Leptospirosis: predictores de mala evolución clínica en pacientes hospitalizados, 25 años de experiencia / Leptospirosis: predictors of poor outcomes in hospitalized patients, 25 years of experience

Introducción: La leptospirosis es una zoonosis que cons-tituye un problema emergente de salud pública. La insufi-ciencia renal, plaquetopenia y compromiso respiratorio se describen como predictores de mortalidad.Objetivos: Describir características clínicas, radiológicas y de laboratorio de individuos hospitalizados por leptos-pirosis y evaluar los predictores de mala evolución clínica (MEC).Materiales y métodos: Estudio de cohorte de inclusión ambispectiva de pacientes con leptospirosis internados en un hospital de la ciudad de Santa Fe entre 1997 y 2022. Se definió MEC como la admisión a Unidad de Cuidados Intensivos (UCI), requerimiento de asistencia respiratoria mecánica (ARM) y/o muerte. Se utilizaron las pruebas de Chi2, test T de Student o la U de Mann-Whitney, según co-rrespondiera. Se construyó una regresión logística binaria con las variables con p<0,05.Resultados: 101 pacientes, 87,1% (n=88) hombres, media-na de edad de 29 (RIC 20-44) años. La fiebre fue el síntoma más frecuente [83,2% (n=84)], seguido del compromiso di-gestivo [62,4% (n=63)]. Las alteraciones de laboratorio más frecuentes fueron: eritrosedimentación elevada [91,9% (n=79)] y leucocitosis [61% (n=61)]. Se observó MEC en el 25,7% (n=26). El 25,7% (n=26) fue admitido en UCI, el 13,9% (n=14) requirió ARM y el 5% (n=5) falleció. La presencia de plaquetopenia (OR=13,3, IC95% 2-80), las alteraciones en la radiografía de tórax (OR=33,5, IC95% 5-225) y la ausencia de cefalea (OR=6,8, IC95% 1-32) fueron predictores inde-pendientes de MEC.Conclusiones: En concordancia con la bibliografía, la afec-tación pulmonar y plaquetopenia son factores de riesgo para la mala evolución clínica. En nuestra serie, la cefalea constituyó un síntoma protector

Introduction: Leptospirosis is an emerging zoonotic di-sease that poses a public health problem. Renal failu-re, thrombocytopenia, and respiratory involvement have been described as predictors of mortality.Objectives: To describe the clinical, radiological, and la-boratory characteristics of hospitalized individuals with leptospirosis and evaluate predictors of poor clinical outcomes (PCO).Materials and methods: A prospective cohort study was conducted including patients with leptospirosis admit-ted to a hospital in the city of Santa Fe between 1997 and 2022. PCO was defined as admission to the Intensive Care Unit (ICU), requirement for mechanical respiratory assistance (MRA), and/or death. The chi-square test, Student>s t-test, or Mann-Whitney U test were used as appropriate. A binary logistic regression was performed with variables having p<0.05.Results: Out of the 101 patients included, 87.1% (n=88) were male, with a median age of 29 (IQR 20-44) years. Fever was the most common symptom [83.2% (n=84)], followed by digestive involvement [62.4% (n=63)]. The most frequent laboratory abnormalities were elevated erythrocyte sedimentation rate [91.9% (n=79)] and leuko-cytosis [61% (n=61)]. PCO was observed in 25.7% (n=26) of patients, with 25.7% (n=26) admitted to the ICU, 13.9% (n=14) requiring MRA, and 5% (n=5) resulting in death. The presence of thrombocytopenia (OR=13.3, 95% CI 2-80), abnormalities in chest X-rays (OR=33.5, 95% CI 5-225), and absence of headache (OR=6.8, 95% CI 1-32) were predictors of PCO. Conclusions: Consistent with the literature, pulmonary involvement and thrombocytopenia are independent risk factors for poor clinical outcomes. In our series, the pre-sence of headache was a protective symptom

Molecular detection of leptosipira in synanthropic and wild rodents from Villavicencio municipality, Colombia / Detección molecular de leptospiras en roedores del municipio de Villavicencio, Colombia

Introduction: Rodents are potential transmitters of Leptospira spp. In the municipality of Villavicencio, Colombia, leptospirosis is a disease that, although notifiable, is still underreported. In this region, rodent species that can host pathogenic leptospira remain unknown. Objective: To detect the presence of Leptospira spp. through molecular analysis in rodents (Rodentia) from peri-urban and rural areas belonging to the municipality of Villavicencio in Colombia. Methods: Peri-urban and rural areas of the townships belonging to Villavicencio municipality were selected for sampling. These areas presented similar ecological conditions: they were near water bodies and peridomiciliary areas, and some of them included fields of agricultural crops. Rodents´ kidneys were removed and frozen in liquid nitrogen. DNA was extracted using a commercial kit and subsequently amplified through conventional polymerase chain reaction. Results: The rodent species collected were: Rattus rattus, Mus musculus, Zygodontomys brevicauda, Oligoryzomys sp, Hylaeamys (formerly Oryzomys) and Proechimys cf. oconnelli. Leptospira DNA was amplified in six rodents and the purified amplicons were sent to Macrogen Inc. (Seoul, Korea) for sequencing. The alignment analysis of the sequenced products demonstrated 98.64 percent of coverage and identity with Leptospira interrogans. Conclusions: This is the first study carried out on wild and synanthropic rodents in the municipality of Villavicencio. The incidence of leptospirosis raises the alarm due to the important role of these small mammals in the transmission of this zoonosis, which is considered the second cause, after dengue, of undifferentiated febrile illness in Villavicencio(AU)

