Molecular detection of leptosipira in synanthropic and wild rodents from Villavicencio municipality, Colombia / Detección molecular de leptospiras en roedores del municipio de Villavicencio, Colombia

Introduction: Rodents are potential transmitters of Leptospira spp. In the municipality of Villavicencio, Colombia, leptospirosis is a disease that, although notifiable, is still underreported. In this region, rodent species that can host pathogenic leptospira remain unknown. Objective: To detect the presence of Leptospira spp. through molecular analysis in rodents (Rodentia) from peri-urban and rural areas belonging to the municipality of Villavicencio in Colombia. Methods: Peri-urban and rural areas of the townships belonging to Villavicencio municipality were selected for sampling. These areas presented similar ecological conditions: they were near water bodies and peridomiciliary areas, and some of them included fields of agricultural crops. Rodents´ kidneys were removed and frozen in liquid nitrogen. DNA was extracted using a commercial kit and subsequently amplified through conventional polymerase chain reaction. Results: The rodent species collected were: Rattus rattus, Mus musculus, Zygodontomys brevicauda, Oligoryzomys sp, Hylaeamys (formerly Oryzomys) and Proechimys cf. oconnelli. Leptospira DNA was amplified in six rodents and the purified amplicons were sent to Macrogen Inc. (Seoul, Korea) for sequencing. The alignment analysis of the sequenced products demonstrated 98.64 percent of coverage and identity with Leptospira interrogans. Conclusions: This is the first study carried out on wild and synanthropic rodents in the municipality of Villavicencio. The incidence of leptospirosis raises the alarm due to the important role of these small mammals in the transmission of this zoonosis, which is considered the second cause, after dengue, of undifferentiated febrile illness in Villavicencio(AU)

Introducción: Los roedores son potenciales transmisores de Leptospira spp. En el municipio de Villavicencio, Colombia, la leptospirosis es una enfermedad que, aunque debe notificarse obligatoriamente, sigue subreportada. En esta región, algunas especies de roedores pueden ser reservorios de leptospiras patógenas, situación que se desconoce. Objetivo: Detectar la presencia de Leptospira spp. a través del análisis molecular en roedores (Rodentia) de áreas periurbanas y rurales del municipio de Villavicencio, Colombia. Métodos: Para el trampeo se seleccionaron áreas periurbanas y rurales de las veredas pertenecientes al municipio de Villavicencio. Las áreas escogidas presentaban condiciones ecológicas similares: cerca de cuerpos de agua y áreas peridomiciliarias; algunas de ellas localizadas en campos de cultivos de la agricultura. Se extirparon los riñones de los roedores y se conservaron en nitrógeno líquido. Se extrajo el ADN usando un estuche comercial y posteriormente se amplificó mediante reacción en cadena de la polimerasa convencional. Resultados: Las especies de roedores colectadas fueron: Rattus rattus, Mus musculus, Zygodontomys brevicauda, Oligoryzomys sp., Hylaeamys (ahora Oryzomys) y Proechimys oconnelli. El ADN de leptospira se amplificó en seis roedores y los amplicones purificados se enviaron a Macrogen Inc. (Seoul, Korea) para secuenciación. El análisis de alineamiento de los productos secuenciados demostró un 98,64 por ciento de cobertura e identidad con Leptospira interrogans. Conclusiones: Este es el primer estudio llevado a cabo en roedores silvestres y sinantrópicos en el municipio de Villavicencio. La incidencia de la leptospirosis genera una alarma con respecto a la importancia del papel de esos pequeños mamíferos en la transmisión de esta zoonosis, la cual es la segunda causa de los síndromes febriles indiferenciados en Villavicencio, después del dengue(AU)

Seroprevalence and incidence of Leptospira spp. in domestic dogs in the Southeast region of São Paulo State, Brazil / Soroprevalência e incidência de Leptospira spp. em cães domésticos na região sudeste do estado de São Paulo, Brasil

Leptospirosis is a zoonotic disease caused by Leptospira and domestic dogs can act as host of some serovars. In order to analyze the transmission dynamics in a dog population, with and without immunization, a longitudinal study was carried out with a focus to evaluate antibody response and to identify serovars. Blood samples were collected in three consecutive years (2015 to 2017) from 331, 373 and 347 dogs respectively. The dog seroprevalence in each year was 11%, 7% and 14%, respectively, and the incidence in 2016 was 5% and in 2017, 14%. The most frequent serovars were Cynopteri and Butembo in 2015, Cynopteri, Butembo and Hardjoprajitno in 2016, and Canicola and Butembo in 2017. Dogs can play a role as sentinel animals and hosts of Leptospira serovars. The percentage of seropositive dogs due to vaccination was higher than the previous years without immunization and lower than in previous years for other serovars, which we interpret as evidence for the importance of immunization. These parameters associated with active canine population control are important for prevention and control of leptospirosis not only in dogs but alsoto inhibit the transmission between dogs and humans.(AU)

