Seroprevalence and Risk Factors for Rickettsia and Leptospira Infection in Four Ecologically Distinct Regions of Peru

Gabriela Salmon-Mulanovich U.S. Naval Medical Research Unit No. 6, Callao, Peru;
Universidad Peruana Cayetano Heredia, Lima, Peru;

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Mark P. Simons U.S. Naval Medical Research Unit No. 6, Callao, Peru;

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Carmen Flores-Mendoza U.S. Naval Medical Research Unit No. 6, Callao, Peru;

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Steev Loyola U.S. Naval Medical Research Unit No. 6, Callao, Peru;

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María Silva U.S. Naval Medical Research Unit No. 6, Callao, Peru;

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Matthew Kasper Armed Forces Health Surveillance Center, Silver Spring, Maryland;

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Hugo R. Rázuri U.S. Naval Medical Research Unit No. 6, Callao, Peru;

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Luis Enrique Canal U.S. Naval Medical Research Unit No. 6, Callao, Peru;

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Mariana Leguia U.S. Naval Medical Research Unit No. 6, Callao, Peru;

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Daniel G. Bausch U.S. Naval Medical Research Unit No. 6, Callao, Peru;
Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana;

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Allen L. Richards Viral and Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, Maryland

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Rickettsia and Leptospira spp. are under-recognized causes of acute febrile disease worldwide. Rickettsia species are often placed into the spotted fever group rickettsiae (SFGR) and typhus group rickettsiae (TGR). We explored the antibody prevalence among humans for these two groups of rickettsiae in four regions of Peru (Lima, Cusco, Puerto Maldonado, and Tumbes) and for Leptospira spp. in Puerto Maldonado and Tumbes. We also assessed risk factors for seropositivity and collected serum samples and ectoparasites from peri-domestic animals from households in sites with high human seroprevalence. In total, we tested 2,165 human sera for antibodies (IgG) against SFGR and TGR by ELISA and for antibodies against Leptospira by a microscopic agglutination test. Overall, human antibody prevalence across the four sites was 10.6% for SFGR (ranging from 6.2% to 14.0%, highest in Tumbes) and 3.3% for TGR (ranging from 2.6% to 6.4%, highest in Puerto Maldonado). Factors associated with seroreactivity against SFGR were male gender, older age, contact with backyard birds, and working in agriculture or with livestock. However, exposure to any kind of animal within the household decreased the odds ratio by half. Age was the only variable associated with higher TGR seroprevalence. The prevalence of Leptospira was 11.3% in Puerto Maldonado and 5.8% in Tumbes, with a borderline association with keeping animals in the household. We tested animal sera for Leptospira and conducted polymerase chain reaction (PCR) to detect Rickettsia species among ectoparasites collected from domestic animals in 63 households of seropositive participants and controls. We did not find any association between animal infection and human serostatus.

Author Notes

Address correspondence to Gabriela Salmon-Mulanovich, U.S. Naval Medical Research Unit No. 6, Av. Venezuela cdra. 36 s/n, Bellavista, Callao, Peru. E-mail: gsalmonm.veid@gmail.com

Financial support: The study was funded by U.S. DoD Global Emerging Infections Surveillance and Response System, work unit 847705 82000 25GB B0016.

Disclosure: The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the U.S. government. Some authors are or were military service members and employees of the U.S. government. This work was prepared as part of their official duties. Title 17 U.S.C. §105 provides that “Copyright protection under this title is not available for any work of the United States Government.” Title 17 U.S.C. §101 defines a U.S. government work as a work prepared by a military service member or employee of the U.S. government as part of that person’s official duties. The study protocol was approved by the Naval Medical Research Unit-6 Institutional Review Board (Protocol No. NAMRU6.2013.0002) in compliance with all applicable Federal regulations governing the protection of human subjects. The experiments reported herein were conducted in compliance with the Animal Welfare Act and in accordance with principles set forth in the “Guide for the Care and Use of Laboratory Animals,” Institute of Laboratory Animals Resources, National Research Council, National Academy Press, 2011. This study was approved via Resolucion Directoral No. 297-2015-SERFOR/DGGSPFFS by the Forestry and Wild Fauna Service, Peruvian Ministry of Agriculture.

Authors’ addresses: Gabriela Salmon-Mulanovich, Department of Virology and Emerging Infections, Naval Medical Research Unit No. 6, Callao, Peru, Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru, and Ingeniería Biomédica, Pontificia Universidad Católica del Perú, Lima, Peru, E-mail: gsalmonm.veid@gmail.com. Mark P. Simons, Wound Infections, Naval Medical Research Unit No. 6, Silver Spring, MD, E-mail: mark.p.simons.mil@mail.mil. Carmen Flores-Mendoza, Department of Entomology, Naval Medical Research Unit No. 6, Callao, Peru, E-mail: carmen.flores.fn@mail.mil. Steev Loyola and María Silva, Department of Virology and Emerging Infections, Naval Medical Research Unit No. 6, Callao, Peru, E-mails: steev.loyola@gmail.com and maritasilva71@gmail.com. Matthew Kasper, Department of Bacteriology, U.S. Naval Medical Research Unit No. 6, Lima, Peru, E-mail: matthew.r.kasper2.mil@mail.mil. Hugo R. Rázuri, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Canada, and Department of Virology and Emerging Infections, Naval Medical Research Unit No. 6, Callao, Peru, E-mail: hugorazuri@gmail.com. Luis Enrique Canal, Department of Bacteriology, Naval Medical Research Unit No. 6, Callao, Peru, E-mail: enrique.a.canal.fn@mail.mil. Mariana Leguia, Department of Virology and Emerging Infections, Naval Medical Research Unit No. 6, Callao, Peru, and Vicerrectorado de Investigación, Pontificia Universidad Catolica del Peru, Lima, Peru, E-mail: mariana.leguia@gmail.com. Daniel G. Bausch, Department of Virology and Emerging Infections, Naval Medical Research Unit No. 6, Callao, Peru, School of Public Health and Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, Public Health England London Region, UK Public Health Rapid Support Team, London, United Kingdom, and London School of Hygiene and Tropical Medicine, UK Public Health Rapid Support Team, London, United Kingdom, E-mail: daniel.bausch@phe.gov.uk. Allen L. Richards, Department of Viral and Rickettsial Diseases, Naval Medical Research Center, Silver Spring, MD, E-mail: allen.l.richards.civ@mail.mil.

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