Leptospirosis Outbreak in Sri Lanka in 2008: Lessons for Assessing the Global Burden of Disease

Suneth B. Agampodi Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka Saliyapura, Sri Lanka; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, University of Cambridge, Cambridge, United Kingdom; Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; World Health Organization/Food and Agricultural Organization/World Organization for Animal Health Collaborating Centre for Reference and Research on Leptospirosis, Western Pacific Region, Archerfield, Queensland, Australia; Faculty of Science, Health And Education, University of The Sunshine Coast, Sippy Downs, Queensland, Australia; Epidemiology Unit, Colombo, Sri Lanka; Department of Medicine, University of California San Diego, La Jolla, California

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Sharon J. Peacock Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka Saliyapura, Sri Lanka; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, University of Cambridge, Cambridge, United Kingdom; Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; World Health Organization/Food and Agricultural Organization/World Organization for Animal Health Collaborating Centre for Reference and Research on Leptospirosis, Western Pacific Region, Archerfield, Queensland, Australia; Faculty of Science, Health And Education, University of The Sunshine Coast, Sippy Downs, Queensland, Australia; Epidemiology Unit, Colombo, Sri Lanka; Department of Medicine, University of California San Diego, La Jolla, California

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Vasanthi Thevanesam Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka Saliyapura, Sri Lanka; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, University of Cambridge, Cambridge, United Kingdom; Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; World Health Organization/Food and Agricultural Organization/World Organization for Animal Health Collaborating Centre for Reference and Research on Leptospirosis, Western Pacific Region, Archerfield, Queensland, Australia; Faculty of Science, Health And Education, University of The Sunshine Coast, Sippy Downs, Queensland, Australia; Epidemiology Unit, Colombo, Sri Lanka; Department of Medicine, University of California San Diego, La Jolla, California

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Danaseela B. Nugegoda Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka Saliyapura, Sri Lanka; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, University of Cambridge, Cambridge, United Kingdom; Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; World Health Organization/Food and Agricultural Organization/World Organization for Animal Health Collaborating Centre for Reference and Research on Leptospirosis, Western Pacific Region, Archerfield, Queensland, Australia; Faculty of Science, Health And Education, University of The Sunshine Coast, Sippy Downs, Queensland, Australia; Epidemiology Unit, Colombo, Sri Lanka; Department of Medicine, University of California San Diego, La Jolla, California

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Lee Smythe Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka Saliyapura, Sri Lanka; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, University of Cambridge, Cambridge, United Kingdom; Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; World Health Organization/Food and Agricultural Organization/World Organization for Animal Health Collaborating Centre for Reference and Research on Leptospirosis, Western Pacific Region, Archerfield, Queensland, Australia; Faculty of Science, Health And Education, University of The Sunshine Coast, Sippy Downs, Queensland, Australia; Epidemiology Unit, Colombo, Sri Lanka; Department of Medicine, University of California San Diego, La Jolla, California

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Janjira Thaipadungpanit Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka Saliyapura, Sri Lanka; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, University of Cambridge, Cambridge, United Kingdom; Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; World Health Organization/Food and Agricultural Organization/World Organization for Animal Health Collaborating Centre for Reference and Research on Leptospirosis, Western Pacific Region, Archerfield, Queensland, Australia; Faculty of Science, Health And Education, University of The Sunshine Coast, Sippy Downs, Queensland, Australia; Epidemiology Unit, Colombo, Sri Lanka; Department of Medicine, University of California San Diego, La Jolla, California

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Scott B. Craig Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka Saliyapura, Sri Lanka; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, University of Cambridge, Cambridge, United Kingdom; Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; World Health Organization/Food and Agricultural Organization/World Organization for Animal Health Collaborating Centre for Reference and Research on Leptospirosis, Western Pacific Region, Archerfield, Queensland, Australia; Faculty of Science, Health And Education, University of The Sunshine Coast, Sippy Downs, Queensland, Australia; Epidemiology Unit, Colombo, Sri Lanka; Department of Medicine, University of California San Diego, La Jolla, California

