Kamilah Fernandez, Kemba Lewis and Resul Boncu.

Leptospirosis

Leptospirosis
Leptospirosis is caused by exposure to several types of the Leptospira, a bacteria is from the genus spirochete which can be found in fresh water that has been contaminated by animal urine.
Scan showing the leptospira bacteria and its characteristic elongated spiral structure.

MODES OF TRANSMISSION
By direct or indirect contact of nasal, oral, or eye mucosal membranes or abraded or traumatized skin with urine or carcasses of infected animals. Urine: Indirect exposure through water, soil, or foods contaminated by urine from infected animals is the most common route. After a short period of circulating high levels of the spirochete in their blood, animals shed the spirochete in their urine, contaminating the environment. Inhalation of droplet aerosols of contaminated fluids can occasionally occur.

Leptospirosis- Chain of Infection

Leptospirosis- Symptoms
Symptoms can take 2 - 26 days (average 10 days) to develop, and may include: Dry cough Fever Headache Muscle pain Nausea, vomiting, and diarrhea Shaking chills Less common symptoms include: Abdominal pain Abnormal lung sounds Bone pain Conjunctivitis Enlarged lymph glands Enlarged spleen or liver Joint aches Muscle rigidity Muscle tenderness Skin rash Sore throat

Leptospirosis Diagnosis
The diagnosis of Leptospirosis is made by culture of the bacterial organism Leptospira from infected blood, spinal fluid, or urine. The diagnosis can also be made on rising Leptospira antibody levels in the blood

Leptospirosis Treatment
Medications to treat Leptospirosis include: Ampicillin Ceftriaxone Doxycycline Penicillin Complicated or serious cases may need supportive care or treatment in a hospital intensive care unit (ICU).

Leptospirosis in Georgia
Table #1 : The prevalence per 100000 of Leptospirosis in Georgia
Year 2001 2002 2003 2004 2005 2006 2007 2008 Number of cases 9 7 7 10 6 27 28 18 Prevalence per 100000 0.203 0.157 0.157 0.225 0.135 0.608 0.631 0.405

2009
2010 Total

16
72 200

0.36
1.623 4.504

Leptospirosis in Georgia

 A sporadic occurrence of leptospirosis can be observed within the Republic of Georgia. Cases showed similar occurrences in the years 2001 to 2005, Then a slight increase in the years 2006 and 2007. It then decreased slightly in the years 2008 and 2009 with a sudden increase to 72 in the year 2010.

Leptospirosis in Georgia

Leptospirosis in Georgia
Table#2: Table showing the Age Specific Rate of Leptospirosis in Georgia
Ages >1 1-4 5-14 15-19 Age Specific Rate per 100000 0 0 0.2 1.17

20-29
30-59 60

0.99
0.98 0.81

 No cases occurred under the age of 4 years of age while a rate of 0.2 occurred between the ages of 5-14. An average of 0.93 occurred within the age groups 20 to 60 years of age. The highest cases occurred within the age group 15 to 19.

Leptospirosis in Georgia

Leptospirosis in Georgia
Table#3: Table showing the monthly distribution of Leptospirosis in Georgia from 2008 to 2010
Month January February Number of cases 1 1

March
April May June July

1
1 1 1 5

August
September October November December

8
9 5 2 0

Leptospirosis in Georgia
The most cases occurred between the months of July to October. These months had the highest rainfall.

Leptospirosis In Georgia

Leptospirosis in Georgia
Table#4: Table showing the number of cases and prevalence of Leptospirosis for the regions of Georgia
Region
Tbilisi Kakheti Imereti Samgrelo and Zemo Svaneti Adjara Shida Kartli Kvemo Kartli Guria

Number of Cases
5 3 3 2 16 2 2 1

Prevalence per 100000

0.46 0.737 0.428 0.429 4.25 0.636 0.40 0.699

Samtskheti Javakheti
Mtsketa Mtianeti Kacha Lechkhumi

1
0 0

0.48
0 0

Leptospirosis in Georgia
Spot Map showing the cases of Leptospirosis in the different regions in Georgia.

