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An outbreak of leptospirosis among reserve military recruits, Hulu Perdik, Malaysia

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Abstract

Here, we investigated an outbreak of leptospirosis among reserve military recruits that occurred following a survival exercise in the Hulu Perdik forest within the Hulu Langat district, Kuala Lumpur, Malaysia. Blood samples from the 12 patients that presented symptoms for febrile illness on clinical examination were subjected to laboratory investigation, comprising Lepto IgM rapid test, IgM ELISA, and microscopic agglutination test (MAT). All these patients were interviewed for possible risk factors for leptospirosis. Rodent trapping and environmental sampling for possible isolation of leptospires in the outbreak site was performed. The isolated leptospires were genetically characterized and investigated for the potential epidemiological link with human leptospirosis. Among the 12 patients, two (2/12; 16.6%) were confirmed positive for leptospirosis by microscopic agglutination test (MAT with titers 400–800; serovar autumnalis and hardjobovis). Two Leptospira species from rodents (L. interrogans and L. borgpetersenii) and two from the environment (L. kmetyi and L. wolffii) were identified. The possible epidemiological link between human serovars and animal Leptospira species indicates rodents as the potential reservoir while the environment (soil and water) serves as a transmission route. This investigation highlights the robust presence of pathogenic leptospires on Malaysian environment and rodents which may present the risk of infection, especially among high-risk individuals. Hence, occupational risk individuals are cautioned to observe appropriate preventive measures including prophylaxis and seek immediate medical attention for any illness following similar activities.

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References

  1. Sejvar J, Bancroft E, Winthrop K, Bettinger J, Bajani M, Bragg S, Shutt K, Kaiser R, Marano N, Popovic T, Tappero J, Ashford D, Mascola L, Vugia D, Perkins B, Rosenstein N Leptospirosis in “eco-challenge” athletes, Malaysian Borneo, 2000. Emerg Infect Dis. 2003 Jun [cited 2015 Sep 16];9(6):702–7. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3000150&tool=pmcentrez&rendertype=abstract

  2. Benacer D, Thong KL, Bin VK, Galloway RL, Hartskeerl RA, Lewis JW, Mohd Zain SN (2016) Human leptospirosis in Malaysia. Asia Pac J Public Health 28(4):290–302

    Article  PubMed  Google Scholar 

  3. Garba B, Bahaman AR, Khairani-Bejo S, Zakaria Z, Mutalib AR (2017) Retrospective study of leptospirosis in Malaysia. EcoHealth 14(2):389–398

    Article  PubMed  PubMed Central  Google Scholar 

  4. Lim VKE Leptospirosis: a reemerging infection. Malays J Pathol. 2011 Jun [cited 2015 Sep 16];33(1):1–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21874744

  5. Ridzlan FR, Bahaman AR, Khairani-Bejo S, Mutalib AR Detection of pathogenic Leptospira from the selected environment in Kelantan and Terengganu, Malaysia. Trop Biomed. 2010 Dec [cited 2015 Sep 16];27(3):632–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21399605

  6. Pui CF, Bilung LM, Apun K, Su’ut L, ut L Diversity of Leptospira spp. in rats and environment from urban areas of Sarawak, Malaysia. J Trop Med [Internet]. 2017 [cited 2017 Apr 18];2017:1–8. Available from: https://www.hindawi.com/journals/jtm/2017/3760674/

  7. Mohamed Hassan SN, Bahaman AR, Mutalib AR, Bejo SK Serological prevalence of leptospiral infection in wild rats at the National Service Training Centres in Kelantan and Terengganu. Tropical Biomedicine. Malaysian Society of Parasitology and Tropical Medicine; 2010 [cited 2015 Sep 16]. Available from: http://psasir.upm.edu.my/7457/1/30_-_32_Mohamed_Hassan_SN.pdf

  8. El Jalii IM, Bahaman AR A review of human leptospirosis in Malaysia. Trop Biomed. 2004 Dec [cited 2014 Nov 26];21(2):113–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16493403

  9. Samsudin S, Masri SN, Jamaluddin TZMT, Saudi SNS, Ariffin UKM, Amran F, Osman M Seroprevalence of leptospiral antibodies among healthy municipal service workers in Selangor. Adv Public Heal. 2015 Jan 1 [cited 2015 Oct 8];2015. Available from: https://doaj.org/article/46b731b6860a4603a1ceccba46775b9a

