Leptospirosis

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.

FIG. 1

Scanning electron micrograph of L. interrogans serovar icterohaemorrhagiae strain RGA bound to a 0.2-μm membrane filter. Reproduced from reference with permission from the publisher.

FIG. 2

Biphasic nature of leptospirosis and relevant investigations at different stages of disease. Specimens 1 and 2 for serology are acute-phase specimens, 3 is a convalescent-phase sample which may facilitate detection of a delayed immune response, and 4 and 5 are follow-up samples which can provide epidemiological information, such as the presumptive infecting serogroup. (Adapted from reference with permission of the publisher.)

FIG. 3

Paradoxical immune response to acute infection with serovar bim, in which the presumptive serogroup (Autumnalis) was identified during follow-up (a), and copenhageni, in which serogroup Icterohaemorrhagiae was never identified as the predominant serogroup (b).