Leptospirosis among Hospitalized Febrile Patients in Northern Tanzania

Holly Biggs

Duy Bui

Renee Galloway

Robyn Stoddard

Venance Maro+3 authors

Division of Infectious Diseases and International Health and Duke Global Health Residency Program, Department of Medicine and Department of Pathology, Duke University Medical Center, Durham, North Carolina; Bacterial Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Duke Global Health Institute, Duke University, Durham, North Carolina; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania; Mawenzi Regional Hospital, Moshi, Tanzania

*Address correspondence to John A. Crump, Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Box 102359, Durham, NC 27710. E-mail: ude.ekud@pmurc.nhoj

Received 2011 Mar 25; Accepted 2011 Apr 28.

Abstract

We enrolled consecutive febrile admissions to two hospitals in Moshi, Tanzania. Confirmed leptospirosis was defined as a ≥ 4-fold increase in microscopic agglutination test (MAT) titer; probable leptospirosis as reciprocal MAT titer ≥ 800; and exposure to pathogenic leptospires as titer ≥ 100. Among 870 patients enrolled in the study, 453 (52.1%) had paired sera available, and 40 (8.8%) of these met the definition for confirmed leptospirosis. Of 832 patients with ≥ 1 serum sample available, 30 (3.6%) had probable leptospirosis and an additional 277 (33.3%) had evidence of exposure to pathogenic leptospires. Among those with leptospirosis the most common clinical diagnoses were malaria in 31 (44.3%) and pneumonia in 18 (25.7%). Leptospirosis was associated with living in a rural area (odds ratio [OR] 3.4, P < 0.001). Among those with confirmed leptospirosis, the predominant reactive serogroups were Mini and Australis. Leptospirosis is a major yet underdiagnosed cause of febrile illness in northern Tanzania, where it appears to be endemic.

Abstract

ACKNOWLEDGMENTS

We thank Ahaz T. Kulanga for providing administrative support to this study; Pilli M. Chambo, Beata V. Kyara, Beatus A. Massawe, Anna D. Mtei, Godfrey S. Mushi, Lillian E. Ngowi, Flora M. Nkya, and Winfrida H. Shirima for reviewing and enrolling study participants; Gertrude I. Kessy, Janeth U. Kimaro, Bona K. Shirima, and Edward Singo for managing participant follow-up; and Evaline M. Ndosi and Enock J. Kessy for their assistance in data entry. We acknowledge the Hubert-Yeargan Center for Global Health at Duke University for critical infrastructure support for the Kilimanjaro Christian Medical Centre-Duke University Collaboration. We are grateful to the leadership, clinicians, and patients of KCMC and MRH for their contributions to this research.

ACKNOWLEDGMENTS

Notes

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services or the Centers for Disease Control and Prevention.

Notes

Footnotes

Financial support: This research was supported by an International Studies on AIDS Associated Co-infections (ISAAC) award, a United States National Institutes of Health (NIH) funded program (U01 {"type":"entrez-nucleotide","attrs":{"text":"AI062563","term_id":"3338402","term_text":"AI062563"}}AI062563). Authors received support from the NIH Fogarty International Center AIDS International Training and Research Program D43 PA-03-018 (JAC, JAB, JJO, VPM), the Duke Clinical Trials Unit and Clinical Research Sites U01 {"type":"entrez-nucleotide","attrs":{"text":"AI069484","term_id":"3392459","term_text":"AI069484"}}AI069484 (JAC, JAB, JJO, VPM), and the Duke University Center for AIDS Research P30 AI 64518 (JAB).

Disclosure: Presented in part at the 59th American Society of Tropical Medicine and Hygiene annual meeting, Atlanta, GA, 3–7 November 2010, abstract 856.

Authors' addresses: Holly M. Biggs, Anne B. Morrissey, John A. Bartlett, and John A. Crump, Department of Medicine, Duke University Medical Center, Durham, NC, E-mails: ude.ekud@sggib.ylloh, ten.labolgcbs@3201rroma, ude.ekud@tteltrab.nhoj, and ude.ekud@pmurc.nhoj. Duy M. Bui, Renee L. Galloway, Robyn A. Stoddard, and Sean V. Shadomy, Bacterial Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, E-mails: vog.cdc@iubd, vog.cdc@0luz, vog.cdc@8drf, and vog.cdc@4fua. Jecinta J. Onyango, Venance P. Maro, and Grace D. Kinabo, Kilimanjaro Christian Medical Centre, Moshi, Tanzania, E-mails: moc.oohay@ognayno_yccej, ku.oc.oohay@oramnev, and moc.liamtoh@obanikg. Wilbrod Saganda, Mawenzi Regional Hospital, Moshi, Tanzania.

Footnotes

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