Environmental Exposure and Leptospirosis, Peru Michael A.S
RESEARCH Environmental Exposure and Leptospirosis, Peru Michael A.S. Johnson,*† Hannah Smith,† Priya Joseph,† Robert H. Gilman,*† Christian T. Bautista,*‡ Kalina J. Campos,*§ Michelle Cespedes,† Peter Klatsky,† Carlos Vidal,¶ Hilja Terry,† Maritza M. Calderon,*§ Carlos Coral,† Lilia Cabrera,† Paminder S. Parmar,† and Joseph M. Vinetz# Human infection by leptospires has highly variable shown in many rural places throughout the developing clinical manifestations, which range from subclinical infec- world, including, for example, Nicaragua (16). tion to fulminant disease. We conducted a population- The environment of Iquitos, Peru, in the Amazon Basin, based, cross-sectional seroepidemiologic study in Peru to is ideal for the transmission of Leptospira with its hot, determine potential relationships of environmental context humid tropical conditions and dense human and potential to human exposure to Leptospira and disease associated with seroconversion. Three areas were studied: a flooded, mammalian reservoir populations (17). We have observed ≈ urban slum in the Peruvian Amazon city of Iquitos; rural, that 30% of patients in this region seen with acute undif- peri-Iquitos villages; and a desert shantytown near Lima. ferentiated fever have serologic results suggestive of acute Seroprevalence in Belen was 28% (182/650); in rural leptospirosis (microscopic agglutination test with titers areas, 17% (52/316); and in a desert shantytown, 0.7% >1/400, seroconversion, or fourfold rise in titer; Vinetz et (1/150). Leptospira-infected peridomestic rats were found al. unpub. data). in all locales. In Belen, 20 (12.4%) of 161 patients serocon- Our objective was to determine potential relationships verted between dry and wet seasons (an incidence rate of of environmental context to human exposure to 288/1,000).
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