Information

Can Leptospirosis be spread through human urine


I am wondering if Leptospirosis can be spread via the urine of an infected human individual. All of the sources I have been able to find on the web have stated that the disease is primarily spread through infected animal urine, however, none of them mention human urine.

However, Wikipedia states:

After 7 to 10 days the microorganism can be found in fresh urine

Which would imply that it could be spread via the urine of an infected individual?


It can be spread from human to human through urine but it is very rare seeing as we are relatively clean creatures (most of the time) and our excrement hardly ever comes into contact with other individuals without first being purified.

Sources:


Increase in Leptospirosis Disease in Sea Lions

The Marine Mammal Center is seeing a large number of leptospirosis cases in California sea lions this year and is leading a study to determine when and why the sea lions contract this disease. Every four to five years, the Center sees a surge in the number of sea lions admitted as a result of this bacterial infection that affects the kidneys and can be lethal for patients.

The current research will focus on the factors contributing to these cycles of disease so that scientists will have an understanding of how the disease spreads and what the risks are to sea lions and other animals. Recently, the Center began taking blood samples, tagging, and releasing wild juvenile California sea lions in the Bay Area as part of the new research study.

"The blood samples our team will collect from wild California sea lions will help them determine kidney function and exposure rates among these animals," said Dr. Jeffrey Boehm, Executive Director at The Marine Mammal Center. "The data will also help us understand more about the susceptibility of sea lions in the population during an epidemic and clarify the relationship between the stranded sea lions with leptospirosis we see here at the Center and those that are susceptible in the population."

Leptospirosis epidemics were first documented in California sea lions in the early 1970s and are caused by spiral shaped bacteria called leptospires. Many different animal species, including humans, carry the bacterium which can leech into water or soil and survive there for weeks to months. Humans and animals can become infected through contact with contaminated urine, water, or soil. If not treated, the patient can develop kidney damage, meningitis, liver failure, and respiratory distress. The Marine Mammal Center advises beach goers and their dogs to stay away from marine mammals they may encounter on beaches and to call the Center's 24-hour response line at (415) 289-SEAL should they come across any marine mammal in distress.

Collaborators in this new study include the National Oceanic Atmospheric Administration, University of California Los Angeles, University of California at Davis, Penn State University and the National Animal Disease Center in Ames, Iowa.

Story Source:

Materials provided by The Marine Mammal Center. Note: Content may be edited for style and length.


15.22D: Leptospirosis

Leptospirosis (also known as Weil&rsquos Syndrome, canicola fever, canefield fever, nanukayami fever, 7-day fever, Rat Catcher&rsquos Yellows, Fort Bragg fever, black jaundice, and Pretibial fever) is caused by bacteria of the genus Leptospira, and affects humans as well as other animals. Symptoms can range from none to mild such as headaches, muscle pains, and fevers to severe with bleeding from the lungs or meningitis. If the infection causes the person to turn yellow, have kidney failure and bleeding it is then known as Weil&rsquos disease. If the infection causes lots of bleeding from the lungs it is known as severe pulmonary haemorrhage syndrome.

Figure: Leptospira bactera that cause Leptospirosis: Scanning electron micrograph of a number of Leptospira sp. bacteria atop a 0.1 µm polycarbonate filter.

Leptospirosis is among the world&rsquos most common diseases transmitted to people from animals. The infection is commonly transmitted to humans by allowing water that has been contaminated by animal urine to come in contact with unhealed breaks in the skin, eyes, or mucous membranes. Outside of tropical areas, leptospirosis cases have a relatively distinct seasonality, with most cases occurring in spring and autumn.

Leptospirosis is caused by a spirochaete bacterium called Leptospira spp. There are at least five serotypes of importance in the United States and Canada, all of which cause disease in dogs (Icterohaemorrhagiae, Canicola, Pomona, Grippotyphosa, and Bratislava).There are other (less common) infectious strains as well. Leptospirosis is transmitted by the urine of an infected animal and is contagious as long as it is still moist. Although rats, mice, and moles are important primary hosts, a wide range of other mammals (including dogs, deer, rabbits, hedgehogs, cows, sheep, raccoons, opossums, skunks, and certain marine mammals) are able to carry and transmit the disease as secondary hosts. Dogs may lick the urine of an infected animal off the grass or soil or drink from an infected puddle.

Figure: Leptospirosis in kidney: Photomicrograph of kidney tissue, using a silver staining technique, revealing the presence of Leptospira bacteria.

There have been reports of &ldquohouse dogs&rdquo contracting leptospirosis from licking the urine of infected mice that enter the house. The type of habitats most likely to carry infectious bacteria are muddy riverbanks, ditches, gullies, and muddy livestock-rearing areas where there is regular passage of either wild or farm mammals. There is a direct correlation between the amount of rainfall and the incidence of leptospirosis, making it seasonal in temperate climates and year-round in tropical climates. Leptospirosis is also transmitted by the semen of infected animals. Humans become infected through contact with water, food, or soil containing urine from these infected animals. This may result from swallowing contaminated food and water or through skin contact. The disease is not known to be spread from person to person, and cases of bacterial dissemination in convalescence are extremely rare in humans. Leptospirosis is common among water-sport enthusiasts in specific areas, as prolonged immersion in water is known to promote the entry of the bacteria. Surfers and whitewater paddlers are at especially high risk in areas that have been shown to contain the bacteria, and can contract the disease by swallowing contaminated water, splashing contaminated water into their eyes or nose, or exposing open wounds to infected water.


Is leptospirosis specific to Chile or a general challenge in Latin America, and possibly other tropical countries, around the world?

