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Reference Manager
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Zotero
EndNote
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Mayhood MK, Afwamba IA, Odhiambo CO, Ndanu E, Thielman NM, Morrissey AB, Shao JF, Pence BW, Crump JA, 2008. Validation, performance under field conditions, and cost-effectiveness of Capillus HIV-1/HIV-2 and Determine HIV-1/2 rapid human immunodeficiency virus antibody assays using sequential and parallel testing algorithms in Tanzania. J Clin Microbiol 46: 3946–3951.
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Scott LE, Crump JA, Msuya E, Morrissey AB, Venter WF, Stevens WS, 2011. Abbott RealTime HIV-1 m2000rt viral load testing: manual extraction versus the automated m2000sp extraction. J Virol Methods 172: 78–80.
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Leptospirosis among Hospitalized Febrile Patients in Northern Tanzania
Holly M. Biggs
Holly M. Biggs
Division of Infectious Diseases and International Health and Duke Global Health Residency Program, Department of Medicine and Department of Pathology, Duke University Medical Center, Durham, North Carolina; Bacterial Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Duke Global Health Institute, Duke University, Durham, North Carolina; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania; Mawenzi Regional Hospital, Moshi, Tanzania
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Duy M. Bui
Duy M. Bui
Division of Infectious Diseases and International Health and Duke Global Health Residency Program, Department of Medicine and Department of Pathology, Duke University Medical Center, Durham, North Carolina; Bacterial Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Duke Global Health Institute, Duke University, Durham, North Carolina; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania; Mawenzi Regional Hospital, Moshi, Tanzania
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Renee L. Galloway
Renee L. Galloway
Division of Infectious Diseases and International Health and Duke Global Health Residency Program, Department of Medicine and Department of Pathology, Duke University Medical Center, Durham, North Carolina; Bacterial Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Duke Global Health Institute, Duke University, Durham, North Carolina; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania; Mawenzi Regional Hospital, Moshi, Tanzania
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Robyn A. Stoddard
Robyn A. Stoddard
Division of Infectious Diseases and International Health and Duke Global Health Residency Program, Department of Medicine and Department of Pathology, Duke University Medical Center, Durham, North Carolina; Bacterial Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Duke Global Health Institute, Duke University, Durham, North Carolina; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania; Mawenzi Regional Hospital, Moshi, Tanzania
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Sean V. Shadomy
Sean V. Shadomy
Division of Infectious Diseases and International Health and Duke Global Health Residency Program, Department of Medicine and Department of Pathology, Duke University Medical Center, Durham, North Carolina; Bacterial Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Duke Global Health Institute, Duke University, Durham, North Carolina; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania; Mawenzi Regional Hospital, Moshi, Tanzania
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Anne B. Morrissey
Anne B. Morrissey
Division of Infectious Diseases and International Health and Duke Global Health Residency Program, Department of Medicine and Department of Pathology, Duke University Medical Center, Durham, North Carolina; Bacterial Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Duke Global Health Institute, Duke University, Durham, North Carolina; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania; Mawenzi Regional Hospital, Moshi, Tanzania
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John A. Bartlett
John A. Bartlett
Division of Infectious Diseases and International Health and Duke Global Health Residency Program, Department of Medicine and Department of Pathology, Duke University Medical Center, Durham, North Carolina; Bacterial Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Duke Global Health Institute, Duke University, Durham, North Carolina; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania; Mawenzi Regional Hospital, Moshi, Tanzania
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Jecinta J. Onyango
Jecinta J. Onyango
Division of Infectious Diseases and International Health and Duke Global Health Residency Program, Department of Medicine and Department of Pathology, Duke University Medical Center, Durham, North Carolina; Bacterial Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Duke Global Health Institute, Duke University, Durham, North Carolina; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania; Mawenzi Regional Hospital, Moshi, Tanzania
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Venance P. Maro
Venance P. Maro
