A systematic review of human and animal leptospirosis in the Pacific Islands reveals pathogen and reservoir diversity.

Existing Reviews

Please note, new claims can take a short while to show up.

No claims yet.

Annotation Summary

Term Occurence Count Dictionary
leptospirosis 125 infectiousdiseases
typhus 3 infectiousdiseases
chikungunya 2 infectiousdiseases
infectious disease 4 infectiousdiseases

There are not enough annotations found in this document to create the proximity graph.

Review

Having read the paper, please pick a pair of statements from the paper to indicate that a drug and disease are related.

Select Drug Character Offset Drug Term Instance
Select Disease Character Offset Disease Term Instance
chikungunya 46354 gardening (30%); working in piggeries (14%), farmer (29%)[[24]]2014–152 cases (co-infection with chikungunya )N/A[[48]]2014–1544 confirmed casesPossible risk factors: rats and dogs (as they share common types
chikungunya 66101 Several studies included in our review were conducted during outbreaks of dengue [[81], [142], [150]], chikungunya [[24]] or murine typhus [[76]], and coincidentally identified leptospirosis cases that might otherwise
infectious disease 4229 but accurate diagnosis was challenging and often delayed because symptoms overlapped with many other infectious disease s, and access to laboratory diagnosis was limited. A wide variety of animal hosts of Leptospira were
infectious disease 8972 Poverty, remoteness and tropical climate all contribute to vulnerability to, and significant burden of, infectious disease s in the PICTs [[17]]. Global emergence of leptospirosis has been associated with environmental factors
infectious disease 9663 [[22], [23]], poor medical awareness, and non-specific symptoms that overlap with many other tropical infectious disease s, especially arbovirus infections [[24]]. As a consequence, little is known about the ecological, epidemiological
infectious disease 66291 cases that might otherwise have remained undetected. On the contrary, the co-circulation of different infectious disease s sharing similar clinical presentation in the PIs might lead to leptospirosis under-diagnosis, sometimes
leptospirosis 79 Title: PLoS Neglected Tropical DiseasesA systematic review of human and animal leptospirosis in the Pacific Islands reveals pathogen and reservoir diversityAlternative Title: A systematic review
leptospirosis 215 reveals pathogen and reservoir diversityAlternative Title: A systematic review of human and animal leptospirosis in the Pacific IslandsVanina Guernier (Conceptualization) (Data curation) (Formal analysis) (Investigation)
leptospirosis 1498 5/2018AbstractBackgroundThe Pacific Islands have environmental conditions highly favourable for transmission of leptospirosis , a neglected zoonosis with highest incidence in the tropics, and Oceania in particular. Recent reports
leptospirosis 1654 incidence in the tropics, and Oceania in particular. Recent reports confirm the emergence and outbreaks of leptospirosis in the Pacific Islands, but the epidemiology and drivers of transmission of human and animal leptospirosis
leptospirosis 1761 leptospirosis in the Pacific Islands, but the epidemiology and drivers of transmission of human and animal leptospirosis are poorly documented, especially in the more isolated and less developed islands.Methodology/Principal
leptospirosis 1940 developed islands.Methodology/Principal findingsWe conducted a systematic review of human and animal leptospirosis within 25 Pacific Islands (PIs) in Polynesia, Melanesia, Micronesia, as well as Easter Island and Hawaii.