Leptospirosis is, in fact, classified as the zoonotic disease with the greatest global distribution. It is a major problem in tropical countries or in areas affected by flooding, as it spreads more easily through water. In Chile, leptospirosis is considered an emerging disease, and was incorporated into the Ministry of Health Decree No. 158 of Obligatory Declaration Diseases in July 2002.[3]

Currently, 80 percent of the nation&rsquos milk is produced in a high rainfall area, which is a characteristic that aids the prevalence of leptospirosis in dairy cattle and the environment.

The tropical countries of Latin America, such as Brazil, Africa and Southeast Asia, such as Thailand, recognize this disease as a public health issue. Since leptospirosis is generally confused with diseases such as influenza, malaria, dengue, yellow fever or hantavirus, it&rsquos a challenge to reduce its impact on the population.[4]


Human disease leptospirosis identified in new species, the banded mongoose, in Africa

Banded mongoose troops are radio-collared and tracked across the landscape in Botswana. Credit: B. Fairbanks, Virginia Tech

(Medical Xpress)—The newest public health threat in Africa, scientists have found, is coming from a previously unknown source: the banded mongoose. Leptospirosis, the disease is called. And the banded mongoose carries it.

Leptospirosis is the world's most common illness transmitted to humans by animals. It's a two-phase disease that begins with flu-like symptoms. If untreated, it can cause meningitis, liver damage, pulmonary hemorrhage, renal failure and death.

"The problem in Botswana and much of Africa is that leptospirosis may remain unidentified in animal populations but contribute to human disease, possibly misdiagnosed as other diseases such as malaria," said disease ecologist Kathleen Alexander of Virginia Tech.

With a grant from the National Science Foundation's (NSF) Coupled Natural and Human Systems Program, Alexander and colleagues found that the banded mongoose in Botswana is infected with Leptospira interrogans, the pathogen that causes leptospirosis.

Coupled Natural and Human Systems is part of NSF's Science, Engineering and Education for Sustainability investment and is supported by NSF's Directorates for Biological Sciences Geosciences and Social, Behavioral and Economic Sciences.

"The transmission of infectious diseases from wildlife to humans represents a serious and growing public health risk due to increasing contact between humans and animals," said Alan Tessier, program director in NSF's Division of Environmental Biology. "This study identified an important new avenue for the spread of leptospirosis."

The results are published today in a paper in the journal Zoonoses and Public Health. The paper was co-authored by Alexander, Sarah Jobbins and Claire Sanderson of Virginia Tech.

The banded mongoose, although wild, lives in close proximity to humans, sharing scarce water resources and scavenging in human waste.

The disease-causing pathogen it carries can pass to humans through soil or water contaminated with infected urine.

Mongoose and other species are consumed as bushmeat, which may also contribute to leptospirosis exposure and infection in humans.

"I was convinced that we were going to find Leptospira interrogans in some species in the ecosystem," said Alexander.

Mongoose, along with other species such as warthogs, are experts at finding human trash. Credit: P. Laver, Virginia Tech

"The pathogen had not been reported previously in Botswana, with the exception of one cow more than a quarter of a century ago.

"We looked at public health records dating back to 1974 and there were no records of any human cases of leptospirosis. Doctors said they were not expecting to see the disease in patients. They were not aware that the pathogen occurred in the country."

Alexander conducted a long-term study of human, wildlife and environmental health in the Chobe District of Northern Botswana, an area that includes the Chobe National Park, forest reserves and surrounding villages.

"This pathogen can infect many animals, both wild and domestic, including dogs," said Jobbins. "Banded mongoose is likely not the only species infected."

The researchers worked to understand how people, animals and the environment are connected, including the potential for diseases to move between humans and wildlife.

"Diseases such as leptospirosis that have been around for a very long time are often overlooked amid the hunt for the next newly emerging disease," Alexander said.

Leptospirosis was first described in 1886, said Jobbins, "but we still know little about its occurrence in Africa."

With the new identification of leptospirosis in Botswana, Alexander is concerned about the public health threat it may pose to the immunocompromised population there. Some 25 percent of 15- to 49-year-olds are HIV positive.

"In much of Africa, people die without a cause being determined," she said.

"Leptospirosis is likely affecting human populations in this region. But without knowledge that the organism is present in the environment, overburdened public health officials are unlikely to identify clinical cases in humans, particularly if the supporting diagnostics are not easily accessible."

The researchers looked for Leptospira interrogans in archived kidneys collected from banded mongoose that had been found dead from a variety of causes. Of the sampled mongoose, 43 percent tested positive for the pathogen.

"Given this high prevalence in the mongoose, we believe that Botswana possesses an as-yet-unidentified burden of human leptospirosis," said Jobbins.

"There is an urgent need to look for this disease in people who have clinical signs consistent with infection."

Because banded mongoose have an extended range across sub-Saharan Africa, the results have important implications for public health beyond Botswana.

"Investigating exposure in other wildlife, and assessing what species act as carriers, is essential for improving our understanding of human, wildlife, and domestic animal risk of leptospirosis in this ecosystem," the scientists write in their paper.

The paper also cites predictions that the region will become more arid, concentrating humans and animals around limited water supplies and increasing the potential for disease transmission.

"Infectious diseases, particularly those that can be transmitted from animals, often occur where people are more vulnerable to environmental change and have less access to public health services," said Alexander.

"That's particularly true in Africa. While we're concerned about emerging diseases that might threaten public health—the next new pandemic—we need to be careful that we don't drop the ball and stop pursuing important diseases like leptospirosis."