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Mary Ann Burns Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka Saliyapura, Sri Lanka; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, University of Cambridge, Cambridge, United Kingdom; Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; World Health Organization/Food and Agricultural Organization/World Organization for Animal Health Collaborating Centre for Reference and Research on Leptospirosis, Western Pacific Region, Archerfield, Queensland, Australia; Faculty of Science, Health And Education, University of The Sunshine Coast, Sippy Downs, Queensland, Australia; Epidemiology Unit, Colombo, Sri Lanka; Department of Medicine, University of California San Diego, La Jolla, California

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Michael Dohnt Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka Saliyapura, Sri Lanka; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, University of Cambridge, Cambridge, United Kingdom; Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; World Health Organization/Food and Agricultural Organization/World Organization for Animal Health Collaborating Centre for Reference and Research on Leptospirosis, Western Pacific Region, Archerfield, Queensland, Australia; Faculty of Science, Health And Education, University of The Sunshine Coast, Sippy Downs, Queensland, Australia; Epidemiology Unit, Colombo, Sri Lanka; Department of Medicine, University of California San Diego, La Jolla, California

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Siriphan Boonsilp Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka Saliyapura, Sri Lanka; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, University of Cambridge, Cambridge, United Kingdom; Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; World Health Organization/Food and Agricultural Organization/World Organization for Animal Health Collaborating Centre for Reference and Research on Leptospirosis, Western Pacific Region, Archerfield, Queensland, Australia; Faculty of Science, Health And Education, University of The Sunshine Coast, Sippy Downs, Queensland, Australia; Epidemiology Unit, Colombo, Sri Lanka; Department of Medicine, University of California San Diego, La Jolla, California

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Thamarasi Senaratne Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka Saliyapura, Sri Lanka; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, University of Cambridge, Cambridge, United Kingdom; Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; World Health Organization/Food and Agricultural Organization/World Organization for Animal Health Collaborating Centre for Reference and Research on Leptospirosis, Western Pacific Region, Archerfield, Queensland, Australia; Faculty of Science, Health And Education, University of The Sunshine Coast, Sippy Downs, Queensland, Australia; Epidemiology Unit, Colombo, Sri Lanka; Department of Medicine, University of California San Diego, La Jolla, California

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Athula Kumara Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka Saliyapura, Sri Lanka; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, University of Cambridge, Cambridge, United Kingdom; Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; World Health Organization/Food and Agricultural Organization/World Organization for Animal Health Collaborating Centre for Reference and Research on Leptospirosis, Western Pacific Region, Archerfield, Queensland, Australia; Faculty of Science, Health And Education, University of The Sunshine Coast, Sippy Downs, Queensland, Australia; Epidemiology Unit, Colombo, Sri Lanka; Department of Medicine, University of California San Diego, La Jolla, California

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Paba Palihawadana Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka Saliyapura, Sri Lanka; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, University of Cambridge, Cambridge, United Kingdom; Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; World Health Organization/Food and Agricultural Organization/World Organization for Animal Health Collaborating Centre for Reference and Research on Leptospirosis, Western Pacific Region, Archerfield, Queensland, Australia; Faculty of Science, Health And Education, University of The Sunshine Coast, Sippy Downs, Queensland, Australia; Epidemiology Unit, Colombo, Sri Lanka; Department of Medicine, University of California San Diego, La Jolla, California

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Sahan Perera Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka Saliyapura, Sri Lanka; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, University of Cambridge, Cambridge, United Kingdom; Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; World Health Organization/Food and Agricultural Organization/World Organization for Animal Health Collaborating Centre for Reference and Research on Leptospirosis, Western Pacific Region, Archerfield, Queensland, Australia; Faculty of Science, Health And Education, University of The Sunshine Coast, Sippy Downs, Queensland, Australia; Epidemiology Unit, Colombo, Sri Lanka; Department of Medicine, University of California San Diego, La Jolla, California

