Fatal acute undifferentiated febrile illness among clinically suspected leptospirosis cases in Colombia, 2016-2019.

BACKGROUND: Acute undifferentiated febrile illness is a common challenge for clinicians, especially in tropical and subtropical countries. Incorrect or delayed diagnosis of febrile patients may result in medical complications or preventable deaths. Common causes of acute undifferentiated febrile illness in Colombia include leptospirosis, rickettsioses, dengue fever, malaria, chikungunya, and Zika virus infection. In this study, we described the acute undifferentiated febrile illness in postmortem patients reported as suspected cases of leptospirosis through the national leptospirosis surveillance in Colombia, 2016-2019. METHODOLOGY/PRINCIPAL FINDINGS: We retrospectively analyze human fresh and formalin-fixed tissue samples from fatal suspected leptospirosis cases reported by the Public Health Laboratories in Colombia. Leptospirosis confirmation was made by immunohistochemistry, real-time polymerase chain reaction (PCR) in the tissue samples. In some cases, the serum sample was used for confirmation by Microagglutination test (MAT). Simultaneously, tissue samples were tested by PCR for the most common viral (dengue, Zika, and chikungunya), bacterial (Brucella spp., and Rickettsia spp.), and parasitic (malaria). Fresh tissue samples from 92 fatal suspected leptospirosis cases were reported to the National Reference Laboratory from 22/32 departments in Colombia. We confirmed leptospirosis in 27% (25/92) of cases. Other pathogens identified by real-time PCR were Brucella spp. (10.9%), Rickettsia spp. (14.1%), and dengue (2.2%). Dengue (6.9%), hepatitis (3.5%), and Yellow Fever cases (2.2%) were detected by the pathology. All patients were negative for chikungunya and Plasmodium spp. Most cases were classified as undifferentiated febrile illnesses (45.7%; 42/92). CONCLUSIONS/SIGNIFICANCE: This study underscores the importance of early and accurate recognition of leptospirosis to prevent mortalities. Moreover, it draws attention to the existence of other febrile syndromes in Colombia, including rickettsiosis and brucellosis, that currently lack sufficient human surveillance and regular reporting. Expanding laboratory surveillance to include viruses such as Hantavirus, Mayaro virus, Oropouche virus, and West Nile virus is crucial.

Distribution, frequency and clinical presentation of leptospirosis and coinfections: a systematic review protocol.

INTRODUCTION: Leptospirosis is a zoonotic disease with high prevalence in low-income and middle-income countries and tropical and subtropical regions. The clinical symptoms of the disease are similar to symptoms presented by other endemic infectious diseases that could be present simultaneously. Thus, leptospirosis could be masked by similar infections like dengue, malaria, hantavirus, melioidosis and borreliosis, among others. Therefore, leptospirosis could present itself as an under-reported infection or as a coinfection with another pathogen, as has been reported in the literature. However, there is a lack of documented evidence about the specific risk factors of leptospirosis infection, the symptoms, the coinfection's mortality and the frequency of coinfection. Additionally, leptospirosis coinfections have not been considered a neglected public health concern. Therefore, this systematic review aims to evaluate published articles that show the risk factors associated with leptospirosis infection and coinfection with other pathogens. METHODS AND ANALYSIS: The search process to identify eligible studies will be conducted including the LILACS, ProQuest, PubMed and Scopus databases with no restriction in terms of publication date. Also, grey literature will be included in the research. Authors will independently screen the title and abstracts of the articles identified from the search using Rayyan free software. Eligibility criteria include peer-reviewed research articles written in English or Spanish, including observational studies, cohorts, case-control, cross-sectional, ecological studies and report cases. The systematic review will include studies that report descriptions of leptospirosis cases with coinfection or co-occurrence. The search will be accomplished by articles from 1950 to May 2022. The data will be extracted in a standard extraction form using an Excel format. ETHICS AND DISSEMINATION: Results will be published in a peer-reviewed journal. Also, findings will be disseminated through scientific meetings. Ethical approval will not be required as this is a systematic review and primary data will be not collected or included. PROSPERO REGISTRATION NUMBER: CRD42021234754.

