Contributors: University of Otago Dunedin, Nouvelle-Zélande; London School of Hygiene and Tropical Medicine (LSHTM); Centro de Investigação em Saúde de Manhiça Maputo, Mozambique (CISM); Instituto de Salud Global - Institute For Global Health Barcelona (ISGlobal); Universitat de Barcelona (UB); Malawi Liverpool Wellcome Trust Clinical Research Programme (MLW); Liverpool School of Tropical Medicine (LSTM)-University of Liverpool-Wellcome Trust-University of Malawi; Liverpool School of Tropical Medicine (LSTM); Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU); Mahidol University Bangkok -Mahosot Hospital; University of Oxford; Nuffield Department of Clinical Medicine Oxford; University of Health Sciences Vientiane, Laos (UHS); National University of Singapore (NUS); Biomedical Research and Training Institute (BRTI); University Hospital Münster - Universitaetsklinikum Muenster Germany (UKM); Biologie des Spirochètes / Biology of Spirochetes; Université Paris Cité (UPCité)-Microbiologie Intégrative et Moléculaire (UMR6047); Institut Pasteur Paris (IP)-Centre National de la Recherche Scientifique (CNRS)-Institut Pasteur Paris (IP)-Centre National de la Recherche Scientifique (CNRS); Centre National de Référence de la Leptospirose - National Reference Center Leptospirosis (CNR); Institut Pasteur Paris (IP)-Université Paris Cité (UPCité); The Febrile Illness Evaluation in a Broad Range of Endemicities study is funded by the UK government; the views expressed, however, do not necessarily reflect the UK government's official policies. P. N. N. is supported by the Wellcome Trust. For the purpose of Open Access, the author has applied a CC BY public copyright license to any Author Accepted Manuscript version arising from this submission. The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the manuscript. I. D. O. received support through a Wellcome Trust Clinical PhD Programme awarded to the London School of Hygiene and Tropical Medicine (grant number 203905/Z/16/Z).; The authors thank study team members for their work on the FIEBRE study. They thank Victoria Gould for managing sample aliquoting and shipment to reference lab- oratories and Michael Lawrence for administrative support of the FIEBRE study at the London School of Hygiene and Tropical Medicine. They thank Amandine Houvert, Vallier Sordoillet, Farida Zinini, Céline Lorioux, Jean-Francois Mariet, and Farah Martin, Unité Biologie des Spirochètes, French National Reference Center for Leptospirosis, WHO Collaborating Center for Reference and Research on Leptospirosis, Institut Pasteur. The study was presented in part at the 71st American Society of Tropical Medicine and Hygiene annual meeting, Seattle, Washington, 30 October to 3 November 2022 (Abstract LB-5320)
نبذة مختصرة : International audience ; BackgroundWe investigated the prevalence, diversity, and risk factors for acute leptospirosis in the Febrile Illness Evaluation in a Broad Range of Endemicities (FIEBRE) study.MethodsFebrile patients aged ≥2 months in Laos, Malawi, Mozambique, and Zimbabwe underwent a standardized clinical and exposure assessment. Acute and convalescent serum were tested by Leptospira microscopic agglutination test (MAT) and acute plasma by lfb1 polymerase chain reaction. A ≥4-fold rise in antibody titer, or a single reciprocal titer ≥800, or Leptospira PCR positive defined confirmed leptospirosis. The identity of possible infecting strains was investigated by MAT and sequencing of PCR products.ResultsOf 7851 febrile participants enrolled, 134 (1.7%) had confirmed leptospirosis: 88 (4.6%) in Laos, 17 (1.0%) Malawi, 7 (0.3%) Mozambique, and 22 (1.2%) Zimbabwe, and 23 (0.8%) had supportive evidence of leptospirosis. Participants with leptospirosis had greater odds of headache (adjusted odds ratio [aOR] 2.20, P < .001), rash (aOR 1.45, P < .001), conjunctivitis (aOR 3.33, P < .001), and jaundice (aOR 1.75, P < .001); and had greater odds of being older (aOR 1.02 per year, P < .001), working in rice fields (aOR 6.24, P < .001), drinking river water (aOR 5.11, P = .001). Predominant reactive Leptospira serogroups were Ballum and Icterohemorrhagiae at African sites, and Australis in Laos. Identified species were Leptospira borgpetersenii, L. interrogans, and L. kirschneri.ConclusionsLeptospirosis was a cause of febrile illness at all sites. Some clinical features helped to identify patients with leptospirosis. Interventions related to rice field work and river exposure may prevent disease. Diverse Leptospira serogroup reactivity was observed and may suggest potential hosts.
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