A leptospirose é uma zoonose causada pelo agente etiológico Leptospira. Cães domésticos atuam como hospedeiro de diversos sorovares deste agente. Com intuito de analisar a dinâmica da leptospirose em uma população canina, com e sem imunização, um estudo longitudinal foi realizado avaliando a resposta sorológica destes animais e identificando seus sorovares. Foram coletadas amostras de 331, 373 e 347 cães em três anos consecutivos (2015 a 2017). As soroprevalências foram de 11%, 7% e 14%, respectivamente, e a incidência em 2016 foi de 5% e em 2017 de 14%. Os sorovares mais frequentes foram Cynopteri e Butembo em 2015, Cynopteri, Butembo e Hardjoprajitno em 2016, e Canicola e Butembo em 2017. Estes cães estão atuando como bio-indicadores da presença de Leptospira na região do estudo, incluindo sorovares zoonóticos, e contribuindo com a sua manutenção no ambiente. A soropositividade para sorovares protegidos pela vacina foi mais alta do que nos anos anteriores à imunização, enquanto para os sorovares não protegidos pela vacina diminuiu, demonstrando a importância da imunização para essa população de cães. Medidas de prevenção e controle para a leptospirose, como imunização e controle populacional canino, são recomendadas no local para inibir a transmissão do agente entre as populações de cães e humanos envolvidas.(AU)

A leptospirose humana como doença duplamente negligenciada no Brasil / Human leptospirosis as a doubly neglected disease in Brazil

Resumo O objetivo do presente artigo é analisar as discrepâncias e lacunas informacionais que produzem uma versão duplamente negligenciada da leptospirose humana na política pública de saúde brasileira. Para alcançar esse objetivo, comparamos dados de morbidade, mortalidade, custos hospitalares e sociais, perfis populacionais, hábitos dos vetores, determinantes sociais de saúde e práticas diagnósticas relacionadas à leptospirose com outra doença de maior reconhecimento no país: a dengue. Nossa análise mostra que a arbitrariedade dos critérios para atribuições de prioridades de intervenção em saúde, a invisibilidade do perfil populacional da leptospirose humana nos dados oficiais da política de saúde e seu caráter clínico mimético corroboram para a produção de uma versão da leptospirose humana que é invisível e, portanto, duplamente negligenciada pela política pública de saúde brasileira. Concluímos que essas discrepâncias e lacunas informacionais relacionam-se ao fato de que a leptospirose humana acomete uma população que o Estado não tem interesse em manter viva.

Abstract The aim of this article is to analyze discrepancies and informational gaps which produce a doubly neglected version of human leptospirosis in the Brazilian public health policy. To achieve this goal, we compared data on morbidity, mortality, hospital and social costs, population profiles, vector habits, social health determinants and diagnostic practices related to leptospirosis with another disease of higher recognition in Brazil: dengue fever. Our analysis shows that the arbitrariness of criteria for assigning health priorities, the invisibility of the population profile of human leptospirosis in official data and its mimetic character in clinic corroborate the production of a version of human leptospirosis that is invisible and, because of that, doubly neglected by the Brazilian public health policy. We conclude that these discrepancies and informational gaps are related to the fact that human leptospirosis affects a population which the State has no interest in keeping alive.

DNA nanovaccines prepared using LemA antigen protect Golden Syrian hamsters against Leptospira lethal infection

BACKGROUND Nanoparticles (NPs) are viable candidates as carriers of exogenous materials into cells via transfection and can be used in the DNA vaccination strategy against leptospirosis. OBJECTIVES We evaluated the efficiency of halloysite clay nanotubes (HNTs) and amine-functionalised multi-walled carbon nanotubes (NH2-MWCNTs) in facilitating recombinant LemA antigen (rLemA) expression and protecting Golden Syrian hamsters (Mesocricetus auratus) against Leptospira interrogans lethal infection. METHODS An indirect immunofluorescent technique was used to investigate the potency of HNTs and NH2-MWCNTs in enhancing the transfection and expression efficiency of the DNA vaccine in Chinese hamster ovary (CHO) cells. Hamsters were immunised with two doses of vaccines HNT-pTARGET/lemA, NH2-MWCNTs-pTARGET/lemA, pTARGET/lemA, and empty pTARGET (control), and the efficacy was determined in terms of humoral immune response and protection against a lethal challenge. FINDINGS rLemA DNA vaccines carried by NPs were able to transfect CHO cells effectively, inducing IgG immune response in hamsters (p < 0.05), and did not exhibit cytotoxic effects. Furthermore, 83.3% of the hamsters immunised with NH2-MWCNTs-pTARGET/lemA were protected against the lethal challenge (p < 0.01), and 66.7% of hamsters immunised with HNT-pTARGET/lemA survived (p < 0.05). MAIN CONCLUSIONS NH2-MWCNTs and HNTs can act as antigen carriers for mammalian cells and are suitable for DNA nanovaccine delivery.

Seroprevalencia de leptospirosis en grupos humanos en riesgo por factores ambientales, laborales o sociales / Seroprevalence of leptospirosis in human groups at risk due to environmental, labor or social conditions

Abstract Leptospirosis is important in Uruguay due to the economic loss caused by the diseases of production animals, mainly bovines, and also due to frequent human infection. We decided to study anti-Leptospira antibodies in the sera of dairy workers, rice laborers, veterinarians, suburban slum dwellers and garbage recyclers. Our aims were to estimate the seroprevalence of infection by Leptospira spp. in these people at risk, the relative importance of the known risk factors associated with infection, and the impact of human infections in each setting. Groups at risk were identified and 35 visits to their locations were made, conducting field surveys and exchange talks for information and education. Simple epidemiological questionnaires were administered and sera samples were taken from 308 persons. The microagglutination Technique (MAT) and the IgM Indirect Immunofluorescence (IIF) assay were employed to detect antibodies. Environmental water samples, canine and equine sera were also examined. More than 45% of human sera were reactive and the studied groups were confirmed to be widely exposed to infection. Female sera were frequently reactive, though most illnesses occur in men, and the most severe cases in elderly males; the emergence and evolution of the disease may strongly depend on the host condition and functions. Animal contact and unsafe water usage were the main identified risk factors to be considered in prevention. Fifty per cent of the studied horses showed a positive MAT reaction. The underdiagnosis of the illness and its long-term symptoms require further study, as well as greater health and social attention efforts.

