Leptospira Seroprevalence and Risk Factors in Health Centre Patients in Hoima District, Western Uganda

Anou Dreyfus, Jonathan W. Dyal, Raewynne Pearson, Clovice Kankya, Charles Kajura, Lordrick Alinaitwe, Steven Kakooza, Katey Pelican, Dominic A Travis, Michael W Mahero, David R Boulware, Lawrence Mugisha

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Abstract

Background: 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. Methodology and Principal Findings: 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. Conclusions/Significance: 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.

Original languageEnglish (US)
Article numbere0004858
JournalPLoS neglected tropical diseases
Volume10
Issue number8
DOIs
StatePublished - Aug 3 2016

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Leptospira
Uganda
Seroepidemiologic Studies
Leptospirosis
Health
Agglutination Tests
Malaria
Nigeria
Haplorhini
Fever
Eastern Africa
Brucellosis
Serogroup
Antibodies
Typhoid Fever
Health Surveys
Serum
History
Recurrence

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Dreyfus, A., Dyal, J. W., Pearson, R., Kankya, C., Kajura, C., Alinaitwe, L., ... Mugisha, L. (2016). Leptospira Seroprevalence and Risk Factors in Health Centre Patients in Hoima District, Western Uganda. PLoS neglected tropical diseases, 10(8), [e0004858]. https://doi.org/10.1371/journal.pntd.0004858

Leptospira Seroprevalence and Risk Factors in Health Centre Patients in Hoima District, Western Uganda. / Dreyfus, Anou; Dyal, Jonathan W.; Pearson, Raewynne; Kankya, Clovice; Kajura, Charles; Alinaitwe, Lordrick; Kakooza, Steven; Pelican, Katey; Travis, Dominic A; Mahero, Michael W; Boulware, David R; Mugisha, Lawrence.

In: PLoS neglected tropical diseases, Vol. 10, No. 8, e0004858, 03.08.2016.

Research output: Contribution to journalArticle

Dreyfus, Anou ; Dyal, Jonathan W. ; Pearson, Raewynne ; Kankya, Clovice ; Kajura, Charles ; Alinaitwe, Lordrick ; Kakooza, Steven ; Pelican, Katey ; Travis, Dominic A ; Mahero, Michael W ; Boulware, David R ; Mugisha, Lawrence. / Leptospira Seroprevalence and Risk Factors in Health Centre Patients in Hoima District, Western Uganda. In: PLoS neglected tropical diseases. 2016 ; Vol. 10, No. 8.
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abstract = "Background: 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. Methodology and Principal Findings: 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. Conclusions/Significance: 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.",
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