Influence of Rainfall on <i>Leptospira</i> Infection and Disease in a Tropical Urban Setting, Brazil

Hacker, Kathryn P.; Sacramento, Gielson Almeida do; Cruz, Joana; Oliveira, Daiana de; Nery, Nívison; Lindow, Janet C.; Carvalho, Mayara; Hagan, José E; Diggle, Peter J.; Begon, Michael; Reis, Mitermayer Galvão dos; Wunder, Elsio A.; Ko, Albert I.; Costa, Federico

doi:10.3201/eid2602.190102

Cited by 45 publications

(40 citation statements)

References 13 publications

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“…Beginning in January 2007, trained personnel conducted active surveillance for 36 months (until December 2009) in this hospital, to consecutively identify patients from Salvador that fulfilled a clinical case definition for severe leptospirosis defined as a hospitalized patient with acute undifferentiated fever associated with either bleeding, acute renal failure, jaundice, or acute liver injury with transaminases <1,000 U/L [5]. Additionally, acute and convalescent-phase serum samples were collected and evaluated by microscopic agglutination test (MAT) for laboratorial confirmation [5]. Using panels including the most common Leptospira species in Salvador [8], L. interrogans serogroup Icterohaemorrhagiae serovar Copenhageni (strain Fiocruz L130), a laboratory-confirmed case of leptospirosis was defined as the presence of a four-fold rise in the MAT titer between paired acute and convalescent-phase serum samples or a titer of 1:800 in a single sample [8].…”

Section: Surveillance Sitementioning

confidence: 99%

Household rat infestation in urban slum populations: Development and validation of a predictive score for leptospirosis

et al. 2021

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Domestic rats are the principal reservoir for urban leptospirosis. However, few studies have identified infestation markers in slums and evaluated their predictivity for leptospirosis risk. We compared households with leptospirosis cases in Salvador, Brazil between 2007 and 2009 and their neighbors using a case control design, surveying for rodent infestation signs and environmental characteristics. With the 2007–2008 data, a conditional logistic regression modeling identified the peridomiciliar presence of rodent burrows (OR, 3.30; 95% CI, 1.50–7.26), rat feces (2.86; 1.24–6.59), runs (2.57; 1.06–6.22), households bordering abandoned houses (2.48; 1.04–6.02), and unplastered walls (2.22; 1.02–6.02) as risk factors and developed a predictive score for leptospirosis. With an independent data set from 2009, a receiver operating characteristic (ROC) curve analysis evaluated the prediction score performance, with the area under the curve being 0.70 (95% CI, 0.64–0.76) for score development and 0.71 (0.65–0.79) for validation. Results indicate that high proportions of urban slum households are infested with R. norvegicus. The score performed well when identifying high-risk households within slums. These findings need confirmation in other urban centers, but suggest that community-based screening for rodent infestation can allow to target rodent and environmental control measures in populations at highest risk for leptospirosis.

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Section: Surveillance Sitementioning

confidence: 99%

Household rat infestation in urban slum populations: Development and validation of a predictive score for leptospirosis

et al. 2021

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“…In tropical countries, individuals exposed to unsanitary conditions typical of urban slums are at greater risk of contracting leptospirosis [1,5,7]. The subject in this case lives in an urban city where leptospirosis outbreaks annually, affecting the population living in areas of poor sanitation infrastructure during the rainy season [8]. However, the subject's residence is located in a middle-income neighborhood with appropriated sanitary conditions, and she is not in a high-risk occupational group [7].…”

