Anicteric Leptospirosis-Associated Meningitis in a Tropical Urban Environment, Brazil.

While studying aseptic meningitis in Salvador, Brazil, we diagnosed anicteric leptospirosis in 1.7% (5/295) of patients hospitalized for aseptic meningitis. Leptospirosis-associated meningitis patients had lower mean cerebrospinal fluid cell counts and protein than other-cause aseptic meningitis (p<0.05). Clinicians must consider leptospirosis-associated meningitis in appropriate clinical-epidemiologic contexts.

Prospective evaluation of accuracy and clinical utility of the Dual Path Platform (DPP) assay for the point-of-care diagnosis of leptospirosis in hospitalized patients.

Early detection of leptospirosis with field-ready diagnostics may improve clinical management and mitigate outbreaks. We previously validated the point-of-care Dual Path Platform (DPP) for leptospirosis with sera in the laboratory. This prospective study compares the diagnostic accuracy and clinical utility of the DPP using finger stick blood (FSB) against the serum DPP, venous whole blood (VWB) DPP, IgM-ELISA, and clinical impression. We sequentially enrolled 98 patients hospitalized for acute febrile illnesses, of which we confirmed 32 by leptospirosis reference tests. Among syndromes consistent with classic leptospirosis, the FSB DPP showed similar sensitivity and specificity (Se 93% and Sp 80%), and positive and negative predictive values (PPV 74% and NPV 95%), to VWB DPP (Se 96%, Sp 75%, PPV 68%, and NPV 97%), serum DPP (Se 85%, Sp 87%, PPV 79%, and NPV 91%) and IgM-ELISA (Se 81%, Sp 100%, PPV 100%, and NPV 90%). The FSB DPP provided a favorable likelihood ratio profile (positive LR 4.73, negative LR 0.09) in comparison to other assays and clinical impression alone. Additionally, we identified four of five leptospirosis-associated meningitis patients by whole blood DPP, none of which clinicians suspected. This demonstrates potential for the DPP in routine detection of this less common syndrome. The FSB DPP demonstrated similar discrimination for severe human leptospirosis compared with serum assays, and it is a simpler option for diagnosing leptospirosis. Its performance in other epidemiological settings and geographic regions, and for detecting atypical presentations, demands further evaluation.

Distinct antibody responses of patients with mild and severe leptospirosis determined by whole proteome microarray analysis.

BACKGROUND: Leptospirosis is an important zoonotic disease worldwide. Humans usually present a mild non-specific febrile illness, but a proportion of them develop more severe outcomes, such as multi-organ failure, lung hemorrhage and death. Such complications are thought to depend on several factors, including the host immunity. Protective immunity is associated with humoral immune response, but little is known about the immune response mounted during naturally-acquired Leptospira infection. METHODS AND PRINCIPAL FINDINGS: Here, we used protein microarray chip to profile the antibody responses of patients with severe and mild leptospirosis against the complete Leptospira interrogans serovar Copenhageni predicted ORFeome. We discovered a limited number of immunodominant antigens, with 36 antigens specific to patients, of which 11 were potential serodiagnostic antigens, identified at acute phase, and 33 were potential subunit vaccine targets, detected after recovery. Moreover, we found distinct antibody profiles in patients with different clinical outcomes: in the severe group, overall IgM responses do not change and IgG responses increase over time, while both IgM and IgG responses remain stable in the mild patient group. Analyses of individual patients' responses showed that >74% of patients in the severe group had significant IgG increases over time compared to 29% of patients in the mild group. Additionally, 90% of IgM responses did not change over time in the mild group, compared to ~51% in the severe group. CONCLUSIONS: In the present study, we detected antibody profiles associated with disease severity and speculate that patients with mild disease were protected from severe outcomes due to pre-existing antibodies, while patients with severe leptospirosis demonstrated an antibody profile typical of first exposure. Our findings represent a significant advance in the understanding of the humoral immune response to Leptospira infection, and we have identified new targets for the development of subunit vaccines and diagnostic tests.

Oxidative stress markers correlate with renal dysfunction and thrombocytopenia in severe leptospirosis.

Leptospirosis is a zoonotic disease that causes severe manifestations such as Weil's disease and pulmonary hemorrhage syndrome. The aim of this study was to evaluate whether reactive oxygen species (ROS) production and antioxidant reduced glutathione (GSH) levels are related to complications in patients hospitalized with leptospirosis. The ROS production and GSH levels were measured in blood samples of 12 patients and nine healthy controls using chemiluminescence and absorbance assays. We found that ROS production was higher and GSH levels were lower in leptospirosis patients compared with healthy individuals. Among patients, GSH depletion was correlated with thrombocytopenia and elevated serum creatinine, whereas a strong positive correlation was observed between ROS production and elevated serum potassium. Additional investigation of the biological significance of ROS production and GSH levels is warranted as they may guide the development of novel adjuvant therapies for leptospirosis targeting oxidative stress.

Avaliação da atividade antibacteriana dos extratos de Avicennia schaueriana Stapf & Leechm. ex Moldenke, Verbenaceae / Evaluation of the antibacterial activity of extracts of Avicennia schaueriana Stapf & Leechm. ex Moldenke, Verbenaceae

A flora tem sido uma fonte valiosa de constituintes bioativos para manutenção da saúde humana. Tal fato tem reforçado a crescente investigação do potencial terapêutico das plantas medicinais. Neste contexto, o presente trabalho teve como objetivo avaliar o potencial antibacteriano dos extratos hidro-alcoólicos da casca, folha, e raiz de Avicennia schaueriana Stapf & Leechm. ex Moldenke, Verbenaceae. As partes vegetais foram coletadas no povoado pesqueiro de Siribinha, Bahia e os extratos vegetais foram preparados pelo método de maceração. Todos os testes de sensibilidade dos extratos vegetais foram avaliados por meio de testes não-paramétricos. O extrato da raiz de A. schaueriana apresentou uma atividade inibitória do crescimento superior aos extratos da folha e casca, com halos de inibição que variaram entre 7 a 18 mm de acordo com as concentrações e as cepas bacterianas testadas. Já a concentração inibitória mínima dos extratos hidro-alcoólicos de A. schaueriana apresentaram uma média de valores entre 0,62 a 10,00 mg/mL para as bactérias analisadas. Os resultados estatísticos confirmaram a diferença de sensibilidade dos microrganismos estudados frente aos extratos de A. schaueriana.

Natural products have been a valuable bioactives constituent source for maintenance of the health human being. Such fact has strengthened the increasing inquiry of the therapeutical potential of medicinal plants. This work had as objective evaluate the antibacterial potential from leaf, root and bark hydro-alcoholics extracts of Avicennia schaueriana Stapf & Leechm. ex Moldenke, Verbenaceae. The plant parts had been collected in the fishing town of Siribinha, Bahia and the plant extracts had been prepared by the method of maceration. All the tests of sensitivity of plant extracts had been evaluated by means of notparametric tests. The results of the test of diffusion in disk showed that the extract of the root of the A. schaueriana had been higher to extracts of the leaf and bark, with inhibition rings from growth varying of 7 to 18 mm; in accordance with the tested concentrations. Already the minimum inhibitory concentration of hydro-alcoholic extracts of A. schaueriana had presented an average of values between 0,62 to 10,00 mg/mL for the analyzed bacteria. The statistical results had confirmed the difference of sensitivity of the studied microorganisms front to extracts of the A. schaueriana.