Depending on its time of evolution, leptospirosis
presents two phases: acute and chronic. The chronic leptospirosis is widely accepted in animals and, until
recently, this was denied in humans. Since the 1990s, we have studied dozens of
cases demonstrating the chronicity of leptospirosis, including an asymptomatic
or undetermined form that may remain so
throughout life time or may evolve into a definitive chronic disease and/or worsen, becoming severe cases. A fundamental part
for its demonstration is the isolation and characterization of the etiologic
agent. In this work, the first 14 isolations of Leptospira sp. are
reported from human chronic leptospirosis and an African lion diagnosed with
chronic leptospirosis, obtained between 2002 and 2006, in urine, blood, and
skin microbiopsies. From the 14 isolations from patients with chronic
leptospirosis, one of the cases is apparently congenital and two are from
patients with chronic asymptomatic leptospirosis. The diagnosis was performed
by means of videorecording in darkfield microscopy in blood and urine, specific
culture media, and MAT serology. Argentic impregnation and detection of
specific antigen by immunostaining in blood were performed in seven patients;
in two patients, skin microbiopsies and biopsies were performed. All cases were
positive by video-recording
in darkfield, one of them MAT was 1:160, and the rest were positive at low
titers (≤1:80). The two skin biopsies were positive by argentic impregnation
and immunostaining. Eleven isolates were obtained from blood, two from skin,
and one from urine. The isolates were characterized by monoclonal antibodies as Leptospira serovar Pomona. L. Pomona is considered of low virulence
and high adaptability to the host, and is frequently associated to chronic
leptospirosis in animals. In our study, it was the only isolated serovar, including
the one isolated from the lion, which would seem the most common one in our
country and responsible for a large portion of
References
[1]
Vinetz, J.M. (2001) Leptospirosis. Current Opinion in Infectious Diseases, 14, 527-538. https://doi.org/10.1097/00001432-200110000-00005
Hartskeerl, R.A., Collares-Pereira, M. and Ellis, W.A. (2011) Emergency, Control and Re-Emerging Leptospirosis: Dynamics of Infection in the Changing World. Clinical Microbiology and Infection, 17, 494-501. https://doi.org/10.1111/j.1469-0691.2011.03474.x
[4]
Hartskeerl, R.A. (2005) International Leptospirosis Society: Objectives and Achievements. Revista Cubana de Medicina Tropical, 57, 7-10.
[5]
Gouveia, E.L., Metcalfe, J., de Carvalho, A.L.F., Aires, T.S.F., Villasboas-Bisneto, J.C., Queirroz, A., et al. (2008) Leptospirosis-Associated Severe Pulmonary Hemorrhagic Syndrome, Salvador, Brazil. Emerging Infectious Diseases, 14, 505-508. https://doi.org/10.3201/eid1403.071064
[6]
Velasco-Castrejón, O., Rivas-Sánchez, B. and Rivera-Reyes, H.H. (2008) Leptospirosis Humana Crónica. In: Narro-Robles, J., Rivero, S.O. and López, B.J.J., Eds., Diagnóstico y Tratamiento en la Práctica Médica. El Manual Moderno, 3a Edition, El Manual Moderno, México DF, 765-775.
[7]
Velasco-Castrejón, O., Rivas-Sánchez, B., Espinoza, J. and Martinez, H.E. (2007) Diagnóstico de leptospirosis crónica, comparación entre la aglutinación microscópica y 3 técnicas diagnósticas confirmatorias. Revista Cubana de Medicina Tropical, 59. http://www.bvs.sld.cu/revistas/mtr/vol59_1_07/mtr01107.htm
[8]
Velasco-Castrejón, O., Rivas-Sánchez, B., Sánchez, S.M.E., Soriano, J., Rivera, R.H.H. and Garibay, F.V. (2009) Leptospirosis crónica en México: diagnóstico microscópico y evidencias que respaldan su existencia e importancia. Rev Mex Patol Clín, 56, 157-167.
[9]
Velasco-Castrejón, O., Rivas-Sánchez, B., Sánchez, S.M.E. and Rivera, R.H.H. (2009) Transición de la leptospirosis aguda a crónica. Seguimiento de siete casos. Rev Mex Patol Clín, 56, 183-192.
[10]
World Organization for Animal Health. (2008) Leptospirosis. In: OIE, Ed., Manual of Standards for Diagnostic Test and Vaccines, Office International des Epizooties, Paris, 251-264.
[11]
Avdeeva, M.G. (2003) Outcome and Tendency of Late Convalescence in Icterohemorrhagic Leptospirosis. Klin Med (Mosk), 81, 42-47.
[12]
Murgatroyd, F. (1973) Chronic Meningitis in Weil’s Disease. British Medical Journal, 1, 7-11. https://doi.org/10.1136/bmj.1.3965.7
[13]
Hazen, H.H. (1919) Syphilis A Treatise on Etiology, Pathology, Diagnosis, Prognosis, Prophylaxis and Treatment. CV Mosby Company Editors, St. Louis, 647
[14]
Pachner, A.R. and Steere, A.C. (1985) The Triad of Neurologic Manifestations of Lyme Disease: Meningitis, Cranial Neuritis and Radiculoneuritis. Neurology, 35, 47-53. https://doi.org/10.1212/WNL.35.1.47
[15]
Logigiam, E.L., Kaplan, R.F. and Steere, A.C. (1990) Chronic Neurologic Manifestation of Lyme Disease. The New England Journal of Medicine, 323, 1438-1444. https://doi.org/10.1056/NEJM199011223232102
[16]
Hartskeerl, R.A., Smits, H.L., Korver, H., Goris, M.G.A., Terpstra, W.J., Fernández, C., Obregón, A.M., Rodríguez, I., Zamora, Y., Rodríguez, N., Rodríguez, J.E. and Martinez, M.B. (2004) International Course of Laboratory Methods for Diagnosis of Leptospirosis. II Taller Internacional de Leptospirosis, La Habana, Cuba.