leptospirosis 2287 We further included grey literature available on the internet. We identified 148 studies describing leptospirosis epidemiology, but the number of studies varied significantly between PIs. No data were available from
leptospirosis 2419 the number of studies varied significantly between PIs. No data were available from four PIs. Human leptospirosis has been reported from 13 PIs, with 63% of all studies conducted in Hawaii, French Polynesia and New
leptospirosis 2552 from 13 PIs, with 63% of all studies conducted in Hawaii, French Polynesia and New Caledonia. Animal leptospirosis has been investigated in 19 PIs and from 14 host species, mainly pigs (18% of studies), cattle (16%)
leptospirosis 2745 studies), cattle (16%) and dogs (11%). Only 13 studies provided information on both human and animal leptospirosis from the same location. Serology results were highly diverse in the region, both in humans and animals.Conclusions/SignificanceOur
leptospirosis 2941 in humans and animals.Conclusions/SignificanceOur study suggests that, as in other tropical regions, leptospirosis is widespread in the PIs while showing some epidemiological heterogeneity. Data are scarce or absent
leptospirosis 3825 disease burden is often underestimated. In this systematic review, we aimed to describe the extent of leptospirosis in the Pacific Islands, including the diversity of pathogens and animal reservoirs. We identified 148
leptospirosis 4065 islands that described Leptospira infection in humans or animals. In hospitalized febrile patients, leptospirosis was a common cause of the acute febrile illness, but accurate diagnosis was challenging and often delayed
leptospirosis 4545 relative importance in human infection remains unclear. Our review demonstrates that the epidemiology of leptospirosis varies across the Pacific Islands, but information about risk factors and transmission routes is currently
leptospirosis 5061 files.IntroductionLeptospira is a genus of bacteria belonging to the phylum of Spirochaetes causing leptospirosis in humans and other mammals [[1]]. Leptospirosis is the most widespread and potentially fatal bacterial
leptospirosis 5611 Pacific region [[5]], and a recent systematic review found that Oceania was the region most impacted by leptospirosis in terms of morbidity (150.68 cases per 100,000 per year), mortality (9.61 deaths per 100,000 per year)
leptospirosis 5955 reported in 2008 in Futuna (a Polynesian island) during a multi-year outbreak [[7]]. The health impacts of leptospirosis have been predominantly attributed to acute infections and early complications such as pulmonary haemorrhage
leptospirosis 6106 acute infections and early complications such as pulmonary haemorrhage and renal failure. However, leptospirosis can also cause subacute and chronic complications and long-term sequelae [[8]].Two classification schemes
leptospirosis 6881 and clustered into saprophytic, intermediate and pathogenic groups [[11]]. Laboratory diagnosis of leptospirosis may be accomplished by direct detection of the organism or its components in body fluid or tissues,
leptospirosis 7277 humour, cerebrospinal fluid (CSF) or post-mortem tissue samples [[14]]. Historically, most cases of leptospirosis have been diagnosed by serology, because capacity for culture and PCR were limited. IgM antibodies are
leptospirosis 9033 vulnerability to, and significant burden of, infectious diseases in the PICTs [[17]]. Global emergence of leptospirosis has been associated with environmental factors including rainfall, flooding, poverty, and urbanization
leptospirosis 9280 are important drivers of transmission in the Pacific Islands. Recent reports confirm the emergence of leptospirosis in the Pacific region, with increase in incidence and reports of unprecedented outbreaks [[5], [21]].
leptospirosis 9422 increase in incidence and reports of unprecedented outbreaks [[5], [21]]. However, the incidence of leptospirosis is unfortunately not well-documented from many Pacific Islands, mainly because of the unavailability
leptospirosis 9828 consequence, little is known about the ecological, epidemiological and clinical characteristics of leptospirosis in the region, and the burden of the disease might be even higher than recognized.To tackle these gaps
leptospirosis 10004 higher than recognized.To tackle these gaps in current knowledge and understanding of human and animal leptospirosis infection in the Pacific Islands, we conducted a systematic review of both peer-reviewed and grey literature
leptospirosis 10292 and Meta-analyses (PRISMA) guidelines [[25]]. Our aims were to summarise and compare human and animal leptospirosis within and between the Pacific Islands.MethodsGeographic scopeThe selection of the countries and territories
leptospirosis 13133 included in this review if it contained qualitative and/or quantitative information on human or/and animal leptospirosis in the PIs, including environmental studies, case reports, outbreak description or epidemiologic surveys.