Resumen La leptospirosis es importante en Uruguay por las pérdidas económicas que ocasionan las enfermedades en los animales de producción, principalmente en los bovinos, y a causa de la frecuente infección humana. Decidimos estudiar anticuerpos anti -Leptospira en trabajadores de tambo y de plantaciones de arroz, así como en veterinarios, habitantes de asentamientos y recicladores de residuos. Buscamos evaluar la importancia de distintos factores de riesgo conocidos asociados con la infección por Leptospira spp., y estimar la frecuencia y el impacto de las infecciones humanas en la población expuesta. Se efectuaron 35 visitas a colectivos de riesgo, realizando relevamientos de campo e intercambios educativos, llenando formularios epidemiológicos sencillos y tomando muestras de sangre a 308 personas. Se investigaron anticuerpos séricos con técnicas de microaglutinación (MAT) e inmunofluorescencia indirecta para IgM. Se examinaron también, muestras de agua ambiental, y sueros caninos y equinos. Más del 45% de los sueros humanos fueron reactivos y se confirmó que los grupos estudiados estaban ampliamente expuestos a la infección. Los sueros de mujeres fueron frecuentemente reactivos, aunque la mayoría de las enfermedades ocurren en varones, y los casos más graves en varones añosos. La emergencia y la evolución de la afección pueden depender fuertemente del estado del huésped y su respuesta. El contacto con animales y el uso de agua insegura fueron los principales factores de riesgo identificados para considerar en la prevención. El 50% de los sueros equinos fueron reactivos por MAT. Es necesario incrementar los esfuerzos de atención social y sanitaria en estos sectores, superar el subdiagnóstico y estudiar la evolución y la sintomatología a largo plazo de los pacientes.

Comportamiento epidemiológico de la leptospirosis humana en Colombia, 2012-2016 / Epidemiology of human leptospirosis in Colombia, 2012-2016

Introducción: La leptospirosis en una enfermedad zoonótica, bacteriana de amplia distribución mundial, con impacto socioeconómico desconocido por la falta de estudios epidemiológicos que ofrezcan datos de mortalidad y morbilidad más cercanos a la realidad. Objetivo: Describir el comportamiento de casos de leptospirosis humana notificados al Sivigila en Colombia durante los años 2012 a 2016. Métodos: Estudio observacional descriptivo, mediante el cual se analizaron los registros de los informes anuales de evento de leptospirosis notificados al Sivigila durante los años 2012 al 2016 en Colombia. Para ello se utilizó la hoja de cálculo Excel. Resultados: Durante el quinquenio observado se notificó un total de 10 435 casos de leptospirosis. Según características sociodemográficas el mayor número se presentó en hombres, el 49,8 por ciento pertenecía al régimen subsidiado, la mayoría se presentó en la cabecera municipal y la población más afectada correspondió a sin identificación étnica. Dentro de los antecedentes epidemiológicos más importantes se halló el contacto con caninos, ratas en el domicilio y actividades de río. Conclusiones: La compilación de los datos epidemiológicos de la vigilancia de leptospirosis humana demuestra que sigue siendo un problema de salud pública, lo cual genera preocupación y demanda mejoras en las estrategias nacionales de prevención y control(AU)

Introduction: Leptospirosis is a zoonotic bacterial disease of broad worldwide distribution. Its socioeconomic impact is not known, due to the lack of epidemiological studies providing reliable mortality and morbidity data. Objective: Describe the evolution of cases of human leptospirosis reported to Sivigila in Colombia from 2012 to 2016. Methods: An observational descriptive study was conducted based on the records of annual reports of leptospirosis notified to Sivigila in Colombia from 2012 to 2016. Use was made of Microsoft Excel spreadsheets. Results: A total 10 435 cases of leptospirosis were reported during the five-year period analyzed. Sociodemographic characterization showed that the largest number of cases were men, 49.8 % belonged to the subsidized regime, most occurred in the municipal capital, and the most commonly affected population was the group without ethnic identification. The most relevant epidemiological antecedents were contact with canines, rats in the household and fluvial activities. Conclusions: Gathering of epidemiological data about surveillance of human leptospirosis revealed that this disease continues to be a worrisome public health problem that demands improved national prevention and control strategies(AU)

Brotes emergentes de leptospirosis del Amazonas colombiano / Emerging leptospirosis outbreaks in the Colombian Department of Amazonas

Se describe por primera vez una serie de nueve casos con clínica indicativa de leptospirosis en el municipio Puerto Nariño en el departamento Amazonas, Colombia. Se muestran evidencias serológicas de exposición con Rickettsia del grupo de las fiebres manchadas. Los casos fueron clínicamente considerados como síndrome febril de origen desconocido. Se descartó infección por dengue y malaria. El diagnóstico de Leptospira se realizó mediante el método de reacción en cadena de la polimerasa en tiempo real. Igualmente, se detectó la presencia de anticuerpos contra rickettsias del grupo de las fiebres manchadas por inmunofluorescencia Indirecta. Finalmente, se realiza revisión del tema(AU)