Introducción: Los roedores son potenciales transmisores de Leptospira spp. En el municipio de Villavicencio, Colombia, la leptospirosis es una enfermedad que, aunque debe notificarse obligatoriamente, sigue subreportada. En esta región, algunas especies de roedores pueden ser reservorios de leptospiras patógenas, situación que se desconoce. Objetivo: Detectar la presencia de Leptospira spp. a través del análisis molecular en roedores (Rodentia) de áreas periurbanas y rurales del municipio de Villavicencio, Colombia. Métodos: Para el trampeo se seleccionaron áreas periurbanas y rurales de las veredas pertenecientes al municipio de Villavicencio. Las áreas escogidas presentaban condiciones ecológicas similares: cerca de cuerpos de agua y áreas peridomiciliarias; algunas de ellas localizadas en campos de cultivos de la agricultura. Se extirparon los riñones de los roedores y se conservaron en nitrógeno líquido. Se extrajo el ADN usando un estuche comercial y posteriormente se amplificó mediante reacción en cadena de la polimerasa convencional. Resultados: Las especies de roedores colectadas fueron: Rattus rattus, Mus musculus, Zygodontomys brevicauda, Oligoryzomys sp., Hylaeamys (ahora Oryzomys) y Proechimys oconnelli. El ADN de leptospira se amplificó en seis roedores y los amplicones purificados se enviaron a Macrogen Inc. (Seoul, Korea) para secuenciación. El análisis de alineamiento de los productos secuenciados demostró un 98,64 por ciento de cobertura e identidad con Leptospira interrogans. Conclusiones: Este es el primer estudio llevado a cabo en roedores silvestres y sinantrópicos en el municipio de Villavicencio. La incidencia de la leptospirosis genera una alarma con respecto a la importancia del papel de esos pequeños mamíferos en la transmisión de esta zoonosis, la cual es la segunda causa de los síndromes febriles indiferenciados en Villavicencio, después del dengue(AU)

Ocorrência de sorogrupos/sorovares de Leptospira spp. em cães com suspeita clínica de leptospirose em Santa Maria ­ RS / Occurrence of serogroups/serovars of Leptospira spp. in dogs with clinical suspicion of leptospirosis in Santa Maria ­ RS

A leptospirose é uma zoonose de distribuição mundial que pode acometer cães e ser altamente letal para a espécie. No Brasil, tal enfermidade tem caráter endêmico na espécie canina e configura-se como um sério problema de saúde pública. Objetivou-se verificar a ocorrência dos sorogrupos/sorovares de Leptospira spp. que mais acometem cães com suspeita clínica de leptospirose na cidade de Santa Maria ­ RS, Brasil, analisando sua titulação de anticorpos. No estudo, utilizou-se os laudos dos exames de soroaglutinação microscópica (SAM) para leptospirose de 218 cães provenientes da cidade de Santa Maria ­ RS durante o período de janeiro de 2015 a dezembro de 2019. Todos os laudos foram emitidos pelo Laboratório de Leptospirose (LabLepto - UFSM). Das 218 amostras de soro processadas nos cinco anos, 101 (46,33%) resultaram positivas para, pelo menos, um sorogrupo/sorovar testado. Este estudo demonstrou maior ocorrência do sorogrupo Icterohaemorrhagiae (53,37%) contemplado pelas sorovares Copenhageni e Icterohaemorrhagiae, com 49 (30,06%) e 38 (23,31%) soros reagentes, respectivamente. As titulações variaram de 100 a 6400, sendo que a mais recorrente encontrada nas amostras deste estudo foi 100, representando 47,85% dos títulos de anticorpos. Os dados obtidos neste estudo são de grande valia para o conhecimento dos sorogrupos/sorovares circulantes na região e sua epidemiologia podendo, inclusive, auxiliar para futuras formulações vacinais considerando sorogrupos/sorovares mais frequentemente detectados, contribuindo, assim, com a saúde pública.

Leptospirosis is a worldwide distribution zoonosis that can affect dogs and be highly lethal for the species. In Brazil, this disease is endemic in the canine species and represents a serious public health problem. The aim of this study was to verify the occurrence of Leptospira spp. that most affect dogs with clinical suspicion of leptospirosis in the city of Santa Maria ­ RS, Brazil, analyzing their antibody titers. In the study, we used the reports of microscopic agglutination tests (MAS) for leptospirosis in 218 dogs from the city of Santa Maria - RS during the period from January 2015 to December 2019. All reports were issued by the Leptospirosis Laboratory (LabLepto - UFSM). Of the 218 serum samples processed over the five years, 101 (46.33%) were positive for at least one serogroup/serovar tested. This study showed a higher occurrence of serogroup Icterohaemorrhagiae (53.37%) covered by serovars Copenhageni and Icterohaemorrhagiae, with 49 (30.06%) and 38 (23.31%) reagent sera, respectively. The titers ranged from 100 to 6400, and the most recurrent found in the samples in this study was 100, representing 47.85% of the antibody titers. The data obtained in this study are of great value for understanding the serogroups/serovars circulating in the region and their epidemiology, and may even contribute to future vaccine formulations considering the most frequently detected serogroups/serovars, thus contributing to public health.

Incidence of leptospirosis in Fujian province, 2015-2020 / 中华流行病学杂志

Objective: To analyze the incidence of leptospirosis in Fujian province from 2015 to 2020 and provide the scientific evidences for the risk assessment, prevention and control of leptospirosis. Methods: The incidence data of leptospirosis in Fujian during 2015-2020 were collected from China Information System for Disease Control and Prevention for a descriptive analysis, and software ArcGIS 10.3.1 was used for spatial autocorrelation analysis, and rats were captured in 17 surveillance areas during the same period, and the rat organs were collected for pathogen culture, the level of Leptospira antibody was detected in serum samples of rats, healthy population and the serum samples of patients sent by the hospitals. The infection status of Leptospira in human and rats were analyzed. Results: The incidence of leptospirosis in Fujian showed a downward trend from 2015 to 2020. A total of 176 cases of leptospirosis were reported. There were obvious seasonality and bimodal distribution. The majority of cases were farmers, accounting for 49.43% (87/176). Most cases were aged 30-69 years (85.80%, 151/176). The male to female ratio of the cases was 3.51∶1 (137∶39). Spatial autocorrelation analysis showed that leptospirosis had high or low clustering areas. From 2015 to 2020, the average capture rate of rats in 17 surveillance areas was 6.96% (1 519/21 838), Rattus losea, Rattus flavipectus and Niviventer fulvescens were the main species. The average positive rate of Leptospira antibody in rats was 28.64% (252/880). Java and Autumnalis were the predominant serogroups, accounting for 56.75% (143/252) and 17.46% (44/252), respectively. The average positive rate of Leptospira antibody in healthy population was 16.13% (254/1 575), and Autumnalis and Australis were the predominant serogroups, accounting for 71.65% (182/254). The confirmation rate of leptospirosis in patient serum samples sent by the hospitals was 2.23% (188/8 431), Autumnalis (56.38%, 106/188) and Hebdomadis (19.68%, 37/188) were the major serogroups. Conclusions: The incidence of leptospirosis in Fujian showed a downward trend from 2015 to 2020, there were obvious area clustering and seasonality. The high clustering areas were mainly distributed in northern, western and central Fujian. Java and Autumnalis were the predominant serogroups in rats. The infection rate in healthy population decreased year by year. Autumnalis and Hebdomadis were the main serogroups in population in Fujian.