Alexander is working to identify immediate research and management actions—in particular, alerting frontline medical practitioners and public health officials to the potential for leptospirosis in humans.


Introduction

It is estimated that over 60% of the western families own a pet. The majority of these households keep a dog. Dogs have been kept as pets for over 14 centuries. Many studies have confirmed the precious roles of pets in the human life. Evidence has shown that owning a pet can increase the activity of pet owners and consequently reduced serum cholesterol, low triglyceride levels, and fewer cardiovascular events [1,2]. Also, some other studies demonstrated that pet owners suffer from depression and mental stress less and have a higher self esteem compared to others. Although dogs have several positive effects on the psychosocial and psychical health of their owners, many diseases among humans are attributed to them [3]. Children and immunocompromised individuals are especially at an increased risk of developing zoonoses infections. Several studies demonstrated that domestic dogs have a dramatic role in developing zoonoses disease and hospitalization [4,5].

Regarding domestic dogs, the increase in the population of stray and semi domestic dogs in urban areas has increased the risk of zoonoses diseases. About 5 million people throughout the world are annually bitten by dogs. Many parasitic and zoonotic pathogens are transmitted by dogs [6,7]. This review focused on the most important viral and bacterial zoonotic diseases, which can be transmitted by dogs.

Rabies is a single strand RNA virus belonging to the Rhabdoviridae family. Rabies infection is an ancient disease with a high mortality rate in human and animal population. Based on the World Health Organization reports, annually between 30000 and 70000 deaths occurred throughout the world due to rabies infection [8]. Dogs are the major animal reservoirs for rabies infection. The majority of the infected patients in developing countries are infected by dog bites while, in developed countries, wild animals including raccoons, bats and foxes are the main cause for rabies transmission [9]. In a study in the United States, a rabies control program was conducted by using extensive vaccination in domestic dogs and reducing the rabies infection [8]. The incubation period for rabies varies between 4 days to several years depending on the location of the inoculating wound and the amount of induced viruses. Patients may present agitation, anxiety, confusion, hallucination, and hydrophobia. Post exposure prophylaxis with frequent doses of human rabies immunoglobulin (HRIG) within 14 days after the suspected dog bite can prevent the disease. Washing the wound with water and liquid soap can dramatically reduce the viral lead and consequently the probability of rabies infection [10].

Noroviruses

Noroviruses are a heterogeneous single strand RNA virus belonging to the Caliciviridae family. Noroviruses are the main cause of sporadic and epidemic gastroenteritis in humans [11]. This virus can affect humans of all ages. The virus can be found in the gastrointestinal tract and consequently in the feces or diarrhea of the infected dogs. It can be transmitted from contaminated food or water to humans and the infection can rapidly spread in the human population by fecal oral rate. Serum therapy should be considered for patients with acute gastroenteritis [12].

Pasteurella

Pasteurella species are Gram-negative coccobacilli, which were primarily found in animals. Pasteurella spp are normal flora of the upper respiratory tract of dogs and cats. Pasteurella infection can be transmitted to humans by direct and indirect contact such as dog or cat bites or licks and even cat scratches [6]. Several infectious diseases in humans are attributed to Pasteurella spp. The soft tissue infection is the most important infection transmitted by Pasteurella spp. However, meningitis, bone and joint infections and respiratory infection can be transmitted by Pasteurella spp [13]. In a prospective study in United States, the author demonstrated that Pasteurella spp. was the most frequent organism isolated from dog and cat bites [2]. Pasteurella infection can be treated by second and third generation cephalosporin, macrolides, fluoroquinolones, cotrimoxazole, and penicillin [14].

Salmonella species are anaerobic and motile gram-negative bacilli that colonize in the large intestine of a variety of mammals, especially in the distal part of the colon and the mesenteric lymph nodes of the canine. Humans can also get infected through the gastrointestinal tract [fecal transmission] and develop several infectious diseases such as gastroenteritis, enteric fever, bacteremia and osteomyelitis. Gastrointestinal diseases are the most prevalent clinical presentations of salmonella in human and dogs however, the majority of infected animals or humans is asymptomatic and may shed the pathogen through feces for a period of 6 weeks and transmit the pathogen to other animals or individuals. In developing nations, Salmonella spp. is also more prevalent than in developed countries [15,16]. An antibiogram should be considered for patients infected with Salmonella spp. however, it could be treated by various families of antibiotics including fluoroquinolones, beta-lactams, and macrolides [17].

Brucellosis is one of the most prevalent zoonoses, which imposes a heavy burden on the national health services. It is commonly transmitted to humans by consuming unpasteurized dairy products. Various types of brucella spp. have been recognized that resulted in human brucellosis such as B. melitensis, B. abortus and B. suis but, B. canis has been less known as an usual pathogen in brucellosis infection in humans [18,19]. Although B. canis is not responsible for the brucellosis infection in humans, the reported cases were more often seen among farmer populations who had a history of exposure to body fluids of dogs, which were infected with B. canis. The incubation period may last for one to four weeks up to several months [19]. The patients may be asymptomatic or may even present serious clinical symptoms especially fever, night sweats and low back pain in the endemic region that should be differentiated from tuberculosis and other malignancies [20]. Brucellosis should be treated in order to avoid complications and sequelae of the disease. Combination therapies, which are widely employed in the treatment of brucellosis, consisted of doxycycline plus streptomycin or rifampin for 6 weeks [21].

