Acute Undifferentiated Febrile Illness Research Articles

Identification of Bacteria and Viruses Associated with Patients with Acute Febrile Illness in Khon Kaen Province, Thailand.

The majority of cases of undifferentiated acute febrile illness (AFI) in the tropics have an undefined etiology. In Thailand, AFI accounts for two-thirds of illnesses reported to the Ministry of Public Health. To characterize the bacterial and viral causes of these AFIs, we conducted molecular pathogen screening and serological analyses in patients who sought treatment in Chum Phae Hospital, Khon Kaen province, during the period from 2015 to 2016. Through integrated approaches, we successfully identified the etiology in 25.5% of cases, with dengue virus infection being the most common cause, noted in 17% of the study population, followed by scrub typhus in 3.8% and rickettsioses in 6.8%. Further investigations targeting viruses in patients revealed the presence of Guadeloupe mosquito virus (GMV) in four patients without other pathogen co-infections. The characterization of four complete genome sequences of GMV amplified from AFI patients showed a 93-97% nucleotide sequence identity with GMV previously reported in mosquitoes. Nucleotide substitutions resulted in amino acid differences between GMV amplified from AFI patients and mosquitoes, observed in 37 positions. However, these changes had undergone purifying selection pressure and potentially had a minimal impact on protein function. Our study suggests that the GMV strains identified in the AFI patients are relatively similar to those previously reported in mosquitoes, highlighting their potential role associated with febrile illness.

Evaluation of serological tests in the diagnosis of scrub typhus

Scrub typhus is a leading cause of acute undifferentiated febrile illness in India. Overlapping clinical presentation and very low incidence of characteristic eschar makes serology the main stay of diagnosis. IgM ELISA is the most common test performed in tertiary care centres along with rapid diagnostic tests (RDT) and Weil Felix with varying sensitivity and specificityThe present study was conducted to compare the RDT’s and Weil Felix with IgM ELISA and analyse the demographic and clinical profile of scrub positive patientsSerum samples from clinically suspected scrub typhus patients admitted in a tertiary care hospital were tested by Weil Felix, RDT and IgM ELISA. Scrub typhus was confirmed in 38 of the 100 clinically suspected patients by IgM ELISA. Fever was the most common presenting symptom with significant proportion of patients being exposed to vegetation (p=0.0001).Sensitivity of Weil Felix and RDT was 42.1% and 84.2% respectively. Acute Kidney injury was the most common complication and mortality rate was 7.9%.Weil Felix is not a reliable test for scrub typhus diagnosis due to low sensitivity. Results of positive RDT’s can used for early initiation of specific treatment and IgM ELISA can be used as a confirmatory test in highly suspected cases.

Scrub typhus among patients with acute febrile illness in a tertiary health care centre

Scrub typhus, caused by Orientia tsutsugamushi and transmitted by bite of larval trombiculid mite of the Leptotrombidium genus and is a vector borne zoonotic disease. It has been predominantly reported from Southeast Asia, the Asian Pacific Rim, and Australia. The incidence of this disease is increased in India. These patients show an acute undifferentiated febrile illness and laboratory confirmation is essential. Delay in diagnosis may be fatal. : To assess the Scrub typhus burden among acute febrile illness patients. This Cross-sectional study, conducted in Dept. of Microbiology, Basaveshwara Medical College & Hospital, Chitradurga, Karnataka, India. Study duration was from August 2020 to January 2021. In this study, a total of 100 febrile illness patients were involved. Among them, 66 were males and 34 females. Under aseptic conditions, venous blood samples were collected from all subjects. Serum was separated by centrifugation, aliquoted, and stored at −20°C for further testing. The serum sample was tested for scrub typhus IgM ELISA using the INBIOS kit. Samples were also checked for dengue fever, typhoid fever, leptospirosis, and malaria. The serum samples that tested positive for any other infectious disease mentioned above (with or without detectable rickettsial antibodies) were excluded from the study. Data was represented in numbers and percentages. : In this study, out of 100 samples 30 were seropositive. Of the 30 seropositive scrub typhus cases, women were 11 (37%) and men were 19 (63%), suggesting that seropositivity was more in men than women. Among the seropositive cases, maximum number of the cases were in 16-30 years (33%) of age, followed by 31–45 years (23%). In this study, more number of positive cases 17 (56.6%) were found during the post-monsoon season i.e., October and November 2020. Fever, the most common symptom (100%). Headache, reported in (70 %) of cases, myalgia (40%), abdominal pain (37%), cough (23%), vomiting (20%), lymphadenopathy (17%), rashes (13%), hepato-spleenomegaly (10%), eschar (3%). The study results may conclude that Scrub typhus seropositivity rate was higher in males than females and also to be included in differential diagnosis of fever of unknown origin.