A description is provided for the first time of a series of nine cases with a clinical examination suggestive of leptospirosis in the municipality of Puerto Nariño, Department of Amazonas, Colombia. Serological evidence is presented of exposure to Rickettsia, spotted fever group. The cases were clinically considered as febrile syndrome of unknown origin. Infection with dengue or malaria was ruled out. Diagnosis of leptospirosis was achieved by real-time polymerase chain reaction. Additionally, indirect immunofluorescence detected the presence of antibodies against rickettsia, spotted fever group. Finally, a review was conducted about the topic(AU)

Vulnerabilidade socioambiental à leptospirose humana no aglomerado urbano metropolitano de Curitiba, Paraná, Brasil: proposta metodológica a partir da análise multicritério e álgebra de mapas / Socio-environmental vulnerability to human leptospirosis in urban agglomeration metropolitan of Curitiba, Paraná, Brazil: methodological proposal from the multicriteria analysis and maps algebra

Resumo A análise da vulnerabilidade socioambiental é realizada por meio de distintas abordagens, que utilizam uma gama de dados e técnicas. Nesse contexto, este trabalho aborda um índice sintético de vulnerabilidade em face dos condicionantes socioambientais da leptospirose humana no aglomerado urbano metropolitano de Curitiba. Para isso, aplicou-se a técnica da cartografia de síntese para avaliar a vulnerabilidade social e, de modo integrado, demarcou-se as áreas de inundações. Os resultados indicam, dentro das possibilidades e limites do mapeamento, que a metodologia é eficaz para representar a vulnerabilidade socioambiental à leptospirose humana, fato comprovado pelos trabalhos de campo. As condições de alta e muito alta vulnerabilidade social são identificadas, em maiores proporções espaciais, nas cidades da periferia geográfica do aglomerado e nas periferias sociológicas, enquanto as condições de baixa e muito baixa vulnerabilidade estão associadas às regiões centrais e mais valorizadas, concentrando-se na cidade de Curitiba. Ressalta-se que esse indicador de vulnerabilidade possibilita monitorar a distribuição espacial das fragilidades da sociedade e do ambiente em relação a uma problemática e, assim, se constitui em uma ferramenta de auxílio para a implantação de políticas públicas que visam o controle e a erradicação da leptospirose humana.

Abstract The analysis of socio-environmental vulnerability is carried out through different approaches, using a broad range of data and techniques. In this context, this work deals with a synthetic index of vulnerability face the environmental conditionings of human leptospirosis in urban agglomeration of the Metropolitan Area of Curitiba. To do so, the technique of synthesis mapping was applied to assess social vulnerability and, in an integrated manner, mark the flooding areas. The results allowed to identify, within the possibilities and limits of the mapping, that the methodology is effective to represent the environmental vulnerability to human leptospirosis, a fact proven by field work. Conditions of high and very-high social vulnerability are identified, in larger proportions, in the cities of the geographical peripheries of the agglomeration and in sociological peripheries, whereas the conditions of low and very-low vulnerability are associated with the central and most valued regions, concentrating on the city of Curitiba. It is noteworthy that this vulnerability indicator allows monitoring the spatial distribution of the social and environmental frailty conditions regarding a problem, and thus constitutes a proper assistance tool for the implementation of public policies aimed at the control and eradication of human leptospirosis.

Efficacy of leptospiral commercial vaccines on the protection against an autochtonous strain recovered in Brazil

Abstract In swine and bovines, leptospirosis prevention and control is carried out via vaccination of susceptible animals using bacterins. However, the efficiency of leptospirosis vaccines has been questioned. This work aimed to investigate the potency of five leptospirosis vaccines sold commercially in Brazil, challenging the animals with one autochthonous strain of Leptospira, Canicola serovar, denoted LO4, isolated from swine. The standard protocol was followed, and renal carriers of Leptospira were identified among the surviving animals by culture and PCR. Of the five vaccines tested, only two proved effective. None of the surviving animals was positive by culture; however, one animal was positive by PCR. Three of the five vaccines sold commercially in Brazil for the immunization of swine or bovines failed the test of the efficacy to protect the vaccinated animals following challenge with an autochthonous Leptospira strain, Canicola serovar. The two vaccines provided protection against the renal carrier state in the surviving animals. The criteria used to produce leptospirosis bacterins sold commercially in Brazil must be reviewed. The industry should support researches on leptospiral vaccinology to improve the quality of the present vaccines and discover new immunogenic strains, because it is known that vaccination is one of the most important tools to increase the reproduction rates in livestock.

Estrategias de participación en la prevención comunitaria para el control de la Leptospirosis humana / Participation strategies in community prevention for human leptospirosis control

Introducción: Las estrategias de prevención comunitaria resultan básicas para alcanzar logros en salud y en especial en las tasas de mortalidad infantil, así como en las de morbilidad y mortalidad por enfermedades transmisibles. Objetivo: Sistematizar los resultados de investigaciones sobre estrategias de prevención de la leptospirosis a través de la participación comunitaria. Métodos: Se realizó una revisión documental, investigación cualitativa y descriptiva, se emplearon métodos teóricos: el histórico-lógico, analítico-sintético, inductivo-deductivo. Conclusiones: La sistematización de la bibliografía especializada y las investigaciones realizadas sobre la temática de las estrategias de prevención para la leptospirosis humana con carácter integral participativo ha puesto de manifiesto suficientes elementos de juicio para efectuar apreciaciones en función de planear una estrategia educativa con fines preventivos fundamentada en las mejores experiencias de Cuba y del resto del mundo(AU)