Estudo retrospectivo da leptospirose canina em hospital veterinário escola no município de Londrina, Pr / Retrospective study of canine leptospirosis in a veterinary school hospital in the municipality of Londrina, Pr / Estudio retrospectivo de leptospirosis canina en un hospital veterinario escolar del municipio de Londrina, Pr

O objetivo do trabalho foi relatar a ocorrência de casos de cães com Leptospira spp. no Hospital Veterinário de Londrina. Foram avaliados 5.454 prontuários, durante os meses de janeiro a dezembro de 2016, e selecionados os que apresentaram solicitação de exame para Lepstopira por meio da técnica de campo escuro (CE). Nos positivos pela técnica CE dados sobre o sexo, sinais clínicos, endereço, data do atendimento e resultado na SAM foram coletados. A análise dos dados foi realizada pelo programa EpiInfo (7.2.3.1), dos 5.454 prontuários nos quais foi solicitado exame CE em 7,06% (385/5.454), e nesses, 13,76% (53/385) foi identificada a presença da espiroqueta. Dos animais positivos na técnica CE, 20,75% (11/53) foram reagentes na SAM. O sorovar Canicola foi o mais frequente em 90,91% (10/11) dos animais, apresentando títulos variados de 100 a 12.800. Para o sorovar Pomona 9,09% (1/11) dos animais apresentaram títulação de 100. Os sinais clínicos mais observados foram apatia em 58,49% (31/53), azotemia em 49,06% (26/53) e êmese em 49,06% (26/53) dos casos. Quanto ao sexo, os machos constituíram 71,70% dos casos e as fêmeas 28,30% (p=0,0015). Os resultados demonstraram a presença de Leptospira spp. entre os animais atendidos no hospital veterinário de Universidade Estadual de Londrina e reforçam a importância do sorovar Canicola entre os cães, visto que esse foi o mais frequente entre os sorovares e que apresentou os maiores títulos.(AU)

The purpose of this work is to report the occurrence of cases of dogs with Leptospira spp. at the Veterinary Hospital of Londrina. A total of 5,454 medical records were evaluated from January to December 2016, and data obtained from the examination for Lepstopira using the dark field technique (DF) were selected. In cases which were positive by the DF technique, data on gender, clinical signs, address, care data, and SAM results were collected. Data analysis was performed using the EpiInfo program (7.2.3.1). From the total 5,454 medical records in which DF examination was requested, in 7.06% (385/5.454), and from those, 13.76% (53/385) were positive for Leptospira. From the animals positive in the DF technique, 20.75% (11/53) were reactive in SAM. The Canicola serovar was the most prevalent, being present in 90.91% (10/11) of the animals, with titers ranging from 100 to 12,800. For the Pomona serovar, 9.09% (1/11) of the animals presented a title of 100. The most frequent clinical signs observed were apathy, in 58.49% (31/53); azotemia in 49.06% (26/53); and emesis in 49.06% (26/53) of the cases. As for gender, male animals constituted 71.70% of the cases and female 28.30% (p = 0.0015). The results demonstrated the presence of Leptospira spp. among animals treated at the Veterinary Hospital of the State University of Londrina which reinforces the importance of the Canicola serovar among dogs, since it was the serovar with the highest prevalence and highest titer found.(AU)

El objetivo de este trabajo fue reportar la ocurrencia de casos de perros con Leptospira spp. en el Hospital Veterinario de Londrina. Se evaluaron un total de 5.454 historias clínicas de enero a diciembre de 2016, y se seleccionó los que presentaron solicitud de examen de Lepstopira mediante la técnica de campo oscuro (CE). En los positivos por la técnica de CE se recogieron datos de sexo, signos clínicos, domicilio, fecha de atención y resultado en la SAM. El análisis de los datos se realizó mediante el programa EpiInfo (7.2.3.1), de las 5.454 historias clínicas en las que se solicitó examen CE en el 7,06% (385/5.454), y en estas, el 13,76% (53/385) se identificaron la de espiroqueta. De los animales positivos en la técnica CE, el 20,75% (11/53) fueron reactivos en la SAM. El serovar Canicola fue el más frecuente en el 90,91% (10/11) de los animales, con títulos que oscilaron entre 100 y 12.800. Para el serovar Pomona, el 9.09% (1/11) de los animales tuvo un título de 100. Los signos clínicos más observados fueron apatía en 58.49% (31/53), azotemia en 49.06% (26/53) y emesis en 49.06% (26/53) de los casos. Cuanto al sexo, los machos constituyeron el 71,70% de los casos y las hembras el 28,30% (p = 0,0015). Los resultados demostraron la presencia de Leptospira spp. entre los animales tratados en el Hospital Veterinario de la Universidad Estatal de Londrina y refuerzan la importancia del serovar Canicola entre los perros, ya que este fue el más frecuente entre los serovares y tuvo los títulos más altos.(AU)

First report of pathogenic Leptospira spp. in Tadaridabrasiliensis bats (family Molossidae) and Eptesicus furinalis (family Vespertilionidae) of Argentina. New host species in this country? / Primer reporte de Leptospira spp. patógena en murciélagos Tadaridabrasiliensis (familia: Molossidae) y Eptesicusfurinalis (familia: Vespertilionidae) en Argentina. ¿Nuevas especies hospedadoras en el país?