Clinical Presentation, Risk Factors, and Comparison of Laboratory Diagnostics for Seasonal Influenza Virus Among Cambodians From 2007 to 2020.

Despite its global significance, challenges associated with understanding the epidemiology and accurately detecting, measuring, and characterizing the true burden of seasonal influenza remain in many resource-poor settings. A prospective observational study was conducted in Cambodia at 28 health facilities between 2007 and 2020 utilizing passive surveillance data of patients presenting with acute undifferentiated febrile illness (AUFI) to describe the prevalence of influenza A and B and characterize associated risk factors and symptoms using a questionnaire. A comparison of rapid influenza diagnostic tests (RIDTs) and real-time reverse transcription polymerase chain reaction (rRT-PCR) results was also conducted. Of 30 586 total participants, 5634 (18.4%) tested positive for either influenza A or B, with 3557 (11.6%) positive for influenza A and 2288 (7.5%) positive for influenza B during the study. Influenza A and B were strongly associated with the rainy season (odds ratio [OR], 2.30; P < .001) and being from an urban area (OR, 1.45; P < .001). Analysis of individual symptoms identified cough (OR, 2.8; P < .001), chills (OR, 1.4; P < .001), and sore throat (OR, 1.4; P < .001) as having the strongest positive associations with influenza among patients with AUFI. Analysis comparing RIDTs and rRT-PCR calculated the overall sensitivity of rapid tests to be 0.492 (95% CI, 0.479-0.505) and specificity to be 0.993 (95% CI, 0.992-0.994) for both influenza type A and B. Findings from this 14-year study include describing the epidemiology of seasonal influenza over a prolonged time period and identifying key risk factors and clinical symptoms associated with infection; we also demonstrate the poor sensitivity of RIDTs in Cambodia.

Incidence of acute undifferentiated febrile illnesses in an urban slum of Delhi: A longitudinal cohort study

ObjectiveAcute undifferentiated febrile illness (AUFI) is a neglected topic in health care. It has considerable morbidity and mortality worldwide. Slum dwellers are at high risk due to poor living conditions. This longitudinal cohort study estimated the incidence of AUFI in urban slum dwellers in Delhi. MethodsThis study was conducted on urban slum dwellers in Delhi. Data were collected using a structured interviewer-administered questionnaire over a period of 18 months. Adjusted incidence rates (IR) and incidence rate ratios (IRR) were calculated using Poisson regression models. Kaplan-Meier survival curves were used to estimate survival from fever. ResultsA total of 1497 population were studied. Incidence rate of AUFI was 47.43 per 1000 person-months (95% CI: 44.88; 50.08). The incidence was highest among the 50–59 year age group (54.18 per 1000 person months; 95% CI: 43.19; 67.17). Significant seasonal variation was observed with IR high in winter (IR: 32.80 per 1000 person month; adjusted IRR: 1.44 (95% CI: 1.26; 1.66) and monsoon (IR:19.89 per 1000 person month; adjusted IRR: 0.44 (95% CI: 0.36; 0.53). ConclusionThis study has shown a high incidence rate of AUFI amongst the slum dwellers in Delhi. This calls for awareness about clinical investigation and management among patients and healthcare providers. The findings from this study may sensitize policymakers and healthcare stakeholders to draw a road map with insightful consideration of the environmental factors that bring health burdens to the slum population. Further, comparative studies between slum and non-slum dwellers may be undertaken to evaluate the incidence of AUFI.

From fever to action: diagnosis, treatment, and prevention of acute undifferentiated febrile illnesses.