Introduction: Community prevention strategies are basic to achieve positive health outcome, especially in infant mortality rates, as well as regarding morbidity and mortality for due to communicable diseases. Objective: To systematize research outcome on leptospirosis prevention strategies through community involvement. Methods: A documentary review was carried out, for a qualitative and descriptive research, theoretical methods were used: the historical-logical, the analytical-synthetic, and the inductive-deductive. Conclusions: The systematization of the specialized bibliography and the research carried out on the topic of human leptospirosis prevention strategies with a participatory holistic character has revealed enough elements of judgment to make appraisals in order to plan an educational strategy with preventive purposes based on the best experiences of Cuba and the rest of the world(AU)

Protocolo del Sistema Nacional de Vigilancia Epidemiológica: enfermedades zoonóticas. No. 08 / Protocol of the National Epidemiological Surveillance System: zoonotic diseases. No. 08

Estos protocolos están dirigido a personal médico, paramédico y otros profesionales que realizan acciones gerenciales y operativas de vigilancia epidemiológica en los servicios de salud del país, y están divididos en varios tomos para dar a conocer y actualizar la identificación y medidas de control para diversos padecimientos a fin de continuar con el mejoramiento de las capacidades técnicas de los trabajadores de salud, que permita planificar la prestación de servicios con decisiones partiendo de un enfoque epidemiológico comprobado, para responder a los cambios de tendencias epidemiológicas y con ello contribuir al fortalecimiento de prácticas asertivas de la salud pública de nuestro país.

Nivel de conocimientos clínico-epidemiológicos de la leptospirosis en estudiantes / Level of clinical-epidemiological knowledge of leptospirosis in students

Introducción: la incidencia de leptospirosis se ha elevado en los últimos años en la provincia de Guantánamo. Objetivo: caracterizar el comportamiento del conocimiento sobre las características clínico-epidemiológicas de la leptospirosis en los estudiantes de la carrera de Higiene y Epidemiología de la Facultad de Ciencias Médicas Guantánamo. Método: se realizó un estudio descriptivo de corte transversal durante el periodo comprendido entre abril de 2016 hasta marzo de 2017. El universo estuvo constituido por 380 estudiantes y se tomó una muestra de 114. Se estudiaron variables, tales como: nivel de conocimientos sobre concepto, vías de transmisión y medidas de prevención de la leptospirosis. Para el desarrollo de este trabajo se utilizaron métodos teóricos, empíricos y matemáticos entre los que se encuentra el histórico-lógico, análisis-síntesis, inductivo-deductivo, sistémico estructural y funcional, análisis de documentos, la encuesta, criterios de especialistas, entre otros. Resultados: se encontró un predominio de mediano conocimiento en los estudiantes encuestados sobre el concepto de leptospirosis y nivel de conocimiento sobre las vías de transmisión, en cuanto a las medidas de prevención el resultado general fue de bajo conocimientos. Conclusiones: se concluyó que los estudiantes del estudio no poseen los conocimientos suficientes acerca de la leptospirosis, por lo que resulta necesaria la pronta realización de acciones para evitar esta problemática()AU

Introduction: the incidence of leptospirosis has increased in the province of Guantanamo in recent years. Objective: to characterize the behavior of knowledge about the clinical-epidemiological characteristics of leptospirosis in the students of the Hygiene and Epidemiology career of the Faculty of Medical Sciences Guantanamo. Method: a cross-sectional descriptive study was carried out during from April 2016 to March 2017. The universe consisted of 380 students and a sample of 114 was taken. Variables were studied, such as: level of knowledge about the concept, transmission routes and measures for the prevention of leptospirosis. For the development of this work, theoretical, empirical and mathematical methods were used, including historical-logical, analysis-synthesis, inductive-deductive, structural and functional systemic, document analysis, survey, specialist criteria, among others. Results: a predominance of low knowledge was found in the students surveys about the concept of leptospirosis and level of knowledge about the transmission routes, in terms of prevention measures, the general result was low knowledge. Conclusions: it was concluded that the students of the study do not have sufficient knowledge about leptospirosis, so it is necessary to carry out emergent actions to avoid this problem(AU)

Detección de Leptospira spp. en animales y muestras ambientales de áreas peridomésticas en Nicaragua / Detection of Leptospire spp. in animals and in environmental samples from peridomestic areas in Nicaragua / Detecção de Leptospira spp. em animais e em amostras ambientais de áreas peridomiciliares na Nicarágua

RESUMEN Objetivo El objetivo de este estudio fue conocer las características epidemiológicas de la leptospirosis en animales domésticos y en los casos de leptospirosis humana en áreas peridomésticas en Nicaragua entre 2014 y 2016. Métodos Las muestras se extrajeron en áreas donde se confirmaron casos en humanos utilizando un muestreo no probabilístico en 10 de los 17 departamentos del país. Se incluyeron 112 muestras de orina de animales domésticos, 129 muestras de agua y 69 de tierra para aislar leptospiras en medio Ellinghausen-McCullough-Johnson-Harris (EMJH). Además, se aplicó la prueba de microaglutinación (MAT) en 263 muestras de suero de animales y 88 aislados se analizaron mediante PCR. Resultados En 32,6% (101/310) de las muestras se aislaron espiroquetas, 23,2% (26/112) se aislaron en la orina de animales domésticos, 47,3% (61/129), en las muestras de agua y 20,3 % (14/69), en las de tierra. El análisis de aislamiento mostró diferencias significativas (P < 0,05) entre los departamentos para los diferentes tipos de muestras, y el aislamiento fue más frecuente en agua que en tierra (OR = 3,49; IC95%: 1,56-7,80). El 14,1% (37/263) de los animales fueron reactores en la prueba de microaglutinación. El serogrupo más frecuente fue Icterohaemorrhagiae (40%). En el análisis con la PCR para identificar leptospiras de las especies patógenas 10,2% (9/88) de los aislamientos fueron positivos. Conclusiones Esta investigación demuestra que los animales domésticos y el ambiente desempeñan un papel importante en la aparición de brotes de la leptospirosis y confirma el comportamiento endémico de la enfermedad en Nicaragua.

