Risk factors for human acute leptospirosis in northern Tanzania

Maze, M. J. et al. (2018) Risk factors for human acute leptospirosis in northern Tanzania. PLoS Neglected Tropical Diseases, 12(6), e0006372. (doi:10.1371/journal.pntd.0006372) (PMID:29879114) (PMCID:PMC5991637)

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Abstract

Introduction: Leptospirosis is a major cause of febrile illness in Africa but little is known about risk factors for human infection. We conducted a cross-sectional study to investigate risk factors for acute leptospirosis and Leptospira seropositivity among patients with fever attending referral hospitals in northern Tanzania. Methods: We enrolled patients with fever from two referral hospitals in Moshi, Tanzania, 2012–2014, and performed Leptospira microscopic agglutination testing on acute and convalescent serum. Cases of acute leptospirosis were participants with a four-fold rise in antibody titers, or a single reciprocal titer ≥800. Seropositive participants required a single titer ≥100, and controls had titers <100 in both acute and convalescent samples. We administered a questionnaire to assess risk behaviors over the preceding 30 days. We created cumulative scales of exposure to livestock urine, rodents, and surface water, and calculated odds ratios (OR) for individual behaviors and for cumulative exposure variables. Results: We identified 24 acute cases, 252 seropositive participants, and 592 controls. Rice farming (OR 14.6), cleaning cattle waste (OR 4.3), feeding cattle (OR 3.9), farm work (OR 3.3), and an increasing cattle urine exposure score (OR 1.2 per point) were associated with acute leptospirosis. Conclusions: In our population, exposure to cattle and rice farming were risk factors for acute leptospirosis. Although further data is needed, these results suggest that cattle may be an important source of human leptospirosis. Further investigation is needed to explore the potential for control of livestock Leptospira infection to reduce human disease.

Item Type:Articles
Additional Information:This work was supported by the joint US National Institutes of Health (NIH:www.nih.gov)-National Science Foundation (NSF:www.nsf.gov) Ecology of Infectious Disease program (R01TW009237) and the Research Councils UK, Department for International Development (UK) and UK Biotechnology and Biological Sciences Research Council (BBSRC:www.bbsrc.ac.uk) (grant numbers BB/J010367/1, BB/L018926, BB/L017679, BB/L018845), and in part by an US National Institutes of Health International Studies on AIDS Associated Co-infections (ISAAC) award (grant number U01 AI062563) and in part by the Bill & Melinda Gates Foundation funded Typhoid Fever Surveillance in sub-Saharan Africa Program (TSAP) grant (grant number OPPGH5231). MJM received support from University of Otago scholarships: the Frances G. Cotter Scholarship and the MacGibbon Travel Fellowship. SCG and MPR received support from National Institutes of Health Research Training Grants (grant numbers R25 TW009337 and R25 TW009343) funded by the Fogarty International Center and the National Institute of Mental Health. HMB received support from the National Institutes of Health Interdisciplinary Research Training Program in AIDS (grant number NIAID-AI007392). KJA received support from the Wellcome Trust (www.wellcome.ac.uk) (grantnumber 096400/Z/11/Z). MPR, VPM, CM and JAC received support from a US National Institutes of Health National Institute for Allergy and Infectious grant (grant number R01 AI121378).
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Shand, Mr Michael and Allan, Dr Kathryn and Cleaveland, Professor Sarah and Halliday, Dr Joanna
Authors: Maze, M. J., Cash-Goldwasser, S., Rubach, M. P., Biggs, H. M., Galloway, R. L., Sharples, K. J., Allan, K. J., Halliday, J. E.B., Cleaveland, S., Shand, M. C., Muiruri, C., Kazwala, R. R., Saganda, W., Lwezaula, B. F., Mmbaga, B. T., Maro, V. P., and Crump, J. A.
College/School:College of Medical Veterinary and Life Sciences > Institute of Biodiversity Animal Health and Comparative Medicine
Journal Name:PLoS Neglected Tropical Diseases
Publisher:Public Library of Science
ISSN:1935-2727
ISSN (Online):1935-2735
Copyright Holders:This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose​.
First Published:First published in PLoS Neglected Tropical Diseases 12(6):e0006372
Publisher Policy:Reproduced under a Creative Commons CC0 public domain dedication

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
568221Impact, ecology and social determinants of bacterial zoonoses in northern TanzaniaSarah CleavelandBiotechnology and Biological Sciences Research Council (BBSRC)BB/J010367/1RI BIODIVERSITY ANIMAL HEALTH & COMPMED
627871Social, economic and environmental drivers of zoonoses in Tanzania (SEEDZ)Sarah CleavelandBiotechnology and Biological Sciences Research Council (BBSRC)BB/L018926/1RI BIODIVERSITY ANIMAL HEALTH & COMPMED
628321Molecular epidemology of brucellosis in northern TanzaniaDaniel HaydonBiotechnology and Biological Sciences Research Council (BBSRC)BB/L018845/1RI BIODIVERSITY ANIMAL HEALTH & COMPMED
573981Leptospirosis in Tanzania; a study of the role of rodents in an emerging public health problem.Sarah CleavelandWellcome Trust (WELLCOTR)096400/Z/11/ZRI BIODIVERSITY ANIMAL HEALTH & COMPMED
628341Hazards associated with zoonotic enteric pathogens in emerging livestock meat pathways (HAZEL)Ruth ZadoksBiotechnology and Biological Sciences Research Council (BBSRC)BB/L017679/1RI BIODIVERSITY ANIMAL HEALTH & COMPMED