Division of Infectious Diseases and International Health and Duke Global Health Residency Program, Department of Medicine and Department of Pathology, Duke University Medical Center, Durham, North Carolina; Bacterial Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Duke Global Health Institute, Duke University, Durham, North Carolina; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania; Mawenzi Regional Hospital, Moshi, Tanzania
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Grace D. Kinabo
Grace D. Kinabo
Division of Infectious Diseases and International Health and Duke Global Health Residency Program, Department of Medicine and Department of Pathology, Duke University Medical Center, Durham, North Carolina; Bacterial Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Duke Global Health Institute, Duke University, Durham, North Carolina; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania; Mawenzi Regional Hospital, Moshi, Tanzania
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Wilbrod Saganda
Wilbrod Saganda
Division of Infectious Diseases and International Health and Duke Global Health Residency Program, Department of Medicine and Department of Pathology, Duke University Medical Center, Durham, North Carolina; Bacterial Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Duke Global Health Institute, Duke University, Durham, North Carolina; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania; Mawenzi Regional Hospital, Moshi, Tanzania
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John A. Crump
John A. Crump
Division of Infectious Diseases and International Health and Duke Global Health Residency Program, Department of Medicine and Department of Pathology, Duke University Medical Center, Durham, North Carolina; Bacterial Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Duke Global Health Institute, Duke University, Durham, North Carolina; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania; Mawenzi Regional Hospital, Moshi, Tanzania
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We enrolled consecutive febrile admissions to two hospitals in Moshi, Tanzania. Confirmed leptospirosis was defined as a ≥ 4-fold increase in microscopic agglutination test (MAT) titer; probable leptospirosis as reciprocal MAT titer ≥ 800; and exposure to pathogenic leptospires as titer ≥ 100. Among 870 patients enrolled in the study, 453 (52.1%) had paired sera available, and 40 (8.8%) of these met the definition for confirmed leptospirosis. Of 832 patients with ≥ 1 serum sample available, 30 (3.6%) had probable leptospirosis and an additional 277 (33.3%) had evidence of exposure to pathogenic leptospires. Among those with leptospirosis the most common clinical diagnoses were malaria in 31 (44.3%) and pneumonia in 18 (25.7%). Leptospirosis was associated with living in a rural area (odds ratio [OR] 3.4, P < 0.001). Among those with confirmed leptospirosis, the predominant reactive serogroups were Mini and Australis. Leptospirosis is a major yet underdiagnosed cause of febrile illness in northern Tanzania, where it appears to be endemic.
Author Notes
Financial support: This research was supported by an International Studies on AIDS Associated Co-infections (ISAAC) award, a United States National Institutes of Health (NIH) funded program (U01 AI062563). Authors received support from the NIH Fogarty International Center AIDS International Training and Research Program D43 PA-03-018 (JAC, JAB, JJO, VPM), the Duke Clinical Trials Unit and Clinical Research Sites U01 AI069484 (JAC, JAB, JJO, VPM), and the Duke University Center for AIDS Research P30 AI 64518 (JAB).
Disclosure: Presented in part at the 59th American Society of Tropical Medicine and Hygiene annual meeting, Atlanta, GA, 3–7 November 2010, abstract 856.
Authors' addresses: Holly M. Biggs, Anne B. Morrissey, John A. Bartlett, and John A. Crump, Department of Medicine, Duke University Medical Center, Durham, NC, E-mails: holly.biggs@duke.edu, amorr1023@sbcglobal.net, john.bartlett@duke.edu, and john.crump@duke.edu. Duy M. Bui, Renee L. Galloway, Robyn A. Stoddard, and Sean V. Shadomy, Bacterial Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, E-mails: dbui@cdc.gov, zul0@cdc.gov, frd8@cdc.gov, and auf4@cdc.gov. Jecinta J. Onyango, Venance P. Maro, and Grace D. Kinabo, Kilimanjaro Christian Medical Centre, Moshi, Tanzania, E-mails: jeccy_onyango@yahoo.com, venmaro@yahoo.co.uk, and gkinabo@hotmail.com. Wilbrod Saganda, Mawenzi Regional Hospital, Moshi, Tanzania.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Weyant RS, Bragg SL, Kaufmann AF, 1999. Leptospira and Leptonema. Murray PR, Baron EJ, Pfaller MA, Tenover FC, Yolken RH, eds. Manual of Clinical Microbiology. Washington, DC: American Society for Microbiology, 739–745.
-
2.
Cachay ER, Vinetz JM, 2005. A global research agenda for leptospirosis. J Postgrad Med 51: 174–178.
-
3.
Levett PN, 2001. Leptospirosis. Clin Microbiol Rev 14: 296–326.
-
4.
National Bureau of Statistics, ORC Macro, 2005. Tanzania Demographic and Health Survey 2004–05. Dar es Salaam, Tanzania: National Bureau of Statistics, Calverton, MD: ORC Macro, 381.
-
5.
Crump JA, Ramadhani HO, Morrissey AB, Msuya LJ, Yang L-Y, Chow S-C, Morpeth SC, Reyburn H, Njau BN, Shaw AV, Diefenthal HC, Bartlett JA, Shao JF, Schimana W, Cunningham CK, Kinabo GD, 2011. Invasive bacterial and fungal infections among hospitalized HIV-infected and HIV-uninfected children and infants in northern Tanzania. Trop Med Int Health 16: 830–837.
