Prevalence of leptospirosis in man. Pilot survey

A survey on the prevalence of leptospirosis was performed on the population living in an area of central Italy. The size of the sample was calculated in order to provide significant results in the case of a prevalence of infection in not less than 1 % of the population.Results demonstrated an unexpectedly wide circulation of leptospirosis in the surveyed area, showing a prevalence rate of infection of 11.34% for people living in rural areas and 3:08% for people living in the main town. The highest prevalence of infection (17.44%) was found in people between 30 and 44 years of age, living in rural areas.Such a wide circulation of undiagnosed past leptospiral infections was attributed both to the prevalence of mild clinical cases of leptospirosis in humans and the lack of microbiological tests performed to differentiate current leptospirosis from other infectious illnesses. An unexpected persistence in sera of co-agglutinins towards non-pathogenic serovars of L. biflexa was also noticed in healthy people.Criteria were established for the extension of the survey on the prevalence of leptospirosis to cover larger areas by limiting sampling to the more exposed age groups and to areas representative of a larger land belt.Corresponding author.     

A twelve-year study of leptospirosis on Barbados

Between November 1979 and December 1991, 398 cases of severe leptospirosis were confirmed on Barbados (range for 1980–1991 23–56; mean 32.7; incidence 13.3/100,000/year). For the six-year periods 1980–1985 and 1986–1991 there was no significant change in incidence with time. Incidence is unlikely to change significantly in the next decade. Monthly average case numbers ranged from 1.4 (July) to 4.3 (November). The average (2.8) for June to December (the 7 wetter months) was not significantly higher than that (2.5) for January to May (the 5 drier months). The age range was 7–86. There were three times as many male cases (302) as female (96), and nearly 10 times as many in those <35. Although the highest number of cases (69) was in males aged 15–24, the highest incidence was in the older age groups, particularly the male 65–74 year-olds, and the female 55–64 year-olds. Leptospirosis was the proven cause of death in 55 (13.8%) hospital patients (annual range 0–13, mean 4.5). Some of a further 39 fatalities might have been cases. Death from leptospirosis was nearly twice as common among the women as among the men. Only one patient under 20 years of age died.Leptospira were isolated and identified from 117 (29.4%) of the 398 sick patients. The infecting organisms werebim (serogroup Autumnalis — 75),copenhageni (Icterohaemorrhagiae — 26),arborea (Ballum — 14) andbajan (Australis — 2). These infecting serovars could not be distinguished clinically, but infection was milder in children than in adults. Despite its predominance in surveyed children, serogroup Panama was virtually absent in this study. Rainfall is the major factor affecting the distribution of cases; not surprisingly, sanitation workers and agricultural workers appear to be the groups at highest risk. The general lack of clear-cut risk factors reflects the ubiquity of leptospires in the environment and the fact that the disease is not entirely occupational.     

Recent trends in human leptospirosis in Italy

The recent epidemiological trends of human leptospirosis in Italy were investigated using data collected for the years 1981–1985. A total of 626 hospitalized patients with clinical diagnoses of suspected leptospirosis were reported by hospital centers from several Italian regions. Epidemiological, clinical and seroimmunological data were collected in 517 of these cases and examined by the National Center for Leptospirosis.Serological findings in 33.5% of these subjects met the criteria for confirmation of the disease. In 21.8% of the subjects, low titer antibodies were detected, which possibly reflected previous leptospiral infections. An early antibiotic treatment of the current infection may also have lowered the seroimmunological response in some of these patients.In 59.3% of the confirmed cases, modes of transmission were allotted equally between accidental events and recreational or occupational activities. Drinking water from an open air fountain emerged as an uncommon mode of transmission; it was responsible for an outbreak of 33 cases of leptospirosis. In another 37.07% of the subjects, it was impossible to establish the mode of transmission.Respiratory or influenza-like symptoms were the only clinical signs of illness in 21.2% of the patients with confirmed leptospirosis.In comparison to the sixties and seventies, the prevalence of infecting serovars showed increasing incidence of infections due to serovars of the Javanica (11.0%) and Australis (11.0%) serogroups and an important decrease in the Bataviae serogroup infections (from 58.8% in rice-field workers in the forties to 0.6% in the years 1981–1985). Sejroe serogroup infections accounted for 4.5 per cent of confirmed cases of leptospirosis.In 49.7% of subjects with confirmed leptospirosis, cross-agglutination at the same titre with two or more serovars of different sero-groups occurred, thus preventing the identification of the serogroup of the infecting strain.     