ABSTRACT Leptospirosis is an endemic disease caused byLeptospiraspp., a bacterium that affects animals and humans. In recent years, the number of reports of leptospirosis in wild animals has increased, which highlights the need to study the infectious agents in these animals. In this study, a duplex PCR for the detection of leptospiral DNA was performed on 50 kidney samples from bats, and a MAT (Microscopic Agglutination Test) for serological detection of anti-leptospiral antibodies was applied to 47 serum samples from bats from different regions of Buenos Aires Province, Argentina. DNA was extracted using Chelex-100 and duplex PCR was performed by targeting the detection of genessecYandflaB, of pathogenicLeptospiraspp. Of the 50 kidney samples, 3 were positive forEumopssp. andTadaridabrasiliensisby duplex PCR. Of the 47 serum samples, 12 were positive for different serovars:Leptospira interrogansserovars Icterohaemorrhagiae, Cynopteri and Bataviae, andLeptospira borgpeterseniiserovar Ballum. This is the first report of the detection of pathogenic leptospires by serology in bats belonging to theT. brasiliensisandEptesicus furinalisspecies in Argentina. In addition, this is the first report of the detection of pathogenic leptospiral DNA by PCR inT. brasiliensisspecies. The detection ofLeptospiraspp. in these wild animals shows that they may play an important role as wildlife reservoirs of leptospires.

RESUMEN La leptospirosis es una enfermedad endémica causada porLeptospiraspp., una bacteria que afecta a animales y a humanos. En los últimos años, el número de reportes de leptospirosis en animales silvestres ha aumentado, lo que resalta la necesidad de analizar los agentes infecciosos en estos animales. En este estudio, se aplicó una reacción en cadena de la polimerasa (PCR) dúplex para la identificación del ADN leptospiral en 50 muestras de riñones de murciélagos y la prueba de aglutinación microscópica (MAT) para la detección serológica de anticuerpos antileptospira en 47 muestras de suero de murciélagos de diferentes regiones de la provincia de Buenos Aires, Argentina. El ADN fue extraído usando Chelex-100 y la PCR dúplex estuvo dirigida a la detección de los genessecYyflaBdeLeptospiraspp. patógena. De las 50 muestras de riñón, tres resultaron positivas por PCR dúplex paraEumopssp. yTadaridabrasiliensis. De las 47 muestras de suero, 12 fueron positivas a diferentes serovares:LeptospirainterrogansserovaresIcterohaemorrhagiae, Cynopteri y Bataviae, yLeptospiraborgpeterseniiserovarBallum. Este es el primer reporte de detección de leptospiras patógenas por serología en murciélagos pertenecientes a las especiesT. brasiliensisyEptesicusfurinalisen Argentina. Además, también es el primero en la localización de ADN leptospiral por PCR en la especieT. brasiliensis.La identificación deLeptospiraspp. en estos animales silvestres muestra que pueden desempeñar un papel importante como reservorios de leptospiras en la fauna silvestre.

Leptospirose: Características da enfermidade em humanos e principais técnicas de diagnóstico laboratorial / Leptospirosis: Characteristics of the human disease and main laboratory diagnostic techniques

A leptospirose é a zoonose de maior distribuição geográfica, com estimativa de cerca de 60.000 mortes por ano. A doença é causada por bactérias do gênero Leptospira, que possui mais de 300 diferentes sorovares e 64 espécies já identificadas, sendo o ambiente a principal fonte de contaminação. A doença em humanos apresenta manifestações clínicas variadas e caráter bifásico, devendo ser confirmada por meio do diagnóstico laboratorial. O objetivo deste trabalho foi reunir conceitos atualizados sobre a leptospirose humana e as principais técnicas de diagnóstico laboratorial empregadas. A MAT é considerada o padrão-ouro para o diagnóstico da leptospirose, mas devido à baixa sensibilidade na fase inicial da doença é necessário o emprego de técnicas mais sensíveis neste período. Baseado em diversos estudos, as metodologias de PCR, ELISA-IgM e teste rápido apresentaram sensibilidade satisfatória nos primeiros dias após o início dos sintomas. Na segunda semana, a MAT apresentou 100% de sensibilidade, mantendo sua alta especificidade em ambas as fases. No geral, os testes sorológicos de ELISA-IgM e teste rápido apresentaram resultados satisfatórios como métodos de diagnóstico precoce, principalmente tratando-se de locais com pouca infraestrutura, diferente dos laboratórios de referência onde é possível empregar as técnicas de PCR e MAT.

Leptospirosis is the most widespread zoonosis, which has a balance of almost 60,000 deaths per year. Bacteria of Leptospira genus, which has more than 300 different serovars and 64 species already identified, cause the disease, being the environment the main source of contamination. The human disease presents a large set of clinical manifestations, showing biphasic presentation, the reason why leptospirosis must be confirmed by laboratory diagnosis. This study aimed to group recent concepts concerning human leptospirosis and the main diagnosis techniques employed at the laboratory. MAT is considered the gold standard for leptospirosis diagnosis, but has low sensitivity on the onset of disease, leading to the use of techniques with higher sensitivity on this period. Based on several studies, PCR, ELISA-IgM and rapid test presented satisfactory sensitivity on the onset of symptoms. In the second week, MAT showed 100% of sensitivity, maintaining its high specificity in both phases. In general, the ELISA-IgM and rapid serological tests showed satisfactory results as methods for early diagnosis, especially in the case of places with poor infrastructure, different from the reference laboratories where it is possible to use the PCR and MAT techniques.

