Prevalence of leptospirosis among patients attending renal and general outpatient clinics in Mulago Hospital, Kampala, Uganda

Abstract

In this study, we sought to establish the prevalence of leptospirosis among renal patients and general outpatients attending Mulago National Referral Hospital, Uganda. A total of 254 patients were recruited, their blood samples collected and interviewer-administered semi-structured questionnaires provided between July and October 2018. These questionnaires captured data on sociodemographic characteristics and symptoms of leptospirosis disease. An individual with an average body temperature of 37.3 ± 1.1 °C was considered to be having fever. The blood samples were analyzed using the standard Microscopic Agglutination Test (MAT) with a panel of 14 Leptospira-serovars belonging to 11 serogroups. Prevalence was reported with confidence intervals while questionnaire data was analyzed using logistic regression analysis. We present an overall prevalence of leptospirosis at 4.70% (95% CI = 2.60–8.30) after analysis of samples from recruited patients. This seropositivity (12/254) was classified into 7 serovars, among which, Canicola and Djasiman presented with titers between ≥ 200 and ≥ 400 in samples of both renal patients and outpatients, indicative of the active disease. Djasiman was the highest contributor to the reported prevalence. Overall, most examined participants presented with common symptoms of abdominal pain (AOR = 24.4, 95% CI (2.42–267.89), p = 0.02) and dehydration (AOR = 0.1, 95% CI (0.01–0.69), p = 0.05). Our study suggests that these symptoms and previous history of abdominal pain may be caused by Leptospira infections among the studied participants. We therefore recommend inclusion of leptospirosis in the differential diagnosis for renal and febrile illnesses. Indeed, abdominal pain and dehydration should be further studied with a bigger sample size and for other related febrile illnesses.

Seroprevalence of leptospirosis among hospitalized febrile patients in Unguja Island

“…On the other hand, the findings of this study showed the presence of some participants prior to exposure to Leptospira bacteria due to their antibodies reacting to MAT titers, which ranged from 1:20 to 1:80, below the cut-off point of significance. This result agreed with the study of [30], which concluded the presence numbers of participants' prior exposure to Leptospira infection. These conditions occur probably due to the routine practice of healthcare workers in primary and secondary levels of treatment to suggest the frequency of uses of recommended antibiotics among non-malarial febrile patients that may be un-diagnosed.…”

“…The findings of this study revealed that the overall seroprevalence of human leptospirosis was 7.7%, which was in line with the previous studies in different parts of the world, including northern Tanzania, with a prevalence of 8.8% [16,26] and northeastern Malaysia, with a seroprevalence of 8.4% [27]. However, this study's seroprevalence was higher than the findings reported from Nepal (4.8%) [28], Mozambique (1.3%) [29], and Uganda 4.7% [30]. In contrast, the study prevalence was lower compared to a prevalence of 13% reported in Kilosa district, Tanzania [31], 14.7 % in Ecuador [32], 21% in Nepal [33], 11.2% in northern Peru [34], and 46.3% reported in Japan [35].…”

“…Furthermore, the frequent use of the recommended antibiotics among non-malaria febrile patients could help clear the infection early. Therefore, previous exposure to recommended antibiotics among non-malaria febrile patients could probably lead to low seroprevalence of disease in the studies [25,30]. In terms of sex variables, the findings of this study showed that female participants have a higher seroprevalence of leptospirosis than males.…”

“…These conditions occur probably due to the routine practice of healthcare workers in primary and secondary levels of treatment to suggest the frequency of uses of recommended antibiotics among non-malarial febrile patients that may be un-diagnosed. Leptospira bacteria become highly susceptible to recommended antibiotics, and the history of Leptospira infections remains for a long time in humans due to the presence of the IgG antibody [30]. The present study had certain limitations.…”

Cross-sectional serosurvey of Leptospira species among slaughter pigs, goats, and sheep in Uganda

“…For East Sub-Saharan Africa, annual morbidity of 91,100 cases per 100,000 population has been reported [6]. In Uganda, Leptospira exposure has been shown in febrile patients from geographically distinct areas [7][8][9][10]. Domestic animals, particularly cattle and pigs are speculated as the source of these human Leptospira exposures [7,8,10], despite evidence of exposure in other main reservoirs such as wildlife [11].…”