Yersinia enterocolitica

Y. enterocolitica is a gram-negative coccobacillus zoonotic pathogen that causes yersiniosis in human and animals. Several animals are main reservoirs for Y. enterocolitica including birds, pigs, deer, and cattle. The pathogen has been isolated from dog bite wound in some studies [22]. The patients may be asymptomatic in early stage and when the pathogen invades the mucosal surface of the intestine, watery or bloody diarrhea may be present. The pathogen can also involve the peyer’s patches and represent the appendicitis symptoms [23,24]. Y. enterocolitica is mostly a self-limiting disease that does not need antibiotic therapy, however, patients with severe infection and immunocompromised patients should be treated with a combination of an aminoglycoside and doxycycline [24].

Campylobacter

Campylobacter spp. including campylobacter jejuni and campylobacter coli are gram-negative bacteria that usually result in campylobacter enteritis. This organism normally lives in the gastrointestinal tract of many animals. Direct contact with infected animals or their products is a leading cause of campylobacter transmission. Dogs and puppies are the major reservoirs for campylobacter. For example, in a study it was demonstrated that about 47% of the fecal specimens of dogs’ campylobacter was isolated [25,26]. The incubation period in campylobacter enteritis varies from one to seven days. Most of the patients present fever, vomiting, diarrhea, and abdominal pain. Also, bloody diarrhea may be present in more than 50 percent of the infected patients. Convulsion and seizure may be observed in some patients [27]. This infection is usually self-limited and does not need antimicrobial therapy. Focus on correction of electrolyte imbalance and hydration should be considered. Antibiotic therapy with fluoroquinolones, macrolides, or aminoglycosides is indicated in patients with severe disease [28].

Capnocytophaga

Capnocytophaga canimorsus is a gram-negative bacterium, which is found in the normal flora of the oropharyngeal tract of dogs and cats. The pathogen is mostly transmitted to human by dogs bite and causes an overwhelming sepsis, particularly in elderly, immunocompromised or asplenic patients [25]. The pathogen can also lead to other fatal infections including meningitis, osteomyelitis, arthritis, lung abscess or empyema and endocarditis. In addition, thrombotic thrombocytopenic purpura and hemolytic uremic syndrome can be associated with capnocytophaga septicemia especially in immunocompromised patients [25,29]. The literature data have demonstrated that the mortality rate due to capnocytophaga septicemia is estimated to be of one third of the infected patients. Accordingly, early empirical therapy with third generation cephalosporins in patients who received a dog bite should be considered [30].

Bordetella bronchiseptica

Bordetella bronchiseptica is a gram-negative rod bacterium belonging to the genus Bordetella. The pathogen normally lives in the upper respiratory tract of the mammals such as dogs and cats and is transmitted to humans by aerosol. B. bronchiseptica can lead to acute tracheobronchitis in dogs, which presents with harsh and kennel cough [31,32]. Human infection with B. bronchiseptica is very rare however, the pathogen can also cause pneumonia and upper respiratory tract infection in dog owners [33]. Evidences demonstrated that this organism is resistant to macrolides and cephalosporins however, in several studies, the organism was sensitive to fluoroquinolones and Trimethoprim/ sulfamethoxazole [34].

Coxiella burnetii

C. burnetii is an obligate intracellular gram-negative bacterium that causes Q fever in humans. The pathogen normally infects individuals via aerosol and direct contact with the body fluids of the infected animals. Although dogs are not the main reservoirs for C. burnetii, however, in a study it was demonstrated that C. burnetii was isolated from approximately 10 percent of farm dogs [35]. In addition, in another study by Buhariwalla and colleagues, it was reported that C. burnetii could be transmitted to human from an infected parturient dog. In addition, the patients developed the symptoms of Q fever including fever, chills, nausea, vomiting and productive cough. Opacity is a common finding in chest radiography, and, in physical examination, crackles may be heard during auscultation. The incubation period in this study was estimated to be between 8 and 12 days after the exposure to the infected animal. The patients with C. burnetii can be treated with fluoroquinolones or doxycycline successfully [36].

L. interrogans is an aerobic spirochete, which is the major cause of Leptospirosis in human. Leptospirosis is worldwide zoonoses that are mostly transmitted to human by environmental sources including contaminated soil, water, urine, or tissue of the infected animals. Rodents are the major reservoirs for Leptospirosis however, domestic animals including dogs can play an important role in leptospirosis transmission in endemic regions [37]. Mucosal surfaces of the human body including eye, vagina, nose, mouth, or erosive lesions, which have a direct contact with the contaminated urine, are the main ways of Leptospirosis transmission. The incubation period for this infection is averagely of about 10 days (ranging from 2 to 26 days) [38,39]. Leptospirosis may present with a variety of symptoms from no symptom to fever, nonproductive cough, headache, musculoskeletal pain, diarrhea, nausea, vomiting, alveolar hemorrhage, and even meningitis [39]. Several antibiotics such as doxycycline, ceftriaxone, cefotaxime, penicillin, amoxicillin, and ampicilin have been successfully employed for the treatment of Leptospirosis [40].

Staphylococcus intermedius

S. intermedius is a gram-positive bacterium with a coagulase activity that normally lives in the anterior part of the nasal cavity of several animals such as dogs, pigeons, and horses. Some evidences demonstrated that this pathogen could also be isolated from the gingival of healthy dogs [41]. S. intermedius is not a common zoonotic pathogen in humans however, several studies demonstrated that this bacterium is a potential pathogen associated with dog bite wounds and cellulitis can develop in inflicted humans [42,43]. This pathogen should be discriminated from staphylococcus aureus. Penicillin and amoxicillin-clavulanate are effective in the treatment of this infection [44].