Seroprevalencia de Leptospira spp. en equinos de tiro de comunidades indígenas mapuche de la Región de la Araucanía Chile / Seroprevalence of Leptospira spp. in draft horses from indigenous communities in the Araucanía Region, Chile

Resumen En la Región de la Araucanía no existen estudios sobre seroprevalencia de leptospirosis en equinos. Se analizaron muestras serológicas provenientes de 100 equinos de tiro de comunidades mapuche de cuatro comunas de la región mediante la técnica de microMAT. La seroprevalencia fue de 35% para al menos un serovar de Leptospira spp., siendo los serovares más frecuentes canicola (22%), grippotyphosa (21%), hardjo (13%) y pomona (10%). Se evidenció que las poblaciones equinas estudiadas están expuestas a la infección por Leptospira spp. y revelan un riesgo potencial de transmisión a sus propietarios.

Abstract In the Araucanía Region there are no studies on the seroprevalence of leptospirosis in horses. Serological samples from 100 draft horses from Mapuche communities of four communes in the region were analyzed using the microMAT technique. The seroprevalence was 35% for at least one serovar of Leptospira spp. being the most frequent serovars canicola (22%), grippotyphosa (21%), hardjo (13%) and pomona (10%). It was evident that the equine populations studied are exposed to infection by Leptospira spp. and reveal a potential risk of transmission to their owners.

Antibody prevalence of Leptospira spp. and Brucella abortus in domestic cats from Araguaína, Tocantins, North Region of Brazil / Prevalência de anticorpos para Leptospira spp. e Brucella Abortus em gatos domésticos de Araguaína, Tocantins, Região Norte do Brasil

Leptospira spp. and Brucella abortus are bacterial pathogens that can infect humans and animals. The present study aimed to detect anti-Leptospira and anti-B. abortus antibodies and verified the presence of factors associated with seropositivity in cats. One hundred and eighty serum samples were collected from domestic cats (Felis silvestris catus) from the urban area of the municipality of Araguaína-Tocantins by phlebocentesis of the cephalic and jugular veins. The samples were subjected to detection of anti-Leptospira and anti-B.abortus antibodies, respectively, by microscopic seroagglutination and buffered acidified antigen testing, followed by confirmation by the 2-mercaptoethanol test and slow seroagglutination in tubes. Data from the epidemiological questionnaire (the age, sex, origin, breed, and presence of clinical signs) were analyzed using Epi Info® software with seropositivity data found to search for associated factors using the chi-square test. In the present study, the prevalence of Leptospira spp. was 5.56% (10/180). However, no sample was reactive to B. abortus. None of the studied variables were associated with seropositivity for the pathogens evaluated. Therefore, there is contact between Leptospira spp. and the feline population of the municipality, indicating the possibility of the circulation of pathogenic serovars and that the presence of anti-Leptospira antibodies does not depend on the variables analyzed.

Leptospira spp. e Brucella abortus são patógenos bacterianos que podem infectar humanos e animais. O presente estudo teve como objetivo detectar anticorpos anti-Leptospira e anti-B.abortus e verificar a presença de fatores associados com a soropositividade em gatos. Foram coletadas 180 amostras de soro de gatos domésticos (Felis silvestris catus) da zona urbana do município de Araguaína-Tocantins por flebocentese das veias cefálica e jugular. As amostras foram submetidas à detecção de anticorpos anti-Leptospira e anti-B. abortus, respectivamente, por soroaglutinação microscópica e teste do antígeno acidificado tamponado, seguido de confirmação pelo teste de 2-mercaptoetanol e soroaglutinação lenta em tubos. Os dados do questionário epidemiológico (idade, sexo, procedência, raça e presença de sinais clínicos) foram analisados no software Epi Info® com os dados de soropositividade encontrados para pesquisa de fatores associados pelo teste do qui-quadrado. No presente estudo, a prevalência de Leptospira spp. foi de 5,56% (10/180). No entanto, nenhuma amostra foi reativa para B. abortus. Nenhuma das variáveis estudadas foi associada com a soropositividade para os patógenos avaliados. Portanto, há contato entre Leptospiraspp. e a população felina do município, indicando a possibilidade de circulação de sorovares patogênicos e que a presença de anticorpos anti-Leptospira independe das variáveis analisadas.

A molecular survey reveals high occurrence of co-infections in intensive pork production farms with increased rates of mummified swine fetuses in Southern Brazil / [Pesquisa molecular revela alta ocorrência de coinfecções em granjas de produção intensiva de suínos com altas taxas de mumificação fetal no sul do Brasil]

Neste estudo, 308 amostras de fetos mumificados foram testadas para parvovírus suíno (PPV), circovírus suíno tipos 2 e 3 (PCV2 e PCV3) e leptospiras patogênicas. A idade gestacional no momento da perda gestacional e a frequência da mumificação fetal de acordo com a ordem de parto também foram investigadas. As amostras foram coletadas em granjas comerciais de criação de suínos da região sul do Brasil que apresentassem taxas de mumificação fetal igual ou maiores a 2,5%. Fragmentos de pulmão, rim, fígado e coração de fetos suínos mumificados foram coletados para análise molecular. Resultados da PCR foram classificados de acordo com a região de origem das amostras, tendo Santa Catarina, Paraná e Rio Grande do Sul contabilizado 87 (28,25%), 89 (28,90%) e 132 (42,86%) do total de amostras de fetos suínos mumificados, respectivamente. Coinfecções foram observadas na maioria dos casos e PCV3 foi o agente mais prevalente detectado, encontrado em 298 amostras (96,75%). A maioria das perdas gestacionais foi observada entre 50 e 70 dias de gestação (168; 54,5%) e a mumificação fetal não foi associada à ordem de parto das matrizes. Os achados sugerem que as altas taxas de fetos suínos mumificados na região Sul do Brasil podem ser explicadas pela infecção com esses agentes virais.(AU)

Glucocorticoides en hemorragia alveolar por leptospira / Glucocorticoids in leptospira alveolar hemorrhage

Resumen Se presentan los casos clínicos de dos pacientes que ingresaron en la guardia de Emergencias del HIGA San Martín de La Plata con un cuadro clínico compatible con leptospirosis, que evolucionaron con insuficiencia respiratoria y hemorragia alveolar. En ambos se administraron glucocorticoides con buena evolución. Se realizó una búsqueda bibliográfica de artículos publicados desde 2005 en castellano e inglés y la revisión del tema. Basada en la evidencia actual no se puede hacer una clara recomendación para el uso de corticoides en la leptospirosis grave. La bibliografía publicada es escasa y de baja calidad. Aparentemente habría un beneficio en el uso de corticoides en los casos de afectación pulmonar por leptospirosis grave. Se necesitan estudios de alta calidad para realizar recomendaciones con evidencia científica, para verificar la dosis adecuada de corticoides, tiempo de inicio, duración del tratamiento y los casos en los que se debería administrar esta terapéutica.

