2012-11-01

    This review will try to address the question of whether we are diagnosing too many people with coeliac disease. The key reasons for diagnosing coeliac disease may be that it is a common condition affecting up to 1% of the adult population. Delays in diagnosis are common. The average time delay reported by Coeliac UK (National Medical Patient Charity), for patients with symptoms prior to the diagnosis being made is 13 years. For every adult case detected, it is estimated that there are eight cases not detected. Patients with coeliac disease have an associated morbidity and mortality. In addition, quality of life studies suggest that the majority of patients benefit from a gluten-free diet (GFD). Furthermore, the GFD reduces or alleviates the risk of the associated complications. All of these facts could even be used to support the argument for screening! However, conversely the tests for coeliac disease are not 100% sensitive and specific. In addition, we do not know whether patients with milder symptoms will derive less benefit from treatment and are at less risk of complications. Furthermore, evidence presented in this review suggests that actual outcomes for screening studies in an adult population have revealed poor uptake and subsequently difficulties with adherence. What little published data that are available also infers that individuals recognised through screening programmes could have been detected if carefully questioned for symptoms. There is evidence to suggest that diagnosing celiac disease is cost-effective and that the diagnostic costs are offset by reduced medical expenditures, reduced hospital and general practice attendances, but this view depends on the population prevalence of coeliac disease. We believe on the basis of the evidence presented in this review that we are not diagnosing too many adults with coeliac disease. However, the authors consider case-finding with a low threshold for serological testing to be the optimal approach. If you

  5. Carriage of Leptospira interrogans among domestic rats from an urban setting highly endemic for leptospirosis in Brazil

    NARCIS (Netherlands)

    de Faria, Marcos Tucunduva; Calderwood, Michael S.; Athanazio, Daniel A.; McBride, Alan J. A.; Hartskeerl, Rudy A.; Pereira, Martha Maria; Ko, Albert I.; Reis, Mitermayer G.

    2008-01-01

    A survey was conducted to identify reservoirs for urban leptospirosis in the city of Salvador, Brazil. Sampling protocols were performed in the vicinity of households of severe leptospirosis cases identified during active hospital-based surveillance. Among a total of 142 captured Rattus norvegicus

  6. Rapid, actionable diagnosis of urban epidemic leptospirosis using a pathogenic Leptospira lipL32-based real-time PCR assay.

    Directory of Open Access Journals (Sweden)

    Irina N Riediger

    2017-09-01

    Full Text Available With a conservatively estimated 1 million cases of leptospirosis worldwide and a 5-10% fatality rate, the rapid diagnosis of leptospirosis leading to effective clinical and public health decision making is of high importance, and yet remains a challenge.Based on parallel, population-based studies in two leptospirosis-endemic regions in Brazil, a real-time PCR assay which detects lipL32, a gene specifically present in pathogenic Leptospira, was assessed for the diagnostic effectiveness and accuracy. Patients identified by active hospital-based surveillance in Salvador and Curitiba during large urban leptospirosis epidemics were tested. Real-time PCR reactions were performed with DNA-extracted samples obtained from 127 confirmed and 23 unconfirmed cases suspected of leptospirosis, 122 patients with an acute febrile illness other than leptospirosis, and 60 healthy blood donors.The PCR assay had a limit of detection of 280 Leptospira genomic equivalents/mL. Sensitivity for confirmed cases was 61% for whole blood and 29% for serum samples. Sensitivity was higher (86% for samples collected within the first 6 days after onset of illness compared to those collected after 7 days (34%. The real-time PCR assay was able to detect leptospiral DNA in blood from 56% of serological non-confirmed cases. The overall specificity of the assay was 99%.These findings indicate that real-time PCR may be a reliable tool for early diagnosis of leptospirosis, which is decisive for clinical management of severe and life-threatening cases and for public health decision making.

  7. Human leptospirosis: occurrence of serovars of Leptospira spp. in the state of Minas Gerais, Brazil, from 2008 to 2012.

    Science.gov (United States)

    Oliveira, Marluce Aparecida Assunção; Leal, Élida Aparecida; Correia, Max Assunção; Serufo Filho, José Carlos; Dias, Ricardo Souza; Serufo, José Carlos

    Leptospirosis is an infectious and acute disease caused by Leptospira spp. that have high epidemic potential. This study verified the main Leptospira spp. serovars detected by MAT from serum of patients with suspicion of leptospirosis from 2008 to 2012 in Minas Gerais State. The laboratory received sera from 4654 patients. All serum were screened by IgM-ELISA according to the manufacturer's instructions. Each sample reactive or indeterminate were tested against twenty-four serovars of Leptospira by MAT. In this study, 597 patients were classified as reactive on MAT. Only 301 patients were confirmed by laboratory test. It was not possible confirmation by laboratory diagnosis of 296 patients. Among the samples classified as reactive on MAT, 273 patients exhibited titers bigger than 800 for one or more serovars; seroconversion was detected in 28 cases. Percentage of 85.1% of the samples reactive on MAT corresponded to males, 39.4% corresponded to patients aged between 20 and 39 years old. The most common serovars found were Icterohaemorrhagiae, Andamana, Patoc, Tarassovi, Copenhageni, Hardjo and Australis. Concerning the samples that exhibited titers bigger than 800, serovar Icterohaemorrhagiae was also the most common, followed by Copenhageni, Andamana, Patoc, Tarassovi, Grippotyphosa and Canicola. In this study, 40% of the cases occurred to the metropolitan area, state capital and 34 neighboring towns. Our results show the possibly spreading serovars in Minas Gerais State and contribute to knowledge of human leptospirosis, aiming at improving the prevention, control of the disease, as well as the treatment of infected patients. Copyright © 2017 Sociedade Brasileira de Microbiologia. Published by Elsevier Editora Ltda. All rights reserved.

  8. Diagnosing Coronary Heart Disease using Ensemble Machine Learning

    OpenAIRE

    Kathleen H. Miao; Julia H. Miao; George J. Miao

    2016-01-01

    Globally, heart disease is the leading cause of death for both men and women. One in every four people is afflicted with and dies of heart disease. Early and accurate diagnoses of heart disease thus are crucial in improving the chances of long-term survival for patients and saving millions of lives. In this research, an advanced ensemble machine learning technology, utilizing an adaptive Boosting algorithm, is developed for accurate coronary heart disease diagnosis and outcome predictions. Th...

  9. Clinical heterogeneity in newly diagnosed Parkinson's disease

    NARCIS (Netherlands)

    Post, Bart; Speelman, Johannes D.; de Haan, Rob J.

    2008-01-01

    OBJECTIVE: To determine clinical heterogeneity in newly diagnosed Parkinson's disease using cluster analysis and to describe the subgroups in terms of impairment, disability, perceived quality of life, and use of dopaminergic therapy. METHODS: We conducted a k-means cluster analysis in a prospective

  10. Differences among children, adolescents and adults with severe leptospirosis: A comparative analysis

    Directory of Open Access Journals (Sweden)

    E F Daher

    2014-01-01

    Full Text Available Leptospirosis is a zoonosis of global importance caused by Leptospira interrogans. The aim of this study was to compare the data between children, adolescents and adults with leptospirosis. This is a retrospective study including a total of 373 consecutive patients with leptospirosis, admitted to tertiary hospitals in Northeast of Brazil, from May 1985 to August 2010. The patients were divided into two groups (age ≤21 years and >21 years. The adults were 304 (81.5% of the population, with a mean ge of 41 ± 13 (range 22-84 years. The pediatric group was 16 ± 3 (range 9-21 years. Signs and symptoms where similar between the groups, excepting arrhythmia, which was more frequent in adults and vomiting, more common in children (16% vs. 0%, P = 0.04 and 65% vs. 79%, P = 0.02, respectively. Adult group presented with higher serum urea (137 vs. 97 mg/dl, P = 0.002 and creatinine (4.3 vs. 3.0 mg/dl, P = 0.007. Acute kidney injury (AKI was observed in 80%, mainly in adults (83% vs. 70% P < 0.005. Adults required renal replacement therapy more frequently than children (38% vs. 11%, P < 0.0001. Mortality was higher in adults (14.8% vs. 2.8%, P = 0.005 and in adults with AKI (93% vs. 7%, P < 0.05. There are important differences between the adults and children with leptospirosis. AKI was more frequent in adults and it was associated with increased mortality.

  11. Simple Additive Weighting to Diagnose Rabbit Disease

    Science.gov (United States)

    Ramadiani; Marissa, Dyna; Jundillah, Muhammad Labib; Azainil; Hatta, Heliza Rahmania

    2018-02-01

    Rabbit is one of the many pets maintained by the general public in Indonesia. Like other pet, rabbits are also susceptible to various diseases. Society in general does not understand correctly the type of rabbit disease and the way of treatment. To help care for sick rabbits it is necessary a decision support system recommendation diagnosis of rabbit disease. The purpose of this research is to make the application of rabbit disease diagnosis system so that can help user in taking care of rabbit. This application diagnoses the disease by tracing the symptoms and calculating the recommendation of the disease using Simple Additive Weighting method. This research produces a web-based decision support system that is used to help rabbit breeders and the general public.

  12. Nursing diagnoses in children with congenital heart disease: a survival analysis.

    Science.gov (United States)

    Martins da Silva, Viviane; Lopes, Marcos Venícios de Oliveira; Leite de Araujo, Thelma

    2007-01-01

    To analyze the relationship between nursing diagnoses and survival rates in children with congenital heart disease. A total of 270 observations were carried out in 45 children with congenital heart disease who were followed for 15 days. Differences in mean survival times were identified in children not more than 4 months of age with respect to the following diagnoses: impaired gas exchange, ineffective breathing pattern, activity intolerance, delayed growth and development, and decreased cardiac output. The main diagnoses are identified early in the hospitalization period and are conditions resulting from hemodynamic alterations and prescribed medical treatment. Congenital heart disease provokes serious hemodynamic alterations that generate human responses, which should be treated proactively.

  13. [Generalized metastatic intestinal and cutaneous calcinosis in a Hovawart puppy with leptospirosis].

    Science.gov (United States)

    Michel, E; Kook, P H; Voss, K; Boretti, F; Reichler, I M

    2011-01-01

    A 10-week old male Hovawart presented with acute renal failure. Based on clinical symptoms, blood analysis results and serology, a diagnosis of leptospirosis was made. Besides being acotemic, the puppy was initially also severely hypercalcemic. The dog was treated successfully, but developed widespread cutaneous and visceral calcifications. Severe pyloric calcification resulted in functional pyloric obstruction, which was successfully treated by pyloromyotomy. All skin lesions were cured with topical therapy within a few weeks. To the authors' knowledge, this is the first report of generalized intestinal and cutaneous calcification associated with acute renal failure due to Leptospirosis.

  14. Accuracy of Veterans Affairs Databases for Diagnoses of Chronic Diseases

    OpenAIRE

    Singh, Jasvinder A.

    2009-01-01

    Introduction Epidemiologic studies usually use database diagnoses or patient self-report to identify disease cohorts, but no previous research has examined the extent to which self-report of chronic disease agrees with database diagnoses in a Veterans Affairs (VA) health care setting. Methods All veterans who had a medical care visit from October 1, 1996, through May 31, 1998, at any of the Veterans Integrated Service Network 13 facilities were surveyed about physician diagnosis of chronic ob...

  15. Leptospirosis and brucellosis seroepidemiology in sheep and dogs from non-mechanized rural properties in the northwestern region in the state of Paraná

    Directory of Open Access Journals (Sweden)

    Leila Alves de Oliveira

    2016-10-01

    Full Text Available Sheep breeding has been important in agribusiness, transforming the Brazilian productive scenario. However, it is still deficient due to the damages caused by infectious diseases. Leptospirosis is a severe disease with global distribution, caused by bacteria from the Leptospira genre affecting both humans and animals. The general infection is unapparent, or its clinical signs, when present, are similar to other infections. Brucellosis is an infectious disease caused by bacteria from the Brucella genre responsible for reproductive disorders in animals, especially ruminants. The purpose of this paper was to seroepidemiological study of Leptospira spp. and Brucella ovis in sheep and dogs from nonmechanized rural properties from the northwestern region in the state of Paraná, Brazil. In order to detect anti-Leptospira antibodies, microscopic agglutination (MAT was performed. For anti-Brucella antibodies, the agar gel immunodiffusion assay (AGID was performed. From the total 542 samples from sheep sera analyzed, 11.25% were considered reagent to Leptospira spp. and 18.26% to Brucella ovis. From the 36 dog samples, 25% were reagent to MAT and AGID. From the 32 properties analyzed, 75% were considered positive for leptospirosis and 56.25% for brucellosis. Antibodies against the most probable serovars were Hardjo (34.42% and Butembo (44.44% in sheep and dogs, respectively, and the variable exchange of animals among properties was associated to leptospiric infection (p=0.028 in sheep. Leptospirosis and brucellosis are present in the sheep herd and dogs in the rural properties studied, and such result is a warning of the zoonotic importance and the need to establish sanitary programs directed to these animal species.

  16. Simple Additive Weighting to Diagnose Rabbit Disease

    Directory of Open Access Journals (Sweden)

    Ramadiani

    2018-01-01

    Full Text Available Rabbit is one of the many pets maintained by the general public in Indonesia. Like other pet, rabbits are also susceptible to various diseases. Society in general does not understand correctly the type of rabbit disease and the way of treatment. To help care for sick rabbits it is necessary a decision support system recommendation diagnosis of rabbit disease. The purpose of this research is to make the application of rabbit disease diagnosis system so that can help user in taking care of rabbit. This application diagnoses the disease by tracing the symptoms and calculating the recommendation of the disease using Simple Additive Weighting method. This research produces a web-based decision support system that is used to help rabbit breeders and the general public.

  17. Estudio transversal de leptospirosis y muerte fetal en Yucatán, México

    OpenAIRE

    María Fidelia Cárdenas-Marrufo; Ignacio Vado-Solis; Gaspar Fernando Peniche-Lara; Carlos Perez-Osorio; José Correa-Segura

    2016-01-01

    Introducción: Leptospirosis es una enfermedad zoonótica que afecta principalmente la población humana de bajos recursos. Infección aguda por leptospirosis durante el embarazo se ha asociado con aborto espontáneo y muerte fetal durante el primer trimestre del embarazo.Objetivo: Estimar la frecuencia de infección por Leptospira interrogans en mujeres con aborto espontáneo en el estado de Yucatán, México.Métodos: Se efectuó un estudio trasversal en 81 mujeres con aborto espontáneo. La prueba de ...

  18. Coinfección brucelosis-leptospirosis, Urabá, Colombia: Reporte de caso

    Directory of Open Access Journals (Sweden)

    Laura Jaramillo

    Full Text Available Se presenta un caso clínico de una confección de leptospirosis-brucelosis, en la región del Urabá antioqueño, en un paciente masculino de 45 años de edad con factores de riesgo ocupacionales, quien consultó inicialmente por síndrome febril prolongado y síntomas generales poco específicos además de manifestaciones hemorrágicas, lo que sumado a estar en área endémica, hizo sospechar el diagnóstico de leptospirosis, por lo cual se ordenó tratamiento, además de pruebas de laboratorio específicas. Luego de 45 días, el paciente consulta nuevamente con síndrome febril y orquiepididimitis unilateral, documentándose por pruebas de laboratorio el diagnóstico de brucelosis y leptospirosis, recibiendo tratamiento triconjugado (doxiciclina, rifampicina y gentamicina con resolución de los síntomas. Este caso de coinfección obliga a tener presente la posibilidad de infecciones simultáneas en pacientes con síndromes febriles procedentes de áreas endémicas para zoonosis, particularmente en los más comprometidos clínicamente.

  19. Hemodiafiltration Decreases Serum Levels of Inflammatory Mediators in Severe Leptospirosis: A Prospective Study.

    Directory of Open Access Journals (Sweden)

    Sérgio Aparecido Cleto

    Full Text Available Leptospirosis is a health problem worldwide. Its most severe form is a classic model of sepsis, provoking acute respiratory distress syndrome (ARDS and acute kidney injury (AKI, with associated mortality that remains unacceptably high. We previously demonstrated that early initiation of sustained low-efficiency dialysis (SLED followed by daily SLED significantly decreases mortality. However, the mode of clearance can also affect dialysis patient outcomes. Therefore, the objective of this study was to compare the effects of SLED with traditional (diffusive clearance, via hemodialysis, and SLED with convective clearance, via hemodiafiltration (SLEDf, in patients with severe leptospirosis.In this prospective study, conducted in the intensive care unit (ICU from 2009 through 2012, we compared two groups-SLED (n = 19 and SLEDf (n = 20-evaluating demographic, clinical, and biochemical parameters, as well as serum levels of interleukins, up to the third day after admission. All patients received dialysis early and daily thereafter.During the study period, 138 patients were admitted to our ICU with a diagnosis of leptospirosis; 39 (36 males/3 females met the criteria for ARDS and AKI. All patients were on mechanical ventilation and were comparable in terms of respiratory parameters. Mortality did not differ between the SLEDf and SLED groups. However, post-admission decreases in the serum levels of interleukin (IL-17, IL-7, and monocyte chemoattractant protein-1 were significantly greater in the SLEDf group. Direct bilirubin and the arterial oxygen tension/fraction of inspired oxygen ratio were significantly higher in the SLED group. We identified the following risk factors (sensitivities/specificities for mortality in severe leptospirosis: age ≥ 55 years (67%/91%; serum urea ≥ 204 mg/dl (100%/70%; creatinine ≥ 5.2 mg/dl (100%/58%; Acute Physiology and Chronic Health Evaluation II score ≥ 39.5 (67%/88%; Sequential Organ Failure Assessment score

  20. A propósito del artículo: Leptospirosis en el entorno actual

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    Manuel de Jesús Morales Mayo

    2015-01-01

    Full Text Available Señor editor: Deseamos llamar la atención sobre el artículo “Leptospirosis en el entorno actual”, publicado en la revista Electrónica “Dr. Zoilo E. Marinello Vidaurreta” en el año 2014, volumen 39 (12, debido a que la leptospirosis continúa teniendo importante impacto en el ámbito social y laboral. La incidencia mundial de la leptospirosis todavía se desconoce, especialmente por el subregistro, las dificultades para el diagnóstico a consecuencia de las diversas formas de presentación, la confusión con otras enfermedades febriles o icterohemorrágicas, el uso de herramientas diagnósticas de distinta sensibilidad y especificidad y al desconocimiento de la entidad por parte del personal de salud. (1 La leptospirosis, hasta su identificación por Weil en 1886, era confundida dentro del grupo de las enfermedades febriles, productoras de ictericia. Los agentes causales de la leptospirosis, microorganismos del genero leptospira, son gérmenes filiformes de 6 a 15 micrómetros de longitud, espirales estrechos a todo lo largo de su cuerpo. La transmisión al hombre tiene lugar por contacto directo con la sangre, la orina, los tejidos y órganos infestados de los animales, o bien por exposición a un ambiente contaminado por leptospira. En las edades infanto-juveniles las manifestaciones clínicas están definidas por fiebre, cefalea, vómitos y diarrea. (2 Un tratamiento integral al paciente por parte de los Médicos de Familia, en el que se garantice el diagnóstico y tratamiento oportunos, resultan elementos esenciales para reducir la mortalidad por esta causa. Para ello es importante la calidad de la información recogida por el médico de asistencia, que el interrogatorio sea detallado, que incluya los aspectos epidemiológicos, junto con una exploración minuciosa al examen físico, lo que de forma sumatoria puede contribuir al diagnóstico. La indicación de estudios de laboratorio específicos en el momento oportuno permitir

  1. Diagnostic Accuracy of Recombinant Immunoglobulin-like Protein A-Based IgM ELISA for the Early Diagnosis of Leptospirosis in the Philippines.

    Directory of Open Access Journals (Sweden)

    Emi Kitashoji

    Full Text Available Leptospirosis is an important but largely under-recognized public health problem in the tropics. Establishment of highly sensitive and specific laboratory diagnosis is essential to reveal the magnitude of problem and to improve treatment. This study aimed to evaluate the diagnostic accuracy of a recombinant LigA protein based IgM ELISA during outbreaks in the clinical-setting of a highly endemic country.A prospective study was conducted from October 2011 to September 2013 at a national referral hospital for infectious diseases in Manila, Philippines. Patients who were hospitalized with clinically suspected leptospirosis were enrolled. Plasma and urine were collected on admission and/or at discharge and tested using the LigA-IgM ELISA and a whole cell-based IgM ELISA. Sensitivity and specificity of these tests were evaluated with cases diagnosed by microscopic agglutination test (MAT, culture and LAMP as the composite reference standard and blood bank donors as healthy controls: the mean+3 standard deviation optical density value of healthy controls was used as the cut-off limit (0.062 for the LigA-IgM ELISA and 0.691 for the whole cell-based IgM ELISA. Of 304 patients enrolled in the study, 270 (89.1% were male and the median age was 30.5 years; 167 (54.9% were laboratory confirmed. The sensitivity and ROC curve AUC for the LigA-IgM ELISA was significantly greater than the whole cell-based IgM ELISA (69.5% vs. 54.3%, p<0.01; 0.90 vs. 0.82, p<0.01 on admission, but not at discharge. The specificity of LigA-IgM ELISA and whole cell-based IgM ELISA were not significantly different (98% vs. 97%. Among 158 MAT negative patients, 53 and 28 were positive by LigA- and whole cell-based IgM ELISA, respectively; if the laboratory confirmation was re-defined by LigA-IgM ELISA and LAMP, the clinical findings were more characteristic of leptospirosis than the diagnosis based on MAT/culture/LAMP.The newly developed LigA-IgM ELISA is more sensitive than the

  2. Evaluation of risk factors of prevalence of leptospirosis in sheep flocks

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    M Imandar

    2012-02-01

    Full Text Available Leptospirosis  is  a  worldwide  bacterial  zoonoses  that  its  main  source  are  wild animals  and  rodents  That  leptospirals  excrete  in  their  urine. This  disease  causes  fever, hemoglobinuria, jaundice, abortion, mastitis, reduced  milk  production, reproductive  disorders  and  death  in  cattle, that  major  complications  in  sheep  are  abortion  and  pyelonephritis. The  purpose  of  this  study  is the  evaluation  of   risk  factors  for  leptospirosis  disease  and  its  association  with  high  prevalence  of  infection  in  the  sheep  flocks. Accordingly, 260 serum samples were collected from 20 flocks of  sheep. Then  with  microscopic  agglutination  test (MAT using  6  live  antigen  Leptospira  interrogans  include  Pomona , canicola, icterohaemorrhagiae, gryppotyphoza, ballum  and  hardjo  was  studied. MAT  test  results  of  the  serum  samples  showed  the  contamination  was  28.46%. Most  contamination  of  the  samples  was  allocated  to  sheep  who  lived  in  swampy  areas, so  that  70.28%  of  positive   samples  were  included. 56.25%  of  positive  samples  among  the  samples  showed  positive  reaction  with  serotype canicola. On the other hand, 76.56%  of  the  positive  samples  belonged  to  animals  which  in  their  environment, rodents   in  very  large  numbers  were  observed. The  sheep  that  kept  in moist  and  wet  environment  to  be  had  60%  of  positive  samples , and  finally  the  highest frequency  of  positive  animals  were  ranged  among  ages  3  to  6  years  old, the  incidence  of  the  disease  increased  in  older  animals. By  attention  to  the  results, increasing  of  age, living  in  swampy  and  wet  bed, being  infectious  dogs  in  side  of  flocks and  also  very  large

  3. Modeling seasonal leptospirosis transmission and its association with rainfall and temperature in Thailand using time-series and ARIMAX analyses.

    Science.gov (United States)

    Chadsuthi, Sudarat; Modchang, Charin; Lenbury, Yongwimon; Iamsirithaworn, Sopon; Triampo, Wannapong

    2012-07-01

    To study the number of leptospirosis cases in relations to the seasonal pattern, and its association with climate factors. Time series analysis was used to study the time variations in the number of leptospirosis cases. The Autoregressive Integrated Moving Average (ARIMA) model was used in data curve fitting and predicting the next leptospirosis cases. We found that the amount of rainfall was correlated to leptospirosis cases in both regions of interest, namely the northern and northeastern region of Thailand, while the temperature played a role in the northeastern region only. The use of multivariate ARIMA (ARIMAX) model showed that factoring in rainfall (with an 8 months lag) yields the best model for the northern region while the model, which factors in rainfall (with a 10 months lag) and temperature (with an 8 months lag) was the best for the northeastern region. The models are able to show the trend in leptospirosis cases and closely fit the recorded data in both regions. The models can also be used to predict the next seasonal peak quite accurately. Copyright © 2012 Hainan Medical College. Published by Elsevier B.V. All rights reserved.

  4. Utilization of Exocellular Mannan from Rhodotorula glutinis as an Immunoreactive Antigen in Diagnosis of Leptospirosis

    Science.gov (United States)

    Matsuo, Kouki; Isogai, Emiko; Araki, Yoshio

    2000-01-01

    Previously, Rhodotorula glutinis was reported to produce a large amount of exocellular mannan, having a repeating unit of →3)-d-Manp-(1→4)-d-Manp-(1→. Recently, we found that antigenic polysaccharides of Leptospira biflexa serovar patoc strain Patoc I have the same repeating unit and cross-react with antisera raised against extended strains of other leptospires (K. Matsuo, E. Isogai, and Y. Araki, Carbohydr. Res., in press). This structural identity and the difficulty of producing and isolating antigens led us to confirm the usefulness of Rhodotorula mannan as an immunoreactive antigen in a serological diagnosis of leptospirosis. In the present investigation, we confirmed the structural identity of an exocellular mannan isolated from R. glutinis AHU 3479 and tried to use it as an immunoreactive antigen in a serological diagnosis of leptospirosis. From its chemical analysis and 1H- and 13C-labeled nuclear magnetic resonance spectrometry, the Rhodotorula mannan was confirmed to consist of the same disaccharide units. Furthermore, such a preparation was shown to immunoreact to various sera from patients suffering with leptospirosis as well as to most rabbit antiserum preparations obtained from immunization with various strains of pathogenic leptospires. Therefore, the Rhodotorula mannan preparation is useful as an immunoreactive antigen in the serological diagnosis for leptospirosis. PMID:11015396

  5. Outbreak of leptospirosis among triathlon participants in Langau, Austria, 2010.

    Science.gov (United States)

    Radl, Christoph; Müller, Maria; Revilla-Fernandez, Sandra; Karner-Zuser, Stefanie; de Martin, Alfred; Schauer, Ulrike; Karner, Franz; Stanek, Gerold; Balcke, Peter; Hallas, Andreas; Frank, Herbert; Fürnschlief, Albert; Erhart, Friedrich; Allerberger, Franz

    2011-12-01

    We report on the first documented outbreak of leptospirosis in Austria. In July 2010, four cases of serologically confirmed leptospirosis occurred in athletes after a triathlon held in Langau. Heavy rains preceded the triathlon (rainfall: 22 mm). The index case (Patient A) was a 41-year-old previously healthy male, who was admitted to hospital A on July 8 with a four-day history of fever up to 40°C that began 14 days after attending the triathlon event. On July 7, patient B, a 42-year-old male, was admitted to the same hospital, with signs and symptoms of kidney failure. Hemodialysis was performed every other day for 3 weeks. While the serum drawn on the day of admission was negative for antibodies against Leptospira, a specimen from July 28 tested positive with Leptospira interrogans. On July 11, patient C, a 40-year-old male, was admitted to hospital B for nephritis. On July 14, patient D, a 44-year-old male, was admitted to hospital C with a ten days history of intermittent fever, mild dry cough and headache. Our report underlines that in Austria recreational users of bodies of freshwater must be aware of an existing risk of contracting leptospirosis, particularly after heavy rains. The suppressive influence of a triathlon on the immune system is well documented and therefore an outbreak in this population group can be seen as a sensitive indicator concerning possible risk for the general population.

  6. Radiological Diagnoses in the Context of Emigration: Infectious diseases.

    Science.gov (United States)

    Stojkovic, Marija; Müller, Jan; Junghanss, Thomas; Weber, Tim Frederik

    2018-02-01

     Globalization and emigration impact on the spectrum of diseases challenging health care systems. Medical practitioners have to particularly prepare for infectious diseases.  The database of a health care center specialized on tropical medicine was screened for patients with history of migration and one of the following diagnoses: Cystic echinococcosis, tuberculosis, schistosomiasis, visceral leishmaniosis, and neurocysticercosis. Representative casuistics were prepared from select case histories. Radiological pertinent knowledge was compiled based on literature search.  A small selection of frequently imported infectious diseases covers a considerable fraction of health care problems associated with migration. For cystic echinococcosis, schistosomiasis, and neurocysticercosis imaging is the most relevant diagnostic procedure defining also disease stages. Tuberculosis and visceral leishmaniosis are important differentials for malignant diseases.  Imaging plays a meaningful role in diagnosis, treatment stratification, and follow-up of imported infectious diseases. Radiological skills concerning these diseases are important for providing health care for patients in context of migration.   · Imaging plays a meaningful role in multidisciplinary care for imported infectious diseases.. · A small selection covers a considerable fraction of infectious diseases expected in context of migration.. · Stojkovic M, Müller J, Junghanss T et al. Radiological Diagnoses in the Context of Emigration: Infectious diseases. Fortschr Röntgenstr 2018; 190: 121 - 133. © Georg Thieme Verlag KG Stuttgart · New York.

  7. Leptospirosis-associated acute kidney injury: penicillin at the late stage is still controversial.

    Science.gov (United States)

    Daher, E F; Silva, G B; de Abreu, K L S; Mota, R M S; Batista, D V; Rocha, N A; Araújo, S M H A; Libório, A B

    2012-08-01

    Some antimicrobial agents are active in vitro against Leptospiras. The use of penicillins at the late stage of leptospirosis is still controversial. We aimed to evaluate the use of penicillin in patients with leptospirosis-associated acute kidney injury (AKI). A retrospective study was conducted of patients with leptospirosis admitted to two hospitals in Fortaleza city, Brazil, between 1985 and 2008. AKI was defined according to the RIFLE and AKIN classifications. Patients were divided in two groups according to whether they were treated with a penicillin or not. Two hundred and eighty-seven patients were included, with an average age of 36·8±15·6 years and mostly male (80·8%). One hundred and twelve patients (39%) received a penicillin. Patients treated with a penicillin were younger (32±14 years vs. 39±16 years, P=0·0002) and had a shorter hospital stay (8·4±5·0 vs. 11±7·7 days, Ppenicillin group (111±21 vs. 119±22 mmHg, P=0·04). AKI, need of dialysis and renal recovery at the time of hospital discharge were more frequent in patients who did not use a penicillin (Ppenicillin, remains controversial. The main benefit of using penicillin in the present study was a reduction in the length of hospital stay and fewer complications, such as AKI, but its use was not associated with a decrease in mortality. On balance of risks and benefits, we recommend the use of penicillin in late-stage leptospirosis. © 2011 Blackwell Publishing Ltd.

  8. Mixed Methods Survey of Zoonotic Disease Awareness and Practice among Animal and Human Healthcare Providers in Moshi, Tanzania.

    Directory of Open Access Journals (Sweden)

    Helen L Zhang

    2016-03-01

    Full Text Available Zoonoses are common causes of human and livestock illness in Tanzania. Previous studies have shown that brucellosis, leptospirosis, and Q fever account for a large proportion of human febrile illness in northern Tanzania, yet they are infrequently diagnosed. We conducted this study to assess awareness and knowledge regarding selected zoonoses among healthcare providers in Moshi, Tanzania; to determine what diagnostic and treatment protocols are utilized; and obtain insights into contextual factors contributing to the apparent under-diagnosis of zoonoses.We conducted a questionnaire about zoonoses knowledge, case reporting, and testing with 52 human health practitioners and 10 livestock health providers. Immediately following questionnaire administration, we conducted semi-structured interviews with 60 of these respondents, using the findings of a previous fever etiology study to prompt conversation. Sixty respondents (97% had heard of brucellosis, 26 (42% leptospirosis, and 20 (32% Q fever. Animal sector respondents reported seeing cases of animal brucellosis (4, rabies (4, and anthrax (3 in the previous 12 months. Human sector respondents reported cases of human brucellosis (15, 29%, rabies (9, 18% and anthrax (6, 12%. None reported leptospirosis or Q fever cases. Nineteen respondents were aware of a local diagnostic test for human brucellosis. Reports of tests for human leptospirosis or Q fever, or for any of the study pathogens in animals, were rare. Many respondents expressed awareness of malaria over-diagnosis and zoonoses under-diagnosis, and many identified low knowledge and testing capacity as reasons for zoonoses under-diagnosis.This study revealed differences in knowledge of different zoonoses and low case report frequencies of brucellosis, leptospirosis, and Q fever. There was a lack of known diagnostic services for leptospirosis and Q fever. These findings emphasize a need for improved diagnostic capacity alongside healthcare

  9. Prospective evaluation of three rapid diagnostic tests for diagnosis of human leptospirosis.

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    Marga G A Goris

    Full Text Available BACKGROUND: Diagnosis of leptospirosis by the microscopic agglutination test (MAT or by culture is confined to specialized laboratories. Although ELISA techniques are more common, they still require laboratory facilities. Rapid Diagnostic Tests (RDTs can be used for easy point-of-care diagnosis. This study aims to evaluate the diagnostic performance of the RDTs LeptoTek Dri Dot, LeptoTek Lateral Flow, and Leptocheck-WB, prospectively. METHODOLOGY: During 2001 to 2012, one or two of the RDTs at the same time have been applied prior to routine diagnostics (MAT, ELISA and culture on serum specimens from participants sent in for leptospirosis diagnosis. The case definition was based on MAT, ELISA and culture results. Participants not fulfilling the case definition were considered not to have leptospirosis. The diagnostic accuracy was determined based on the 1(st submitted sample and paired samples, either in an overall analysis or stratified according to days post onset of illness. RESULTS: The overall sensitivity and specificity for the LeptoTek Dri Dot was 75% respectively 96%, for the LeptoTek Lateral Flow 78% respectively 95%, and for the Leptocheck-WB 78% respectively 98%. Based on the 1(st submitted sample the sensitivity was low (51% for LeptoTek Dri Dot, 69% for LeptoTek Lateral Flow, and 55% for Leptocheck-WB, but substantially increased when the results of paired samples were combined, although accompanied by a lower specificity (82% respectively 91% for LeptoTek Dri Dot, 86% respectively 84% for LeptoTek Lateral Flow, and 80% respectively 93% for Leptocheck-WB. CONCLUSIONS: All three tests present antibody tests contributing to the diagnosis of leptospirosis, thus supporting clinical suspicion and contributing to awareness. Since the overall sensitivity of the tested RDTs did not exceed 80%, one should be cautious to rely only on an RDT result, and confirmation by reference tests is strongly recommended.

  10. Leptospirosis-Associated Severe Pulmonary Hemorrhagic Syndrome with Lower Back Pain as an Initial Symptom

    DEFF Research Database (Denmark)

    Søndergaard, Mads Madsen; tursunovic, Amela; Thye-Roenn, Peter

    2016-01-01

    BACKGROUND Leptospirosis is a zoonosis transmitted through urine of infected animals. Symptoms range from mild influenza-like symptoms to severe pulmonary hemorrhagic syndrome (SPHS); the latter are often fatal. The serogroup distribution in Denmark has changed from 1988 to 2012, with Icterohaemo......BACKGROUND Leptospirosis is a zoonosis transmitted through urine of infected animals. Symptoms range from mild influenza-like symptoms to severe pulmonary hemorrhagic syndrome (SPHS); the latter are often fatal. The serogroup distribution in Denmark has changed from 1988 to 2012......, the patient died a few hours after hospital admission....

  11. Optical coherence tomography for diagnosing periodontal disease

    Science.gov (United States)

    Colston, Bill W., Jr.; Everett, Matthew J.; Da Silva, Luiz B.; Otis, Linda L.; Nathel, Howard

    1997-05-01

    We have, in this preliminary study, investigated the use of optical coherence tomography for diagnosis of periodontal disease. We took in vitro OCT images of the dental and periodontal tissues from a young pig and compared them to histological sections. These images distinguish tooth and soft tissue relationships that are important in diagnosing and assessing periodontal disease. We have imaged the attachment of gingiva to the tooth surface and located the cemento-enamel junction. This junction is an important reference point for defining attachment level in the diagnosis of periodontal disease. the boundary between enamel and dentin is also visible for most of the length of the anatomical crown, allowing quantitation of enamel thickness and character.

  12. A case of leptospirosis simulating colon cancer with liver metastases.

    Science.gov (United States)

    Granito, Alessandro; Ballardini, Giorgio; Fusconi, Marco; Volta, Umberto; Muratori, Paolo; Sambri, Vittorio; Battista, Giuseppe; Bianchi, Francesco-B

    2004-08-15

    We report a case of a 61-year-old man who presented with fatigue, abdominal pain and hepatomegaly. Computed tomography (CT) of the abdomen showed hepatomegaly and multiple hepatic lesions highly suggestive of metastatic diseases. Due to the endoscopic finding of colon ulcer, colon cancer with liver metastases was suspected. Biochemically a slight increase of transaminases, alkaline phosphatase and gammaglutamyl transpeptidase were present; alpha-fetoprotein, carcinoembryogenic antigen and carbohydrate 19-9 antigen serum levels were normal. Laboratory and instrumental investigations, including colon and liver biopsies revealed no signs of malignancy. In the light of spontaneous improvement of symptoms and CT findings, his personal history was reevaluated revealing direct contact with pigs and their tissues. Diagnosis of leptospirosis was considered and confirmed by detection of an elevated titer of antibodies to leptospira. After two mo, biochemical data, CT and colonoscopy were totally normal.

  13. Accuracy of loop-mediated isothermal amplification for diagnosis of human leptospirosis in Thailand.

    Science.gov (United States)

    Sonthayanon, Piengchan; Chierakul, Wirongrong; Wuthiekanun, Vanaporn; Thaipadungpanit, Janjira; Kalambaheti, Thareerat; Boonsilp, Siriphan; Amornchai, Premjit; Smythe, Lee D; Limmathurotsakul, Direk; Day, Nicholas P; Peacock, Sharon J

    2011-04-01

    There is a lack of diagnostic tests for leptospirosis in technology-restricted settings. We developed loop-mediated isothermal amplification (LAMP) specific for the 16S ribosomal RNA gene (rrs) of pathogenic and intermediate group Leptospira species. The lower limit of detection was 10 genomic equivalents/reaction, and analytical specificity was high; we observed positive reactions for pathogenic/intermediate groups and negative reactions for non-pathogenic Leptospira species and other bacterial species. We evaluated this assay in Thailand by using a case-control study of 133 patients with laboratory-proven leptospirosis and 133 patients with other febrile illnesses. Using admission blood, we found that the rrs LAMP showed positive results in 58 of 133 cases (diagnostic sensitivity = 43.6, 95% confidence interval [CI] = 35.0-52.5) and in 22 of 133 controls (diagnostic specificity = 83.5, 95% CI = 76.0-89.3). Sensitivity was high for 39 patients who were culture positive for Leptospira spp. (84.6, 95% CI = 69.5-94.1). The rrs LAMP can provide an admission diagnosis in approximately half of patients with leptospirosis, but its clinical utility is reduced by a lower specificity.

  14. Hemorrhagic, Hemostatic, and Thromboelastometric Disorders in 35 Dogs with a Clinical Diagnosis of Leptospirosis: A Prospective Study

    OpenAIRE

    Barth?lemy, A.; Magnin, M.; Pouzot?Nevoret, C.; Bonnet?Garin, J.?M.; Hugonnard, M.; Goy?Thollot, I.

    2016-01-01

    Background Leptospirosis in dogs is occasionally associated with a hemorrhagic syndrome, the pathophysiology of which is not fully understood. Hypothesis/Objectives To characterize hematologic, hemostatic, and thromboelastometric abnormalities in dogs with leptospirosis and to study their association with hemorrhagic diatheses and outcomes. Animals Thirty?five client?owned dogs. Methods A prospective observational single cohort study was conducted. Results from the CBC, coagulation tests (pro...

  15. Seroepidemiological study of leptospirosis among the communities living in periurban areas of Sarawak, Malaysia.

    Science.gov (United States)

    Thayaparan, S; Robertson, I D; Fairuz, A; Suut, L; Gunasekera, U C; Abdullah, M T

    2015-10-01

    Leptospirosis is endemic to tropical regions of the world and is re-emerging as a new danger to public health in Malaysia. the purpose of this particular study was to determine the common leptospiral serovars present in human communities living around wildlife reserves/disturbed forest habitats. the objective of this study was to estimate the seroprevalence of leptospirosis and finding infecting serovars in villages surrounded habitats where wildlife lives in Sarawak, Malaysia. A cross-sectional serological survey of 198 humans was conducted in four villages around Kuching, Sarawak between January 2011 and March 2012. A seroprevalence of 35.9% (95%cI 29.2-43.0) to the MAt was detected in the tested humans. Antibodies to serovar Lepto 175 Sarawak were most commonly detected (31.3%; 95%cI 24.9-38.3) and were detected in individuals at all four locations. the presence of skin wounds (Or 3.1), farm animals (Or 2.5) and rats (Or 11.2) were all significantly associated with seropositivity in a multivariable logistic regression model. the results of the current study are important as wildlife may act as reservoirs of leptospires for humans. Health authorities should expand disease control measures to minimise the spill-over from wildlife to humans visiting, living or working in the sampled locations. the pathogenic status of serovar Lepto 175 Sarawak also requires further investigation.

  16. [Coinfection of dengue and leptospirosis in a girl from the peruvian amazon].

    Science.gov (United States)

    Núñez-Garbín, Alexandra; Espinoza-Figueroa, Jossué; Sihuincha-Maldonado, Moisés; Suarez-Ognio, Luis

    2015-01-01

    We report the case of a 10 year old girl, born and raised in the city of Iquitos in Peru who presented with headache, fever, chills, musculoskeletal pain, mild epigastric pain, epistaxis and hematemesis. On physical examination, the patient was afebrile and in good general condition. Serological tests confirmed infection of dengue and leptospirosis. The patient received intravenous hydration with sodium chloride 0.9% and penicillin G sodium, achieving a favorable clinical course such that she was discharged a few days after admission to the hospital. Although these diseases are common in the Peruvian Amazon, the simultaneous presence of both in the pediatric population is little documented; therefore, a good clinical history and laboratory tests are important for diagnosis and treatment.

  17. A rare case of Weil's disease with alveolar haemorrhage

    Directory of Open Access Journals (Sweden)

    Abhiram Chakrabarti

    2014-05-01

    Full Text Available Leptospirosis, a disease of protean manifestations occurs sporadically throughout the year with a peak seasonal incidence during the rainy season mimicking other febrile viral illness. In the rare case, the disease leads to renal and hepatic involvement with hemorrhage which may be associated with multisystem organ dysfunction in form of pulmonary, cardiac and central nervous system, when it is known as Weil's disease. Rarely haemorrhagic manifestations are assosciated. Early diagnosis is important as sometimes the disease may be life threatening. Proper antibiotics results in dramatic improvement. We hereby presented a case that had clinical features of Weil's disease with cough, dyspnoea and haemoptysis. Leptospirosis was detected on ELISA testing. Patient was cured rapidly with antibiotics.

  18. A rare case of Weil's disease with alveolar haemorrhage.

    Science.gov (United States)

    Chakrabarti, Abhiram; Nandy, Manab; Pal, Dipankar; Mallik, Sudesna

    2014-05-01

    Leptospirosis, a disease of protean manifestations occurs sporadically throughout the year with a peak seasonal incidence during the rainy season mimicking other febrile viral illness. In the rare case, the disease leads to renal and hepatic involvement with hemorrhage which may be associated with multisystem organ dysfunction in form of pulmonary, cardiac and central nervous system, when it is known as Weil's disease. Rarely haemorrhagic manifestations are assosciated. Early diagnosis is important as sometimes the disease may be life threatening. Proper antibiotics results in dramatic improvement. We hereby presented a case that had clinical features of Weil's disease with cough, dyspnoea and haemoptysis. Leptospirosis was detected on ELISA testing. Patient was cured rapidly with antibiotics.

  19. Retrospctive studies of small ruminant diseases diagnosed at the ...

    African Journals Online (AJOL)

    Retrospctive studies of small ruminant diseases diagnosed at the Veterinary Teaching Hospital, University of Agriculture, Makurdi, Nigeria. J.W. Jatfa, A.Y. Adenkola, I Victor, A Kisani, S.S. Adamu, P.A. Onyeyili ...

  20. Low Levels of Knowledge, Attitudes and Preventive Practices on Leptospirosis among a Rural Community in Hulu Langat District, Selangor, Malaysia

    Directory of Open Access Journals (Sweden)

    Noramira Nozmi

    2018-04-01

    Full Text Available Little is known on the knowledge, attitudes and preventive practices (KAP of leptospirosis worldwide. This study embarked on assessing the KAP of leptospirosis among rural communities in Malaysia. A total of 444 participants (223 male; 221 female aged between 18 and 81 years old were surveyed by using a self-administered questionnaire. A majority of participants had poor knowledge level (57.0%, unacceptable attitudes (90.3% and unacceptable preventive practices (69.1% on leptospirosis, and only 29.7% knew “rat-urine disease” as leptospirosis. Only 34.2% of the participants knew the bacteria could enter via wound lesions. Ethnicity and income were strongly associated with knowledge level and preventive practices, respectively (p-values < 0.05. As for attitudes, ethnicity, income and education type were significantly associated (p-values < 0.05. Only 36.5% of the participants were willing to see a doctor and did not mind if their house or surrounding area is dirty (59.7%. Surprisingly, only 32.9% had used rubber boots during floods. By logistic regression analysis, ethnicity was the only significant predictor for both knowledge level (an odds ratio (AOR = 0.39, 95% confidence interval (CI = 0.222–0.680 and preventive practices (AOR = 1.81, 95% CI = 1.204–2.734. Ethnicity (AOR = 0.40, 95% CI = 0.239–0.665, income (AOR = 1.58, 95% CI = 1.041–2.385 and education type (AOR = 3.69, 95% CI = 1.237–10.986 were strong predictors for attitudes. Among the KAP variables, attitude (AOR = 4.357, 95% CI = 2.613–7.264 was the only predictor for the preventive practices by logistic regression analysis. The KAP elements on leptospirosis are still lacking and poor health seeking behavior and attitudes are of our utmost concern. Thus, effective strategies should be planned to impart knowledge, and develop proactive approaches and good preventive modules on leptospirosis to this leptospirosis-prone community.

  1. A case of leptospirosis simulating colon cancer with liver metastases

    Science.gov (United States)

    Granito, Alessandro; Ballardini, Giorgio; Fusconi, Marco; Volta, Umberto; Muratori, Paolo; Sambri, Vittorio; Battista, Giuseppe; Bianchi, Francesco B.

    2004-01-01

    We report a case of a 61-year-old man who presented with fatigue, abdominal pain and hepatomegaly. Computed tomography (CT) of the abdomen showed hepatomegaly and multiple hepatic lesions highly suggestive of metastatic diseases. Due to the endoscopic finding of colon ulcer, colon cancer with liver metastases was suspected. Biochemically a slight increase of transaminases, alkaline phosphatase and gammaglutamyl transpeptidase were present; α - fetoprotein, carcinoembryogenic antigen and carbohydrate 19-9 antigen serum levels were normal. Laboratory and instrumental investigations, including colon and liver biopsies revealed no signs of malignancy. In the light of spontaneous improvement of symptoms and CT findings, his personal history was revaluated revealing direct contact with pigs and their tissues. Diagnosis of leptospirosis was considered and confirmed by detection of an elevated titer of antibodies to leptospira. After two mo, biochemical data, CT and colonoscopy were totally normal. PMID:15285043

  2. Profile of nursing diagnoses of hospitalized patients in an infectious disease unit

    OpenAIRE

    Souza Neto, Vinicius Lino de; Andrade, Lidiane Lima de; Agra, Glenda; Costa, Marta Miriam Lopes; Silva, Richardson Augusto Rosendo da

    2015-01-01

    Objective: To define the profile of nursing diagnoses of hospitalized patients at an infectious diseases unit.Methods: This is a descriptive study based on the quantitative approach conducted at an infectious diseases unit in Paraiba, Brazil, from January to February 2014. The data collection instrument was based on the Theory of Basic Human Needs by Wanda de Aguiar Horta, followed by the classification system CIPE(r) version 2.0 to construct the diagnoses.Results: Data analysis resulted in 3...