神经康复重建疗法对痉挛型脑瘫肌张力的影响

目的观察神经康复重建疗法对痉挛型脑瘫患儿肌张力的影响。方法将24例痉挛型双瘫患儿随机分为治疗组和对照组,每组12例,所有患儿均接受Bobath技术、推拿、脑循环治疗。治疗组在以上基础上应用WOND2000172型神经康复重建仪,对双下肢进行肌电触发的生物反馈刺激。在疗程开始与结束时,用改良的Ashworth量表测定患儿腓肠肌肌张力的变化。结果治疗后,两组患儿的肌张力均有不同程度降低（P〈0．01—0．001）,但治疗组疗效优于对照组（P〈0．05）。结论神经康复重建治疗能有效降低痉挛型腑瘫患儿肌张力。     

Incidence of leptospirosis in a select population in Nepal

The geographic distribution of leptospirosis is widespread but no national surveillance program exists in Nepal to establish the incidence of leptospirosis or the disease burden. This study reports the incidence of symptomatic leptospirosis in military personnel participating in an efficacy study of a hepatitis E virus vaccine in Nepal. Among the 1566 study volunteers who completed follow-up, we evaluated 271 illnesses over 2.2 years for the presence of leptospira IgM antibodies by ELISA. Positive ELISA results were confirmed by the microscopic agglutination test. The annual incidence of disease was between 3.5 and 6.1 cases/1000. The prevalence of confirmed leptospirosis was 9% among hepatitis cases and 8% among febrile cases. The most reactive serovars were Bratislava, Autumnalis, Icterohaemorrhagiae, and Sejroe. Leptospirosis should be considered in the differential diagnosis of febrile illnesses and icteric syndromes in Nepal. Additional studies are needed to establish the broader distribution and the spectrum of disease in Nepal.     

四川省2004－2018年钩端螺旋体病流行特征分析

目的 了解2004-2018年四川省钩端螺旋体病（钩体病）流行病学特征,为防控策略提供依据。方法 钩体病数据来源于全国法定传染病疫情监测网络直报系统和11个监测点数据,采用描述性流行病学方法分析,采用ArcGIS 10.2软件进行地图绘制,采用SaTScan 9.1.1软件进行时空扫描分析,描述钩体病时空聚集性特征。结果 2004-2018年四川省报告钩体病发病2 834例,死亡41例,发病率0.23/10万,死亡率0.003/10万,发病趋势波动向下。发病有明显季节性,主要集中在8月下旬至9月底,较水稻收割时间晚1~2周。男性为主,男女性别比为2.05：1;发病率较高的为50~65岁组。职业以农民为主,占82.75%（2 345/2 834）;其次为学生,占12.74%（361/2 834）,但2011年后学生病例报告极少。高发地区在南部长江流域沿岸马边彝族自治县（马边县）、沐川县等和东部嘉陵江流域仪陇县之间不断交替。时空扫描聚集性分析发现2个高发聚集区域（P<0.001）。11个监测点2004-2018年平均鼠密度为5.44%（14 351/263 767）;主要野外鼠种有四川短尾鼩（占69.07%）、黑线姬鼠（占12.73%）等;其中黑线姬鼠密度介于4.60%~0.19%之间,呈持续下降趋势,2018年达最低水平。鼠肾标本培养钩体阳性率的各年度间也呈下降态势。2007-2018年健康人群血清钩体抗体阳性率平均为24.52%（3 271/13 339）,主要流行菌群为黄疸出血群,近年未出现菌群的更替。结论 2004-2018年四川省钩体病发病水平极低,季节特征符合稻田型流行特征,人群以老年农民为主;高发地区在长江和嘉陵江流域周边互相交替。黑线姬鼠密度和带菌率均较低;主要流行菌群持续以黄疸出血群为主,健康人群钩体抗体阳性率处于较低水平。     