Abstract We present the clinical cases of two patients who were admitted to the HIGA San Martín de La Plata emergency ward with a clinical picture compatible with leptospirosis, who evolved with respiratory failure and alveolar hemorrhage. In both, glucocorticoids were administered with good evolution. A bibliographic search of articles published since 2005 in Spanish and English and a review of the topic was carried out. Based on the current evidence, no clear recommendation can be made for the use of corticosteroids in severe leptospirosis. The published bibliography is scarce and of low quality. There would appear to be a benefit in the use of corticosteroids in cases of pulmonary involvement due to severe leptospirosis. High-quality studies are needed to make recommendations with scientific evidence, to verify the adequate dose of corticosteroids, time of initiation, duration of treatment and the cases in which this therapy should be administered.

Antibodies against Leptospira spp. in bovine serum samples from several Brazilian states analyzed in the period from 2007 to 2015 / [Anticorpos contra Leptospira spp. em amostra de soro bovino de diversos estados brasileiros analisados no período entre 2007 e 2015]

Bovine leptospirosis assumes great economic importance since it affects several production aspects. Therefore, knowledge about the occurrence and distribution of this disease is fundamental to adopt the correct prevention measures. The present study aimed to evaluate the frequency of anti-Leptospira spp. antibodies in 24,483 bovine serum samples received between 2007 to 2015 from 21 Brazilian states. Of these, 8,643 (35.3%) were reagents in the microscopic agglutination test to one or more serovars of Leptospira spp. The most frequent serovars were Wolffi (61.47%), Tarassovi (9.62%) and Pomona (7.20%). Hardjo serovar presented a prevalence of 6.27%. Among the 21 states analyzed, the State of Pernambuco had the highest frequency with 88.24% and the State of São Paulo was the origin of the largest number of analyzed samples (13,838), with a frequency of 31.54% of reagents. The results demonstrate a high exposure to several serovars of Leptospira spp. in bovine species in Brazilian states, showing the importance of adopting prophylactic measures in order to reduce the risk of infection in this specie.(AU)

Com o objetivo de avaliar a frequência de anticorpos anti-Leptospira spp., foram analisadas 24.483 amostras de soro sanguíneo bovino, provenientes de 21 estados brasileiros, recebidas no período de 2007 a 2015. Destas, 8.643 (35,3%) foram reagentes no teste de soroaglutinação microscópica a uma ou mais sorovariedades de Leptospira spp., e as sorovariedades com maior frequência foram Wolffi (61,47%), Tarassovi (9,62%) e Pomona (7,20%). A sorovariedade Hardjo apresentou prevalência de 6,27%. Entre os 21 estados analisados, o estado de Pernambuco apresentou a maior frequência, com 88,24%, e o estado de São Paulo foi a origem do maior número de amostras para análise, 13.838, com frequência de 31,54% de reagentes.(AU)

Monitoring of Leptospira in captive turtles by DNA analysis / [Monitoramento de Leptospira em quelônios mantidos em cativeiro pela análise de DNA]

Existem poucos estudos sobre doenças infecciosas em animais silvestres. O objetivo deste estudo foi pesquisar DNA de Leptospira spp. em sangue de tartarugas mantidas em cativeiro, pertencentes ao Bosque Rodrigues Alves (Jardim Zoobotânico da Amazônia). O DNA foi isolado das amostras de sangue coletadas de 148 tartarugas pertencentes a seis espécies diferentes. A reação em cadeia da polimerase (PCR) foi realizada utilizando-se iniciadores específicos para DNA de Leptospira spp. Nenhuma das amostras apresentou resultado positivo para Leptospira spp.(AU)

Risk factors for leptospirosis and brucellosis in people living with human immunodeficiency virus who attended a referral hospital in southeastern Brazil

Abstract INTRODUCTION: Leptospirosis and brucellosis cause immunosuppression that worsens the clinical condition of people living with HIV/AIDS (PLWHA). We investigated the serological profile and risk factors of PLWHA. METHODS: Serum samples (n=238) were researched for Brucella spp. antibodies using Rose Bengal and tube agglutination tests and Leptospira spp. antibodies using the microscopic agglutination test. RESULTS: All samples were negative for Brucella spp. For leptospirosis, four samples (1.69%) were positive, and Andamana was the prevalent serovar. CONCLUSIONS: Low or no detection of these zoonoses does not reduce their importance in PLWHA. Vigilant, educational, and preventive measures should be adopted.

Cross-sectional survey for canine leptospirosis in an Atlantic Rainforest area of the semiarid of Paraíba state, Northeastern Brazil / Estudo transversal para leptospirose canina em área de Mata Atlântica do semiárido da Paraíba, Nordeste do Brasil