  3. Visual System Involvement in Patients with Newly Diagnosed Parkinson Disease.

    Science.gov (United States)

    Arrigo, Alessandro; Calamuneri, Alessandro; Milardi, Demetrio; Mormina, Enricomaria; Rania, Laura; Postorino, Elisa; Marino, Silvia; Di Lorenzo, Giuseppe; Anastasi, Giuseppe Pio; Ghilardi, Maria Felice; Aragona, Pasquale; Quartarone, Angelo; Gaeta, Michele

    2017-12-01

    Purpose To assess intracranial visual system changes of newly diagnosed Parkinson disease in drug-naïve patients. Materials and Methods Twenty patients with newly diagnosed Parkinson disease and 20 age-matched control subjects were recruited. Magnetic resonance (MR) imaging (T1-weighted and diffusion-weighted imaging) was performed with a 3-T MR imager. White matter changes were assessed by exploring a white matter diffusion profile by means of diffusion-tensor imaging-based parameters and constrained spherical deconvolution-based connectivity analysis and by means of white matter voxel-based morphometry (VBM). Alterations in occipital gray matter were investigated by means of gray matter VBM. Morphologic analysis of the optic chiasm was based on manual measurement of regions of interest. Statistical testing included analysis of variance, t tests, and permutation tests. Results In the patients with Parkinson disease, significant alterations were found in optic radiation connectivity distribution, with decreased lateral geniculate nucleus V2 density (F, -8.28; P Parkinson disease and that the entire intracranial visual system can be involved. © RSNA, 2017 Online supplemental material is available for this article.

  4. Descripción de un brote de leptospirosis en la ciudad de Santa Fe, Argentina, marzo-abril de 1998 Description of a leptospirosis outbreak in the city of Santa Fe, Argentina, March-April 1998

    Directory of Open Access Journals (Sweden)

    Norma B. Vanasco

    2000-01-01

    Full Text Available En marzo-abril de 1998 se identificó en un barrio de la ciudad de Santa Fe (Argentina un brote de una enfermedad aguda caracterizada por fiebre, cefaleas y mialgias intensas. Se presentan los estudios realizados en relación con este brote y los intentos de identificación de la fuente y del modo de transmisión. Los hallazgos epidemiológicos, serológicos y clínicos indicaron que el agente causal fue Leptospira interrogans. Como prueba de tamizaje se aplicó la técnica de aglutinación macroscópica con antígeno termorresistente, seguida de la prueba de ELISA y, como prueba de confirmación, la aglutinación microscópica frente a 10 serovariedades de L. interrogans. Se estudiaron 32 individuos, 8 perros y 8 muestras de agua. Se registraron 12 casos confirmados, 2 probables y 18 negativos. En seis perros se demostró la existencia de infección y en las muestras de agua se detectó la presencia de espiroquetas móviles. Los sueros humanos reaccionaron con las serovariedades ballum, canicola, icterohaemorrhagiae y pyrogenes, y los caninos con ballum, canicola y pomona. La coaglutinación observada en todos los casos confirmados indica que se trató de casos agudos de leptospirosis, pero no permite identificar la serovariedad causal. Salvo en el caso índice, no se reconoció clínicamente la enfermedad. Varios hechos sugieren que la causa del brote fue la inundación pluvial de la zona estudiada. Los resultados de este estudio resaltan la necesidad de una vigilancia activa de la leptospirosis ante desastres naturales como las inundaciones.In March-April 1998 in a neighborhood in the city of Santa Fe, Argentina, there was an outbreak of an acute disease characterized by fever, headaches, and intense myalgias. This article presents the studies surrounding this outbreak and the attempts to identify the source and the mode of transmission. The epidemiological, serological, and clinical findings indicated that the causative agent was Leptospira

  5. Seroprevalance of leptospirosis in patients with fever visited Vaysian Health Center ,Khoramabad, summer 1385

    Directory of Open Access Journals (Sweden)

    gholamreza Talei

    2007-10-01

    Full Text Available Talei GR1, Sheikhian A2,Mousavi Z3 1. Assistant professor, Department of Microbiology, Faculty of medicine, Lorestan University medical sciences 2. Assistant professor, Department of Immunology, Faculty of medicine, Lorestan University medical sciences 3. B.Sc of laboratory sciences, Lorestan University medical sciences Abstract Background: Leptospirosis is known to be an emerging infection and the most common zoonosiss of the world. The etiological agent of the disease is spirochetes, Leptospira interogans which infect more than 160 differ rent mammalian species including rodents, cattle, dogs and wild mammals. Clinical syndrome may vary from influenza – like syndrome with fever, headache and myalgia to sever Weils syndrome with jaundice, renal dysfunction and hemorrhagic diathesis. Human infection occurs accidentally through contact with contaminated water or animal materials. There are reports of high prevalence of leptospirosis in rice farm workers, probably acquired during work in paddy. Also there was evidence of leptospirosis in the Lorestan province. In this study, serum IgG and IgM antibody response to leptospira was examined in adult patients who visited Vaysian Health Centre during Shahrivar and October 1384,during the season of paddies. work in slug in Materials and methods: About 8 patients visited the Health Center during the season who were examined for clinical symptoms and then a questionnaire was filled. About 5 ml of blood sample was taken, the serum was separated and freezed before being examined by ELISA thechnique.Serion Classic Leptospira IgG/IgM ELISA (Germany was used and the results were calculated according to the instruction. Results: From 80 patient who participated in this study, 39 (48.8% had IgG antibody to leptospira and 41 (51.2% were negative. From IgG positive patients,28 (35% were IgM positive and 11(65% were negative . Of the people who had antibody to leptospira 30 (76.92% were male and 9 (23.08% were

  6. Refractory coeliac disease in a country with a high prevalence of clinically-diagnosed coeliac disease.

    Science.gov (United States)

    Ilus, T; Kaukinen, K; Virta, L J; Huhtala, H; Mäki, M; Kurppa, K; Heikkinen, M; Heikura, M; Hirsi, E; Jantunen, K; Moilanen, V; Nielsen, C; Puhto, M; Pölkki, H; Vihriälä, I; Collin, P

    2014-02-01

    Refractory coeliac disease (RCD) is thought to be a rare disorder, but the accurate prevalence is unknown. We aimed to identify the prevalence of and the risk factors for developing RCD in a Finnish population where the clinical detection rate of coeliac disease is high. The study involved 11 hospital districts in Finland where the number of treated RCD patients (n = 44), clinically diagnosed coeliac disease patients (n = 12 243) and adult inhabitants (n = 1.7 million) was known. Clinical characteristics at diagnosis of coeliac disease between the RCD patients and patients with uncomplicated disease were compared. The prevalence of RCD was 0.31% among diagnosed coeliac disease patients and 0.002% in the general population. Of the enrolled 44 RCD patients, 68% had type I and 23% type II; in 9% the type was undetermined. Comparing 886 patients with uncomplicated coeliac disease with these 44 patients that developed RCD later in life, the latter were significantly older (median 56 vs 44 years, P coeliac disease. Patients with evolving RCD had more severe symptoms at the diagnosis of coeliac disease, including weight loss in 36% (vs. 16%, P = 0.001) and diarrhoea in 54% (vs. 38%, P = 0.050). Refractory coeliac disease is very rare in the general population. Patients of male gender, older age, severe symptoms or seronegativity at the diagnosis of coeliac disease are at risk of future refractory coeliac disease and should be followed up carefully. © 2014 John Wiley & Sons Ltd.

  7. Evaluación de la efectividad de una nueva vacuna contra la leptospirosis humana en grupos en riesgo Evaluation of the effectiveness of a new vaccine against human leptospirosis among groups at risk

    Directory of Open Access Journals (Sweden)

    Raydel Martínez Sánchez

    2000-12-01

    Full Text Available Se realizó un estudio de cohorte prospectivo cuasi experimental que incluyó a los grupos en riesgo de enfermar de leptospirosis en la provincia de Holguín para evaluar la efectividad de la vacuna contra la leptospirosis humana. Se incluyeron 118 018 personas de 15 a 65 años que presentaban un riesgo permanente o temporal de contraer la enfermedad; de estas, 101 137 fueron inmunizadas con dos dosis de 0,5 mL por vía intramuscular profunda en el músculo deltoides del brazo no dominante, con un intervalo de 6 semanas, constituyendo la cohorte de vacunados, mientras que 16 881 personas no inmunizadas pasaron a integrar la cohorte de no vacunados. A los 21 días de aplicada la segunda dosis, el universo de estudio (previamente censado en un registro de modelo fue seguido por el sistema local de vigilancia epidemiológica con el objetivo de detectar la enfermedad. El criterio de caso sospechoso y confirmado se conservó durante todo el período de estudio. En el presente trabajo se exponen los resultados al año de haber comenzado el período de vigilancia epidemiológica. La efectividad calculada fue de 97%. Se estima que se logró prevenir 8 de cada 10 casos que se hubieran presentado en esta provincia de no haberse realizado la vacunación. También se midió la reactogenicidad de la vacuna en una submuestra de 1 500 voluntarios de 15 a 65 años de edad. La sintomatología observada fue baja, siendo el dolor ligero en el sitio de la inyección el síntoma más referido (25%. Los resultados del estudio aportan elementos que prueban la utilidad de la nueva vacuna para la prevención de la leptospirosis en personas expuestas al riesgo, por lo que en este grupo se recomienda su aplicación.In order to evaluate the effectiveness of a new vaccine against human leptospirosis, a prospective cohort study was done with persons in the Cuban province of Holguín who were at risk of becoming ill with leptospirosis. The study included 118 018 persons from

  8. A changing trend in the management of patients with newly diagnosed Crohn's disease.

    LENUS (Irish Health Repository)

    Qasim, A

    2012-02-01

    BACKGROUND: Epidemiologic shift with rising incidence of Crohn\\'s disease (CD) has been reported in recent studies. AIMS: To determine disease behaviour and therapeutic interventions undertaken in newly diagnosed patients with CD. METHODS: Patients diagnosed with CD between January 2006 and June 2008 were included. Disease type, location, degree of involvement and type of therapeutic interventions were recorded. RESULTS: A total of 78 patients were included. Colonic, ileo-colonic, terminal ileal and isolated small bowel disease were present in 37, 27, 9 and 5 patients, respectively. Disease phenotype was inflammatory, stenosing and fistulising in 42, 30 and 6 patients, respectively. Surgery was required in 22 patients, including right hemicolectomy (n = 8), subtotal colectomy (n = 4), segmental colonic resection (n = 2), segmental small bowel resection (n = 2), appendectomy (n = 2) and perianal surgery (n = 4). Fourteen patients underwent surgery at the time of diagnosis. Laparoscopic surgery was performed in 14 patients. CONCLUSIONS: A significant proportion of newly diagnosed patients with CD underwent surgical intervention on their first admission to hospital. This may signify a changing trend in the management approach.

  9. Decreased delayed hypersensitivity to tuberculin demonstrated in experimental leptospirosis in guinea pigs

    DEFF Research Database (Denmark)

    Colding, H; Johansen, K S; Bentzon, M W

    1976-01-01

    Skin reactivity to tuberculin has been studied during the course of experimental leptospirosis in guinea pigs. A depression of the delayed hypersensitivity to tuberculin was demonstrated in the infected animals. The depression was most pronounced when icterus had developed. The depression...

  10. [Subclinical and established kidney disease in recently diagnosed hypertensive patients].

    Science.gov (United States)

    Gómez-Marcos, Manuel Angel; Martínez-Salgado, Carlos; Grandes, Gonzalo; Recio-Rodríguez, José Ignacio; Castaño Sánchez, Yolanda; Rodríguez Sánchez, Emiliano; García-Ortiz, Luis

    2010-03-06

    To estimate renal disease in recently diagnosed hypertensive patients, and to identify factors related to renal disease. Cross-sectional study, with 425 hypertensive patients recently diagnosed in primary health care; renal disease was estimated with serum creatinine, albumin/creatinine index and glomerular filtration rate (GFR). We analyzed cardiovascular risk factors (CRF), subclinical organ injury and cardiovascular disease following the criteria of the 2007 European Guide of Hypertension. Average age: 58,96 +/- 12,73 years old, 63,3% male. We found dyslipemia in 80%, abdominal obesity in 49% and metabolic syndrome in 36% patients. These patients showed increased serum creatinine 3,3%, a reduction in GFR 9,6%, hidden renal disease 6,4%, microalbuminuria 7,5% and nephropathy 2,4%. Hypertensive patients with renal disease (17,88%) were older, with higher systolic pressure, higher incidence of metabolic syndrome, abnormal carotid intima-media thickness and ankle-arm index, and presence of cardiovascular disease. Variables associated with renal disease were metabolic syndrome (odds ratio = 11,12) and ankle-arm index (odds ratio = 17,55). Variables related to creatinina were sex, ankle-arm index and metabolic syndrome; variables related to GFR were sex, age, ankle-arm index, metabolic syndrome and body mass index (BMI); variables related with albumin/creatinine index included diabetes mellitus. Renal disease is detected in about 2 out of 10 hypertensive patients, when, besides serum creatinina, we analyze albumin/creatinine index and GFR. Metabolic syndrome and ankle-arm index are the main variables associated with renal disease. Copyright 2009 Elsevier España, S.L. All rights reserved.

  11. The characteristics of patients with pulmonary Mycobacterium avium-intracellulare complex disease diagnosed by bronchial lavage culture compared to those diagnosed by sputum culture.

    Science.gov (United States)

    Maekawa, Koichi; Naka, Megumi; Shuto, Saki; Harada, Yuka; Ikegami, Yumiko

    2017-09-01

    The utility of bronchoscopy for the diagnosis of pulmonary Mycobacterium avium-intracellulare complex (MAC) disease has been reported; however, which patients require bronchoscopy remains unclear. Our objective was to identify the characteristics of the patients in whom bronchoscopy is needed for the diagnosis of MAC disease. Fifty-four patients with pulmonary MAC disease were divided into two groups according to established diagnostic criteria: 39 patients were diagnosed by sputum culture and 15 patients were diagnosed by bronchial lavage culture. We analysed the differences in demographic and clinical characteristics as well as microbiological and radiological data between the two groups. There were no significant differences in age, sex, smoking status, MAC species, underlying diseases, or steroid use. Significantly more patients diagnosed by sputum culture than bronchial lavage culture had a positive sputum smear for acid-fast bacilli (79.5% vs. 0.0%, respectively; p disease, bronchiectasis, and cavities. However, more patients diagnosed by sputum culture than bronchial lavage culture had abnormalities in the left upper division (48.7% vs. 13.3%, respectively; p = 0.017) and higher numbers of affected lobes (4.3 ± 1.4 vs. 3.3 ± 1.6, respectively; p = 0.034). If patients suspected of having pulmonary MAC disease have a negative sputum smear, no symptoms, no abnormal findings in the left upper division, or fewer affected lobes on computed tomography, bronchoscopy might be needed for the diagnosis. Copyright © 2017 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  12. The terminal portion of leptospiral immunoglobulin-like protein LigA confers protective immunity against lethal infection in the hamster model of leptospirosis

    OpenAIRE

    Silva, Éverton F.; Medeiros, Marco A.; McBride, Alan J. A.; Matsunaga, Jim; Esteves, Gabriela S.; Ramos, João G. R.; Santos, Cleiton S.; Croda, Júlio; Homma, Akira; Dellagostin, Odir A.; Haake, David A.; Reis, Mitermayer G.; Ko, Albert I.

    2007-01-01

    Subunit vaccines are a potential intervention strategy against leptospirosis, which is a major public health problem in developing countries and a veterinary disease in livestock and companion animals worldwide. Leptospiral immunoglobulin-like (Lig) proteins are a family of surface-exposed determinants that have Ig-like repeat domains found in virulence factors such as intimin and invasin. We expressed fragments of the repeat domain regions of LigA and LigB from Leptospira interrogans serovar...

  13. Profile of nursing diagnoses of hospitalized patients in an infectious disease unit

    Directory of Open Access Journals (Sweden)

    Vinicius Lino de Souza Neto

    Full Text Available Objective: To define the profile of nursing diagnoses of hospitalized patients at an infectious diseases unit.Methods: This is a descriptive study based on the quantitative approach conducted at an infectious diseases unit in Paraiba, Brazil, from January to February 2014. The data collection instrument was based on the Theory of Basic Human Needs by Wanda de Aguiar Horta, followed by the classification system CIPE(r version 2.0 to construct the diagnoses.Results: Data analysis resulted in 36 nursing diagnoses statements, with a higher prevalence of impaired food intake, cachexia, impaired spontaneous bladder elimination, impaired oral cavity hygiene, exposure to contamination, rapid heart rate, insomnia, drug abuse, alcohol and tobacco abuse, social isolation, acceptance and fear.Conclusions: The identification of a diagnostics profile is critical to guide nursing interventions.

  14. Factores de riesgo sociales y ambientales relacionados con casos de leptospirosis de manejo ambulatorio y hospitalario, Turbo, Colombia

    Directory of Open Access Journals (Sweden)

    Dionisia Yusti

    2013-08-01

    Full Text Available Introducción. La leptospirosis es un problema de salud pública en el Urabá colombiano y poco se sabe sobre las condiciones ambientales y sociales de esta enfermedad en la región. Objetivo. Explorar algunos factores de riesgo relacionados con leptospirosis de manejo hospitalario y ambulatorio, en pacientes del municipio de Turbo durante los años 2010 y 2011. Materiales y métodos. Mediante un estudio descriptivo se exploraron factores relacionados conla exposición a Leptospira spp. (aspectos socio-demográficos, hábitos, condiciones físicas y de saneamiento de la vivienda, hacinamiento, fuentes de agua potable, presencia de roedores sinantrópicos y convivencia con animales en pacientes con leptospirosis que requirieron manejo hospitalario en el municipio de Turbo durante los años 2010 y 2011. Se utilizaron medidas estadísticas estandarizadas para estudios descriptivos. Resultados. Se encontró que el hábito de caminar descalzo en ambientes domésticos representó 4,27 (1,32-13,82 veces el riesgo para presentar leptospirosis de manejo hospitalario (p=0,012. El análisis multivariado exploratorio mostró que la presencia de fauna silvestre en las viviendas puede estar relacionada también con casos de manejo hospitalario. Este hallazgo representó 4,22 (1,13-15,72 veces el riesgo comparado con los casos ambulatorios que manifestaron no tener este tipo deanimales dentro de la vivienda (p=0,032. Conclusión. Este estudio plantea bases para diseñar e implementar intervenciones efectivas, orientadas desde el perfil de riesgos al que se exponen sus habitantes, en un área geográfica queexhibe una epidemiología dinámica de contexto complejo para leptospirosis.   doi: http://dx.doi.org/10.7705/biomedica.v33i0.1457

  15. Coupling of ground biosensor networks for water monitoring with satellite observations in assessing Leptospirosis

    Science.gov (United States)

    Skouloudis, A. N.; Rickerby, D. G.

    2012-12-01

    Leptospirosis became recently a major public-health problem that is closely related with the environment (Nature review Oct 2009, Vol 7, pp 736-747). This disease originates from zoonotic pathogens associated with asymptomatic rodent carriers. Unfortunately, it effects human populations via various direct and indirect routes. This disease can claim many victims with large outbreaks during natural disasters or floods occurring during seasonal conditions. The severity of the illness ranges from subclinical infection to a fulminating fatal disease. Improved water quality monitoring techniques based on biosensor, optical, micro-fluidic and information technologies are leading to radical changes in our ability to perceive and monitor the aquatic environment. Biosensors are capable of providing specific, high spatial resolution information and allow unattended operation that will be particularly useful for water borne related diseases. Current research on biosensors is leading to solutions to problems for several contaminants that were previously irresolvable due to their high degree of complexity. Networking of the sensors enables sensitive monitoring systems allowing real-time monitoring of pollutants and facilitates data transmission between the measurement points and central control stations for continuous surveillance and to provide an early warning capability. The application of intelligent biosensor networks for water quality monitoring and detection of localized sources of pollution are discussed together with the setting up of a methodology that utilizes images from satellite coupled with in-situ sensors for anticipating the zones of potential evolution of this disease and assessing the population at risk. Environmental and climatic conditions that are associated the outbreaks are described and the rational of combining earth observations coupled with advanced in-situ biosensors is explained. The implementation of sensor networks for data collection and exposure

  16. Diagnóstico de leptospirosis humana

    Directory of Open Access Journals (Sweden)

    Piedad Agudelo-Flórez

    2010-04-01

    Full Text Available La leptospirosis ha re-emergido como una enfermedad infecciosa importante de distribución universal. El agente etiológico es un grupo de 17 especies del género Leptospira. En el humano la enfermedad puede ser asintomática o presentarse como una enfermedad febril bifásica con sintomatología inespecífica y autolimitada que puede durar de 5-10 días. Los síntomas iniciales además de la fiebre, incluyen dolor de cabeza, escalofríos, vómito, cefalalgia, mialgias generalizadas e infección conjuntival y malestar, a veces, postración. En su forma más común la leptospirosis adopta el aspecto clínico de un síndrome febril anictérico. Lasegunda fase presenta las características de la fase inmune y se correlaciona con la aparición de anticuerpos circulantes de clase IgM. En 5-10% de los casos se agregan ictericia, manifestaciones hemorrágicas e insuficiencia renal aguda y bilirrubinas elevadas, constituyendo la enfermedad de Weil. Otros casos presentan síntomas meníngeos o cursan como síndrome pulmonar hemorrágico que es la forma más grave y fatal descrita hasta el momento, con 25 a 50% de mortalidad asociada, superando la ocasionada por el clásico síndrome de Weil. En términos generales es ampliamente aceptado que el diagnóstico oportuno, el inicio temprano de antibióticos, junto con el manejo apropiado, de la falla renal aguda y la insuficiencia respiratoria, en los casos que lo requieran, disminuye las probabilidades de que la enfermedad curse a formas graves y potencialmente fatales (1-3.

  17. Leptospirosis humana en la atención primaria de salud: pautas para su prevención y control Human leptospirosis in health primary care: guidelines for its prevention and control

    Directory of Open Access Journals (Sweden)

    Denis Berdasquera Corcho

    2007-09-01

    Full Text Available Durante las dos últimas décadas se ha observado a nivel mundial un alza en el número de casos de leptospirosis humana, frecuentemente asociada a desastres naturales. En Cuba, esta enfermedad tiene un comportamiento endemo epidémico, y estacional. Las características tropicales del país, el clima, la orografía, la red fluvial natural y la artificial, las extensas áreas agrícolas, y los regímenes lluviosos en determinadas épocas del año, han propiciado un aumento en el número de casos de esta enfermedad. En el presente artículo se hace una revisión documental del tema y se propone una guía para el control y prevención de esta zoonosis en la atención primaria de salud, y así brindarle al Médico de Familia elementos importantes para su trabajo diario en la comunidad.For two last decades it was observed a rise in cases of human leptospirosis frequently associated to natural disasters. In Cuba, this condition has a endemic, epidemic, and seasonal behaviour. Tropical features of our country, climate, orography, natural and artificial fluvial network, extensive agricultural areas, and rainy regimes en determined times of year, have propitiate a increase in case-number of this disease. In present paper a documentary review of this topic was made and we propose a guide for control and prevention of this zoonosis in health primary care, and thus provide to Family Physician with significant components for his daily practice in community.

  18. Predicting global variation in infectious disease severity

    DEFF Research Database (Denmark)

    Jensen, Per Moestrup; de Fine Licht, Henrik Hjarvard

    2016-01-01

    demographic and population data. Results: Birth rates were the best predictor for mumps and malaria CFR. For tuberculosis CFR death rates were the best predictor and for leptospirosis population density was a significant predictor. Conclusions and implications: CFR predictors differed among diseases according...... and leptospirosis and assessed these for association with a range of population characteristics, such as crude birth and death rates, median age of the population, mean body mass index, proportion living in urban areas and tuberculosis vaccine coverage. We then tested this predictive model on Danish his- torical...... have the opposite effect. Accordingly changes in CFR may occur in parallel with demographic transitions. Methodology: We explored the predictability of CFR using data obtained from the World Health Organization (WHO) disease databases for four human diseases: mumps, malaria, tuberculosis...

  19. A cross-sectional epidemiological study of domestic animals related to human leptospirosis cases in Nicaragua.

    Science.gov (United States)

    Flores, Byron J; Pérez-Sánchez, Tania; Fuertes, Héctor; Sheleby-Elías, Jessica; Múzquiz, José Luis; Jirón, William; Duttmann, Christianne; Halaihel, Nabil

    2017-06-01

    Leptospirosis is one of the most extended zoonosis worldwide and humans become infected most commonly through contact with the urine of carrier animals, either directly or via contaminated water or soil. The aim in this study was to analyse the epidemiological behaviour of Leptospira spp., from domestic animals around the sites of human leptospirosis cases in Nicaragua, from 2007 through 2013. We report the results of a cross-sectional epidemiological study with a non-probability sampling of blood (n=3050) and urine (n=299) from Domestic Animals (DA) around the sites of human leptospirosis cases in Nicaragua. We analysed data obtained through Microscopic Agglutination Test (MAT), in-vitro culture, real time PCR and sequencing of lfb1 locus. Frequencies of 30.31% (95% CI: 28.66-31.95) and 15.38% (95% CI: 11.12-19.64) were obtained from serological test and from in-vitro culture, respectively. Although similar frequencies from serology test (P≥0.05) were found in DA species, in-vitro culture frequencies were significantly higher from bovine, equine and sheep (P<0.05) in comparison with swine and canine species. Ten serogroups of pathogenic Leptospira spp. were encountered, with the highest presence of Icterohaemorrhagiae serogroup 34.65% (95% CI: 29.35-39.94). We identified 7 samples homologous to L. interrogans species Pyrogenes serovar and 3 samples as L. noguchii Louisiana or Panama serovars by analysis of lfb1 sequences. We were able to establish a temporal and spatial correlation from DA and cumulative incidence of human cases. Therefore an effective epidemiological surveillance should be implemented with a specific control program toward DA in order to reduce human leptospirosis incidence. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. The course and outcome of renal failure due to human leptospirosis referred to a hospital in North of Iran; A follow-up study.

    Science.gov (United States)

    Ghasemian, Roya; Shokri, Mehran; Makhlough, Atieh; Suraki-Azad, Mohammad Amin

    2016-01-01

    Renal complication of leptospirosis is common and its clinical manifestations vary from urinary sediment changes to acute renal failure. The aim of this study was to determine the final outcome of renal involvement in leptospirosis. This longitudinal prospective study included all serologically confirmed cases of leptospirosis with evidence of renal failure. All patients were followed for three months while all patients with renal failure were followed-up for one year. Fifty-one patients, 53.5±14.8 years (82.4% males) with acute renal failure were studied. Over the hospitalization period, 28 patients recovered, and seven (13.72%) patients died of multiple organ failure. At the time of discharge, 16 patients had mild renal failure. Over the follow-up period, all patients recovered but in two patients renal failure persisted at creatinine level of 1.5 mg/dl. Development of renal failure in leptospirosis is not rare. Recovery of renal function may last several months. However, most patients recover completely at least after one year.

  1. The terminal portion of leptospiral immunoglobulin-like protein LigA confers protective immunity against lethal infection in the hamster model of leptospirosis.

    Science.gov (United States)

    Silva, Everton F; Medeiros, Marco A; McBride, Alan J A; Matsunaga, Jim; Esteves, Gabriela S; Ramos, João G R; Santos, Cleiton S; Croda, Júlio; Homma, Akira; Dellagostin, Odir A; Haake, David A; Reis, Mitermayer G; Ko, Albert I

    2007-08-14

    Subunit vaccines are a potential intervention strategy against leptospirosis, which is a major public health problem in developing countries and a veterinary disease in livestock and companion animals worldwide. Leptospiral immunoglobulin-like (Lig) proteins are a family of surface-exposed determinants that have Ig-like repeat domains found in virulence factors such as intimin and invasin. We expressed fragments of the repeat domain regions of LigA and LigB from Leptospira interrogans serovar Copenhageni. Immunization of Golden Syrian hamsters with Lig fragments in Freund's adjuvant induced robust antibody responses against recombinant protein and native protein, as detected by ELISA and immunoblot, respectively. A single fragment, LigANI, which corresponds to the six carboxy-terminal Ig-like repeat domains of the LigA molecule, conferred immunoprotection against mortality (67-100%, P<0.05) in hamsters which received a lethal inoculum of L. interrogans serovar Copenhageni. However, immunization with this fragment did not confer sterilizing immunity. These findings indicate that the carboxy-terminal portion of LigA is an immunoprotective domain and may serve as a vaccine candidate for human and veterinary leptospirosis.

  2. Introducing a multifaceted exercise intervention particular to older adults diagnosed with Parkinson's disease: a preliminary study.

    Science.gov (United States)

    Peacock, Corey A; Sanders, Gabriel J; Wilson, Kayla A; Fickes-Ryan, Emily J; Corbett, Duane B; von Carlowitz, Kyle-Patrick A; Ridgel, Angela L

    2014-08-01

    With a substantial increase in diagnosed Parkinson's disease, it is of great importance to examine tolerance and physical measures of evolving exercise interventions. Of particular importance, a multifaceted exercise intervention combining active-assisted cycling and resistance training to older adults diagnosed with Parkinson's disease is being assessed. Fourteen older adults diagnosed with Parkinson's disease and ten healthy older adults (67.5 ± 7.9 years of age) engaged in an 8-week, 24-session, multifaceted exercise protocol. The protocol consisted of both active-assisted cycling and resistance training. Tolerance was measured, as well as multiple indicators of health-related physical fitness. These indicators examined improvements in cardiovascular performance, muscular strength, muscular endurance, and flexibility. Twenty-two older adults and older adults diagnosed with Parkinson's disease tolerated the intervention by completing all 24 sessions. Repeated-measures analysis of variance demonstrated significant (P ≤ 0.003) improvements in cardiovascular performance, muscular strength, muscular endurance, and flexibility for both groups of individuals. The multifaceted intervention is the first to combine both active-assisted cycling and resistance training. The older adult and the older adult diagnosed with Parkinson's disease exhibited both tolerance and health-related improvements in physical fitness following the intervention.

  3. New testing options for diagnosing and grading dry eye disease.

    Science.gov (United States)

    Foulks, Gary N; Pflugfelder, Stephen C

    2014-06-01

    To describe new options for diagnosis and severity grading of dry eye disease. Perspective on technological advancements to identify tear dysfunction and their value in diagnosing and grading dry eye disease. Evidence is presented on new and evolving technologies to measure tear stability, composition, and meniscus height and their role in dry eye diagnosis and therapeutic efficacy grading is assessed. Evolving concepts regarding pathogenesis and new technologies to evaluate the tears and ocular surface have improved the ability to diagnose, classify, and grade the severity of dry eye disease. New technologies include noninvasive imaging of tear stability and tear meniscus height as a measure of tear volume and tear composition (osmolarity, lacrimal factors, inflammatory mediators, growth and differentiation factors). Approved tests, such as tear osmolarity and tear imaging, are being integrated into clinical practice and may eventually supplant certain traditional tests that have greater variability and less sensitivity. Other tests, such as molecular assays of tears and conjunctival cells, are currently being used in studies investigating pathogenesis and therapeutic mechanism of action. They may eventually translate to routine clinical practice. New technologies have emerged that can noninvasively evaluate the tears and measure disease-associated compositional changes. These tests are being integrated into clinical practice and therapeutic trials for diagnosis, classification, and severity grading of dry eye disease. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. Evaluation of the diagnostic value of serologic microagglutination testing and a polymerase chain reaction assay for diagnosis of acute leptospirosis in dogs in a referral center.

    Science.gov (United States)

    Fraune, Claudia Kümmerle; Schweighauser, Ariane; Francey, Thierry

    2013-05-15

    To determine the diagnostic value of a serologic microagglutination test (MAT) and a PCR assay on urine and blood for the diagnosis of leptospirosis in dogs with acute kidney injury (AKI). Cross-sectional study. Animals-76 dogs with AKI in a referral hospital (2008 to 2009). Dogs' leptospirosis status was defined with a paired serologic MAT against a panel of 11 Leptospira serovars as leptospirosis-associated (n = 30) or nonleptospirosis-associated AKI (12). In 34 dogs, convalescent serologic testing was not possible, and leptospirosis status was classified as undetermined. The diagnostic value of the MAT single acute or convalescent blood sample was determined in dogs in which leptospirosis status could be classified. The diagnostic value of a commercially available genus-specific PCR assay was evaluated by use of 36 blood samples and 20 urine samples. Serologic acute testing of an acute blood sample had a specificity of 100% (95% CI, 76% to 100%), a sensitivity of 50% (33% to 67%), and an accuracy of 64% (49% to 77%). Serologic testing of a convalescent blood sample had a specificity of 92% (65% to 99%), a sensitivity of 100% (87% to 100%), and an accuracy of 98% (88% to 100%). Results of the Leptospira PCR assay were negative for all samples from dogs for which leptospirosis status could be classified. Serologic MAT results were highly accurate for diagnosis of leptospirosis in dogs, despite a low sensitivity for early diagnosis. In this referral setting of dogs pretreated with antimicrobials, testing of blood and urine samples with a commercially available genus-specific PCR assay did not improve early diagnosis.

  5. Risk factors associated with leptospirosis in dairy goats under tropical conditions in Brazil.

    Science.gov (United States)

    Lilenbaum, Walter; Varges, Renato; Medeiros, Luciana; Cordeiro, Ana Gabriela; Cavalcanti, Amanda; Souza, Guilherme N; Richtzenhain, Leonardo; Vasconcellos, Silvio A

    2008-02-01

    Serum samples from 248 adult dairy goats from 13 flocks with lowered fertility farmed in the Rio de Janeiro region of Brazil were examined for Leptospira antibodies by MAT with 24 serovars, cut off 100. A questionnaire was completed for each herd. Antibodies were detected in 20.8% of these goats, mainly to serovar Hardjo. Risk factors associated with seroprevalence to leptospirosis were the frequency of professional veterinary supervision (OR = 2.35), climate (OR = 2.63) and grazing for more than 2h a day. Flock factors as size, type of milking and offering of food supplementation, as well as the location and topography, the type of animal housing or the presence of silos did not significantly affect seroprevalence. We suggest that a successful control program for goat leptospirosis should include a complete investigation of herd management practices, which could influence in the occurrence of the infection.

  6. An Expert System for Diagnosing Eye Diseases using Forward Chaining Method

    Science.gov (United States)

    Munaiseche, C. P. C.; Kaparang, D. R.; Rompas, P. T. D.

    2018-02-01

    Expert System is a system that seeks to adopt human knowledge to the computer, so that the computer can solve problems which are usually done by experts. The purpose of medical expert system is to support the diagnosis process of physicians. It considers facts and symptoms to provide diagnosis. This implies that a medical expert system uses knowledge about diseases and facts about the patients to suggest diagnosis. The aim of this research is to design an expert system application for diagnosing eye diseases using forward chaining method and to figure out user acceptance to this application through usability testing. Eye is selected because it is one of the five senses which is very sensitive and important. The scope of the work is extended to 16 types of eye diseases with 41 symptoms of the disease, arranged in 16 rules. The computer programming language employed was the PHP programming language and MySQL as the Relational Database Management System (RDBMS). The results obtained showed that the expert system was able to successfully diagnose eye diseases corresponding to the selected symptoms entered as query and the system evaluation through usability testing showed the expert system for diagnosis eye diseases had very good rate of usability, which includes learnability, efficiency, memorability, errors, and satisfaction so that the system can be received in the operational environment.

  7. Clinical course of Crohn's disease first diagnosed at surgery for acute abdomen.

    Science.gov (United States)

    Latella, G; Cocco, A; Angelucci, E; Viscido, A; Bacci, S; Necozione, S; Caprilli, R

    2009-04-01

    The severity of clinical activity of Crohn's disease is high during the first year after diagnosis and decreases thereafter. Approximately 50% of patients require steroids and immunosuppressants and 75% need surgery during their lifetime. The clinical course of patients with Crohn's disease first diagnosed at surgery has never been investigated. To assess the clinical course of Crohn's disease first diagnosed at surgery for acute abdomen and to evaluate the need for medical and surgical treatment in this subset of patients. Hospital clinical records of 490 consecutive Crohn's disease patients were reviewed. Patients were classified according to the Vienna criteria. Sex, extraintestinal manifestations, family history of inflammatory bowel diseases, appendectomy, smoking habit and medical/surgical treatments performed during the follow-up period were assessed. Kaplan-Meier survival method and Cox proportional hazards regression model. Of the 490 Crohn's disease patients, 115 had diagnosis of Crohn's disease at surgery for acute abdomen (Group A) and 375 by conventional clinical, radiological, endoscopic and histologic criteria (Group B). Patients in Group A showed a low risk of further surgery (Log Rank test pacute abdomen showed a low risk for reintervention and less use of steroids and immunosuppressants during follow-up than those not operated upon at diagnosis. Early surgery may represent a valid approach in the initial management of patients with Crohn's disease, at least in the subset of patients with ileal and complicated disease.

  8. Evaluation of the clinical utility of a rapid blood test for human leptospirosis

    NARCIS (Netherlands)

    Eapen, C. K.; Sugathan, Sheela; Kuriakose, Mariamma; Abdoel, Theresia; Smits, Henk L.

    2002-01-01

    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

  9. Use of geographically weighted logistic regression to quantify spatial variation in the environmental and sociodemographic drivers of leptospirosis in Fiji: a modelling study

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    Helen J Mayfield, PhD

    2018-05-01

    Full Text Available Summary: Background: Leptospirosis is a globally important zoonotic disease, with complex exposure pathways that depend on interactions between human beings, animals, and the environment. Major drivers of outbreaks include flooding, urbanisation, poverty, and agricultural intensification. The intensity of these drivers and their relative importance vary between geographical areas; however, non-spatial regression methods are incapable of capturing the spatial variations. This study aimed to explore the use of geographically weighted logistic regression (GWLR to provide insights into the ecoepidemiology of human leptospirosis in Fiji. Methods: We obtained field data from a cross-sectional community survey done in 2013 in the three main islands of Fiji. A blood sample obtained from each participant (aged 1–90 years was tested for anti-Leptospira antibodies and household locations were recorded using GPS receivers. We used GWLR to quantify the spatial variation in the relative importance of five environmental and sociodemographic covariates (cattle density, distance to river, poverty rate, residential setting [urban or rural], and maximum rainfall in the wettest month on leptospirosis transmission in Fiji. We developed two models, one using GWLR and one with standard logistic regression; for each model, the dependent variable was the presence or absence of anti-Leptospira antibodies. GWLR results were compared with results obtained with standard logistic regression, and used to produce a predictive risk map and maps showing the spatial variation in odds ratios (OR for each covariate. Findings: The dataset contained location information for 2046 participants from 1922 households representing 81 communities. The Aikaike information criterion value of the GWLR model was 1935·2 compared with 1254·2 for the standard logistic regression model, indicating that the GWLR model was more efficient. Both models produced similar OR for the covariates, but

  10. Leptospirosis: serie de casos en un centro penitenciario de la costa de Ecuador

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    D. Valarezo-Sevilla

    2014-06-01

    Full Text Available Se describe los casos de dos pacientes inicialmente diagnosticados como dengue e infección urinaria. Los pacientes eran personas privadas de la libertad en la misma prisión y estuvieron en contacto con agua dulce estancada aproximadamente dos semanas antes del inicio de los síntomas durante las fiestas del carnaval, siendo el sitio probable de la contaminación. El tiempo transcurrido entre el ingreso al hospital y la sospecha de leptospirosis (y el inicio del tratamiento fue de cuatro días para el paciente del caso 1 y dos días para el caso 2; entre el ingreso y la confirmación diagnóstica por laboratorio fue de diez días para el caso 1 y cuatro días para el caso 2. Se concluye que la leptospirosis no se considera como una opción dentro del diagnóstico diferencial inicial sino luego de descartar otras patologías.

  11. Lp25 membrane protein from pathogenic Leptospira spp. is associated with rhabdomyolysis and oliguric acute kidney injury in a guinea pig model of leptospirosis.

    Science.gov (United States)

    Abreu, Patrícia A E; Seguro, Antonio C; Canale, Daniele; Silva, Ana Maria G da; Matos, Larissa do R B; Gotti, Tatiane B; Monaris, Denize; Jesus, Denise A de; Vasconcellos, Sílvio A; de Brito, Thales; B Magaldi, Antonio J

    2017-05-01

    Acute kidney injury (AKI) from leptospirosis is frequently nonoliguric with hypo- or normokalemia. Higher serum potassium levels are observed in non-survivor patients and may have been caused by more severe AKI, metabolic disarrangement, or rhabdomyolysis. An association between the creatine phosphokinase (CPK) level and maximum serum creatinine level has been observed in these patients, which suggests that rhabdomyolysis contributes to severe AKI and hyperkalemia. LipL32 and Lp25 are conserved proteins in pathogenic strains of Leptospira spp., but these proteins have no known function. This study evaluated the effect of these proteins on renal function in guinea pigs. Lp25 is an outer membrane protein that appears responsible for the development of oliguric AKI associated with hyperkalemia induced by rhabdomyolysis (e.g., elevated CPK, uric acid and serum phosphate). This study is the first characterization of a leptospiral outer membrane protein that is associated with severe manifestations of leptospirosis. Therapeutic methods to attenuate this protein and inhibit rhabdomyolysis-induced AKI could protect animals and patients from severe forms of this disease and decrease mortality.

  12. Travel and migration associated infectious diseases morbidity in Europe, 2008

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    Lopez-Velez Rogelio

    2010-11-01

    Full Text Available Abstract Background Europeans represent the majority of international travellers and clinicians encountering returned patients have an essential role in recognizing, and communicating travel-associated public health risks. Methods To investigate the morbidity of travel associated infectious diseases in European travellers, we analysed diagnoses with demographic, clinical and travel-related predictors of disease, in 6957 ill returned travellers who presented in 2008 to EuroTravNet centres with a presumed travel associated condition. Results Gastro-intestinal (GI diseases accounted for 33% of illnesses, followed by febrile systemic illnesses (20%, dermatological conditions (12% and respiratory illnesses (8%. There were 3 deaths recorded; a sepsis caused by Escherichia coli pyelonephritis, a dengue shock syndrome and a Plasmodium falciparum malaria. GI conditions included bacterial acute diarrhea (6.9%, as well as giardiasis and amebasis (2.3%. Among febrile systemic illnesses with identified pathogens, malaria (5.4% accounted for most cases followed by dengue (1.9% and others including chikungunya, rickettsial diseases, leptospirosis, brucellosis, Epstein Barr virus infections, tick-borne encephalitis (TBE and viral hepatitis. Dermatological conditions were dominated by bacterial infections, arthropod bites, cutaneous larva migrans and animal bites requiring rabies post-exposure prophylaxis and also leishmaniasis, myasis, tungiasis and one case of leprosy. Respiratory illness included 112 cases of tuberculosis including cases of multi-drug resistant or extensively drug resistant tuberculosis, 104 cases of influenza like illness, and 5 cases of Legionnaires disease. Sexually transmitted infections (STI accounted for 0.6% of total diagnoses and included HIV infection and syphilis. A total of 165 cases of potentially vaccine preventable diseases were reported. Purpose of travel and destination specific risk factors was identified for several

  13. Four Cases of Parkinson Disease Diagnosed During the Postpartum Period.

    Science.gov (United States)

    Maltête, David; Grangeon, Lou; Le Goff, Floriane; Ozel, Gulden; Fetter, Damien; Ahtoy, Patrick; Temgoua, Olivier; Rouillé, Audrey; Lefaucheur, Romain

    2017-07-01

    There is little experience with the effect of pregnancy on Parkinson disease because the number of women with Parkinson disease who are of childbearing age is small. We report four cases beginning during the postpartum period and discuss the potential contribution of different factors that may influence the occurrence of Parkinson disease in this time period. Four women aged 29-35 years developed arm tremor, shoulder pain, dizziness, or decreased dexterity of the hand in the first few days or months after childbirth. They were initially diagnosed with postpartum depression or psychogenic parkinsonism. Finally, dopamine transporter imaging confirmed the diagnosis of young-onset Parkinson disease. Early-onset Parkinson disease may present in postpartum women. In women with atypical motor symptoms in addition to depression, this diagnosis should be considered.

  14. Marked increase in leptospirosis infections in humans and dogs in the Netherlands, 2014

    NARCIS (Netherlands)

    Pijnacker, Roan; Goris, M.G.; Wierik, te M.J.; Broens, E.M.; Giessen, van der J.W.; Rosa, de M.; Wagenaar, J.A.; Hartskeerl, R.A.; Notermans, D.W.; Maassen, K.; Schimmer, B.

    2016-01-01

    In the Netherlands, 97 human leptospirosis cases were notified in 2014. This represents a 4.6-fold increase in autochthonous cases (n = 60) compared with the annual average between 2010 and 2013. Most cases had symptom onset between June and November. This marked increase in humans coincided with

  15. Marked increase in leptospirosis infections in humans and dogs in the Netherlands, 2014

    NARCIS (Netherlands)

    Pijnacker, Roan; Goris, Marga G. A.; te Wierik, Margreet J. M.; Broens, Els M.; van der Giessen, Joke W. B.; de Rosa, Mauro; Wagenaar, Jaap A.; Hartskeerl, Rudy A.; Notermans, Daan W.; Maassen, Kitty; Schimmer, Barbara

    2016-01-01

    In the Netherlands, 97 human leptospirosis cases were notified in 2014. This represents a 4.6-fold increase in autochthonous cases (n = 60) compared with the annual average between 2010 and 2013. Most cases had symptom onset between June and November. This marked increase in humans coincided with an

  16. Inbred Rats as a Model to Study Persistent Renal Leptospirosis and Associated Cellular Immune Responsiveness

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    Jarlath E. Nally

    2018-03-01

    Full Text Available Pathogenic species of Leptospira cause leptospirosis, a bacterial zoonotic disease with a global distribution affecting over one million people annually. Rats are regarded as one of the most significant reservoir hosts of infection for human disease, and in the absence of clinical signs of infection, excrete large numbers of organisms in their urine. A unique biological equilibrium exists between pathogenic leptospires and reservoir hosts of infection, but surprisingly, little is known concerning the host's cellular immune response that facilitates persistent renal colonization. To address this deficiency, we established and applied an immunocompetent inbred rat model of persistent renal colonization; leptospires were detected in urine of experimentally infected rats by 3 weeks post-infection and remained positive until 8 weeks post-infection. However, there was little, if any, evidence of inflammation in colonized renal tubules. At 8 weeks post-infection, a robust antibody response was detected against lipopolysaccharide and protein outer membrane (OM components. Purified B and T cells derived from the spleen of infected and non-infected rats proliferated in response to stimulation with 0.5 μg of OM fractions of Leptospira, including CD4+ T cells, which comprised 40% of proliferating cells, compared to 25% in non-infected controls. However, analysis of gene expression did not determine which immunoregulatory pathways were activated. Lymphocytes purified from the lymph node draining the site of colonization, the renal lymph node, also showed an increase in percentage of proliferating B and T cells. However, in contrast to a phenotype of 40% CD4+ T cells in the spleen, the phenotype of proliferating T cells in the renal lymph node comprised 65% CD4+ T cells. These results confirm that the renal lymph node, the local lymphoid organ, is a dominant site containing Leptospira reactive CD4+ T cells and highlight the need to consider the local, vs

  17. DNA isolation by Chelex-100: an efficient approach to consider in leptospirosis early stages

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    Angel Alberto Noda

    2014-06-01

    Full Text Available Objective: To compare the value of leptospiral DNA extraction procedures from clinical samples for the early diagnosis of leptospirosis. Methods: Three DNA extraction procedures were applied for microbiological analysis, results of QIAmp DNA mini kit (QIAGEN, Germany, CLART HPV kit (GENOMICA, Spain and Chelex-100 assay were compared concerning extraction efficiency, DNA purity and DNA suitability for amplification by specific polymerase chain reaction for pathogenic leptospires from blood, plasma and serum artificially infected. Results: The comparison of extraction methods highlighted the efficiency of Chelex-100 and QIAmp DNA mini kit. Chelex-100 achieved the isolation of the highest concentration of leptospiral DNA from the culture and the spiked samples, with acceptable purities and without inhibitors to PCR. Conclusions: Chelex-100 assay is a rapid and effective approach for DNA isolation in clinical samples having pathogenic leptospires and it could be useful in the early diagnosis of leptospirosis.

