An Outbreak of Leptospirosis Among Peruvian Military Recruits

Abstract

Acute undifferentiated febrile illnesses are common in tropical developing countries but are difficult to diagnose on clinical grounds alone. Leptospirosis is rarely diagnosed, despite evidence that sporadic cases and epidemics continue to occur worldwide. The purpose of this study was to diagnose an outbreak of acute undifferentiated febrile illness among Peruvian military recruits that developed after a training exercise in the high jungle rainforest of Peru. Of 193 military recruits, 78 developed an acute febrile illness with varied manifestations. Of these, 72 were found to have acute leptospirosis by a microscopic agglutination test (MAT). An enzyme-linked immunosorbent assay using Leptospira biflexa antigen was insensitive for the detection of anti-leptospiral IgM antibodies compared with the MAT (20 of 72, 28%). This outbreak of acute undifferentiated febrile illness among Peruvian military recruits was due to leptospirosis. High clinical suspicion, initiation of preventative measures, and performance of appropriate diagnostic testing is warranted in similar settings to identify, treat, and prevent leptospirosis.

Leptospirosis in the tropics and in travelers

“…Despite antigenic differences among Leptospira, serologic tests using a single leptospiral antigen to detect leptospiral antibodies have been developed. These tests use lysates of a nonpathogenic leptospire, Leptospira biflexa, whose antigens (primarily a simple LPS [26]) cross-react with many (but not all [14]) leptospires [27]. Indirect hemagglutination (sensitized red cells) [28,29•], enzyme linked immunsorbent assay (ELISA) and lateral flow (dip-stick) assays [29•,30-35] have been exhaustively tested using L. biflexa antigen.…”

“…The severe pulmonary form of leptospirosis manifesting as hemorrhage has globally emerged as a clinical important form of this disease [1][2][3]4••]. In recent years, leptospirosis has increasingly been recognized as an urban disease in both industrialized and developing countries [5,6], as an endemic disease with substantial morbidity in tropical settings [4••,7,8•], and, increasingly, as a disease associated with exotic exposures, whether among adventure travelers [9][10][11][12][13] or military personnel [14]. A recent case was described in which a medical school professor acquired leptospirosis while chasing gliders with her son through soggy grounds in upstate New York [15].…”

Etiologies of Illness Among Patients Meeting Integrated Management of Adolescent and Adult Illness District Clinician Manual Criteria for Severe Infections in Northern Tanzania: Implications for Empiric Antimicrobial Therapy

“…800. 24,25 Syndrome criteria. We used IMAI criteria for the three clinical syndromes 4 and retrospectively applied them to participants from the febrile illness cohort study using information that was prospectively collected on the standardized study case report forms at the time of enrollment.…”

Anicteric Leptospirosis and Renal Involvement

“…In addition, despite evidence to the effect that sporadic cases and epidemics are continuing worldwide, it is rarely identified. [5] Therefore, all cases presenting with fever and multiorgan involvement together with the kidney must be examined with regard to leptospirosis, even if not icteric, particularly if accompanied by a high serum creatinine phosphokinase (CPK) level and thrombocytopenia.…”