Leptospirosis among Hospitalized Febrile Patients in Northern Tanzania

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 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 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 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 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 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 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 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 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 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 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 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

*Address correspondence to John A. Crump, Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Box 102359, Durham, NC 27710. E-mail: john.crump@duke.edu

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.

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