  18. MHC class II DRB diversity predicts antigen recognition and is associated with disease severity in California sea lions naturally infected with Leptospira interrogans

    Science.gov (United States)

    Acevedo-Whitehouse, Karina; Gulland, Frances; Bowen, Lizabeth

    2018-01-01

    We examined the associations between California sea lion MHC class II DRB (Zaca-DRB) configuration and diversity, and leptospirosis. As Zaca-DRB gene sequences are involved with antigen presentation of bacteria and other extracellular pathogens, we predicted that they would play a role in determining responses to these pathogenic spirochaetes. Specifically, we investigated whether Zaca-DRB diversity (number of genes) and configuration (presence of specific genes) explained differences in disease severity, and whether higher levels of Zaca-DRB diversity predicted the number of specific Leptospira interrogans serovars that a sea lion's serum would react against. We found that serum from diseased sea lions with more Zaca-DRB loci reacted against a wider array of serovars. Specific Zaca-DRB loci were linked to reactions with particular serovars. Interestingly, sea lions with clinical manifestation of leptospirosis that had higher numbers of Zaca-DRB loci were less likely to recover from disease than those with lower diversity, and those that harboured Zaca-DRB.C or –G were 4.5 to 5.3 times more likely to die from leptospirosis, regardless of the infective serovars. We propose that for leptospirosis, a disadvantage of having a wider range of antigen presentation might be increased disease severity due to immunopathology. Ours is the first study to examine the importance of Zaca-DRB diversity for antigen detection and disease severity following natural exposure to infective leptospires.

  19. The diagnose of oil palm disease using Naive Bayes Method based on Expert System Technology

    Science.gov (United States)

    Nababan, Marlince; Laia, Yonata; Sitanggang, Delima; Sihombing, Oloan; Indra, Evta; Siregar, Saut; Purba, Windania; Mancur, Roy

    2018-04-01

    Expert system is dealt with system that used computer-based human intelligence to overcome particular problem which is commonly conducted by an expert. Frequent problem faced by the farmers of oil palm is the difficulty in defining the type of plant disease. As a result, the delay treatment of plant disease brings out the declining of farm products. An application system is needed to deal with the obstacles and diagnosing the type of oil palm plant disease. The researcher designed an intelligence-based application with input-output plan which is able to diagnose the type of oil palm plant disease by applying naive bayes method. Based on the research result by conducting bayes method with recognized symptom, diagnose of oil palm plant disease could be accomplished. The data of symptoms found are leaves turned yellow 0.4, dead leaves 0.4, black and brown color among the veins of leaves 0.5, young and old fruit with whole space 0.4, and decay of bunches is 0.3. The roots are tender in the amount of 0.5, and damage on sheath is 0.3. Through the chosen symptoms as mentioned above, the value of bayes is 80% with the type of disease is rotten bunch.

  20. Gene expression profiles of immune mediators and histopathological findings in animal models of leptospirosis: comparison between susceptible hamsters and resistant mice.

    Science.gov (United States)

    Matsui, Mariko; Rouleau, Vincent; Bruyère-Ostells, Lilian; Goarant, Cyrille

    2011-11-01

    Leptospirosis is a widespread zoonosis characterized by multiple organ failure and variable host susceptibility toward pathogenic Leptospira strains. In this study, we put the role of inflammatory mediators in parallel with bacterial burdens and organ lesions by comparing a susceptible animal model, the hamster, and a resistant one, the Oncins France 1 (OF1) mouse, both infected with virulent Leptospira interrogans serovar Icterohaemorrhagiae strain Verdun. Histological observations evidenced edema, congestion, hemorrhage, and inflammatory infiltration in the organs of hamsters, in contrast to limited changes in mice. Using reverse transcription-quantitative PCR techniques, we showed that the relative Leptospira burden progressively increased in hamster tissues, while a rapid clearance was observed in mouse tissues. The early regulation of the proinflammatory mediators interleukin-1β (IL-1β), IL-6, tumor necrosis factor alpha, and cyclo-oxygenase-2 and the chemokines gamma interferon-inducible protein 10 kDa/CXCL10 and macrophage inflammatory protein-1α/CCL3 in mouse tissues contrasted with their delayed and massive overexpression in hamster tissues. Conversely, the induction of the anti-inflammatory cytokine IL-10 was faster in the resistant than in the susceptible animal model. The role of these cytokines in the pathophysiology of leptospirosis and the implications of their differential regulation in the development of this disease are discussed.

  1. Serological prevalence of leptospirosis in cattle slaughtered in the Zango abattoir in Zaria, Kaduna State, Nigeria

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    Emmanuel O. Ngbede

    2012-06-01

    Full Text Available Leptospirosis is an occupational zoonosis caused by pathogenic leptospires. In this study, the presence and prevalence of antibodies specific to Leptospira spp. serovar Hardjo in 142 cattle slaughtered between June and July 2011 was investigated using the enzyme-linked immunosorbent assay (ELISA. Five (3.50% of the 142 cattle sampled were seropositive for antibodies to Leptospira spp. serovar Hardjo. Despite the fact that there was no significant difference (p>0.05 in seropositivity between sexes and between breeds sampled, there was a significant difference (p<0.05 in sero-positivity between the different age groups examined. Leptospirosis is present in cattle slaughtered in the Zango abattoir; butchers and abattoir workers are exposed to infected animals and are at risk of being infected by Leptospira spp. serovar Hardjo.

  2. Características clínicas y epidemiológicas de la leptospirosis en el departamento del Quindío, 2005-2006 Clinical and epidemiological characteristics of leptospirosis in the Quindío department (2005-2006

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    Gregorio Sanchez Vallejo

    2008-06-01

    Full Text Available Objetivo. Describir el comportamiento clínico, epidemiológico y serológico de los pacientes con leptospirosis humana en el departamento del Quindío en un periodo de 2 años (2005-2006. Diseño. Estudio prospectivo de serie de casos. Resultados. Se diagnosticaron 38 casos de leptospirosis humana en el 2005 y 31 casos en el 2006, en el departamento del Quindío. En ellos se encontró una letalidad de 13% en el 2005 y de 3,2% en el 2006. Las manifestaciones clínicas más frecuentes fueron fiebre, mialgia, ictericia y cefalea. La prueba MAT estandarizada fue el método diagnóstico confirmatorio. La variedad serológica icterohemorrágica se encontró con mayor frecuencia y estuvo presente en la mayoría de los casos de mortalidad. Los hallazgos paraclínicos más frecuentes fueron alteraciones de la función hepática (78% PK elevada (60%. Conclusiones. Contrario a lo que se cree, la leptospirosis sintomática en el departamento del Quindío no se encontró en la población rural sino en la población urbana. Al realizar la búsqueda, el diagnóstico y el tratamiento adecuado, se disminuyeron las complicaciones y la mortalidad, como se puede observar al comparar los años 2005 y 2006.

  3. Automated diagnostic kiosk for diagnosing diseases

    Science.gov (United States)

    Regan, John Frederick; Birch, James Michael

    2014-02-11

    An automated and autonomous diagnostic apparatus that is capable of dispensing collection vials and collections kits to users interesting in collecting a biological sample and submitting their collected sample contained within a collection vial into the apparatus for automated diagnostic services. The user communicates with the apparatus through a touch-screen monitor. A user is able to enter personnel information into the apparatus including medical history, insurance information, co-payment, and answer a series of questions regarding their illness, which is used to determine the assay most likely to yield a positive result. Remotely-located physicians can communicate with users of the apparatus using video tele-medicine and request specific assays to be performed. The apparatus archives submitted samples for additional testing. Users may receive their assay results electronically. Users may allow the uploading of their diagnoses into a central databank for disease surveillance purposes.

  4. Use of geographically weighted logistic regression to quantify spatial variation in the environmental and sociodemographic drivers of leptospirosis in Fiji: a modelling study.

    Science.gov (United States)

    Mayfield, Helen J; Lowry, John H; Watson, Conall H; Kama, Mike; Nilles, Eric J; Lau, Colleen L

    2018-05-01

    Leptospirosis is a globally important zoonotic disease, with complex exposure pathways that depend on interactions between human beings, animals, and the environment. Major drivers of outbreaks include flooding, urbanisation, poverty, and agricultural intensification. The intensity of these drivers and their relative importance vary between geographical areas; however, non-spatial regression methods are incapable of capturing the spatial variations. This study aimed to explore the use of geographically weighted logistic regression (GWLR) to provide insights into the ecoepidemiology of human leptospirosis in Fiji. We obtained field data from a cross-sectional community survey done in 2013 in the three main islands of Fiji. A blood sample obtained from each participant (aged 1-90 years) was tested for anti-Leptospira antibodies and household locations were recorded using GPS receivers. We used GWLR to quantify the spatial variation in the relative importance of five environmental and sociodemographic covariates (cattle density, distance to river, poverty rate, residential setting [urban or rural], and maximum rainfall in the wettest month) on leptospirosis transmission in Fiji. We developed two models, one using GWLR and one with standard logistic regression; for each model, the dependent variable was the presence or absence of anti-Leptospira antibodies. GWLR results were compared with results obtained with standard logistic regression, and used to produce a predictive risk map and maps showing the spatial variation in odds ratios (OR) for each covariate. The dataset contained location information for 2046 participants from 1922 households representing 81 communities. The Aikaike information criterion value of the GWLR model was 1935·2 compared with 1254·2 for the standard logistic regression model, indicating that the GWLR model was more efficient. Both models produced similar OR for the covariates, but GWLR also detected spatial variation in the effect of each

  5. Comparison of 3T and 7T susceptibility-weighted angiography of the substantia nigra in diagnosing Parkinson disease.

    Science.gov (United States)

    Cosottini, M; Frosini, D; Pesaresi, I; Donatelli, G; Cecchi, P; Costagli, M; Biagi, L; Ceravolo, R; Bonuccelli, U; Tosetti, M

    2015-03-01

    Standard neuroimaging fails in defining the anatomy of the substantia nigra and has a marginal role in the diagnosis of Parkinson disease. Recently 7T MR target imaging of the substantia nigra has been useful in diagnosing Parkinson disease. We performed a comparative study to evaluate whether susceptibility-weighted angiography can diagnose Parkinson disease with a 3T scanner. Fourteen patients with Parkinson disease and 13 healthy subjects underwent MR imaging examination at 3T and 7T by using susceptibility-weighted angiography. Two expert blinded observers and 1 neuroradiology fellow evaluated the 3T and 7T images of the sample to identify substantia nigra abnormalities indicative of Parkinson disease. Diagnostic accuracy and intra- and interobserver agreement were calculated separately for 3T and 7T acquisitions. Susceptibility-weighted angiography 7T MR imaging can diagnose Parkinson disease with a mean sensitivity of 93%, specificity of 100%, and diagnostic accuracy of 96%. 3T MR imaging diagnosed Parkinson disease with a mean sensitivity of 79%, specificity of 94%, and diagnostic accuracy of 86%. Intraobserver and interobserver agreement was excellent at 7T. At 3T, intraobserver agreement was excellent for experts, and interobserver agreement ranged between good and excellent. The less expert reader obtained a diagnostic accuracy of 89% at 3T. Susceptibility-weighted angiography images obtained at 3T and 7T differentiate controls from patients with Parkinson disease with a higher diagnostic accuracy at 7T. The capability of 3T in diagnosing Parkinson disease might encourage its use in clinical practice. The use of the more accurate 7T should be supported by a dedicated cost-effectiveness study. © 2015 by American Journal of Neuroradiology.

  6. Discovery of Novel Leptospirosis Vaccine Candidates Using Reverse and Structural Vaccinology

    Directory of Open Access Journals (Sweden)

    Alan John Alexander McBride

    2017-04-01

    Full Text Available Leptospira spp. are diderm (two membranes bacteria that infect mammals causing leptospirosis, a public health problem with global implications. Thousands of people die every year due to leptospirosis, especially in developing countries with tropical climates. Prophylaxis is difficult due to multiple factors, including the large number of asymptomatic hosts that transmit the bacteria, poor sanitation, increasing numbers of slum dwellers, and the lack of an effective vaccine. Several leptospiral recombinant antigens were evaluated as a replacement for the inactivated (bacterin vaccine; however, success has been limited. A prospective vaccine candidate is likely to be a surface-related protein that can stimulate the host immune response to clear leptospires from blood and organs. In this study, a comprehensive bioinformatics approach based on reverse and structural vaccinology was applied toward the discovery of novel leptospiral vaccine candidates. The Leptospira interrogans serovar Copenhageni strain L1-130 genome was mined in silico for the enhanced identification of conserved β-barrel (βb transmembrane proteins and outer membrane (OM lipoproteins. Orthologs of the prospective vaccine candidates were screened in the genomes of 20 additional Leptospira spp. Three-dimensional structural models, with a high degree of confidence, were created for each of the surface-exposed proteins. Major histocompatibility complex II (MHC-II epitopes were identified, and their locations were mapped on the structural models. A total of 18 βb transmembrane proteins and 8 OM lipoproteins were identified. These proteins were conserved among the pathogenic Leptospira spp. and were predicted to have epitopes for several variants of MHC-II receptors. A structural and functional analysis of the sequence of these surface proteins demonstrated that most βb transmembrane proteins seem to be TonB-dependent receptors associated with transportation. Other proteins

  7. Narratives of Self in Older Bilingual Adults Diagnosed with Alzheimer's Disease

    Science.gov (United States)

    López de Victoria Rodríguez, Patria C.

    2016-01-01

    As the boom in the older adult population continues to grow, so too grows the number of persons suffering from cognitive diseases, such as dementia of the Alzheimer's type (DAT). Older Latinos diagnosed with the disease make up 4 percent (200,000) of the current population; however, little research on bilinguals with DAT has been carried out…

  8. Pulmonary manifestation of leptospirosis: Clinical and experimental correlation

    International Nuclear Information System (INIS)

    Im, J.G.; Yeon, K.M.; Han, M.C.; Kim, C.W.; Chang, W.H.; Lee, J.S.

    1987-01-01

    Pulmonary radiographic findings were noted in 24 (56%) of 43 patients with leptospirosis, proved by positive serology. Three radiographic patterns were evident: (1) small nodular densities (n = 11), (2) patchy or confluent consolidation (n = 4), and (3) diffuse ill-defined groundglass density (n = 9). Abnormalities were bilateral, nonlobar, and peripheral. Pulmonary abnormalities all resolved within 10 days, except in three patients who died. Artificial infection was induced through intraperitoneal injection of Leptospira interohemorrhagiae into 20 guinea pigs. The lungs from the guinea pigs initially showed petechial hemorrhage which progressed to large confluent ares of hemorrhage. The typical pulmonary radiographic findings of leptopirosis are compatible with the multifocal pulmonary hemorrhage seen in the guinea pigs

  9. Decreased erytrocyte osmotic fragility during canine leptospirosis Diminuição da fragilidade osmótica eritrocitária na leptospirose canina

    Directory of Open Access Journals (Sweden)

    Marcelo L. Santoro

    1994-02-01

    Full Text Available Erythrocyte osmotic fragility (EOF was carried out in nineteen dogs naturally infected by Leptospira interrogans serovar icterohaemorrhagiae/copenhagi. A decreased EOF was observed, suggesting a modification of erythrocyte components secondary to disturbances that occur during canine leptospirosis, such as renal damage and hepatic disease.A fragilidade osmótica eritrocitária foi estudada em dezenove cães infectados naturalmente pela Leptospira interrogans serovar icterohaemorrhagiae/copenhagi. Observou-se uma redução da fragilidade osmótica eritrocitária, sem a presença de anemia, possivelmente relacionada aos distúrbios hepato-renais que ocorrem nesta patologia.

  10. How to manage a late diagnosed Hirschsprung′s disease

    Directory of Open Access Journals (Sweden)

    Mohamed Ouladsaiad

    2016-01-01

    Full Text Available Background: How to manage a late diagnosed Hirschsprung′s disease (HD and how to avoid calibre discrepancy? Subjects and Methods: A retrospective study of all patients diagnosed with HD over 2 years in our hospital from January 2009 to December 2012. Data were analysed for clinical presentations, investigations, surgical procedures and post-operative outcome. Results: Fifteen patients, operated by one single surgeon, were included in this study. The mean age was 6 years (2-16 years. Patients had an ultra-short segment type in 4 cases, rectosigmoid type in 9 cases and descending colonic aganglionosis in 2 cases. Rectal wash out was effective in 12 patients. A blowhole transverse colostomy was performed in 2 patients. Twelve patients underwent one single stage endorectal pull-through. Anastomosis incongruence was avoided by a plication procedure never described before. The assessment of post-operative outcomes by the paediatric incontinence and constipation scoring system revealed a normal continence function in all our patients, but 3 patients suffered from soiling secondary to constipation. Conclusion: One single stage pull-through can be safe and effective in children with late diagnosed HD. Routine rectal washout is a good way to prepare the colon. In some cases, blowhole colostomy can be an option. Anastomosis incongruence is a challenge; we describe a plication procedure to avoid it.

  11. COMPARISON OF CARDIAC BIOMARKERS AND ECHOCARDIOGRAPHY IN DIAGNOSING MYOCARDITIS

    Directory of Open Access Journals (Sweden)

    Nimi Bharathan

    2017-03-01

    Full Text Available BACKGROUND Conventional methods used to diagnose or rule out myocarditis is not useful in detecting cardiac myocyte injury in clinically suspected cases. Endomyocardial biopsy and histopathological examination is not feasible in most government hospitals in India. Sensitive parameters have yet to be found out. The study was conducted to find out whether diagnosis of myocarditis in clinically suspected cases can be done by measurement of serum levels of cardiac troponinI (cTnI and MB isoform of creatine kinase (CK-MB. MATERIALS AND METHODS 19 patients with clinically suspected myocarditis were screened for CK-MB activity and cTnI. Echocardiography, ECG and IgM for leptospirosis were also checked in these patients. RESULTS cTnI was elevated in 10 out of 19 patients with clinically suspected myocarditis. CK-MB was elevated in 7 patients. CONCLUSION Elevation of cTnI level in blood can be taken as an indicator of cardiac muscle cell injury in suspected cases of myocarditis.

  12. Leptospirosis in Caspian Sea littoral, Gilan Province, Iran.

    Science.gov (United States)

    Garshasbi, Vahid; Naddaf, Saied Reza; Aghighi, Zohreh; Hassan, Nayerreh; Pooya, Mohammad; Mostafavi, Ehsan

    2018-05-01

    In Iran, leptospirosis is endemic to Caspian Sea littoral. The disease appears as a seasonal infection mostly affecting people in rural areas involved in farming. We investigated the prevalence of this infection among suspected patients in Gilan Province by an indirect immunofluorescent assay (IFA), and two PCR protocols, a nested-PCR and a real-time PCR (qPCR), targeting rrs and lipL32 genes, respectively. We also identified the common Leptospira species by sequencing a partial sequence of rrs gene. Out of the 128 sera examined by IFA, 25.78% were positive with the antibody titers ≥1/80. The antibody titer in 39.06% of sera ranged from 1/10 to 1/140, and 35. 16% showed no antibodies, all considered negative. Nested PCR and qPCR detected Leptospira DNA in 20.31% and 18.75% of the sera, respectively. The two PCR assays had 98.43% agreement (K = 0.93) and showed an inverse correlation with the IFA titers. Also, three pathogenic Leptospira species, L. kirschneri (n = 10), L. introgans (n = 8), and L. borgpetersenii (n = 2) were identified from the clinical specimens in the study area. In our hands both PCR assays proved very efficient for early diagnosis of illness and could be used in combination with IFA for both diagnosis and epidemiological studies, but nested PCR was cheaper and appeared more appropriate for our laboratories in rural settings. Copyright © 2018 Elsevier B.V. All rights reserved.

  13. High Leptospira Diversity in Animals and Humans Complicates the Search for Common Reservoirs of Human Disease in Rural Ecuador.

    Science.gov (United States)

    Barragan, Veronica; Chiriboga, Jorge; Miller, Erin; Olivas, Sonora; Birdsell, Dawn; Hepp, Crystal; Hornstra, Heidie; Schupp, James M; Morales, Melba; Gonzalez, Manuel; Reyes, Soraya; de la Cruz, Carmen; Keim, Paul; Hartskeerl, Rudy; Trueba, Gabriel; Pearson, Talima

    2016-09-01

    Leptospirosis is a zoonotic disease responsible for high morbidity around the world, especially in tropical and low income countries. Rats are thought to be the main vector of human leptospirosis in urban settings. However, differences between urban and low-income rural communities provide additional insights into the epidemiology of the disease. Our study was conducted in two low-income rural communities near the coast of Ecuador. We detected and characterized infectious leptospira DNA in a wide variety of samples using new real time quantitative PCR assays and amplicon sequencing. We detected infectious leptospira in a high percentage of febrile patients (14.7%). In contrast to previous studies on leptospirosis risk factors, higher positivity was not found in rats (3.0%) but rather in cows (35.8%) and pigs (21.1%). Six leptospira species were identified (L. borgpetersenii, L kirschnerii, L santarosai, L. interrogans, L noguchii, and an intermediate species within the L. licerasiae and L. wolffii clade) and no significant differences in the species of leptospira present in each animal species was detected (χ2 = 9.89, adj.p-value = 0.27). A large portion of the world's human population lives in low-income, rural communities, however, there is limited information about leptospirosis transmission dynamics in these settings. In these areas, exposure to peridomestic livestock is particularly common and high prevalence of infectious leptospira in cows and pigs suggest that they may be the most important reservoir for human transmission. Genotyping clinical samples show that multiple species of leptospira are involved in human disease. As these genotypes were also detected in samples from a variety of animals, genotype data must be used in conjunction with epidemiological data to provide evidence of transmission and the importance of different potential leptospirosis reservoirs.

  14. Clinical outcomes for young people with screening-detected and clinically-diagnosed rheumatic heart disease in Fiji.

    Science.gov (United States)

    Engelman, Daniel; Mataika, Reapi L; Ah Kee, Maureen; Donath, Susan; Parks, Tom; Colquhoun, Samantha M; Carapetis, Jonathan R; Kado, Joseph H; Steer, Andrew C

    2017-08-01

    Echocardiographic screening is under consideration as a disease control strategy for rheumatic heart disease (RHD). However, clinical outcomes of young people with screening-detected RHD are unknown. We aimed to describe the outcomes for a cohort with screening-detected RHD, in comparison to patients with clinically-diagnosed RHD. A retrospective cohort study included all young people with screening-detected RHD in the Central Division of Fiji in the primary cohort. Screen-negative and clinically-diagnosed comparison groups were matched 1:1 to the primary cohort. Data were collected on mortality, clinical complications and healthcare utilisation from the electronic and paper health records and existing databases. Seventy participants were included in each group. Demographic characteristics of the groups were similar (median age 11years, 69% female, median follow-up 7years). There were nine (12.9%) RHD-related deaths in the clinically-diagnosed group and one (1.4%) in the screening-detected group (Incident Rate Ratio: 9.6, 95% CI 1.3-420.6). Complications of RHD were observed in 39 (55.7%) clinically-diagnosed cases, four (20%) screening-detected cases and one (1.4%) screen-negative case. There were significant differences in the cumulative complication curves of the groups (pFiji. The prognosis of clinically-diagnosed RHD remains poor, with very high mortality and complication rates. Further studies in other settings will inform RHD screening policy. Comprehensive control strategies are required for disease prevention. Copyright © 2017 Elsevier B.V. All rights reserved.

  15. Use of doxycycline for leptospirosis after high-risk exposure in São Paulo, Brazil

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    Claudio R. GONSALEZ

    1998-01-01

    Full Text Available A clinical trial pilot study, double-blinded, randomized, and controlled with a placebo to assess the effectiveness of oral doxycycline (200 mg, single dose in preventing leptospirosis after high exposure to potentially contamined water was performed in São Paulo, SP, Brazil. Confirmed cases were defined as those with leptospira IgM antibody and symptoms; asymptomatic cases were those presenting with IgM antibodies but no symptoms; and suspected cases were individuals with symptoms but no IgM antibody. Forty subjects were given doxycycline and 42 were given placebo. In the drug-treated group there were 2 confirmed cases, 11 asymptomatic cases, and 6 suspected cases. In the placebo group there were 5 confirmed, 6 symptomatic, and 5 suspected cases. Even though we found a protective association of doxycycline for confirmed leptospirosis cases (RR = 2.3 and seroconversion only (RR = 2.0, the association was not statistically significant because of the small number of individuals enrolled in this pilot study. We observed that the 22% of the volunteers already had IgM antibodies to leptospirosis at the first sampling. Finally, the attack rate to confirmed, asymptomatic, and suspected cases of Leptospirosis was 8.5%, 22%, and 13%, respectively, in this population.Um ensaio clínico, duplo-cego, ao acaso, e controlado com placebo para aferir a eficácia da doxiciclina (200 mg, dose única em prevenir leptospirose após exposição de alto risco com água potencialmente contaminada foi realizado em São Paulo, SP, Brasil. Casos confirmados foram definidos como aqueles que apresentavam anticorpos IgM anti-Leptospira e sintomas; casos assintomáticos eram aqueles que apresentavam somente anticorpo IgM, casos suspeitos apresentavam sintomas, porém sem anticorpo IgM. 40 indivíduos tomaram doxaciclina e 42 tomaram placebo. No grupo tratado houve 2 casos confirmados, 11 assintomáticos e 6 casos suspeitos. No grupo placebo houve 5 casos confirmados, 6

  16. [Common pediatric infectious diseases following natural disasters].

    Science.gov (United States)

    Yao, Kai-Hu

    2013-06-01

    Natural disasters may lead to the outbreaks of infectious diseases because they increase the risk factors for infectious diseases. This paper reviews the risk factors for infectious diseases after natural disasters, especially earthquake, and the infectious diseases following disasters reported in recent years. The infectious diseases after earthquake include diarrhea, cholera, viral hepatitis, upper respiratory tract infection, tuberculosis, measles, leptospirosis, dengue fever, tetanus, and gas gangrene, as well as some rare infections. Children are vulnerable to infectious diseases, so pediatricians should pay more attention to the research on relationship between infectious diseases and natural disasters.

  17. Coinfection of dengue and leptospirosis in a girl from the Peruvian Amazon

    OpenAIRE

    Núñez-Garbín, Alexandra; Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas. Lima, Perú; Espinoza-Figueroa, Jossué; Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas. Lima, Perú; Sihuincha-Maldonado, Moisés; Hospital de Apoyo Iquitos. Loreto, Perú; Suarez-Ognio, Luis; Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas. Lima, Perú

    2015-01-01

    We report the case of a 10 year old girl, born and raised in the city of Iquitos in Peru who presented with headache, fever, chills, musculoskeletal pain, mild epigastric pain, epistaxis and hematemesis. On physical examination, the patient was afebrile and in good general condition. Serological tests confirmed infection of dengue and leptospirosis. The patient received intravenous hydration with sodium chloride 0.9% and penicillin G sodium, achieving a favorable clinical course such that she...

  18. [Diseases diagnosed at a pneumology unit integrated with its health area. Comparison with historical controls].

    Science.gov (United States)

    Martín Escribano, P; López Encuentra, A; Martín García, I; Cienfuegos Agustín, M I; Caballero Borda, C

    1996-01-01

    An understanding of changes in pulmonology disease patterns observed at a general hospital before and after implantation of a population-based model of health care not only provides useful insight into the diseases treated but also aids adjustment of health care service organization. The aim of this study was to compare data collected after 1992 (when the new system was established) with records kept by the same pulmonology group in earlier years (1974-1986). Data after 1992 described patients attended in Health District 11 by the newly organized pneumologists. For the two periods the most common pneumological diagnoses were chronic air flow obstruction and chronic hypersecretory bronchitis. The most common non pneumological diagnoses were systemic arterial hypertension, obesity, diabetes, liver disease and hiatus hernia/gastroesophageal reflux. The prospective study covered a larger population and was closer to primary care, including as it did patients at clinics unattached to hospitals. In the earlier hospital-based experience the most common diagnoses were acute respiratory infection, chronic air flow obstruction and asthma, apart from those patients referred in whom no respiratory disease was found. With the organizational integration of hospital and health district pulmonology service, contact between patients and specialists has increased. Record systems have been established for a well-defined population to permit better forecasting at less cost and facilitate contact with primary care givers and epidemiological studies.

  19. Nonalcoholic Fatty Liver Disease: Noninvasive Methods of Diagnosing Hepatic Steatosis

    Science.gov (United States)

    AlShaalan, Rasha; Aljiffry, Murad; Al-Busafi, Said; Metrakos, Peter; Hassanain, Mazen

    2015-01-01

    Hepatic steatosis is the buildup of lipids within hepatocytes. It is the simplest stage in nonalcoholic fatty liver disease (NAFLD). It occurs in approximately 30% of the general population and as much as 90% of the obese population in the United States. It may progress to nonalcoholic steatohepatitis, which is a state of hepatocellular inflammation and damage in response to the accumulated fat. Liver biopsy remains the gold standard tool to diagnose and stage NAFLD. However, it comes with the risk of complications ranging from simple pain to life-threatening bleeding. It is also associated with sampling error. For these reasons, a variety of noninvasive radiological markers, including ultrasound, computed tomography, magnetic resonance spectroscopy, and the controlled attenuation parameter using transient elastography and Xenon-133 scan have been proposed to increase our ability to diagnose NAFLD, hence avoiding liver biopsy. The aim of this review is to discuss the utility and accuracy of using available noninvasive diagnostic modalities for fatty liver in NAFLD. PMID:25843191

  20. Tropical diseases on insurgence: Clinician's perspective

    Directory of Open Access Journals (Sweden)

    Partha Chatterjee

    2017-01-01

    Full Text Available Many known and unknown factors play a synergistic role in the emergence or re-emergence of some infections in a particular area or country. In recent years, India has seen a significant increase in the prevalence of many viral or bacterial diseases. Many are vector borne and are zoonotic disease while others have different source and mode of transmission. These diseases are often associated with high morbidity and mortality. Five important diseases such as leptospirosis, dengue, chikungunya, Japanese encephalitis, and leishmaniasis have been discussed in this article.

  1. Thrombocytopenia and leptospirosis Trombocitopenia e leptospirose

    Directory of Open Access Journals (Sweden)

    Antonio Carlos Nicodemo

    1990-08-01

    Full Text Available The present study has intended to contribute to the elucidation of the pathogenic mechanisms, involved in the thrombocytopenia and in the bleeding diathesis seen in the course of Leptospirosis. The group of cases included in the present prospective study consisted of 30 patients with Leptospirosis, admitted to the Infectious and Parasitic Diseases Ward, Hospital das Clínicas, Faculty of Medicine, University of São Paulo. The following possible mechanisms of thrombocytopenia have been considered and therefore investigated: platelet consumption, due to disseminated intravascular coagulation; immune-mediated platelet destruction, due to platelet-associated antibodies and an inhibited platelet production in the bone marrow. Thrombocytopenia occurred in 86.6% of 30 patients and did not seem to be immune-mediated by platelet-associated antibodies. Furthermore it did not seem to be due to a disseminated intravascular coagulation consumption. Although there was a statistically-significant correlation between bone marrow platelet production and platelet counts we think that the static microscopic examination of a bone marrow aspirate cannot accurately depict the dynamic mechanisms of platelet production when these cells are being consumed in peripheral blood. Vasculitis should be considered as the most important factor for the pathogenesis of the bleeding disturbances in Leptospirosis. However, we believe that thrombocytopenia, uremia and coagulation disorders, individually or as a group, should be included among the contributing factors that lead to and worsen bleeding episodes, which represent the leading cause of death in this disease.O propósito do presente trabalho é colaborar para o estudo da patogenia da plaquetopenia que ocorre na Leptospirose. A pesquisa foi feita de maneira prospectiva e o grupo de casos foi constituído por 30 pacientes internados com hipótese diagnostica de Leptospirose na Clínica de Doenças Infecciosas e Parasit

  2. Evaluation of the Standard Diagnostics Leptospira IgM ELISA for diagnosis of acute leptospirosis in Lao PDR

    NARCIS (Netherlands)

    Tanganuchitcharnchai, Ampai; Smythe, Lee; Dohnt, Michael; Hartskeerl, Rudy; Vongsouvath, Manivanh; Davong, Viengmone; Lattana, Olay; Newton, Paul N.; Blacksell, Stuart D.

    2012-01-01

    The diagnostic utility of the Standard Diagnostics Leptospira IgM ELISA for detection of acute leptospirosis was assessed in febrile adults admitted in Vientiane, Laos. Using the cut-off suggested by the manufacturer [optical density (OD) >= 0.75], the assay demonstrated limited diagnostic capacity

  3. Seroepidemiological pattern of leptospirosis in bovine of South Gujarat, India

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    J. M. Patel

    2014-11-01

    Full Text Available Aim: Seroepidemiological study of leptospirosis in cattle of various South Gujarat district (Navsari, Tapi, Surat, Valsad. Materials and Methods: Whole blood samples were collected randomly from different age groups, and breeds of cattle of either sex reared in different districts (Navsari, Surat, Tapi, Valsad of South Gujarat. To obtain serum, whole blood was kept in slanting position in 9.0 ml plain vacutainers until serum extracted out of the whole blood. Then these 9.0 ml plain vacutainers were centrifuged at 7000 rpm for 10 min. The straw colored serum was then collected in 1.5 ml sterile cryo vials and aliquoted and stored at −20°C for microscopic agglutination test. Results: In the present study, overall 12.81% (51/398 seroprevalence were recorded with highest seroprevalence (47.06%, 24/51 from Valsad followed by Navsari (9.14%, 18/197, Surat (6.90%, 2/29 and Tapi (5.79%, 7/121 among cattle. The seroprevalence rate of breed and sex wise did not differ significantly (p≤0.05. Maximum incidence of seropositivity was found above 4 years (16.32%, 39/239 of age group followed by animals between 1 and 4 years (9.68%, 12/124. Thus, the age was significantly influencing the seropositivity (p≤0.05. In cattle out of 398 sera screened, 51 were positive with one or more serovars. The highest seropositivity was recorded against serovar Pomona (28.89%. Conclusions: Overall 12.81% seroprevalence of leptospirosis in apparently healthy and clinically ailing bovine of South Gujarat indicating potential zoonotic risk to farmers, labor, and animal owners.

  4. Characterization and immunogenicity of rLipL32/1-LipL21-OmpL1/2 fusion protein as a novel immunogen for a vaccine against Leptospirosis

    Directory of Open Access Journals (Sweden)

    Zhao Xin

    2015-01-01

    Full Text Available Vaccination is an effective strategy to prevent leptospirosis, a global zoonotic disease caused by infection with pathogenic Leptospira species. However, the currently used multiple-valence vaccine, which is prepared with whole cells of several Leptospira serovars, has major side effects, while its cross-immunogenicity among different Leptospira serovars is weak. LipL32, LipL21 and 2 OmpL1 have been confirmed as surface-exposed antigens in all pathogenic Leptospira strains, but their immunoprotective efficiency needs to be improved. In the present study, we generated a fusion gene lipL32/1-lipL21-ompL1/2 using primer-linking PCR and an engineered E. coli strain to express the recombinant fusion protein rLipL32/1-LipL21-OmpL1/2 (rLLO. Subsequently, the expression conditions were optimized using a central composite design that increased the fusion protein yield 2.7-fold. Western blot assays confirmed that rLLO was recognized by anti-rLipL32/1, anti-rLipL21, and anti-rOmpL1/2 sera as well as 98.5% of the sera from leptospirosis patients. The microscopic agglutination test (MAT demonstrated that rLLO antiserum had a stronger ability to agglutinate the strains of different Leptospira serovars than the rLipL32/1, rLipL21, and rOmpL1/2 antisera. More importantly, tests in hamsters showed that rLLO provided higher immunoprotective rates (91.7% than rLipL32/1, rLipL21 and rOmpL1/2 (50.0-75.0%. All the data indicate that rLLO, a recombinant fusion protein incorporating three antigens, has increased antigenicity and immunoprotective effects, and so can be used as a novel immunogen to develop a universal genetically engineered vaccine against leptospirosis.

  5. Comparison of polymerase chain reaction and Warthin-Starry techniques to detect Leptospira spp. in kidneys of slaughtered cattle

    Directory of Open Access Journals (Sweden)

    Shahrzad Azizi

    2014-11-01

    Full Text Available Leptospirosis is a worldwide zoonotic disease that is caused by Gram-negative spirochaetes, Leptospira species. Affected animals excrete the organism in the urine into the environment and act as a source of infection. Cattle are maintenance hosts for some serovars of leptospirosis and are important in the transmission of the infection to humans. At post mortem examination, affected cattle show white spots in their kidneys but these are not specific for leptospirosis. Sometimes it is necessary that leptospirosis be diagnosed in the carcass. Different direct methods, including polymerase chain reaction (PCR, Warthin-Starry silver stain (WS, immunofluorescence (IF and immunohistochemistry (IHC can be used in order to diagnose leptospirosis in the affected tissues, such as kidney. The main advantage of the WS technique is direct visualisation of the bacteria in the tissue samples. Silver staining is useful for retrospective studies on formalin-fixed and paraffin-embedded samples but little information is available on the sensitivity and specificity of the technique. The present study aimed to find a simple and inexpensive method that can be used in any laboratory and that also, if clinical samples are not available, can detect Leptospira in tissue samples post mortem. This study was performed on 19 paraffin-embedded kidneys of slaughtered cows that grossly had focal to multifocal white spots. Leptospirosis was confirmed in these samples with PCR based on the LipL32 gene. Out of 19 PCR positive kidneys, Leptospira was identified in 13 stained samples by WS. The kidneys revealed different grades of interstitial nephritis. No relationship was found between severity of lesions and presence of leptospires in the kidneys. The PCR results on the urine and blood were consistent with matching WS stained kidneys. Out of 13 kidneys that were positive with silver staining, 7 matching blood and 10 matching urine samples were confirmed positive for leptospirosis

  6. Sensitivity of single contrast barium enema with regard to colorectal disease as diagnosed by colonoscopy

    International Nuclear Information System (INIS)

    Kaude, J.V.; Harty, R.F.

    1982-01-01

    The results of single contrast barium enema were retrospectively correlated with colonoscopically diagnosed colorectal disease in 54 patients (75 lesions). Altogether 66 lesions (88%) were correctly diagnosed. The sensitivity of barium enema for polyps was 81% (26/32). There were three perceptive errors and three polyps 5 mm or less in size were not demonstrated by barium enema. Twenty-nine cases of inflammatory disorders were all correctly diagnosed. One of 12 malignancies was missed by perceptive error. In two cases with vascular malformations the barium enema was normal. 4/9 (44%) of missed lesions were perceptive errors and could have been probably avoided by a second independent reading of films. (orig.)

  7. Celiac disease diagnosed after uncomplicated pregnancy in a patient with history of bulimia nervosa.

    Science.gov (United States)

    Milisavljević, Nemanja; Cvetković, Mirjana; Nikolić, Goran; Filipović, Branka; Milinić, Nikola

    2013-01-01

    The association between celiac disease and eating disorders has been very rarely reported. This is the first report on celiac disease associated with bulimia in this part of Europe. An adult female patient with history of bulimia and one uncomplicated pregnancy was admitted to the Gastroenterology Department, due to long lasting dyspeptic symptoms, constipation, major weight loss and fatigue. After positive serological screening, the diagnosis of celiac disease was confirmed with histopathology examination of duodenal biopsy specimen. Complicated interactions between celiac disease and bulimia can make them difficult to diagnose and treat. It is important to consider the presence of celiac disease in patients with bulimia and gastrointestinal symptoms.

  8. Weil’s disease in a 36 years old female: a case report

    Science.gov (United States)

    Rozalena, S.; Handayani, L.; Arman, A.; Permata, M.; Hudari, H.

    2018-03-01

    Leptospirosis is an acute zoonotic infection, itis caused by spirochetes of the genus Leptospira, has extensive vasculitis characterizes, can usually be transmitted indirectly, per contaminated water, rarely directly, and through contact with infected animals. Leptospira bacteria commonly enter the body through the damaged skin or mucous membranes. The clinical syndromes may vary from a subclinical infection and mild febrile condition to severe clinical symptoms with jaundice and renal failure. It is the case report from a woman 36 years old with leptospirosis (Weil’s disease) whose clinical manifestations included: icterus, renal failure, hemorrhagic syndrome and disturbances of consciousness. After the use of antibiotics, symptomatic and substitution therapy, all symptoms resolved completely.

  9. Comparison of the usefulness of selected formulas for GFR estimation in patients with diagnosed chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Paweł Wróbel

    2018-03-01

    Conclusions: CKD-EPI and abbreviated MDRD formulas have a similar usefulness in GFR value estimation in patients with diagnosed chronic kidney disease. Lower eGFR values achieved using abbreviated MDRD formula and CKD-EPI equation in comparison with Bjornsson’s formula may result in an increased number of patients diagnosed with CKD.

  10. Lived Experiences of Adult Children Who Have a Parent Diagnosed with Parkinson's Disease

    Science.gov (United States)

    Blanchard, Amy; Hodgson, Jennifer; Lamson, Angela; Dosser, David

    2009-01-01

    Little is known about the experience among adult children who have a parent with Parkinson's Disease (PD). The purpose of this study was to explore, appreciate, and describe their experiences using a phenomenological methodology. Narratives were collected from seven participants who have a parent diagnosed with PD and analyzed according to…

  11. Trends in incidence of end-stage renal disease among persons with diagnosed diabetes--Puerto Rico, 1996-2010.

    Science.gov (United States)

    Burrows, Nilka Rios; Hora, Israel; Williams, Desmond E; Geiss, Linda S

    2014-03-07

    During 2010, approximately 6,091 persons aged ≥18 years in Puerto Rico were living with end-stage renal disease (ESRD) (i.e., kidney failure that requires regular dialysis or kidney transplantation for survival). This included 1,462 persons who began treatment for ESRD in 2010. Diabetes is the leading cause of ESRD in Puerto Rico, accounting for 66% of new cases in adults, followed by hypertension, which accounts for 15% of the cases. Although the number of adults initiating ESRD treatment (i.e., dialysis or kidney transplantation) in Puerto Rico each year who have diabetes listed as a primary cause (ESRD-D) has increased since 1996, ESRD-D incidence among adults with diagnosed diabetes has not shown a consistent trend. To assess recent trends in ESRD-D incidence among adults aged ≥18 years in Puerto Rico with diagnosed diabetes and to further examine trends by age group and sex, CDC analyzed 1996-2010 data from the U.S. Renal Data System (USRDS) and the Behavioral Risk Factor Surveillance System (BRFSS). After increasing in the late 1990s, ESRD-D incidence decreased during the 2000s among adult men and among persons aged 18-44 years with diagnosed diabetes in Puerto Rico. Throughout the period, ESRD-D incidence among adult women and among persons aged 45-64 and ≥75 years with diagnosed diabetes did not show a consistent trend, and ESRD-D incidence among persons aged 65-74 years with diagnosed diabetes increased. Increased awareness of the risk factors for kidney disease and implementation of effective interventions to prevent or delay kidney disease among persons with diagnosed diabetes might decrease ESRD incidence in Puerto Rico, particularly among women and older persons.

  12. Atypical lymphocytosis in leptospirosis: a cohort of hospitalized cases between 1996 and 2009 in State of Rio de Janeiro, Brazil Linfócitos atípicos na leptospirose: coorte de pacientes hospitalizados entre 1996 e 2009, Estado do Rio de Janeiro

    Directory of Open Access Journals (Sweden)

    Paulo Vieira Damasco

    2011-10-01

    Full Text Available INTRODUCTION: Leptospirosis is a zoonotic disease found in tropical and temperate countries, and its clinical diagnostic confusion with arboviruses (dengue fever, oropouche fever and yellow fever, Brazilian spotted fever, viral hepatitis and hantaviruses has been an ongoing public health concern. The aim of this observational study was to demonstrate an association between findings of atypical lymphocytosis and the progression of endemic leptospirosis. METHODS: A retrospective analysis was performed on the demographic, epidemiological, clinical and laboratory aspects of 27 human leptospirosis cases that occurred over a period of 13 years (1996-2009 with no reported epidemic outbreaks in Rio de Janeiro, Brazil. RESULTS: The overall mortality rate was 11.1% in our cohort of hospitalized cases. However, there was no mortality among patients with atypical lymphocytosis (OR = 11.1; 95% CI = 1.12-110.9; p = 0.04. Two patients who were in the septicemic phase showed signs of expansion of γδ T cell responses in peripheral blood. CONCLUSIONS: Atypical lymphocytosis may be observed in patients with leptospirosis. Our observations suggest that these atypical leukocyte subsets are associated with partial protection during the disease course of leptospirosis.INTRODUÇÃO: Leptospirose é uma zoonose que permanece endêmica em regiões tropicais e temperadas. A dificuldade no diagnóstico clínico diferencial entre os quadros de leptospirose humana e as várias arboviroses (dengue, febre amarela, febre de oropouche, febre maculosa brasileira, hepatite viral e hantavirose permanece um problema na Saúde Pública. MÉTODOS: No presente estudo, foi realizada análise retrospectiva de características demográficas, epidemiológicas, clínicas e laboratoriais de 27 casos de leptospirose humana que ocorrerem durante um período de 13 anos sem ocorrência de notificação de surtos epidêmicos no Rio de Janeiro, Brasil (1996-2009. RESULTADOS: A mortalidade da

  13. Leptospiral outer membrane protein LipL41 is not essential for acute leptospirosis but requires a small chaperone protein, lep, for stable expression.

    Science.gov (United States)

    King, Amy M; Bartpho, Thanatchaporn; Sermswan, Rasana W; Bulach, Dieter M; Eshghi, Azad; Picardeau, Mathieu; Adler, Ben; Murray, Gerald L

    2013-08-01

    Leptospirosis is a worldwide zoonosis caused by pathogenic Leptospira spp., but knowledge of leptospiral pathogenesis remains limited. However, the development of mutagenesis systems has allowed the investigation of putative virulence factors and their involvement in leptospirosis. LipL41 is the third most abundant lipoprotein found in the outer membranes of pathogenic leptospires and has been considered a putative virulence factor. LipL41 is encoded on the large chromosome 28 bp upstream of a small open reading frame encoding a hypothetical protein of unknown function. This gene was named lep, for LipL41 expression partner. In this study, lipL41 was found to be cotranscribed with lep. Two transposon mutants were characterized: a lipL41 mutant and a lep mutant. In the lep mutant, LipL41 protein levels were reduced by approximately 90%. Lep was shown through cross-linking and coexpression experiments to bind to LipL41. Lep is proposed to be a molecular chaperone essential for the stable expression of LipL41. The roles of LipL41 and Lep in the pathogenesis of Leptospira interrogans were investigated; surprisingly, neither of these two unique proteins was essential for acute leptospirosis.

  14. Nuclear cardiology procedures to diagnose ischemia in coronary artery disease

    International Nuclear Information System (INIS)

    Kropp, J.

    1999-01-01

    Nuclear cardiology is equipped with a broad spectrum of diagnostic capabilities which allow the evaluation of ventricular performance, perfusion and metabolism of the heart. The principle of nuclear medicine procedures consists in the administration of free radioisotopes or radiopharmaceuticals to detect their spatial distribution within the body by detecting their y-rays from outside by gamma cameras. Myocardial perfusion scintigraphy is the most important procedure in nuclear cardiology and is performed on a routine basis with 201 Thallium-Chloride ( 201 Tl) since 1975. With the Single-Photon Emission Computerized Tomography (SPECT) technique it is possible to diagnose ischemia of the left ventricle on the basis of coronary artery disease with a sensitivity of 90-95% and a specificity of about 55%. Recently 99m Tc-tracers were developed for this purpose, which have many advantages due to their better physical properties, their easy handling and availability. The diagnostic accuracy is the same compared to ( 201 Tl). Free fatty acids labeled with 123 Iodine like 123 IPPA are alternative tracers to diagnose ischemia by the metabolic alteration and are pathognomonic tracers to diagnose the heart involvement in myopathies or metabolic defects related to fatty acid degradation which are the main fuel of the normal myocytes. Finally we should not forget the radionuclide ventriculography (RNVG) which is one of the oldest nuclear cardiology procedures providing us with very objective, reliable results of ventricular performance. (orig.)

  15. Diagnosing Dementia—Positive Signs

    Science.gov (United States)

    ... Navigation Bar Home Current Issue Past Issues Diagnosing Dementia—Positive Signs Past Issues / Fall 2007 Table of ... easy, affordable blood test that could accurately diagnose Alzheimer's disease (AD)—even before symptoms began to show? Researchers ...