Methicillin resistance staphylococcus aureus

Methicillin resistance staphylococcus aureus (MRSA) is a major cause of fatal infection in humans. Several investigations have reported that this pathogen has been isolated from some animals such as pigs, horses, cattle, cats and dogs. Of them, some believed that companion animals were the main reservoirs for the transmission of MRSA, being able to transmit the bacterium by direct contact with their owners. However, it seems that animal to human infection of MRSA is more seen in immunocompromised patients. Nevertheless, some evidences showed that this bacterium could be transmitted to healthy humans who own an infected animal [45,46]. Traditional anti staphylococcal antibiotics are not more effective in the treatment of infections caused by MRSA. Accordingly, newer drugs including vancomycin, linezolid and daptomycin are widely used in the treatment of MRSA infections [47].


Leptospirosis diagnosis

Multiple diagnostic tests are available, and it is important to order the appropriate test(s) and understand their interpretation for each phase of the illness. Tests that detect the presence of bacteria (e.g., polymerase chain reaction [PCR], culture) will only yield positive results in the acute/bacteraemic phase. Tests that detect antibodies will produce positive results later, from days six to eight from illness onset for immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA), and from day 10 to 12 from illness onset for microscopic agglutination test (MAT). A confirmed case is based on culture or microscopic agglutination test (MAT), the gold standard tests in the acute/bacteremic and late/immune phases respectively 16) . Positive polymerase chain reaction (PCR) alone or immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA) alone are considered probable rather than confirmatory, but are nevertheless valuable for guiding clinical diagnosis in patients who present with suspected leptospirosis.

A ‘confirmed case’ requires definitive laboratory evidence of leptospirosis infection by one of the following:

  • Isolation of pathogenic Leptospira species
  • A fourfold or greater rise in Leptospira microscopic agglutination test (MAT) titer between acute-and convalescent-phase sera obtained at least two weeks apart, and preferably conducted at the same laboratory
  • A single Leptospira microscopic agglutination test (MAT) titer ≥400, supported by a positive ELISA IgM result.

In the acute/bacteraemic phase, blood should be collected for PCR (in a serum-separating tube) and IgM ELISA before commencing antibiotics. During the early acute/bacteraemic phase, IgM ELISA has lower sensitivity, compared with PCR,18 but the results are helpful in determining the phase of illness. Blood cultures should be taken if the specific culture medium is available (Ellinghausen–McCullough–Johnson–Harris medium).19 However, it is important to check the availability of the culture medium with the local pathology laboratory, and whether they are able to conduct cultures. Cultures are examined for six weeks by dark-field microscopy, so this method is generally not useful for informing immediate clinical management.

During the late/immune phase, when antibodies are present, both IgM ELISA and MAT tests should be requested. Reactive IgM ELISAs are sent to reference laboratories for confirmation by MAT. A convalescent sample should be collected 14 days later to confirm rising MAT titers, particularly if the initial IgM ELISA was reactive but MAT was found to be non-reactive. MAT combines diluted serum with a panel of serovars from different serogroups 17) . The World Health Organization’s (WHO’s) Leptospirosis Reference Laboratory, uses a routine panel of 22 serovars, which includes a representative from each major serogroup. Any history of overseas travel by the patient should be communicated to the laboratory so that appropriate serovars are included in the panel.

Depending on the clinical presentation, other relevant investigations should include full blood count, biochemistry, arterial blood gases, electrocardiography (ECG), chest X-ray and lumbar puncture. The most common laboratory findings in a patient with leptospirosis are neutrophilia and mildly abnormal liver function tests. Other possible investigation findings, depending on severity and complications, are summarized in Table 1.

Table 1. Possible investigation findings in leptospirosis, depending on severity and complications

InvestigationsFindings
Full blood countLeucocytosis, neutrophilia with left shift, lymphopenia, normochromic anaemia, thrombocytopenia
Urea, electrolytes, creatinineRaised urea and creatinine if renal impairment. Potassium is usually normal or low, high potassium is associated with poor outcomes (an indicator of impaired renal function, and might lead to arrhythmias). Low sodium
Liver function testsRaised bilirubin (mainly direct), may take time to resolve. Normal or raised liver enzymes. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are typically three to five times above normal, but could be much higher in cases with fulminant hepatic failure
UrinalysisProteinuria, microscopic haematuria, pyuria, granular casts
Creatine phosphokinaseRaised in patients with myalgia
CoagulationProthrombin time, partial thromboplastin time and international normalized ratio may be raised because of impaired liver function
Arterial blood gasesLow partial pressure of O2 (PaO2), arterial O2 saturation (SaO2), ratio of partial pressure arterial oxygen and fraction of inspired oxygen (PaO2/FiO2) ratio, metabolic acidosis (ie low pH, low HCO3)
ElectrocardiographAtrial fibrillation, supraventricular or ventricular extrasystoles, atrioventricular block, other arrhythmias
Chest X-rayVariable findings, including alveolar infiltrates, nodular densities and consolidation. Changes could be diffuse or lobar, unilateral or bilateral. Findings could represent a range of pathology, including alveolar haemorrhage, acute respiratory distress syndrome, pulmonary oedema
Lumbar punctureNeutrophilic or lymphocytic pleocytosis, mild elevations in protein, normal glucose

Leptospirosis test

Antibodies for leptospirosis develop between 3-10 days after symptom onset, thus any serologic test must be interpreted accordingly – negative serologic test results from samples collected in the first week of illness do not rule out disease, and serologic testing should be repeated on a convalescent sample collected 7-14 days after the first.