  10. Rafizah AAN, Aziah BD, Azwany YN, Imran MK, Rusli AM, Nazri SM, Nikman AM, Nabilah I, Asma’ HS, Zahiruddin WM, Zaliha I Risk factors of leptospirosis among febrile hospital admissions in northeastern Malaysia. Prev Med (Baltim) 2013 Jan [cited 2015 Sep 16];57 Suppl:S11–3. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23295174

  11. Sharma S, Vijayachari P, Sugunan Ap, Natarajaseenivasan K, SEHGAL SC Seroprevalence of leptospirosis among high-risk population of Andaman Islands, India. Am J Trop Med Hyg. 2006 Feb 1 [cited 2014 Nov 26];74(2):278–83. Available from: http://www.ajtmh.org/content/74/2/278.long

  12. Garba B, Bahaman AR, Bejo SK, Zakaria Z, Mutalib AR, Bande F Major epidemiological factors associated with leptospirosis in Malaysia. Acta Trop. 2018 Feb [cited 2018 Jan 5];178:242–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29217379

  13. Azhari NN, Ramli SNA, Joseph N, Philip N, Mustapha NF, Ishak SN, Mohd-Taib FS, Md Nor S, Yusof MA, Mohd Sah SA, Mohd Desa MNB, Garba B, Zeppelini CG, Costa F, Sekawi Z, Neela V (2018) Molecular characterization of pathogenic Leptospira sp. in small mammals captured from the human leptospirosis suspected areas of Selangor state, Malaysia. Acta Trop 188:68–77

    Article  PubMed  Google Scholar 

  14. García-Ruíz D, Martínez-Guzmán MA, Cárdenas-Vargas A, Marino-Marmolejo E, Gutiérrez-Ortega A, González-Díaz E, Morfin-Otero R, Rodríguez-Noriega E, Pérez-Gómez H, Elizondo-Quiroga D Detection of dengue, West Nile virus, rickettsiosis and leptospirosis by a new real-time PCR strategy. Springerplus [Internet]. 2016 Dec 20 [cited 2018 Aug 14];5(1):671. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27350908

  15. Stoddard RA, Gee JE, Wilkins PP, McCaustland K, Hoffmaster AR Detection of pathogenic Leptospira spp. through TaqMan polymerase chain reaction targeting the LipL32 gene. Diagn Microbiol Infect Dis. 2009 Jul [cited 2018 Aug 14];64(3):247–55. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19395218

  16. Ahmad SN, Shah S, Ahmad FM Laboratory diagnosis of leptospirosis. J Postgrad Med [Internet]. 2005 Jan 1 [cited 2015 Jan 13];51(3):195–200. Available from: http://www.jpgmonline.com/article.asp?issn=0022-3859;year=2005;volume=51;issue=3;spage=195;epage=200;aulast=Ahmad

  17. Kishimoto M, Brown JD, Chung HH, Howman S Leptospirosis misdiagnosed as a pulmonary-renal syndrome. Am J Med Sci. 2004 Aug [cited 2015 Oct 8];328(2):116–20. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15311171

  18. Chusri S, McNeil EB, Hortiwakul T, Charernmak B, Sritrairatchai S, Santimaleeworagun W, Pattharachayakul S, Suksanan P, Thaisomboonsuk B, Jarman RG Single dosage of doxycycline for prophylaxis against leptospiral infection and leptospirosis during urban flooding in southern Thailand: a non-randomized controlled trial. J Infect Chemother. 2014 Nov 1 [cited 2018 Jul 14];20(11):709–15. Available from: https://www.sciencedirect.com/science/article/pii/S1341321X14002578

  19. Slack AT, Khairani-Bejo S, Symonds ML, Dohnt MF, Galloway RL, Steigerwalt AG, Bahaman AR, Craig S, Harrower BJ, Smythe LD Leptospira kmetyi sp. nov., isolated from an environmental source in Malaysia. Int J Syst Evol Microbiol [Internet]. 2009 Apr [cited 2015 Sep 16];59(Pt 4):705–8. Available from: http://ijs.sgmjournals.org/content/journal/ijsem/10.1099/ijs.0.002766-0

  20. Mohammadinia A, Alimohammadi A, Saeidian B Efficiency of geographically weighted regression in modeling human leptospirosis based on environmental factors in Gilan Province, Iran. Geosciences. 2017 Dec 19 [cited 2018 Feb 5];7(4):136. Available from: http://www.mdpi.com/2076-3263/7/4/136