Acute Undifferentiated Febrile Illness (AUFI) presents a clinical challenge, often characterized by sudden fever, non-specific symptoms, and potential life-threatening implications. This review highlights the global prevalence, types, challenges, and implications of AUFI, especially in tropical and subtropical regions where infectious diseases thrive. It delves into the difficulties in diagnosis, prevalence rates, regional variations, and potential causes, ranging from bacterial and viral infections to zoonotic diseases. Furthermore, it explores treatment strategies, preventive measures, and the critical role of the One Health approach in addressing AUFI. The paper also addresses the emerging zoonotic risks and ongoing outbreaks, including COVID-19, Rickettsia spp., and other novel pathogens, emphasizing their impact on AUFI diagnosis and management. Challenges in resource-limited settings are analyzed, highlighting the need for bolstered healthcare infrastructure, enhanced diagnostics, and collaborative One Health strategies. Amidst the complexity of emerging zoonotic threats, this review underscores the urgency for a multifaceted approach to mitigate the growing burden of AUFI, ensuring early diagnosis, appropriate treatment, and effective prevention strategies.

Scrub Typhus Diagnostics: The Present and the Future

Scrub typhus, caused by Orientia tsutsugamushi, is a vector-borne, zoonotic disease commonly occurring in a geographic region known as the ‘tsutsugamushi triangle’. Scrub typhus causes acute undifferentiated febrile illness (AUFI) with non-specific clinical features and is difficult to diagnose when a highly characteristic but not pathognomonic eschar is absent. Because the eschar is not always present, laboratory tests are required for diagnosis. Serological assays have been the mainstay of laboratory diagnosis of scrub typhus to date. Here, we present the major clinical features and clinical algorithms suggestive of this disease, to aid in better selection of diagnostic methods. The advantages and disadvantages of various scrub typhus assays are also discussed. Furthermore, we describe diagnostics, including serological and molecular assays, that may be available in the near future.

The Chikungunya virus: A reemerging cause of acute febrile illness in the high jungle of northern Peru

Background The Chikungunya virus (CHIKV) is an emerging arthropod-borne virus (arbovirus) that causes undifferentiated acute febrile illness. Cases of CHIKV may be under-reported in Peru, given the various difficulties in diagnosing it, such as lack of diagnostic tests in remote areas, the passive nature of epidemiological surveillance, and co-circulation of other arthropod-borne pathogens. Therefore, a study was conducted in the high jungle of northern Peru to determine the prevalence of CHIKV among febrile patients and describe their clinical characteristics. Methods A cross-sectional study was conducted in the province of Jaen, Cajamarca, located in the high jungle of northern Peru. Patients attending primary healthcare centers within Cajamarca’s Regional Health Directorate were enrolled. The study took place from June 2020 through June 2021. Patients were eligible if they sought outpatient healthcare for a clinical diagnosis of acute febrile illness (AFI). Serum samples were collected from all patients, and the diagnosis of CHIKV was determined using real-time RT-PCR, as well as the detection of IgM antibodies by ELISA. A logistic regression model was employed to identify the risk factors for CHIKV, and the odds ratios (ORs) were calculated, along with their corresponding 95% confidence intervals (95% CI). Results A total of 1 047 patients with AFI were included during the study period. CHIKV was identified in 130 patients of 1 047 (12.4%). Among the CHIKV positive cases, 84 of 130 (64.6%) were diagnosed by RT-PCR, 42 of 130 (32.3%) by IgM ELISA detection, and 4 of 130 (3.1%) by both assays. The majority of patients with CHIKV infection fell within the 18–39 years age group (50.0%), followed by the 40–59 years age group (23.9%) and those with 60 years or older (10.8%). The most common clinical symptoms observed in patients with CHIKV infection were headache (85.4%), myalgias (72.3%), and arthralgias (64.6%). The highest number of positive CHIKV cases occurred in May (23.1%), followed by March (20.0%) and February (13.8%) of 2021. Conclusion The study reports a considerable frequency of CHIKV infections among patients with AFI from the high jungle of northern Peru. These findings highlight the importance of recognizing CHIKV as an ongoing pathogen with continuous transmission in various areas of Peru. It is crucial to enhance epidemiological surveillance by implementing reliable diagnostic techniques, as the clinical symptoms of CHIKV infection can be nonspecific.