leptospirosis 13843 cellular, molecular, biochemical or other studies that did not include naturally occurring cases of leptospirosis in humans or animals), and (iv) descriptions or studies of laboratory methods. The inclusion and exclusion
leptospirosis 16204 study design, target population, inclusion criteria, number enrolled, diagnostic tests used, confirmed leptospirosis cases and risk factors. For animal studies, information was compiled on country, year(s) of study, species
leptospirosis 17347 recommendations of the WHO LERG report [[28]] as follows: clinical signs and symptoms consistent with leptospirosis and one or more of the following: (i) positive PCR or isolation by culture; (ii) seroconversion or fourfold
leptospirosis 20578 data were collected from the abstract or from the full text of later published studies.The included leptospirosis studies were conducted in 21 out of the 25 PIs within the scope of our study. No information about leptospirosis
leptospirosis 20691 studies were conducted in 21 out of the 25 PIs within the scope of our study. No information about leptospirosis was retrieved from Nauru, Pitcairn Islands, Tuvalu and Wake Island. Included studies were mostly either
leptospirosis 21113 Leptospira in the environment [[29], [30]]. Detailed information on each study is provided in S1 Table.Human leptospirosis studiesHuman leptospirosis was investigated in 92 eligible studies from 14 PIs. We classified human
leptospirosis 21140 [30]]. Detailed information on each study is provided in S1 Table.Human leptospirosis studiesHuman leptospirosis was investigated in 92 eligible studies from 14 PIs. We classified human studies into two categories:
leptospirosis 21638 reports. The remaining 73 studies (79%) were clinical, including surveillance data, case reports or leptospirosis investigation in sick and/or hospitalised patients). Clinical studies were reported as strong or weak
leptospirosis 21766 in sick and/or hospitalised patients). Clinical studies were reported as strong or weak evidence of leptospirosis following the criteria detailed in the methods section (see S1 Table for detailed classification). French
leptospirosis 22181 [[66]–[84]]. Of the 14 PIs investigated, confirmed cases were reported from 13 PIs only as four suspected leptospirosis cases investigated in Tonga were later reported as negative [[5]].10.1371/journal.pntd.0006503.g003Fig
leptospirosis 23513 ‘*’: includes one study on feral pigs. ‘?’: inconclusive results (reported from [[85]]).Animal leptospirosis studiesPast infection with, or renal carriage of, leptospires in animals was investigated in 66 eligible
leptospirosis 23689 in animals was investigated in 66 eligible studies from 19 PIs, plus one paper that reported animal leptospirosis from 22 PIs [[85]] (S1 Table). In total, 13 different animal species were tested: bandicoots (Echymipera
leptospirosis 26353 least one study over the 1947–2017 period, meaning that studies classified as ‘weak evidence’ for leptospirosis were also included. For this reason, and because of the limitations of the MAT, results should be interpreted
leptospirosis 29813 horsecattle, horse, pigcattle, horsecattle, pigcattle, horse, pig cattle, pigcattlecattle, pigHawaiiHuman leptospirosis was recognised as early as 1936 in Hawaii; seroprevalence studies investigated the general population
leptospirosis 30267 conducted in 2002 in Oahu found a positivity rate of 1.4% (7/488) [[79]]. Sixteen publications reported leptospirosis cases from surveillance data and clinical studies between 1962 and 2008. Information by island was not
leptospirosis 30575 studies were dedicated to Kauai and Oahu, reporting sporadic cases. One study investigated cases of leptospirosis during an outbreak of murine typhus on Kauai (1998) and reported two cases of co-infection with both
leptospirosis 30857 reported in Table 2.10.1371/journal.pntd.0006503.t002Table 2Summary of publications reporting human leptospirosis in Hawaii, 1947–2017.CitationStudy yearsCase reportsSeroprevalence studiesExposure/risk factors[[66]]1936–42Hawaii:
leptospirosis 32771 during a dengue outbreak.In Hawaii, the epidemiology and relative importance of risk factors for human leptospirosis have evolved over the past few decades. Leptospirosis in Hawaii has historically been considered an
leptospirosis 33394 least for the island of Hawaii). At the same time, a significant shift in the seasonal occurrence of leptospirosis from the drier summer months to the wetter winter months was observed [[84]]. An increase in “habitational
leptospirosis 33909 in human cases, shifting from Icterohaemorrhagiae to Australis.Animals were first investigated for leptospirosis in Hawaii during the same 1936–1942 investigation targeting humans. Dogs, cats, rats and mongooses
leptospirosis 34056 1936–1942 investigation targeting humans. Dogs, cats, rats and mongooses were serologically screened for leptospirosis , and revealed evidence of infection in all three species [[66], [88]]. Between 1943 and 2009, more animal