  21. Azali MA, Yean Yean C, Harun A, Aminuddin Baki NN, Ismail N (2016) Molecular characterization of Leptospira spp. in environmental samples from north-eastern Malaysia revealed a pathogenic strain, Leptospira alstonii. J Trop Med 2016

  22. Benacer D, Woh PY, Mohd Zain SN, Amran F, Thong KL Pathogenic and saprophytic Leptospira species in water and soils from selected urban sites in Peninsular Malaysia. Microbes Environ. 2013 [cited 2018 Jul 14];28(1):135–40. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23363618

  23. Benacer D, Mohd Zain SN, Sim SZ, Mohd Khalid MKN, Galloway RL, Souris M, Thong KL Determination of Leptospira borgpetersenii serovar Javanica and Leptospira interrogans serovar Bataviae as the persistent Leptospira serovars circulating in the urban rat populations in Peninsular Malaysia. Parasit Vectors. 2016 Dec 1 [cited 2018 Aug 24];9(1):117. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26927873

  24. Thaipadungpanit J, Wuthiekanun V, Chierakul W, Smythe LD, Petkanchanapong W, Limpaiboon R, Apiwatanaporn A, Slack AT, Suputtamongkol Y, White NJ, Feil EJ, Day NPJ, Peacock SJ A dominant clone of Leptospira interrogans associated with an outbreak of human leptospirosis in Thailand. PLoS Negl Trop Dis. 2007 Oct 31 [cited 2018 Jul 14];1(1):e56. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17989782

  25. Bashiru G, Bahaman A Advances & challenges in leptospiral vaccine development. Indian J Med Res [Internet]. 2018 Jan [cited 2018 Jul 14];147(1):15. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29749356

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Acknowledgments

We wish to acknowledge the support of the Ministry of Higher Education and Ministry of Health, Malaysia, and the Universiti Putra Malaysia, for providing their support throughout the study. We express our gratitude to the Tuanku Mizan Armed Forces Hospital in Kuala Lumpur and all military recruits who participated in the study. The authors thank members of GLEAN (Global Leptospirosis Environmental Action Network) for guidance throughout the study. We would like to thank the Director General of Health, Malaysia, for his permission to publish this data.

Funding

This research work was supported by the Malaysia Ministry of Education through Long-Term Research Grant Scheme (LRGS Phase 2/2014, UPM/700-2/7/LRGS/5526400).

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Authors and Affiliations

  1. Department of Medical Microbiology and Parasitology, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia

    Vasantha Kumari Neela, Nurul Natasya Azhari, Narcisse Joseph, Noraini Philip Mimie, Siti Nur Alia Ramli & Zamberi Sekawi

  2. Infectious Disease Control Unit, Selangor State Health Department, Shah Alam, Selangor, Malaysia

    Nooreen Farzana Mustapha

  3. School of Environmental Sciences & Natural Resource, The National University of Malaysia, Bangi, Selangor, Malaysia

    Siti Nabilah Ishak & Farah Shafawati Mohd-Taib

  4. School of Biological Sciences, University Science Malaysia, Gelugor, Penang, Malaysia

    Muhammad Afif Yusof

  5. Department of Biomedical Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia

    Mohd Nasir Mohd Desa

  6. Department of Veterinary Public Health and Preventive Medicine, Faculty of Veterinary Medicine, Usmanu Danfodiyo University, Sokoto, Sokoto, Nigeria

    Garba Bashiru

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  1. Vasantha Kumari Neela
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  2. Nurul Natasya Azhari
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Correspondence to Vasantha Kumari Neela.

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The authors declare that they have no conflict of interest.

Ethics approval

The approval for the conduct of this study was obtained from the Medical Research and Ethics Committee, Ministry of Health, Malaysia, with reference number NMRR-15-2148-27536. The study was approved by the Animal Ethics Committee of the Universiti Kebangsaan Malaysia (National University of Malaysia) with reference number (UKMAEC) FST/2016/AR-CAT2.

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Neela, V.K., Azhari, N.N., Joseph, N. et al. An outbreak of leptospirosis among reserve military recruits, Hulu Perdik, Malaysia. Eur J Clin Microbiol Infect Dis 38, 523–528 (2019). https://doi.org/10.1007/s10096-018-03450-6

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