Stochastic Computational Heuristic for the Fractional Biological Model Based on Leptospirosis

The purpose of these investigations is to find the numerical outcomes of the fractional kind of biological system based on Leptospirosis by exploiting the strength of artificial neural networks aided by scale conjugate gradient,called ANNs-SCG.The fractional derivatives have been applied to get more reliable performances of the system.The mathematical form of the biological Leptospirosis system is divided into five categories,and the numerical performances of each model class will be provided by using the ANNs-SCG.The exactness of the ANNs-SCG is performed using the comparison of the reference and obtained results.The reference solutions have been obtained by using theAdams numerical scheme.For these investigations,the data selection is performed at 82%for training,while the statics for both testing and authentication is selected as 9%.The procedures based on the recurrence,mean square error,error histograms,regression,state transitions,and correlation will be accomplished to validate the fitness,accuracy,and reliability of the ANNs-SCG scheme.

Risk estimation of chronic kidney disease in a leptospirosis endemic area: A case-control study from south Andaman Islands of India

Objective:To estimate the risk of chronic kidney disease in patients with leptospirosis.Methods:All reported(41890)and later confirmed leptospirosis(1990)cases from 2010-2020 were traced by universal sampling.386 Laboratory-confirmed leptospirosis cases were enrolled and 413 age,gender,area,and occupation matched healthy persons were included as controls.Variables including socio-demographic characteristics,medical history,and health-related behaviours were compared between the two groups and association between these variables and reduced estimated glomerular filtration rate(eGFR)was analyzed with multiple linear regression.Results:The median of eGFR was 49.0(27.0,75.0)mL/min/1.73 m^(2) in the cases and 96.0(72.0,121.0)mL/min/1.73 m^(2) in the controls,showing significant differences(P<0.001).Bivariate analysis showed that leptospirosis seropositivitiy,repeat leptospirosis infection,diabetes,male gender,working in field(sun exposure),COVID-19 infection and smoking had statistically significant association with reduced eGFR.Leptospirosis seropositivity had negative effects on eGFR.Multiple linear regression confirmed that leptospirosis seropositivity had negative effects on eGFR(unstandardised β coefficients=−30.86,95%CI−49.7 to−11.9,P<0.001).Conclusions:Chronic kidney disease is a complex disease with multiple risk factors involved.Exposure to leptospirosis is one of the essential factors in accelerating its progression.

Modeling seasonal leptospirosis transmission and its association with rainfall and temperature in Thailand using time-series and ARIMAX analyses

Objective:To study the number of leptospirosis cases in relations to the seasonal pattern,and its association with climate factors.Methods:Time series analysis was used to study the time variations in the number of leptospirosis cases.The Autoregressive Integrated Moving Average (ARIMA) model was used in data curve fitting and predicting the next leptospirosis cases. Results:We found that the amount of rainfall was correlated to leptospirosis cases in both regions of interest,namely the northern and northeastern region of Thailand,while the temperature played a role in the northeastern region only.The use of multivariate ARIMA(ARIMAX) model showed that factoring in rainfall(with an 8 months lag) yields the best model for the northern region while the model,which factors in rainfall(with a 10 months kg) and temperature(with an 8 months lag) was the best for the northeaslern region.Conclusions:The models are able to show the trend in leptospirosis cases and closely fit the recorded data in both regions.The models can also be used to predict the next seasonal peak quite accurately.

Disproportional exaggerated aspartate transaminase is a useful prognostic parameter in late leptospirosis

AIM: To evaluate the hepatic dysfunction in leptospirosis is usually mild and resolved eventually. However,sequential follow-up of liver biochemical data remained lacking..METHODS: The biochemistry data and clinical symptoms of 11 sporadic patients were collected and analyzed, focusing on the impacts of leptospirosis upon liver biochemistry tests.RESULTS: The results disclosed that of the 11 cases, 5 or 45% died. The liver biochemistry data in the beginning of the disease course were only mildly elevated.Nevertheless, late exaggerated aspartate transaminase (AST)elevations were noted in three cases who finally died when compared with the typical course. Besides, significant higher AST/alanine transaminase (ALT) ratios (AARs) of the peak levels for transaminase were also noted in the cases who eventually succumbed. The mean±SD of AARs for the survival group and dead group were 5.65±2.27 (n = 5)and 1.86±0.64 (n = 6) respectively (P= 0.006). The ratios of the cases who finally died were all more than 3.0.Conversely, the survival group's ratios were less than 3.0.CONCLUSION: Serial follow-up of transaminase might provide evidence to predict some rare evolutions in leptospirosis. If AST elevated progressively without a concomitant change of ALT, it might indicate an acute disease course with ensuing death. Additionally, AAR is another prognostic parameter for leptospirosis. Once the value was higher than 3.0, a grave prognosis is inevitable.