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Joseph M. Vinetz Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka Saliyapura, Sri Lanka; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, University of Cambridge, Cambridge, United Kingdom; Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka; World Health Organization/Food and Agricultural Organization/World Organization for Animal Health Collaborating Centre for Reference and Research on Leptospirosis, Western Pacific Region, Archerfield, Queensland, Australia; Faculty of Science, Health And Education, University of The Sunshine Coast, Sippy Downs, Queensland, Australia; Epidemiology Unit, Colombo, Sri Lanka; Department of Medicine, University of California San Diego, La Jolla, California

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Global leptospirosis disease burden estimates are hampered by the lack of scientifically sound data from countries with probable high endemicity and limited diagnostic capacities. We describe the seroepidemiologic and clinical characteristics of the leptospirosis outbreak in 2008 in Sri Lanka. Definitive/presumptive case definitions proposed by the World Health Organization Leptospirosis Epidemiology Reference Group were used for case confirmation. Of the 404 possible cases, 155 were confirmed to have leptospirosis. Highest titers of patient seum samples reacted with serovars Pyrogenes (28.7%), Hardjo (18.8%), Javanica (11.5%), and Hebdomadis (11.5%). Sequencing of the 16S ribosomal DNA gene identified six infections: five with Leptospira interrogans and one with L. weilli. In this patient population, acute renal failure was the main complication (14.8%), followed by myocarditis (7.1%) and heart failure (3.9%). The case-fatality rate was 1.3%. This report strengthens the urgent need for increasing laboratory diagnostic capabilities to determine the causes of epidemic and endemic infectious diseases in Sri Lanka, a finding relevant to other tropical regions.

Author Notes

*Address correspondence to Suneth B. Agampodi, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka Saliyapura 50008, Sri Lanka. E-mail: sunethagampodi@yahoo.com

Financial support: This study was supported by World Health Organization research grants through the epidemiology unit of Sri Lanka and Welcome Trust through Oxford-Mahidol Medicine Research Unit, Bangkok, Thailand; the U.S. Public Health Service (grants K24AI068903 and D43TW007120); and the University of California San Diego School of Medicine. The ELISA kits for were provided by Inverness Medicals (Sinnamon Park, Queensland, Australia).

Authors' addresses: Suneth B. Agampodi, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, 50008, Sri Lanka and Department of Medicine, School of Medicine, University of California, George Palade Laboratories, La Jolla, CA, E-mails: sunethagampodi@yahoo.com or suneth1@mobileemail.vodafone.ik. Sharon J. Peacock, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Ratchathewi, Bangkok, Thailand, Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand, and Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom. Vasanthi Thevanesam, Thamarasi Senaratne, and Athula Kumara, Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, 20400, Sri Lanka. Danaseela B. Nugegoda and Sahan Perera, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, 50008, Sri Lanka. Lee Smythe, Mary Ann Burns, and Michael Dohnt, World Health Organization/Food and Agricultural Organization/World Organization for Animal Health, Collaborating Centre for Reference and Research on Leptospirosis, Archerfield, Queensland 4108, Australia. Janjira Thaipadungpanit and Siriphan Boonsilp, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Ratchathewi, Bangkok 10400, Thailand. Scott B. Craig, World Health Organization/Food and Agricultural Organization/World Organization for Animal Health Collaborating Centre for Reference and Research on Leptospirosis, Archerfield, Queensland, Australia and Faculty of Science, Health and Education, University of the Sunshine Coast, Sippy Downs, Queensland, Australia. Paba Palihawadana, Epidemiology Unit, Colombo, Sri Lanka. Joseph M. Vinetz, Department of Medicine, School of Medicine, University of California, George Palade Laboratories, La Jolla, CA.

  • 1.

    1999. Leptospirosis worldwide, 1999. Wkly Epidemiol Rec 74: 237242.

  • 2.

    Cachay ER, Vinetz JM, 2005. A global research agenda for leptospirosis. J Postgrad Med 51: 174178.

  • 3.

    Brooks GF, Butel JF, Morse SA, 2004. Leptospira and Leptospirosis. Medical Microbiology. Singapore: McGraw Hill Education (Asia), 338340.

  • 4.

