Active Surveillance and Risk Factors for Leptospirosis in Hawaii

Abstract

A clinic-hospital-based leptospirosis surveillance program was conducted to determine the morbidity and risk factors in nonepidemic settings. The study was conducted on two islands, Kauai and Hawaii (Big Island), in the state of Hawaii for one year during 1988 and 1989. An active, more comprehensive case detection system was used on the Big Island that enabled us to determine the incidence of clinical disease. Subjects from both islands were used to conduct a case-control study for risk factors. One hundred seventy-two subjects from the Big Island (who presented with any two of the following symptoms: fever, headache, myalgia, or nausea/vomiting) were enrolled in the study. Twenty cases were diagnosed by culture, serology, or fluorescent antibody tissue staining at autopsy. Six cases required hospitalization and two succumbed to fatal infections. We estimated that these cases represented an annual incidence rate of 128 per 100,000 person-years in our target population. For 33 cases, 77 controls were matched for island, age, sex, and time of onset of illness. Interviews were conducted retrospectively in a double-blinded fashion with cases and controls and evaluated approximately 30 risk factors. Factors that were associated most strongly with development of leptospirosis were household use of rainwater catchment systems (P = 0.003), presence of skin cuts during the incubation period (P = 0.008), contact with cattle or the urine of cattle (P = 0.05 and P = 0.03, respectively), and handling of animal tissues (P = 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)

Risk factors for death and changing patterns in leptospirosis acute renal failure.

“…11,12,14, 22 However, this frequency was higher than the value of 35% found in hospitalized patients in New Caledonia, 16% in an outbreak in Korea, and 20% among the cases observed in an active surveillance in Hawaii. 6,8,18 These differences could be explained by the design of each study: hospitalized versus nonhospitalized patients, with or without acute renal failure, the presence or absence of an outbreak.…”

“…6,8,[17][18][19][20][21][22] Jaundice was recorded in 98% of the patients, although all had abnormal levels of bilirubins. This percentage was similar to the 85% found in hospitalized patients in French West Indies, 100% in Turkey, 95% in Barbados, and 70% in São Paulo, Brazil.…”

“…3,4 The reported mortality due to leptospirosis varies from 19% in Barbados, 5 10% in Hawaii, 6 8% in Trinidad, 7 and 5% in Korea. 8 In the absence of acute renal failure, death due to leptospirosis is very uncommon, but the reported mortality due to leptospirosis with acute renal failure is high: 36% in Barbados, 9 26% in Sri Lanka, 10 and 17% in Turkey.…”

Leptospirosis Serology in the Common Brushtail Possum (Trichosurus vulpecula) from Urban Sydney, Australia

“…In Australia, the use of rainwater tanks is increasing, and tank water is generally collected from roof tops which are frequently used by urban brushtail possums as runways. In Hawaii, human cases of leptospirosis have been linked with household use of rainwater catchment systems contaminated by rat urine (Sasaki et al, 1993). The potential role that possums could have in leptospirosis disease transmission to humans in urban Australia requires further investigation.…”

Alveolar Septal Deposition of Immunoglobulin and Complement Parallels Pulmonary Hemorrhage in a Guinea Pig Model of Severe Pulmonary Leptospirosis

“…Although serovar Icterohaemorrhagiae is most often associated with severe disease, it is well established that infections with diverse Leptospira can present with similar clinical manifestations. 1,2,19 It is unknown whether the seeming emergence of cases of severe pulmonary hemorrhagic leptospirosis reflects unique virulence properties of specific strains.…”