  16. Value of neuropsychological tests, neuroimaging, and biomarkers for diagnosing Alzheimer's disease in younger and older age cohorts

    NARCIS (Netherlands)

    Schmand, B.; Eikelenboom, P.; van Gool, W.A.

    2011-01-01

    OBJECTIVES: To examine the influence of age on the value of four techniques for diagnosing Alzheimer's disease (AD). DESIGN: Observational cohort study. SETTING: Alzheimer's Disease Neuroimaging Initiative. PARTICIPANTS: Individuals with mild cognitive impairment (MCI; n=179), individuals with AD

  17. Celiac disease diagnosed after uncomplicated pregnancy in a patient with history of bulimia nervosa

    Directory of Open Access Journals (Sweden)

    Milisavljević Nemanja

    2013-01-01

    Full Text Available Introduction. The association between celiac disease and eating disorders has been very rarely reported. This is the first report on celiac disease associated with bulimia in this part of Europe. Case report. An adult female patient with history of bulimia and one uncomplicated pregnancy was admitted to the Gastroenterology Department, due to long lasting dyspeptic symptoms, constipation, major weight loss and fatigue. After positive serological screening, the diagnosis of celiac disease was confirmed with histopathology examination of duodenal biopsy specimen. Conclusion. Complicated interactions between celiac disease and bulimia can make them difficult to diagnose and treat. It is important to consider the presence of celiac disease in patients with bulimia and gastrointestinal symptoms.

  18. Anos potenciais de vida perdidos e custos hospitalares da leptospirose no Brasil Años potenciales de vida perdidos y costos hospitalarios de la leptospirosis en Brasil Years of potential life lost and hospitalization costs associated with leptospirosis in Brazil

    Directory of Open Access Journals (Sweden)

    Verena Maria Mendes de Souza

    2011-12-01

    linkage of cases and hospitalizations leading to death by leptospirosis in 2007. Within the Information System for Notifiable Diseases, confirmed cases were subdivided into hospitalization and death. These were then linked to the Hospital Information System (records with primary diagnosis and the Mortality Information System (underlying cause of death A27.0, A27.8, and A27.9 databases. The partial cost of hospitalization, deaths by disease, and years of potential life and work lost, were estimated. RESULTS: Most hospitalizations leading to death occurred among males aged 18-49 years, of white ethnicity, living in urban areas, and with incomplete elementary education. Years of potential life lost amounted to 6,490, 75% of which were in the 20-49 years age group. When adjusted for the population, this loss represented 15 days of life/thousand persons. The ratio of years of potential life lost to number of deaths was on average 30 years per death. The estimated financial impact amounted to R$ 22.9 million in non-earned wages. Hospitalization costs totaled R$ 831.5 thousand. Estimated days of wages lost per admission period (median: 6 days amounted to R$ 103.0 thousand. CONCLUSIONS: There was a high social cost in terms of years of potential life lost and partial hospital costs associated with leptospirosis when compared to the possibility of early treatment or prevention of infection, both of which could minimize the impact of the disease on the Brazilian population.

  19. Validation of celiac disease diagnoses recorded in the Danish National Patient Register using duodenal biopsies, celiac disease-specific antibodies, and human leukocyte-antigen genotypes

    DEFF Research Database (Denmark)

    Dydensborg Sander, Stine; Størdal, Ketil; Plato Hansen, Tine

    2016-01-01

    PURPOSE: The purpose of this study was to validate the celiac disease diagnoses recorded in the Danish National Patient Register. To validate the diagnoses, we used information on duodenal biopsies from a national register of pathology reports (the Patobank) and information on celiac disease......-specific antibodies and human leukocyte antigen (HLA) genotypes obtained from patient medical records. PATIENTS AND METHODS: We included all the children who were born from 1995 to 2012 and who were registered as having celiac disease in the Danish National Patient Register. We reviewed all the pathology reports...... on duodenal biopsies in the Patobank and the information in the medical records on celiac disease-specific antibodies (ie, anti-tissue transglutaminase 2 IgA and IgG, endomysial antibodies IgA, and anti-deamidated gliadin peptide IgG) and HLA genotypes. RESULTS: We identified 2,247 children who were...

  20. Screening of coeliac disease in undetected adults and patients diagnosed with irritable bowel syndrome in Riyadh, Saudi Arabia.

    Science.gov (United States)

    Al-Ajlan, Abdulrahman S

    2016-07-01

    The present study is to determine the prevalence and implication of coeliac disease (CD) among adult Saudis and compared to those with diagnosed irritable bowel syndrome. This prospective study was conducted among 980 adults. Out of that, 482 subjects (staff and students of Riyadh Health Science College) were designated as control cohorts for undetected coeliac disease. Furthermore, another contingent of 498 subjects diagnosed with irritable bowel syndrome (IBS) at Prince Salman Hospital and Al-Iman General Hospital also constituted a segment of the overall initial 1020 subjects. Both cases and control were tested for serological markers of coeliac disease (tissues transglutaminase (tTGAs) and endomysial autoantibody (EMAs) and were confirmed by histopathology test. All the positive for cases of coeliac disease were screened for iron deficiency anaemia, Vitamin D deficiency, and osteoporosis and weight assessment. The percentage of coeliac disease in control subjects and patients diagnosed with irritable bowel syndrome (IBS) were found to be 1.9% and 9.6% respectively, about 38% of the total coeliac disease patients are among females of middle age (20-39-years) and 16% of the males in the same age range. Whereas, 20% and 25% of all coeliac disease cases with ages of 40-59 were remarked as females and males respectively. The identical nature and overlap of symptoms of the two conditions could possibly result in misdiagnosis of coeliac diseases or over-diagnosis of irritable bowel syndrome. The findings of the study might also give considerable implications of the disease in the nutritional level which is noticeable.

  1. Screening of coeliac disease in undetected adults and patients diagnosed with irritable bowel syndrome in Riyadh, Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Abdulrahman S. Al-Ajlan

    2016-07-01

    Full Text Available The present study is to determine the prevalence and implication of coeliac disease (CD among adult Saudis and compared to those with diagnosed irritable bowel syndrome. This prospective study was conducted among 980 adults. Out of that, 482 subjects (staff and students of Riyadh Health Science College were designated as control cohorts for undetected coeliac disease. Furthermore, another contingent of 498 subjects diagnosed with irritable bowel syndrome (IBS at Prince Salman Hospital and Al-Iman General Hospital also constituted a segment of the overall initial 1020 subjects. Both cases and control were tested for serological markers of coeliac disease (tissues transglutaminase (tTGAs and endomysial autoantibody (EMAs and were confirmed by histopathology test. All the positive for cases of coeliac disease were screened for iron deficiency anaemia, Vitamin D deficiency, and osteoporosis and weight assessment. The percentage of coeliac disease in control subjects and patients diagnosed with irritable bowel syndrome (IBS were found to be 1.9% and 9.6% respectively, about 38% of the total coeliac disease patients are among females of middle age (20–39-years and 16% of the males in the same age range. Whereas, 20% and 25% of all coeliac disease cases with ages of 40–59 were remarked as females and males respectively. The identical nature and overlap of symptoms of the two conditions could possibly result in misdiagnosis of coeliac diseases or over-diagnosis of irritable bowel syndrome. The findings of the study might also give considerable implications of the disease in the nutritional level which is noticeable.

  2. Brotes de leptospirosis humana en la provincia de Ciego de Ávila, Cuba Human leptospirosis outbreak in the district of Ciego de Ávila, Cuba

    Directory of Open Access Journals (Sweden)

    Miguel Suárez Hernández

    1999-02-01

    Full Text Available Se analizan los brotes de leptospirosis ocurridos en la provincia de Ciego de Ávila en el periodo de 1980 a 1995. En la etapa se notifican 40 brotes. Las actividades principales vinculadas a los mismos fueron la atención al cultivo de la caña de azúcar, al cultivo del plátano, el baño en río y las inundaciones. Se nota un incremento de brotes a partir del mes de junio. En los meses de octubre y noviembre se reportan las mayores incidencias. Los grupos de edades que más casos aportaron fueron de 10-14 años, 15-19 años y 30-34 años. El sexo más afectado fue el masculino. Los grupos más afectados fueron los estudiantes, pobladores urbanos y trabajadores agrícolas cañeros. De los 40 brotes, 21 fueron confirmados por medio de la prueba de microaglutinación y 19 por la prueba hemolitica, siendo los serogrupos más frecuentes Pomona y Australis.Forty leptospirosis outbreaks occurred in Ciego de Avila province from 1980 to 1995. The main events involved in the outbreaks were floods, bathing in rivers and activities related to sugar cane and banana cultivation. The number of cases increased after June, with higher incidences reported in October and November. The most affected age groups were 10-14 years, 15-19 years and 30-34 years. Men were more affected than women. Students, people residing in the urban zone and farmers were the most affected groups. A total of 21 outbreaks out of 40 were confirmed by the microagglutination test and the remaining 19 by the hemolytic test. Pomona and Australis were the serogroups most frequently detected by microagglutination.

  3. Who Can Diagnose Parkinson's Disease First? Role of Pre-motor Symptoms.

    Science.gov (United States)

    Rodríguez-Violante, Mayela; Zerón-Martínez, Rosalía; Cervantes-Arriaga, Amin; Corona, Teresa

    2017-04-01

    In 1817, James Parkinson described the disease which bears his name. The disease was defined as a neurological syndrome characterized by tremor, rigidity, and slowness of movements. Almost one hundred years later, degeneration of neurons in the substantia nigra and low levels of dopamine were identified as the putative cause of the disease, thus the disease remained as a pure neurological disorder. In the late 1990s, non-motor symptoms of the disease began to gain interest because of their clinical relevance, as well as for their potential role in broadening the understanding of the pathophysiological mechanisms involved. In the last decade, focus has shifted to the pre-motor symptoms, those non-motor symptoms that present years before the motor onset of the disease. The main premotor symptoms include rapid eye movement sleep behavior disorder, hyposmia, constipation and depression. Subjects with these symptoms usually are not initially seen by a neurologist, and by the time they are consulted neuronal loss in the substantia nigra is over 50%. This review summarizes the overall relevance of non-motor symptoms, their frequency and their pathophysiological implications. Also, the importance of pre-motor symptoms, and the role of specialists other than neurologists in diagnosing subjects with Parkinson's disease is discussed. Two hundred years after the first description of the disease, it is now evident that Parkinson's disease is a systemic disease and a multispecialty team approach is mandatory. Copyright © 2017 IMSS. Published by Elsevier Inc. All rights reserved.

  4. Comportamiento de la vigilancia epidemiológica de la leptospirosis humana en Colombia, 2007-2011

    Directory of Open Access Journals (Sweden)

    Solmara Bello

    2013-08-01

    Full Text Available Introducción. La leptospirosis es una zoonosis reemergente de distribución mundial causada por una espiroqueta del género Leptospira. Durante los últimos años en Colombia aumentó el número de casos en humanos y animales. Objetivo. Caracterizar epidemiológicamente los casos de leptospirosis notificados al Sistema Nacional de Vigilancia en Salud Pública de Colombia y hacer una aproximación para conocer los serogrupos que circulan en el país. Materiales y métodos. Se diseñó un estudio observacional de corte retrospectivo, con registros del proceso de vigilancia de los casos reportados por el software Sivigila y muestras enviadas al Grupo de Microbiología de la Red Nacional de Laboratorios, durante el periodo 2007 a 2011. Se registraron variables de tipo sociodemográficas y se analizaron 17 serogrupos de Leptospira. En el análisis seutilizaron medidas de frecuencia, tendencia central y dispersión. Resultados. Se procesaron 11.786 registros, confirmándose 4.621 casos de leptospirosis. Las entidades territoriales con mayor registro fueron Valle del Cauca, Antioquia, Risaralda, Atlántico y Barranquilla; y las de incidencia más alta fueron Guaviare, Risaralda, San Andrés, Santa Marta y Barranquilla. El mayor número de casos reportados perteneció al área urbana, con mayor frecuencia de hombres (77 %, estudiantes (19,4 % y amas de casas (13,6 %, con una mediana por edad de 29 años (rango intercuartílico: 45-19. Se evidenció la circulación de 17 serogrupos en el país; los más frecuentes fueron Australis (24,89 %, Hebdomadis (9,33 % y Sejroe (8,0 %. Conclusión. En Colombia se ha mejorado la notificación y clasificación final de los casos, lo que ha permitido identificar al serogrupo Australis como el de mayor circulación.   doi: http://dx.doi.org/10.7705/biomedica.v33i0.1608

  5. Value of neuropsychological tests, neuroimaging, and biomarkers for diagnosing Alzheimer's disease in younger and older age cohorts

    NARCIS (Netherlands)

    Schmand, Ben; Eikelenboom, Piet; van Gool, Willem A.

    2011-01-01

    To examine the influence of age on the value of four techniques for diagnosing Alzheimer's disease (AD). Observational cohort study. Alzheimer's Disease Neuroimaging Initiative. Individuals with mild cognitive impairment (MCI; n = 179), individuals with AD (n = 91), and normal controls (n = 105).

  6. A longitudinal study of gastrointestinal diseases in individuals diagnosed with infantile autism as children

    DEFF Research Database (Denmark)

    Mouridsen, Svend-Erik; Rich, B; Isager, T

    2009-01-01

    Abstract Background A number of studies have indicated a link between gastrointestinal (GI) diseases and autism spectrum disorders. Method The objective of this study was to compare the prevalence and types of GI diseases in a clinical sample of 118 individuals diagnosed as children with infantile...... autism (IA) with GI diseases in 336 matched controls from the general population, based on data from the nationwide Danish National Hospital Register (DNHR). The average observation time was 30.3 years (SD 0.4) (range 27-30 years), and mean age at the end of the observation period was 42.7 years (SD 7...

  7. Diseases of the gastrointestinal tract in individuals diagnosed as children with atypical autism

    DEFF Research Database (Denmark)

    Mouridsen, Svend Erik Birkebæk; Isager, Torben; Rich, Bente

    2013-01-01

    The purpose of this study is to compare the prevalence and types of diseases (International Classification of Mental and Behavioural Disorders, 10th Edition codes K20-K93) relating to the gastrointestinal tract in a clinical sample of 89 individuals diagnosed as children with atypical autism...... with atypical autism, a total of 22 (24.7%) were registered with at least one diagnosis of any disease of the gastrointestinal tract, against 47 of 258 (18.2%) in the comparison group (p = 0.22; odds ratio = 1.5; 95% confidence interval = 0.8-2.6). Without reaching statistical significance, the rate of diseases...... of the gastrointestinal tract was particularly high (odds ratio = 1.2) in those with intelligence quotient autism had about the same frequency of gastric, intestinal and hepatic diseases as had controls....

  8. Risk perception of future cardiovascular disease in women diagnosed with a hypertensive disorder of pregnancy.

    Science.gov (United States)

    Traylor, Jessica; Chandrasekaran, Suchitra; Limaye, Meghana; Srinivas, Sindhu; Durnwald, Celeste P

    2016-01-01

    The objective of this study is to evaluate a woman's risk perception for future cardiovascular disease (CVD) after being diagnosed with a hypertensive disorder of pregnancy. A prospective cohort of women diagnosed with a hypertensive disorder of pregnancy (HDP) was studied. Each woman completed two surveys, one prior to hospital discharge and one 2 weeks later, designed to assess knowledge of and risk perception for future CVD based on their recent diagnosis of a HDP. Rates of postpartum depression were also assessed. Of the 146 subjects included, 28% were diagnosed with preeclampsia with severe features, 52.1% with preeclampsia with mild features, and 19.9% had chronic hypertension. Women with severe features and those delivering preterm were more likely to report a perception of increased risk of both recurrent HDP in a future pregnancy (p = 0.004 and 0.005, respectively) and hypertension later in life (p = 0.01 and 0.03, respectively). Women delivering preterm were more likely to report an accurate perception of increased risk of myocardial infarction and stroke compared to those delivering at term (p = 0.006 and 0.002, respectively). Disease severity and preterm delivery were associated with a higher likelihood of the perception of an increased risk for both recurrent HDP and hypertension in the future. Only preterm delivery was associated with a higher risk perception for stroke and myocardial infarction. Interventions targeted at improved health awareness in women diagnosed with HDP are warranted.

  9. Proteínas recombinantes útiles para el diagnóstico, prevención y estudios patogénicos de la leptospirosis : Estudio de mecanismos patogénicos involucrados

    OpenAIRE

    Prêtre, Gabriela

    2011-01-01

    Objetivo general El propósito general de este trabajo es: 1. Generar herramientas moleculares que sean útiles contra la leptospirosis, ya sea para su diagnóstico, prevención o un mejor conocimiento de su patogénesis. 2. Estudiar mecanismos patogénicos involucrados en la leptospirosis. Objetivos específicos 1. Clonado, expresión y purificación de proteínas recombinantes. 2. Producción de antisuero contra las proteínas recombinantes....

  10. Serum selenium is low in newly diagnosed Graves´disease: a population-based study

    DEFF Research Database (Denmark)

    Bülow Pedersen, Inge; Knudsen, Nils; Carle, Allan

    2013-01-01

    by a fluorimetric method. Patients with newly diagnosed Graves’ disease (GD) (n = 97) or autoimmune overt hypothyroidism (AIH) (n = 96), euthyroid subjects with high serum levels of thyroid peroxidase antibody (TPO‐Ab) (TPO‐Ab > 1500 U/ml, n = 92) and random controls (n = 830). Differences in s‐Se values. S...

  11. CTSH regulates β-cell function and disease progression in newly diagnosed type 1 diabetes patients

    DEFF Research Database (Denmark)

    Fløyel, Tina; Brorsson, Caroline; Nielsen, Lotte B

    2014-01-01

    expression and increased insulin secretion. Additionally, islets from Ctsh(-/-) mice contained less insulin than islets from WT mice. Importantly, the TT genotype was associated with higher daily insulin dose and faster disease progression in newly diagnosed T1D patients, indicating agreement between...

  12. Unexpectedly diagnosed Caroli's disease on HIDA scintigraphy in a patient with calculous cholecystitis

    Energy Technology Data Exchange (ETDEWEB)

    Shinto, A. S.; Selvakumar, J. [Amala Institute of Medical Sciences, Amalanagar (India)

    2010-12-15

    Caroli's disease, which is a rare condition with congenital dilatation if the intrahepatic bile ducts, is usually diagnosed postoperatively. The clinical suspicion in a patient with gallstones and choledocholithiasis presenting with dilated intrahepatic biliary radicles and jaundice is usually an obstructive etiology. However, scintigraphic evaluation of this entity, as in this case, gives additional information on liver function, biliary drainage and predisposing conditions like Caroli's disease, which could be missed otherwise

  13. How are self-rated health and diagnosed disease related to early or deferred retirement? A cross-sectional study of employees aged 55-64

    Directory of Open Access Journals (Sweden)

    Kerstin Nilsson

    2016-08-01

    Full Text Available Abstract Background More people will probably continue working into old age in the future due to the increased size of aging populations in many countries. We therefore need to know more about older workers’ health in relation to their work situation and retirement. This study is a part of a theoretical development of older workers’ situations. Older workers’ situations are theoretically themed in nine areas by the authors of this study. The aims of the study were to investigate the relationship between: i diagnosed disease and factors in older workers’ situations, theoretically themed in nine areas; ii self-rated health and factors in older workers’ situations, theoretically themed in nine areas; iii diagnosed disease and self-rated health; and iv the relationships between these health measures and retirement. Methods A questionnaire-based cross-sectional study, using logistic regression, with 1,756 health care personnel aged 55–64 years. The questionnaire used gave an overview of most different areas in the older workers’ situations. Result There was a difference in the participants’ frequency of objectively specified diagnosed disease and their subjectively experienced self-rated health. A bad self-rated health was related higher to early retirement than diagnosed diseases. In the multivariate model, having ‘Diagnosed disease’ was not significantly related to whether older workers thought they could not work beyond 65 years of age. A bad ‘Self-rated health’ was also more highly related to whether older workers thought they could not work beyond 65 years, than if the respondents stated that a ‘Diagnosed disease is a hindrance in my daily work’ in the multivariate model. Conclusion This study showed an important difference between older workers’ own experiences and the effect of their self-rated health and their diagnosed diseases. Subjective self-rated health seems to be more important to people’s retirement

  14. Neumonía aguda de la comunidad y hemorragia pulmonar por leptospirosis en el área metropolitana Buenos Aires

    Directory of Open Access Journals (Sweden)

    Alfredo Seijo

    2011-04-01

    Full Text Available El objetivo del trabajo es comunicar los hallazgos epidemiológicos, clínicos y de diagnóstico de la neumonía y hemorragia pulmonar por leptospirosis, en el período enero 2007 a octubre 2009. Un 64% (20/31 de pacientes con diagnóstico de leptospirosis tuvieron neumonía. Quince de ellos (75% presentaron neumonía grave, de los cuales siete (35% desarrollaron hemorragia pulmonar. En diez enfermos (32% el motivo de consulta e inicio del cuadro clínico fue una gastroenteritis secretoria con fiebre y dolor abdominal. La ictericia sólo se manifestó en once pacientes (35%. La técnica de reacción en cadena de la polimerasa (PCR fue útil para el diagnóstico en muestra obtenida post mortem. De un hemocultivo se aisló una cepa clasificada dentro del serogrupo canicola. Se clasificaron las neumonías en tres tipos: neumonías de curso no grave con escasa repercusión general; neumonías graves asociadas a formas clínicas sistémicas con ictericia, insuficiencia renal, trombocitopenia y hemorragia pulmonar; también de curso grave, no asociada a ictericia, insuficiencia renal o trombocitopenia grave. El tratamiento antibiótico iniciado en los primeros días de enfermedad (promedio 3.2 días no tuvo influencia en la evolución de las neumonías graves. Se plantea además considerar tres formas clínicas de leptospirosis: anictérica, ictérica (con sus variantes evolutivas y hemorragia pulmonar.

  15. A 27-year-old woman diagnosed as polycystic ovary syndrome associated with Graves' disease.

    Science.gov (United States)

    Jung, Jung Hwa; Hahm, Jong Ryeal; Jung, Tae Sik; Kim, Hee Jin; Kim, Ho Soo; Kim, Sungsu; Kim, Soo Kyoung; Lee, Sang Min; Kim, Deok Ryong; Choi, Won Jun; Seo, Yeong Mi; Chung, Soon Il

    2011-01-01

    Polycystic ovary syndrome (PCOS) and Graves' disease are the common causes of menstrual irregularity leading to infertility in women of child-bearing age. A 21-year-old female patient visited us with complaints of oligomenorrhea and hand tremor. She was diagnosed as having PCOS and hyperthyroid Graves' disease, simultaneously. She had low body weight (BMI: 16.4 kg/m(2)), mild hirsutism, and thyrotoxicosis. The patient was treated with anti-thyroid drug and beta-blocker for about two years, and then recovered to normal thyroid function. Although some studies have suggested a connection between PCOS and autoimmune thyroiditis, no study indicated that PCOS is associated with Graves' disease until now. Here, we describe the first case report of a lean woman with normal insulin sensitivity presenting PCOS and Graves' disease simultaneously.

  16. How Important Are Rats As Vectors of Leptospirosis in the Mekong Delta of Vietnam?

    Science.gov (United States)

    Loan, Hoang Kim; Van Cuong, Nguyen; Takhampunya, Ratree; Kiet, Bach Tuan; Campbell, James; Them, Lac Ngoc; Bryant, Juliet E.; Tippayachai, Bousaraporn; Van Hoang, Nguyen; Morand, Serge; Hien, Vo Be

    2015-01-01

    Abstract Leptospirosis is a zoonosis known to be endemic in the Mekong Delta of Vietnam, even though clinical reports are uncommon. We investigated leptospira infection in rats purchased in food markets during the rainy season (October) (n=150), as well as those trapped during the dry season (February–March) (n=125) in the region using RT-PCR for the lipL32 gene, confirmed by 16S rRNA, as well as by the microscopic agglutination test (MAT). Results were compared with the serovar distribution of human cases referred from Ho Chi Minh City hospitals (2004–2012) confirmed by MAT (n=45). The MAT seroprevalence among rats was 18.3%. The highest MAT seroprevalence corresponded, in decreasing order, to: Rattus norvegicus (33.0%), Bandicota indica (26.5%), Rattus tanezumi (24.6%), Rattus exulans (14.3%), and Rattus argentiventer (7.1%). The most prevalent serovars were, in descending order: Javanica (4.6% rats), Lousiana (4.2%), Copenageni (4.2%), Cynopterie (3.7%), Pomona (2.9%), and Icterohaemorrhagiae (2.5%). A total of 16 rats (5.8%) tested positive by RT-PCR. Overall, larger rats tended to have a higher prevalence of detection. There was considerable agreement between MAT and PCR (kappa=0.28 [0.07–0.49]), although significantly more rats were positive by MAT (McNemar 29.9 (pgeographically linked co-sampling of humans and animals to establish the main sources of leptospirosis in the region. PMID:25629781

  17. Overweight and obesity in children with newly diagnosed inflammatory bowel disease.

    Science.gov (United States)

    Pituch-Zdanowska, Aleksandra; Banaszkiewicz, Aleksandra; Dziekiewicz, Marcin; Łazowska-Przeorek, Izabella; Gawrońska, Agnieszka; Kowalska-Duplaga, Kinga; Iwańczak, Barbara; Klincewicz, Beata; Grzybowska-Chlebowczyk, Urszula; Walkowiak, Jarosław; Albrecht, Piotr

    2016-03-01

    Determination of overweight and obesity prevalence in children with inflammatory bowel disease (IBD) at the time of diagnosis. This was a multicenter retrospective study. The study group consisted of children with new cases of IBD diagnosed in 2005-2013 according to the Porto criteria. Hospital admission records were reviewed for demographic and clinical characteristics. BMI-for-age and gender percentile charts were used to define overweight as ≥85th BMI percentile and obesity as ≥95th BMI percentile. 675 patients were evaluated: 368 with Crohn's disease (CD) and 307 with ulcerative colitis (UC). Of these, 54.8% were boys and 45.2% were girls. There were no statistically significant differences in age, weight, height and disease activity between the CD and UC patients. The UC patients had higher BMI values than the CD patients. The prevalence of overweight and obesity was higher in the UC than the CD patients (4.89% CI95 2.76-7.93 vs. 2.45% CI95 1.12-4.59 and 8.47% CI95 5.61-12.16 vs. 1.9% CI95 0.77-3.88, respectively); the differences were statistically significant (-2.44% CI95 -5.45 to 0.49 and -6.57% CI95 -10 to -3.1, respectively). The risk of overweight/obesity was 3.5 times higher for patients with UC (OR=0.272, CI95 0.14-0.49, p=0.0004). The prevalence of overweight and obesity in newly diagnosed children with IBD was 8.4% and was higher in patients with UC than in patients with CD. The results of this study have shown that not only malnourished children may suffer from IBD but also children who are overweight or obese at the time of diagnosis. Copyright © 2015 Medical University of Bialystok. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

  18. A model of Leptospirosis infection in an African rodent to determine risk to humans: Seasonal fluctuations and the impact of rodent control

    DEFF Research Database (Denmark)

    Holt, J; Davis, S; Leirs, Herwig

    2006-01-01

    Human leptospirosis (Leptospira spp. infection) is aworldwide public health problem that is of greatest concern for humid tropical and subtropical regions. The magnitude of the problem in these areas is larger because of the climatic and environmental conditions the bacterium face outside...... their hosts but also because of the frequency of contacts between people and sources of infection. Rodents are thought to play the most important role in the transmission of human leptospirosis. We here model the dynamics of infection in an African rodent (Mastomys natalensis) that is thought...... to be the principal source of infection in parts of Tanzania. Our model, representing the climatic conditions in central Tanzania, suggests a strong seasonality in the force of infection on humans with a peak in the abundance of infectious mice between January and April in agricultural environments. In urban areas...

  19. Health-related quality of life is not impaired in children with undetected as well as diagnosed celiac disease: a large population based cross-sectional study

    Science.gov (United States)

    2014-01-01

    Background Knowledge regarding the health-related quality of life (HRQoL) of children with celiac disease remains limited and inconclusive. We investigated the HRQoL of three groups of 12-year-olds with: i) undetected celiac disease ii) clinically diagnosed celiac disease, and iii) without celiac disease. Methods A school-based cross-sectional multicenter screening study invited 18 325 children, whereof 68% consented to participate. Participants provided a blood sample, which was later analyzed for anti-tissue-tranglutaminase antibodies, and alongside filled in a questionnaire. When anti-tissue-tranglutaminase antibodies were elevated, a small intestinal biopsy verified the screening-detected celiac disease diagnosis. Self-reported HRQoL was measured using Kidscreen, a generic 52 items instrument with proven reliability and validity. Scores were linearly transformed into a 0–100 scale with higher values indicating better HRQoL. Mean values with standard deviations (mean ± SD) were compared, and uni- and multivariate logistic regression models tested the odds of a low HRQoL among children with undetected or diagnosed celiac disease, respectively. Results Children with undetected celiac disease (n = 238) reported similar HRQoL as children without celiac disease (n = 12 037) (83.0 ± 11.0 vs. 82.5 ± 11.3, P = 0.51), and also similar HRQoL (82.2 ± 12.2, P = 0.28) to that of children with diagnosed celiac disease (n = 90), of whom 92% were adherent to treatment. Having undetected celiac disease did not increase the odds of low overall HRQoL, independent of sex, area of residence, study year and occurrence of gastrointestinal symptoms (adjusted odds ratio 0.77, 95% CI 0.54-1.10). Comparable results were seen for diagnosed celiac disease cases (adjusted odds ratio 1.11, 95% CI 0.67-1.85). Conclusion Children with undetected celiac disease reported comparable HRQoL as their peers with diagnosed celiac disease, and those without celiac disease

  20. Computational Fluid Dynamics and Additive Manufacturing to Diagnose and Treat Cardiovascular Disease.

    Science.gov (United States)

    Randles, Amanda; Frakes, David H; Leopold, Jane A

    2017-11-01

    Noninvasive engineering models are now being used for diagnosing and planning the treatment of cardiovascular disease. Techniques in computational modeling and additive manufacturing have matured concurrently, and results from simulations can inform and enable the design and optimization of therapeutic devices and treatment strategies. The emerging synergy between large-scale simulations and 3D printing is having a two-fold benefit: first, 3D printing can be used to validate the complex simulations, and second, the flow models can be used to improve treatment planning for cardiovascular disease. In this review, we summarize and discuss recent methods and findings for leveraging advances in both additive manufacturing and patient-specific computational modeling, with an emphasis on new directions in these fields and remaining open questions. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. [Evaluation of eating habits and nutritional behaviors of women in the perimenopausal period with the diagnosed celiac disease].

    Science.gov (United States)

    Friedrich, Mariola; Podlaszewska, Grazyna; Kuchlewska, Magdalena

    2012-01-01

    The aim of this study was to evaluate eating habits and nutritional behaviors of women in the perimenopausal period with celiac disease diagnosed within the last 4 years. The study covered a group of 26 women, at the age of 51-54 years, with celiac disease diagnosed in the last 4 years and staying on a gluten-free diet for 6 months to 4 years and agreed to participate in this studies. Information of nutrition were collected from the women, who, after an appropriate instruction, recorded the timing, type and amount of food consumed in the three days a week, selected at random. The amount of consumed portions was defined on the basis of the "Book of portions, products and dishes". The menus (78) were recorded in April and May. Collected data were prepared, based on a computer program Dietetyk 2009 Prof. The analysis of results achieved in this study enabled concluding that--from the viewpoint of the diagnosed disease--the nutritional patterns of the women were very appropriate. However, it failed to meet basic nutritional guidelines, which was reflected in, among other things, unsatisfactory intake of vegetables, fruits, oils and water, and in excessive intake of protein of animal origin. In addition, it did not cover demands resulting from the perimenopausal period the surveyed women were in, which is likely to facilitate, e.g. disorders in lipid metabolism and water-mineral balance, as well as development of osteoporosis. The general picture of behaviors, including the nutritional ones, pointed to a strong predominance of the diagnosed disease but also to the need of compensating for the resultant restrictions, with the latter being perceived by the surveyed women as health-promoting actions.

  2. [Pulmonary Mycobacterium Avium-Complex (MAC) Disease Differentially Diagnosed from Metastasis of Testicular Cancer : A Case Report].

    Science.gov (United States)

    Mori, Kohei; Teranishi, Jyn-Ichi; Yoneyama, Shuko; Ishida, Hiroaki; Hattori, Yusuke; Yumura, Yasushi; Miyoshi, Yasuhide; Kondo, Keiichi; Uemura, Hiroji; Noguchi, Kazumi

    2017-01-01

    A 45 year-old-man was admitted to our hospital because of discomfort in his left scrotum. He had a left testicular tumor. We performed high orchiectomy and pathological findings revealed testicular cancer. He was treated with bleomycin, etoposide and cisplatin. Computed tomography showed a new mass in the left lung after 3 cycles of the chemotherapy. Because of its rapid growth, the tumor was thought to be a metastasis lesion of testicular cancer or pulmonary infection. Transbronchial lung biopsy showed an invasion of multinucleated giant cells and granuloma. The culture and polymerase chain reaction of the bronchial sputum were positive for myobacterium avium-complex (MAC). From these findings, the left lung tumor was diagnosed as pulmonary MAC disease. He received partial resection of the left lung and the lesion was diagnosed as granuloma. There was no recurrence of testicular cancer or pulmonary disease after the surgery.

  3. The added value of using mutational profiling in addition to cytology in diagnosing aggressive pancreaticobiliary disease: review of clinical cases at a single center

    Science.gov (United States)

    2014-01-01

    Background This study aimed to better understand the supporting role that mutational profiling (MP) of DNA from microdissected cytology slides and supernatant specimens may play in the diagnosis of malignancy in fine-needle aspirates (FNA) and biliary brushing specimens from patients with pancreaticobiliary masses. Methods Cytology results were examined in a total of 30 patients with associated surgical (10) or clinical (20) outcomes. MP of DNA from microdissected cytology slides and from discarded supernatant fluid was analyzed in 26 patients with atypical, negative or indeterminate cytology. Results Cytology correctly diagnosed aggressive disease in 4 patients. Cytological diagnoses for the remaining 26 were as follows: 16 negative (9 false negative), 9 atypical, 1 indeterminate. MP correctly determined aggressive disease in 1 false negative cytology case and confirmed a negative cytology diagnosis in 7 of 7 cases of non-aggressive disease. Of the 9 atypical cytology cases, MP correctly diagnosed 7 as positive and 1 as negative for aggressive disease. One specimen that was indeterminate by cytology was correctly diagnosed as non-aggressive by MP. When first line malignant (positive) cytology results were combined with positive second line MP results, 12/21 cases of aggressive disease were identified, compared to 4/21 cases identified by positive cytology alone. Conclusions When first line cytology results were uncertain (atypical), questionable (negative), or not possible (non-diagnostic/indeterminate), MP provided additional information regarding the presence of aggressive disease. When used in conjunction with first line cytology, MP increased detection of aggressive disease without compromising specificity in patients that were difficult to diagnose by cytology alone. PMID:25084836

  4. A standard screening test for the early and rapid diagnosis of leptospirosis

    Directory of Open Access Journals (Sweden)

    Chandrasekaran S

    2004-01-01

    Full Text Available PURPOSE : To perform dark field microscopy (DFM for detection of Leptospira and to validate the results using Leptospira IgM antibody SERION ELISA test. METHODS : After differential centrifugation of Ruys, DFM was done to demonstrate Leptospira in the blood and SERION ELISA was done for Leptospira IgM antibody in single or paired serum samples. One hundred and eleven cases (39 adults and 72 children of suspected leptospirosis were included in the study. RESULTS : Anicteric cases accounted for 66.7% (26/39 of adults and complications involving brain, liver, kidney and eyes were seen in 33.3% (13/39. In children, 90.3% (65/72 were anicteric and involvement of brain and liver was seen in 9.7% (7/72 cases. On testing 60 single samples of blood from 23 adults and 37 children, DFM exhibited greater sensitivity of 93.3% (56/60 than that of SERION ELISA for Leptospira IgM antibody (33.3%, 20/60. It was observed that the positivity of DFM decreased from 100% (15/15 to 90.9% (10/11 with increase in the duration of infection for more than one week. ELISA for Leptospira IgM, done on 51 paired blood samples, was positive in 64.7% (33/51 cases when both (first and second samples were tested while in 45.1% (23/51 cases was positive with first sample alone. 58.8%(30/51 cases were positive by testing second sample. DFM results on paired blood samples showed persistence of Leptospira in 92.9% of cases. CONCLUSION : This study shows the validation of DFM results by SERION ELISA for Leptospira IgM antibody, based on which we recommend that DFM can serve as a standard screening test for early and rapid diagnosis of leptospirosis.

  5. Challenges in diagnosing tuberculosis in children

    DEFF Research Database (Denmark)

    Rahman, Nadia; Pedersen, Karin Kæreby; Rosenfeldt, Vibeke

    2012-01-01

    Clinical investigations of childhood tuberculosis (TB) are challenged by the paucibacillary nature of the disease and the difficulties in obtaining specimens. We investigated the challenges in diagnosing TB in children in a low-incidence country.......Clinical investigations of childhood tuberculosis (TB) are challenged by the paucibacillary nature of the disease and the difficulties in obtaining specimens. We investigated the challenges in diagnosing TB in children in a low-incidence country....

  6. SEROPREVALENCIA DE LA LEPTOSPIROSIS CANINA DE TRES MUNICIPIOS DEL DEPARTAMENTO DEL TOLIMA-COLOMBIA

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    Marlyn Romero P

    2009-08-01

    Full Text Available Objetivo. Determinar la seroprevalencia de Leptospira spp. y los serovares dominantes, en caninos de tres municipios del departamento del Tolima, Colombia. Materiales y métodos. Se realizó un estudio epidemiológico trasversal con 900 caninos localizados en 62 barrios de los tres municipios, de los cuales se obtuvieron muestras de sangre durante los meses de junio, julio y agosto de 2007, que fueron procesadas utilizando la prueba de microaglutinación (MAT. En la prueba se incluyeron 5 serovares: hardjo, pomona, grippotyphosa, canicola, icterohaemorrhagiae y bratislava. La prueba se interpretó como positiva por la presencia de una aglutinación ³50 % de las leptospiras con uno o más serovares, en una dilución del suero ³100. Resultados. La seroprevalencia de leptospirosis en la población canina fue del 20.2%. La mayor dominancia fue para los serovares grippotyphosa (82.4% y pomona (8.2%, observándose una baja reactividad ante canicola e icterohaemorrhagiae, 0.5 y 2.2% respectivamente. Se presentaron coaglutinaciones en el 4.3% de los sueros. La seropositividad presentó diferencias estadísticamente significativas cuando se compararon los resultados por sexo y edad (p=0.038. Conclusiones. Los resultados sugieren que los caninos pueden ser posibles reservorios de la leptospirosis en los tres municipios evaluados, siendo necesario realizar estudios que permitan el aislamiento y tipificación de los serovares prevalentes en las zonas endémicas para orientar las medidas de prevención que eviten el riesgo de transmisión de la enfermedad a la población humana.

  7. Chemoprophylaxis of Tropical Infectious Diseases

    Directory of Open Access Journals (Sweden)

    William J. H. McBride

    2010-05-01

    Full Text Available Travelers to tropical countries are at risk for a variety of infectious diseases. In some cases effective vaccinations are available, but for other infections chemoprophylaxis can be offered. Malaria prevention has become increasingly complex as Plasmodium species become resistant to available drugs. In certain high risk settings, antibiotics can be used to prevent leptospirosis, scrub typhus and other infections. Post-exposure prophylaxis is appropriate for selected virulent infections. In this article the evidence for chemoprophylaxis will be reviewed.

  8. Improving the Specificity of EEG for Diagnosing Alzheimer's Disease

    Directory of Open Access Journals (Sweden)

    François-B. Vialatte

    2011-01-01

    Full Text Available Objective. EEG has great potential as a cost-effective screening tool for Alzheimer's disease (AD. However, the specificity of EEG is not yet sufficient to be used in clinical practice. In an earlier study, we presented preliminary results suggesting improved specificity of EEG to early stages of Alzheimer's disease. The key to this improvement is a new method for extracting sparse oscillatory events from EEG signals in the time-frequency domain. Here we provide a more detailed analysis, demonstrating improved EEG specificity for clinical screening of MCI (mild cognitive impairment patients. Methods. EEG data was recorded of MCI patients and age-matched control subjects, in rest condition with eyes closed. EEG frequency bands of interest were θ (3.5–7.5 Hz, α1 (7.5–9.5 Hz, α2 (9.5–12.5 Hz, and β (12.5–25 Hz. The EEG signals were transformed in the time-frequency domain using complex Morlet wavelets; the resulting time-frequency maps are represented by sparse bump models. Results. Enhanced EEG power in the θ range is more easily detected through sparse bump modeling; this phenomenon explains the improved EEG specificity obtained in our previous studies. Conclusions. Sparse bump modeling yields informative features in EEG signal. These features increase the specificity of EEG for diagnosing AD.

  9. Validation of celiac disease diagnoses recorded in the Danish National Patient Register using duodenal biopsies, celiac disease-specific antibodies, and human leukocyte-antigen genotypes

    Directory of Open Access Journals (Sweden)

    Dydensborg Sander S

    2016-12-01

    Full Text Available Stine Dydensborg Sander,1-3 Ketil Størdal,4,5 Tine Plato Hansen,6 Anne-Marie Nybo Andersen,7 Joseph A Murray,8 Søren Thue Lillevang,9 Steffen Husby1,2 1Hans Christian Andersen Children’s Hospital, Odense University Hospital, 2Institute of Clinical Research, University of Southern Denmark, 3Odense Patient Data Explorative Network (OPEN, Odense University Hospital, Odense, Denmark; 4Mental and Physical Health, Norwegian Institute of Public Health, Oslo, 5Department of Pediatrics, Ostfold Hospital Trust, Fredrikstad, Norway; 6Department of Pathology, Hvidovre Hospital, 7Department of Public Health, University of Copenhagen, Copenhagen, Denmark; 8Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA; 9Department of Clinical Immunology, Odense University Hospital, Odense, Denmark Purpose: The purpose of this study was to validate the celiac disease diagnoses recorded in the Danish National Patient Register. To validate the diagnoses, we used information on duodenal biopsies from a national register of pathology reports (the Patobank and information on celiac disease-specific antibodies and human leukocyte antigen (HLA genotypes obtained from patient medical records.Patients and methods: We included all the children who were born from 1995 to 2012 and who were registered as having celiac disease in the Danish National Patient Register. We reviewed all the pathology reports on duodenal biopsies in the Patobank and the information in the medical records on celiac disease-specific antibodies (ie, anti-tissue transglutaminase 2 IgA and IgG, endomysial antibodies IgA, and anti-deamidated gliadin peptide IgG and HLA genotypes.Results: We identified 2,247 children who were registered in the Danish National Patient Register with celiac disease. Duodenal biopsies for 1,555 of the children (69% were registered in the Patobank; 1,127 (50% had a biopsy that was compatible with celiac disease (ie, Marsh 2–3. We accessed the medical

  10. How doctors diagnose diseases and prescribe treatments: an fMRI study of diagnostic salience

    OpenAIRE

    Melo, Marcio; Gusso, Gustavo D. F.; Levites, Marcelo; Amaro Jr., Edson; Massad, Eduardo; Lotufo, Paulo A.; Zeidman, Peter; Price, Cathy J.; Friston, Karl J.

    2017-01-01

    Understanding the brain mechanisms involved in diagnostic reasoning may contribute to the development of methods that reduce errors in medical practice. In this study we identified similar brain systems for diagnosing diseases, prescribing treatments, and naming animals and objects using written information as stimuli. Employing time resolved modeling of blood oxygen level dependent (BOLD) responses enabled time resolved (400 milliseconds epochs) analyses. With this approach it was possible t...

  11. A study on clinical findings about vertebral disease diagnosed with MRI

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ham-Gyum [Ansan College, Seoul (Korea, Republic of)

    2006-09-15

    In order to analyze clinical characteristics like sex-and age-based onset frequency and onset region from vertebral disease cases, this study investigated total 1,291 cases of vertebral disease that were diagnosed via magnetic resonance imaging (MRI) from January to December 2004 at B University Hospital in metropolitan area. For higher diagnostic accuracy in cases of spinal disorder diagnosed, this study analyzed findings from data reading conducted by veteran specialists in diagnostic radiology. But this study excluded uncertain lesion cases, the cases requiring differential diagnosis from other disorders and so on from subjects under analysis. This study employed superconductive 1.5 Tesla SIGNA MR/i for MRI test and basically received resulting images via FSE (fast spin echo). In particular, this study obtained T1 and T2 myelogram with regard to regional characteristics (such as cervical vertebrae, thoracic vertebrae and lumbar vertebra) and imaging characteristics for sagittal and transverse section. As a result, this study came to the following conclusions: 1. In terms of general characteristics of subjects under analysis, male group comprised 53.5% and female 46.5% out of total 1,291 subjects. 2. The regional onset frequency of spinal disorders was converged primarily on lumbar vertebra (65.5%), which was followed by cervical vertebrae (27.3%) and thoracic vertebrae (7.0%) respectively. 3. Top 10 cases with high onset frequency of spinal disorders can be listed as follows: 1) posterior bulging disc 65.8% 2) narrowing of neural foramen 23.8% 3) herniated intervertebral disc (HIVD) 22.4% 4) spinal stenosis 16.7% 5) osteochondrosis 6.4% 6) compression fracture 6.4% 7) facet joint arthropathy 6.2% 8) spondylolisthesis 6.0% 9) spinal cord tumor 3.5% 10) inter body fusion 2.6%.

  12. A study on clinical findings about vertebral disease diagnosed with MRI

    International Nuclear Information System (INIS)

    Kim, Ham-Gyum

    2006-01-01

    In order to analyze clinical characteristics like sex-and age-based onset frequency and onset region from vertebral disease cases, this study investigated total 1,291 cases of vertebral disease that were diagnosed via magnetic resonance imaging (MRI) from January to December 2004 at B University Hospital in metropolitan area. For higher diagnostic accuracy in cases of spinal disorder diagnosed, this study analyzed findings from data reading conducted by veteran specialists in diagnostic radiology. But this study excluded uncertain lesion cases, the cases requiring differential diagnosis from other disorders and so on from subjects under analysis. This study employed superconductive 1.5 Tesla SIGNA MR/i for MRI test and basically received resulting images via FSE (fast spin echo). In particular, this study obtained T1 and T2 myelogram with regard to regional characteristics (such as cervical vertebrae, thoracic vertebrae and lumbar vertebra) and imaging characteristics for sagittal and transverse section. As a result, this study came to the following conclusions: 1. In terms of general characteristics of subjects under analysis, male group comprised 53.5% and female 46.5% out of total 1,291 subjects. 2. The regional onset frequency of spinal disorders was converged primarily on lumbar vertebra (65.5%), which was followed by cervical vertebrae (27.3%) and thoracic vertebrae (7.0%) respectively. 3. Top 10 cases with high onset frequency of spinal disorders can be listed as follows: 1) posterior bulging disc 65.8% 2) narrowing of neural foramen 23.8% 3) herniated intervertebral disc (HIVD) 22.4% 4) spinal stenosis 16.7% 5) osteochondrosis 6.4% 6) compression fracture 6.4% 7) facet joint arthropathy 6.2% 8) spondylolisthesis 6.0% 9) spinal cord tumor 3.5% 10) inter body fusion 2.6%

  13. Human leptospirosis in Tanzania: sequencing and phylogenetic analysis confirm that pathogenic Leptospira species circulate among agro-pastoralists living in Katavi-Rukwa ecosystem.