Scrub typhus in Northeast India: epidemiology, clinical presentations, and diagnostic approaches.

Scrub typhus is one of the most neglected tropical diseases, a leading cause of acute undifferentiated febrile illness in areas of the 'tsutsugamushi triangle', diagnosed frequently in South Asian countries. The bacteria Orientia tsutsugamushi is the causative agent of the disease, which enters the human body through the bite of trombiculid mites (also known as chiggers) of the genus Leptotrombidium deliense. Diagnosis of the disease is challenging, as its early symptoms mimic other febrile illnesses like dengue, influenza and corona viruses. Lack of rapid, reliable and cost-effective diagnostic methods further complicates the identification process. Northeast India, a mountainous region with a predominantly rural tribal population, has witnessed a resurgence of scrub typhus cases in recent years. Various ecological factors, including rodent populations, habitat characteristics and climatic conditions, influence its prevalence. Entomological investigations have confirmed the abundance of vector mites, highlighting the importance of understanding their distribution and the probability of transmission of scrub typhus in the region. Proper diagnosis, awareness campaigns and behavioural interventions are essential for controlling scrub typhus outbreaks and reducing its impact on public health in Northeast India. Further research and community-based studies are necessary to accurately assess the disease burden and implement effective prevention strategies.

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

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. 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). 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.

Epidemiology, clinical characteristics, diagnosis, and complications of scrub typhus infection in Nepal: a systematic review.

Scrub typhus (ST) is a neglected tropical disease of serious concern in Nepal. This systematic review aims to describe the burden of disease, clinical presentation, and complications of ST infection in Nepal. A systematic search of PubMed, EMBASE, Google Scholar, and national databases was conducted for any literature published in English between January 2000 and January 2023. Any type of study design (observational studies, case series, and interventional studies) that reported laboratory-confirmed ST and was conducted in Nepal among patients of all age groups was included. The seroprevalence of ST among acute undifferentiated febrile illness (AUFI) cases, geographical distribution, monthly distribution, clinical presentations, complications, and treatment were assessed by the study. A total of 15 studies with 10,977 participants were included in the review. The seroprevalence of ST among the AUFI cases in Nepal was 19.31%. Young people at or below 20 years of age were mostly affected. The maximum number of cases were reported from Bagmati province (59.46%) and in the month of August (26.33%). Fever, headache, cough, shortness of breath, nausea, and abdominal pain were the clinical characteristics in decreasing order of occurrence. The most common complication was acute kidney injury, followed by respiratory problems, cardiac issues, and neurological manifestations. The case fatality rate of ST in Nepal was 2.56%. The authors findings showed a significant burden of ST among AUFI cases in Nepal. Improved surveillance, general public awareness, and early detection post-calamities could help reduce the disease burden and improve patient outcomes.

Non-Covid causes of acute undifferentiated febrile illness during the Covid pandemic: an etiological analysis from Uttar Pradesh, India

Non-Covid causes of acute undifferentiated febrile illness during the Covid pandemic: an etiological analysis from Uttar Pradesh, India

Isothermal amplification technology (IAT) for rapid diagnosis of Rickettsioses: scope, overview, existing evidence, and the way forward

Rickettsioses, a category of zoonosis primarily caused by Rickettsia and Orientia, is a huge cause of public health concern worldwide. Diseases like murine typhus, scrub typhus, Mediterranean spotted fever and rocky mountain spotted fever are major contributors of Rickettsioses globally, with peculiar distributions in south-east Asia, Africa, Arabia and the Americas. With the innovations in molecular diagnostics, Isothermal Amplification Technology is gaining popularity for its fidelity, rapidity and cost-effectiveness. Compared to commercial assays, they are easily adaptable for point-of-care (PoC) settings. Due to nonspecific presentation as an acute undifferentiated febrile illness, diagnosis of Rickettsioses poses a great challenge. Certain isothermal amplification assays have proven to be highly efficient in diagnosing vector borne diseases like dengue, malaria, and chikungunya. The purpose of this review is to provide readers the current advancements, scope, challenges, and future prospects of isothermal amplification technologies in the detection of zoonotic pathogens like Rickettsia and Orientia.