In the acute phase of illness, leptospires are present in the blood (septicemia) for approximately the first 4–6 days of illness.

Leptospires may be shed intermittently in the urine after approximately the first week of illness onset. Due to the transience of leptospires in body fluids, a negative polymerase chain reaction (PCR) test does not rule out leptospisosis.

It is best to submit as many specimen types as possible. Recommended specimens based on collection timing:

  • Acute illness (first week): whole blood and serum
  • Convalescent illness (after first week): serum +/- urine

Supportive diagnostic tests

IgM-based commercial assays, such as

IgM assays are screening tests and results should be confirmed using one of the confirmatory methods below.

Confirmatory diagnostic tests

1) Microscopic agglutination test (MAT) — confirmatory serologic testing, available at Centers for Disease Control and Prevention (CDC)

  • Acute and convalescent serum samples collected 7–14 days apart is ideal.
  • If only one serum sample can be sent for testing, a sample collected after the first 7–10 days of illness is preferred.

2) Polymerase chain reaction (PCR) – available at Centers for Disease Control and Prevention (CDC) and some commercial labs

  • Whole blood collected in the first week of illness (in the first 4 days is ideal)
  • Urine (collected at least 1 week after symptom onset is ideal)
  • Cerebrospinal fluid from a patient with signs of meningitis
  • Fresh frozen kidney and/or liver (if available from deceased patients) — kidney preferred

3) Pathology (immunohistochemistry) — available at CDC


06/ First Aid treatment

Treatment for leptospirosis has the most chance of success if it begins as soon as exposure to infection is known or suspected.

It is important to display first aid advice in work areas, provide a first aid kit, and follow first aid procedures. A readily available supply
of clean water is important when exposure is known or suspected.

Look after your health. As soon as there is exposure to urine or infection is suspected:

  • dry off the urine splash straight away (leptospires tend to dry out easily), then wash the area
  • wash out fresh or old cuts and grazes with water and disinfectant, and dry well
  • flush out your mouth and eyes, and any exposed skin, with lots of running water
  • wash your hands and face well:
    • taking particular care with facial hair
    • using soap and water, and drying thoroughly

    See a doctor within 24 hours of suspected exposure or if flu-like symptoms develop, to get a blood sample and antibiotic treatment.
    Tell the doctor that leptospirosis may be the cause of your illness – some doctors may not be familiar with the symptoms.

    Treatment options will depend on the severity and duration of the symptoms. There is no firm evidence about how effective antibiotic treatment is 9 however, there is agreement that early antibiotic treatment (with doxycycline or amoxicillin) should be given if infection is strongly suspected. 10

    The blood sample MUST be taken before medication is taken, and a subsequent sample may be needed 3-4 weeks later. All patients with severe infection or signs of meningitis should be sent to hospital immediately.

    9 Brett-Major D.M., Coldren R. (2012). Antibiotics for leptospirosis. Cochrane Review cited in Leptospirosis in New Zealand: an overview of clinical best practice. ACC Review 54 . Retrieved December 2014 from: www.acc.co.nz .

    10 Day, N. (2014). Treatment and prevention of leptospirosis. Topic 5524 version 7.0 cited in Leptospirosis in New Zealand: an overview of clinical best practice. ACC Review 54 . Retrieved December 2014 from: www.acc.co.nz .


    Human disease leptospirosis identified in new species, the banded mongoose, in Africa

    The newest public health threat in Africa, scientists have found, is coming from a previously unknown source: the banded mongoose.

    Leptospirosis, the disease is called. And the banded mongoose carries it.

    Leptospirosis is the world's most common illness transmitted to humans by animals. It's a two-phase disease that begins with flu-like symptoms. If untreated, it can cause meningitis, liver damage, pulmonary hemorrhage, renal failure and death.

    "The problem in Botswana and much of Africa is that leptospirosis may remain unidentified in animal populations but contribute to human disease, possibly misdiagnosed as other diseases such as malaria," said disease ecologist Kathleen Alexander of Virginia Tech.

    With a grant from the National Science Foundation's (NSF) Coupled Natural and Human Systems Program, Alexander and colleagues found that the banded mongoose in Botswana is infected with Leptospira interrogans, the pathogen that causes leptospirosis.

    Coupled Natural and Human Systems is part of NSF's Science, Engineering and Education for Sustainability investment and is supported by NSF's Directorates for Biological Sciences Geosciences and Social, Behavioral and Economic Sciences.

    "The transmission of infectious diseases from wildlife to humans represents a serious and growing public health risk due to increasing contact between humans and animals," said Alan Tessier, program director in NSF's Division of Environmental Biology. "This study identified an important new avenue for the spread of leptospirosis."

    The results are published today in a paper in the journal Zoonoses and Public Health. The paper was co-authored by Alexander, Sarah Jobbins and Claire Sanderson of Virginia Tech.

    The banded mongoose, although wild, lives in close proximity to humans, sharing scarce water resources and scavenging in human waste.

    The disease-causing pathogen it carries can pass to humans through soil or water contaminated with infected urine.

    Mongoose and other species are consumed as bushmeat, which may also contribute to leptospirosis exposure and infection in humans.

    "I was convinced that we were going to find Leptospira interrogans in some species in the ecosystem," said Alexander.

    "The pathogen had not been reported previously in Botswana, with the exception of one cow more than a quarter of a century ago.

    "We looked at public health records dating back to 1974 and there were no records of any human cases of leptospirosis. Doctors said they were not expecting to see the disease in patients. They were not aware that the pathogen occurred in the country."