    Science.gov (United States)

    Muller, Shabani K; Assenga, Justine A; Matemba, Lucas E; Misinzo, Gerald; Kazwala, Rudovick R

    2016-06-10

    Leptospirosis is a neglected zoonotic disease of worldwide public health importance. The disease affects humans, domestic animals and wildlife. However, leptospirosis is challenging in its diagnosis in humans. Culture technique, which is time consuming, is not recommended for clinical diagnosis. For these reasons, serological and molecular techniques remain the test of choice. The major objective of this study was to explore the genetic characteristic of Leptospira species which are prevalent among agro-pastoralists living in Katavi-Rukwa Ecosystem, Tanzania. A cross-sectional epidemiological study was carried out in the Katavi-Region South-west, Tanzania between August, 2013 and November, 2014. A total of 267 participants were randomly recruited for the study. Microscopic agglutination test (MAT) was used to detect antibody against six Leptospira antigens including local serogroups Icterohaemorrhagiae, Ballum, Grippotyphosa, Sejroe and reference serogroups Hebdomadis, and Australis. Samples with MAT titers ≥ 1:160 were scored as positive, samples with MAT titers ranging from 1:20 to 1:80 were scored as exposed to Leptospira, and absence of agglutination titers was scored as negative. All MAT positive samples, including the low titre samples were subjected to PCR using the respective 16S rRNA primers for the pathogenic and non-pathogenic species. Out of 267 samples tested, 80 (29.9 %) were positive with MAT. The major circulating leptospiral serogroups were Sejroe (15.7 %,), Icterohaemorrhagiae (8.9 %), Grippotyphosa (4.8 %), Hebdomadis (3.37 %), Australis (1.49 %) and Ballum (1.19 %). By using PCR, 33 (15.7 %) out of 210 samples were pathogenic Leptospira while no saprophytic Leptospira spp. was detected. Partial 16S rRNA gene sequences of Leptospira species which were obtained from this study were submitted to GenBank and acquired accession numbers KP313246 and KP313247. Phylogenetic analysis of the nucleotide sequences revealed that species

  14. Laser photocoagulation at birth prevents blindness in Norrie's disease diagnosed using amniocentesis.

    Science.gov (United States)

    Chow, Clement C; Kiernan, Daniel F; Chau, Felix Y; Blair, Michael P; Ticho, Benjamin H; Galasso, John M; Shapiro, Michael J

    2010-12-01

    To report the first case of prophylactic laser treatment to prevent blindness in a patient who was diagnosed with Norrie's disease by genetic testing with amniocentesis. Case report. A 2-year-old white boy with Norrie's disease. A 37-week gestational age male with a family history of Norrie's disease was born via Cesarean section after the mother had undergone prenatal amniocentesis fetal-genetic testing at 23 weeks of gestation. A C520T (nonsense) mutation was found in the Norrie's disease gene. After examination under anesthesia confirmed the diagnosis on the first day of life, laser photocoagulation was applied to the avascular retina bilaterally. The patient was followed closely by ophthalmology, pediatrics, and occupational therapy departments. Functional outcome, as documented by Teller visual acuity and formal occupational therapy testing, and anatomic outcome, as documented by Retcam photography and fluorescein angiography. Complete regression of extraretinal fibrovascular proliferation was observed 1 month after laser treatment. No retinal detachment had occurred to date at 24 months. Teller visual acuity at 23 months of life was 20/100 in both eyes. The patient's vision and developmental milestones were age appropriate. Pre-term genetic diagnosis with immediate laser treatment after birth may preserve vision in individuals affected with Norrie's disease. Copyright © 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

  15. Nuclear medicine methods used in diagnosing diseases of the gastrointestinal tract

    International Nuclear Information System (INIS)

    Kostadinova, I.

    2001-01-01

    Using physiologic tracer scintigraphy may give unique information on gastrointestinal (GI) motility and function, supplementing the findings of rather invasive methods. Conventional barium-contrast x-ray studies of the GI tract, computed tomography, ultrasonography and magnetic resonance imaging afford high resolution images of the GI anatomy, but have a serious shortcoming - hardly lending themselves to quantification. As shown by the results functional scintigraphy is a sensitive, quantitative and noninvasive procedure. The potential of nuclear medicine methods to diagnose successfully diseases of the salivary glands, esophagus, stomach and visualization of GI bleeding and hepatobiliary system are comprehensively discussed. The advantages and drawbacks of radionuclide techniques are outlined, and compared with other methods of visualization. (author)

  16. A case of the Behcet's disease diagnosed by the panniculits after mesotherapy.

    Science.gov (United States)

    Babacan, Taner; Onat, Ahmet Mesut; Pehlivan, Yavuz; Comez, Gazi; Tutar, Ediz

    2010-11-01

    We herein report a case of 32-year-old woman who developed erythematous, indurated plaques, nodules on her lower back, hips and inguinal areas which had started after immunotherapy on the injection sites. She had a history of recurrent oral aphthous-like ulcers for 2 years and also had abdominal pain for 2 months. Colonoscopy revealed multiple aphthous ulcers on intestine. Diagnosis of lobular panniculitis was confirmed by histopathological finding of the skin biopsy and she was diagnosed as Behcet's disease. Eruptions due to mesotherapy accepted as hypersensitivity reaction. Before employing this technique, patients should be carefully examined for Behcet's pathognomonic clinical findings.

  17. Lymphogranuloma venereum proctitis: a differential diagnose to inflammatory bowel disease.

    Science.gov (United States)

    Høie, Sverre; Knudsen, Lene Surland; Gerstoft, Jan

    2011-04-01

    Lymphogranuloma venereum (LGV) is a sexually transmitted disease, endemic in tropical and subtropical areas for many years. After 2003 there have been several outbreaks in western countries, especially among HIV-positive men who have sex with men (MSM). An important manifestation of LGV is a proctitis, with a clinical presentation and endoscopic findings resembling those of inflammatory bowel diseases (IBDs). LGV is considered new in Scandinavia. This case report focuses on difficulties in differentiating LGV and IBD. This case report used a systematic search in the literature using PubMed and clinical cases from the Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark (Cases 1-3) and the Section of Surgery, Hamar Hospital, Norway (Case 4). Clinical and endoscopic findings in LGV and IBD resemble each other. All cases were MSM. Three out of four were HIV-positive. Three out of four contacted their general practitioner (GP) due to gastrointestinal (GI) symptoms, and were referred to a gastroenterologist (GE) with suspicion of IBD. Because of non-successful IBD treatment, control of HIV status, relapses of GI-symptoms or extended information concerning sexual habits, LGV was suspected and diagnosed. All patients responded with remission of GI-symptoms and endoscopic findings after oral treatment with doxycycline. Due to similarities between LGV and IBD, LGV should be considered as a differential diagnosis in patients with proctitis or IBD-related symptoms, especially among HIV-positive men. Hence LGV patients may be spared long-lasting examination, mistreatment and surgery.

  18. Clinical Evaluation of Rapid Diagnostic Test Kit for Scrub Typhus with Improved Performance.

    Science.gov (United States)

    Kim, Young-Jin; Park, Sungman; Premaratna, Ranjan; Selvaraj, Stephen; Park, Sang-Jin; Kim, Sora; Kim, Donghwan; Kim, Min Soo; Shin, Dong Hoon; Choi, Kyung-Chan; Kwon, Soon-Hwan; Seo, Wonjun; Lee, Nam Taek; Kim, Seung-Han; Kang, Heui Keun; Kim, Yoon-Won

    2016-08-01

    Diagnosis of scrub typhus is challenging due to its more than twenty serotypes and the similar clinical symptoms with other acute febrile illnesses including leptospirosis, murine typhus and hemorrhagic fever with renal syndrome. Accuracy and rapidity of a diagnostic test to Orientia tsutsugamushi is an important step to diagnose this disease. To discriminate scrub typhus from other diseases, the improved ImmuneMed Scrub Typhus Rapid Diagnostic Test (RDT) was evaluated in Korea and Sri Lanka. The sensitivity at the base of each IgM and IgG indirect immunofluorescent assay (IFA) in Korean patients was 98.6% and 97.1%, and the specificity was 98.2% and 97.7% respectively. The sensitivity and specificity for retrospective diagnosis at the base of IFA in Sri Lanka was 92.1% and 96.1%. ImmuneMed RDT was not reactive to any serum from seventeen diseases including hemorrhagic fever with renal syndrome (n = 48), leptospirosis (n = 23), and murine typhus (n = 48). ImmuneMed RDT shows superior sensitivity (98.6% and 97.1%) compared with SD Bioline RDT (84.4% at IgM and 83.3% at IgG) in Korea. The retrospective diagnosis of ImmuneMed RDT exhibits 94.0% identity with enzyme-linked Immunosorbent assay (ELISA) using South India patient serum samples. These results suggest that this RDT can replace other diagnostic tests and is applicable for global diagnosis of scrub typhus. This rapid and accurate diagnosis will be beneficial for diagnosing and managing scrub typhus.

  19. New proposals for the international classification of diseases-11 revision of pain diagnoses

    DEFF Research Database (Denmark)

    Rief, Winfried; Kaasa, Stein; Jensen, Rigmor

    2012-01-01

    The representation of pain diagnoses in current classification systems like International Classification of Diseases (ICD)-10 and Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV does not adequately reflect the state of the art of pain research, and does not sufficiently support...... the clinical management and research programs for pain conditions. Moreover, there is an urgent need to harmonize classification of pain syndromes of special expert groups (eg, International Classification of Headache Disorders) and general classification systems (eg, ICD-11, DSM-V). Therefore, this paper...

  20. Do clinical diagnoses correlate with pathological diagnoses in cardiac transplant patients? The importance of endomyocardial biopsy

    DEFF Research Database (Denmark)

    Luk, Adriana; Metawee, Mohammed; Ahn, Eric

    2009-01-01

    . Patient records were reviewed for preoperative clinical diagnoses and other relevant data, including pretransplant endomyocardial biopsy (EMB) results, information regarding left ventricular assist devices and, finally, evidence of disease recurrence in the grafted heart. RESULTS: A shift...... diagnose patients with diseases such as sarcoidosis, amyloidosis and particular types of myocarditis because these can readily recur in the grafted heart. The risk for recurrence must be known to practitioners and, most importantly, to the patient. We strongly recommend the use of EMB if a nonischemic...

  1. Lyme Disease Diagnosed by Alternative Methods: A Phenotype Similar to That of Chronic Fatigue Syndrome.

    Science.gov (United States)

    Patrick, David M; Miller, Ruth R; Gardy, Jennifer L; Parker, Shoshana M; Morshed, Muhammad G; Steiner, Theodore S; Singer, Joel; Shojania, Kam; Tang, Patrick

    2015-10-01

    A subset of patients reporting a diagnosis of Lyme disease can be described as having alternatively diagnosed chronic Lyme syndrome (ADCLS), in which diagnosis is based on laboratory results from a nonreference Lyme specialty laboratory using in-house criteria. Patients with ADCLS report symptoms similar to those reported by patients with chronic fatigue syndrome (CFS). We performed a case-control study comparing patients with ADCLS and CFS to each other and to both healthy controls and controls with systemic lupus erythematosus (SLE). Subjects completed a history, physical exam, screening laboratory tests, 7 functional scales, reference serology for Lyme disease using Centers for Disease Control and Prevention criteria, reference serology for other tick-associated pathogens, and cytokine expression studies. The study enrolled 13 patients with ADCLS (12 of whom were diagnosed by 1 alternative US laboratory), 25 patients with CFS, 25 matched healthy controls, and 11 SLE controls. Baseline clinical data and functional scales indicate significant disability among ADCLS and CFS patients and many important differences between these groups and controls, but no significant differences between each other. No ADCLS patient was confirmed as having positive Lyme serology by reference laboratory testing, and there was no difference in distribution of positive serology for other tick-transmitted pathogens or cytokine expression across the groups. In British Columbia, a setting with low Lyme disease incidence, ADCLS patients have a similar phenotype to that of CFS patients. Disagreement between alternative and reference laboratory Lyme testing results in this setting is most likely explained by false-positive results from the alternative laboratory. © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  2. Being publicly diagnosed

    DEFF Research Database (Denmark)

    Konradsen, Hanne; Lillebaek, Troels; Wilcke, Torgny

    2014-01-01

    a patient with TB, and finally being in medical treatment. Before being diagnosed with TB, patients were weighing between biding their time and deciding to undergo an examination. Social pressure and feelings of social responsibility tended to affect the decision. Having undergone the examination......INTRODUCTION: Tuberculosis (TB) is a disease which affects people worldwide, but there is knowledge lacking about patients' experiences in low-prevalence and high-income countries. AIM: To provide a theoretical framework for the process of being diagnosed with tuberculosis in a Danish setting....... METHOD: A grounded theory design with field studies and qualitative interviews, following the recommendations from Glaser and Strauss. RESULT: A process of being publicly diagnosed was identified, which developed during the patient's trajectory from being on the way to becoming a patient, becoming...

  3. Challenges in developing methods for quantifying the effects of weather and climate on water-associated diseases: A systematic review

    OpenAIRE

    Lo Iacono, Giovanni; Armstrong, Ben; Fleming, Lora E.; Elson, Richard; Kovats, Sari; Vardoulakis, Sotiris; Nichols, Gordon L.

    2017-01-01

    Infectious diseases attributable to unsafe water supply, sanitation and hygiene (e.g. Cholera, Leptospirosis, Giardiasis) remain an important cause of morbidity and mortality, especially in low-income countries. Climate and weather factors are known to affect the transmission and distribution of infectious diseases and statistical and mathematical modelling are continuously developing to investigate the impact of weather and climate on water-associated diseases. There have been little critica...

  4. Perilaku Pengendalian Tikus di Daerah Berisiko Penularan Leptospirosis

    Directory of Open Access Journals (Sweden)

    Tri Isnani

    2016-10-01

    Full Text Available Abstrak Tikus merupakan binatang yang mempunyai daya adaptasi dan daya kembang biak yang tinggi sehingga bisa hidup di semua tempat.  Dampak tikus bagi manusia antara lain tikus sebagai hama pertanian dan menularkan penyakit seperti pes dan leptospirosis.  Berbagai pengendalian tikus telah dilakukan baik secara tradisional yang telah ada sejak nenek moyang maupun cara-cara modern.  Tulisan ini mengeksplorasi perilaku masyarakat dalam usaha pengendalian serta faktor-faktor yang mempengaruhi dilakukannya cara-cara tersebut.  Penelitian dilakukan dengan metode kualitatif desain deskriptif.  Pengumpulan data dengan wawancara mendalam dan diskusi kelompok terarah pada 5 informan dan 2 kelompok Diskusi Kelompok Terarah (DKT.  Lokasi penelitian di sebuah desa di Nanggulan, Kulon Progo, Daerah Istimewa Yogyakarta.  Hasil penelitian menunjukkan terdapat beberapa cara dalam pengendalian tikus yaitu gropyokan, burung hantu, lem, racun tikus, pengemposan, menggunakan pewangi pakaian, dengan makanan umpan, kucing, dan dengan slametan.  Ada pengendalian tikus dengan mengusirnya saja atau tidak membunuhnya, dan ada pengendalian dengan membunuhnya.  Terdapat mitos dan kepercayaan terhadap tikus.  Kesimpulan penelitian bahwa perilaku dalam pengendalian tikus dipengaruhi oleh latar belakang pengetahuan dan kepercayaan.   kata kunci :  perilaku; pengendalian tikus; mitos dan kepercayaan

  5. Chronic kidney disease in Nigeria: an evaluation of the spatial accessibility to healthcare for diagnosed cases in Edo State

    Directory of Open Access Journals (Sweden)

    Osaretin Oviasu

    2016-05-01

    Full Text Available Chronic kidney disease (CKD is a growing problem in Nigeria, presenting challenges to the nation’s health and economy. This study evaluates the accessibility to healthcare in Edo State of CKD patients diagnosed between 2006 and 2009. Using cost analysis techniques within a geographical information system, an estimated travel time to the hospital was used to examine the spatial accessibility of diagnosed patients to available CKD healthcare in the state. The results from the study indicated that although there was an annual rise in the number of diagnosed cases, there were no significant changes in the proportion of patients that were diagnosed at the last stage of CKD. However, there were indications that the travel time to the hospital for CKD treatment might be a contributing factor to the number of diagnosed CKD cases. This implies that the current structure for CKD management within the state might not be adequate.

  6. Infectious Risks of Traveling Abroad.

    Science.gov (United States)

    Chen, Lin H; Blair, Barbra M

    2015-08-01

    A popular leisure activity, international travel can be associated with some infections. The most common travel-related illnesses appear to be gastrointestinal, dermatologic, respiratory, and systemic febrile syndromes. The pretravel medical consultation includes immunizations, malaria chemoprophylaxis, self-treatment for traveler's diarrhea, and advice on the prevention of a myriad of other infectious causes including dengue, chikungunya, rickettsiosis, leptospirosis, schistosomiasis, and strongyloidiasis. Travel to locations experiencing outbreaks such as Ebola virus disease, Middle East respiratory syndrome, avian influenza, and chikungunya call for specific alerts on preventive strategies. After travel, evaluation of an ill traveler must explore details of exposure, including destinations visited; activities; ingestion of contaminated food or drinks; contact with vectors, animals, fresh water, or blood and body fluids; and other potential exposures. Knowledge of the geographic distribution of infectious diseases is important in generating the differential diagnoses and testing accordingly. Empiric treatment is sometimes necessary when suspicion of a certain diagnosis is strong and confirmatory tests are delayed or lacking, particularly for infections that are rapidly progressive (for example, malaria) or for which timing of testing is prolonged (such as leptospirosis).

  7. Diagnosing and ranking retinopathy disease level using diabetic fundus image recuperation approach.

    Science.gov (United States)

    Somasundaram, K; Rajendran, P Alli

    2015-01-01

    Retinal fundus images are widely used in diagnosing different types of eye diseases. The existing methods such as Feature Based Macular Edema Detection (FMED) and Optimally Adjusted Morphological Operator (OAMO) effectively detected the presence of exudation in fundus images and identified the true positive ratio of exudates detection, respectively. These mechanically detected exudates did not include more detailed feature selection technique to the system for detection of diabetic retinopathy. To categorize the exudates, Diabetic Fundus Image Recuperation (DFIR) method based on sliding window approach is developed in this work to select the features of optic cup in digital retinal fundus images. The DFIR feature selection uses collection of sliding windows with varying range to obtain the features based on the histogram value using Group Sparsity Nonoverlapping Function. Using support vector model in the second phase, the DFIR method based on Spiral Basis Function effectively ranks the diabetic retinopathy disease level. The ranking of disease level on each candidate set provides a much promising result for developing practically automated and assisted diabetic retinopathy diagnosis system. Experimental work on digital fundus images using the DFIR method performs research on the factors such as sensitivity, ranking efficiency, and feature selection time.

  8. Diagnóstico de leptospirosis humana: evaluación de la aglutinación macroscópica en diferentes etapas de la enfermedad

    Directory of Open Access Journals (Sweden)

    Norma Bibiana Vanasco

    2012-10-01

    Full Text Available OBJETIVO: Evaluar la aglutinación macroscópica con antígeno termorresistente (TR como tamiz diagnóstico de leptospirosis humana en diferentes etapas de la enfermedad. MATERIAL Y MÉTODOS:La definición de casos se basó en la microaglutinación (MAT, recuento de leucocitos y neutrofilia. Se incluyeron 218 casos confirmados y 242 no casos. Cada muestra del banco de sueros del laboratorio del Instituto Nacional de Enfermedades Respiratorias de Santa Fe, Argentina, de 2008 a 2010, se clasificó según días de evolución en tres etapas: primera (25 días. RESULTADOS: La sensibilidad hallada fue: 71.1, 93.4 y 95.6% para etapas 1, 2 y 3 respectivamente. La especificidad varió de 79.0 a 69.2%. La variabilidad intra e interoperador fue moderada. CONCLUSIÓN: La variabilidad del TR, su baja sensibilidad en la primera etapa y baja especificidad en todas las etapas de la enfermedad sugieren que sería indispensable la incorporación de nuevos métodos diagnósticos de tamiz para la detección precoz de casos en nuestro país, y países donde aún se apliquen este tipo de métodos.OBJECTIVE: To evaluate the macroscopic agglutination test using Temperature Resistant (TR antigen as a screening test for the diagnosis of human leptospirosis in different stages of the disease. MATERIALS AND METHODS: The criteria for case definition were based on the results of the microscopic agglutination test (MAT, leukocyte counts and neutrophilia, resulting 218 confirmed cases and 242 non- cases. Each sample was classified according to the days of the disease progression in three stages: first ( 25 days. The design was cross-sectional observational. RESULTS: TR sensitivity was 71,1% on stage 1. 93.4% on stage 2 and 95.6% on stage 3. The specificity at different stages ranged from 79.0 to 69.2%. Intra and inter-operator variability was moderate. CONCLUSION: TR variability, low sensitivity in the first stage and low specificity found in all stages of the disease, suggest

  9. Prognostic factors for weight loss over 1-year period in patients recently diagnosed with mild Alzheimer Disease

    DEFF Research Database (Denmark)

    Hansen, M.L.; Waldorff, F.B.; Waldemar, G.

    2011-01-01

    The aim of the study was to identify prognostic factors for weight loss in patients recently diagnosed with mild Alzheimer disease (AD), with special emphasis on the patients' social participation and living arrangements. The data used in this study was part of the Danish Alzheimer Intervention...

  10. Maximum standard uptake value on pre-chemotherapeutic FDG-PET is a significant parameter for disease progression of newly diagnosed lymphoma

    International Nuclear Information System (INIS)

    Eo, Jae Seon; Lee, Won Woo; Chung, June Key; Lee, Myung Chul; Kim, Sang Eun

    2005-01-01

    F-18 FDG-PET is useful for detection and staging of lymphoma. We investigated the prognostic significance of maximum standard uptake (maxSUV) value of FDG-PET for newly diagnosed lymphoma patients before chemotherapy. Twenty-seven patients (male: female = 17: 10: age: 49±19 years) with newly diagnosed lymphoma were enrolled. Nine-teen patients suffered from B cell lymphoma, 6 Hodgkins disease and 2 T cell lymphoma. One patient was stage I, 9 stage II, 3 stage III, 1 stage IV and 13 others. All patients underwent FDG-PET before initiation of chemotherapy. MaxSUV values using lean body weight were obtained for main and largest lesion to represent maxSUV of the patients. The disease progression was defined as total change of the chemotherapeutic regimen or addition of new chemotherapeutic agent during follow up period. The observed period was 389±224 days. The value of maxSUV ranged from 3 to 18 (mean±SD = 10.6±4.4). The disease progressions occurred in 6 patients. Using Cox proportional-hazard regression analysis, maxSUV was identified as a significant parameter for the disease progression free survival (p=0.044). Kaplan-Meier survival curve analysis revealed that the group with higher maxSUV (=10.6, n=5) suffered from shorter disease progression free survival (median 299 days) than the group with lower maxSUV (<10.6, n = 22) (median 378 days, p=0.0146). We found that maxSUV on pre-chemotherapeutic F-18 FDG-PET for newly diagnosed lymphoma patients is a significant parameter for disease progression. Lymphoma patients can be stratified before initiation of chemotherapy in terms of disease progression by the value of maxSUV 10.6

  11. Epidemiology of Tropical Neglected Diseases in Ecuador in the Last 20 Years

    Science.gov (United States)

    Cartelle Gestal, Monica; Holban, Alina Maria; Escalante, Santiago; Cevallos, Marcelo

    2015-01-01

    Background Tropical and zoonotic diseases are major problems in developing countries like Ecuador. Poorly designed houses, the high proportion of isolated indigenous population and under developed infrastructure represent a fertile environment for vectors to proliferate. Control campaigns in Ecuador over the years have had varying success, depending on the disease and vectors targeted. Aims In our study we analyse the current situation of some neglected diseases in Ecuador and the efficiency of the control campaigns (by measuring changes in numbers of cases reported) that the Ecuadorian government has been running to limit the spread of these infectious and parasitic diseases. Results Our study reveals that Brucellosis, Chagas Disease, Rabies and Onchocerciasis have been controlled, but small outbreaks are still detected in endemic areas. Leptospirosis and Echinococcosis have been increasing steadily in recent years in Ecuador since the first records. The same increase has been reported world-wide also. Better diagnosis has resulted in a higher number of cases being identified, particularly with regard to the linking of outdoor activities and contact with farm animals as contributing vectors. Improvements in diagnosis are due to regular professional training, implementation of automatized systems, establishing diagnosis protocols and the creation of an epidemiological vigilance network that acts as soon as a case is reported. Conclusion Control campaigns performed in Ecuador have been successful in recent years, although natural phenomena limit their efficiency. Leptospirosis and Echinococcosis infections remain a growing problem in Ecuador as it is worldwide. PMID:26394405

  12. Epidemiology of Tropical Neglected Diseases in Ecuador in the Last 20 Years.

    Science.gov (United States)

    Cartelle Gestal, Monica; Holban, Alina Maria; Escalante, Santiago; Cevallos, Marcelo

    2015-01-01

    Tropical and zoonotic diseases are major problems in developing countries like Ecuador. Poorly designed houses, the high proportion of isolated indigenous population and under developed infrastructure represent a fertile environment for vectors to proliferate. Control campaigns in Ecuador over the years have had varying success, depending on the disease and vectors targeted. In our study we analyse the current situation of some neglected diseases in Ecuador and the efficiency of the control campaigns (by measuring changes in numbers of cases reported) that the Ecuadorian government has been running to limit the spread of these infectious and parasitic diseases. Our study reveals that Brucellosis, Chagas Disease, Rabies and Onchocerciasis have been controlled, but small outbreaks are still detected in endemic areas. Leptospirosis and Echinococcosis have been increasing steadily in recent years in Ecuador since the first records. The same increase has been reported world-wide also. Better diagnosis has resulted in a higher number of cases being identified, particularly with regard to the linking of outdoor activities and contact with farm animals as contributing vectors. Improvements in diagnosis are due to regular professional training, implementation of automatized systems, establishing diagnosis protocols and the creation of an epidemiological vigilance network that acts as soon as a case is reported. Control campaigns performed in Ecuador have been successful in recent years, although natural phenomena limit their efficiency. Leptospirosis and Echinococcosis infections remain a growing problem in Ecuador as it is worldwide.

  13. Long-Term Nationwide Follow-Up Study of Simple Congenital Heart Disease Diagnosed in Otherwise Healthy Children

    DEFF Research Database (Denmark)

    Videbæk, Jørgen; Laursen, Henning Bækgaard; Olsen, Morten

    2016-01-01

    BACKGROUND: Systematic follow-up is currently not recommended for patients with simple congenital heart disease; however, only a few data exist on the long-term prognosis of simple congenital heart disease. METHODS AND RESULTS: We undertook a nationwide follow-up study of a cohort of 1241 simple...... congenital heart disease patients, diagnosed from 1963 through 1973, in otherwise healthy children and alive at 15 years of age. We identified 10 age- and sex-matched general population controls per patient. We followed the study population through Danish public registries from the age of 15 years up...... with simple congenital heart disease in the 1960s have substantially increased long-term mortality and cardiac morbidity compared with the general population. Further studies on the effectiveness of systematic medical follow-up programs appear warranted....

  14. Application of PCR-based DNA sequencing technique for the detection of Leptospira in peripheral blood of septicemia patients

    OpenAIRE

    Ram, S.; Vimalin, J.M.; Jambulingam, M.; Tiru, V.; Gopalakrishnan, R.K.; Madhavan, H.N.

    2012-01-01

    Aim: Isolation, dark field detection and microscopic agglutination test (MAT) are considered ―gold standard‖ tests for diagnosis of Leptospirosis. Several PCR assays are reported but very few have been evaluated for detection of Leptospirosis. Therefore, this study was undertaken. This study aims to design and standardize polymerase chain reaction (PCR) - based DNA sequencing technique for the detection of pathogenic Leptospira from peripheral blood of patients clinically diagnosed with septi...

  15. Risk Factors of Leptospirosis in Khuzestan, South West of Iran, 2012

    Directory of Open Access Journals (Sweden)

    Leila Alavi

    2013-11-01

    Full Text Available Background: Leptospirosis as a common zoonotic disease is the widest spread infection worldwide. Human is infected via direct contact with infected animals or through exposure or drinking contaminated water infected by animal urine. Objectives: The aim of this study was to identify risk factors for leptospira infection in Khuzestan which is expected to be an endemic area for this infection. Patients and Methods: As part of an investigation on rural area in Khuzestan, this comparative study was conducted in the region. Sixty five cases, which were positive for IgM anti-leptospira antibodies, and 215 controls that were negative for IgM antibodies included in the study. A questionnaire including variables related to leptospira exposure was administered. SPSS-16 using Chi square and Fisher exact test were used to compare data. Differences with P-values less than 0.05 were considered as significant. The 95% confidence interval (CI for the odds ratios (OR were calculated. Results: Occupation in rice farm was the most important risk factors (OR: 5.32, 95% CI = 2.71-10.43, P < 0.0001. Other risk factors were as: exposure to rat/rodent in house (OR: 3.53, 95% CI = 1.98-6.29, P < 0.0001, swimming in river or brooks (OR: 4.02, 95% CI = 2.21-7.47, P < 0.0001 and keeping cattle in house (OR: 11.53, 95% CI = 3.50-37.97, P < 0.0001. Conclusions: The main risk factors for this infection in Khuzestan are rice farming and keeping animals (such as cattle as well as contact to rodent in houses. Another frequent risk factor was swimming in river or brooks.

  16. Vascular disease in women: comparison of diagnoses in hospital episode statistics and general practice records in England

    Directory of Open Access Journals (Sweden)

    Wright F

    2012-10-01

    Full Text Available Abstract Background Electronic linkage to routine administrative datasets, such as the Hospital Episode Statistics (HES in England, is increasingly used in medical research. Relatively little is known about the reliability of HES diagnostic information for epidemiological studies. In the United Kingdom (UK, general practitioners hold comprehensive records for individuals relating to their primary, secondary and tertiary care. For a random sample of participants in a large UK cohort, we compared vascular disease diagnoses in HES and general practice records to assess agreement between the two sources. Methods Million Women Study participants with a HES record of hospital admission with vascular disease (ischaemic heart disease [ICD-10 codes I20-I25], cerebrovascular disease [G45, I60-I69] or venous thromboembolism [I26, I80-I82] between April 1st 1997 and March 31st 2005 were identified. In each broad diagnostic group and in women with no such HES diagnoses, a random sample of about a thousand women was selected for study. We asked each woman’s general practitioner to provide information on her history of vascular disease and this information was compared with the HES diagnosis record. Results Over 90% of study forms sent to general practitioners were returned and 88% of these contained analysable data. For the vast majority of study participants for whom information was available, diagnostic information from general practice and HES records was consistent. Overall, for 93% of women with a HES diagnosis of vascular disease, general practice records agreed with the HES diagnosis; and for 97% of women with no HES diagnosis of vascular disease, the general practitioner had no record of a diagnosis of vascular disease. For severe vascular disease, including myocardial infarction (I21-22, stroke, both overall (I60-64 and by subtype, and pulmonary embolism (I26, HES records appeared to be both reliable and complete. Conclusion Hospital admission data

  17. Association of Thiazolidinedione with a Lower Risk of Parkinson's Disease in a Population with Newly-Diagnosed Diabetes Mellitus.

    Science.gov (United States)

    Lin, Hsiu-Li; Lin, Hsiu-Chen; Tseng, Yuan-Fu; Chao, Jane Chen-Jui; Hsu, Chien-Yeh

    2018-06-11

    We investigated the association of thiazolidinedione and its dose effect with the risk of Parkinson's disease (PD) in patients with diabetes mellitus (DM). This study enrolled 38,521 patients with newly-diagnosed DM between 2001 and 2013 and compared them to matched subjects without DM. The hazard ratios (HRs) for PD were compared between the thiazolidinedione-treated and non-thiazolidinedione-treated groups of the study cohort, and between subgroups who received different cumulative dosages of thiazolidinedione. We observed 544 (1.4%) patients with PD during the follow up of median duration of 6.2 years in patients with newly-diagnosed DM who had a higher risk for PD than patients without DM (HR = 1.150). In the study cohort, the risk of PD was significantly lower in the thiazolidinedione-treated group (HR = 0.399) compared to the non-thiazolidinedione-treated group. Thiazolidinedione reduced the risk of PD in a dose-dependent manner, with HRs ranging from 0.613 to 0.081 with defined daily doses of 0-90 to > 720, respectively. Thiazolidinedione use was associated with a significantly reduced risk of PD in patients with newly-diagnosed DM. Further studies to elucidate the common mechanism of PD and DM may provide novel therapies for these two diseases.

  18. 99Tcm-MIBI imaging in diagnosing benign/malign pulmonary disease and analysis of lung cancer DNA content

    International Nuclear Information System (INIS)

    Feng Yanlin; Tan Jiaju; Yang Jie; Zhu Zheng; Yu Fengwen; He Xiaohong; Huang Kemin; Yuan Baihong; Su Shaodi

    2002-01-01

    Objective: To evaluate the value of 99 Tc m -methoxyisobutylisonitrile (MIBI) lung imaging in diagnosing benign/malign pulmonary disease and the relation of 99 Tc m -MIBI uptake ratio (UR) with lung cancer DNA content. Methods: Early and delay imaging were performed on 27 cases of benign lung disease and 46 cases of malign lung disease. Visual analysis of the images and T/N uptake ratio measurement were performed on every case. Cancer cell DNA content and DNA index (DI) were measured in 24 cases of malign pulmonary disease. Results: The delay phase UR was 1.13 ± 0.19 in benign disease group, and the delay phase UR was 1.45 ± 0.21 in malign disease group (t6.51, P 99 Tc m -MIBI is not an ideal imaging agent for differentiating pulmonary benign/malign disease. Lung cancer DNA content may be reflected by delay phase UR

  19. A model for diagnosing and explaining multiple disorders.

    Science.gov (United States)

    Jamieson, P W

    1991-08-01

    The ability to diagnose multiple interacting disorders and explain them in a coherent causal framework has only partially been achieved in medical expert systems. This paper proposes a causal model for diagnosing and explaining multiple disorders whose key elements are: physician-directed hypotheses generation, object-oriented knowledge representation, and novel explanation heuristics. The heuristics modify and link the explanations to make the physician aware of diagnostic complexities. A computer program incorporating the model currently is in use for diagnosing peripheral nerve and muscle disorders. The program successfully diagnoses and explains interactions between diseases in terms of underlying pathophysiologic concepts. The model offers a new architecture for medical domains where reasoning from first principles is difficult but explanation of disease interactions is crucial for the system's operation.

  20. Diagnosing and reporting of occupational diseases: a quality improvement study

    NARCIS (Netherlands)

    Spreeuwers, D.; de Boer, A. G. E. M.; Verbeek, J. H. A. M.; van Beurden, M. M.; van Dijk, F. J. H.

    2008-01-01

    AIM: To assess the need for quality improvement of diagnosing and reporting of noise-induced occupational hearing loss and occupational adjustment disorder. METHODS: Performance indicators and criteria for the quality of diagnosing and reporting were developed. Self-assessment questionnaires were

  1. Seroprevalence of Leptospira infection in bats roosting in human ...

    African Journals Online (AJOL)

    Leptospirosis is a neglected emerging infectious disease with high burden in Africa. Major reservoirs of leptospirosis are rodents and other small mammals. Studies of leptospirosis in bats and the extent to which they contribute to its transmission to humans and domestic animals in Tanzania are lacking. The objective of this ...

  2. El endemismo por paludismo, lepra, leishmaniosis y leptospirosis en la provincia de Castellón, a mediados del siglo XX : vivencias personales

    OpenAIRE

    Martínez Urrea, José

    2009-01-01

    Discurso de inauguración del curso 2009 de la Reial Acadèmia de Medicina de la Comunitat Valenciana por el Ilmo. Sr. Dr. D. José Martínez Urrea: El endemismo por paludismo, lepra, leishmaniosis y leptospirosis en la provincia de Castellón, a mediados del siglo XX. Vivencias personales.

  3. 76 FR 54392 - Animal Welfare; Importation of Live Dogs

    Science.gov (United States)

    2011-09-01

    ... distemper, hepatitis, leptospirosis, parvovirus, and parainfluenza virus (DHLPP) \\1\\ at a frequency that..., nervous system disturbances, jaundice, or diarrhea). \\1\\ Distemper is an airborne viral disease of the lungs, intestines and brain; infectious canine hepatitis is a viral disease of the liver; leptospirosis...

  4. Pathogenic leptospires modulate protein expression and post-translational modifications in response to mammalian host signals

    Science.gov (United States)

    Pathogenic species of Leptospira cause leptospirosis, a bacterial zoonotic disease with a global distribution affecting over one million people annually. Reservoir hosts of leptospirosis, including rodents, dogs and cattle, exhibit little to no signs of disease but shed large numbers of organisms in...

  5. Diagnosing and Ranking Retinopathy Disease Level Using Diabetic Fundus Image Recuperation Approach

    Directory of Open Access Journals (Sweden)

    K. Somasundaram

    2015-01-01

    Full Text Available Retinal fundus images are widely used in diagnosing different types of eye diseases. The existing methods such as Feature Based Macular Edema Detection (FMED and Optimally Adjusted Morphological Operator (OAMO effectively detected the presence of exudation in fundus images and identified the true positive ratio of exudates detection, respectively. These mechanically detected exudates did not include more detailed feature selection technique to the system for detection of diabetic retinopathy. To categorize the exudates, Diabetic Fundus Image Recuperation (DFIR method based on sliding window approach is developed in this work to select the features of optic cup in digital retinal fundus images. The DFIR feature selection uses collection of sliding windows with varying range to obtain the features based on the histogram value using Group Sparsity Nonoverlapping Function. Using support vector model in the second phase, the DFIR method based on Spiral Basis Function effectively ranks the diabetic retinopathy disease level. The ranking of disease level on each candidate set provides a much promising result for developing practically automated and assisted diabetic retinopathy diagnosis system. Experimental work on digital fundus images using the DFIR method performs research on the factors such as sensitivity, ranking efficiency, and feature selection time.

  6. How Do Health Care Providers Diagnose Vaginitis?

    Science.gov (United States)

    ... used to diagnose vaginitis. 1 Centers for Disease Control and Prevention. (2010). Self-study STD ... Halvorson New Chief of Gynecologic Health and Disease Branch Division of Epidemiology, Statistics, ...

  7. Resource allocation and the burden of co-morbidities among patients diagnosed with chronic obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Ahnfeldt-Mollerup, Peder; Lykkegaard, Jesper; Halling, Anders

    2016-01-01

    Background Chronic obstructive pulmonary disease is a leading cause of mortality, and associated with increased healthcare utilization and healthcare expenditure. In several countries, morbidity-based systems have changed the way resources are allocated in general practice. In primary care, fee......-for-services tariffs are often based on political negotiation rather than costing systems. The potential for comprehensive measures of patient morbidity to explain variation in negotiated expenditures for patients with chronic obstructive pulmonary disease has not previously been examined. The aim of this study...... is to analyze fee-for-service expenditure of patients diagnosed with chronic obstructive pulmonary disease visiting Danish general practice clinics and further to assess what proportion of fee-for-service expenditure variation was explained by patient morbidity and general practice clinic characteristics...

  8. Longer-term effects of ADAS use on speed and headway control in drivers diagnosed with Parkinson's disease.

    Science.gov (United States)

    Dotzauer, Mandy; Caljouw, Simone R; De Waard, Dick; Brouwer, Wiebo H

    2015-01-01

    An advanced driver assistance system (ADAS) provided information about speed limits, speed, speeding, and following distance. Information was presented to the participants by means of a head-up display. Effects of the information on speed and headway control were studied in a longer-term driving simulator study including 12 repeated measures spread out over 4 weeks. Nine healthy older drivers between the ages of 65 and 82 years and 9 drivers between the ages of 68 and 82 years diagnosed with Parkinson's disease (PD) participated in the study. Within the 4 weeks, groups completed 12 consecutive sessions (10 with ADAS and 2 without ADAS) in a driving simulator. Results indicate an effect of ADAS use on performance. Removing ADAS after short-term exposure led to deterioration of performance in all speed measures in the group of drivers diagnosed with PD. These results suggest that provision of traffic information was utilized by drivers diagnosed with PD in order to control their speed.

  9. Prospective study of leptospirosis transmission in an urban slum community: role of poor environment in repeated exposures to the Leptospira agent.

    Science.gov (United States)

    Felzemburgh, Ridalva D M; Ribeiro, Guilherme S; Costa, Federico; Reis, Renato B; Hagan, José E; Melendez, Astrid X T O; Fraga, Deborah; Santana, Francisco S; Mohr, Sharif; dos Santos, Balbino L; Silva, Adriano Q; Santos, Andréia C; Ravines, Romy R; Tassinari, Wagner S; Carvalho, Marília S; Reis, Mitermayer G; Ko, Albert I

    2014-01-01

    Leptospirosis has emerged as an urban health problem as slum settlements have rapidly spread worldwide and created conditions for rat-borne transmission. Prospective studies have not been performed to determine the disease burden, identify risk factors for infection and provide information needed to guide interventions in these marginalized communities. We enrolled and followed a cohort of 2,003 residents from a slum community in the city of Salvador, Brazil. Baseline and one-year serosurveys were performed to identify primary and secondary Leptospira infections, defined as respectively, seroconversion and four-fold rise in microscopic agglutination titers. We used multinomial logistic regression models to evaluate risk exposures for acquiring primary and secondary infection. A total of 51 Leptospira infections were identified among 1,585 (79%) participants who completed the one-year follow-up protocol. The crude infection rate was 37.8 per 1,000 person-years. The secondary infection rate was 2.3 times higher than that of primary infection rate (71.7 and 31.1 infections per 1,000 person-years, respectively). Male gender (OR 2.88; 95% CI 1.40-5.91) and lower per capita household income (OR 0.54; 95% CI, 0.30-0.98 for an increase of $1 per person per day) were independent risk factors for primary infection. In contrast, the 15-34 year age group (OR 10.82, 95% CI 1.38-85.08), and proximity of residence to an open sewer (OR 0.95; 0.91-0.99 for an increase of 1 m distance) were significant risk factors for secondary infection. This study found that slum residents had high risk (>3% per year) for acquiring a Leptospira infection. Re-infection is a frequent event and occurs in regions of slum settlements that are in proximity to open sewers. Effective prevention of leptospirosis will therefore require interventions that address the infrastructure deficiencies that contribute to repeated exposures among slum inhabitants.

  10. Classification of optical coherence tomography images for diagnosing different ocular diseases

    Science.gov (United States)

    Gholami, Peyman; Sheikh Hassani, Mohsen; Kuppuswamy Parthasarathy, Mohana; Zelek, John S.; Lakshminarayanan, Vasudevan

    2018-03-01

    Optical Coherence tomography (OCT) images provide several indicators, e.g., the shape and the thickness of different retinal layers, which can be used for various clinical and non-clinical purposes. We propose an automated classification method to identify different ocular diseases, based on the local binary pattern features. The database consists of normal and diseased human eye SD-OCT images. We use a multiphase approach for building our classifier, including preprocessing, Meta learning, and active learning. Pre-processing is applied to the data to handle missing features from images and replace them with the mean or median of the corresponding feature. All the features are run through a Correlation-based Feature Subset Selection algorithm to detect the most informative features and omit the less informative ones. A Meta learning approach is applied to the data, in which a SVM and random forest are combined to obtain a more robust classifier. Active learning is also applied to strengthen our classifier around the decision boundary. The primary experimental results indicate that our method is able to differentiate between the normal and non-normal retina with an area under the ROC curve (AUC) of 98.6% and also to diagnose the three common retina-related diseases, i.e., Age-related Macular Degeneration, Diabetic Retinopathy, and Macular Hole, with an AUC of 100%, 95% and 83.8% respectively. These results indicate a better performance of the proposed method compared to most of the previous works in the literature.

  11. Challenges with diagnosing and investigating suspected active tuberculosis disease in military trainees.

    Science.gov (United States)

    Chang, David; Webber, Bryant J; Hetrick, Steven M; Owen, Jerry B; Blasi, Audra A; Steele, Bernadette M; Yun, Heather C

    2017-08-01

    Between 1 January 2010 and 31 December 2016, a total of 14 U.S. and international military personnel in training at Joint Base San Antonio-Lackland, TX, were hospitalized due to suspected pulmonary tuberculosis (TB); of these, five personnel were diagnosed with active TB disease. Only one TB case had pulmonary symptoms, but these symptoms were not suggestive of TB. The incidence rate in the training population was 1.89 per 100,000 population (95% CI: 0.81, 4.42), with a higher rate when restricted to international military students attending the Defense Language Institute English Language Center. No instances of TB transmission were identified. The variety of atypical presentations and their resulting diagnostic and public health challenges prompted this retrospective review of all hospitalized cases. This case series highlights both the importance of a high index of clinical suspicion when TB is being considered in close congregate settings as well as the risk of overreliance on acid-fast bacilli staining and nucleic acid amplification testing for ruling out active pulmonary disease in young, otherwise healthy trainees. Practical solutions are suggested.

  12. Artificial intelligence techniques applied to the development of a decision–support system for diagnosing celiac disease

    Science.gov (United States)

    Tenório, Josceli Maria; Hummel, Anderson Diniz; Cohrs, Frederico Molina; Sdepanian, Vera Lucia; Pisa, Ivan Torres; de Fátima Marin, Heimar

    2013-01-01

    Background Celiac disease (CD) is a difficult-to-diagnose condition because of its multiple clinical presentations and symptoms shared with other diseases. Gold-standard diagnostic confirmation of suspected CD is achieved by biopsying the small intestine. Objective To develop a clinical decision–support system (CDSS) integrated with an automated classifier to recognize CD cases, by selecting from experimental models developed using intelligence artificial techniques. Methods A web-based system was designed for constructing a retrospective database that included 178 clinical cases for training. Tests were run on 270 automated classifiers available in Weka 3.6.1 using five artificial intelligence techniques, namely decision trees, Bayesian inference, k-nearest neighbor algorithm, support vector machines and artificial neural networks. The parameters evaluated were accuracy, sensitivity, specificity and area under the ROC curve (AUC). AUC was used as a criterion for selecting the CDSS algorithm. A testing database was constructed including 38 clinical CD cases for CDSS evaluation. The diagnoses suggested by CDSS were compared with those made by physicians during patient consultations. Results The most accurate method during the training phase was the averaged one-dependence estimator (AODE) algorithm (a Bayesian classifier), which showed accuracy 80.0%, sensitivity 0.78, specificity 0.80 and AUC 0.84. This classifier was integrated into the web-based decision–support system. The gold-standard validation of CDSS achieved accuracy of 84.2% and k = 0.68 (p < 0.0001) with good agreement. The same accuracy was achieved in the comparison between the physician’s diagnostic impression and the gold standard k = 0. 64 (p < 0.0001). There was moderate agreement between the physician’s diagnostic impression and CDSS k = 0.46 (p = 0.0008). Conclusions The study results suggest that CDSS could be used to help in diagnosing CD, since the algorithm tested achieved excellent

  13. [Prevalence of diseases diagnosed by the Program of Neonatal Screening in Maringá, Paraná, Brazil: 2001-2006].

    Science.gov (United States)

    Luz, Geisa dos Santos; Carvalho, Maria Dalva de Barros; Pelloso, Sandra Marisa; Higarashi, Ieda Harumi

    2008-09-01

    Irreversible sequels of some genetic diseases can be prevented by neonatal screening. The aim of this paper was to verify the prevalence of diseases diagnosed by the National Program of Neonatal Screening (PNTN) in Maringá, Paraná, Brazil, between 2001 and 2006. This cross-sectional descriptive study included 20,529 newborn infants screened by that program. Out of those, 859 were re-examined, and 21 had the disease confirmed. Considering all screened newborn infants and the number of diagnostics per disease, the following disease prevalence was determine: phenylketonuria--1:20,529; congenital hypothyrodism--1:2,281; hemoglobinopahies--1:3,421; cystic fibrosis--1:10,264; and biotinidase deficiency--1:6,843. Understanding disease status and prevalence of newborns in a population allows the establishment and the improvement of public policies aimed at the children.

  14. Estrogen-related and other disease diagnoses preceding Parkinson's disease

    DEFF Research Database (Denmark)

    Latourelle, Jeanne C; Dybdal, Merete; Destefano, Anita L

    2010-01-01

    Estrogen exposure has been associated with the occurrence of Parkinson's disease (PD), as well as many other disorders, and yet the mechanisms underlying these relations are often unknown. While it is likely that estrogen exposure modifies the risk of various diseases through many different...... mechanisms, some estrogen-related disease processes might work in similar manners and result in association between the diseases. Indeed, the association between diseases need not be due only to estrogen-related factors, but due to similar disease processes from a variety of mechanisms....

  15. Diseases of the circulatory system among adult people diagnosed with infantile autism as children

    DEFF Research Database (Denmark)

    Mouridsen, Svend Erik; Rich, Bente; Isager, Torben

    2016-01-01

    BACKGROUND: Research dealing with adult people with autism spectrum disorders (ASD) noticeably lags behind studies of children and young individuals with ASD. AIMS: The objective of this study was to compare the prevalence and types of diseases of the circulatory system in a clinical sample of 118...... adult people diagnosed with infantile autism (IA) as children with 336 sex and age matched controls from the general population. METHODS AND PROCEDURES: All participants were screened through the nationwide Danish National Hospital Register. The average observation time of both groups was 37.2 years...