-
6.
Crump JA, Ramadhani HO, Morrissey AB, Saganda W, Mwako MS, Yang L-Y, Chow S-C, Morpeth SC, Reyburn H, Njau BN, Shaw AV, Diefenthal HC, Shao JF, Bartlett JA, Maro VP, 2011. Invasive bacterial and fungal infections among hospitalized HIV-infected and HIV-uninfected adults and adolescents in northern Tanzania. Clin Infect Dis 52: 341–348.
-
7.
Mayhood MK, Afwamba IA, Odhiambo CO, Ndanu E, Thielman NM, Morrissey AB, Shao JF, Pence BW, Crump JA, 2008. Validation, performance under field conditions, and cost-effectiveness of Capillus HIV-1/HIV-2 and Determine HIV-1/2 rapid human immunodeficiency virus antibody assays using sequential and parallel testing algorithms in Tanzania. J Clin Microbiol 46: 3946–3951.
-
8.
Scott LE, Crump JA, Msuya E, Morrissey AB, Venter WF, Stevens WS, 2011. Abbott RealTime HIV-1 m2000rt viral load testing: manual extraction versus the automated m2000sp extraction. J Virol Methods 172: 78–80.
-
9.
Crump JA, Scott LE, Msuya E, Morrissey AB, Kimaro EE, Shao JF, Stevens WS, 2009. Evaluation of the Abbott m2000rt RealTime HIV-1 assay with manual sample preparation compared with the ROCHE COBAS AmpliPrep/AMPLICOR HIV-1 MONITOR 1.5 using specimens from East Africa. J Virol Methods 162: 218–222.
-
10.
Dikken H, Kmety E, 1978. Serological typing methods of leptospires. Bergan T, Norris JR, eds. Methods in Microbiology. London: Academic Press, 259–307.
-
11.
Centers for Disease Control and Prevention, 1997. Case definitions for infectious conditions under public health surveillance. MMWR Recomm Rep 46: 1–55.
-
12.
Faine S, 1982. Guidelines for the Control of Leptospirosis. Geneva: World Health Organization.
-
13.
World Health Organization, 2003. Human Leptospirosis: Guidance for Diagnosis, Surveillance and Control. Malta: World Health Organization.
-
14.
Government of Tanzania, 2002. 2002 Population and Housing Census. Dar es Salaam, Tanzania.
-
15.
Saathoff E, Schneider P, Kleinfeldt V, Geis S, Haule D, Maboko L, Samky E, de Souza M, Robb M, Hoelscher M, 2008. Laboratory reference values for health adults from southern Tanzania. Trop Med Int Health 13: 612–625.
-
16.
Buchanan AM, Muro FJ, Gratz J, Crump JA, Musyoka AM, Sichangi MW, Morrissey AB, M'rimberia JK, Njau BN, Msuya LJ, Bartlett JA, Cunningham CK, 2010. Establishment of hematological and immunological reference values for healthy Tanzanian children in the Kilimanjaro Region. Trop Med Int Health 15: 1011–1021.
-
17.
Everard CO, Fraser-Chanpong GM, James AC, Butchery LV, 1985. Serological studies on leptospirosis in livestock and chickens from Grenada and Trinidad. Trans R Soc Trop Med Hyg 79: 859–864.
-
18.
van der Hoeden J, 1958. Leptospiral infections in hedgehogs. J Infect Dis 103: 225–238.
-
19.
Everard CO, Cazabon EP, Dreesen DW, Sulzer CR, 1979. Leptospirosis in dogs and cats on the Island of Trinidad: West Indies. Int J Zoonoses 6: 33–40.
-
20.
Babudieri B, 1958. Animal reservoirs of leptospires. Ann N Y Acad Sci 70: 393–413.
-
21.
Diallo AA, Dennis SM, 1982. Bacteriological survey of leptospirosis in Zaria, Nigeria. Trop Geogr Med 34: 29–34.
-
22.
Ball MG, 1966. Animal hosts of leptospires in Kenya and Uganda. Am J Trop Med Hyg 15: 523–530.
-
23.
Feresu SB, 1992. Isolation of Leptospira interrogans from kidneys of Zimbabwe beef cattle. Vet Rec 130: 446–448.
-
24.
Cacciapuoti B, Ciceroni L, Maffei C, Di Stanislao F, Strusi P, Calegari L, Lupidi R, Scalise G, Cagnoni G, Renga G, 1987. A waterborne outbreak of leptospirosis. Am J Epidemiol 126: 535–545.
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