Ribeiro Policarpo, Bhatt Nilesh, Ali Sádia, Monteiro Vanessa, da Silva Edmilson, Balassiano Ilana Teruszkin, Aquino Carolina, de Deus Nilsa, Guiliche Onelia, Muianga Argentina Felisbela, Alho Pascoal Jorge, Lara Evaristo Virginia, Manhiça Ivan, Medeiros Marco, Gudo Eduardo Samo
Instituto Nacional de Saúde, Ministry of Health, Maputo, Mozambique.
Laboratório Tecnologia Diagnóstico Bio-Manguinhos, Fiocruz, Rio de Janeiro, Brazil.
Int J Infect Dis. 2017 Nov;64:50-57. doi: 10.1016/j.ijid.2017.08.018. Epub 2017 Sep 8.
Leptospirosis is one of the most widespread zoonoses in the world and is caused by spirochetes of the genus Leptospira. In Mozambique, the disease is largely ignored and its epidemiology is unknown. The objective of this study was to investigate the occurrence of leptospirosis in febrile patients.
This cross-sectional study was performed between July 2012 and September 2015 among febrile patients. A total of 373 paired serum samples were drawn from febrile patients; 208 were from Caia District Hospital (rural setting) in Sofala Province and 165 were from Polana Caniço General Hospital (suburban setting) in Maputo City. Samples were initially screened using an in-house ELISA for IgM and IgG antibodies. Double positive samples were confirmed using a microagglutination test (MAT).
Of the 373 febrile patients, five (1.3%) had acute leptospirosis (MAT ≥400) and 38 (10.2%) had a presumptive infection (IgM-positive/MAT <400). While most of the patients with a presumptive infection lived in the rural setting (84.2%, 32/38), the majority of patients with acute infections (60%, 3/5) and with negative results (60.3%, 199/330) lived in the suburban setting (p=0.000). Contact with rodents was significantly higher in patient with acute leptospirosis (100%, 5/5) than in those with a presumptive infection (39.5%, 15/38) or negative results (41.8%, 138/330) (p=0.031). Four out of the five patients (80%) with acute leptospirosis were treated with antimalarial drugs although malaria results were negative. The prevailing serogroup, according to MAT results, was Australis (40%; 4/10), followed by Icterohaemorrhagiae (30%, 3/10).
This study found that leptospirosis is prevalent among Mozambicans, and most cases are misdiagnosed as malaria.
钩端螺旋体病是世界上分布最广泛的人畜共患病之一，由钩端螺旋体属的螺旋体引起。在莫桑比克，该病基本被忽视，其流行病学情况尚不清楚。本研究的目的是调查发热患者中钩端螺旋体病的发病情况。
本横断面研究于2012年7月至2015年9月期间在发热患者中进行。共采集了373对发热患者的血清样本；其中208份来自索法拉省凯亚区医院（农村地区），165份来自马普托市的波拉纳卡尼科综合医院（郊区）。样本最初使用内部酶联免疫吸附测定法（ELISA）检测IgM和IgG抗体。双阳性样本通过显微凝集试验（MAT）进行确认。
在373例发热患者中，5例（1.3%）患有急性钩端螺旋体病（MAT≥400），38例（10.2%）有疑似感染（IgM阳性/MAT<400）。虽然大多数疑似感染患者居住在农村地区（84.2%，32/38），但大多数急性感染患者（60%，3/5）和检测结果为阴性的患者（60.3%，199/330）居住在郊区（p=0.000）。急性钩端螺旋体病患者与啮齿动物的接触率（100%，5/5）显著高于疑似感染患者（39.5%，15/38）或检测结果为阴性的患者（41.8%，138/330）（p=0.031）。5例急性钩端螺旋体病患者中有4例（80%）尽管疟疾检测结果为阴性，但接受了抗疟药物治疗。根据MAT结果，主要血清群为澳洲群（40%；4/10），其次是出血性黄疸群（30%，3/10）。
本研究发现钩端螺旋体病在莫桑比克人中普遍存在，且大多数病例被误诊为疟疾。