  16. [Community pneumonia - fundamentals of diagnosing and treatment].

    Science.gov (United States)

    Kolek, Vítězslav

    Pneumonia is the most serious respiratory disease which causes more than 3 000 deaths per year in the Czech Republic. Community-acquired pneumonia is contracted in the ordinary life environment outside of hospitals, its development is caused by known infectious agents which mostly exhibit satisfactory sensitivity to antibiotics. Diagnosing, prevention and treatment of the disease are described including considerations of individual evaluation of the risk of complications and possible death. The strategy of administering antibiotics is discussed.Key words: antibiotics - community-acquired pneumonias - diagnosing - treatment.

  17. Phylomedicine: An evolutionary telescope to explore and diagnose the universe of disease mutations

    Science.gov (United States)

    Kumar, Sudhir; Dudley, Joel T.; Filipski, Alan; Liu, Li

    2011-01-01

    Modern technologies have made the sequencing of personal genomes routine. They have revealed thousands of nonsynonymous (amino-acid altering) single nucleotide variants (nSNVs) of protein coding DNA per genome. What do these variants foretell about an individual’s predisposition to diseases? The experimental technologies required to carry out such evaluations at a genomic scale are not yet available. Fortunately, the process of natural selection has lent us an almost infinite set of tests in nature. During the long-term evolution, new mutations and existing variations have been evaluated for their biological consequences in countless species, and outcomes were readily revealed by multispecies genome comparisons. We review studies that have investigated evolutionary characteristics and in silico functional diagnoses of nSNVs found in thousands of disease-associated genes. We conclude that the patterns of long-term evolutionary conservation and permissible divergence are essential and instructive modalities for functional assessment of human genetic variations. PMID:21764165

  18. Distribution of Leptospira serogroups in cattle herds and dogs in France.

    Science.gov (United States)

    Ayral, Florence C; Bicout, Dominique J; Pereira, Helena; Artois, Marc; Kodjo, Angeli

    2014-10-01

    A retrospective study was conducted to identify and describe the distribution pattern of Leptospira serogroups in domestic animals in France. The population consisted of cattle herds and dogs with clinically suspected leptospirosis that were tested at the "Laboratoire des Leptospires" between 2008 and 2011. The laboratory database was queried for records of cattle and dogs in which seroreactivity in Leptospira microagglutination tests was consistent with a recent or current infection, excluding vaccine serogroups in dogs. A total of 394 cattle herds and 232 dogs were diagnosed with clinical leptospirosis, and the results suggested infection by the Leptospira serogroup Australis in 43% and 63%, respectively; by the Leptospira serogroup Grippotyphosa in 17% and 9%, respectively; and by the Leptospira serogroup Sejroe in 33% and 6%, respectively. This inventory of infecting Leptospira serogroups revealed that current vaccines in France are not fully capable of preventing the clinical form of the disease. © The American Society of Tropical Medicine and Hygiene.

  19. Application of the pessimistic pruning to increase the accuracy of C4.5 algorithm in diagnosing chronic kidney disease

    Science.gov (United States)

    Muslim, M. A.; Herowati, A. J.; Sugiharti, E.; Prasetiyo, B.

    2018-03-01

    A technique to dig valuable information buried or hidden in data collection which is so big to be found an interesting patterns that was previously unknown is called data mining. Data mining has been applied in the healthcare industry. One technique used data mining is classification. The decision tree included in the classification of data mining and algorithm developed by decision tree is C4.5 algorithm. A classifier is designed using applying pessimistic pruning in C4.5 algorithm in diagnosing chronic kidney disease. Pessimistic pruning use to identify and remove branches that are not needed, this is done to avoid overfitting the decision tree generated by the C4.5 algorithm. In this paper, the result obtained using these classifiers are presented and discussed. Using pessimistic pruning shows increase accuracy of C4.5 algorithm of 1.5% from 95% to 96.5% in diagnosing of chronic kidney disease.

  20. Efficiency of the confocal method of laser endomicroscopy in complex diagnoses of diseases of common bile duct

    International Nuclear Information System (INIS)

    Anaskin, S G; Korniletsky, I D; Panchenkov, D N; Chertyuk, V B; Sazonov, D V; Zabozlayev, F G; Danilevskaya, O V; Mokshina, N V

    2017-01-01

    One of the more frequent manifestations of diseases of the bile ducts are its’ strictures or stenoses that could be of either malignant or benign nature. Current methods of diagnosing this pathology include computer tomography (CT) scan, magnetic resonance cholangiopancreatography (MRCP), endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP). However, these methods are not always informative, which makes this a current and topical problem. A fundamentally new method that broadens the capabilities of ERCP when diagnosing diseases of the bile duct accompanied by the development of strictures or stenoses is probe-based confocal laser endomicroscopy (pCLE). The method is based on the principle of confocal fluorescence microscopy. The most elaborate complications arise with the presence of the pre-existing pancreatobiliary pathology: pseudotumoral chronic pancreatitis, acute cholangitis, etc. Early stage cholangiocarcinoma diagnosis can be difficult (and not always possible) even with the help of modern research methods. For the timely diagnostic it is advantageous to conduct pCLE and targeted biopsy of the zone with most manifested changes. In all instances, the first use of the pCLE method for diagnostic purposes allowed us to clarify and correctly verify the diagnosis. When concerning the diseases of the bile duct, the modern stage of pCLE development can be of critical importance when other methods are not effective. (paper)

  1. Evidência do cão como reservatório da leptospirose humana: isolamento de um sorovar, caracterização molecular e utilização em inquérito sorológico Evidence of dog as a reservoir for human leptospirosis: a serovar isolation, molecular characterization and its use in a serological survey

    Directory of Open Access Journals (Sweden)

    Claudiomar Soares Brod

    2005-08-01

    Full Text Available A leptospirose canina é conhecida como enfermidade de Stuttgard desde 1898, sendo os cães, depois dos roedores, considerados como a segunda principal fonte de infecção para o homem. O isolamento de um sorovar patogênico da urina de um cão, laboratorial e clinicamente identificado como tendo leptospirose, e sua utilização para testar amostras de soro de casos de leptospirose humana e canina, evidenciou a sua importância no ecossistema da região sul do Brasil. Os resultados do teste de soroaglutinação microscópica indicaram que 100% das amostras de soro humano de 12 pacientes do banco de soro de 2001 do Centro de Controle de Zoonoses, que haviam reagido com títulos que variaram de 25 a 3.200 para o sorovar canicola, e 72% das amostras de 105 soros caninos do mesmo banco de soro, também reagiram contra o novo isolado. O título médio e mediana dos soros humanos testados com a bateria de antígenos recomendada pela OMS, foi respectivamente 630 e 100, ao passo que os testados com o isolado foi de 1.823 e 400. Nos soros caninos, os títulos foram respectivamente de 347 e 100 para a bateria e de 1.088 e 200 para o isolado.Canine leptospirosis has been known as Stuttgart disease since 1898, and dogs are considered to be the second principal source of infection in man. The isolation of a pathogenic serovar from dog urine that was diagnosed clinically and laboratorial as having leptospirosis and its utilization to test serological samples of human and canine cases of leptospirosis, has demonstrated its importance to the ecosystem of the southern region of Brazil. The results of the serological microscopic agglutination test indicated that 100% of human serum samples from 12 patients from the serum bank of 2001 at the Center for Control of Zoonoses, that had titers between 25 and 3,200 with the canicola serovar, and 72% of 105 canine serum samples from the same serum bank, also reacted with the new isolate. The mean and median titers of the

  2. Lipidomic analysis of immune activation in equine leptospirosis and Leptospira-vaccinated horses.

    Science.gov (United States)

    Wood, Paul L; Steinman, Margaret; Erol, Erdal; Carter, Craig; Christmann, Undine; Verma, Ashutosh

    2018-01-01

    Currently available diagnostic assays for leptospirosis cannot differentiate vaccine from infection serum antibody. Several leptospiral proteins that are upregulated during infection have been described, but their utility as a diagnostic marker is still unclear. In this study, we undertook a lipidomics approach to determine if there are any differences in the serum lipid profiles of horses naturally infected with pathogenic Leptospira spp. and horses vaccinated against a commercially available bacterin. Utilizing a high-resolution mass spectrometry serum lipidomics analytical platform, we demonstrate that cyclic phosphatidic acids, diacylglycerols, and hydroperoxide oxidation products of choline plasmalogens are elevated in the serum of naturally infected as well as vaccinated horses. Other lipids of interest were triacylglycerols that were only elevated in the serum of infected horses and sphingomyelins that were increased only in the serum of vaccinated horses. This is the first report looking at the equine serum lipidome during leptospiral infection and vaccination.

  3. Cerebral glucose metabolism and cognition in newly diagnosed Parkinson's disease: ICICLE-PD study.

    Science.gov (United States)

    Firbank, M J; Yarnall, A J; Lawson, R A; Duncan, G W; Khoo, T K; Petrides, G S; O'Brien, J T; Barker, R A; Maxwell, R J; Brooks, D J; Burn, D J

    2017-04-01

    To assess reductions of cerebral glucose metabolism in Parkinson's disease (PD) with 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET), and their associations with cognitive decline. FDG-PET was performed on a cohort of 79 patients with newly diagnosed PD (mean disease duration 8 months) and 20 unrelated controls. PD participants were scanned while on their usual dopaminergic medication. Cognitive testing was performed at baseline, and after 18 months using the Cognitive Drug Research (CDR) and Cambridge Neuropsychological Test Automated Battery (CANTAB) computerised batteries, the Mini-Mental State Examination (MMSE), and the Montreal Cognitive Assessment (MoCA). We used statistical parametric mapping (SPM V.12) software to compare groups and investigate voxelwise correlations between FDG metabolism and cognitive score at baseline. Linear regression was used to evaluate how levels of cortical FDG metabolism were predictive of subsequent cognitive decline rated with the MMSE and MoCA. PD participants showed reduced glucose metabolism in the occipital and inferior parietal lobes relative to controls. Low performance on memory-based tasks was associated with reduced FDG metabolism in posterior parietal and temporal regions, while attentional performance was associated with more frontal deficits. Baseline parietal to cerebellum FDG metabolism ratios predicted MMSE (β=0.38, p=0.001) and MoCA (β=0.3, p=0.002) at 18 months controlling for baseline score. Reductions in cortical FDG metabolism were present in newly diagnosed PD, and correlated with performance on neuropsychological tests. A reduced baseline parietal metabolism is associated with risk of cognitive decline and may represent a potential biomarker for this state and the development of PD dementia. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  4. Reactogenicidad de la vacuna cubana trivalente contra la leptospirosis humana en un ensayo clínico de fase II

    OpenAIRE

    Raydel Martínez,; Alberto Pérez; Alberto Baly; Morelia Baró; Reynaldo Menéndez; Aroldo Ruíz; Amelia Urbino López; Manuel Díaz; Marlene Armesto

    2001-01-01

    Con el objetivo de evaluar la reactogenicidad de la vacuna cubana trivalente contra la leptospirosis humana (vax- SPIRAL) en grupos de voluntarios sanos utilizando diferentes dosis, se realizó un ensayo clínico controlado, aleatorio y a doble ciego. Los voluntarios fueron distribuidos en dos grupos (vacunados y placebos) para evaluar las reacciones adversas en diferentes concentraciones de dosis (0,25 y 0,5 mL). Los síntomas y signos locales evaluados fueron: dolor, rubor, infiltración local,...

  5. [Degenerative cerebellar diseases and differential diagnoses].

    Science.gov (United States)

    Reith, W; Roumia, S; Dietrich, P

    2016-11-01

    Cerebellar syndromes result in distinct clinical symptoms, such as ataxia, dysarthria, dysmetria, intention tremor and eye movement disorders. In addition to the medical history and clinical examination, imaging is particularly important to differentiate other diseases, such as hydrocephalus and multi-infarct dementia from degenerative cerebellar diseases. Degenerative diseases with cerebellar involvement include Parkinson's disease, multiple system atrophy as well as other diseases including spinocerebellar ataxia. In addition to magnetic resonance imaging (MRI), nuclear medicine imaging investigations are also helpful for the differentiation. Axial fluid-attenuated inversion recovery (FLAIR) and T2-weighted sequences can sometimes show a signal increase in the pons as a sign of degeneration of pontine neurons and transverse fibers in the basilar part of the pons. The imaging is particularly necessary to exclude other diseases, such as normal pressure hydrocephalus (NPH), multi-infarct dementia and cerebellar lesions.

  6. Degenerative cerebellar diseases and differential diagnoses

    International Nuclear Information System (INIS)

    Reith, W.; Roumia, S.; Dietrich, P.

    2016-01-01

    Cerebellar syndromes result in distinct clinical symptoms, such as ataxia, dysarthria, dysmetria, intention tremor and eye movement disorders. In addition to the medical history and clinical examination, imaging is particularly important to differentiate other diseases, such as hydrocephalus and multi-infarct dementia from degenerative cerebellar diseases. Degenerative diseases with cerebellar involvement include Parkinson's disease, multiple system atrophy as well as other diseases including spinocerebellar ataxia. In addition to magnetic resonance imaging (MRI), nuclear medicine imaging investigations are also helpful for the differentiation. Axial fluid-attenuated inversion recovery (FLAIR) and T2-weighted sequences can sometimes show a signal increase in the pons as a sign of degeneration of pontine neurons and transverse fibers in the basilar part of the pons. The imaging is particularly necessary to exclude other diseases, such as normal pressure hydrocephalus (NPH), multi-infarct dementia and cerebellar lesions. (orig.) [de

  7. Prediction of complicated disease course for children newly diagnosed with Crohn's disease: a multicentre inception cohort study.

    Science.gov (United States)

    Kugathasan, Subra; Denson, Lee A; Walters, Thomas D; Kim, Mi-Ok; Marigorta, Urko M; Schirmer, Melanie; Mondal, Kajari; Liu, Chunyan; Griffiths, Anne; Noe, Joshua D; Crandall, Wallace V; Snapper, Scott; Rabizadeh, Shervin; Rosh, Joel R; Shapiro, Jason M; Guthery, Stephen; Mack, David R; Kellermayer, Richard; Kappelman, Michael D; Steiner, Steven; Moulton, Dedrick E; Keljo, David; Cohen, Stanley; Oliva-Hemker, Maria; Heyman, Melvin B; Otley, Anthony R; Baker, Susan S; Evans, Jonathan S; Kirschner, Barbara S; Patel, Ashish S; Ziring, David; Trapnell, Bruce C; Sylvester, Francisco A; Stephens, Michael C; Baldassano, Robert N; Markowitz, James F; Cho, Judy; Xavier, Ramnik J; Huttenhower, Curtis; Aronow, Bruce J; Gibson, Greg; Hyams, Jeffrey S; Dubinsky, Marla C

    2017-04-29

    Stricturing and penetrating complications account for substantial morbidity and health-care costs in paediatric and adult onset Crohn's disease. Validated models to predict risk for complications are not available, and the effect of treatment on risk is unknown. We did a prospective inception cohort study of paediatric patients with newly diagnosed Crohn's disease at 28 sites in the USA and Canada. Genotypes, antimicrobial serologies, ileal gene expression, and ileal, rectal, and faecal microbiota were assessed. A competing-risk model for disease complications was derived and validated in independent groups. Propensity-score matching tested the effect of anti-tumour necrosis factor α (TNFα) therapy exposure within 90 days of diagnosis on complication risk. Between Nov 1, 2008, and June 30, 2012, we enrolled 913 patients, 78 (9%) of whom experienced Crohn's disease complications. The validated competing-risk model included age, race, disease location, and antimicrobial serologies and provided a sensitivity of 66% (95% CI 51-82) and specificity of 63% (55-71), with a negative predictive value of 95% (94-97). Patients who received early anti-TNFα therapy were less likely to have penetrating complications (hazard ratio [HR] 0·30, 95% CI 0·10-0·89; p=0·0296) but not stricturing complication (1·13, 0·51-2·51; 0·76) than were those who did not receive early anti-TNFα therapy. Ruminococcus was implicated in stricturing complications and Veillonella in penetrating complications. Ileal genes controlling extracellular matrix production were upregulated at diagnosis, and this gene signature was associated with stricturing in the risk model (HR 1·70, 95% CI 1·12-2·57; p=0·0120). When this gene signature was included, the model's specificity improved to 71%. Our findings support the usefulness of risk stratification of paediatric patients with Crohn's disease at diagnosis, and selection of anti-TNFα therapy. Crohn's and Colitis Foundation of America, Cincinnati

  8. Newly diagnosed rheumatic heart disease among indigenous populations in the Pacific.

    Science.gov (United States)

    Mirabel, Mariana; Tafflet, Muriel; Noël, Baptiste; Parks, Tom; Axler, Olivier; Robert, Jacques; Nadra, Marie; Phelippeau, Gwendolyne; Descloux, Elodie; Cazorla, Cécile; Missotte, Isabelle; Gervolino, Shirley; Barguil, Yann; Rouchon, Bernard; Laumond, Sylvie; Jubeau, Thierry; Braunstein, Corinne; Empana, Jean-Philippe; Marijon, Eloi; Jouven, Xavier

    2015-12-01

    Rheumatic heart disease (RHD) remains the leading acquired heart disease in the young worldwide. We aimed at assessing outcomes and influencing factors in the contemporary era. Hospital-based cohort in a high-income island nation where RHD remains endemic and the population is captive. All patients admitted with newly diagnosed RHD according to World Heart Federation echocardiographic criteria were enrolled (2005-2013). The incidence of major cardiovascular events (MACEs) including heart failure, peripheral embolism, stroke, heart valve intervention and cardiovascular death was calculated, and their determinants identified. Of the 396 patients, 43.9% were male with median age 18 years (IQR 10-40)). 127 (32.1%) patients presented with mild, 131 (33.1%) with moderate and 138 (34.8%) with severe heart valve disease. 205 (51.8%) had features of acute rheumatic fever. 106 (26.8%) presented with at least one MACE. Among the remaining 290 patients, after a median follow-up period of 4.08 (95% CI 1.84 to 6.84) years, 7 patients (2.4%) died and 62 (21.4%) had a first MACE. The annual incidence of first MACE and of heart failure were 59.05‰ (95% CI 44.35 to 73.75) and 29.06‰ (95% CI 19.29 to 38.82), respectively. The severity of RHD at diagnosis (moderate vs mild HR 3.39 (0.95 to 12.12); severe vs mild RHD HR 10.81 (3.11 to 37.62), pdisease and no secondary prophylaxis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  9. Age-Dependent Fecal Bacterial Correlation to Inflammatory Bowel Disease for Newly Diagnosed Untreated Children

    Directory of Open Access Journals (Sweden)

    Felix Chinweije Nwosu

    2013-01-01

    Full Text Available The knowledge about correlation patterns between the fecal microbiota and inflammatory bowel diseases (IBD—comprising the two subforms Crohn's disease (CD and ulcerative colitis (UC—for newly diagnosed untreated children is limited. To address this knowledge gap, a selection of faecal specimens (CD, n=27 and UC, n=16 and non-IBD controls (n=30 children (age < 18 years was analysed utilising bacterial small subunit (SSU rRNA. We found, surprising age dependence for the fecal microbiota correlating to IBD. The most pronounced patterns were that E. coli was positively (R2=0.16, P=0.05 and Bacteroidetes, negatively (R2=0.15, P=0.05 correlated to age for CD patients. For UC, we found an apparent opposite age-related disease correlation for both Bacteroides and Escherichia. In addition, there was an overrepresentation of Haemophilus for the UC children. From our, results we propose a model where the aetiology of IBD is related to an on-going immunological development in children requiring different age-dependent bacterial stimuli. The impact of our findings could be a better age stratification for understanding and treating IBD in children.

  10. The effects of obesity on doctor-diagnosed chronic diseases in Africa: empirical results from Senegal and South Africa.

    Science.gov (United States)

    Asfaw, Abay

    2006-01-01

    While inadequate food and communicable infectious diseases have been a concern of researchers and policy makers in Africa, little attention has been given to obesity and chronic, non-communicable diseases. Africa is not usually associated with obesity and chronic diseases. Yet there has been a sharp rise in the incidence of obesity and chronic diseases, a major public health problem in many countries. The paper examines the impact of obesity on the prevalence of four doctor-diagnosed chronic diseases in Senegal and South Africa. The results reveal that obese respondents were 4.7, 2.8, and 4.8% more likely to face the risks of arthritis, diabetes, and heart diseases in South Africa and 6.5 and 7.4% more likely to face the risks of heart disease and asthma in Senegal than their lean counterparts. Obesity imposes a real and substantial danger, affecting the prevalence of chronic diseases. Unchecked it can be a major public health problem, impose a serious challenge to the health sector, and can jeopardize future developments.

  11. Adherence to secondary antibiotic prophylaxis for patients with rheumatic heart disease diagnosed through screening in Fiji.

    Science.gov (United States)

    Engelman, Daniel; Mataika, Reapi L; Kado, Joseph H; Ah Kee, Maureen; Donath, Susan; Parks, Tom; Steer, Andrew C

    2016-12-01

    Echocardiographic screening for rheumatic heart disease (RHD) can detect subclinical cases; however, adequate adherence to secondary antibiotic prophylaxis (SAP) is required to alter disease outcomes. We aimed to investigate the adherence to SAP among young people with RHD diagnosed through echocardiographic screening in Fiji and to investigate factors associated with adherence. Patients diagnosed with RHD through echocardiographic screening in Fiji from 2006 to 2014 were included. Dates of benzathine penicillin G injections were collected from 76 health clinics nationally from December 2011 to December 2014. Adherence was measured using the proportion of days covered (PDC). Multivariate logistic regression analysis was used to identify characteristics associated with any adherence (≥1 injection received) and adequate adherence (PDC ≥0.80). Of 494 patients, 268 (54%) were female and the median age was 14 years. Overall, 203 (41%) had no injections recorded and just 33 (7%) had adequate adherence. Multivariate logistic regression showed increasing age (OR 0.93 per year, 95% CI 0.87-0.99) and time since diagnosis ≥1.5 years (OR 0.53, 95% CI 0.37-0.79) to be inversely associated with any adherence. Non-iTaukei ethnicity (OR 2.58, 95%CI 1.04-6.33) and urban residence (OR 3.36, 95% CI 1.54-7.36) were associated with adequate adherence, whereas time since diagnosis ≥1.5 years (OR 0.38, 95%CI 0.17-0.83) was inversely associated with adequate adherence. Adherence to SAP after screening in Fiji is currently inadequate for individual patient protection or population disease control. Secondary prevention should be strengthened before further screening can be justified. © 2016 John Wiley & Sons Ltd.

  12. Lipidomic analysis of immune activation in equine leptospirosis and Leptospira-vaccinated horses.

    Directory of Open Access Journals (Sweden)

    Paul L Wood

    Full Text Available Currently available diagnostic assays for leptospirosis cannot differentiate vaccine from infection serum antibody. Several leptospiral proteins that are upregulated during infection have been described, but their utility as a diagnostic marker is still unclear. In this study, we undertook a lipidomics approach to determine if there are any differences in the serum lipid profiles of horses naturally infected with pathogenic Leptospira spp. and horses vaccinated against a commercially available bacterin. Utilizing a high-resolution mass spectrometry serum lipidomics analytical platform, we demonstrate that cyclic phosphatidic acids, diacylglycerols, and hydroperoxide oxidation products of choline plasmalogens are elevated in the serum of naturally infected as well as vaccinated horses. Other lipids of interest were triacylglycerols that were only elevated in the serum of infected horses and sphingomyelins that were increased only in the serum of vaccinated horses. This is the first report looking at the equine serum lipidome during leptospiral infection and vaccination.

  13. Diagnose, behandling og prognose ved fibromyalgi

    DEFF Research Database (Denmark)

    Danneskiold-Samsøe, Bente; Bartels, Else Marie; Amris, Kirstine

    2010-01-01

    It is important to recognize the diagnosis of fibromyalgia (FM) to adequately advise patients with this chronic pain disease. FM coexists with other rheumatic diseases and may therefore serve as a confounder in connection with estimation of disease activity. The aetiology and pathogenesis of FM...... remain unknown, although central sensitisation seems to play a major role. Following exclusion of a number of differential diagnoses, the remaining patients have several treatment options including centrally-acting medication....

  14. Evaluation of prolactin levels in patients with newly diagnosed pemphigus vulgaris and its correlation with pemphigus disease area index.

    Science.gov (United States)

    Lajevardi, Vahideh; Hallaji, Zahra; Daneshpazhooh, Maryam; Ghandi, Narges; Shekari, Peyman; Khani, Sepideh

    2016-06-01

    Prolactin is a hormone; in addition to it known roles, it has immunomodulatory effects on lymphocytes maturation and immunoglobulins production. Hyperprolactinemia has been demonstrated in various autoimmune diseases such as systemic lupus erythematosus, rheumatoid arthritis, type I diabetes mellitus, and Graves' disease. In view of the prolactin immunomodulatory roles, studying prolactin levels in pemphigus as an autoimmune blistering disease may introduce new ways of understanding disease etiology and developing treatment strategies. Our purpose was to determine the prolactin levels in patients with newly diagnosed pemphigus vulgaris and study its correlation with pemphigus disease area index. Our study was limited by the lack of a control group. In this cross-sectional study, prolactin and anti-desmoglein 1 and 3 autoantibodies levels were measured in 50 patients with newly diagnosed pemphigus vulgaris in Razi Dermatology Hospital. Pemphigus severity and extent was estimated using the Pemphigus Disease Area Index. Of the 50 patients, 18 were male and 32 were female with a mean age of 41.56 ± 13.66 years. Mean prolactin (PRL) level was 15.60 ± 11.72 ng/ml (10.68 in males and 18.37 in females). Mean anti-desmoglein 1 and 3 autoantibodies were 135.8 ± 119.8 and 245.8 ± 157.4 U/ml, respectively. Eleven out of 50 patients had a higher than normal prolactin range. No relation was found between prolactin level and disease activity ( p = .982). Also, correlation studies show no relation between prolactin and anti-desmoglein 1 and 3 autoantibodies levels (respectively, p = .771 and .738). In comparing the extent of the disease between the two groups with normal and high prolactin, paired t-test showed no significance ( p = .204). In our study, 22% of patients had hyperprolactinemia, which was greater among females. The highest PRL level was detected in mucocutaneous group. Although serum PRL levels were higher in patients with a greater Pemphigus Disease Area Index

  15. Limited value of transbronchial lung biopsy for diagnosing Mycobacterium avium complex lung disease.

    Science.gov (United States)

    Sekine, Akimasa; Saito, Takefumi; Satoh, Hiroaki; Morishita, Yukio; Tsunoda, Yoshiya; Tanaka, Toru; Yatagai, Yohei; Lin, Shih-Yuen; Miyazaki, Kunihiko; Miura, Yukiko; Hayashihara, Kenji

    2017-11-01

    It remains unclear whether transbronchial lung biopsy (TBLB) is useful for diagnosing Mycobacterium avium complex (MAC) lung disease. Thirty-eight consecutive patients with MAC lung disease, who were evaluated with TBLB tissue culture between June 2006 and May 2010, were included. Bronchial washing (BW) and histopathological evaluation were performed in all patients. The positivity rates of BW and TBLB tissue culture, and typical histopathological findings for MAC disease were investigated. Furthermore, all patients were divided into two groups according to the presence of intrabronchial purulent or mucopurulent secretion and the clinical, bacteriological and pathological characteristics were compared between the two groups. The positive culture rates of BW and TBLB specimens for MAC were 100% (38 patients) and 28.9% (11 patients). BW materials were much more sensitive for culture positivity than TBLB specimens (P present in the TBLB specimens of only 11 patients (28.9%). Intrabronchial secretion was identified in 15 patients (39.5%, secretion-positive group) and absent in 23 patients (60.5%, secretion-negative group). Typical histopathological findings for MAC disease were more common in the secretion-positive group than in the secretion-negative group (53.3% vs 13.0%, P = 0.01), although the radiological classification and smear positivity of BW were not different between the two groups. TBLB for pathological and bacterial investigations would provide only a limited value for MAC diagnosis. Moreover, the presence of intrabronchial secretion may be an important manifestation of ongoing airway damage, which would require early treatment. © 2016 John Wiley & Sons Ltd.

  16. IgG4-related disease with cavernous sinus and intra-orbital lesions diagnosed by nasal mucosa biopsy.

    Science.gov (United States)

    Nakata, Ruka; Yoshimura, Shunsuke; Motomura, Masakatsu; Tsujino, Akira; Hayashi, Tomayoshi; Hara, Minoru

    2016-09-29

    IgG4-related disease is a systemic disease characterized by lesions with IgG4 positive plasma cell infiltration in the involved organs and a raised serum IgG4 level. We report a patient of 70-year-old male presented orbital inflammation of IgG4-related disease. The patient developed right eye pain, double vision, and reduced eye sight. MRI image revealed mild right ocular proptosis and swelling of right carvenous sinus, bilateral intraorbital extraocular muscles and right optic nerve. Right optic nerve showed ring-like enhancement. IgG4-related disease was suspected with increased serum IgG4 level of 355 mg/dl, mediastinal lymphadenopathy and prostate enlargement. Transbronchial lung biopsy and prostate needle biopsy were administered with negative results. The eye related symptoms resolved with time, but serum IgG4 continuously increased. IgG4-related disease was diagnosed by nasal mucosa biopsy, which showed IgG4 positive plasma cells within the inflammatory infiltrate. This report emphasizes the usefulness of nasal mucosa biopsy for the diagnosis of IgG4 related disease with lesions difficult to approach.

  17. Left ventricular functions in children with newly diagnosed Graves' disease. A single-center study from Upper Egypt.

    Science.gov (United States)

    Metwalley, Kotb Abbass; Farghaly, Hekma Saad; Abdelhamid, Abdelrahman

    2018-01-01

    This study aimed to evaluate the left ventricular (LV) functions in a cohort of children with Graves' disease (GD). This is a cross-sectional case-control study. It included 36 children with GD and 36 healthy children matched for age and gender. Thyroid hormones (TSH, FT4, and FT3) and anti-thyroid autoantibodies [anti-thyroid peroxidase (anti-TPO), thyrotropin receptor (TRAbs), and thyroglobulin antibodies] were measured. Conventional and tissue Doppler imaging (TDI) echocardiographies were used to assess left ventricular systolic and diastolic functions. LV mass index (LVMI) and myocardial performance index (MPI) were also measured. Compared to healthy children, conventional echocardiography of patients with GD revealed higher LVMI (P = 0.001) indicating LV hypertrophy but normal LV functions while TDI revealed lower Em/Am ratio indicating LV diastolic dysfunction (P = 0.001). Significant correlations were reported between FT4 with LVMI (P = 0.05), Em/Am (P = 0.01), and MPI (P = 0.01). In multivariate analysis, a positive correlation was identified between FT4 with MPI (OR = 1.17; 95% CI = 1.09-1.15; P = 0.001). Children with newly diagnosed GD may have significant subclinical changes in LV structure and function (diastolic and global). TDI is more sensitive than conventional Doppler in detecting LV dysfunction. These findings highlight the importance of early monitoring of children with GD for left ventricular mass index and diastolic function. What is Known: • There is an increased risk for cardiac abnormalities in children with Graves' disease (GD). • Limited studies assessed left ventricular function in patients with GD. What is New: • Children with newly diagnosed GD may have significant subclinical changes in left ventricular structure and functions. • Children with newly diagnosed GD should be monitored for left ventricular mass index and diastolic function.

  18. Diagnosing night sweats.

    Science.gov (United States)

    Viera, Anthon J; Bond, Michael M; Yates, Scott W

    2003-03-01

    Night sweats are a common outpatient complaint, yet literature on the subject is scarce. Tuberculosis and lymphoma are diseases in which night sweats are a dominant symptom, but these are infrequently found to be the cause of night sweats in modern practice. While these diseases remain important diagnostic considerations in patients with night sweats, other diagnoses to consider include human immunodeficiency virus, gastroesophageal reflux disease, obstructive sleep apnea, hyperthyroidism, hypoglycemia, and several less common diseases. Antihypertensives, antipyretics, other medications, and drugs of abuse such as alcohol and heroin may cause night sweats. Serious causes of night sweats can be excluded with a thorough history, physical examination, and directed laboratory and radiographic studies. If a history and physical do not reveal a possible diagnosis, physicians should consider a purified protein derivative, complete blood count, human immunodeficiency virus test, thyroid-stimulating hormone test, erythrocyte sedimentation rate evaluation, chest radiograph, and possibly chest and abdominal computed tomographic scans and bone marrow biopsy.

  19. Infectious diseases following natural disasters: prevention and control measures.

    Science.gov (United States)

    Kouadio, Isidore K; Aljunid, Syed; Kamigaki, Taro; Hammad, Karen; Oshitani, Hitoshi

    2012-01-01

    Natural disasters may lead to infectious disease outbreaks when they result in substantial population displacement and exacerbate synergic risk factors (change in the environment, in human conditions and in the vulnerability to existing pathogens) for disease transmission. We reviewed risk factors and potential infectious diseases resulting from prolonged secondary effects of major natural disasters that occurred from 2000 to 2011. Natural disasters including floods, tsunamis, earthquakes, tropical cyclones (e.g., hurricanes and typhoons) and tornadoes have been secondarily described with the following infectious diseases including diarrheal diseases, acute respiratory infections, malaria, leptospirosis, measles, dengue fever, viral hepatitis, typhoid fever, meningitis, as well as tetanus and cutaneous mucormycosis. Risk assessment is essential in post-disaster situations and the rapid implementation of control measures through re-establishment and improvement of primary healthcare delivery should be given high priority, especially in the absence of pre-disaster surveillance data.

  20. Occurrence of anti-Brucella abortus and anti-Leptospira spp. antibodies in buffaloes from Paraíba state, Northeastern Brazil

    Directory of Open Access Journals (Sweden)

    Arthur Willian de Lima Brasil

    2015-07-01

    Full Text Available The objective of this study was to determine the frequency of animals that tested positive for brucellosis and leptospirosis and the risk factors for these diseases in the State of Paraíba. A total of 136 buffaloes from 14 herds were examined. For brucellosis, we used the buffered acidified plate antigen (BAPA test as screening method and 2-mercaptoethanol as confirmatory test. For leptospirosis, we conducted a microscopic agglutination test (MAT, with a cut-off point of 1:100. Of the animals examined, two [1.5%; 95% CI = 0.4%–5.2%] were positive for brucellosis, and 38 (27.9%; 95% CI = 21.1%–36.0% were positive for leptospirosis. The brucellosis-positive animals were from two (14.3% herds, while nine (64.3% herds had leptospirosis-seropositive animals. The more frequent Leptospira spp. serotypes were Bratislava, Pomona, and Canicola. We concluded that leptospirosis was widespread in buffaloes in the state of Paraíba and suggested that breeding alongside horses and pigs might be na important factor in the spread of leptospirosis-positive animals. The presence of brucellosispositive animals indicated the possibility of negative-impacting measures on disease control in bovines, and it is therefore recommended that greater attention be given to these animals for brucellosis control.

  1. Artificial intelligence techniques applied to the development of a decision-support system for diagnosing celiac disease.

    Science.gov (United States)

    Tenório, Josceli Maria; Hummel, Anderson Diniz; Cohrs, Frederico Molina; Sdepanian, Vera Lucia; Pisa, Ivan Torres; de Fátima Marin, Heimar

    2011-11-01

    Celiac disease (CD) is a difficult-to-diagnose condition because of its multiple clinical presentations and symptoms shared with other diseases. Gold-standard diagnostic confirmation of suspected CD is achieved by biopsying the small intestine. To develop a clinical decision-support system (CDSS) integrated with an automated classifier to recognize CD cases, by selecting from experimental models developed using intelligence artificial techniques. A web-based system was designed for constructing a retrospective database that included 178 clinical cases for training. Tests were run on 270 automated classifiers available in Weka 3.6.1 using five artificial intelligence techniques, namely decision trees, Bayesian inference, k-nearest neighbor algorithm, support vector machines and artificial neural networks. The parameters evaluated were accuracy, sensitivity, specificity and area under the ROC curve (AUC). AUC was used as a criterion for selecting the CDSS algorithm. A testing database was constructed including 38 clinical CD cases for CDSS evaluation. The diagnoses suggested by CDSS were compared with those made by physicians during patient consultations. The most accurate method during the training phase was the averaged one-dependence estimator (AODE) algorithm (a Bayesian classifier), which showed accuracy 80.0%, sensitivity 0.78, specificity 0.80 and AUC 0.84. This classifier was integrated into the web-based decision-support system. The gold-standard validation of CDSS achieved accuracy of 84.2% and k=0.68 (pdiagnosis. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  2. Is rhabdomyolysis an additional factor in the pathogenesis of acute renal failure in leptospirosis? É a rabdomiólise um fator adicional na patogônese da insuficiencia renal aguda na leptospirose?

    Directory of Open Access Journals (Sweden)

    Reinaldo Martinelli

    1994-04-01

    Full Text Available Leptospirosis is an important cause of acute renal failure in our environment. Although several mechanisms are implicated, the role of rhabdomyolysis in the pathogenesis of acute renal failure in leptospirosis has not been analysed. Sixteen patients with the diagnosis of leptospiroses consecutively admitted to the hospital were prospectively studied. The disease was characterized by sudden onset in all patients and, at admission, jaundice, conjunctival suffusion and myalgias. Mild to moderate proteinuria with unremarkable urinary sediment was recorded in 37.5% of the patients and abnormal levels of urea creatinine were found in 87.5% and 74.0%, respectively. Increased levels of aminotranspherase were documented in all 12 and CPK in all 10 patients studied. Serum myoglobin levels greater than 120µg/l recorded in 56.2%. A correlation between myoglobin and renal failure or severity of disease, however, could not be established.Leptospirose é uma importante causa de insuficiência renal aguda, em nosso ambiente. Embora vários sejam os mecanismos implicados, o papel da rabdomiólise na patogênese da insuficiência renal aguda na leptospirose ainda não foi analisado. Com esse objetivo, 16 pacientes com o diagnóstico da forma icterohemorrágica da leptospirose consecutivamente admitidos no Hospital Couto Maia, Salvador, Bahia, foram prospectivamente estudados. A doença foi caracterizada por início súbito e, à admissão, ictericia, sufusões hemorrágicas conjuntivais e mialgias. Proteinúria de intensidade média a moderada com sedimento urinário inexpressivo foi observada em 37,5% dos pacientes e níveis séricos elevados de uréia e creatinina em 78,5% e 74,0%, respectivamente. Níveis aumentados de aminotransferase foram documentados em todos os 12 e de CPK em todos os 10 pacientes avaliados para essas enzimas. Níveis séricos maiores que 120µg/l foram observados em 56,2% dos pacientes. Não foram encontradas correlações, entretanto

  3. Prevalence and predictors of chronic kidney disease in newly diagnosed human immunodeficiency virus patients in Owerri, Nigeria

    Directory of Open Access Journals (Sweden)

    E N Anyabolu

    2016-01-01

    Full Text Available Human immunodeficiency virus (HIV infection is a common cause of chronic kidney disease (CKD in Sub-Saharan Africa. This study aims at identifying the prevalence and predictors of CKD in newly diagnosed HIV patients in Owerri, South East Nigeria. This was a cross-sectional study consisting of 393 newly diagnosed HIV-seropositive subjects and 136 age- and sex-matched seronegative subjects as controls. CKD was defined as 24-hour urine protein (24-HUP ≥0.3 g and/or glomerular filtration rate (GFR < 60 ml/min. Subjects were recruited from the HIV clinic and the Medical Outpatient Department of Federal Medical Centre, Owerri. Clinical and anthropometric data were collected. Relevant investigations were performed, including HIV screening and relevant urine and blood investigations. The mean age of the HIV subjects was 38.84 ± 10.65 years. CKD was present in 86 (22.9% HIV subjects and 11 (8.l % controls. Low waist circumference (WC, high serum creatinine, high spot urine protein/creatinine ratio (SUPCR, high 24-HUP/creatinine Ratio (24-HUPCR, high 24-HUP/osmolality Ratio (24-HUPOR predicted CKD in HIV subjects. CKD prevalence is high (22.9% among newly diagnosed HIV patients in South East Nigeria. The predictors of CKD included WC, serum creatinine, SUPCR, 24-HUPCR, and 24-HUPOR.

  4. Screening for thyroid cancer according to French recommendations with thyroid ultrasound in newly diagnosed Graves' disease without palpable nodule is not useful.

    Science.gov (United States)

    Nys, Pierre; Cordray, Jean-Pierre; Sarafian, Véronique; Lefort-Mossé, Ève; Merceron, Robert-Édouard

    2015-02-01

    The aim of the study was to evaluate systematic thyroid ultrasonography (US) relevance in newly diagnosed Graves' disease among patients presenting without palpable nodules. We consecutively recruited 208 cases of Graves' disease without palpable nodule. All patients were screened for thyroid antibodies and underwent a thyroid US. Ultrasonically guided biopsy was proposed for the assessment of all nodules upper or equal to 10mm in diameter. Two third of patients had an abnormal thyroid at palpation requiring an US. One third of patients had a normal thyroid at palpation and US was consequently unwarranted. Among all patients, US detected non-palpable nodules in 26% of cases. We found no smears suspected to be cancerous. In newly diagnosed Graves' disease, the US relevance is only questionable in patients without abnormal thyroid at palpation. Ultrasonography detected non-palpable nodules and none was suspected to be cancerous. These data suggest that US is not useful in patients without abnormal thyroid at palpation. Nevertheless, the recent Thyroid Imaging-Reporting And Data System classification (TI-RADS) might change our conclusions. The TI-RADS classification indeed improves the selection of nodules lower than 10mm in diameter requiring a biopsy. Nodules lower than 10mm in diameter were not biopsied in the present study. The other US data presented herein (echogenicity, vascularisation) provide no further relevance for systematic US in newly diagnosed patients. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  5. Autopsy interrogation of emergency medicine dispute cases: how often are clinical diagnoses incorrect?

    Science.gov (United States)

    Liu, Danyang; Gan, Rongchang; Zhang, Weidi; Wang, Wei; Saiyin, Hexige; Zeng, Wenjiao; Liu, Guoyuan

    2018-01-01

    Emergency medicine is a 'high risk' specialty. Some diseases develop suddenly and progress rapidly, and sudden unexpected deaths in the emergency department (ED) may cause medical disputes. We aimed to assess discrepancies between antemortem clinical diagnoses and postmortem autopsy findings concerning emergency medicine dispute cases and to figure out the most common major missed diagnoses. Clinical files and autopsy reports were retrospectively analysed and interpreted. Discrepancies between clinical diagnoses and autopsy diagnoses were evaluated using modified Goldman classification as major and minor discrepancy. The difference between diagnosis groups was compared with Pearson χ 2 test. Of the 117 cases included in this study, 71 of cases (58 class I and 13 class II diagnostic errors) were revealed as major discrepancies (60.7%). The most common major diagnoses were cardiovascular diseases (54 cases), followed by pulmonary diseases, infectious diseases and so on. The difference of major discrepancy between the diagnoses groups was significant (ppay special attention to in practice. This study reaffirmed the necessity and usefulness of autopsy in auditing death in EDs. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  6. Newly Diagnosed Meniere's Disease: Clinical Course With Initiation of Noninvasive Treatment Including an Accounting of Vestibular Migraine.

    Science.gov (United States)

    Sbeih, Firas; Christov, Florian; Gluth, Michael B

    2018-05-01

    To describe the course of Meniere's disease with noninvasive treatment during the first few years after initial diagnosis. A retrospective review of consecutive patients with newly diagnosed definite Meniere's disease between 2013 and 2016 and a minimum follow-up of 1 year. Patients received a written plan for low sodium, water therapy, and treatment with a diuretic and/or betahistine. Subjects were screened and treated for vestibular migraine as needed. Vertigo control and hearing status at most recent follow-up were assessed. Forty-four subjects had an average follow up of 24.3 months. Thirty-four percent had Meniere's disease and vestibular migraine, and 84% had unilateral Meniere's disease. Seventy-five percent had vertigo well controlled at most recent follow-up, with only noninvasive treatments. Age, gender, body mass index, presence of vestibular migraine, bilateral disease, and duration of follow-up did not predict noninvasive treatment failure. Worse hearing threshold at 250 Hz and lower pure tone average (PTA) at the time of diagnosis did predict failure. Fifty-two percent of ears had improved PTA at most recent visit, 20% had no change, and 28% were worse Conclusions: Encountering excellent vertigo control and stable hearing after a new diagnosis of Meniere's disease is possible with noninvasive treatments. Worse hearing status at diagnosis predicted treatment failure.

  7. Liver function evaluation in leptospirosis with colloidal gold 1 9 8 Au

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    Walber Miranda Silva

    1977-12-01

    Full Text Available Eight patients with leptospirosis were studied with colloidal gold 1 9 8 Au. The radiocolloidal hepatic distribution was altered, presenting a non-homogeneous tiver concentration in seven cases, and a minute to moderate splenic visualization in five. Two patients presented doubtful splenic image, and one seemed to be normal. Liver scanning with colloidal gold 1 9 8 Au is demonstra ted to be a good liver function test.Oito pacientes com Leptospirose foram investigados com ouro coloidal radioativo (1 9 8 Au. A distribuição intrahepática do radiocoloide era alterada, apresentando uma concentração hepática não-homogênea em 7 casos, e visualização esp/ênica de mínima a moderada em 5. Dois tinham dúvida quanto à imagem do baço, e um parecia normal. A cintigrafia hepática com ouro coloidai radioativo (1 9 8 Au é demonstrada ser um bom teste de função hepática.

  8. Canine leptospirosis in Switzerland-A prospective cross-sectional study examining seroprevalence, risk factors and urinary shedding of pathogenic leptospires.

    Science.gov (United States)

    Delaude, Alessandro; Rodriguez-Campos, Sabrina; Dreyfus, Anou; Counotte, Michel Jacques; Francey, Thierry; Schweighauser, Ariane; Lettry, Sophie; Schuller, Simone

    2017-06-01

    Leptospirosis is an important worldwide zoonosis. While human leptospirosis remains rare in Switzerland, the incidence of canine leptospirosis is unusually high compared to other European countries. The aims of this cross-sectional study were to determine the exposure of asymtomatic dogs to pathogenic Leptospira in Switzerland, to characterise risk factors associated with seropositivity and to determine the prevalence of urinary shedding. Sampling was stratified to cover the whole of Switzerland. Sera were tested by microscopic agglutination test for antibodies against a panel of 12 serovars. Urine was tested for pathogenic Leptospira using a LipL32 real-time PCR. Of 377 sera, 55.7% (95%CI 51.2-60.7) showed a reciprocal MAT titre of ≥1:40 and 24.9% (95%CI 20.7-29.4) of ≥1:100 to at least one serovar. Seropositivity (MAT ≥1:100) was most common to serovars Australis (14.9%; 95% CI 11.4-18.6) and Bratislava (8.8%; 95%CI 6.1-11.7), followed by Copenhageni (6.1%; 95%CI 3.7-8.5), Canicola (5%; 95%CI 2.9-7.4), Grippotyphosa (4.5%; 95%CI 2.7-6.9), Pomona (4%; 95%CI 2.1-6.1), Autumnalis (2.7%; 95%CI 1.3-4.2) and Icterohaemorrhagiae (1.6%; 95%CI 0.5-2.9). In unvaccinated dogs (n=84) the prevalence of a MAT titre ≥100 was 17.9% (95%CI 10.7-26.2), with a similar distribution of reactive serovars. Variables associated with seropositivity (≥1:40) to any serovar included age (OR 1.29/year; 95%CI: 1.1-1.5) and bioregion with higher risks in the regions Northern Alps (OR 14.5; 95%CI 2.2-292.7), Central Plateau (OR 12.3; 95%CI 2.0-244.1) and Jura (OR 11.2; 95%CI 1.7-226.7) compared to Southern Central Alps. Dogs living with horses were significantly more likely to have antibodies to serovar Bratislava (OR 4.68;95%CI 1.2-17.2). Hunting was a significant risk factor for seropositivtiy to serovar Grippotyphosa (OR 8.03; 95%CI 1.6-30.8). Urine qPCR positivity was uncommon (1/408 dogs; 0.2%; 95% CI0-0.7). These results demonstrate that dogs in Switzerland are commonly exposed

  9. A PROSPECTIVE STUDY OF HYPOTHYROIDISM IN DIAGNOSED CASE OF GALLSTONE DISEASE

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    P. Sundareswar

    2016-11-01

    Full Text Available BACKGROUND Disturbances in lipid metabolism, which occur during hypothyroidism lead to the formation of gallstones. This study aims to evaluate the thyroid function pattern in patients with gallstones. The aim of this study was to investigate the association between hypothyroidism and gallstone disease. MATERIALS AND METHODS 200 patients admitted as inpatients for management of gallstone disease in Department of General Surgery, GRH, Madurai, between September 2014 to August 2015 were evaluated with details of cases, full history, clinical examination, symptoms and signs of hypothyroidism (loss of appetite, gaining weight, tiredness, constipation, cold intolerance, menstrual disturbances, bradycardia, presence or absence of goiter, etc. and investigations (USG abdomen, USG neck, thyroid function test (T3, T4, TSH. Patients are divided according to history, clinical examination, USG neck and lab estimation of T3, T4 and TSH. 1. Subclinical Hypothyroidism: Symptom free patient with TSH concentration above upper limit of normal range and T3/T4 or both decrease below normal limit. 2. Clinical Hypothyroidism: In which, there are symptoms of hypothyroidism with TSH level above the upper limit and T3/T4 or both decrease below normal limit. 3. Euthyroid Group: Where clinical and lab tests are within normal range (all these groups may present with or without goiter. RESULTS This study included 200 gallstone patients who were studied prospectively over a period of 1 year from September 2014 to August 2015. Among them, 18 patients had subclinical hypothyroidism and 6 patients had clinical hypothyroidism. A total of 12% of gallstone patients were diagnosed to have hypothyroidism showing that there is association of hypothyroidism with gallstone disease. CONCLUSION Thyroid dysfunction is more common among patients with gallstones and it maybe a risk factor for biliary stone formation. This may be attributed to the absence of the pro-relaxing effects of

  10. Validity of peptic ulcer disease and upper gastrointestinal bleeding diagnoses in administrative databases: a systematic review protocol.