Scrub typhus, a salient threat: Needs attention.

Scrub typhus (ST) infection is one of the most significant causes of acute undifferentiated febrile illness, and its prevalence has been increasing across the globe. Clinical suspicion and growing clinical understanding among healthcare professionals have resulted in the rapid diagnosis and effective management. Since ST has the potential to cause multiorgan failure and a higher mortality rate, it is critical to enhance surveillance, make rapid diagnosis, and administer antibiotics appropriately.

Scrub typhus: emerging as a co-infection of acute undifferentiated febrile illness in children in a district hospital of Eastern India

Scrub typhus, a zoonosis, caused by Orientia tsuttsutgamushi is transmitted to man through bite of infected tromboculid mite. It is endemic in India as other other South-east Asia countries of Tsuttsutgamuhi triangle and affects children as well. It generally presents as an acute febrile illness with non-specific features like headache rash, lymphadenopathy resembling many other commonly prevalent febrile infections. An eschar, though pathognomonic of Scrub typhus, is often missed clinically. Therefore, a high index of clinical suspicion is essential to establish a diagnosis of Scrub typhus and hence it remains usually under-diagnosed in any undifferentiated febrile illness. In this case series including three cases, we decided to rule out Scrub typhus as a co-infection when there was persistence of fever associated with thrombocytopenia even after ongoing treatment of the primarily diagnosed infection. An eschar was incidentally detected in one case only.

A Review of Rickettsial Diseases Other Than Scrub Typhus in India.

Rickettsial diseases (RD) are widely reported all over the world. Scrub typhus (ST) is a major tropical infection which is well documented all over India. Therefore, the index of suspicion of scrub typhus is high among physicians with regard to patients presenting with acute febrile illness (AFI) and acute undifferentiated febrile illness (AUFI) in India. Rickettsial diseases other than ST (non-ST RDs), which include spotted fever group (SFG) rickettsioses and typhus group (TG) rickettsioses are not uncommon in India, but the index of suspicion is not as high as ST unless there is a history of the presence of fever with rashes and/or recent arthropod bites. This review aims to look into the Indian scenario on the epidemiology of non-ST RDs, especially the SFG and TG rickettsioses based on various investigations, spectrum of clinical presentation, challenges and gaps in knowledge to suspect and diagnose these infections.

A study on acute undifferentiated febrile illness in children (Age 2 Months to 18 Years)

: Acute Undifferentiated Febrile Illness (AUFI) is a common cause of patients seeking healthcare in India. Appropriate diagnosis is essential for proper management of children, since failure to identify the nature of the causative pathogen results in increased morbidity and mortality due to diseases either being untreated or treated with inappropriate antimicrobials, Also there is waste of medicines and increased resistance to antimicrobials, which has a major public health threat worldwide.: To study clinical profile of children admitted with AUFI and to find out common causes of AUFI in Children (2 months to 18 years of age) and their seasonal trends. : A prospective study was carried out over 200 children of age 2 months to 18 months admitted in Balchikitsalaya MBGH Hospital with Acute Undifferentiated Febrile Illness of less than 7 days duration over a period of 12 months from November 2021 to October 2022. : Majority of the patients were in the age group of 10-15 years (32.5%). Out of 200 AUFI patients, majority had undifferentiated illness (53%) followed by Malaria (16.5%), UTI (12.5%), Dengue(11%), Scrub Typhus(5%) and Enteric Fever(2.5%). Higher incidence of AUFI was seen from August to November. : More than 50% cases of Acute Febrile Illness were due to Undifferentiated Illnesses, hence it can be concluded that provided the cause of undifferentiated illness is found, the irrational use of antibiotics and antimalarial should be prevented.