leptospirosis 34333 Seropositive rats and mongooses were reported from nine and seven more studies respectively. Evidence of leptospirosis infection was also found in cattle (2/2 studies), mice (6/6), feral swine (1/1) and Hawaiian monkey
leptospirosis 34673 reported in Table 3.10.1371/journal.pntd.0006503.t003Table 3Summary of publications reporting animal leptospirosis in Hawaii, 1947–2017.CitationStudy yearsAnimal speciesTestNPositive cases (%)[[88]]N/ADogsS10039 (39%)[[66]]1936–42CatsS1000RatsDF44718
leptospirosis 36417 sequenced amplicons (n = 42) were characterised as pathogenic Leptospira wolffii.New CaledoniaHuman leptospirosis was first reported in 1954 and 1957. A total of 20 articles from New Caledonia were identified. Two
leptospirosis 36907 except between 1990–1998, suggesting endemic transmission. Three clinical studies focused on severe leptospirosis : severe icteric leptospirosis cases with cardiac manifestations [[55]], the influence of age on the
leptospirosis 36937 suggesting endemic transmission. Three clinical studies focused on severe leptospirosis: severe icteric leptospirosis cases with cardiac manifestations [[55]], the influence of age on the development of severe leptospirosis
leptospirosis 37043 leptospirosis cases with cardiac manifestations [[55]], the influence of age on the development of severe leptospirosis in children [[63]], and risk factors and predictors of severe leptospirosis [[64]]. The complete list
leptospirosis 37119 the development of severe leptospirosis in children [[63]], and risk factors and predictors of severe leptospirosis [[64]]. The complete list of human leptospirosis studies from New Caledonia is reported in Table 4.10.1371/journal.pntd.0006503.t004Table
leptospirosis 37168 [[63]], and risk factors and predictors of severe leptospirosis [[64]]. The complete list of human leptospirosis studies from New Caledonia is reported in Table 4.10.1371/journal.pntd.0006503.t004Table 4Summary of
leptospirosis 37312 reported in Table 4.10.1371/journal.pntd.0006503.t004Table 4Summary of publications reporting human leptospirosis in New Caledonia, 1947–2017.CitationStudy yearsCase reportsSeroprevalence studiesExposure/risk factors[[32]]1954,
leptospirosis 39200 fishing, hunting (OR>3)[[63]]2006–1260 cases under 18yoAge-dependant association with severity of leptospirosis [[64]]2008–1172 severe leptospirosis / 306 casesDelay in diagnosis, tabacco use, infection by L. interrogans
leptospirosis 39238 (OR>3)[[63]]2006–1260 cases under 18yoAge-dependant association with severity of leptospirosis[[64]]2008–1172 severe leptospirosis / 306 casesDelay in diagnosis, tabacco use, infection by L. interrogans Icterohaemorragiae[[65]]2000–12731
leptospirosis 39507 anomaly, rainfall, temperatureN/A: information unavailable from the study.The risk factors for human leptospirosis in New Caledonia varied little between the 1980s and today. The disease was more frequent among young
leptospirosis 40374 pigs, horses, dogs, rats and, less commonly, deer [[56], [61]].Eleven studies were published on animal leptospirosis in New Caledonia between 1983 and 2004. Leptospira spp. infection was demonstrated in a wide range of
leptospirosis 40829 seropositive animals. Results on sheep (one study) were inconclusive. The complete list of studies on animal leptospirosis in New Caledonia is reported in Table 5.10.1371/journal.pntd.0006503.t005Table 5Summary of publications
leptospirosis 40964 reported in Table 5.10.1371/journal.pntd.0006503.t005Table 5Summary of publications reporting animal leptospirosis in New Caledonia, 1947–2017.For study [[54]] the number of tested animals ‘N’ is provided separately
leptospirosis 43193 that 58% of soil samples were contaminated with pathogenic leptospires.French PolynesiaThe first human leptospirosis cases were reported from Tahiti in the 1950s [[31]]. Two serological surveys in the general population
leptospirosis 43578 seroprevalence (9.5%) was found. In addition, 20 clinical studies from 1952 to 2015 provided evidence of human leptospirosis , suggesting endemic transmission throughout the archipelago. Available reports generally covered the
leptospirosis 44137 reported in Table 6.10.1371/journal.pntd.0006503.t006Table 6Summary of publications reporting human leptospirosis in French Polynesia, 1947–2017.CitationStudy yearsCase reportsSeroprevalence studiesExposure/risk
leptospirosis 46678 case investigations (through questionnaires) that aimed to identify risk factors associated with human leptospirosis (2006–2010), and important factors common between the studies included contact with rats or domestic
leptospirosis 47224 occupational, but potential infecting sources were numerous.Only three studies investigated animal leptospirosis in French Polynesia. The first study (1952–53) investigated renal carriage in rats from Tahiti by
leptospirosis 47907 two sheep and twelve dogs tested were found to be seronegative. The last study investigated animal leptospirosis in dogs, pigs and rats from Tahiti [[48]]. Renal carriage of pathogenic leptospires was demonstrated