An Outbreak of Leptospirosis in Lezhi County, China in 2010 May Possibly Be Linked to Rainfall

A total of 26 leptospirosis cases occurred in the outbreak, of whom six died after hospitalization. All 26 patients were clinically diagnosed as leptospirosis Microscopic agglutination test （MAT） revealed that 13 of 26 patients were affected with laboratory confirmed leptospirosis. Furthermore, MAT data suggested that serogroup Icterohaemorrhagiae were the main pathogens responsible for this outbreak. And the rainfall data suggested that the increased rainfall might be responsible for the leptospirosis outbreak in Lezhi County. This outbreak has reminded us that leptospirosis should not be neglected, especially during flood season, although its incidence rate is low.

Etiological agents causing leptospirosis in Sri Lanka:A review

Objective:To systematically review the etiological agent causing human leptospirosis in Sri Lanka.Methods:Published ailicles on leptospirosis and Leptospira in Sri Lanka were all reviewed to determine serovar,strain and species level indentification of Leptospira.After screening process.74 full text articles/reports were reviewed and among of them.12 published papers describing isolation of Leptospira from Sri Lankan patients/animals.5 molecular epidemiology papers on newer typing methods citing Sri Lanka isolates,with a descriptions of the isolates and 6 published papers reporting PCR based species level identification were identified.Results:Published literature showed that more than 40 strains classified under at least 20 serovars and 10 serogroups have been isolated from Sri Lanka.These isolates belong to four species,namely.Leptospira interrogans,Leptospira kirscluneri.Leptospira borgpetersenii,and Leptospira sanlarosai.In addition.recent studies on direct patient samples without culture and isolation showed Leptospira from Leptospira weilli is also circulating in Sri Lanka.Mulli locus sequence typing showed L3 genotypes of Leptospira from Sri Lankan isolates.Conclusions:This review shows the diversity of Leptospira in Sri Lanka,but culture isolation data has not been published in Sri Lanka during last 30 years.

Two uncommon manifestations of leptospirosis:Sweet's syndrome and central nervous system vasculitis

To leptospirosis is the commonest spirocheatal infection in the tropical and temperate countries of Indian sub-continent and Africa and the most common zoonosis worldwide.The protean manifestation of this infectious disease is a challenge for practising clinicians across the world. In poor developing countries,at most clinical suspicion it is essential in the diagnosis of this disease.In this report,we are able to document two uncommon manifestations of leptospirosis, namely Sweet’s syndrome and central nervous system vasculitis.

Manifestations and outcomes of leptospirosis during local outbreaks in high endemic districts of Sri Lanka: A retrospective multi-center study

Objective:To determine the clinical presentations and disease outcomes of suspected and confirmed cases of leptospirosis from 3 high endemic districts of Sri Lanka,during outbreaks reported between 2013 and 2017.Methods:The retrospective multi-center study was carried out during 2013-2017 in 5 selected hospitals representing 3 high endemic districts in Sri Lanka.Clinically suspected leptospirosis patients were recruited according to the Communicable Disease Epidemiology Profile Sri Lanka,WHO.Leptospirosis was confirmed by either single microscopic agglutination test titre 1:400 or by positive polymerase chain reaction(PCR)test result.Results:Out of 372 clinically suspected cases,29.00%were confirmed as leptospirosis cases by either microscopic agglutination test(50.00%)or positive polymerase chain reaction(52.77%)and 12.90%were presumptively identified as leptospirosis.Clinical symptoms(headache,vomiting,jaundice and dyspnoea)and variations in haematological parameters(haemoglobin,platelet count)and biochemical parameters(serum creatinine,serum urea,serum bilirubin and C-reactive protein)were associated with confirmed leptospirosis(P<0.05).Acute kidney injury,meningitis,myocarditis,pulmonary haemorrhage and acute liver failure was seen among 21.30%,12.04%,6.48%,6.48%,5.56%,respectively with 4.63%fatality among the leptospirosis confirmed patients.The sensitivity,specificity,positive predictive value and negative predictive value of the case definition of Ministry of Health,Sri Lanka were 96.29%,9.09%,31.13%and 85.71%,respectively,when benchmarked against either positive polymerase chain reaction or microscopic agglutination test as the gold standard.Conclusions:Acute kidney injury is the predominant complication observed among the leptospirosis confirmed patients.However,pulmonary haemorrhage is predominantly associated with mortality.The case definition of Ministry of Health,Sri Lanka is found to have higher sensitivity and enabled the screening of all probable cases of leptospirosis.

Leptospirosis:a re-emerging infection

Leptospirosis,long thought to be a disease of sewage workers and found post-flooding is reemerging as a potentially life threatening infectious disease in urban India during monsoon and immediately after due to poor sanitation and drainage.However,it is often ignored and under diagnosed due to a low index of suspicion.We present a fatal case of leptospirosis with acute liver failure,respiratory failure and jaundice and encephalopathy.