Molecular diagnosis and genotyping of Orientia tsutsugamushi in Maesot and Chiangrai, Thailand

IntroductionScrub typhus is a neglected tropical disease with an estimated 1 million cases annually. The Asia-Pacific region is an endemic area for scrub typhus, especially in Thailand.MethodsBetween June 2018 and December 2019, 31 patients with acute undifferentiated febrile illness (AUFI) were recruited for clinical trials and tested positive by a scrub typhus IgM RDT.ResultsOf the 17 buffy coat patient samples tested by 47kDa real-time PCR and 56kDa type-specific antigen (TSA) nested PCR, 94% (16/17) were positive, and of the 11 patients that presented with eschar lesions, 100% (11/11) of the eschar samples were confirmed positive. Genetic analysis of the 560 bp partial 56-kDa TSA gene demonstrated that most Orientia tsutsugamushi (Ot) infections were with Karp, Gilliam, Taiwan, P23, and CM606-like strains.DiscussionThis is the second occasion that the CM606-like and P23-like strains were reported in northern Thailand (first reported in 2011 and 2013, respectively). This study demonstrates that 1) the eschar remains the most reliable biological sample for PCR diagnosis of scrub typhus and 2) Northwestern Thailand has significant diversity of Ot strains, which underlines the requirement for ongoing surveillance to increase our understanding of Ot diversity to ensure accurate diagnostics and treatment.

Dengue and typhoid co-infection: a case report from a tertiary care hospital in Puducherry

Acute undifferentiated febrile illness is the most common presenting symptom in both adults and children during the monsoon. Incidence of both vector- and water-borne diseases are highest during these seasons, co-infections of dengue with typhoid, malaria, leptospirosis, scrub typhus and other arboviruses can occur in endemic areas. We report the case of a 3-year-old child who presented with dengue and typhoid fever coinfection and subsequently recovered. In every febrile patients’ common infections should be evaluated with through history, clinical examinations and logical investigations. If not treated early, dengue and typhoid together, may lead to multi-organ involvement with significant morbidity and mortality.

Leptospirosis in Ecuador: Current Status and Future Prospects.

The location of Ecuador-an equatorial nation-favors the multiplication and dispersal of the Leptospira genus both on the Pacific Coast and in the Amazon tropical ecoregions. Nevertheless, leptospirosis epidemiology has not been fully addressed, even though the disease has been recognized as a significant public health problem in the country. The purpose of this literature review is to update knowledge on the epidemiology and geographical distribution of Leptospira spp. and leptospirosis in Ecuador to target future research and develop a national control strategy. A retrospective literature search using five international, regional, and national databases on Leptospira and leptospirosis including humans, animals, and environmental isolations of the bacteria and the disease incidence in Ecuador published between 1919 and 2022 (103 years) with no restriction on language or publication date was performed. We found and analyzed 47 publications including 22 of humans, 19 of animals, and two of the environments; three of these covered more than one of these topics, and one covered all three (i.e., One Health). Most (60%) of the studies were conducted in the Coastal ecoregion. Twenty-four (51%) were published in international journals, and 27 (57%) were in Spanish. A total of 7342 human and 6314 other animal cases were studied. Leptospirosis was a frequent cause of acute undifferentiated febrile illness in the Coast and Amazon and was associated with rainfall. All three major clusters of Leptospira-pathogenic, intermediate, and saprophytic-were identified from both healthy and febrile humans, the environment, and animals; moreover, nine species and 29 serovars were recorded over the three Ecuadorian ecoregions. Leptospira infections were diagnosed in livestock, companion, and wild animals from the Amazon and the Coast regions along with sea lions from the Galápagos Islands. Microscopic-agglutination test was the diagnostic tool most widely used. Three reviews covering national data on outpatients and inpatients determined the varied annual incidence and mortality rate, with males being more commonly affected. No human cases have been reported in the Galápagos Islands. Genomic sequences of three pathogenic Leptospira were reported. No studies on clinical ground, antibiotic resistance, or treatment were reported, nor were control programs or clinical-practice guidelines found. The published literature demonstrated that leptospirosis was and still is an endemic disease with active transmission in the four geoclimatic regions of Ecuador including the Galápagos Islands. Animal infections, distributed in mainland and insular Ecuador, pose a significant health risk for humans. Nationwide epidemiological surveys-encouraging more research on the fauna and environment with appropriate sampling design on risk factors for human and animal leptospirosis, Leptospira genotyping, increased laboratory capability, and readily available official data-are required to improve our understanding of transmission patterns and to develop effective national intervention strategies with the intention of applying One Health approaches.