    World Health Organization, 2010. Report of the First Meeting of Leptospirosis Burden Epidemiology Reference Group. Geneva: World Health Organization 134.

    • Search Google Scholar
    • Export Citation
  • 5.

    Agampodi S, Peacock SJ, Thevanesam V, 2009. The potential emergence of leptospirosis in Sri Lanka. Lancet Infect Dis 9: 524526.

  • 6.

    Unit E, 2009. Selected notifiable diseases reported by Medical Officers of Health. Wkly Epidemiol Rec 36: 4.

  • 7.

    Unit E, 2010. Selected notifiable diseases reported by Medical Officers of Health. Wkly Epidemiol Rec 37: 4.

  • 8.

    Unit E, 2011. Selected notifiable diseases reported by Medical Officers of Health. Wkly Epidemiol Rec 38: 4.

  • 9.

    Pappas G, Papadimitriou P, Siozopoulou V, Christou L, Akritidis N, 2008. The globalization of leptospirosis: worldwide incidence trends. Int J Infect Dis 12: 351357.

    • Search Google Scholar
    • Export Citation
  • 10.

    Koizumi N, Gamage CD, Muto M, Kularatne SA, Budagoda BD, Rajapakse RP, Tamashiro H, Watanabe H, 2009. Serological and genetic analysis of leptospirosis in patients with acute febrile illness in Kandy, Sri Lanka. Jpn J Infect Dis 62: 474475.

    • Search Google Scholar
    • Export Citation
  • 11.

    Gamage CD, Yasuda SP, Nishio S, Kularatne SA, Weerakoon K, Rajapakse J, Nwafor-Okoli C, Lee RB, Obayashi Y, Yoshimatsu K, Arikawa J, Tamashiro H, 2011. Serological evidence of Thailand virus-related hantavirus infection among suspected leptospirosis patients in Kandy, Sri Lanka. Jpn J Infect Dis 64: 7275.

    • Search Google Scholar
    • Export Citation
  • 12.

    Thaipadungpanit J, Wuthiekanun V, Chierakul W, Smythe LD, Petkanchanapong W, Limpaiboon R, Apiwatanaporn A, Slack AT, Suputtamongkol Y, White NJ, Feil EJ, Day NP, Peacock SJ, 2007. A dominant clone of Leptospira interrogans associated with an outbreak of human leptospirosis in Thailand. PLoS Negl Trop Dis 1: e56.

    • Search Google Scholar
    • Export Citation
  • 13.

    Levett PN, Branch SL, 2002. Evaluation of two enzyme-linked immunosorbent assay methods for detection of immunoglobulin M antibodies in acute leptospirosis. Am J Trop Med Hyg 66: 745748.

    • Search Google Scholar
    • Export Citation
  • 14.

    World Health Organization, 2010. Leptospirosis. Communicable Disease Epidemiological Profile. Geneva: World Health Organization, 102108.

    • Search Google Scholar
    • Export Citation
  • 15.

    Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P, 2004. Acute renal failure—definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 8: R204R212.

    • Search Google Scholar
    • Export Citation
  • 16.

    Sanders EJ, Rigau-Perez JG, Smits HL, Deseda CC, Vorndam VA, Aye T, Spiegel RA, Weyant RS, Bragg SL, 1999. Increase of leptospirosis in dengue-negative patients after a hurricane in Puerto Rico in 1996. Am J Trop Med Hyg 61: 399404.

    • Search Google Scholar
    • Export Citation
  • 17.

    Cruz LS, Vargas R, Lopes AA, 2009. Leptosoirosis: a worldwide resurent zoonoses and important cause of acute renal failure and death in developing nations. Eth Dis 19 (Suppl 1): S137S141.

    • Search Google Scholar
    • Export Citation
  • 18.

    Deepak NA, Patel ND, 2006. Differential diagnosis of acute liver failure in India. Ann Hepatol 5: 150156.

  • 19.

    Santos VM, Rocha de Sa DA, Turra TZ, Ferreira Borges NM, Nascimento UM, Damasceno EA, 2009. Hantavirus pulmonary syndrome in Brasilia periphery: a diagnostic challenge. J Infect Dev Ctries 3: 639643.

