Abstract
The objective of this study was to determine the changing trend of leptospirosis over time in Thailand using two prospective hospital-based studies conducted amongst adult patients with acute undifferentiated fever (AUFI) admitted to Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima Province, Thailand between July 2001 to December 2002 and between July 2011 to December 2012. During the first period, leptospirosis (98 patients, 40%) and scrub typhus (59 patients, 24.1%) were the two major causes of AUFI. In the second period, scrub typhus (137 patients, 28.3%) was found to be more common than leptospirosis (61 patients, 12.7%). Amongst patients with leptospirosis, the proportion of male patients and the median age were similar. Leptospira interrogans serogroup Autumnalis was the major infecting serogroup in both study periods. The case fatality rate of leptospirosis was significantly higher in 2011–2012 as compared with the case fatality rate in 2001–2002 (19.7% vs. 6.3%, p < 0.001). In summary, we found that number of leptospirosis cases had decreased over time. This trend is similar to reportable data for leptospirosis complied from passive surveillance by the Ministry of Public Health, Thailand. However, the case fatality rate of severe leptospirosis has increased. Severe lung hemorrhage associated with leptospirosis remained the major cause of death.
Highlights
Leptospirosis, caused by pathogenic members of genus Leptospira, is the most widespread bacterial zoonosis and a global public health problem [1]
A total of 245 patients with acute undifferentiated fever (AUFI) were enrolled in this study period and leptospirosis was diagnosed in 98 (40%) of them
The diagnosis of leptospirosis was made by isolation of leptospires from blood samples for five patients, by positive PCR for eight patients, by a four-fold rise of antibody against leptospires by immunofluorescent antibody assay (IFA) for 51 patients and by a single titer or stable antibody titer of 1:400 for 36 patients
Summary
Leptospirosis, caused by pathogenic members of genus Leptospira, is the most widespread bacterial zoonosis and a global public health problem [1]. In Thailand reporting of cases of leptospirosis is mandatory, and since 1996 there has been a marked increase in the number of reported leptospirosis cases and leptospirosis-associated deaths occurring annually in this country [2]. The peak incidence period was seen during 2000–2003 after which the annual number of reported case decreased over time. Severe pulmonary involvement and multi-organ failure have emerged as the main cause of death associated with leptospirosis in many countries, including Thailand [4,5]. The reported mortality rate of severe pulmonary hemorrhage syndrome caused by diffuse alveolar hemorrhage varied from 40% to 75% [4,5,6,7,8]. To determine changing trends of this disease over time in Thailand, we analyzed data from two clinical studies conducted in a tertiary hospital in North Eastern Thailand between July 2001 to December 2002, and between July 2011 to December 2012
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