Clin Microbiol Rev 14(2): 296-326

Leptospirosis

University of the West Indies, School of Clinical Medicine & Research, and Leptospira Laboratory, Ministry of Health, Barbados

^{Mailing address: University of the West Indies, School of Clinical Medicine & Research, Queen Elizabeth Hospital, Barbados. Phone: (246) 427-5586. Fax: (246) 429-6738. E-mail:}ten.hcaebnus@ttevel.

Abstract

Leptospirosis is a worldwide zoonotic infection with a much greater incidence in tropical regions and has now been identified as one of the emerging infectious diseases. The epidemiology of leptospirosis has been modified by changes in animal husbandry, climate, and human behavior. Resurgent interest in leptospirosis has resulted from large outbreaks that have received significant publicity. The development of simpler, rapid assays for diagnosis has been based largely on the recognition that early initiation of antibiotic therapy is important in acute disease but also on the need for assays which can be used more widely. In this review, the complex taxonomy of leptospires, previously based on serology and recently modified by a genotypic classification, is discussed, and the clinical and epidemiological value of molecular diagnosis and typing is also evaluated.

Abstract

Leptospirosis is now identified as one of the emerging infectious diseases, exemplified by recent large outbreaks in Nicaragua (78, 100, 349, 507, 581), Brazil, India (645), southeast Asia, the United States (98, 102), and most recently in several countries as a result of the EcoChallenge Sabah 2000 competition in Malaysia (99, 126, 204). In the landmark Institute of Medicine report “Emerging Infections: Microbial Threats to Health in the United States,” leptospirosis was used as an example of an infection which had in the past caused significant morbidity in military personnel deployed in tropical areas (340).

Much of the resurgent international interest in leptospirosis stems from several large clusters of cases which have occurred in Central and South America following flooding as a result of El Niño-related excess rainfall (201, 332, 436, 581, 664). However, the occurrence of large outbreaks of leptospirosis following severe floods is not a new phenomenon and is not restricted to tropical regions (226, 232, 425, 442, 526, 590).

In this review, the epidemiology and clinical features of leptospirosis are described, recent taxonomic changes affecting the genus Leptospira are discussed, and advances in the diagnosis of leptospirosis by serological and molecular methods are analyzed.

ACKNOWLEDGMENTS

I thank the many colleagues who have assisted me with access to the literature, particularly Esther Maria Fajardo, Peter Gaskin, Albert Ko, Diane Van Alstyne, and Rob Weyant and the staff of the Information Center, CDC, Atlanta, Ga.

ACKNOWLEDGMENTS

REFERENCES

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