Section: The Presenting Casementioning

confidence: 99%

Severe leptospirosis after rat bite: A case report

et al. 2020

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A 43-year-old woman presented to an emergency department in Salvador, Brazil, with a twoday history of fever (39.5 o to 40.0˚C), chills, headache, arthralgia, myalgia, and loss of appetite in the setting of a recent rat bite. She had no previous relevant medical history but reported a street-rat bite on her right ankle 13 days prior to presentation (Fig 1). The rat bite occurred while she was walking to a drugstore in the early evening in December 2014 in a mediumincome neighborhood of Salvador, a coastal city in the northeast of Brazil. Shortly after the incident, she went to an urgent care unit where she received tetanus and rabies vaccines and wound care. She denied exposure to other potentially leptospires-contaminated environments, such as water or mud. When the symptoms began, she was seen at the hospital where she received medical examination and laboratory evaluation. Her complete blood count (Day 1) showed discrete anemia, leukocytosis with neutrophilia, and thrombocytopenia (Table 1). Her urinalysis showed hematuria. The erythrocyte sedimentation rate was 24 mm 3 /hr, creatine phosphokinase was 1,182 U/L, and no other pertinent findings were reported. Blood culture showed no growth, and a rapid dengue test was nonreactive. She received intravenous fluids, muscle relaxants, and analgesics and was discharged without a clear diagnosis. Persistent symptoms brought the patient back to the hospital the next day (Day 2) complaining of shortness of breath, diffused myalgia, arthralgia, odynophagia, dry mouth, and hemoptysis as well as cutaneous rashes. Clinical examination recorded a temperature of 38.0˚C, blood pressure of 117/72 mmHg, heart rate of 100 beats per minute, respiratory rate of 16 breaths per minute, and oxygen saturation of 99% breathing room air, in addition to dehydration. She was admitted to the hospital that same day-antibiotics (ceftriaxone) and supportive measures were initiated. On Day-3, she developed shortness of breath and crepitus on thorax auscultation at the base of her right lung and had 82% of oxygen saturation at room air. The patient was admitted to the intensive care unit (ICU) for noninvasive respiratory support. Thorax computed tomography and X-ray revealed bilateral diffused consolidation with air bronchogram and a posterior basal laminar stroke of her left lung (Fig 2). The antibiotics were changed to moxifloxacin and cefepime. Oseltamivir and corticosteroids were introduced. Additionally, during Day 3 in the ICU, the patient presented with hemoptysis and pulmonary congestion, likely associated to hypervolemia, which were resolved by the Day 4. The patient was discharged on Day 6 with complete resolution of fever and respiratory symptoms. A definitive diagnosis of leptospirosis was made based on the epidemiological history of rat bite, compatible clinical symptoms, and laboratory tests. A positive immunoglobulin M (IgM) ELISA (Bio-Manguinhos, Rio de

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“…and [32,58]. It is located on the periphery of the city of Salvador in Northeast Brazil and has been a focus for leptospirosis research for over fifteen years [30,32,41].…”

Section: Spatial Prediction and Assessment Of The Contribution Of Eacmentioning

confidence: 99%

A multivariate geostatistical framework for combining multiple indices of abundance for disease vectors and reservoirs: a case study ofrattinessin a low-income urban Brazilian community

Eyre

Carvalho-Pereira

Souza

et al. 2020

J. R. Soc. Interface.

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A key requirement in studies of endemic vector-borne or zoonotic disease is an estimate of the spatial variation in vector or reservoir host abundance. For many vector species, multiple indices of abundance are available, but current approaches to choosing between or combining these indices do not fully exploit the potential inferential benefits that might accrue from modelling their joint spatial distribution. Here, we develop a class of multivariate generalized linear geostatistical models for multiple indices of abundance. We illustrate this novel methodology with a case study on Norway rats in a low-income urban Brazilian community, where rat abundance is a likely risk factor for human leptospirosis. We combine three indices of rat abundance to draw predictive inferences on a spatially continuous latent process, rattiness , that acts as a proxy for abundance. We show how to explore the association between rattiness and spatially varying environmental factors, evaluate the relative importance of each of the three contributing indices and assess the presence of residual, unexplained spatial variation, and identify rattiness hotspots. The proposed methodology is applicable more generally as a tool for understanding the role of vector or reservoir host abundance in predicting spatial variation in the risk of human disease.

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Influence of Rainfall on Leptospira Infection and Disease in a Tropical Urban Setting, Brazil

Cited by 45 publications

References 13 publications

Household rat infestation in urban slum populations: Development and validation of a predictive score for leptospirosis

Household rat infestation in urban slum populations: Development and validation of a predictive score for leptospirosis

Severe leptospirosis after rat bite: A case report

A multivariate geostatistical framework for combining multiple indices of abundance for disease vectors and reservoirs: a case study ofrattinessin a low-income urban Brazilian community

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