Sero-epidemiology study of leptospirosis in febrile patients from Terai region of Nepal

Abstract

BackgroundLeptospirosis is a re-emerging zoonotic disease caused by pathogenic strains of bacteria belonging to genus Leptospira whose symptoms can range from mild clinical manifestations to a severe life threatening illness. This disease may be under-recognized in resource poor settings like Nepal where many clinical laboratories lack appropriate equipment, technology and personnel for proper diagnosis.MethodsWe used IgM ELISA to estimate the sero-prevalence of leptospirosis in a group of febrile patients in a western region of Nepal. We also tested for possible co-infection with two other common febrile diseases endemic to Nepal including dengue and typhoid fever.ResultsAmong samples from 144 febrile patients, 30 (21%) were positive for leptospiral IgM. In univariate analysis, leptospirosis was significantly associated with being of working age (p = 0.019), farming (p = 0.045) and water and animal contact (p = 0.0001). Widal and dengue serological study showed that the majority of leptospirosis infections did not have an alternative diagnosis.ConclusionAs indicated by the study, regular surveillance of animal reservoirs in collaboration with veterinary department and inclusion of leptospirosis as a differential diagnosis of febrile illness is thus recommended based on the current findings.

Sero-prevalence of leptospirosis among presumptive malaria patients in a secondary health facility in Oyo state, Southwest Nigeria

“…This is in harmony with findings from the Nepal study which also showed that persons in this age group are the active work force in the population, hence are more likely to get exposed during their various day-day jobs compared to others , [22,23]. Sixty-six percent of those that tested positive for the disease were female.…”

“…It is however much lower than the prevalence reported from the Terai region of Nepal [22]. The lower prevalence in our study could be as a result of the fact that we conducted our study between April and May when the rains were just starting as compared to the Nepal study, conducted during heavy rains and flooding [22]. Majority of the Leptospira-positive patients in this study were 25-40 years old.…”

“…This is the same as the prevalence found among febrile patients in Tanzania [16] and falls within the range of the prevalence of other studies conducted on febrile patients in other parts of Africa: Egypt (4.0-19.8%) [17,18], Kenya (3.2-17.9%) [19], and Ghana (4.5 -7.8%) [20, , 21]. It is however much lower than the prevalence reported from the Terai region of Nepal [22]. The lower prevalence in our study could be as a result of the fact that we conducted our study between April and May when the rains were just starting as compared to the Nepal study, conducted during heavy rains and flooding [22].…”

“…The presence of Leptospira organism in farm animals in Nigeria is a welldocumented fact, including in Ibadan , [1,25]. Many studies have shown leptospirosis to be a disease of the poor and less educated in society [22,9]. However, this study reported a different finding in which two third of patients that tested positive for leptospirosis had a minimum of tertiary education, with an average monthly salary of approximately 28,000 naira (USD 80 at USD 1 = 350 naira), an amount above the national minimum wage of 17,000 naira (USD 49).…”

Changing Trend of Infectious Diseases in Nepal

“…Seropositive rate among the suspected cases of leptospirosis in central Terai and in Kathmandu has been reported at 4.8% and 28.6% [118,119], respectively. However, in western Terai, among the 144 febrile cases, 21% have been reported to be positive for leptospiral antibodies (IgM) indicating the acute leptospirosis [120]. Among the undiagnosed cases of acute encephalitis cases, 51.6% were positive and was higher in the age group of 6-15 years [121].…”