Frequency of typhoon occurrence accounts for the Poisson distribution of human leptospirosis cases across the different geographic regions in the Philippines

Objective: To study the distribution of human leptospirosis cases across the different geographic regions in the Philippines in 2015-2017 and to determine the relationship between the frequency of typhoon occurrence and human leptospirosis cases. Methods: Information on the frequency of leptospirosis cases and typhoon occurrence across the different regions in the Philippines from 2015 to 2017 was retrieved from the databases of the Department of Health and the Philippine Atmospheric, Geophysical, and Astronomical Services Administration, respectively. Descriptive measures on the prevalent cases and occurrence of typhoons across the different regions were summarized. Linear regression analysis was employed to establish the functional relationship between leptospirosis cases and typhoon occurrence. The distribution of human leptospirosis cases was assessed using the Poisson distribution. Results: The frequency of typhoon occurrence accounted for the significant linear variation in the geographic distribution of human leptospirosis cases in the Philippines(P<0.001). Moreover, the human leptospirosis cases obeyed a Poisson distribution(λ=6.89, P<0.001). Conclusions: The Philippines has frequently experienced severe weather perturbations such as typhoons resulting in flooding and subsequently increasing the risk of transmitting bacterial infections including leptospirosis. Information obtained regarding the determinants and distribution of human leptospirosis will provide better understanding of the disease propagation for subsequent design of optimal disease prevention measures, appropriate resource allocation, effective control strategies, and necessary public health programs.

Serologic evidence of human leptospirosis in and around Kolkata,India:A clinico-epidemiological study

Objective:To investigate the prevalence of leptospirosis among patients from within and outside Kolkata.India,attending the Calcutta School of Tropical Medicine,for treatment during August 2002 to August 2008.Methods:The leptospirosis cases were determined on the basis of clinical, epidemiological,and biochemical factors,and were tested for leptospiral antibodies using IgM ELISA.Serum samples with absorbance ratio≥1.21 were interpreted as reactive.Results:The commonest presentation involved fever,headache and jaundice.The male-female ratio was 61:46.A total of 65(64.20%) cases had abnormal liver and renal functions respectively,and 57.1% had both the abnormalities.The highest incidence(75.35.04%) was recorded in SeptemberOctober followed by July-August(53.24.77%).The reactive cases had absorbance ratios between 1.21 and 8.21.and 53 showed equivocal result,while IgM non reactivity were seen in 90 patients (absorbance ratios 0.10-0.90).The patients responded to treatment with parenteral antibiotics, penicillin,ceftriaxone and cefotaxime;follow up did not reveal case fatality.Conclusions:The cardinal signs of leptospirosis help in making clinical diagnosis,but in any hyper-endemic situation any patient reporting with acute lever and signs of pulmonary,hepatic or renal involvement should be suspected to have leptospirosis and investigated accordingly.Increased awareness,and early diagnosis and treatment,can reduce mortality due to leptospirosis.

Acute pancreatitis caused by leptospirosis: Report of two cases

Two cases of acute pancreatitis with leptospirosis are reported in this article. Case 1: A 68-year-old woman,presented initially with abdominal pain, nausea, vomiting,and jaundice. She was in poor general condition, and had acute abdominal signs and symptoms on physical examination. Emergency laparotomy was performed, acute pancreatitis and leptospirosis were diagnosed on the basis of surgical findings and serological tests. The patient died on postoperative d 6. Case 2: A 62-year-old man, presented with fever, jaundice, nausea, vomiting, and malaise. Acute pancreatitis associated with leptospirosis was diagnosed,according to abdominal CT scanning and serological tests.The patient recovered fully with antibiotic treatment and nutritional support within 19 d.

Serum nitrite levels in Sri Lankan patients with leptospirosis

Objective:To determine whether blood nitrite levels are elevated in patients with leptospirosis. Methods:Male patients Fulfilling clinical and epidemiological criteria for a diagnosis of leptospirosis were recruited.Those with MAT title of≥400 together with those seroconverting to a titer of≥200 were included in the analysis.Serum nitrite levels were measured in these patients and age.sex matched healthy controls.Results:Patients from 3 hospitals(n=75) were screened during a 3 month period from 28th June to 3rd September 2009,of whom 20 were eligible for the study.Serum nilrile levels were found to be significantly higher in patients with acute leptospirosis[n=20.(0.359±0.229)μM]compared to controls[(n= 13.(0.216±0.051)μM] (P=0.014).A significant correlation was also observed between the MAT titre and the day of illness (r = 0.547;P【0.0001).Conclusions:Serum nitrite levels are higher in patients with acute leptospirosis compared to age and sex matched controls.No correlation could be assessed with severity of illness,as sample size was inadequate to determine this.