leptospirosis 48137 (48/181) of farmed pigs, 20.4% (23/113) of rats, and four sick dogs.FijiThe first study reporting human leptospirosis in Fiji was published in 1978 [[109]], describing 240 cases between 1969 and 1977. Since then, two community-based
leptospirosis 49415 third study [[116]] showed significant heterogeneity in the relative importance of animal species in leptospirosis transmission in different ethnic groups and residential settings.Five studies have been published on
leptospirosis 49537 transmission in different ethnic groups and residential settings.Five studies have been published on animal leptospirosis in Fiji [[113], [117]–[120]], exploring a wide range of host species, including dogs, goats, mongooses,
leptospirosis 49937 Leptospira infection seems common in multiple animal species in Fiji.Papua New GuineaStudies on human leptospirosis in Papua New Guinea (PNG) were published between 1955 and 1968 [[121]–[124]], including three seroprevalence
leptospirosis 50273 Hebdomadis the most common serogroups. One study explored risk factors for human infections and found that leptospirosis in PNG was common in both males and females, and in both adults and children, reflecting high risk in
leptospirosis 51960 in feral pigs was 23.9%.The first human clinical study was published in 1998, describing two human leptospirosis cases with pancreatitis [[74]]. Three human clinical studies in the 2000s reported sporadic cases only
leptospirosis 52121 clinical studies in the 2000s reported sporadic cases only [[5], [74], [134], [135]]. In addition, two leptospirosis cases reported in Hawaii for the period 1999–2008 were suspected to have been acquired in Guam [[84]].
leptospirosis 52501 out of 46 participants surveyed, 21 reported being ill and three of them were confirmed with recent leptospirosis infections [[136]]. Reported exposures were often recreational activities involving swimming in fresh
leptospirosis 53671 the most common. Despite similar cultural and socio-economical patterns between the islands, human leptospirosis was considered endemic in Futuna while it only occurred sporadically in Wallis.Three studies focused
leptospirosis 53796 considered endemic in Futuna while it only occurred sporadically in Wallis.Three studies focused on animal leptospirosis in Wallis and Futuna. A first study focusing on livestock only reported the detection of specific Leptospira
leptospirosis 54766 found negative in the uninhabited island of Alofi, 2 km from Futuna.Risk factors associated with human leptospirosis have not been formally investigated, but rodents in Futuna have a much higher Leptospira carriage rate
leptospirosis 55230 facilitate the spread of Leptospira among rats and subsequently to humans [[140]].American SamoaHuman leptospirosis was first investigated in American Samoa in 1948 [[141]]; ten patients hospitalised for jaundice were
leptospirosis 56903 demonstrated the importance of environmental drivers of transmission [[147]].Two studies focused on animal leptospirosis . Renal carriage of leptospires by rats was examined on Tutuila Island in 1948; out of 126 individuals
leptospirosis 57772 reservoir hosts.Federated States of MicronesiaSeven clinical studies reported information about human leptospirosis in the Federated States of Micronesia (FSM), which consists of the four states of Yap, Chuuk, Kosrae
leptospirosis 57966 of Yap, Chuuk, Kosrae and Pohnpei in the Northwestern Pacific Ocean. In 1989–1997, eight confirmed leptospirosis cases identified in Hawaii were acquired from Kosrae and Pohnpei [[74]], and from 1999–2008 one reported
leptospirosis 58181 reported case in Hawaii was acquired from FSM [[84]]. A multi-centre survey of patients with suspected leptospirosis conducted in 2003–2005 reported no seropositive case from Yap (0/1 suspected) or Pohnpei (0/27 suspected)
leptospirosis 58400 suspected) [[5]]. In 2010, an investigation of 10 febrile patients in Chuuk revealed two confirmed cases of leptospirosis [[148]]. In 2011, a hospital-based survey conducted in Pohnpei on 54 patients presenting with undifferentiated
leptospirosis 58726 172 patients with suspected dengue were investigated by qPCR and five (2.9%) were confirmed as acute leptospirosis infections [[150]]. Lastly, one study investigated the health risks associated with climate change in
leptospirosis 58890 the health risks associated with climate change in FSM using a time series distribution of monthly leptospirosis outpatient cases in Pohnpei. This study was based on hospital records and is assumed to represent close
leptospirosis 59089 to represent close to all of the reported cases [[151]]. Taken together, those studies suggest that leptospirosis is endemic in FSM.Rats were the first animal species to be investigated in 1947, but microscopic examination
leptospirosis 59590 (Pohnpei, Chuuk, Yap) showed positive results from all species [[153]].Solomon IslandsNo papers on human leptospirosis were identified from the Solomon Islands, and only three papers on animal leptospirosis have been published.