    Alexander conducted a long-term study of human, wildlife and environmental health in the Chobe District of Northern Botswana, an area that includes the Chobe National Park, forest reserves and surrounding villages.

    "This pathogen can infect many animals, both wild and domestic, including dogs," said Jobbins. "Banded mongoose is likely not the only species infected."

    The researchers worked to understand how people, animals and the environment are connected, including the potential for diseases to move between humans and wildlife.

    "Diseases such as leptospirosis that have been around for a very long time are often overlooked amid the hunt for the next newly emerging disease," Alexander said.

    Leptospirosis was first described in 1886, said Jobbins, "but we still know little about its occurrence in Africa."

    With the new identification of leptospirosis in Botswana, Alexander is concerned about the public health threat it may pose to the immunocompromised population there. Some 25 percent of 15- to 49-year-olds are HIV positive.

    "In much of Africa, people die without a cause being determined," she said.

    "Leptospirosis is likely affecting human populations in this region. But without knowledge that the organism is present in the environment, overburdened public health officials are unlikely to identify clinical cases in humans, particularly if the supporting diagnostics are not easily accessible."

    The researchers looked for Leptospira interrogans in archived kidneys collected from banded mongoose that had been found dead from a variety of causes. Of the sampled mongoose, 43 percent tested positive for the pathogen.

    "Given this high prevalence in the mongoose, we believe that Botswana possesses an as-yet-unidentified burden of human leptospirosis," said Jobbins.

    "There is an urgent need to look for this disease in people who have clinical signs consistent with infection."

    Because banded mongoose have an extended range across sub-Saharan Africa, the results have important implications for public health beyond Botswana.

    "Investigating exposure in other wildlife, and assessing what species act as carriers, is essential for improving our understanding of human, wildlife, and domestic animal risk ofleptospirosisin this ecosystem," the scientists write in their paper.

    The paper also cites predictions that the region will become more arid, concentrating humans and animals around limited water supplies and increasing the potential for disease transmission.

    "Infectious diseases, particularly those that can be transmitted from animals, often occur where people are more vulnerable to environmental change and have less access to public health services," said Alexander.

    "That's particularly true in Africa. While we're concerned about emerging diseases that might threaten public health--the next new pandemic--we need to be careful that we don't drop the ball and stop pursuing important diseases like leptospirosis."

    Alexander is working to identify immediate research and management actions--in particular, alerting frontline medical practitioners and public health officials to the potential for leptospirosis in humans.

    The research was also funded by the WildiZe Foundation. Jobbins and Sanderson were supported in part by Virginia Tech's Fralin Life Science Institute.


    Vaccines the tugboat for prevention-based animal production

    20.5.1.5 Leptospirosis

    Leptospirosis is a neglected zoonotic disease of humans and animals, caused by Leptospira spp. ( Bharti et al., 2003 ). The disease is characterized by fever, icterus, vomiting, dysentery, dehydration, petechiae of pleura, hemoglobinuria, and grayish white focal necrotic lesions of kidneys. Leptospirosis is a major public health important disease in developing, improvised countries and causes huge production loss in animal husbandry. Current vaccines used for immunization are based on whole cell killed preparation (bacterin), cell membrane extract, and purified outer envelope ( Bolin et al., 1991 Cullen et al., 2002 Bharti et al., 2003 ). Most killed vaccines are of animal use while very few are licensed for human use. The immunity of Leptospira is serovar-specific and there are so many types of serovars present worldwide therefore multivalent bacterin formulations having locally prevalent serovar are used for immunization of cattle, pigs, and dogs worldwide ( Bolin et al., 1991 ). Some recombinant vaccines based on outer membrane proteins, leptospira immunoglobuline-like proteins, and lipoproteins of leptospira were also experimentally evaluated but none of them are available for immunization purpose ( Silveira et al., 2017 Faine et al., 1999 Levett, 2001 ).


    National Science Foundation - Where Discoveries Begin

    Scientists find widespread but neglected disease is significant health threat in Botswana


    Banded mongoose troops are radio-collared and tracked across the landscape in Botswana.

    May 14, 2013

    This material is available primarily for archival purposes. Telephone numbers or other contact information may be out of date please see current contact information at media contacts.

    The newest public health threat in Africa, scientists have found, is coming from a previously unknown source: the banded mongoose.

    Leptospirosis, the disease is called. And the banded mongoose carries it.

    Leptospirosis is the world's most common illness transmitted to humans by animals. It's a two-phase disease that begins with flu-like symptoms. If untreated, it can cause meningitis, liver damage, pulmonary hemorrhage, renal failure and death.

    "The problem in Botswana and much of Africa is that leptospirosis may remain unidentified in animal populations but contribute to human disease, possibly misdiagnosed as other diseases such as malaria," said disease ecologist Kathleen Alexander of Virginia Tech.

    With a grant from the National Science Foundation's (NSF) Coupled Natural and Human Systems Program, Alexander and colleagues found that the banded mongoose in Botswana is infected with Leptospira interrogans, the pathogen that causes leptospirosis.

    Coupled Natural and Human Systems is part of NSF's Science, Engineering and Education for Sustainability investment and is supported by NSF's Directorates for Biological Sciences Geosciences and Social, Behavioral and Economic Sciences.

    "The transmission of infectious diseases from wildlife to humans represents a serious and growing public health risk due to increasing contact between humans and animals," said Alan Tessier, program director in NSF's Division of Environmental Biology. "This study identified an important new avenue for the spread of leptospirosis."

