Abstract
.A 1-year population-based prospective study was launched in Seychelles, a country with one of the highest human incidence of leptospirosis worldwide, to describe the characteristic features of the epidemiology of the disease and highlight the most prominent risk factors. Diagnosis was based on the IgM enzyme-linked immunosorbent assay, microscopic agglutination test, and real-time PCR. A standardized questionnaire was administered to 219 patients aged ≥ 13 years consulting for acute febrile illness. The high incidence of leptospirosis in Seychelles was confirmed. The disease was particularly severe, as the case fatality rate was 11.8%. Leptospirosis was positively associated in univariate analysis with socio-professional and clinical variables including gardening/farming, oliguria, jaundice, conjunctivitis, history of hepatitis C virus infection, anemia, thrombocytopenia, and/or biological renal failure. Epidemiological analyses of the questionnaires highlighted a link of the disease with living in houses (versus apartment), the presence of animals around and in houses, gardening, and misuse of personal protective equipment. Multivariate analyses indicated that being a farmer/landscaper and having cattle and cats around the home are the most significant drivers of leptospirosis. Biological features most associated with leptospirosis were thrombocytopenia, leukocytosis, high values for renal function tests, and elevated total bilirubin. We report changes in behavior and exposure compared with data collected on leptospirosis 25 years ago, with indication that healthcare development has lowered case fatality. Continuous health education campaigns are recommended as well as further studies to clarify the epidemiology of human leptospirosis, especially the role of domestic animals.
Highlights
Leptospirosis is an often neglected tropical infectious disease caused by spirochetes of the genus Leptospira[1,2,3] and is considered as a emerging zoonosis
We evaluated the risk factors contributing to leptospirosis in Seychelles and describe the clinical features of the disease and their changing patterns compared with the data reported in previous studies conducted in the country some 25 years ago
When leptospirosis cases who died before completion of the form were not included, the nonresponse rates between leptospirosis cases and other causes of fever were not statistically different (6.2% versus 2.4%, Fisher test, P = 0.12)
Summary
Leptospirosis is an often neglected tropical infectious disease caused by spirochetes of the genus Leptospira[1,2,3] and is considered as a (re-) emerging zoonosis. 90% of cases are asymptomatic or mild.[8] Symptomatic disease in humans escalates from mild, self-limited febrile illness to severe forms displaying multisystemic complications leading to fulminant life-threatening illness.[9] Risk factors associated with leptospirosis include behavioral and environmental variables such as rainfall and temperature.[10] Rodents have traditionally been considered as the main reservoir of Leptospira spp., several other animals (such as cattle, buffaloes, dogs, and cats) can act as reservoirs.[11,12,13,14]
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