    • Search Google Scholar
    • Export Citation
  • 20.

    Akritidis N, Boboyianni C, Pappas G, 2010. Reappearance of viral hemorrhagic fever with renal syndrome in northwestern Greece. Int J Infect Dis 14: e13e15.

    • Search Google Scholar
    • Export Citation
  • 21.

    Nachega JB, Bottieau E, Zech F, Van Gompel A, 2007. Travel-acquired scrub typhus: emphasis on the differential diagnosis, treatment, and prevention strategies. J Travel Med 14: 352355.

    • Search Google Scholar
    • Export Citation
  • 22.

    Leelarasamee A, Chupaprawan C, Chenchittikul M, Udompanthurat S, 2004. Etiologies of acute undifferentiated febrile illness in Thailand. J Med Assoc Thai 87: 464472.

    • Search Google Scholar
    • Export Citation
  • 23.

    Murav'Ev NV, 1956. Problem of differential diagnosis of malaria from leptospirosis [in German]. Zh Mikrobiol Epidemiol Immunobiol 27: 97101.

    • Search Google Scholar
    • Export Citation
  • 24.

    Sunil-Chandra NP, Premaratne R, Somasiri DA, de Silva HJ, 2003. Evidence of leptospira and hanta virus co-infections amongst pateints hospitalized for leptospirosis-like illness. Bulletin of the Sri Lankan Colleage of Microbiology 1: 3233.

    • Search Google Scholar
    • Export Citation
  • 25.

    Smythe LD, Wuthiekanun V, Chierakul W, Suputtamongkol Y, Tiengrim S, Dohnt MF, Symonds ML, Slack AT, Apiwattanaporn A, Chueasuwanchai S, Day NP, Peacock SJ, 2009. The microscopic agglutination test (MAT) is an unreliable predictor of infecting Leptospira serovar in Thailand. Am J Trop Med Hyg 81: 695697.

    • Search Google Scholar
    • Export Citation
  • 26.

    Levett PN, 2003. Usefulness of serologic analysis as a predictor of the infecting serovar in patients with severe leptospirosis. Clin Infect Dis 36: 447452.

    • Search Google Scholar
    • Export Citation
  • 27.

    Hurst FP, Neff RT, Katz AR, Buchholz AE, Sasaki DM, Berg BW, Abbott KC, 2009. Acute kidney injury requiring hemodialysis in patients with anicteric leptospirosis. Clin Nephrol 72: 186192.

    • Search Google Scholar
    • Export Citation
  • 28.

    Merien F, Perolat P, 1996. Public health importance of human leptospirosis in the South Pacific: a five-year study in New Caledonia. Am J Trop Med Hyg 55: 174178.

    • Search Google Scholar
    • Export Citation
  • 29.

    Yersin C, Bovet P, Merien F, Wong T, Panowsky J, Perolat P, 1998. Human leptospirosis in the Seychelles (Indian Ocean): a population-based study. Am J Trop Med Hyg 59: 933940.

    • Search Google Scholar
    • Export Citation
  • 30.

    Gunawardhana SA, Sellahewa KH, 2008. Clinical features of leptospirosis: a prospective descriptive study at the National Hospital of Sri Lanka (NHSL) in 2007. Ceylon Med J 53: 155156.

    • Search Google Scholar
    • Export Citation
  • 31.

    Rajasuriya K, Munasinghe DR, Vitarne UT, Ratnaike VT, Peiris OA, 1964. Leptospirosis in Ceylon: a Clinical Study. Ceylon Med J 93: 136153.

  • 32.

    Kularatne SA, 2008. Human leptospirosis: case studies. Zoonotic and Emerging Zoonotic Diseases and their Prevention in the SAARC Region. Faculty of Veterinary Medicine and Animal Science. Peradeniya, Sri Lanka: University of Peradeniya.

    • Search Google Scholar
    • Export Citation
  • 33.

    Faine S, 1994. Leptospira and Leptospirosis. Boca Raton, FL: CRC Press.

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