Leptospira Seroprevalence and Risk Factors in Health Centre Patients in Hoima District, Western Uganda.
Leptospira Seroprevalence and Risk Factors in Health Centre Patients in Hoima District, Western Uganda.
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DOI：
10.1371/journal.pntd.0004858
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发表时间：
2016-08
影响因子：
3.8
通讯作者：
Mugisha L
中科院分区：
文献类型：
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作者：
Dreyfus A;Dyal JW;Pearson R;Kankya C;Kajura C;Alinaitwe L;Kakooza S;Pelican KM;Travis DA;Mahero M;Boulware DR;Mugisha L
乌干达的人类钩端螺旋体病负担尚不清楚。我们估计了乌干达西部农村人群中钩端螺旋体抗体的血清阳性率、可能的急性/近期钩端螺旋体病和血清阳性的危险因素。在2014年3月和4月期间，连续招募了359名访问Kikuube和Kigorobya卫生中心的非怀孕成年人。健康史调查和血清收集从同意的参与者。总体而言，69%的人报告在过去一年中有发热，49%的人报告疟疾，14%的人报告疟疾复发，6%的人报告伤寒，3%的人报告布鲁氏菌病，0%的人报告钩端螺旋体病。我们用显微镜凝集试验（MAT）对代表7个血清群的8个钩端螺旋体血清型进行了血清检测。钩端螺旋体血清阳性率为35%（126/359; 95%CI 30.2-40.3%），定义为任何血清型的MAT滴度≥ 1：100。患病率最高的是L。尼日利亚borgpetersenii（血清群Pyrogenes）为19.8%（71/359; 95%CI 15.9-24.4%）。可能的近期钩端螺旋体病（MAT滴度≥1：800）的患病率为1.9%（95%CI 0.9-4.2%），与血清型尼日利亚（Pyrogenes血清群）唯一相关。最近可能的钩端螺旋体病与过去一年内自我报告的疟疾有关（p = 0.048）。高风险活动包括剥皮牛（n = 6），与未剥皮牛相比，钩端螺旋体血清阳性的几率高12.3（95%CI 1.4-108.6; p = 0.024）。与附近没有猴子的参与者相比，生活在猴子附近的参与者（n = 229）血清阳性率高1.92（95%CI 1.2-3.1; p = 0.009）。35%的钩端螺旋体抗体流行率表明，在乌干达农村，特别是尼日利亚血清型（Pyrogenes血清群），钩端螺旋体病的暴露很常见。在东非农村，钩端螺旋体病应作为发热性疾病和“涂片阴性疟疾”的诊断考虑因素。钩端螺旋体病是一种由钩端螺旋体属细菌引起的人畜共患疾病。尽管其发病率相对较常见，但轻度/中度细螺旋体病通常因其发烧、呕吐和不适等非特异性症状而无法被识别。乌干达对钩端螺旋体病的认识有限，这种疾病经常被误诊为疟疾。这项研究试图确定乌干达西部农村地区寻求医疗保健的乌干达人的百分比，他们的血液中有钩端螺旋体抗体，表明先前的暴露。我们发现35%的研究参与者至少有一种钩端螺旋体血清型抗体，主要是L。borgpetersenii sv尼日利亚，代表Pyrogenes血清群（占所有参与者的20%）。感染钩端螺旋体抗体几率增加的个体包括给牛剥皮的参与者和报告家附近有猴子的参与者。自我报告最近诊断为疟疾的人更有可能有钩端螺旋体病抗体。钩端螺旋体病的抗体不是终身的，通常持续几年。高达35%的血清阳性率表明存在持续暴露。需要进一步研究，以了解非洲农村的钩端螺旋体病负担，与暴露相关的风险因素，以及减轻钩端螺旋体病的公共卫生机会。
The burden of human leptospirosis in Uganda is unknown. We estimated the seroprevalence of Leptospira antibodies, probable acute/recent leptospirosis, and risk factors for seropositivity in humans in rural Western Uganda. 359 non-pregnant adults visiting the Kikuube and Kigorobya Health Centers were sequentially recruited during March and April 2014. A health history survey and serum were collected from consented participants. Overall, 69% reported having fever in the past year, with 49% reporting malaria, 14% malaria relapse, 6% typhoid fever, 3% brucellosis, and 0% leptospirosis. We tested sera by microscopic agglutination test (MAT) against eight Leptospira serovars representing seven serogroups. Leptospira seroprevalence was 35% (126/359; 95%CI 30.2–40.3%) defined as MAT titer ≥ 1:100 for any serovar. The highest prevalence was against L. borgpetersenii Nigeria (serogroup Pyrogenes) at 19.8% (71/359; 95%CI 15.9–24.4%). The prevalence of probable recent leptospirosis (MAT titer ≥1:800) was 1.9% (95%CI 0.9–4.2%) and uniquely related to serovar Nigeria (serogroup Pyrogenes). Probable recent leptospirosis was associated with having self-reported malaria within the past year (p = 0.048). Higher risk activities included skinning cattle (n = 6) with 12.3 higher odds (95%CI 1.4–108.6; p = 0.024) of Leptospira seropositivity compared with those who had not. Participants living in close proximity to monkeys (n = 229) had 1.92 higher odds (95%CI 1.2–3.1; p = 0.009) of seropositivity compared with participants without monkeys nearby. The 35% prevalence of Leptospira antibodies suggests that exposure to leptospirosis is common in rural Uganda, in particular the Nigeria serovar (Pyrogenes serogroup). Leptospirosis should be a diagnostic consideration in febrile illness and “smear-negative malaria” in rural East Africa. Leptospirosis is an emerging zoonotic disease caused by bacteria of the genus Leptospira. Despite its relatively common frequency, mild/moderate leptospirosis often goes unrecognized, due to its usually non-specific symptoms of fever, vomiting, and malaise. Knowledge of leptospirosis in Uganda is limited, and the disease may often be misdiagnosed as malaria. This study sought to define the percentage of healthcare seeking Ugandans in rural Western Uganda who have antibodies to Leptospira in their blood, suggesting prior exposure. We found 35% of study participants had antibodies to at least one Leptospira serovar, predominantly L. borgpetersenii sv Nigeria representing the Pyrogenes serogroup (20% of all participants). Individuals with increased odds of having antibodies to leptospires included participants who skinned cattle and those who reported monkeys near their home. Individuals who self-reported recent diagnosis of malaria were more likely to have leptospirosis antibodies. Antibodies to leptospirosis are not lifelong, typically lasting a few years. The high 35% seroprevalence suggests there is ongoing exposure. Further studies are needed to understand the burden of leptospirosis in rural Africa, the risk factors associated with exposure, and the public health opportunities to mitigate leptospirosis.