Leptospirosis is a worldwide zoonosis caused by the bacteria Leptospira spp. that affects humans, domestic and wild animals. The present work aimed to conduct a cross-sectional survey for leptospirosis in the canine population of the Brejo Paraibano microregion, semiarid of Northeastern Brazil. From May to October 2017, blood samples from 414 dogs were collected in the counties of Alagoa Grande (n=100), Areia (n=79), Bananeiras (n=72), Alagoa Nova (n=73), Serrraria (n=25), Pilões (n=25), Borborema (n=20) and Matinhas (n=20). The tutors of the sampled dogs answered an epidemiological questionnaire, obtaining information about the animals, owner, residence and breeding of the dogs. Subsequently, the serum samples were subjected to the microscopic agglutination test (MAT), using a collection of 23 serovar pathogenic antigens and using the 1:50 dilution as the cutoff point. Of the 414 dogs analyzed 52 were seroreactive, resulting in an apparent prevalence of 12.6% and a real prevalence of 12.2%. Seroreactive dogs were found in the eight counties. Dogs were reactive for the serogroups Icterohaemorrhagiae (76.9%), Autumnalis (13.55%), Pomona (3.8%), Grippotyphosa (3.8%) and Serjoe (1.9%) Antibody titers ranged from 50 to 800. The statistical analysis (robust Poisson regression) detected six factors associated with seropositivity, including the rainy season (prevalence ratio; PR=1.94, P=0.013), male dogs (PR=2.10, P=0.005), animals with age greater than five years (PR=4.21, P=0.012), consumption of untreated water (PR=1.87, P=0.043), free access of dogs to street (PR=2.15, P=0.011) and contact with wildlife (PR=3.54, P=0.050). The serogroup Icterohaemorrhagiae has a high zoonotic potential and was the most frequent in seropositive animals. The high real prevalence of Leptospira spp. in a transmission region of the semiarid region of Paraíba and the occurrence of seroreactive animals in all the counties suggest wide distribution of the infection and reinforce the need for preventive measures to avoid infection in pets and, consequently, to humans. The analysis of factors associated with the prevalence suggest greater manegment cares with the dogs.(AU)

A leptospirose é uma zoonose mundial causada pela bactéria Leptospira spp. que afeta seres humanos, animais domésticos e selvagens. O presente trabalho teve como objetivo realizar um estudo transversal de leptospirose na população canina da microrregião Brejo Paraibano, semiárido do Nordeste do Brasil. No período de maio a outubro de 2017, amostras de sangue de 414 cães foram coletadas nas cidades de Alagoa Grande (n=100), Areia (n=79), Bananeiras (n=72), Alagoa Nova (n=73), Serraria (n=25), Pilões (n=25), Borborema (n=20) e Matinhas (n=20). Os tutores dos cães amostrados responderam a um questionário epidemiológico, sendo obtidas informações sobre os animais, proprietário, residência e criação dos cães. Posteriormente as amostras de soro foram submetidas à prova de soroaglutinação microscópica (SAM), utilizando-se uma coleção de 23 sorovares antígenos patogênicos e adotando como ponto de corte a diluição 1:50. Dos 414 cães analisados 52 foram sorreativos, resultando em uma prevalência aparente de 12.6% e uma prevalência real de 12,2%. Cães sororreativos foram encontrados nos oito municípios. Os cães foram reativos para o sorogrupo Icterohaemorrhagiae (76,9%), Autumnalis (13,55%), Pomona (3,8%), Grippotyphosa (3,8%) and Serjoe (1,9%) Os títulos de anticorpos variaram de 50 a 800. A análise estatística (regressão de Poisson robusta) detectou seis fatores associados à soropositividade, incluindo o período chuvoso (razão de prevalência - RP=1,94; P=0,013), cães machos (RP=2,10; P=0,005), animais com idade maior que cinco anos (RP=4,21; P=0,012), consumo de água não tratada (RP=1,87; P=0,043), cães com livre acesso à rua (RP=2,15; P=0,011) e contato com animais silvestres (RP=3,54; P=0,050). Os resultados desse estudo indicaram que há a exposição por Leptospira spp. em cães da microrregião do Brejo paraibano. O sorogrupo Icterohaemorrhagiae possui alto potencial zoonótico e foi o mais frequente nos animais soropositivos. A alta prevalência real de Leptospira spp. em uma região de transmissão da região semiárida da Paraíba e a ocorrência de animais sororreativos em todos os municípios sugerem uma ampla distribuição da infecção e reforçam a necessidade de medidas preventivas para evitar a infecção em animais de estimação e, consequentemente, em seres humanos. A análise dos fatores associados à prevalência sugere maior cuidado com os cães.(AU)

Spatial distribution of serologically reactive sheep to Leptospira spp. in the northeast region of Brazil

Considering the importance of leptospirosis in sheep farming and public health and the significance of identifying which serogroups circulate in sheep within each region, the objective of this study was to determine the seroprevalence and spatial distribution of the most frequent serogroups causing infection by Leptospira sp. in ovine herds in the Northeast region of Brazil. Blood samples were collected from 4197 sheep from 229 herds in 7 Northeastern States. Sera were analyzed via microscopic agglutination test (MAT). The frequency of seroreactive sheep for Leptospira sp. was 14.06%. The states of Alagoas, Ceará, Paraíba, Piauí, Rio Grande do Norte, and Sergipe, located in the Caatinga biome, had the highest frequencies of serologically reactive sheep, and Maranhão, in the Cerrado biome, had the lowest frequency. The most frequent serogroups were Autumnalis (19.49%), Australis (15.76%) and Serjoe (14.41%). In the states of Ceará, Paraíba, Rio Grande do Norte, and Sergipe, 100% of their municipalities had at least one seroreactive animal. The highest frequencies of seropositive animals were found in the municipalities of União (50%), Passagem (49.06%), Canindé (48.89%), Igaci (28.95%), Gararu (31.2%), Pirapemas (17.5%), and Angicos (16%) located in the states of Piauí, Paraíba, Ceará, Alagoas, Sergipe, Maranhão and Rio Grande do Norte, respectively. The animal-level prevalence (14.06%) obtained in the present study is significant, especially considering the rustic nature of the species and the adverse conditions of the region for the infectious agent. In semi-arid conditions, it has been suggested that perhaps sheep do not seroconvert detectable titers on MAT with a cut-off point of 1:100. It is important to highlight that the ovine population in the Northeast region of Brazil is composed of mixed animals, which have been considered more resistant to infection by Leptospira spp. Also, environmental factors hostile to the survival of the infectious agent in the studied region should be taken into consideration, since they may have influenced the seropositive animal-level prevalence. A noteworthy variation was observed in agglutinin titers, which ranged from 100 to 1,600, where 80.2% of the positive samples had titers ≤ 200. It is important to highlight that more elevated titers (≥ 400) were obtained in all seven states, which may suggest an acute infection caused by a non-adapted serovar, indicating that preventive and control measures focused on possible infection sources for sheep should be adopted. Although some states showed the same serogroups as the most frequent, a variety of serogroups was observed in municipalities, which may indicate different sources of infection, whether interspecies, intraspecies, or via alternative routes of transmission in semi-arid conditions, such as venereal. This indicates that even though sheep are more resistant to infection, they become exposed due to the environment or management conditions. As such, identification, isolation, and treatment of the affected animals are alternative measures recommended for prevention and control of leptospirosis in sheep in the semi-arid region. It is evident that despite the lack of rain observed in the last decade in the Northeast region of Brazil, which prevented the formation of favorable environments for the presence of Leptospira, the infectious agent remains among the sheep, as well as other production and wild animals in the region. Some factors may be contributing to this scenario, such as the fact that sheep farming in the region is = characterized mainly by subsistence systems, where veterinary assistance and adequate sanitary management are absent, thus increasing the possibility of contact with Leptospira. (AU)

