Leptospirosis-Improving Healthcare Outcomes for a Neglected Tropical Disease

Abstract

Leptospirosis is a globally distributed zoonotic disease transmitted from animal reservoirs to humans. It is particularly common in tropical regions of Africa, Asia, and Central and South America during heavy rainfall when bacterial spirochetes are released from soil into areas of flooding. Despite causing >1 million severe cases, 58 900 deaths, and 2.9 million disability-adjusted life-years annually-exceeding established neglected tropical diseases-leptospirosis remains underrecognized as a neglected tropical disease. It affects occupational groups like farmers due to high prevalence in livestock and is spread by rodents in urban settings that have poor sanitation and infrastructure. Although effectively treated with inexpensive antibiotics, neglect of leptospirosis research and development has led to a lack of awareness and unavailability of preventive and diagnostic approaches. This review covers the geographic prevalence, disproportionate impacts on marginalized communities, and opportunities for improving social, economic, and healthcare burdens for patients with leptospirosis.

Keywords: bacterial zoonoses; global health; leptospirosis; neglected diseases; one health.

Figure 1.

Pathways of neglect and their impacts on leptospirosis. Underrecognition of leptospirosis as a neglected tropical disease results in insufficient funding for research, surveillance, prevention, control, and diagnostics, which reduces awareness, limits access to diagnostics, and results in therapeutic delays that produce a higher burden of infection.

Figure 2.

Controlled studies comparing fever duration ± antibiotic therapy for leptospirosis. Controlled studies of antibiotic therapy for leptospirosis arranged by percent of icteric patients at time of enrollment. All studies showed reduced days of fever except those with ≥96% icteric patients. References provided in the text.

Figure 3.

Pathways of investment and their impacts on leptospirosis. Recognition of leptospirosis as a neglected tropical disease results in increased investment in community engagement, physician awareness, improved surveillance, integrated One Health disease prevention and control, access to rapid diagnostics, and early treatment—all of which reduce the disease burden.