ABSTRACT Objective The objective of this study was to determine the epidemiological characteristics of leptospirosis in pets and in humans in peridomestic settings in Nicaragua between 2014 and 2016. Methods The samples were taken in areas where cases were confirmed in humans using non-probabilistic sampling in 10 of the country's 17 departments. This included 112 urine samples from pets, 129 water samples, and 69 soil samples in order to isolate leptospires in Ellinghausen-McCullough-Johnson-Harris (EMJH) medium. Furthermore, the microscopic agglutination test (MAT) was applied to 263 samples of animal serum, and 88 isolates were analyzed using PCR. Results In 32.6% (101/310) of the samples, spirochetes were isolated: 23.2% (26/112) in the pet urine, 47.3% (61/129) in water samples, and 20.3% (14/69) in soil samples. Isolation analysis showed significant differences (p<0.05) between departments for the different types of samples, and isolation was more frequent in water than in soil (OR = 3.49; CI95%: 1.56-7.80). In total, 14.1% (37/263) of the animals were reactors in the microscopic agglutination test. The most frequent serogroup was Icterohaemorrhagiae (40%). PCR analysis to identify pathogenic species of leptospires resulted in 10.2% (9/88) positive isolations. Conclusions This research demonstrates that pets and environment conditions play an important role in the emergence of outbreaks of leptospirosis, and confirms the endemic behavior of the disease in Nicaragua.

RESUMO Objetivo Descrever as características epidemiológicas da leptospirose em animais domésticos e em casos de leptospirose humana em áreas peridomiciliares na Nicarágua entre 2014 e 2016. Métodos As amostras foram coletadas por amostragem não probabilística em áreas com casos confirmados de leptospirose humana em 10 das 17 províncias do país. Foram analisadas 112 amostras de urina de animais domésticos, 129 amostras de água e 69 amostras de solo com o uso do meio de cultura padrão para o isolamento de leptospiras (Ellinghausen-McCullough-Johnson-Harris, EMJH). Além disso, foi realizado o teste de aglutinação microscópica em 263 amostras séricas de animais e 88 isolados foram analisados com a técnica de PCR. Resultados Em 32,6% (101/310) das amostras foram isoladas espiroquetas, sendo 23,2% (26/112) isoladas na urina de animais domésticos, 47,3% (61/129) nas amostras de água e 20,3% (14/69) nas amostras de solo. Houve diferença significativa (P < 0,05) entre as províncias no isolamento nos diferentes tipos de amostras analisadas, sendo o isolamento mais frequente nas amostras de água que de solo (OR = 3,49; IC95%: 1,56-7,80). Reatividade no teste de aglutinação microscópica foi observada em 14,1% (37/263) das amostras de animais. O sorogrupo mais frequentemente isolado foi Icterohaemorrhagiae (40%). A técnica de PCR demonstrou que 10,2% (9/88) dos isolados eram positivos para espécies patogênicas de leptospiras. Conclusões Esta pesquisa demonstra que os animais domésticos e o entorno têm papel importante no surgimento de surtos de leptospirose e confirma o comportamento endêmico da doença na Nicarágua.

Avances de laboratorio sobre la leptospirosis humana en Cuba, 1989-2016 / Laboratory advances about human leptospirosis in Cuba, 1989-2016

La leptospirosis humana es una enfermedad que tiene en Cuba un comportamiento endemo-epidémico con un carácter cíclico estacional. El avance tecnológico introducido en el país ha permitido tener un mejor conocimiento del agente causal en las provincias cubanas, así como realizar intervenciones en los brotes epidémicos ocurridos durante años, y brindar informaciones que fortalezcan al Programa Nacional de Prevención y Control y a los ensayos clínicos de la vacuna cubana vaxSPIRAL®. En este trabajo se resumen aspectos de interés relacionados con la vigilancia de laboratorio y los resultados de algunas de las investigaciones realizadas en el periodo 1989-2016(AU)

In Cuba human leptospirosis is a condition of an endemic-epidemic, cyclic-seasonal nature. Technological advances introduced into the country have made it possible to expand knowledge about the causal agent in Cuban provinces, carry out interventions in the epidemic outbreaks which have occurred during years, and offer information strengthening the National Prevention and Control Program and the clinical assays for the Cuban vaccine vaxSPIRAL®. The paper summarizes aspects of interest related to laboratory surveillance, as well as the results of some of the studies conducted in the period 1989-2016(AU)

Leptospirosis humana: un abordaje epidemiológico desde los factores ambientales / Human leptospirosis: an epidemiologic approach from environmental factors