Comportamiento de la vigilancia epidemiológica de la leptospirosis humana en Colombia, 2007-2011 / Epidemiological surveillance of human leptospirosis in Colombia, 2007-2011

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

Introduction: Leptospirosis is a reemerging zoonosis of worldwide distribution, caused by a spirochete of the genus Leptospira . In Colombia, the disease represents a major public health issue, and there has been an increased number of cases in humans and animals. Objective: To characterize epidemiologically cases of leptospirosis reported to the National Public Health Surveillance in Colombia, and to make an approach to determine the serogroups circulating in the country. Materials and methods: A retrospective observational study was designed using a process of monitoring records, which included cases reported by the software SIVIGILA and samples sent to the Microbiology Group of the National Laboratory Network (GM-RNL), for the period 2007-2011. We registered socio-demographic variables and analyzed 17 serogroups of Leptospira . Results: A total of 11,786 records were processed, with 4,621 confirmed cases of leptospirosis. The geographic places which reported the highest number of cases were: Valle del Cauca, Antioquia, Risaralda, Atlántico and Barranquilla, and those with the highest incidence were Guaviare, Risaralda, San Andres, Santa Marta and Barranquilla. The largest number of cases was from urban areas, and more commonly in men (77%), students (19.4%) and housewives (13.6%). A median age of 29 years (IQR 45-19) was observed. There was evidence of 17 serogroups circulating in the country, from which the three most frequent were Australis (24.89%), Hebdomadis (9.33%) and Sejroe (8.0%). Conclusions: In Colombia, the reported cases have improved as well as their final classification, allowing us to determine the Australis serogroup as the most widely circulating one.

[Epidemiological surveillance of human leptospirosis in Colombia, 2007-2011]. / Comportamiento de la vigilancia epidemiológica de la leptospirosis humana en Colombia, 2007-2011.

INTRODUCTION: Leptospirosis is a reemerging zoonosis of worldwide distribution, caused by a spirochete of the genus Leptospira . In Colombia, the disease represents a major public health issue, and there has been an increased number of cases in humans and animals. OBJECTIVE: To characterize epidemiologically cases of leptospirosis reported to the National Public Health Surveillance in Colombia, and to make an approach to determine the serogroups circulating in the country. MATERIALS AND METHODS: A retrospective observational study was designed using a process of monitoring records, which included cases reported by the software SIVIGILA and samples sent to the Microbiology Group of the National Laboratory Network (GM-RNL), for the period 2007-2011. We registered socio-demographic variables and analyzed 17 serogroups of Leptospira . RESULTS: A total of 11,786 records were processed, with 4,621 confirmed cases of leptospirosis. The geographic places which reported the highest number of cases were: Valle del Cauca, Antioquia, Risaralda, Atlántico and Barranquilla, and those with the highest incidence were Guaviare, Risaralda, San Andres, Santa Marta and Barranquilla. The largest number of cases was from urban areas, and more commonly in men (77%), students (19.4%) and housewives (13.6%). A median age of 29 years (IQR 45-19) was observed. There was evidence of 17 serogroups circulating in the country, from which the three most frequent were Australis (24.89%), Hebdomadis (9.33%) and Sejroe (8.0%). CONCLUSIONS: In Colombia, the reported cases have improved as well as their final classification, allowing us to determine the Australis serogroup as the most widely circulating one.

Cryptococcosis in Colombia: Results of the national surveillance program for the years 2006-2010 / Criptococosis en Colombia: resultados de la encuesta nacional, 2006-2010

Introduction: A survey on cryptococcosis is being conducted regularly in Colombia since 1997. We present hereby the results corresponding to patients diagnosed from 2006 to 2010. Objective: To analyze the data obtained during this period. Materials and methods: Retrospective analysis of the corresponding surveys. Results: A total of 526 surveys originating from 72% of the Colombian political divisions were received during the 5-year period. Most patients (76.6%) were males and 74.9% were 21-50 years old. The most prevalent risk factor was HIV infection (83.5%) with cryptococcosis defining AIDS in 23% of the cases. In the general population the estimated mean annual incidence rate for cryptococcosis was 2.4 x 106 inhabitants while in AIDS patients this rate rose to 3.3 x 103. In 474 surveys stating clinical features, most frequent complaints were headache 84.5%, fever 63.4%, nausea and vomiting 57.5%, mental alterations 46.3%, meningeal signs 33.0%, cough 26.4% and visual alterations 24.5%. Neurocryptococcosis was recorded in 81.8% of the cases. Laboratory diagnosis was based on direct examination, culture and latex in 29.3% cases. From 413 Cryptococcus isolates analyzed, 95.6% were identified as C. neoformans var. grubii, 1% C. neoformans var. neoformans, and 3.4% C. gattii. Treatment was reported for 71.6% of the cases with amphotericin B alone or in combination with fluconazole prescribed in 28%. Conclusions: Surveys done through passive surveillance continue to be sentinel markers for HIV infection and represent a systematic approach to the study of opportunistic problems regularly afflicting AIDS patients since cryptococcosis requires no compulsory notification in Colombia.