Leptospirosis in Georgia

Leptospirosis in Georgia
Table#5: Table showing the prevalence and average annual precipitation for each region in Georgia
Region Tbilisi Kakheti Imereti Samgrelo Adjara Shida Kvemo Guria Samtskhe Mtsketa Racha Prevalence Per 100000 0.46 0.737 0.428 0.429 4.25 0.636 0.40 0.699 0.480 0 0 Average Annual Precipitation (mm) 568 1000 1730 2100 8060 585 425 1900 550 650 900

Leptospirosis in Georgia
Graph showing the relationship between the prevalence of leptospirosis and the average annual precipitation
9000 8000 7000 Average Annual Precipitation 6000 5000 4000 4.5 4 3.5 3 2.5 2 Prevalence per 100000

Average Annual Precipitation Prevalence per 100000

3000
2000 1000 0

1.5
1 0.5 0

Regions in Georgia

Leptospirosis in Georgia
From the graph showing the relationship between Leptospirosis prevalence and average annual precipitation it can be seen that the greater the amount of rainfall the greater the prevalence This is especially seen in the region of Ajara where the prevalence of Leptospirosis and the average annual precipitation were both substantially high

Leptospirosis in Georgia
Trend of Leptospirosis was studied in Georgia. Prevalence rate has significantly increased since 2006 to 2007 with a decrease in 2008 to 2009 and 500% increase from 2009 to 2010 the highest rate 1.632 per 100 000 population. The highest prevalence was observed the age group 15-19. There was an increase prevalence from the month of July to October. Ajara had the highest prevalence

Leptospirosis in Georgia
Source of infection were: Contact with a natural water reservoir- 54% Ground contaminated with rodent excretions- 8% Cattle-raising activity- 8% Unknown source- 15.5% Leading to an overall fatality of 714%

Leptospirosis in Trinidad and Tobago

A total of 278 cases were recorded, with an average annual incidence rate of 1.84 per 100,000 population. 75% of the cases occurred during the wet season, with the highest number of cases recorded in November. A positive correlation was found between number of cases and rainfall.

Leptospirosis in Trinidad and Tobago (1996 to 2007)

Males constituted 80% of all cases, and the overall male: female ratio was 4.6:1 The total case fatality rate was 5.8%, with deaths among males four times more common than in females.

Clinical Leptospirosis was greatest in the 1019 age group and lowest in the 0-9 age group.

Leptospirosis in Trinidad and Tobago

The total prevalence was 22 per 100,000 population, with the highest prevalence 41 per 100,000 recorded in the regional corporation of Sangre Grande and the lowest (6 per 100,000) in the city of Port of Spain. The lack of important information and active surveillance showed that the level of awareness of the disease is low in the country.

Leptospirosis in T&T and Georgia

Parameter Highest Annual Prevalence per 100000 Country Georgia 1.632 Trinidad and Tobago 1.84

Age most Prevalent

Month most Prevalent Sex most Prevalent Region most Prevalent

15-19
September NA Ajara

10-19
November Males Sangre Grande

There is also a direct relationship between Leptospirosis prevalence and season as Leptospirosis is most prevalent in Trinidad and Tobago during the rainy season and Leptospirosis is most prevalent in Georgia during the rainiest periods (July to October) of the year at the end of summer to the beginning of autumn.

Leptospirosis- Conclusion
Leptospirosis has a direct correlation with the rainy periods of the year and cases occurred in areas with the highest prevelance of rainfall
(hospital/general practitioner/laboratory) to intermediate level.

Recommendations
Inform the public that the risk of acquiring Leptospirosis can be greatly reduced by not swimming or wading in water that might be contaminated with animal urine, or eliminating contact with potentially infected animals. Immediate case-based reporting of suspected or confirmed cases.

 All cases must be investigated since investigation can identify environmental point sources of transmission and lead to control measures. Routine reporting of aggregated data of confirmed cases from intermediate to central level. Hospital-based surveillance may give information on severe cases of leptospirosis. Serosurveillance may give information on whether leptospiral infections occur or not in certain areas or populations

References

Epidemiology of human leptospirosis in Trinidad and Tobago, 1996-2007: a retrospective study. Mohan AR, Cumberbatch A, Adesiyun AA, Chadee DD. Source Department of Life Sciences, The University of The West Indies, St. Augustine, Trinidad and Tobago.