Prospective serological study of leptospirosis in Southern Spain

This article reports data concerning a serosurvey carried out in Southern Spain to assess the current epidemiological status of a population exposed to risk of leptospirosis. Microagglutination and IgM-EIA tests were carried out on sera from a sample of workers in agriculture-related occupations, exposed to marsh waters. A cohort of 197 workers were followed for a year in an active surveillance program to evaluate seroconversion (laboratory confirmed leptospirosis). The results have shown for the cohort a density of incidence: 6.4 × 100 persons per year, and for the reference population an accumulated incidence of 41.25/ 100,000. Prevalence rates (P) were 21.3 × 100 and 144 × 10⁵ for the cohort and population respectively. Rates were higher in cray-fishers (P: 62.7%), rice-workers, and butchers. This is the first report identifying cray-fishers as a high risk group for leptospirosis, and the reporting of human contamination by Australis serogroup in Spain.     

36例钩端螺旋体病暴发调查

对金华市磐安县九和乡发生的一起因下水采集石菖蒲而引发钩端螺旋体(钩体)病暴发疫情进行调查.     

湖北省宜昌市38年钩端螺旋体病流行周期性的论证

目的　了解钩端螺旋体病（ 钩体病） 发病周期性规律。方法　采用周期图法分析了宜昌市１９６０ ～１９９７ 年钩体病疫情资料。结果　宜昌市３８ 年来钩体病年发病率为１５ ．４３／１０ 万,流行周期为１０ 年,周期振动有统计学上显著性意义（Ｊ＝ ４．１７９,Ｐ＜ ０ ．０５） 。结论　这为掌握钩体病流行规律,有效控制疫情提供依据。     

Epidemiology of leptospirosis in New Caledonia (South Pacific): a one-year survey

We describe a series of 144 cases of leptospirosis diagnosed in 1989 in New Caledonia. The incidence rate was 90 per 100,000 person-years, with a specific mortality rate of 4% patients. Those affected (100 males, 44 females) were mainly aged 20 to 40 years. Incidence in rural areas (112 per 100,000 person-years) was seven times higher than in urban settlements. Two periods with higher incidence were noticed corresponding to highest rainfall. Twenty-nine of the cases occurred in individuals with professions commonly associated with leptospirosis. Contacts with rats, dogs and ditch or river water were the most frequently mentioned. The clinical expression of the disease was polymorphic: 60% of the patients had mild symptoms, 40% were acute forms including Weil's disease. Of 57 hospitalized, 23% were admitted with an initial diagnosis of dengue, and 37% with leptospirosis. Main clinical syndromes were: icterus and/or renal syndrome in 50% of patients, cardiac syndrome in 65%, acute myalgies in 58% and pulmonary syndrome in 50%. Although hemorrhages were uncommon (17%), 40% of the cases demonstrated thrombocytopenia (< 50,000/m³). Pancreatic involvement with hyperamylasemia was evidenced in 50% of cases. Twelve serogroups of Leptospira were implicated, icterohaemorragiae predominated (41%), but was not associated with severe forms. In New Caledonia, like in all tropics, leptospirosis must be considered as an environmental disease, professional activities being just an additional risk factor. Use of serology as a reliable tool for confirmation of cases in areas of high environmental contamination is discussed.     

Occupational hazard of unnoticed leptospirosis in water ways maintenance staff

A serological survey was performed with M.A.T. on the maintenance staff of water ways and public works and lock keepers to study the occupational hazards of leptospirosis.The target population was 58 professional people, 40 working on French rivers and 18 on a channel in the same western area of France. When we compared serological tests between these two groups, no significant difference appeared. But when we linked fish handling to close contact with water, we found a higher number of positive tests in the channel group than in the rivers group (P < 0.01). We conclude that people working on the channel were susceptible to unnoticed Leptospira infection.     

