Leptospirosis in the Tohoku Region: Re-emerging Infectious Disease

Abstract

Leptospirosis is a zoonotic and disaster-related infectious disease. It is mainly endemic in subtropical or tropical countries and has not been reported since 2009 in the Tohoku region (northern Japan), including the Yamagata and Miyagi Prefectures. However, we experienced four patients with leptospirosis in the Tohoku region from 2012 to 2014; three patients (#1-3) live in the agricultural areas of the Yamagata Prefecture and one patient (#4) was a visitor to the Miyagi Prefecture. Patient 1 (81-year-old female) is a villager, with a rat bite, while Patient 2 (77-year-old male) and Patient 3 (84-year-old female) are farmers and were infected probably during agriculture work. Patient 4 (40-year-old male US citizen) was infected while traveling in Thailand. They had chief complaint of fever, headache, and myalgia and showed manifestations of hyperbilirubinemia (mean, 4.35 mg/dL), thrombocytopenia and acute kidney injury (AKI). All patients were diagnosed by polymerase chain reaction using blood and/or urine samples and a microscopic agglutination test for the anti-Leptospira antibody. All the patients were treated with infused antibiotics, including minocycline. The patients underwent hemodialysis due to severe AKI (mean serum creatinine, 4.44 mg/dL), except for Patient 2 with the normal serum creatinine level (1.12 mg/dL). All the patients recovered and were discharged. The presence of the three patients in the Yamagata Prefecture implies that leptospirosis does re-emerge in the Tohoku region. Therefore, careful survey of the pathogen is necessary for febrile patients with AKI who engage in agriculture or have a recent history of travelling in subtropical or tropical countries.

Knowledge, Attitude and Practices towards Leptospirosis among Lakeshore Communities of Calamba and Los Baños, Laguna, Philippines

“…Agricultural workers engaged in crop farming, fish culture, and livestock raising and slaughtering are among the groups at high risk of acquiring leptospirosis because their work entails close contact with infected animals or urine-contaminated water and soil [13][14][15][16][17][18]. Moreover, agricultural workers typically lack awareness and basic knowledge of leptospirosis, hence making them more vulnerable to infection [19].…”

Urine Levels of Defensin α1 Reflect Kidney Injury in Leptospirosis Patients

“…Based on global data, the International Leptospirosis Society has estimated that 300,000–500,000 cases of leptospirosis occur annually, and it is assumed to be the most prevalent zoonosis [2]. Flooding and heavy rainfall have been associated with numerous leptospirosis outbreaks around the world [3], and it is also re-emerging as an infectious disease worldwide, with four cases recently identified in the Tohoku region of Japan [4]. …”

Development of Point-of-Care Testing for Disaster-Related Infectious Diseases

“…However, we experienced four patients with leptospirosis in the Tohoku region from 2012 to 2014; three patients lived in the agricultural areas of the Yamagata Prefecture and one patient was a visitor to the Miyagi Prefecture. The presence of the three patients in the Yamagata Prefecture implies that leptospirosis has reemerged in the Tohoku region, probably as a result of global warming (Saitoh et al 2015). We have not encountered an outbreak of leptospirosis patients after flooding in Japan, but such outbreaks are frequently observed in Manila and many patients are hospitalized in SLH after flood.…”