Introducción: la leptospirosis es una enfermedad infecciosa zoonótica. La vía por la que el hombre puede enfermar está relacionada con el medio natural y su calidad. Objetivo: describir aspectos epidemiológicos de la leptospirosis y la influencia de los factores ambientales en la incidencia de la enfermedad. Métodos: se realizó una revisión bibliográfica relacionada con las formas clínicas de la enfermedad, diagnóstico y tratamiento preventivo, así como la influencia de los factores ambientales en la incidencia de la enfermedad. Conclusiones: la leptospirosis es una enfermedad en la que el médico de la atención primaria ejerce un papel fundamental al tener un pensamiento epidemiológico y poder realizar un diagnóstico oportuno ante la sospecha de un paciente con síntomas clínicos; y la identificación de grupos riesgo; para orientar las medidas de prevención relacionadas con la enfermedad, debido a que el agente causal utiliza el medio ambiente natural o creado por el hombre con condiciones favorables para sobrevivir y pasar al huésped susceptible(AU)

Introduction: Leptospirosis is an infectious zoonotic disease. The way the human being can become sick is related to the natural environment and its quality. Objective: To describe epidemiological aspects of leptospirosis and the influence of environmental factors on the disease incidence. Methods: A bibliographic review was carried out considering the disease's clinical forms, diagnosis and preventive treatment, as well as the influence of environmental factors on the disease incidence. Conclusions: Leptospirosis is a disease in which the primary care physician plays a fundamental role in having an epidemiological approach and being able to make a timely diagnosis when a patient is suspected with clinical symptoms, and the identification of risk groups, to guide the prevention measures related to the disease, because the causal agent uses the natural or man-made environment with favorable conditions to survive and pass to the susceptible host(AU)

O círculo vicioso da negligência da leptospirose no Brasil / The vicious circle of the leptospirosis negligence in Brazil

A leptospirose é uma das zoonoses de maior incidência mundial, estimando-se que ocorramem torno de um milhão de casos e, possivelmente, 59.000 óbitos anualmente. Foi proposto ummodelo lógico que avaliasse os aspectos que permeiam o tema, por meio de revisão narrativada literatura indexada e de manuais técnicos, que despertassem a ideia da negligência paraesta doença no Brasil. Ao fomentar uma nova abordagem paradigmática, procurou-se refletir adificuldade em se realizar um diagnóstico mais atilado e precoce, em colaboração a um processode naturalização da subnotificação pelos que organizam, gerenciam e operam o Sistema de Saúde,e que influenciam negativamente no investimento na gestão da vigilância e controle da doença nopaís, tornando-se possível a manutenção do círculo vicioso para a negligência da leptospirose noBrasil.

Leptospirosis is one of the most widespread and incident zoonosis in the world, estimated tooccur around one million cases and possibly 59,000 deaths annually. A logical model to evaluatethe aspects that permeate the theme through the narrative review of indexed literature andtechnical manuals, it was proposed to awaken the idea of the neglect of this disease in Brazil.By fostering a new paradigm approach, it was considered the difficulty in performing a moresagacious and early diagnosis. This condition contributes to a process of naturalization ofunderreporting by those who organize, manage and operate the health system. And, directlyit causes negative impact on the investment for managing the disease surveillance and controlin the country, making it possible to maintain a vicious circle for neglecting leptospirosis in Brazil.

Leptospirosis in the Caribbean: a literature review / Leptospirosis en el Caribe: una revisión bibliográfica / Leptospirose no Caribe: uma revisão da literatura científica

ABSTRACT Objective To describe leptospirosis epidemiology, seroprevalence, and serovars among humans and animals in the Caribbean from 1979 - 2013. Methods A retrospective study of the literature was performed on the general epidemiology, historical records, and geographical locations of leptospirosis outbreaks and cases in the Caribbean from 1979 - 2013. The primary sources of information were identified with PubMed Central, Google Scholar, CAREC, CaribVET, and The School of Veterinary Medicine at the University of the West Indies. Search terms used were: "human leptospirosis," "animal leptospirosis," "serovars," "livestock," "seroprevalence," "Caribbean countries," "risk factors," "confirmed cases," "suspected cases," "MAT," and "ELISA." Confirmed and suspected cases of human and animal leptospirosis were identified through laboratory analysis. Results Most cases of leptospirosis occurred during the rainy season (June - December) and had a positive correlation with flood conditions. The disease was more prevalent in males than females due to behavioral and occupational exposure. The highest incidence rates of human leptospirosis were recorded in Barbados, Trinidad and Tobago, and Jamaica. In animals, leptospirosis has been found in rodents, livestock, and dogs in many Caribbean countries. Inadequate active surveillance and misdiagnosis of human leptospirosis has contributed to under-reporting of the disease. Conclusion This review highlights the epidemiology and distribution of leptospirosis in the Caribbean. Prevalence rates and serovars vary greatly among the countries. Leptospirosis poses a significant health risk for humans and animals in the Caribbean and requires a "One Health" multisectoral approach to reduce incidence rates and protect at-risk individuals. Increased laboratory capacity to identify leptospirosis cases is required, along with awareness campaigns for both the public and animal and human health professionals.