三峡坝区钩端螺旋体病监测结果分析

目的调查长江三峡水库坝区钩端螺旋体病流行因素和疫情。方法选择调查点,收集1996~2006年钩端螺旋体病疫情资料,进行钩端螺旋体病病原分离和抗体检测。结果2003~2006年长江三峡水库坝区钩端螺旋体病发病率比蓄水前低,采13份散发钩端螺旋体病人双份血清,用交叉吸收实验检测出临海、致热、乳山3个新的钩端螺旋体血清型;水库坝区清底后,鼠密度2.09%。室内褐家鼠为优势鼠种,占57.1%;户外黑线姬鼠和褐家鼠为优势鼠种,占66.67%。分离钩端螺旋体菌36株,分属5个血清群7个血清型,其中黄疸出血群占47.22%,波摩那群占27.78%,鼠肾、猪肾和蛙肾带菌率分别为2.67%、0.81%和0.25%,健康人群黄胆出血群阳性率为31.12%。结论长江三峡水库坝区蓄水期间没有发生钩端螺旋体病暴发流行,采取水库坝区清底可以有效降低鼠密度。     

Diagnosis and epidemiology of leptospirosis

Leptospirosis is a zoonosis found worldwide, the main reservoir of which is the rat. Human infection generally results from exposure to contaminated river or lake water or animals. Around 600 cases are diagnosed per year in France. Half of these cases occur in French overseas territories, where the incidence can be more than 100 times higher than in mainland France. Leptospirosis has been under-diagnosed because of non-specific symptoms, inadequate surveillance system, and lack of readily available quick and simple diagnostic tests. Most cases of leptospirosis are currently detected by PCR amplification of bacterial DNA from the blood during the first week after the onset of symptoms, or by detection of antibodies during the second week of the disease. More than 300 serovars have been identified among leptospires, including serovar Icterohaemorrhagiae, the most frequent in human infections. Leptospirosis remains a major public health issue in many developing countries, one century after discovering the causative agent. Leptospirosis is expected to become more important due to a rapid urbanization in developing countries (slums), global warming, and extreme climatic events (floods).     

Clinical,nerve conduction and nerve biopsy study in vitamin B12 deficiency neurological syndrome with a short-term follow-up

Objective

The frequency and type of neuropathy in vitamin B12 deficiency neurological syndrome (VBDNS) is controversial. This study reports the frequency and type of nerve dysfunction in VBDNS using nerve conduction and sural nerve biopsy and its response to treatment.

Method

Sixty-six patients with VBDNS diagnosed on the basis of low serum vitamin B12 level and/or megaloblastic bone marrow were subjected to clinical evaluation, hemoglobin, mean corpuscular volume, thyroid function test, HIV serology, and vasculitic profile. Peroneal motor and sural sensory nerve conduction studies were done. Sural nerve biopsy was done in six patients. The patients were treated with cyanocobalamin injection and followed up clinically and with nerve conduction study at 3 and 6 months.

Results

The median age of the patients was 46 (12–80) years and 11 patients were females. The duration of symptoms was 1–96 (median 7) months. Clinical features of neuropathy were present in 46 (69.7%) patients and nerve conduction was abnormal in 36 (54.5%) patients. On nerve conduction study, 8 (22.2%) patients had axonal, 4 (11.1%) had demyelinating, and 24 (66.7%) had mixed features. Nerve biopsy revealed acute axonal degeneration in early stage and chronic axonopathy with demyelination in the late stages of disease. The nerve conduction parameters improved at 6 months along with clinical recovery.

Conclusion

Nearly 70% patients with VBDNS had evidence of neuropathy which is mainly axonal with some demyelinating features.     

Adjuvanted leptospiral vaccines: Challenges and future development of new leptospirosis vaccines

Leptospirosis is a neglected infectious disease of global importance. Vaccination is the most viable strategy for the control of leptospirosis, but in spite of efforts for the development of an effective vaccine against the disease, few advances have been made, and to date, bacterin is the only option for prevention of leptospirosis. Bacterins are formulations based on inactivated leptospires that present a series of drawbacks, such as serovar-dependence and short-term immunity. Therefore, bacterins are not widely used in humans, and only Cuba, France and China have these vaccines licensed for at-risk populations. The development of recombinant DNA technology emerges as an alternative to solve the problem. Recombinant protein-based vaccines or DNA vaccines seem to be an attractive strategy, but the use of adjuvants is critical for achievement of a protective immune response. Adjuvants are capable of enhancing and/or modulating immune responses by exposing antigens to antigen-presenting cells. In the last years, several components have been tested as adjuvants, such as aluminum salts, oil based-emulsion adjuvants, bacteria-derived components and liposomes. This review highlights the use of adjuvants in the multiple vaccine approaches that have been used for leptospirosis and their most important immunological aspects. Immune response data generated by these strategies can contribute to the understanding of the immune mechanisms involved in protection against leptospirosis, and consequently, the development of effective vaccines against this disease. This is the first review on leptospiral vaccines focusing on adjuvant aspects.     

