Abstract. We enrolled consecutive febrile admissions to two hospitals in Moshi, Tanzania. Confirmed leptospirosis was defined as a ≥ 4-fold increase in microscopic agglutination test (MAT) titer; probable leptospirosis as reciprocal MAT titer ≥ 800; and exposure to pathogenic leptospires as titer ≥ 100. Among 870 patients enrolled in the study, 453 (52.1%) had paired sera available, and 40 (8.8%) of these met the definition for confirmed leptospirosis. Of 832 patients with ≥ 1 serum sample available, 30 (3.6%) had probable leptospirosis and an additional 277 (33.3%) had evidence of exposure to pathogenic leptospires. Among those with leptospirosis the most common clinical diagnoses were malaria in 31 (44.3%) and pneumonia in 18 (25.7%). Leptospirosis was associated with living in a rural area (odds ratio [OR] 3.4, P < 0.001). Among those with confirmed leptospirosis, the predominant reactive serogroups were Mini and Australis. Leptospirosis is a major yet underdiagnosed cause of febrile illness in northern Tanzania, where it appears to be endemic. Laboratory methods. Leptospirosis laboratory diagnosis was made using the standard MAT performed at the CDC. 10 Live leptospiral cell suspensions representing 20 serovars and 17 serogroups were incubated with serially diluted serum specimens. Resulting agglutination titers were read using darkfield microscopy. The reported titer was the highest dilution of serum that agglutinated at least 50% of the cells for each serovar tested. 10 The serogroups (serovars) included in the antigen panel were Australis ( Leptospira interrogans serovar Australis, L. interrogans serovar Bratislava), Autumnalis ( L. interrogans serovar Autumnalis), Ballum ( Leptospira borgpetersenii serovar Ballum), Bataviae ( L. interrogans serovar Bataviae), Canicola ( L. interrogans serovar Canicola), Celledoni ( Leptospira weilii serovar Celledoni), Cynopteri ( Leptospira kirschneri sero-interrogans serovar Wolffi), and Tarassovi ( L. borgpetersenii serovar Tarassovi).Study definitions. Confirmed leptospirosis was defined as a ≥ 4-fold rise in the agglutination titer between acute and convalescent serum samples.11 Probable leptospirosis was defined as a single reciprocal MAT titer ≥ 800.3, 12, 13 Exposure to pathogenic leptospires was defined as any reciprocal MAT titer ≥ 100.3, 12 Predominant reactive serogroup was defined as the serogroup for the reacting serovar with the highest MAT titer. Rural or urban residence, based on the 2002 Tanzania Population and Housing Census, was determined on a village level for all those with complete residence demographics available.14 Statistical analysis. Data were entered using the Cardiff Teleform system (Cardiff, Inc ., Vista, CA) into an Access database (Microsoft Corp., Redmond, WA). Descriptive statistics are presented as proportions, medians, ranges and interquartile ranges (IQR). Pearson's χ 2 was used to compare categorical data; Fisher's exact test was used when any cell contained fewer than 10 observations. Wilcoxon rank sum was used to compare categor...

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We tested paired sera from 584 febrile persons in an low-income urban community in Bangladesh for evidence of Leptospira infection. A total of 8.4% of the persons met criteria for definite or probable infection. Persons with leptospirosis were older than those with undifferentiated fever in this population. The dominant infecting serogroups in Bangladesh differed from serogroups commonly reported in nearby regions.

Abstract. In 2009, an increased proportion of suspected dengue cases reported to the surveillance system in Puerto Rico were laboratory negative. As a result, enhanced acute febrile illness (AFI) surveillance was initiated in a tertiary care hospital. Patients with fever of unknown origin for 2-7 days duration were tested for Leptospira, enteroviruses, influenza, and dengue virus. Among the 284 enrolled patients, 31 dengue, 136 influenza, and 3 enterovirus cases were confirmed. Nearly half (48%) of the confirmed dengue cases met clinical criteria for influenza. Dengue patients were more likely than influenza patients to have hemorrhage (81% versus 26%), rash (39% versus 9%), and a positive tourniquet test (52% versus 18%). Mean platelet and white blood cell count were lower among dengue patients. Clinical diagnosis can be particularly difficult when outbreaks of other AFI occur during dengue season. A complete blood count and tourniquet test may be useful to differentiate dengue from other AFIs. BACKGROUND

Leptospira is a global pathogen of emerging public health importance in both developing and industrialized nations and can infect almost all mammalian species, including humans. As suburbanization and the popularity of outdoor recreational activities increases, so do human-wildlife and companion animal-wildlife interfaces. Florida offers a tropical climate favorable for outdoor activities and a semirural landscape that sustains an abundant feral hog population. Because no survey ofleptospirosis in feral hogs (Sus scrofa) in Florida has been published to our knowledge, we sought to establish preliminary seroprevalence ofleptospirosis exposure in feral hogs in Florida. Blood samples were collected opportunistically from 158 male and 166 female feral hogs taken at managed hunts and by permitted trappers in the northern, central, and southern regions of Florida. Samples were then analyzed using the microscopic agglutination test (MAT) for antibody titers to 20 Leptospira serovars representing 17 serogroups. A titer of > 1:100 was considered positive; 33% (107/324 total samples) were positive to at least one serovar, and 46% of those were positive to multiple serovars. Antibodies to L. interrogans serovar Bratislava strain Jez Bratislava (serogroup Australis) was the most common, with 18% (58/324) testing positive for antibodies. These initial data indicate that there is a significant possibility of feral hogs having a larger role in the complex etiology of leptospirosis in Florida than historically estimated and that further investigation is warranted.