Introducción. Desde 1997 se viene realizando un programa nacional de vigilancia sobre la criptococosis en Colombia. Se presentan los resultados correspondientes a los pacientes diagnosticados entre el 2006 y el 2010. Objetivo. Analizar los datos obtenidos durante este periodo. Materiales y métodos. Análisis retrospectivo de las encuestas. Resultados. Durante los cinco años mencionados se recibieron 526 encuestas representativas del 72 % de la división política colombiana. La mayoría de pacientes (76,6 %) eran hombres y 74,9 % estaban entre los 21 y los 50 años. El factor de riesgo prevalente fue la infección por VIH (83,5 %), y la criptococosis definió el sida en 23 % de los casos. La incidencia anual promedio en la población general fue de 2,4 por un millón de habitantes mientras que, en pacientes con sida, aumentó a 3,3 por 1.000. En 474 encuestas se informaron manifestaciones clínicas; las más frecuentes fueron: cefalea (84,5 %), fiebre (63,4 %), náuseas y vómito (57,5 %), alteraciones mentales (46,3 %), signos meníngeos (33 %), tos (26,4 %) y alteraciones visuales (24,5 %). La neurocriptococosis se reportó en 81,8 % de los casos. El diagnóstico se hizo por examen directo, cultivo y antigenemia en 29,3 % de los casos. De 413 aislamientos recuperados, 95,6 % fueron C. neoformans var. grubii, 1 % C. neoformans var. neoformans, y 3,4 % C. gattii. En 71,6 % de los casos para el tratamiento se administró anfotericina B y en 28 % se combinó con fluconazol. Conclusiones. La vigilancia pasiva continúa siendo un marcador centinela para la infección por VIH, y constituye una aproximación sistemática al estudio de infecciones oportunistas en pacientes con sida, debido a que la criptococosis no es de notificación obligatoria en Colombia.

Cryptococcosis in Colombia: results of the national surveillance program for the years 2006-2010.

INTRODUCTION: A survey on cryptococcosis is being conducted regularly in Colombia since 1997. We present hereby the results corresponding to patients diagnosed from 2006 to 2010. OBJECTIVE: To analyze the data obtained during this period. MATERIALS AND METHODS: Retrospective analysis of the corresponding surveys. RESULTS: A total of 526 surveys originating from 72% of the Colombian political divisions were received during the 5-year period. Most patients (76.6%) were males and 74.9% were 21-50 years old. The most prevalent risk factor was HIV infection (83.5%) with cryptococcosis defining AIDS in 23% of the cases. In the general population the estimated mean annual incidence rate for cryptococcosis was 2.4 x 106 inhabitants while in AIDS patients this rate rose to 3.3 x 103. In 474 surveys stating clinical features, most frequent complaints were headache 84.5%, fever 63.4%, nausea and vomiting 57.5%, mental alterations 46.3%, meningeal signs 33.0%, cough 26.4% and visual alterations 24.5%. Neurocryptococcosis was recorded in 81.8% of the cases. Laboratory diagnosis was based on direct examination, culture and latex in 29.3% cases. From 413 Cryptococcus isolates analyzed, 95.6% were identified as C. neoformans var. grubii, 1% C. neoformans var. neoformans, and 3.4% C. gattii. Treatment was reported for 71.6% of the cases with amphotericin B alone or in combination with fluconazole prescribed in 28%. CONCLUSIONS: Surveys done through passive surveillance continue to be sentinel markers for HIV infection and represent a systematic approach to the study of opportunistic problems regularly afflicting AIDS patients since cryptococcosis requires no compulsory notification in Colombia.