RESUMEN Objetivo Describir las características epidemiológicas de la leptospirosis, su seroprevalencia y serovariedades en seres humanos y animales en el Caribe desde 1979 hasta el 2013. Métodos Se realizó un estudio retrospectivo de la bibliografía en relación con las características epidemiológicas generales, los registros históricos y las ubicaciones geográficas de los brotes y casos de leptospirosis en el Caribe desde 1979 hasta el 2013. Se determinaron las fuentes primarias de información con PubMed central, Google Scholar, CAREC, CaribVET y la Escuela de Medicina Veterinaria de la Universidad de las Indias Occidentales. Los términos de búsqueda que se usaron en inglés fueron los equivalentes de "leptospirosis humana", "leptospirosis animal", "serovariedades", "ganado", "seroprevalencia", "países del Caribe", "factores de riesgo", "casos confirmados", "presuntos casos", "MAT" y "ELISA". Se determinaron los casos confirmados y presuntos de leptospirosis humana y animal mediante el análisis de laboratorio. Resultados La mayor parte de los casos de leptospirosis se dieron durante la temporada de lluvias (junio a diciembre) y tuvieron una correlación positiva con las inundaciones. La enfermedad fue más prevalente en los hombres que en las mujeres debido a la exposición laboral y por los comportamientos. Las tasas de incidencia más altas de leptospirosis humana se registraron en Barbados, Trinidad y Tabago y Jamaica. En el caso de los animales, la leptospirosis se ha detectado en los roedores, el ganado y los perros de muchos países del Caribe. La vigilancia activa insuficiente y el diagnóstico erróneo de la leptospirosis humana han contribuido a que haya una subnotificación de los casos de esta enfermedad. Conclusiones En esta revisión se ponen de relieve las características epidemiológicas y la distribución de la leptospirosis en el Caribe. Las tasas de prevalencia y las serovariedades varían enormemente de un país a otro. La leptospirosis supone un riesgo considerable para la salud de los seres humanos y los animales en el Caribe y requiere un enfoque multisectorial de "Una Salud" para reducir la incidencia y proteger a las personas en riesgo. Se necesita una mayor capacidad en materia de laboratorios para detectar los casos de leptospirosis, junto con campañas de sensibilización tanto del público como de los profesionales de la sanidad animal y la salud humana.

RESUMO Objetivo Descrever o perfil epidemiológico, a soroprevalência e as sorovariedades da leptospirose em seres humanos e animais no Caribe de 1979 a 2013. Métodos Estudo retrospectivo de revisão da literatura científica realizado sobre a epidemiologia geral, registros históricos e localizações geográficas de casos e surtos de leptospirose no Caribe no período de 1979 a 2013. As fontes primárias de informação foram identificadas através das bases de dados PubMed Central, Google Scholar, CAREC, CaribVET e Faculdade de Medicina Veterinária da Universidade das Índias Ocidentais. Os seguintes termos de busca foram usados: "human leptospirosis", "animal leptospirosis", "serovars", "livestock", "seroprevalence", "Caribbean countries", "risk factors", "confirmed cases", "suspected cases", "MAT" e "ELISA" (leptospirose humana, leptospirose animal, sorovariedades, gado, soroprevalência, países do Caribe, fatores de risco, casos confirmados, casos suspeitos, MAT e ELISA). Os casos suspeitos e confirmados de leptospirose humana e animal foram identificados por exames laboratoriais. Resultados A maioria dos casos de leptospirose ocorreu no período de chuvas (junho a dezembro), apresentando uma correlação positiva com a ocorrência de enchentes. A doença foi mais prevalente no sexo masculino que no feminino devido à exposição comportamental e ocupacional. As maiores taxas de incidência de leptospirose humana foram registradas em Barbados, Trinidad e Tobago e Jamaica. Entre os animais, foi verificada a ocorrência de leptospirose em roedores, gado e cães em vários países do Caribe. Vigilância ativa insatisfatória e diagnóstico incorreto dos casos de leptospirose humana são fatores que contribuem para a subnotificação da doença. Conclusões Este estudo de revisão destacou a epidemiologia e a distribuição da leptospirose no Caribe. As taxas de prevalência e sorovariedades variam muito entre os países. A leptospirose representa um importante risco à saúde dos seres humanos e animais no Caribe, sendo necessário um enfoque multissetorial baseado no conceito de saúde única (one health) para reduzir a incidência da doença e proteger os indivíduos em risco. Faz-se necessário melhorar a capacidade laboratorial de identificar os casos de leptospirose, juntamente com campanhas de conscientização dirigidas ao público em geral e aos profissionais de saúde humana e animal.

Avaliação do padrão sazonal da infecção assintomática por leptospira spp e das formas grave da leptospirose / Evaluation of syndecan-4 expression and its role as biomarkers in chronic chagasic cardiomyopathy

INTRODUÇÃO E OBJETIVO: A leptospirose é uma zoonose, causada pela bactéria Leptospira, de ampla distribuição e elevado impacto à saúde humana. As epidemias de leptospirose no Brasil acontecem a cada ano em áreas urbanas durante o período de chuvas sazonais. Porém não existem estudos que avaliem se as formas assintomáticas e/ou subclínicas seguem este padrão estacional relacionado a precipitação. O objetivo deste trabalho é determinar a incidência de infecção assintomática e de leptospirose grave durante diferentes períodos de precipitação em Salvador. METODOLOGIA: Realizamos cinco inquéritos sorológicos estacionais em uma coorte com 3176 habitantes na comunidade de Pau da Lima, Salvador – Bahia, para identificar infecções assintomáticas por Leptospira spp (2013-2015)...

INTRODUCTION AND AIM: Introduction and aim: Leptospirosis is a zoonosis caused by Leptospira bacteria, and has a wide distribution with a high impact to human health. Outbreaks of leptospirosis in Brazil occur each year in urban areas during the rainy season. However, there are no studies to assess whether the asymptomatic and/or subclinical follow this seasonal pattern related to precipitation. The aim of this study is to determine the incidence of asymptomatic infection and severe leptospirosis. during different periods of rainfall in Salvador. METHODOLOGY: We conducted five seasonal serosurveys in a cohort of 3176 inhabitants in the community of Pau da Lima, Salvador-Bahia to identify asymptomatic infections by Leptospira (2013-2015)...