[17]
Russell, F.B. and Russel, C.J. (1978) Protein-Free and Low-Protein Media for the Cultivation of Leptospira. Infection and Immunity, 19, 562-569.
[18]
Te, B.L.A. and Louw, N.H. (1985) Addition of Rabbit Serum to EMJH Medium Improves Isolation of Leptospira Interrogans Serovar Hardjo. The Onderstepoort Journal of Veterinary Research, 52, 53-54.
[19]
Bartholomew, J.W. (1981) Stains for Microorganisms in Smears. In: George, C., Ed., Staining Procedures, 4th Edition, Williams & Wilkins, USA, 409-410.
[20]
Javois, L.C. (1999) Immunocytochemical Methods and Protocols. 2nd Edition, Humana Press, USA, Vol. 115, 131-140. https://doi.org/10.1385/1592592139
[21]
Tripathy, D.N. and Hanson, L.E. (1974) Immunoperoxidase Staining of Leptospires. Applied Microbiology, 27, 268-269.
[22]
WHO-ILS (2003) Human Leptospirosis. Guidance for Diagnosis Surveillance and Control. WHO-ILS. http://www.who.int/csr/don/en/WHO_CDS_CSR_EPH_2002.23.pdf
[23]
Ellis, W.A. (1986) The Diagnosis of Leptospirosis in Farm Animals. In: Ellis, W.A. and Little, T.W.A., Eds., The Present State of Leptospirosis Diagnosis and Control, Martinus Nijhoff, Dordrecht, The Netherlands, 13-31.
[24]
Brem, S., Gerhads, H., Wollanke, B., Meyer, P. and Kopp, H. (1998) Demonstration of Intraocular Leptospira in 4 Horses Suffering from Equine Recurrent Uveitis (ERU). Berliner und Münchener Tierärztliche Wochenschrift, 111, 415-417.
[25]
Faber, N.A., Crawford, M., LeFebure, R., Buyukmihci, N.C., Madigan, J.E. and Willits, N.H. (2000) Detection of Leptospira spp. in the Aqueous Humor Horses with Naturally Acquired Recurrent Uveitis. Journal of Clinical Microbiology, 38, 2731-2733.
[26]
McDonough, P.L. (2001) Leptospirosis in Dogs—Current Status. In: Carmichael, L., Ed., International Veterinary Information Service, Ithaca, New York. http://www.ivis.org/advances/Infect_Dis_Carmichael/mcdonough/ivis.pdf
The Leptospirosis Information Center (2009) Persistent Human Leptospirosis. http://www.leptospirosis.org
[29]
Romero, E.C., Billerbeck, A.E., Lando, V.S., Camargo, E.D., Souza, C.C. and Yasuda, P.H. (1998) Detection of Leptospira DNA in Patients with Aseptic Meningitis by PCR. Journal of Clinical Microbiology, 36, 1453-1455.
[30]
Saengjaruk, P., Chaicumpa, W., Watt, G., Bunyaraksyotin, G., Wuthiekanun, V., Tapchaisri, P., Sittinont, Ch., Panaphut, T., Tomanakan, K., Sakolvaree, Y., Chongsa-Nguan, M., Mahakunkijcharoen, Y., Kalambaheti, T., Naigowit, P., Wambangco, M.A.L., Kurazono, H. and Hayashi, H. (2002) Diagnosis of Human Leptospirosis by Monoclonal Antibody-Based Antigen Detection Urine. Journal of Clinical Microbiology, 40, 480-489. https://doi.org/10.1128/JCM.40.3.480-489.2002
[31]
Ganoza, Ch.A., Matthias, M.A., Saito, M., Cespedes, M., Gotuzzo, E. and Vinetz, J.M. (2010) Asymtomatic Renal Colonization of Humans in the Peruvian Amazon by Leptospira. PLoS Neglected Tropical Diseases, 4, e612. https://doi.org/10.1371/journal.pntd.0000612
[32]
Dias-Pinto, J.C. and Rodriguez-Coura, J. (1997) Clinica terapeutica da Doença da Chagas. Edit Fio Cruz, Rio de Janeiro, 486.
[33]
Estrada-Parra, S., Velasco-Castrejon, O., Rebora, F., Diaz, M.L. and Padierna, J. (1983) Inmunoterapia de la tuberculosis pulmonar avanzada con factor de transferencia especifico. Salud pública de México, 25, 589-600.
[34]
Berrón-Pérez, R., Chavez-Sánchez, R., Estrada-García, I., Espinosa-Padilla, S., Cortéz-Gómez, R., Serrano-Miranda, E., Ondarza-Aguilera, R., Pérez-Tapia, M., Pineda, O.B., Jiménez-Martínes, M. del C., Portugués, A., Rodríguez, A., Cano, L., Pacheco, P.U., Barrientos, J., Chacón, R., Serafín, J., Mendez, P., Monges, A., Ceravantes, E. and Estrada-Parra, S. (2007) Indications, Usage, and Dosage of Transfer Factor. Revista Alergia México, 54, 134-139.