leptospirosis 59678 papers on human leptospirosis were identified from the Solomon Islands, and only three papers on animal leptospirosis have been published. Between 1967 and 1977, a large veterinary survey investigated cattle diseases from
leptospirosis 59935 (165 herds with a total of 8,930 cattle) plus some of the 650 herds established after 1967 [[86]]. For leptospirosis , only the female cattle over one year of age were tested, of which 62 were found seropositive. In 1985,
leptospirosis 60365 goats, and 71% of 31 horses tested were seropositive by MAT [[155]].VanuatuOnly sporadic cases of human leptospirosis have been reported in Vanuatu in the 1990s [[156], [157]] and the 2000s [[5]]. No human seroprevalence
leptospirosis 61220 with a ‘viral syndrome’ were investigated in Palau, of whom seven were serologically confirmed as leptospirosis [[160]]. Over the period 2000–2006, the disease surveillance system recorded 81 cases, all living
leptospirosis 61462 of the country [[161]]. In 2003–2005, a multi-centre survey of patients with clinically suspected leptospirosis reported one seropositive out of eight tested [[5]]. In 2014, two Japanese travellers developed leptospirosis
leptospirosis 61572 leptospirosis reported one seropositive out of eight tested [[5]]. In 2014, two Japanese travellers developed leptospirosis after returning from Palau; the suspected exposure was swimming in Ngardmau falls [[15]].Cattle (n =
leptospirosis 62107 cases was conducted in 2003–2005; four patients were tested by PCR or MAT but none were confirmed as leptospirosis [[5]]. Cattle (n = 171) and pigs (n = 244) from different Tongan islands (Tongatapu, 'Eua, Ha'apai,
leptospirosis 62464 cattle, and from 5.0% to 16.7% in pigs.In the Commonwealth of the Northern Mariana Islands (CNMI), leptospirosis has been reported as endemic, but our search retrieved only one study; in 2000–2001, 10 cases of leptospirosis
leptospirosis 62577 has been reported as endemic, but our search retrieved only one study; in 2000–2001, 10 cases of leptospirosis were reported in Saipan, of which eight were severe, and three were fatal [[164]]. In none of the cases
leptospirosis 63041 after a tropical storm, slaughtering pigs, and occupational gardening.In 1989–1997, one confirmed leptospirosis case identified in Hawaii was acquired from the Marshall Islands [[74]].For the remaining Pacific Islands,
leptospirosis 63203 Marshall Islands [[74]].For the remaining Pacific Islands, our search retrieved no studies on human leptospirosis , but few animal studies were available for Easter Island, Kiribati, Niue, Cook Islands, Samoa and Tokelau.
leptospirosis 63443 summarised in Table 7.10.1371/journal.pntd.0006503.t007Table 7Summary of publications reporting animal leptospirosis in the Pacific Islands for which no studies on human leptospirosis were reported, 1947–2017.CitationPICTsStudy
leptospirosis 63510 of publications reporting animal leptospirosis in the Pacific Islands for which no studies on human leptospirosis were reported, 1947–2017.CitationPICTsStudy yearsHostNConfirmed cases (%)[[165]]Easter Island1946–65Cattle5746
leptospirosis 64345 seropositiveDiscussionThis systematic review is the first to synthesize and compile data on the epidemiology of human leptospirosis and pathogenic Leptospira spp. infection in animals in the PIs. Considering the limited population and
leptospirosis 64632 number of studies retrieved was impressive (n = 148). Overall, the systematic review demonstrates that leptospirosis is an important cause of acute febrile illness across the PIs, with evidence of human disease demonstrated
leptospirosis 65026 prevalence ranging from 10% to 88%. Taken together, these findings reflect the public health importance of leptospirosis in the region, and corroborate recent estimates of very high disease burden in Oceania [[3]]. A wide
leptospirosis 65778 Icterohaemorrhagiae was identified from human cases (e.g. Palau).Even though many studies on human leptospirosis in the PIs were retrieved, these studies probably under-estimate the true burden as leptospirosis is
leptospirosis 65876 human leptospirosis in the PIs were retrieved, these studies probably under-estimate the true burden as leptospirosis is thought to be under-reported globally, particularly in developing countries such as the majority
leptospirosis 66175 dengue [[81], [142], [150]], chikungunya [[24]] or murine typhus [[76]], and coincidentally identified leptospirosis cases that might otherwise have remained undetected. On the contrary, the co-circulation of different