安徽省首次从灰麝鼩肾组织中分离出致病性钩端螺旋体

钩端螺旋体病（钩体病）病原菌群复杂、储存宿主种类较多，在我国农村广泛存在。安徽省自1962年证实钩体病以来每年都有不同程度的疫情发生。由于省内具有不同的地理区划，自然因素和社会因素不同，因而钩体病流行特征、菌群分布、流行形式及宿主动物种类不同。     

Evaluation of a passive microcapsule agglutination test for the screening of human leptospirosis

Microcapsules, absorbed with two mixed antigens- each composed of 3 sonicated leptospira serovars — were developed in the past as a microcapsule agglutination test (MCA-LS) for the screening of clinical leptospirosis.Fof this study, fifty serum samples, taken at an earlier and at a later stage of illness from 25 Italian in-patients with clinical symptoms of leptospirosis, were tested with both the MCA-LS one-dilution test and the microscopic agglutination (MA) test, the confirmatory test for leptospirosis, with 18 leptospira strains circulating in Italy. Compared with MA, MCA-LS showed a sensitivity of 91.7%, and a specificity of 92.3%, including leptospiroses not substained by the diagnostic strains used in the MCA-LS kit.     

2001—2005年衢州市钩端螺旋体病监测研究

目的了解钩端螺旋体病（钩体病）流行病学特点与衢州市疫源地情况，为控制钩体病的暴发流行提供依据。方法运用描述流行病学办法，对1960-2005年的历史疫情进行分析。采用现场调查方法，采集鼠、水鸭、猪、青蛙的双肾标本和牛中段尿做钩体培养分离，青蛙和水鸭血清做抗体测定，分析感染情况和感染菌群。结果1960—2005年衢州市共报告钩体病11047例，年均发病率11．58／10万，死亡72例，病死率0．65％。7—9月发病例数占全年总病例数的90．26％；农民发病例数占总病例数的88．20％；男女之比为2．74：1；常山及开化县是衢州市最主要的疫区。2001—2005年监测点野外鼠密度为3．93％，黑线姬鼠占51．40％，动物标本培养阳性率0．49％，动物血清抗体阳性率14．02％。人血清中菌群为七日热群和黄疸出血群，动物中主要菌群为黄疸出血群、秋季热群、赛罗群、流感伤寒群。结论钩体病发病年度与地区波动十分明显，主要是受局部暴发疫情的影响。夏秋季为商发季节，青壮年农民为重点人群。近6年来的洪水低发，与动物间的低带菌率一致，但衢州市动物感染菌群复杂，多种动物均可携带，受气候影响导致暴发的危险始终存在。     

足底内侧神经检测在2型糖尿病周围神经病诊断中的价值分析

目的 探讨足底内侧神经检测对糖尿病周围神经病的诊断价值.方法 选取2020年1—7月就诊于大连市中心医院内分泌科,明确诊断2型糖尿病的109例患者为研究对象,应用肌电诱发电位仪对患者胫神经、足底内侧神经、腓肠神经、腓浅神经进行检测.结果 足底内侧神经检出异常率均高于腓肠神经、腓浅神经和胫神经H反射及F波异常率,差异均有...     

福建省2012年钩端螺旋体病监测和感染菌群分析

目的 掌握福建省钩端螺旋体（钩体）感染菌群,为防治工作提供科学依据。方法 根据全省疫情选取调查点,采集鼠、猪、青蛙的血或肾、尿标本进行钩体培养,采集人、鼠血清测定抗体,分析钩体感染情况和感染菌群。结果 宿主动物调查显示,鼠密度为5.83%,以黄毛鼠、黄胸鼠和针毛鼠为主,分别占29.87%、28.19%和17.11%,首次从长泰县白腹巨鼠分离出钩体。鼠血清钩体抗体阳性率为11.04%,主要感染菌群为秋季群、澳洲群和流感伤寒群,健康人群钩体抗体阳性率为8.25%,感染菌群以秋季群、致热群、七日热群和澳洲群为主。结论 福建省鼠类和人群感染钩体菌群复杂,应切实做好钩体病的监测工作。