    Science.gov (United States)

    Montedori, Alessandro; Abraha, Iosief; Chiatti, Carlos; Cozzolino, Francesco; Orso, Massimiliano; Luchetta, Maria Laura; Rimland, Joseph M; Ambrosio, Giuseppe

    2016-09-15

    Administrative healthcare databases are useful to investigate the epidemiology, health outcomes, quality indicators and healthcare utilisation concerning peptic ulcers and gastrointestinal bleeding, but the databases need to be validated in order to be a reliable source for research. The aim of this protocol is to perform the first systematic review of studies reporting the validation of International Classification of Diseases, 9th Revision and 10th version (ICD-9 and ICD-10) codes for peptic ulcer and upper gastrointestinal bleeding diagnoses. MEDLINE, EMBASE, Web of Science and the Cochrane Library databases will be searched, using appropriate search strategies. We will include validation studies that used administrative data to identify peptic ulcer disease and upper gastrointestinal bleeding diagnoses or studies that evaluated the validity of peptic ulcer and upper gastrointestinal bleeding codes in administrative data. The following inclusion criteria will be used: (a) the presence of a reference standard case definition for the diseases of interest; (b) the presence of at least one test measure (eg, sensitivity, etc) and (c) the use of an administrative database as a source of data. Pairs of reviewers will independently abstract data using standardised forms and will evaluate quality using the checklist of the Standards for Reporting of Diagnostic Accuracy (STARD) criteria. This systematic review protocol has been produced in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol (PRISMA-P) 2015 statement. Ethics approval is not required given that this is a protocol for a systematic review. We will submit results of this study to a peer-reviewed journal for publication. The results will serve as a guide for researchers validating administrative healthcare databases to determine appropriate case definitions for peptic ulcer disease and upper gastrointestinal bleeding, as well as to perform outcome research using

  11. Análise espacial e sazonal da leptospirose no município de São Paulo, SP, 1998 a 2006 Análisis espacial y estacional de la leptospirosis en el municipio de Sao Paulo, SP, 1998 a 2006 Spatial and seasonal analysis on leptospirosis in the municipality of São Paulo, Southeastern Brazil, 1998 to 2006

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    Tatiana Spinelli Martins Soares

    2010-04-01

    de Información de Agravios de Notificación. Fueron realizados mapas temáticos con las variables tasa de incidencia, letalidad, tasa de alfabetización, renta promedio mensual, número de moradores por domicilio, abastecimiento de agua y red de cloacas. Para identificar el patrón espacial (disperso, en aglomerado o azaroso, fueron analizados por el Índice de Moran global y local. Fue utilizado el coeficiente de correlación de Spearman para evaluar asociaciones entre las variables con patrón espacial en aglomerados. RESULTADOS: El patrón espacial en aglomerados fue observado en las variables tasa de incidencia de leptospirosis, tasa de alfabetización, renta promedio mensual, número de moradores por domicilio, abastecimiento de agua y red de cloacas. Fueron notificados 773 casos en el período seco y 1.717 en el húmedo. La incidencia y la letalidad están correlacionadas con las condiciones socioeconómicas de la población, independientemente del período. CONCLUSIONES: La leptospirosis está distribuida por todo el municipio de Sao Paulo y su incidencia aumenta en el período de lluvias. En el período seco, los locales de aparecimiento de los casos coinciden con las áreas de peores condiciones de vivienda y, durante el período húmedo, también aumenta en otros distritos, probablemente debido a la proximidad de ríos y riachuelos.OBJECTIVE: To analyze the spatial and seasonal distribution of leptospirosis and identify possible ecological and social components of its transmission. METHODS: A total of 2,490 cases registered in each district of the municipality of São Paulo, Southeastern Brazil, between 1998 and 2006, were georeferenced. The data were obtained from the Notifiable Diseases Information System. Thematic maps were made, showing the variables of incidence rate, lethality rate, literacy rate, average monthly income, number of residents per household, water supply and sewage system. To identify spatial patterns (dispersed, clustered or random

  12. Prediction of complicated disease course for children newly diagnosed with Crohn’s disease: a multicentre inception cohort study

    Science.gov (United States)

    Kugathasan, Subra; Denson, Lee A; Walters, Thomas D; Kim, Mi-Ok; Marigorta, Urko M; Schirmer, Melanie; Mondal, Kajari; Liu, Chunyan; Griffiths, Anne; Noe, Joshua D; Crandall, Wallace V; Snapper, Scott; Rabizadeh, Shervin; Rosh, Joel R; Shapiro, Jason M; Guthery, Stephen; Mack, David R; Kellermayer, Richard; Kappelman, Michael D; Steiner, Steven; Moulton, Dedrick E; Keljo, David; Cohen, Stanley; Oliva-Hemker, Maria; Heyman, Melvin B; Otley, Anthony R; Baker, Susan S; Evans, Jonathan S; Kirschner, Barbara S; Patel, Ashish S; Ziring, David; Trapnell, Bruce C; Sylvester, Francisco A; Stephens, Michael C; Baldassano, Robert N; Markowitz, James F; Cho, Judy; Xavier, Ramnik J; Huttenhower, Curtis; Aronow, Bruce J; Gibson, Greg; Hyams, Jeffrey S; Dubinsky, Marla C

    2017-01-01

    Summary Background Stricturing and penetrating complications account for substantial morbidity and health-care costs in paediatric and adult onset Crohn’s disease. Validated models to predict risk for complications are not available, and the effect of treatment on risk is unknown. Methods We did a prospective inception cohort study of paediatric patients with newly diagnosed Crohn’s disease at 28 sites in the USA and Canada. Genotypes, antimicrobial serologies, ileal gene expression, and ileal, rectal, and faecal microbiota were assessed. A competing-risk model for disease complications was derived and validated in independent groups. Propensity-score matching tested the effect of anti-tumour necrosis factor α (TNFα) therapy exposure within 90 days of diagnosis on complication risk. Findings Between Nov 1, 2008, and June 30, 2012, we enrolled 913 patients, 78 (9%) of whom experienced Crohn’s disease complications. The validated competing-risk model included age, race, disease location, and antimicrobial serologies and provided a sensitivity of 66% (95% CI 51–82) and specificity of 63% (55–71), with a negative predictive value of 95% (94–97). Patients who received early anti-TNFα therapy were less likely to have penetrating complications (hazard ratio [HR] 0·30, 95% CI 0·10–0·89; p=0·0296) but not stricturing complication (1·13, 0·51–2·51; 0·76) than were those who did not receive early anti-TNFα therapy. Ruminococcus was implicated in stricturing complications and Veillonella in penetrating complications. Ileal genes controlling extracellular matrix production were upregulated at diagnosis, and this gene signature was associated with stricturing in the risk model (HR 1·70, 95% CI 1·12–2·57; p=0·0120). When this gene signature was included, the model’s specificity improved to 71%. Interpretation Our findings support the usefulness of risk stratification of paediatric patients with Crohn’s disease at diagnosis, and selection of

  13. Pulse oximetry findings in newborns with antenatally diagnosed congenital heart disease.

    Science.gov (United States)

    Mawson, Isabel E; Babu, Pratusha L; Simpson, John M; Fox, Grenville F

    2018-05-01

    A retrospective review of admission preductal oxygen saturations of neonates with antenatally diagnosed critical congenital heart disease (CCHD) was performed to investigate the differences in newborn pulse oximetry (Pulsox) by specific CCHD diagnosis. Saturations were recorded at median of  34 weeks and birth weight > 1.8 kg. A statistically significant increase in the proportion with low admission saturations was seen using ≤ 95% saturation threshold (72% (95% CI 66-78)) compared to ≤ 92% (52% (95% CI 46-59)) and ≤ 90% (46% (95% CI 39-52)). Sub-group analysis found the proportion of neonates with low saturations varied according to the specific CCHD diagnosis with only 20-42% of neonates with aortic stenosis, coarctation of the aorta and pulmonary stenosis having saturations ≤ 95%. The proportion of neonates with low admission oxygen saturation varied by CCHD diagnosis with those without critically reduced pulmonary blood flow not having low admission saturations, in general, even using the ≤ 95% threshold which had the highest proportions of abnormal saturations. This data may assist developing Pulsox screening policies. What is Known: • The addition of pulse oximetry (Pulsox) screening to the routine newborn examination increases the sensitivity of CCHD detection. Pulsox screening is also highly specific for CCHD in asymptomatic neonates, with low false-positive rates. • Early diagnosis of CCHD improves patient outcomes in relation to both morbidity and mortality. What is New: • The proportion of affected infants with an abnormal Pulsox result varies by CCHD diagnosis and screening threshold. In our study using the ≤ 95% threshold gave the highest proportion of neonates with abnormal saturations at admission. • In general, Pulsox yield of abnormal results is low for CCHD diagnoses not associated with critically reduced pulmonary blood flow; however, increasing the Pulsox threshold increased the proportion of infants with an

  14. Detection of Anti-Leptospira IgM Antibody in Serum Samples of Suspected Patients Visiting National Public Health Laboratory, Teku, Kathmandu

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    Krishna Prasad Dahal

    2016-01-01

    Full Text Available Leptospirosis is a globally distributed zoonosis with varied clinical outcomes and multiorgan involvement in humans. In this study conducted from July 2011 to December 2011, 178 serum samples from patients suspected of leptospirosis were tested by Panbio IgM ELISA at National Public Health Laboratory, Kathmandu, out of which 51 (28.65% were positive for anti-Leptospira IgM antibody. Leptospirosis was more common in people in their 2nd and 3rd decades of their life which together comprised 56.86% of the total positive cases. Most of those tested positive were farmers followed by students and housewives. Both animal contact and water contact seemed to play significant roles in disease transmission. Symptoms were vague with the most common being fever, headache, myalgia, abdominal pain, vomiting, jaundice, and diarrhoea. Life style heavily dominated by agronomical and farming activities in Nepal is conducive to leptospirosis transmission. Leptospirosis seems to be a significant public health problem in Nepal but is underestimated. In resource poor countries like Nepal where laboratories performing MAT or maintaining cultures are rarely available, serological test like ELISA could well depict the scenario of the disease prevalence.

  15. Undifferentiated tropical febrile illness in Cordoba, Colombia: Not everything is dengue

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    Salim Mattar

    2017-09-01

    Full Text Available Summary: In Colombia, undifferentiated tropical febrile illness (UTFI are frequent and of considerable concern. They also share many clinical features. Between 2012 and 2013 in an endemic tropical area of Cordoba, Colombia, we conducted a prospective study to establish an etiological diagnosis of UTFI. Using diagnostic tests for dengue, leptospirosis, hantavirus, malaria, rickettsia, brucellosis, hepatitis A and B on 100 patients recruited for the study. We identified 69 patients with presumed UTFI: leptospirosis (n = 27, dengue (n = 26, hantavirus infection (n = 4, malaria (n = 4, rickettsial infection (n = 2, hepatitis A (n = 1, and brucellosis (n = 1; no hepatitis B cases were detected. Co-infections with malaria and leptospirosis (n = 1, hepatitis A and dengue (n = 1, hantavirus and dengue (n = 1, hantavirus, dengue, and leptospirosis (n = 1 were also identified. No etiologic agent was identified for 31 patients. We conclude that other etiologic agents besides dengue virus deserve greater attention by physicians and public health authorities in tropical area of Colombia. Keywords: Leptospirosis, Hantaviruses, Malaria, Vector-borne diseases, Zoonotic diseases

  16. The ICD diagnoses of fetishism and sadomasochism.

    Science.gov (United States)

    Reiersøl, Odd; Skeid, Svein

    2006-01-01

    In this article we discuss psychiatric diagnoses of sexual deviation as they appear in the International Classification of Diseases (ICD-10), the internationally accepted classification and diagnostic system of the World Health Organization (WHO). Namely, we discuss the background of three diagnostic categories: Fetishism (F65.0), Fetishistic Transvestism (F65.1), and Sadomasochism (F65.5). Pertinent background issues regarding the above categories are followed by a critique of the usefulness of diagnosing these phenomena today. Specifically, we argue that Fetishism, Fetishistic Transvestism, and Sadomasochism, also labeled Paraphilia or perversion, should not be considered illnesses. Finally, we present the efforts of an initiative known as ReviseF65, which was established in 1997, to abolish these diagnoses.

  17. Prueba de Elisa indirecta para la detección de anticuerpos IgM para el diagnóstico de Leptospirosis humana

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    Manuel Céspedes Z

    2002-01-01

    Full Text Available Para el diagnóstico temprano de enfermedades con cuadro clínico inespecífico como la leptospirosis, es necesario la confirmación laboratorial mediante pruebas específicas, con la finalidad de que el diagnóstico sea más acertado y rápido. Objetivo: se realizó un estudio comparativo entre la prueba de microaglutinacion (MAT y la prueba de ELISA indirecta estandarizada con un "pool" de antígenos de Leptospira interrogans, para la detección de anticuerpos IgM, en muestras de suero de fase aguda de leptospirosis humana. Materiales y métodos: 40 muestras de pacientes con sospecha clínica y con títulos de 1:100-1:12800 por la prueba de MAT, 80 muestras negativas de pacientes aparentemente sanos con enfermedades como Brucelosis, Sífilis, Tifus murino, Hepatitis B, Fiebre Amarilla, Dengue y Enfermedad de Carrión fueron evaluados por ELISA IgM. Resultados: se obtuvo una sensibilidad de 97,5% y especificidad de 98,75%, no observándose reacción cruzada con otras enfermedades. Conclusión: ELISA IgM validado en el laboratorio es suficiente sensible, específico y de fácil aplicación para el uso como prueba de tamizaje en una infección por Leptospiras con la subsecuente confirmación por MAT.

  18. Value of the radiological study of the thorax for diagnosing left ventricular dysfunction in Chagas' disease

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    Perez Amanda Arantes

    2003-01-01

    Full Text Available OBJECTIVE: To determine the value of the radiological study of the thorax for diagnosing left ventricular dilation and left ventricular systolic dysfunction in patients with Chagas' disease. METHODS: A cross-sectional study of 166 consecutive patients with Chagas' disease and no other associated diseases. The patients underwent cardiac assessment with chest radiography and Doppler echocardiography. Sensitivity, specificity, and positive and negative predictive values of chest radiography were calculated to detect left ventricular dysfunction and the accuracy of the cardiothoracic ratio in the diagnosis of left ventricular dysfunction with the area below the ROC curve. The cardiothoracic ratio was correlated with the left ventricular ejection fraction and the left ventricular diastolic diameter. RESULTS: The abnormal chest radiogram had a sensitivity of 50%, specificity of 80.5%, and positive and negative predictive values of 51.2% and 79.8%, respectively, in the diagnosis of left ventricular dysfunction. The cardiothoracic ratio showed a weak correlation with left ventricular ejection fraction (r=-0.23 and left ventricular diastolic diameter (r=0.30. The area calculated under the ROC curve was 0.734. CONCLUSION: The radiological study of the thorax is not an accurate indicator of left ventricular dysfunction; its use as a screening method to initially approach the patient with Chagas' disease should be reevaluated.

  19. Early manifestations of type 1 Gaucher disease in presymptomatic children diagnosed after parental carrier screening.

    Science.gov (United States)

    Yang, Amy C; Bier, Louise; Overbey, Jessica R; Cohen-Pfeffer, Jessica; Desai, Khyati; Desnick, Robert J; Balwani, Manisha

    2017-06-01

    The overall published experience with pediatric type 1 Gaucher disease (GD1) has been based on ascertainment through clinical presentation of the disease. We describe the longitudinal follow-up in a presymptomatic pediatric cohort. The cohort includes children diagnosed with GD1, either prenatally or postnatally by molecular genetic testing, and followed for clinical care at our center from 1998 to 2016. All patients' parents were GBA mutation carriers identified through carrier screening programs. Longitudinal clinical, laboratory, and imaging data were obtained through chart review. Thirty-eight patients aged 1-18 years (mean at last visit 6.9 ± 4.1 years) were followed, including 32 p.N409S homozygotes and 6 p.N409S/p.R535H compound heterozygotes. At the last evaluation, a minority had hematological (5%), bone (15%), or linear growth (19%) issues. Only 12% had splenomegaly and 74% had moderate hepatomegaly. Chitotriosidase activity varied widely (6-5,640 nmol/hour/ml) and generally increased with age. Pediatric Gaucher severity scores (GSS) remained stable and within the mild-disease range for most (95%). Treatment for progressive disease during this period was recommended for four children. Most children with the p.N409S/p.N409S and p.N409S/p.R535H GD1 genotypes have minimal disease manifestations and progression during childhood and can be monitored using limited assessments. Those with other mutations may require additional monitoring. These data are valuable for newborn screening and counseling.Genet Med advance online publication 13 October 2016.

  20. Reliability of the minimum basic dataset for diagnoses of cerebrovascular disease.

    Science.gov (United States)

    Hernández Medrano, I; Guillán, M; Masjuan, J; Alonso Cánovas, A; Gogorcena, M A

    2017-03-01

    The minimum basic dataset is the largest available hospital care administrative database that is used in clinical studies and hospital management in association with diagnosis-related groups (DRGs). In 2011, the quality of the national MBDS in hospital discharges was audited, in order to assess its reliability. This paper presents a sub-analysis of the results from that analysis which are referred to cerebrovascular disease (CVD). Using all discharge reports from the Spanish MBDS in 2009, a representative sample was obtained by stratified sampling and 11 209 records were evaluated. Outcome indicators were obtained to measure any differences observed between the national MBDS being evaluated and the hospital's original MBDS. Analysis of codes for CVD as a primary diagnosis was performed for ICD-9-CM diagnostic categories 430 through 438. We evaluated error rates in the selection and classification of main diagnoses, as well as in DRG assignment. There were 397 discharges of cases of CVD which included 21 different DRGs. Diagnostic coding showed a concordance rate of 81.87%; the selection error rate was 2.26% and the classification error rate was 15.87%. The error rate in the DRG was 16.12% and associated with the greatest impact on the mortality risk level. While the errors we observed must be taken into account, data suggest that the quality of the MBDS for CVD is sufficient to ensure delivery of valid information. The hospital discharge registry serves as a valuable tool for use in studies of this disease. Copyright © 2014 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. Bayesian comparison of cost-effectiveness of different clinical approaches to diagnose coronary artery disease

    International Nuclear Information System (INIS)

    Patterson, R.E.; Eng, C.; Horowitz, S.F.; Gorlin, R.; Goldstein, S.R.

    1984-01-01

    The objective of this study was to compare the cost-effectiveness of four clinical policies (policies I to IV) in the diagnosis of the presence or absence of coronary artery disease. A model based on Bayes theorem and published clinical data was constructed to make these comparisons. Effectiveness was defined as either the number of patients with coronary disease diagnosed or as the number of quality-adjusted life years extended by therapy after the diagnosis of coronary disease. The following conclusions arise strictly from analysis of the model and may not necessarily be applicable to all situations. As prevalence of coronary disease in the population increased, it caused a linear increase in cost per patient tested, but a hyperbolic decrease in cost per effect, that is, increased cost-effectiveness. Thus, cost-effectiveness of all policies (I to IV) was poor in populations with a prevalence of disease below 10%. Analysis of the model also indicates that at prevalences less than 80%, exercise thallium scintigraphy alone as a first test (policy II) is a more cost-effective initial test than is exercise electrocardiography alone as a first test (policy I) or exercise electrocardiography first combined with thallium imaging as a second test (policy IV). Exercise electrocardiography before thallium imaging (policy IV) is more cost-effective than exercise electrocardiography alone (policy I) at prevalences less than 80%. 4) Noninvasive exercise testing before angiography (policies I, II and IV) is more cost-effective than using coronary angiography as the first and only test (policy III) at prevalences less than 80%. 5) Above a threshold value of prevalence of 80% (for example patients with typical angina), proceeding to angiography as the first test (policy III) was more cost-effective than initial noninvasive exercise tests (policies I, II and IV)

  2. Assessment for markers of nephropathy in newly diagnosed type 2 ...

    African Journals Online (AJOL)

    Objective: To assess for markers of nephropathy in newly diagnosed type 2 diabetics, using blood pressure levels, endogenous creatinine clearance and urinary protein excretion as markers of renal disease. Study design: Ninety newly diagnosed type 2 diabetics were studied within 6 weeks of diagnosis. They were in ...

  3. Relapse and disease specific survival in 1143 Danish women diagnosed with borderline ovarian tumours (BOT).

    Science.gov (United States)

    Karlsen, Nikoline Marie Schou; Karlsen, Mona Aarenstrup; Høgdall, Estrid; Nedergaard, Lotte; Christensen, Ib Jarle; Høgdall, Claus

    2016-07-01

    The aim of the study was to evaluate the rate of relapse as well as disease-free, overall, and disease-specific survival in women with borderline ovarian tumour (BOT). Furthermore, the study aims to identify the clinical parameters correlated to relapse. National clinical data of women diagnosed with BOT from January 2005 to January 2013 constituted the basis for our study population. The prognostic influence of clinical variables was evaluated using univariate and multivariate analyses. A total of 1143 women were eligible for analysis, with 87.9% in FIGO stage I and 12.1% in FIGO stages II-IV. Relapse of BOT was detected in 3.7%, hereof 40.5% with malignant transformation. The five-year disease-free survival was 97.6% in FIGO stage I and 87.3% in FIGO stages II-IV. Younger age, laparoscopic surgical approach, fertility sparing surgery, FIGO stages II-IV, bilateral tumour presence, serous histology, implants and microinvasion of the tumour were significantly associated with relapse in univariate analyses. The overall five-year survival rate was 92.2% in FIGO stage I and 89.0% in FIGO stages II-IV. Out of 77 deaths in total, only seven women died from BOT. A general favourable prognosis in women with BOT was confirmed in our study. Our findings indicate that systematic, long-term follow-up does not seem necessary in women treated for FIGO stage IA BOT with no residual disease or microinvasion. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Dry Eye Disease in Patients with Newly Diagnosed Depressive Disorder.

    Science.gov (United States)

    Tiskaoglu, Nesime Setge; Yazıcı, Alper; Karlıdere, Tunay; Sari, Esin; Oguz, Elif Yilmaz; Musaoglu, Musa; Aslan, Seyda; Samet Ermiş, Sıtkı

    2017-05-01

    Psychiatric conditions and not just the treatments themselves might be involved in the pathophysiology of dry eye disease (DED). The aim of our study was to evaluate the association between depression and DED using objective and subjective tests in patients with newly diagnosed depressive disorder who were not using any medication which may help us to determine the sole effect of depression on dry eye. Thirty-six patients from the psychiatry clinic with a new diagnosis of depressive disorder and 32 controls were included in the study. All met the Diagnostic and Statistical Manual IV criteria for depression. Beck Depression Inventory (BDI) was used to measure depression severity and the State-Trait Anxiety Inventory (Stai1, Stai2) for concomitant anxiety symptoms. The Ocular Surface Disease Index (OSDI) and Visual Functioning Questionnaires (VFQ25) were completed and used to confirm diagnosis of DED in conjunction with the tear break up time (TBUT), ocular surface vital dye staining, and Schirmer's test. The comparison of depressive and control groups revealed significantly lower Schirmer (20.3 ± 9.9 vs. 25.7 ± 9.3 mm) and TBUT (7.8 ± 5.7 vs. 12.5 ± 7.8 s) scores with a consistently higher Oxford score (1.8 ± 3.2 vs. 0.2 ± 0.4) in the depressive group. Although the parameters were affected in the depressive group, this did not influence OSDI (86.1 ± 13.6 vs. 86.6 ± 13.3) and VFQ25 (30.8 ± 21.6 vs. 38.5 ± 29.1) scores. In both groups, the three psychological test scores (Stai1-2 and BDI) were correlated to each other but none of these tests were correlated to OSDI, VRQL, Schirmer, TBUT, and Oxford staining scores. Our study shows a definite association between depression and DED. We feel that it is important that psychiatrists take this into account especially while prescribing antidepressants which may aggravate dry eye signs.

  5. Gulhane Military Medical Academy Training Hospital, the applicant Determination of Healthy Lifestyle Behaviors in Individuals Diagnosed Coronary Artery Disease

    Directory of Open Access Journals (Sweden)

    Nilgun Kuru

    2012-06-01

    Full Text Available AIM: The aim of the study, Coronary Artery Disease (CAD diagnosed with identification of individuals in specific behaviors to improve health, health status and related factors to determine the levels of detection. METHODS: This descriptive study of data types of the Gulhane Military Medical Academy (GATA Hospital cardiology clinic in December 2009 - February 2010 were collected. The study group, at least 6 months before the diagnosis of CAD area, between the ages of 20-65 individuals who accept and participate in the study (n = 300 formed. Sociodemographic characteristics and health behaviors of the personal information form for the 33-item, 52-item scale of a healthy lifestyle behaviors and health status of the single-item scale working group of the detection technique applied to the face-to-face interview. The aim of the study, Coronary Artery Disease (CAD for the development of health behaviors in the case of individuals diagnosed with the identification, health status and related factors to determine the levels of detection. The statistical analysis techniques such as Mann Whitney U and Kruskal-Wallis were used for the comparison. RESULTS: Of the group 57,7% were males, 46,3% were 50-59 years of age and 56,3% were higher education graduates. As regard to total Health Promotion Life-Style Profile Scale scores statistically significant differences had been found between age, gender, education, disease period, occupation and chronic condition groups. As regard to the average PHSS scores statistically significant differences had been found between age, education, body mass index, disease period, occupation, chronic condition and CAD related course groups (p<0.05. CONCLUSION: Healthy lifestyle behaviors before planning training programs, individual models of health behavior and the behavior of individuals using the analyzed factors affecting.. [TAF Prev Med Bull 2012; 11(3.000: 287-298

  6. Diagnosing extracranial atherosclerotic diseases with spiral CT

    International Nuclear Information System (INIS)

    Moran, C.J.; Vannier, M.W.; Erickson, K.K.; Broderick, D.F.; Kido, D.K.; Yoffie, R.L.

    1991-01-01

    This paper reports that this discovery study was performed to determine whether extracranial carotid artery plaques could be diagnosed with a new CT technique (spiral CT) that allows nondistorted three-dimensional (3D) reconstructions in the z axis. Twenty carotid arteries were examined with spiral CT in normal volunteers and in patients suspected of having atherosclerotic plaques in the extracranial carotid arteries. The Somatom Plus CT table was advanced at a constant rate, the x-ray tube was continuously rotated, and 3D data were continuously acquired. Sixty milliliters of nonionic contrast medium was injected intravenously previous to and during the acquisition of data. The carotid bifurcations were identified in all patients. Planar images, similar to conventional intraarterial angiograms, were routinely produced from the volumetric CT data

  7. Case report patients diagnosed with rheumatoid arthritis

    OpenAIRE

    Váňová, Tereza

    2012-01-01

    Title of bachelors thesis: Case report patients diagnosed with rheumatoid arthritis Summary: The work is focused on diseases rheumatoid arthritis and its physiotherapy care. It consists of two parts. Part of the general anatomy of the joint contains a general, deals with the disease rheumatoid arthritis, its diagnosis, treatment and comprehensive rehabilitation treatment. Part has its own special case report physiotherapy sessions on this topic. Key words: rheumatoid arthritis, comprehensive ...

  8. Progression of the load of waterborne and intestinal parasitic diseases in the State of Amazonas

    Directory of Open Access Journals (Sweden)

    Marilaine Martins

    2015-06-01

    Full Text Available In the State of Amazonas, Brazil, urban expansion together with precarious basic sanitation conditions and human settlement on river banks has contributed to the persistence of waterborne and intestinal parasitic diseases. Time series of the recorded cases of cholera, typhoid fever, hepatitis A and leptospirosis are described, using data from different levels of the surveillance systems. The sources for intestinal parasitosis prevalence data (non-compulsory reporting in Brazil were Medical Literature Analysis and Retrieval System Online (MEDLINE, Literatura Latino-Americana (LILACS and the annals of major scientific meetings. Relevant papers and abstracts in all languages were accessed by two independent reviewers. The references cited by each relevant paper were scrutinized to locate additional papers. Despite its initial dissemination across the entire State of Amazonas, cholera was controlled in 1998. The magnitude of typhoid fever has decreased; however, a pattern characterized by eventual outbreaks still remains. Leptospirosis is an increasing cause of concern in association with the annual floods. The overall prevalence of intestinal parasites is high regardless of the municipality and the characteristics of areas and populations. The incidence of hepatitis A has decreased over the past decade. A comparison of older and recent surveys shows that the prevalence of intestinal parasitic diseases has remained constant. The load of waterborne and intestinal parasitic diseases ranks high among the health problems present in the State of Amazonas. Interventions aiming at basic sanitation and vaccination for hepatitis A were formulated and implemented, but assessment of their effectiveness in the targeted populations is still needed.

  9. Progression of the load of waterborne and intestinal parasitic diseases in the State of Amazonas.

    Science.gov (United States)

    Martins, Marilaine; Lacerda, Marcus Vinícius Guimarães; Monteiro, Wuelton Marcelo; Moura, Marco Antonio Saboia; Santos, Eyde Cristianne Saraiva; Saraceni, Valéria; Saraiva, Maria Graças Gomes

    2015-01-01

    In the State of Amazonas, Brazil, urban expansion together with precarious basic sanitation conditions and human settlement on river banks has contributed to the persistence of waterborne and intestinal parasitic diseases. Time series of the recorded cases of cholera, typhoid fever, hepatitis A and leptospirosis are described, using data from different levels of the surveillance systems. The sources for intestinal parasitosis prevalence data (non-compulsory reporting in Brazil) were Medical Literature Analysis and Retrieval System Online (MEDLINE), Literatura Latino-Americana (LILACS) and the annals of major scientific meetings. Relevant papers and abstracts in all languages were accessed by two independent reviewers. The references cited by each relevant paper were scrutinized to locate additional papers. Despite its initial dissemination across the entire State of Amazonas, cholera was controlled in 1998. The magnitude of typhoid fever has decreased; however, a pattern characterized by eventual outbreaks still remains. Leptospirosis is an increasing cause of concern in association with the annual floods. The overall prevalence of intestinal parasites is high regardless of the municipality and the characteristics of areas and populations. The incidence of hepatitis A has decreased over the past decade. A comparison of older and recent surveys shows that the prevalence of intestinal parasitic diseases has remained constant. The load of waterborne and intestinal parasitic diseases ranks high among the health problems present in the State of Amazonas. Interventions aiming at basic sanitation and vaccination for hepatitis A were formulated and implemented, but assessment of their effectiveness in the targeted populations is still needed.

  10. Prevalence of Attention Deficit Hyperactivity Disorder in Pediatrics Patients Newly Diagnosed with Gastroesophageal Reflux Disease

    Directory of Open Access Journals (Sweden)

    Mohammad Effatpanah

    2017-09-01

    Full Text Available Background: Gastroesophageal reflux disease (GERD is associated with a number of comorbidities in pediatrics. However, its association with attention deficit hyperactivity disorder (ADHD has not been reported. The aim of the present study was to investigate the prevalence of ADHD in pediatric patients newly diagnosed with GERD. Materials and Methods: Sixty newly-diagnosed treatment naive GERD patients and sixty healthy controls aging between 5 to 12 years referring to the Children and Adolescent’s medical center, Tehran, Iran were recruited in a case-control study during the year 2015. Then patients were evaluated for ADHD by a psychiatrist according to the DSM-IV criteria. The revised Conners' Parent Rating Scale (CPRS-R was used for assessment of the symptoms of ADHD. To screen for psychiatry disorders other than ADHD, the Kiddie-Sads-Present and Lifetime Version (K-SADS-PL questionnaire was used. Logistic regression analysis was used for modeling the association between GERD and ADHD in the study sample. Results: The mean age of GERD patients was 5.77±2.27 and for non-GERD controls was 6.03±2.52 (P= 0.543. Thirty-three out of 60 (55% GERD patients and 37 out of 60(61.66% non-GERD controls were male (P: 0.579. Prevalence of ADHD was 33.60 (55% in GERD patients and 10.60 (16.66% in non-GERD (P

  11. Prognostic factors for weight loss over 1-year period in patients recently diagnosed with mild Alzheimer Disease

    DEFF Research Database (Denmark)

    Hansen, Marie-Louise H; Waldorff, Frans B; Waldemar, Gunhild

    2011-01-01

    The aim of the study was to identify prognostic factors for weight loss in patients recently diagnosed with mild Alzheimer disease (AD), with special emphasis on the patients' social participation and living arrangements. The data used in this study was part of the Danish Alzheimer Intervention......%. Furthermore, the results suggested a trend that for men, living alone was a risk factor for losing weight, whereas for women living with somebody was associated with a higher risk. However, further studies are pertinent within this area. As weight loss is a predictor of mortality in patients with AD...

  12. Sudden unexpected death in children with a previously diagnosed cardiovascular disorder

    NARCIS (Netherlands)

    Polderman, Florens N.; Cohen, Joeri; Blom, Nico A.; Delhaas, Tammo; Helbing, Wim A.; Lam, Jan; Sobotka-Plojhar, Marta A.; Temmerman, Arno M.; Sreeram, Narayanswani

    2004-01-01

    BACKGROUND: It is known that children with previously diagnosed heart defects die suddenly. The causes of death are often unknown. OBJECTIVE: The aim of the study was to identify all infants and children within the Netherlands with previously diagnosed heart disease who had a sudden unexpected death

  13. Sudden unexpected death in children with a previously diagnosed cardiovascular disorder

    NARCIS (Netherlands)

    Polderman, F.N.; Cohen, Joeri; Blom, N.A.; Delhaas, T.; Helbing, W.A.; Lam, J.; Sobotka-Plojhar, M.A.; Temmerman, Arno M.; Sreeram, N.

    2004-01-01

    Background: It is known that children with previously diagnosed heart defects die suddenly. The causes of death are often unknown. Objective: The aim of the study was to identify all infants and children within the Netherlands with previously diagnosed heart disease who had a sudden unexpected death

  14. Diagnosing Febrile Illness in a Returned Traveler

    Centers for Disease Control (CDC) Podcasts

    2012-03-01

    This podcast will assist health care providers in diagnosing febrile illness in patients returning from a tropical or developing country.  Created: 3/1/2012 by National Center for Enteric, Zoonotic, and Infectious Diseases (NCEZID).   Date Released: 3/1/2012.

  15. How Is Paget's Disease of Bone Diagnosed?

    Science.gov (United States)

    ... Paget’s disease. Sometimes the disease is found by accident when one of these tests is done for ... contains a higher-than-usual level of a chemical substance called serum alkaline ... that is in the process of healing. However, a SAP level greater than ...

  16. Seroepidemiología de la leptospirosis en bovinos con trastornos reproductivos en el municipio de Montería, Colombia

    Directory of Open Access Journals (Sweden)

    César Betancur Hurtado

    2013-12-01

    Full Text Available Se realizó un estudio descriptivo para determinar la prevalencia de leptospirosis en bovinos con trastornos reproductivos de zonas rurales de Montería, Colombia. Se colectaron muestras de suero de 26 toros y 137 vacas procedentes de 28 fincas con antecedentes de problemas reproductivos, los cuales fueron analizados mediante técnica de microaglutinación (MAT para detección de anticuerpos contra Leptospira. Se utilizaron antígenos de los serovares pomona, hardjo, canicola, grippotyphosa e icterohaemorrhagiae. El 41 % de los sueros fue positivo a Leptospira a punto de corte 1:20. Los serovares prevalentes fueron grippotyphosa (29,85 % hardjo e icterohaemorrhagiae (20,8 y 16,41 %. Se realizó una prueba de chi cuadrado (χ2 para establecer relación entre la seropositividad a Leptospira y las variables de sexo, edad, antecedentes de abortos y repetición de servicios de cada animal, así como zona de muestreo y sistema de producción de las fincas. La seropositividad a Leptospira fue de 26,86 % y 29,85 % en los grupos de edad de 3-4 años y de 5-6 años, y del 43,2 % en bovinos ≥ 7 años. La seroprevalencia en vacas abortadas y no abortadas fue similar (35 y 34 %; asimismo, la seropositividad en vacas con y sin repeticiones de servicio fue de 34 y 35 %, respectivamente. El 41,7 % de las fincas con sistema de producción de carne y el 58,2 % con doble propósito fueron positivas a diferentes serovares. Sin embargo, no se encontró dependencia entre la seropositividad a Leptospira y las variables mencionadas (p > 0,05. Los resultados indican una alta seroprevalencia de leptospirosis en bovinos con trastornos reproductivos del municipio de Montería.

  17. THE FREQUENT SKIN DISEASES DIAGNOSED AT UNIVERSITY STUDENTS

    Directory of Open Access Journals (Sweden)

    Yesim KAYMAK

    2005-12-01

    Full Text Available The incidence of some skin diseases are increasing at adolescent and early adulthood period. The most frequent disease at this period is acne vulgaris whereas fungal diseases, dermatitis, dermatosis which are due to stress and other reasons, oral mucosal lesions and herpetic lesions of perioral region are also frequent. In this research we aim to determine the frequent dermatologic diseases of university students and 147 female, 74 male, a total of 221 students are included. We questioned the dermatologic complaints of students, then examined dermatologically in detail and registered ages, sexes, findings of the dermatological examination and dermatological diagnostic informations. As a result it is found out that the most frequent diseases are acne vulgaris (34.1%, allergic and pruritic dermatosis (16.6%, fungal diseases ( 13.0%, and eritamatous-squamous disease (8.3%. [TAF Prev Med Bull 2005; 4(6.000: 313-320

  18. LOW-BACK PAIN DISORDERS AS OCCUPATIONAL DISEASES IN THE CZECH REPUBLIC AND 22 EUROPEAN COUNTRIES: COMPARISON OF NATIONAL SYSTEMS, RELATED DIAGNOSES AND EVALUATION CRITERIA

    NARCIS (Netherlands)

    Laštovková, Andrea; Nakládalová, Marie; Fenclová, Zdenka; Urban, Pavel; Gad'ourek, Petr; Lebeda, Tomáš; Ehler, Edvard; Ridzoň, Petr; Hlávková, Jana; Boriková, Alena; Kuijer, P. Paul F. M.; Bátora, Igor; Scholz-Odermatt, Stefan M.; Moldovan, Horatiu; Godderis, Lode; Leijon, Ola; Campo, Giuseppe; Vaněčková, Manuela; Bonneterre, Vincent; Stikova, Elisaveta Jasna; Pelclová, Daniela

    2015-01-01

    Low-back pain diseases (LBPD) belong to the most frequent diagnoses determined by general practitioners, and constitute one of the most common reasons for sick leave and permanent disability pension in the Czech Republic and other European countries. Epidemiological studies have shown a

  19. Avoiding pitfalls in diagnosing basilar artery occlusive disease: clinical and imaging clues - case report

    Directory of Open Access Journals (Sweden)

    Adriana Bastos Conforto

    Full Text Available CONTEXT: The aim of this paper was to report on the characteristics that aid in establishing the diagnosis of basilar artery occlusive disease (BAOD among patients with hemiparesis and few or minor symptoms of vertebrobasilar disease. CASE REPORT: This report describes two cases in a public university hospital in São Paulo, Brazil. We present clinical and imaging findings from two patients with hemiparesis and severe BAOD, but without clinically relevant carotid artery disease (CAD. One patient presented transient ischemic attacks consisting of spells of right hemiparesis that became progressively more frequent, up to twice a week. The neurological examination revealed slight right hemiparesis and right homonymous hemianopsia. Magnetic resonance imaging (MRI revealed pontine and occipital infarcts. Magnetic resonance angiography and digital subtraction angiography revealed severe basilar artery stenosis. The other patient presented sudden left-side hemiparesis and hypoesthesia. One year earlier, she had reported sudden onset of vertigo that, at that time, was attributed to peripheral vestibulopathy and was not further investigated. MRI showed a right-side pontine infarct and an old infarct in the right cerebellar hemisphere. Basilar artery occlusion was diagnosed. Both patients presented their symptoms while receiving aspirin, and became asymptomatic after treatment with warfarin. CONCLUSIONS: Misdiagnosing asymptomatic CAD as the cause of symptoms in BAOD can have disastrous consequences, such as unnecessary carotid endarterectomy and exposure to this surgical risk while failing to offer the best available treatment for BAOD. Clinical and imaging features provided important clues for diagnosis in the cases presented.

  20. Pubertal development in children diagnosed with diabetes mellitus type 1 before puberty.

    Science.gov (United States)

    Pereira, K C X; Pugliese, B S; Guimarães, M M; Gama, M P

    2015-02-01

    To investigate an association between pubertal development and timing of menarche with glycemic control, disease duration, and body mass index (BMI) in patients diagnosed with diabetes mellitus type 1 (DM1) before puberty. Retrospective study. The study was performed at the diabetes outpatient clinic of Instituto de Puericultura e Pediatria Martagão Gesteira--IPPMG of the Federal University of Rio de Janeiro--UFRJ. A total of 131 children, 61 girls and 70 boys, diagnosed with DM1 before puberty participated in the study. The study investigated how age at puberty onset relates to mean glycated hemoglobin (HbA1c) before puberty, BMI percentile, and disease duration; how puberty duration relates to mean HbA1c before and during puberty and to disease duration; and how timing of menarche relates to mean HbA1c before puberty, BMI percentile, and disease duration. Age at puberty onset was positively correlated with mean HbA1c before puberty (r = 0.204, R(2) = 0.042; P = .019) and disease duration (r = 0.451, R(2) = 0.203; P puberty later than those diagnosed more recently. Girls in higher BMI percentiles reached menarche sooner.

  1. Queer diagnoses revisited: The past and future of homosexuality and gender diagnoses in DSM and ICD.

    Science.gov (United States)

    Drescher, Jack

    2015-01-01

    The American Psychiatric Association (APA) recently completed a several year process of revising the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). During that time, there were objections raised to retaining DSM's gender identity disorder diagnoses and calls to remove them, just as homosexuality had been removed from DSM-II in 1973. At the conclusion of the DSM-5 revision process, the gender diagnoses were retained, albeit in altered form and bearing the new name of 'gender dysphoria'. The author of this paper was a member of the DSM-5 Workgroup on Sexual and Gender Identity Disorders and presently serves on the WHO Working Group on Sexual Disorders and Sexual Health. Both groups faced similar tasks: reconciling patients' needs for access to care with the stigma of being given a psychiatric diagnosis. The differing nature of the two diagnostic manuals led to two different outcomes. As background, this paper updates the history of homosexuality and the gender diagnoses in the DSM and in the International Statistical Classification of Diseases and Related Health Problems (ICD) as well as what is expected to happen to the homosexuality and gender diagnoses following the current ICD-11 revision process.

  2. Body composition as an indicator of the nutritional status in children with newly diagnosed ulcerative colitis and Crohn’s disease – a prospective study

    Directory of Open Access Journals (Sweden)

    Paweł Więch

    2016-12-01

    Full Text Available Introduction : The prevalence of nutritional status disorders in children with ulcerative colitis (UC is much lower than in the case of Crohn’s disease (CD. The largest variability in the components of body composition occurs at the time of a new diagnosis and in periods of disease exacerbation. Aim: Assessment of body composition in children with UC and CD. Material and methods: The preliminary study included 59 children with inflammatory bowel disease (IBD (34 children with UC vs. 25 children with CD aged 4–18 years. The final analysis included 26 newly diagnosed children (16 children with UC vs. 10 children with CD. The evaluation of body composition was conducted by means of BIA-101 bioimpedance analyser. Results : Decreased values of lean mass were found in children with newly diagnosed IBD (UC: 41.13 kg vs. control group: 42.06 kg; CD: 35.50 kg vs. control group: 45.50 kg. After a year interval, an increase in fat (UC 1: 7.67 kg vs. UC 2: 10.33 kg; CD 1: 7.36 kg vs. CD 2: 9.47 kg as well as lean body mass (UC 1: 35.22 kg vs. UC 2: 39.00 kg; CD 1: 35.99 kg vs. CD 2: 42.41 kg was found in children. Conclusions : Children with newly diagnosed IBD were highly vulnerable to nutritional status disturbances. The increase in fat and lean body mass in an annual interval may be due to the treatment regime and control of the children.

  3. Symptoms, diagnoses, and sporting consequences among athletes referred to a Danish sports cardiology clinic

    DEFF Research Database (Denmark)

    Kaiser-Nielsen, L V; Tischer, S G; Prescott, E B

    2017-01-01

    investigated the prevalence of cardiac symptoms and diagnoses among 201 athletes referred for cardiac evaluation at a Sports Cardiology Clinic in Denmark. To our knowledge, this is the first systematic study of athletes referred for suspected cardiac disease. The athletes were all well-trained recreational...... to elite athletes who participated in various sports with different training loads and a wide age span (13-66 years). All patients were referred by physicians, primarily their general practitioner (38%), and palpitations were the most common cardiac symptom (40%). Cardiac symptoms had a sensitivity of 86......% in detecting cardiac disease and a specificity of 13%. Cardiac disease was diagnosed in 44% of the patients, and atrial fibrillation was the most prevalent diagnosis (7.5%). Cardiac diseases with therapeutic- or sports-related consequences for the patients were diagnosed in 28% of the population, but only 1...

  4. EYE DISEASE IN NEWLY-DIAGNOSED LEPROSY PATIENTS IN EASTERN NEPAL

    NARCIS (Netherlands)

    LUBBERS, WJ; SCHIPPER, A; HOGEWEG, M; DESOLDENHOFF, R

    To determine the magnitude of eye lesions in newly diagnosed leprosy patients we examined their eyes. The Eastern Leprosy Control Project was supported by The Netherlands Leprosy Relief Association; we used the regional clinic in Biratnagar and 5 mobile clinics in surrounding districts as our survey

  5. Fragile X syndrome – a common disease rarely diagnosed

    Directory of Open Access Journals (Sweden)

    Lisik Malgorzata Zofia

    2017-03-01

    Full Text Available Fragile X syndrome (FXS is a single-gene disorder with a broad spectrum of involvement, including cognitive and behavioural impairments of varying degrees with specific physical features and with strong association with autism. The study was conducted on 23 males (10-32 years old who had full mutation in the FMR1 gene. A complete medical evaluation, including medical history, family history, psychological testing and physical examination was conducted on each subject. Three of the FXS patients (13% were isolated cases of mental retardation in the family. The remaining 20 FXS patients belonged to 15 families, where there were other mentally retarded family members present. The degree of mental retardation (MR varied. Mild MR was diagnosed in 1/23 (4.35%, moderate MR in 12/23 (52.17%, severe MR in 10/23 (43.48 %. Moreover, autism spectrum disorder was diagnosed in 5/23 (21.74% FXS patients. Analysis of the BMI showed that in FXS patients, 14 of 23 (60.68% had too high body weight - 9/23 (39.13% were overweight and 5/23 (21.74% were obese. The diagnosis of FXS is difficult because of nonspecific symptoms, yet early diagnosis is crucial for early intervention and genetic counseling. The risk of recurrence is 50%.