Leptospirosis en pediatría, un diagnóstico a tener en cuenta / Leptospirosis in pediatrics, a diagnosis to be considered

Resumen La leptospirosis humana es una importante causa de enfermedad febril aguda que afecta con mayor frecuencia las zonas tropicales. Su principal reservorio es los roedores por lo que la infección está vinculada con factores de pobreza, déficit sanitario, actividades recreativas y laborales que favorecen el contacto con la orina de animales infectados, agua o suelos contaminados. Las infecciones por Leptospira spp tienen una presentación inespecífica desde cuadros asintomáticos hasta un compromiso multisistémico con alta mortalidad, siendo la sospecha clínica y la presencia de factores de riesgo las variables iniciales para el diagnóstico de la enfermedad. Entre los métodos disponibles para el diagnóstico microbiológico se destaca la observación directa, el cultivo, la reacción de polimerasa en cadena y la serología que permiten la confirmación de éste. El tratamiento de leptospirosis en niños se basa en medidas de soporte y en el inicio de antimicrobianos β-lactámicos o macrólidos. Las medidas de prevención de la enfermedad son fundamentales en la población expuesta al riesgo siendo recursos esenciales intervenciones generales, quimioprofilaxis y vacunación. El conocimiento, la consideración diagnóstica y el tratamiento oportuno en el paciente pediátrico, acelera la recuperación y limita la aparición de complicaciones que pueden impactar en la calidad de vida.

Abstract Human leptospirosis is an important cause of acute febrile disease that most frequently affects tropical areas. Its main reserve is rodents, so the infection is limited by factors of poverty, health deficit, recreational and work activities that favor contact with the urine of infected animals, contaminated water or soil. Leptospira spp infections have a non-specific presentation, ranging from asymptomatic to multisystem compromise with high mortality; being the clinical suspicion and the presence of risk factors the initial variables for the diagnosis of the disease. Among the available methods for microbiological diagnosis, direct observation, culture, polymerase chain reaction and serology that allows confirmation of this are highlighted. The treatment of leptospirosis in children is based on clinical support measures and the antibiotic initiation of β-lactams or macrolides. Disease prevention measures are fundamental in the population exposed to risk being essential resources general interventions, chemoprophylaxis and vaccination. The knowledge, diagnostic consideration, and timely treatment in pediatric patients accelerate recovery and limit the appearance of complications that can impact the quality of life

Síndrome hemorrágico pulmonar grave por leptospira / Leptospirosis-Associated Severe Pulmonary Hemorrhagic Syndrome

La leptospirosis es una zoonosis con expresión clínica muy variable. El síndrome pulmonar hemorrágico grave se trata de una forma infrecuente de la enfermedad con una elevada mortalidad. Se presenta caso de una mujer joven, residente de zona urbana que consultó por fiebre, expectoración hemoptoica y disnea evolucionando con insuficiencia ventilatoria y sangrado en la vía aérea. Se obtuvo el diagnóstico mediante pruebas serológicas y antecedente epidemiológico

Leptospirosis is a zoonosis of very variable clinical expression. The severe pulmonary hemorrhagic syndrome is an uncommon form of the disease, with high mortality rates. We report the case of a young woman who lives in an urban area and consulted with the physician for fever, hemoptoic expectoration and dyspnea, and developed ventilatory failure and bleeding of the airway. The diagnosis was obtained by means of serologic tests and epidemiological history.

Lymphocyte proliferative responses in dairy cows supplemented with an immunomodulatory feed additive and administered polyvalent vaccination / [Proliferação de linfócitos em vacas leiteiras suplementadas com um aditivo alimentar imunomodulador e vacinadas com vacina polivalente]

O presente estudo avaliou o efeito da suplementação com OmniGen-AF® na proliferação de linfócitos e títulos de anticorpos após vacinação em bovinos leiteiros. Amostras de sangue periférico foram coletadas de 32 vacas leiteiras para quantificação dos títulos de anticorpos anti-Leptospira, e amostras de sangue periférico de 16 vacas leiteiras foram também coletadas para avaliação da proliferação de linfócitos. Observou-se que a suplementação com OmniGen-AF® aumentou a proliferação basal de linfócitos (sem estímulos) 21 dias após a vacinação (P=0,03), apesar de reduzir a proliferação de linfócitos B quando estimulada com Leptospira borgpetersenii serovar Hardjo inativada pelo calor (P=0,03). Ademais, nenhum efeito da suplementação sobre a proliferação de linfócitos no momento imediatamente anterior à vacinação e nos títulos de anticorpos anti-Leptospira foi encontrado. Além disso, a proliferação de linfócitos estimulada com lipopolissacarídeos foi maior em vacas multíparas que em primíparas 21 dias após a vacinação (P=0,03). Desse modo, o presente estudo demonstra que a suplementação com OmniGen-AF® não afetou de forma robusta a proliferação de linfócitos e os títulos de anticorpos anti-Leptospira após vacinação em vacas leiteiras sadias.(AU)