leptospirosis 66374 co-circulation of different infectious diseases sharing similar clinical presentation in the PIs might lead to leptospirosis under-diagnosis, sometimes resulting in a fatal outcome [[24]]. In the reviewed human clinical studies,
leptospirosis 66506 sometimes resulting in a fatal outcome [[24]]. In the reviewed human clinical studies, diagnosis for leptospirosis often occurred very late, in already hospitalised (n = 21 studies where hospitalisation is specified)
leptospirosis 66715 specified) or even deceased patients [[164]]. A case report from American Samoa highlighted some of the leptospirosis diagnostic challenges faced by clinicians in the PIs [[143]]. There is still a need to raise awareness
leptospirosis 66877 PIs [[143]]. There is still a need to raise awareness and to reinforce diagnostic capabilities for leptospirosis in the PIs. These have to go hand in hand with better agreement about the use of diagnostic tools and
leptospirosis 67117 results. The development of clinical guidelines for the management of febrile patients with suspected leptospirosis should be a priority.Serological studies suggested a wide variety of Leptospira serogroups (n = 21)
leptospirosis 70300 studies, and/or different study designs, and/or the use of different MAT panels. In some PIs, human leptospirosis was not investigated, even though Leptospira infection was demonstrated in animals, i.e. in the Solomon
leptospirosis 70707 rodent studies were available from only eight of these 19 PIs, which might bias our understanding of leptospirosis infection in humans in the PIs.This review identified common behavioural risk factors and environmental
leptospirosis 70837 humans in the PIs.This review identified common behavioural risk factors and environmental drivers for leptospirosis infection across the region. Environmental drivers were mostly climate-related (flooding, extreme events),
leptospirosis 71320 epidemiological surveys that conducted robust statistical analyses of risk factors associated with human leptospirosis . Many studies reported some “possible drivers” of infection, or some “possible exposure” but
leptospirosis 72616 varied between urban, peri-urban and rural settings [[111]]. We also showed a wide heterogeneity of leptospirosis serogroups and individual risk factors within and between islands. Combined with the already discussed
leptospirosis 73108 following an integrated “One Health” approach are needed to understand the exposure pathways for leptospirosis in humans, including the specific role and relative importance of each animal species in different environmental
leptospirosis 73966 intensification could individually, or possibly synergistically, lead to further increases in the burden of human leptospirosis in the Pacific. In the future, guidelines for a proper framework for leptospirosis research may help
leptospirosis 74049 burden of human leptospirosis in the Pacific. In the future, guidelines for a proper framework for leptospirosis research may help to improve our understanding of local epidemiology and complex transmission dynamics
leptospirosis 74169 research may help to improve our understanding of local epidemiology and complex transmission dynamics of leptospirosis worldwide.Supporting informationS1 AppendixPRISMA checklist.(DOC)Click here for additional data file.S2
leptospirosis 74724 vs animal) and the type of study. Human clinical studies were reported as strong or weak evidence of leptospirosis following the criteria detailed in the methods section. The 11 studies for which the full text document
leptospirosis 75444 reason, and because of the limitations of the MAT, some results were considered as “weak evidence” of leptospirosis following the criteria detailed in the methods section; thus this table should be interpreted with caution.(XLS)Click
typhus 30618 reporting sporadic cases. One study investigated cases of leptospirosis during an outbreak of murine typhus on Kauai (1998) and reported two cases of co-infection with both diseases [[76]]. The complete list
typhus 32031 exposure: dogs 71%, rats 30%. Largest outbreak: swimming in a river[[76]]1998 Kauai: 2 cases / 5 murine typhus casesN/A[[78]]1979–98 74 confirmed casesN/A[[79]]2002US Army blood donors, Oahu: 7/488 (1.4%)N/A[[80]]2004Oahu:
typhus 66130 review were conducted during outbreaks of dengue [[81], [142], [150]], chikungunya [[24]] or murine typhus [[76]], and coincidentally identified leptospirosis cases that might otherwise have remained undetected.

You must be authorized to submit a review.