  6. Development of the leptospirosis by experimental infection in hamsters (Mesocricetus auratus with Leptospira interrogans serovar Canicola, strain LO4, by intact and scratched skin exposures

    Directory of Open Access Journals (Sweden)

    Carolina de Sousa Américo Batista

    2010-10-01

    Full Text Available The establishment and evolution of leptospirosis in hamster (Mesocricetus auratus by experimental infection with Leptospira interrogans serovar Canicola, LO4 strain, by intact and scratched skin exposures, having as control the intraperitoneal route, were evaluated. Hundred-twenty female hamsters distributed in two groups according to inoculation route (intact and scratched skin were used. Infectious inoculum was constituted by a pure culture of L. interrogans serovar Canicola (strain LO4, isolated from liver from a slaughtered swine in Londrina, Paraná state and typified by agglutinins adsortion technique with monoclonal antibody kit at the Royal Tropical Institute, Amsterdam, the Netherlands. The animals were observed twice a day during 21 days. Animals that died were necropsied and kidneys, liver, genital tract (uterus and ovaries and brain were aseptically collected. On the 21st post-inoculation day, surviving animals were euthanized. In these animals, serum samples were also collected by cardiac puncture to antileptospires agglutinins research using microscopic agglutination test (MAT. Fresh direct microscopy and microbiological culture were used for the detection of leptospires. Scratched skin route induced larger lethality when compared to intact skin route, with establishment and evolution of leptospirosis. On the other hand, intact skin route induced renal and/or genital carrier state more frequently. LO4 strain presented low immunogenic power, characterized by soroconversion at the MAT in only one inoculated animal.

  7. Characterization of peripartum rumination and activity of cows diagnosed with metabolic and uterine diseases.

    Science.gov (United States)

    Liboreiro, Daniela N; Machado, Karine S; Silva, Paula R B; Maturana, Milton M; Nishimura, Thiago K; Brandão, Alice P; Endres, Márcia I; Chebel, Ricardo C

    2015-10-01

    .2 vs. 461.3 ± 4.1 arbitrary unit). Occurrence of retained fetal membrane tended to and was associated with reduced prepartum (444.3 ± 11.0 vs. 466.5 ± 4.3 arbitrary unit) and postpartum (488.2 ± 14.5 vs. 538.8 ± 5.7 arbitrary unit) activity, respectively. Cows diagnosed with metritis had reduced postpartum DRT (415.9 ± 10.1 vs. 441.0 ± 5.2 min/d) and activity (512.5 ± 11.5 vs. 539.2 ± 6.0 arbitrary unit). Postpartum activity was reduced among cows that were diagnosed with subclinical ketosis (502.20 ± 16.5 vs. 536.6 ± 6.2 arbitrary unit). Although differences in DRT and activity between populations of cows that developed periparturient diseases and healthy cows were observed, further experiments are necessary to determine how DRT and activity data may be used to precociously diagnose individuals that will develop such periparturient diseases. Copyright © 2015 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

  8. Fever, jaundice and acute renal failure.

    Science.gov (United States)

    O'Toole, Sam M; Pathak, Neha; Toms, Graham C; Gelding, Susan V; Sivaprakasam, Venkat

    2015-02-01

    Leptospirosis is an uncommon infectious disease that has protean clinical manifestations ranging from an innocuous 'flu-like' illness to potentially life-threatening multi-organ failure. Here we describe a case of Weil's disease that presented on the acute medical take with fever, jaundice and acute renal failure. We highlight the importance of careful history taking at the time of admission and how understanding the epidemiology and pathophysiology of leptospirosis enables a definitive diagnosis to be reached. © 2015 Royal College of Physicians.

  9. Improving the Recording of Diagnoses in Primary Care with Team Incentives: A Controlled Longitudinal Follow-Up Study

    Directory of Open Access Journals (Sweden)

    Tuomo Lehtovuori

    2018-01-01

    Full Text Available Introduction. We studied whether primary care teams respond to financial group bonuses by improving the recording of diagnoses, whether this intervention leads to diagnoses reflecting the anticipated distribution of diseases, and how the recording of a significant chronic disease, diabetes, alters after the application of these bonuses. Methods. We performed an observational register-based retrospective quasi-experimental follow-up study with before-and-after setting and two control groups in primary healthcare of a Finnish town. We studied the rate of recorded diagnoses in visits to general practitioners with interrupted time series analysis. The distribution of these diagnoses was also recorded. Results. After group bonuses, the rate of recording diagnoses increased by 17.9% (95% CI: 13.6–22.3 but not in either of the controls (−2.0 to −0.3%. The increase in the rate of recorded diagnoses in the care teams varied between 14.9% (4.7–25.2 and 33.7% (26.6–41.3. The distribution of recorded diagnoses resembled the respective distribution of diagnoses in the former studies of diagnoses made in primary care. The rate of recorded diagnoses of diabetes did not increase just after the intervention. Conclusions. In primary care, the completeness of diagnosis recording can be, to varying degrees, influenced by group bonuses without guarantee that recording of clinically significant chronic diseases is improved.

  10. Retrospective analysis of Newcastle disease diagnosed at the ...

    African Journals Online (AJOL)

    Newcastle disease (ND) is a highly contagious viral disease of domestic and wild birds with devastating impact on poultry health and production. Many vaccines and vaccination schedules are in use in controlling the disease but prevention and control are still a problem. A ten-year retrospective study (2002-2011) of ...

  11. Predicting first fall in newly diagnosed Parkinson's disease: Insights from a fall-naïve cohort.

    Science.gov (United States)

    Lord, Sue; Galna, Brook; Yarnall, Alison J; Coleman, Shirley; Burn, David; Rochester, Lynn

    2016-12-01

    Falls are common and associated with reduced independence and mortality in Parkinson's disease. Previous research has been conducted on falls-prevalent or advanced disease cohorts. This study identifies risk factors for first fall for 36 months in a newly diagnosed, falls-naïve cohort. A total of 121 consecutive Parkinson's disease patients were recruited. Falls data were collected prospectively during 36 months from diagnosis via monthly falls diaries and telephone follow-up for 117 participants. Assessment comprised a comprehensive battery of clinical, gait, and cognitive measures. Significant predictors were identified from decision-tree analysis and survival analysis with time to first fall during 36 months as the dependent variable. At baseline, 26 (22%) participants reported retrospective falls. At 36 months, the remaining cohort (n = 91) comprised 47 fallers (52%) and 30 (33%) nonfallers and 14 (15%) participants with incomplete diaries. Fallers presented with a significantly higher disease severity, poorer ability to stand on one leg, slower gait speed, increased stance time variability, and higher swing time asymmetry. Median time to first fall was 847 days. Gait speed, stance time, and Hoehn & Yahr III stage emerged as significant predictors of first fall, hazard ratio 3.44 (95% confidence interval [CI] 1.58 to 7.48), 3.31(95% CI 1.40 to 7.80), and 2.80 (95% CI 1.38 to 5.65), respectively. The hazard ratio for risk factors combined was 7.82 (CI 2.80 to 21.84). Interventions that target gait deficit and postural control in early Parkinson's disease may limit the potential for first fall. © 2016 International Parkinson and Movement Disorder Society. © 2016 International Parkinson and Movement Disorder Society.

  12. Abnormalities in lung volumes and airflow in children with newly diagnosed connective tissue disease.

    Science.gov (United States)

    Peradzyńska, Joanna; Krenke, Katarzyna; Szylling, Anna; Kołodziejczyk, Beata; Gazda, Agnieszka; Rutkowska-Sak, Lidia; Kulus, Marek

    2016-01-01

    Connective tissue diseases (CTDs) of childhood are rare inflammatory disorders, involving various organs and tissues including respiratory system. Pulmonary involvement in patients with CTDs is uncommon but may cause functional impairment. Data on prevalence and type of lung function abnormalities in children with CTDs are scarce. Thus, the aim of this study was to asses pulmonary functional status in children with newly diagnosed CTD and follow the results after two years of the disease course. There were 98 children (mean age: 13 ± 3; 76 girls), treated in Department of Pediatric Rheumatology, Institute of Rheumatology, Warsaw and 80 aged-matched, healthy controls (mean age 12.7 ± 2.4; 50 girls) included into the study. Study procedures included medical history, physical examination, chest radiograph and PFT (spirometry and whole body-plethysmography). Then, the assessment of PFT was performed after 24 months. FEV₁, FEV₁/FVC and MEF50 were significantly lower in CTD as compared to control group, there was no difference in FVC and TLC. The proportion of patients with abnormal lung function was significantly higher in the study group, 41 (42%) vs 9 (11%). 24-months observation didn't reveal progression in lung function impairment. Lung function impairment is relatively common in children with CTDs. Although restrictive ventilatory pattern is considered typical feature of lung involvement in CTDs, airflow limitation could also be an initial abnormality.

  13. TEMPORAL ORDER OF DISEASE PAIRS AFFECTS SUBSEQUENT DISEASE TRAJECTORIES

    DEFF Research Database (Denmark)

    Beck, Mette K; Westergaard, David; Jensen, Anders Boeck

    2016-01-01

    order of appearance. We discuss these different types of disease co-occurrences, and use the two diseases "sleep apnea" and "diabetes" to showcase the approach which otherwise can be applied to any disease pair. We benefit from seven million electronic medical records covering the entire population...... of Denmark for more than 20 years. Sleep apnea is the most common sleep-related breathing disorder and it has previously been shown to be bidirectionally linked to diabetes, meaning that each disease increases the risk of acquiring the other. We confirm that there is no significant temporal relationship......, as approximately half of patients with both diseases are diagnosed with diabetes first. However, we also show that patients diagnosed with diabetes before sleep apnea have a higher disease burden compared to patients diagnosed with sleep apnea before diabetes. The study clearly demonstrates that it is not only...

  14. Incidence of end-stage renal disease attributed to diabetes among persons with diagnosed diabetes --- United States and Puerto Rico, 1996-2007.

    Science.gov (United States)

    2010-10-29

    During 2007, approximately 110,000 persons in the United States and Puerto Rico began treatment for end-stage renal disease (ESRD) (i.e., kidney failure requiring dialysis or transplantation). Diabetes is the leading cause of ESRD in the United States, accounting for 44% of new cases in 2007. Although the number of persons initiating treatment for kidney failure each year who have diabetes listed as a primary cause (ESRD-D) has increased since 1996, ESRD-D incidence among persons with diagnosed diabetes has declined since 1996. To determine whether this decline occurred in every U.S. region and in every state, CDC analyzed 1996-2007 data from the U.S. Renal Data System (USRDS) and the Behavioral Risk Factor Surveillance System (BRFSS). During the period, the age-adjusted rate of ESRD-D among persons with diagnosed diabetes declined 35% overall, from 304.5 to 199.1 per 100,000 persons with diagnosed diabetes, and declined in all U.S. regions and in most states. No state showed a significant increase in the age-adjusted ESRD-D rate. Continued awareness of risk factors for kidney failure and interventions to improve diabetes care are needed to sustain and improve these trends.

  15. Diseases of livestock in the Pacific Islands region: setting priorities for food animal biosecurity.

    Science.gov (United States)

    Brioudes, Aurélie; Warner, Jeffrey; Hedlefs, Robert; Gummow, Bruce

    2015-03-01

    Most Pacific Island countries and territories (PICTs) have developing economies and face a critical shortage of veterinarians with limited financial resources allocated to their animal disease surveillance programmes. Thus, animal health authorities have to set priorities for better focusing their scarce resources. The main objective of this study was to identify animal diseases perceived to be of importance by decision makers within selected PICTs, at the regional and national levels, to ensure better targeting of animal health resources. A second objective was to investigate whether the targeted surveillance programmes resulting from this rationalized approach would also benefit the local communities engaged in livestock production. A multi-criteria prioritization process was developed, involving local experts, to score and rank 132 animal diseases based on their priority at the regional and national levels for four PICTs: Fiji, Papua New Guinea, Solomon Islands, and Vanuatu, which form part of a regional Food Animal Biosecurity Network. In parallel interviews with farmers and field animal health and production workers were conducted to assess their perception of animal diseases. The list of the top-twenty ranked diseases for the Pacific Islands region shows a mix of endemic zoonotic diseases (such as leptospirosis ranked first; brucellosis third; tuberculosis sixth; and endoparasites and ectoparasites, respectively eleventh and thirteenth) with exotic diseases (such as HPAI ranked second, FMD fifth, and rabies ninth). There were different disease ranking lists for each of the four targeted PICTs, confirming different strategies of disease prevention and control may be required for each country, rather than a regional approach. Interviewed animal health and production workers were unfamiliar with most of the prioritized diseases and a majority acknowledged that they would not be able to recognize clinical signs if outbreaks were to occur in their area

  16. A Competition between Care Teams Improved Recording of Diagnoses in Primary Dental Care: A Longitudinal Follow-Up Study.

    Science.gov (United States)

    Kallio, Jouko; Kauppila, Timo; Suominen, Lasse; Heikkinen, Anna Maria

    2017-01-01

    A playful competition was launched in a primary dental health care system to improve the recording of diagnoses into an electronic patient chart system and to study what diagnoses were used in primary dental care. This was a longitudinal follow-up study with public sector primary dental care practices in a Finnish city. A one-year-lasting playful competition between the dental care teams was launched and the monthly percentage of dentists' visits with recorded diagnosis before, during, and after the intervention was recorded. The assessed diagnoses were recorded with the International Classification of Diseases (ICD-10). Before the competition, the level of diagnosis recordings was practically zero. At the end of this intervention, about 25% of the visits had a recorded diagnosis. Two years after the competition, this percentage was 35% without any additional measures. The most frequent diagnoses were dental caries (K02, 38.6%), other diseases of hard tissues of teeth (K03, 14.8%), and diseases of pulp and periapical tissues (K04, 11.4%). Commitment to the idea that recording of diagnoses was beneficial improved the recording of dental diagnoses. However, the diagnoses obtained did not accurately reflect the reputed prevalence of oral diseases in the Finnish population.

  17. A Competition between Care Teams Improved Recording of Diagnoses in Primary Dental Care: A Longitudinal Follow-Up Study

    Directory of Open Access Journals (Sweden)

    Jouko Kallio

    2017-01-01

    Full Text Available Introduction. A playful competition was launched in a primary dental health care system to improve the recording of diagnoses into an electronic patient chart system and to study what diagnoses were used in primary dental care. Methods. This was a longitudinal follow-up study with public sector primary dental care practices in a Finnish city. A one-year-lasting playful competition between the dental care teams was launched and the monthly percentage of dentists’ visits with recorded diagnosis before, during, and after the intervention was recorded. The assessed diagnoses were recorded with the International Classification of Diseases (ICD-10. Results. Before the competition, the level of diagnosis recordings was practically zero. At the end of this intervention, about 25% of the visits had a recorded diagnosis. Two years after the competition, this percentage was 35% without any additional measures. The most frequent diagnoses were dental caries (K02, 38.6%, other diseases of hard tissues of teeth (K03, 14.8%, and diseases of pulp and periapical tissues (K04, 11.4%. Conclusions. Commitment to the idea that recording of diagnoses was beneficial improved the recording of dental diagnoses. However, the diagnoses obtained did not accurately reflect the reputed prevalence of oral diseases in the Finnish population.

  18. Pathogenic Leptospira: Advances in understanding the molecular pathogenesis and virulence

    Science.gov (United States)

    Ghazaei, Ciamak

    2018-01-01

    Leptospirosis is a common zoonotic disease has emerged as a major public health problem, with developing countries bearing disproportionate burdens. Although the diverse range of clinical manifestations of the leptospirosis in humans is widely documented, the mechanisms through which the pathogen causes disease remain undetermined. In addition, leptospirosis is a much-neglected life-threatening disease although it is one of the most important zoonoses occurring in a diverse range of epidemiological distribution. Recent advances in molecular profiling of pathogenic species of the genus Leptospira have improved our understanding of the evolutionary factors that determine virulence and mechanisms that the bacteria employ to survive. However, a major impediment to the formulation of intervention strategies has been the limited understanding of the disease determinants. Consequently, the association of the biological mechanisms to the pathogenesis of Leptospira, as well as the functions of numerous essential virulence factors still remain implicit. This review examines recent advances in genetic screening technologies, the underlying microbiological processes, the virulence factors and associated molecular mechanisms driving pathogenesis of Leptospira species. PMID:29445617

  19. Massively parallel sequencing and targeted exomes in familial kidney disease can diagnose underlying genetic disorders.

    Science.gov (United States)

    Mallett, Andrew J; McCarthy, Hugh J; Ho, Gladys; Holman, Katherine; Farnsworth, Elizabeth; Patel, Chirag; Fletcher, Jeffery T; Mallawaarachchi, Amali; Quinlan, Catherine; Bennetts, Bruce; Alexander, Stephen I

    2017-12-01

    Inherited kidney disease encompasses a broad range of disorders, with both multiple genes contributing to specific phenotypes and single gene defects having multiple clinical presentations. Advances in sequencing capacity may allow a genetic diagnosis for familial renal disease, by testing the increasing number of known causative genes. However, there has been limited translation of research findings of causative genes into clinical settings. Here, we report the results of a national accredited diagnostic genetic service for familial renal disease. An expert multidisciplinary team developed a targeted exomic sequencing approach with ten curated multigene panels (207 genes) and variant assessment individualized to the patient's phenotype. A genetic diagnosis (pathogenic genetic variant[s]) was identified in 58 of 135 families referred in two years. The genetic diagnosis rate was similar between families with a pediatric versus adult proband (46% vs 40%), although significant differences were found in certain panels such as atypical hemolytic uremic syndrome (88% vs 17%). High diagnostic rates were found for Alport syndrome (22 of 27) and tubular disorders (8 of 10), whereas the monogenic diagnostic rate for congenital anomalies of the kidney and urinary tract was one of 13. Quality reporting was aided by a strong clinical renal and genetic multidisciplinary committee review. Importantly, for a diagnostic service, few variants of uncertain significance were found with this targeted, phenotype-based approach. Thus, use of targeted massively parallel sequencing approaches in inherited kidney disease has a significant capacity to diagnose the underlying genetic disorder across most renal phenotypes. Copyright © 2017 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

  20. Development and content validity testing of a comprehensive classification of diagnoses for pediatric nurse practitioners.

    Science.gov (United States)

    Burns, C

    1991-01-01

    Pediatric nurse practitioners (PNPs) need an integrated, comprehensive classification that includes nursing, disease, and developmental diagnoses to effectively describe their practice. No such classification exists. Further, methodologic studies to help evaluate the content validity of any nursing taxonomy are unavailable. A conceptual framework was derived. Then 178 diagnoses from the North American Nursing Diagnosis Association (NANDA) 1986 list, selected diagnoses from the International Classification of Diseases, the Diagnostic and Statistical Manual, Third Revision, and others were selected. This framework identified and listed, with definitions, three domains of diagnoses: Developmental Problems, Diseases, and Daily Living Problems. The diagnoses were ranked using a 4-point scale (4 = highly related to 1 = not related) and were placed into the three domains. The rating scale was assigned by a panel of eight expert pediatric nurses. Diagnoses that were assigned to the Daily Living Problems domain were then sorted into the 11 Functional Health patterns described by Gordon (1987). Reliability was measured using proportions of agreement and Kappas. Content validity of the groups created was measured using indices of content validity and average congruency percentages. The experts used a new method to sort the diagnoses in a new way that decreased overlaps among the domains. The Developmental and Disease domains were judged reliable and valid. The Daily Living domain of nursing diagnoses showed marginally acceptable validity with acceptable reliability. Six Functional Health Patterns were judged reliable and valid, mixed results were determined for four categories, and the Coping/Stress Tolerance category was judged reliable but not valid using either test. There were considerable differences between the panel's, Gordon's (1987), and NANDA's clustering of NANDA diagnoses. This study defines the diagnostic practice of nurses from a holistic, patient

  1. Voice acoustic patterns of patients diagnosed with vibroacoustic disease

    Directory of Open Access Journals (Sweden)

    Ana Mendes

    2006-07-01

    Full Text Available Background: Long-term low frequency noise exposure (LFN (≤ 500 Hz, including infrasound may lead to the development of vibroacoustic disease (VAD, a systemic pathology characterized by the abnormal growth of extra-cellular matrices. The respiratory system is a target for LFN. Fibrosis of the respiratory tract epithelia was observed in VAD patients through biopsy, and confirmed in animal models exposed to LFN. Voice acoustic analysis can detect vocal fold variations of mass, tension, muscular and neural activity. Frequency perturbation (jitter, amplitude perturbation (shimmer and harmonicto- noise ratio (HNR are used in the evaluation of the vocal function, and can be indicators of the presence and degree of severity of vocal pathology. Since the respiratory system is the energy source of the phonation process, this raises questions about the effects of VAD on voice production. The purpose of this study was to determine if voice acoustic parameters of VAD patients are different from normative data. Methods: Nine individuals (5 males and 4 females diagnosed with VAD were recorded performing spoken and sung tasks. The spoken tasks included sustaining vowels and fricatives. The sung tasks consisted of maximum phonational frequency range (MPFR. Voice acoustic parameters analysed were: fundamental frequency (F0, jitter, shimmer, HNR and temporal measures. Results: Compared with normative data, both males and females diagnosed with VAD exhibited increased F0, shimmer and HNR. Jitter, MPFR and one temporal measure were reduced. Conclusions: VAD individuals presented voice acoustic parameter differences in spectral, temporal and perturbation measures, which may be indicative of small morphological changes in the phonatory system. Resumo: Enquadramento: A exposição crónica ao ruído de baixa frequência (RBF (≤ 500 Hz, incluindo infra-sons pode conduzir ao desenvolvimento da doença vibroacústica (VAD

  2. The Epidemiology and Characteristics of Q fever and Co-infections with Scrub Typhus, Murine Typhus or Leptospirosis in Taiwan: A Nationwide Database Study.

    Science.gov (United States)

    Lai, C-H; Sun, W; Lee, C-H; Lin, J-N; Liao, M-H; Liu, S-S; Chang, T-Y; Tsai, K-F; Chang, Y-C; Lin, H-H; Chen, Y-H

    2017-11-01

    Q fever (QF) is a worldwide zoonosis associated with outbreaks. Only a few nationwide studies regarding the surveillance and epidemiology of human QF have been reported. Although QF is endemic in Taiwan, a nationwide database investigation of the epidemiology and characteristics of QF and its associations with scrub typhus (ST), murine typhus (MT) and leptospirosis (LS) has never been reported. We analysed nationwide databases of suspected QF, ST, MT and LS cases from October 2007 to December 2014 obtained from the Centers for Disease Control, Taiwan. A total of 468 (4.2%) QF cases were identified among 11 109 suspected QF cases. QF cases were mainly distributed in the southern and Kaohsiung-Pingtung regions but rarely in the eastern region. Compared to non-QF cases, QF cases had significantly higher percentages of males (88.7 versus 66.2%) and high-risk occupations (farming, animal husbandry or veterinary medicine) (16.2 versus 10.5%). But the percentages of specific animal contact, including cattle (0.6 versus 0.8%) and goats (0.9 versus 1.0%), were low in both. The majority of suspected QF cases (89.4%) were simultaneously suspected with ST, MT or LS, and the combinations of suspected diseases differed between regions. The number of suspected QF cases from the eastern region decreased since 2009, which was not observed in other regions. A total of 1420 (12.8%) cases had confirmed diseases, including QF (453, 4.1%), QF+ST (7, 0.06%), QF+MT (4, 0.04%), QF+LS (4, 0.04%), MT (186, 1.7%), ST (545, 4.9%), ST+LS (11, 0.1%) and LS (210, 1.9%). Compared to cases of unknown disease, QF cases had larger percentages of high-risk occupations (16.2 versus 9.6%) but similar histories of animal contact (29.8 versus 25.1%). QF is an endemic disease in southern Taiwan. It is difficult to differentiate QF from ST, MT or LS only by high-risk occupations and history of animal contact, and co-infection of QF with these diseases should be considered. © 2016 Blackwell Verlag GmbH.

  3. The value of early wireless esophageal pH monitoring in diagnosing functional heartburn in refractory gastroesophageal reflux disease.

    Science.gov (United States)

    Park, Eun-Young; Choi, Myung-Gyu; Baeg, Meonggi; Lim, Chul-Hyun; Kim, Jinsu; Cho, Yukyung; Park, Jaemyung; Lee, Inseok; Kim, Sangwoo; Choi, Kyuyong

    2013-10-01

    It is difficult to differentiate functional heartburn from proton pump inhibitor (PPI) failure. The aims of this study were to assess the role of early wireless esophageal pH monitoring in patients referred with gastroesophageal reflux disease (GERD) and to identify differences in the clinical spectrum among GERD subtypes. We enrolled consecutive referred patients with suspected GERD. After endoscopy on the first visit, all underwent wireless esophageal pH monitoring when off the PPI. Two hundred thirty patients were enrolled. These patients were classified into a reflux esophagitis group (20, 8.7 %) and a normal endoscopic findings group (210, 91.3 %). Among the 210 patients in the normal endoscopic findings group, 63 (27.4 %) were diagnosed with pathological reflux, 35 (15.2 %) with hypersensitive esophagus, 87 (37.8 %) with normal acid exposure with negative symptom association, and 25 (10.9 %) with test failure. These groups did not differ in age, body mass index, smoking habit, alcohol consumption, symptom severity, quality of life, presence of atypical symptoms, overlap with irritable bowel syndrome, and the frequency of somatization, depression, and anxiety. PPI responses were evaluated in 135 patients. Fifty patients (37.0 %) were not responsive to the 4-week treatment; 26 (19.3 %) were diagnosed with refractory non-erosive gastroesophageal disease, and 24 (17.8 %) with functional heartburn. The demographics and clinical and psychological characteristics did not differ between the two groups. Demographic characteristics and symptom patterns alone cannot differentiate functional heartburn from various subtypes of GERD. Wireless esophageal pH monitoring should be considered for the initial evaluation of GERD in the tertiary referral setting.

  4. Comparison of Newly Diagnosed Ocular Hypertension and Open-Angle Glaucoma: Ocular Variables, Risk Factors, and Disease Severity

    Directory of Open Access Journals (Sweden)

    Yvonne M. Buys

    2012-01-01

    Full Text Available Purpose. To describe the distribution of ocular variables, risk factors, and disease severity in newly diagnosed ocular hypertension (OH or open-angle glaucoma (OAG. Methods. Eligible subjects underwent a complete history and examination. Adjusted odds ratios (ORs and 95% confidence intervals (CIs obtained from multiple logistic regression models were used to compare OAG to OH and advanced to early/moderate OAG. Results. 405 subjects were enrolled: 292 (72.1% with OAG and 113 (27.9% with OH. 51.7% had early, 27.1% moderate, and 20.9% advanced OAG. The OR for OAG versus OH was 8.19 (P<0.0001 for disc notch, 5.36 (P<0.0001 for abnormal visual field, 1.45 (P=0.001 for worsening mean deviation, 1.91 (P<0.0001 for increased cupping, 1.03 for increased age (P=0.030, and 0.36 (P=0.010 for smoking. Conclusions. Increased age was a risk for OAG, and smoking decreased the risk of OAG compared to OH. Almost half of the OAG subjects had moderate/advanced disease at diagnosis.

  5. Validity of diagnoses, procedures, and laboratory data in Japanese administrative data.

    Science.gov (United States)

    Yamana, Hayato; Moriwaki, Mutsuko; Horiguchi, Hiromasa; Kodan, Mariko; Fushimi, Kiyohide; Yasunaga, Hideo

    2017-10-01

    Validation of recorded data is a prerequisite for studies that utilize administrative databases. The present study evaluated the validity of diagnoses and procedure records in the Japanese Diagnosis Procedure Combination (DPC) data, along with laboratory test results in the newly-introduced Standardized Structured Medical Record Information Exchange (SS-MIX) data. Between November 2015 and February 2016, we conducted chart reviews of 315 patients hospitalized between April 2014 and March 2015 in four middle-sized acute-care hospitals in Shizuoka, Kochi, Fukuoka, and Saga Prefectures and used them as reference standards. The sensitivity and specificity of DPC data in identifying 16 diseases and 10 common procedures were identified. The accuracy of SS-MIX data for 13 laboratory test results was also examined. The specificity of diagnoses in the DPC data exceeded 96%, while the sensitivity was below 50% for seven diseases and variable across diseases. When limited to primary diagnoses, the sensitivity and specificity were 78.9% and 93.2%, respectively. The sensitivity of procedure records exceeded 90% for six procedures, and the specificity exceeded 90% for nine procedures. Agreement between the SS-MIX data and the chart reviews was above 95% for all 13 items. The validity of diagnoses and procedure records in the DPC data and laboratory results in the SS-MIX data was high in general, supporting their use in future studies. Copyright © 2017 The Authors. Production and hosting by Elsevier B.V. All rights reserved.

  6. Seroprevalencia de leptospirosis y características asociadas en agricultores de arroz de una región tropical del Perú

    Directory of Open Access Journals (Sweden)

    Jorge O Alarcón-Villaverde

    Full Text Available Objetivos . Estimar la seroprevalencia de leptospirosis en agricultores dedicados al cultivo de arroz del valle del Alto Mayo, región San Martín e identificar anticuerpos para los serovares circulantes y los factores asociados a la infección. Materiales y métodos. Se realizó un estudio transversal entre octubre y noviembre de 2010 en una muestra de 254 agricultores procedentes de las once comisiones de regantes del valle de Alto Mayo. Se recolectó una muestra de sangre y se aplicó un cuestionario que incluyó variables sociodemográficas, y características del hogar y del trabajo. Se determinó la presencia de anticuerpos contra leptospira usando la prueba de microaglutinación y ELISA IgM. Resultados. La seroprevalencia determinada por microaglutinación fue del 64,6% (IC 95%: 58,6-70,6. La prueba ELISA IgM fue reactiva en 15,0% (IC 95%: 10,5-19,5. Los tipos de serovar más frecuentes fueron Icterohaemorrhagiae, Autumnalis, Australis , Panama y Grippotyphosa. Los factores asociados independientemente fueron la manipulación de roedores (OR ajustado [ORa] de 7,9, IC 95%: 1,6-37,9, trabajar descalzo (ORa de 2,9, IC 95%: 1,2-6,8 y el sexo masculino (ORa de 4,5, IC 95%: 1,3-15,3. Conclusiones . El valle del Alto Mayo es un área hiperendémica de leptospirosis. Los factores asociados más importantes fueron la práctica de trabajar descalzo y la de manipular roedores en los campos de cultivo. En consecuencia, se recomienda implementar intervenciones que incidan en estos dos factores a fin de reducir el riesgo de infección en los cultivadores de arroz.

  7. Familial Mediterranean Fever: Diagnosing as Early as 3 Months of Age

    Directory of Open Access Journals (Sweden)

    Gonca Keskindemirci

    2014-01-01

    Full Text Available Familial Mediterranean Fever is an autosomal recessive disease. Major symptoms of disease are recurrent fever accompanied by serositis attacks. The disease is usually diagnosed before 20 years of age. Symptoms related to FMF are noted when children become more verbal, usually after 2 years of age. In this case report, the youngest patient with the diagnosis of FMF is presented. She was consulted to pediatric rheumatology for the high acute phase response and fever. It was learned that her mother had recurrent swelling of her ankle joints. Mutation analysis was performed and two homozygous mutations (M694V and R202Q were identified. She was diagnosed as FMF at 3 months of age and colchicine was started. She responded to colchicine. Her uncontrolled acute phase response declined gradually. This case was reported to point out the importance of early remembrance of autoinflammatory diseases even at very early ages especially at endemic countries.

  8. Risk of progression from mild memory impairment to clinically diagnosable Alzheimer's disease in a Japanese community (from the Nakayama Study).

    Science.gov (United States)

    Sonobe, Naomi; Hata, Ryuji; Ishikawa, Tomohisa; Sonobe, Kantaro; Matsumoto, Teruhisa; Toyota, Yasutaka; Mori, Takaaki; Fukuhara, Ryuji; Komori, Kenjiro; Ueno, Shu-Ichi; Tanimukai, Satoshi; Ikeda, Manabu

    2011-06-01

    Memory impairment has been proposed as the most common early sign of Alzheimer's disease (AD). The aims of this work were to evaluate the risk of progression from mild memory impairment/no dementia (MMI/ND) to clinically diagnosable AD in a community-based prospective cohort and to establish the risk factors for progression from MMI/ND to AD in the elderly. Elderly subjects aged over 65 years were selected from the participants in the first Nakayama study. MMI/ND was defined as memory deficit on objective memory assessment, without dementia, impairment of general cognitive function, or disability in activities of daily living. A total of 104 MMI/ND subjects selected from 1242 community-dwellers were followed longitudinally for five years. During the five-year follow-up, 11 (10.6%) subjects were diagnosed with AD, five (4.8%) with vascular dementia (VaD), and six (5.8%) with dementia of other etiology. Logistic regression analysis revealed that diabetes mellitus (DM) and a family history of dementia (within third-degree relatives) were positively associated with progression to AD, while no factor was significantly associated with progression to VaD or all types of dementia. DM and a family history of dementia were significant risk factors for progression from MMI/ND to clinically diagnosable AD in the elderly in a Japanese community.

  9. Spatial scale effects in environmental risk-factor modelling for diseases

    Directory of Open Access Journals (Sweden)

    Ram K. Raghavan

    2013-05-01

    Full Text Available Studies attempting to identify environmental risk factors for diseases can be seen to extract candidate variables from remotely sensed datasets, using a single buffer-zone surrounding locations from where disease status are recorded. A retrospective case-control study using canine leptospirosis data was conducted to verify the effects of changing buffer-zones (spatial extents on the risk factors derived. The case-control study included 94 case dogs predominantly selected based on positive polymerase chain reaction (PCR test for leptospires in urine, and 185 control dogs based on negative PCR. Land cover features from National Land Cover Dataset (NLCD and Kansas Gap Analysis Program (KS GAP around geocoded addresses of cases/controls were extracted using multiple buffers at every 500 m up to 5,000 m, and multivariable logistic models were used to estimate the risk of different land cover variables to dogs. The types and statistical significance of risk factors identified changed with an increase in spatial extent in both datasets. Leptospirosis status in dogs was significantly associated with developed high-intensity areas in models that used variables extracted from spatial extents of 500-2000 m, developed medium-intensity areas beyond 2,000 m and up to 3,000 m, and evergreen forests beyond 3,500 m and up to 5,000 m in individual models in the NLCD. Significant associations were seen in urban areas in models that used variables extracted from spatial extents of 500-2,500 m and forest/woodland areas beyond 2,500 m and up to 5,000 m in individual models in Kansas gap analysis programme datasets. The use of ad hoc spatial extents can be misleading or wrong, and the determination of an appropriate spatial extent is critical when extracting environmental variables for studies. Potential work-arounds for this problem are discussed.

  10. SEROLOGICAL AND MOLECULAR SURVEY OF Leptospira spp. AMONG CART HORSES FROM AN ENDEMIC AREA OF HUMAN LEPTOSPIROSIS IN CURITIBA, SOUTHERN BRAZIL

    Directory of Open Access Journals (Sweden)

    Mariane Angélica Finger

    2014-12-01

    Full Text Available Introduction: Cart horses are a re-emerging population employed to carry recyclable material in cities. Methods: Sixty-two horses were sampled in an endemic area of human leptospirosis. The microscopic agglutination test (MAT and real-time polymerase chain reaction (qPCR were performed. Results: A seropositivity of 75.8% with serovar Icterohaemorrhagiae in 80.8% of the horses was observed. Blood and urine were qPCR negative. MAT showed positive correlations with rainfall (p = 0.02 and flooding (p = 0.03. Conclusions: Although horses may be constantly exposed to Leptospira spp. in the environment mostly because of rainfall and flooding, no leptospiremia or leptospiruria were observed in this study.

  11. GERD: Diagnosing and treating the burn.

    Science.gov (United States)

    Alzubaidi, Mohammed; Gabbard, Scott

    2015-10-01

    Gastroesophageal reflux disease (GERD) is chronic, very common, and frequently encountered in internal medicine and subspecialty clinics. It is often diagnosed on clinical grounds, but specialized testing such as endoscopy and pH monitoring may be necessary in certain patients. Although proton pump inhibitors (PPIs) are the mainstay of treatment, clinicians should be aware of their short-term and long-term side effects. Copyright © 2015 Cleveland Clinic.

  12. Genetic impact on cognition and brain function in newly diagnosed Parkinson’s disease: ICICLE-PD study

    Science.gov (United States)

    Rowe, James B.; Winder-Rhodes, Sophie E.; Hampshire, Adam; Owen, Adrian M.; Breen, David P.; Duncan, Gordon W.; Khoo, Tien K.; Yarnall, Alison J.; Firbank, Michael J.; Chinnery, Patrick F.; Robbins, Trevor W.; O’Brien, John T.; Brooks, David J.; Burn, David J.; Barker, Roger A.

    2014-01-01

    activation associated with memory encoding. This study demonstrates that neurocognitive deficits are common even in recently diagnosed patients with Parkinson’s disease, and that the associated regional brain activations are influenced by genotype. These data further support the dual syndrome hypothesis of cognitive change in Parkinson’s disease. Longitudinal data will confirm the extent to which these early neurocognitive changes, and their genetic factors, influence the long-term risk of dementia in Parkinson’s disease. The combination of genetics and functional neuroimaging provides a potentially useful method for stratification and identification of candidate markers, in future clinical trials against cognitive decline in Parkinson’s disease. PMID:25080285

  13. Photostress Testing Device for Diagnosing Retinal Disease

    Directory of Open Access Journals (Sweden)

    Elizabeth Swan

    2014-08-01

    Full Text Available Retinal diseases such as Age-Related Macular Degeneration (ARMD affect nearly one in three elderly patients. ARMD damages the central vision photoreceptors in the fovea. The Photostress Test is a simple technique for testing for the early effects of ARMD. Here, the illumination sources in a novel self-administered Photostress Testing device were modeled for safety and distribution in illumination software. After satisfying the design constraints in the model, a prototype of the illumination system was fabricated and tested to confirm the modeling results. The resultant prototype can be used to aid in the diagnosis of retinal disease and is well within retinal safety levels.

  14. Agreement between death-certificate and autopsy diagnoses among atomic-bomb survivors

    International Nuclear Information System (INIS)

    Ron, E.; Carter, R.L.; Jablon, S.; Mabuchi, Kiyohiko.

    1993-11-01

    Using the Atomic Bomb Casualty Commission/Radiation Effects Research Foundation series of over 5000 autopsies, we examined death-certificate accuracy for several disease categories and assessed the effect of potential modifying factors on this accuracy. For 12 cause-of-death categories, the overall percent agreement between death-certificate and autopsy diagnoses was only 52.5%. Although neoplasms had the highest detection rate (on the death certificate) in the study, still almost 25% of cancers diagnosed at autopsy were missed on the death certificate. Only for neoplasms and external causes of death were confirmation and detection rates above 70%. Confirmation rates were between 50% and 70% for infectious and parasitic diseases and heart and other vascular diseases. Detection rates reached a similar level for infectious and parasitic, cerebrovascular, and digestive diseases. Specificity rates were above 90% for all but the cerebrovascular disease category. Overall agreement decreased with increasing age of the decedents and was lower for deaths occurring outside of hospital vs those occurring in a hospital. There was some suggestion that agreement rates were higher for more-recent deaths but no indication that radiation dose, sex, city of residence, or inclusion in a biennial clinical-examination program influenced agreement. Because the inaccuracy of death-certificate diagnoses can have major implications for many aspects of health research and planning, it is important to be aware that death-certificate accuracy is low and can vary widely depending on the patient's age at death and the place of death. (J.P.N.)

  15. Exploring Rural Disparities in Medical Diagnoses Among Veterans With Transgender-related Diagnoses Utilizing Veterans Health Administration Care.

    Science.gov (United States)

    Bukowski, Leigh A; Blosnich, John; Shipherd, Jillian C; Kauth, Michael R; Brown, George R; Gordon, Adam J

    2017-09-01

    Research shows transgender individuals experience pronounced health disparities compared with their nontransgender peers. Yet, there remains insufficient research about health differences within transgender populations. This study seeks to fill this gap by exploring how current urban/rural status is associated with lifetime diagnosis of mood disorder, alcohol dependence disorder, illicit drug abuse disorder, tobacco use, posttraumatic stress disorder, human immunodeficiency virus, and suicidal ideation or attempt among veterans with transgender-related diagnoses. This study used a retrospective review of The Department of Veterans Affairs (VA) administrative data for transgender patients who received VA care from 1997 through 2014. Transgender patients were defined as individuals that had a lifetime diagnosis of any of 4 International Classification of Diseases-9 diagnosis codes associated with transgender status. Independent multivariable logistic regression models were used to explore associations of rural status with medical conditions. Veterans with transgender-related diagnoses residing in small/isolated rural towns had increased odds of tobacco use disorder (adjusted odds ratio=1.39; 95% confidence intervals, 1.09-1.78) and posttraumatic stress disorder (adjusted odds ratio=1.33; 95% confidence intervals, 1.03-1.71) compared with their urban transgender peers. Urban/rural status was not significantly associated with other medical conditions of interest. This study contributes the first empirical investigations of how place of residence is associated with medical diagnoses among veterans with transgender-related diagnoses. The importance of place as a determinant of health is increasingly clear, but for veterans with transgender-related diagnoses this line of research is currently limited. The addition of self-reported sex identity data within VA electronic health records is one way to advance this line of research.

  16. Leptospira interrogans in Rodents from Cape Verde.

    Science.gov (United States)

    Plata-Luis, Josué; Foronda, Pilar; Martín-Alonso, Aaron; Feliu, Carlos; Alves, Joana; Gil, Horacio; Valladares, Basilio

    2016-11-01

    Leptospirosis is an important worldwide zoonotic disease that can infect both animals and humans. In most cases, leptospirosis is a nonspecific self-limiting illness, but some patients can develop a severe form with a high mortality. This study was carried out in Santiago Island, Cape Verde, in 2012-2013. A total of 62 wild rodents (Rattus rattus and Mus domesticus) were analyzed. The lipL32 gene, present only in pathogenic Leptospira spp., was amplified by PCR, and 16 samples were positive (25.8%). In both rodent species, Leptospira interrogans was identified. The results show the presence of pathogenic Leptospira in the three localities analyzed in Santiago. The presence of L. interrogans demonstrates a serious health risk for the population, since this species has been associated with the most severe form of leptospirosis, the Weil's disease in humans, a severe infection with jaundice, renal failure, and hemorrhage.

  17. Dominant Fecal Microbiota in Newly Diagnosed Untreated Inflammatory Bowel Disease Patients

    Directory of Open Access Journals (Sweden)

    Lill Therese Thorkildsen

    2013-01-01

    Full Text Available Our knowledge about the microbiota associated with the onset of IBD is limited. The aim of our study was to investigate the correlation between IBD and the fecal microbiota for early diagnosed untreated patients. The fecal samples used were a part of the Inflammatory Bowel South-Eastern Norway II (IBSEN II study and were collected from CD patients (n=30, UC patients (n=33, unclassified IBD (IBDU patients (n=3, and from a control group (n=34. The bacteria associated with the fecal samples were analyzed using a direct 16S rRNA gene-sequencing approach combined with a multivariate curve resolution (MCR analysis. In addition, a 16S rRNA gene clone library was prepared for the construction of bacteria-specific gene-targeted single nucleotide primer extension (SNuPE probes. The MCR analysis resulted in the recovery of five pure components of the dominant bacteria present: Escherichia/Shigella, Faecalibacterium, Bacteroides, and two components of unclassified Clostridiales. Escherichia/Shigella was found to be significantly increased in CD patients compared to control subjects, and Faecalibacterium was found to be significantly reduced in CD patients compared to both UC patients and control subjects. Furthermore, a SNuPE probe specific for Escherichia/Shigella showed a significant overrepresentation of Escherichia/Shigella in CD patients compared to control subjects. In conclusion, samples from CD patients exhibited an increase in Escherichia/Shigella and a decrease in Faecalibacterium indicating that the onset of the disease is associated with an increase in proinflammatory and a decrease in anti-inflammatory bacteria.

  18. Prevalence of leptospiral DNA among wild rodents from a selected area in Beguk Dam Labis, Segamat, Johor, Malaysia.

    Science.gov (United States)

    Latifah, I; Rahmat, M S; Hayarti, K B; Paramasvaran, S; Azizah, M R; Imran, F; Normaznah, Y

    2012-12-01

    Leptospirosis is an emerging infectious disease. The differential diagnosis of leptospirosis is difficult due to the varied and often "flu like" symptoms which may result in a missed or delayed diagnosis. Leptospira is the aetiological agent of leptospirosis, a bacterial zoonosis with worldwide distribution. There are over 230 known serovars in the genus Leptospira. The true prevalence of leptospirosis in Malaysia is unknown or underestimated. Our goal was to determine the prevalence for Leptospira infection in rodents in a selected area in Beguk Dam Labis, Segamat, Johor. A study was carried out on 69 serum samples of trapped wild rodents. DNA was extracted from the sera using Leptospira PCR kit (Shanghai ZJ Bio-Tech Co., Ltd). Of 69 rodent serum samples tested by PCR, 9 (13%) showed positive results. In this study we found that (13%) of wild rodents caught in Beguk Dam Labis were infected by Leptospira.

  19. Experiences of Batswana women diagnosed with both HIV/AIDS and cervical cancer

    Directory of Open Access Journals (Sweden)

    T. Molefe

    2009-09-01

    Full Text Available The central phenomenon of interest to the authors was the experiences of Batswana women who have been diagnosed with both HIV/AIDS and cervical cancer. They wanted to know how these women and their families coped with the burden of the two ‘fatal’ diseases. This interest was brought about by the current surge in cervical cancer cases in the country, and the relationship between the two diseases. There is scant literature on the experiences of women with the dual diagnosis of HIV/AIDS and cervical cancer. The purpose of the study was to explore the experiences of Batswana women who are diagnosed with both HIV/AIDS and cervical cancer. The research question was ‘What are the experiences of Batswana women diagnosed with both HIV/AIDS and cervical cancer?’ A phenomenological descriptive qualitative research design was therefore appropriate to answer the research question. Semi-structured interviews and field notes were used to collect data. One-to-one interviews were conducted with six women diagnosed with the two diseases. Both convenience and purposive sampling techniques were used in selection of participants. The seven procedural steps proposed by Collaizi (1978 were utilized in data analysis as the study was based on the phenomenology approach. The findings revealed that HIV/AIDS and cervical cancer are chronic illnesses that can instill chronic emotional pain. Reactions to diagnosis with these diseases include pain, fear or intense sadness. Coping with these conditions can be facilitated by different strategies such as acceptance, having hope, support from others and positive thinking. Support can come from children, family members, informal or formal groups and health service providers.

  20. ACUTE CHOLECYSTITIS AS AN UNUSUAL PRESENTATION OF SCRUB TYPHUS: A REPORT OF TWO CASES AND REVIEW OF THE LITERATURE.

    Science.gov (United States)

    Charoenphak, Sirima; Rattanawong, Pattara; Sungkanuparph, Somnuek

    2017-01-01

    Scrub typhus rarely presents with acute cholecystitis. We present 2 cases of scrub typhus with cholecystitis. The first patient is a 62 year old female who presented to the hospital with fever and body aches for 1 week and right upper quadrant abdominal pain for 3 days. She gave a history of an insect bite 2 weeks previously. She was diagnosed as having acute cholecystitis and underwent cholecystectomy. She continued with fever post-operatively and physical examination revealed an eschar. She had an immunofluorescence assay (IFA) performed that revealed a high IgM titer for Orientia tsutsugamushi. She was diagnosed as having scrub typhus, treated with doxycycline and she recovered completely. The second patient also presented to the hospital with a 1 week history of fever and upper quadrant abdominal pain. She was diagnosed with having cholecystitis. Her symptoms did not improve with intravenous antibiotics and further investigation revealed elevated titers for O. tsutsugamushi and Leptospira interrogans. She was diagnosed as having a co-infection of scrub typhus and leptospirosis and treated with doxycycline. She recovered completely. Patients from scrub typhus endemic regions who present with acute cholecystitis but do not respond to traditional treatment should be tested for scrub typhus and leptospirosis and should have a careful admission physical examination looking for eschar formation, since scrub typhus may present with acute cholecystitis.