    The results are published today in a paper in the journal Zoonoses and Public Health. The paper was co-authored by Alexander, Sarah Jobbins and Claire Sanderson of Virginia Tech.

    The banded mongoose, although wild, lives in close proximity to humans, sharing scarce water resources and scavenging in human waste.

    The disease-causing pathogen it carries can pass to humans through soil or water contaminated with infected urine.

    Mongoose and other species are consumed as bushmeat, which may also contribute to leptospirosis exposure and infection in humans.

    "I was convinced that we were going to find Leptospira interrogans in some species in the ecosystem," said Alexander.

    "The pathogen had not been reported previously in Botswana, with the exception of one cow more than a quarter of a century ago.

    "We looked at public health records dating back to 1974 and there were no records of any human cases of leptospirosis. Doctors said they were not expecting to see the disease in patients. They were not aware that the pathogen occurred in the country."

    Alexander conducted a long-term study of human, wildlife and environmental health in the Chobe District of Northern Botswana, an area that includes the Chobe National Park, forest reserves and surrounding villages.

    "This pathogen can infect many animals, both wild and domestic, including dogs," said Jobbins. "Banded mongoose is likely not the only species infected."

    The researchers worked to understand how people, animals and the environment are connected, including the potential for diseases to move between humans and wildlife.

    "Diseases such as leptospirosis that have been around for a very long time are often overlooked amid the hunt for the next newly emerging disease," Alexander said.

    Leptospirosis was first described in 1886, said Jobbins, "but we still know little about its occurrence in Africa."

    With the new identification of leptospirosis in Botswana, Alexander is concerned about the public health threat it may pose to the immunocompromised population there. Some 25 percent of 15- to 49-year-olds are HIV positive.

    "In much of Africa, people die without a cause being determined," she said.

    "Leptospirosis is likely affecting human populations in this region. But without knowledge that the organism is present in the environment, overburdened public health officials are unlikely to identify clinical cases in humans, particularly if the supporting diagnostics are not easily accessible."

    The researchers looked for Leptospira interrogans in archived kidneys collected from banded mongoose that had been found dead from a variety of causes. Of the sampled mongoose, 43 percent tested positive for the pathogen.

    "Given this high prevalence in the mongoose, we believe that Botswana possesses an as-yet-unidentified burden of human leptospirosis," said Jobbins.

    "There is an urgent need to look for this disease in people who have clinical signs consistent with infection."

    Because banded mongoose have an extended range across sub-Saharan Africa, the results have important implications for public health beyond Botswana.

    "Investigating exposure in other wildlife, and assessing what species act as carriers, is essential for improving our understanding of human, wildlife, and domestic animal risk of leptospirosis in this ecosystem," the scientists write in their paper.

    The paper also cites predictions that the region will become more arid, concentrating humans and animals around limited water supplies and increasing the potential for disease transmission.

    "Infectious diseases, particularly those that can be transmitted from animals, often occur where people are more vulnerable to environmental change and have less access to public health services," said Alexander.

    "That's particularly true in Africa. While we're concerned about emerging diseases that might threaten public health--the next new pandemic--we need to be careful that we don't drop the ball and stop pursuing important diseases like leptospirosis."

    Alexander is working to identify immediate research and management actions--in particular, alerting frontline medical practitioners and public health officials to the potential for leptospirosis in humans.

    The research was also funded by the WildiZe Foundation. Jobbins and Sanderson were supported in part by Virginia Tech's Fralin Life Science Institute.


    Scientist Kathleen Alexander studies disease transmission in villages in Botswana.
    Credit and Larger Version

    Mongoose, along with other species such as warthogs, are experts at finding human trash.
    Credit and Larger Version

    Residents aren't the only people to meet up with a banded mongoose tourists do too.
    Credit and Larger Version

    Banded mongoose share the Botswana landscape with humans leptospirosis often follows.
    Credit and Larger Version

    Researcher Sarah Jobbins works in a field laboratory in Botswana, testing for leptospirosis.
    Credit and Larger Version

    Media Contacts
    Cheryl Dybas, NSF, (703) 292-7734, email: [email protected]
    Lynn Davis, Virginia Tech, (540) 231-6157, email: [email protected]

    Related Websites
    NSF Science, Engineering and Education for Sustainability Investment: http://www.nsf.gov/sees
    NSF Publication: Discoveries in Sustainability: http://www.nsf.gov/pubs/2012/disco12001/disco12001.pdf
    Conservation of African Resources, Animals, Communities And Land Use: http://www.caracal.info

    The U.S. National Science Foundation propels the nation forward by advancing fundamental research in all fields of science and engineering. NSF supports research and people by providing facilities, instruments and funding to support their ingenuity and sustain the U.S. as a global leader in research and innovation. With a fiscal year 2021 budget of $8.5 billion, NSF funds reach all 50 states through grants to nearly 2,000 colleges, universities and institutions. Each year, NSF receives more than 40,000 competitive proposals and makes about 11,000 new awards. Those awards include support for cooperative research with industry, Arctic and Antarctic research and operations, and U.S. participation in international scientific efforts.


    Scientist Kathleen Alexander studies disease transmission in villages in Botswana.
    Credit and Larger Version

    Mongoose, along with other species such as warthogs, are experts at finding human trash.
    Credit and Larger Version

    Residents aren't the only people to meet up with a banded mongoose tourists do too.
    Credit and Larger Version

    Banded mongoose share the Botswana landscape with humans leptospirosis often follows.
    Credit and Larger Version

    Researcher Sarah Jobbins works in a field laboratory in Botswana, testing for leptospirosis.
    Credit and Larger Version