Acalculous cholecystitis:A rare presentation of leptospirosis progressing to Weil's disease

Leptospirosis is a zoonotic infection with higher incidence in tropics.Leptospirosis,is known for its variable manifestations,and is a clinical challenge for physicians in the tropics.Experienced clinicians,at times can mistake leptospirosis for non-medical conditions.A few reports of Leptospirosis presenting as acalculous cholecystitis was found in review of literature.We intent to highlight acalculous cholecystitis as a rare hut clinically significant presentation of leptospirosis.

A case of leptospirosis simulating colon cancer with liver metastases

We report a case of a 61-year-old man who presented with fatigue,abdominal pain and hepatomegaly.Computed tomography (CT) of the abdomen showed hepatomegaly and multiple hepatic lesions highly suggestive of metastatic diseases.Due to the endoscopic finding of colon ulcer,colon cancer with liver metastases was suspected.Biochemically a slight increase of transaminases,alkaline phosphatase and gammaglutamyl transpeptidase were present;α- fetoprotein,carcinoembryogenic antigen and carbohydrate 19-9 antigen serum levels were normal.Laboratory and instrumental investigations,including colon and liver biopsies revealed no signs of malignancy.In the light of spontaneous improvement of symptoms and CT findings,his personal history was revaluated revealing direct contact with pigs and their tissues.Diagnosis of leptospirosis was considered and confirmed by detection of an elevated titer of antibodies to leptospira.After two mo,biochemical data,CT and colonoscopy were totally normal.

Acute kidney injury in leptospirosis:Overview and perspectives

Leptospirosis is a bacterial disease disseminated through the centuries in the whole world which causes symptoms that go from self-limited diseases to hemorrhagic manifestations and organ failure, including acute kidney injury(AKI), composing the severe disease known as the Weil's syndrome. Mortality rates varies according to the clinical presentation and usually increases when kidney injury is present, and is even higher in the setting of pulmonary hemorrhage. There are recent advances in the search for novel biomarkers of renal involvement and early detection of AKI in leptospirosis, as well as in its pathophysiology. We review in this article the clinical aspects of leptospirosis-associated AKI and the perspectives for future research.

Unsatisfactory Knowledge, Attitude and Practice on Leptospirosis among Army Personnel’s in Northeastern Malaysia

Leptospirosis is a re-emerging zoonotic disease caused by infection of the bacteria belongs to Genus leptospira. It occurs in tropical, subtropical and temperate zones. It is also known as occupational-related disease as certain occupations are associated with the occurrence of leptospirosis. Army is identified as one of the high-risk occupations in contracting leptospirosis. This study was done to determine knowledge, attitude and practice (KAP) among army personnel on leptospirosis. A cross sectional study was conducted among 616 army personnel in four based camps in Northeastern Malaysia, who fulfilled the inclusion and exclusion criteria. A validated KAP questionnaire was used, consisting of knowledge, attitude and practice questions. More than half (52.8%) of the respondents had poor knowledge score. For the attitude score, almost the same proportions had satisfactory attitude. The same finding was seen in practice score, whereby those with good practice (54.9%) and bad practice (45.9%). In conclusion, the finding showed that almost all army personnel had unsatisfactory KAP, thus, it is recommended for the army to have a good health education program on leptospirosis among army personnel to protect the army personnel from risk of getting leptospirosis.

Climate as the Early Warning of Outbreaks of Leptospirosis in the District of Sampang Madura Island Indonesia

In Indonesia, most transmission of leptospirosis occurs through the rat under conditions of high rainfall or flooding. Sampang is endemic leptospirosis, during March-May 2013, there were 55 patients with 8 of them died. The purpose of this study was to analyze risk factors for outbreaks leptospirosis by climatic factors. Study is cross-sectional design of variable causes or risks that occur due to the object of research are measured simultaneously. The results showed that the distribution of events is based on epidemiological characteristics of leptospirosis in districts Sampang both rainy and dry season. Analysis of climatic factors show support to the continuation of leptospirosis whose temperatures ranged from 29.35 ~C-30.62 ~C, humidity range between 63.4%-80.5%. Rainfall ranges from 183-190 ram. Incidence of leptospirosis in Sampang shows the distribution of leptospirosis cases from 18 subdistricts, 14 subdistriets are at risk of the occurrence of leptospirosis. Results obtained rat trapping species caught in the neighborhood residential home patients were mice （Rattus tanezumi and Rattus novergicus） and the identification of the leptospira in rat urine sewers rat positive standing of the potential risk of leptospirosis in the community. The conclusions are climatic conditions, rainfall remarkable effecting on the incidence of leptospirosis.

An Unusual Presentation of Leptospirosis: A Case Report

Leptospirosis is a life-threatening zoonotic disease of global distribution. It has variable presentation ranging from mild febrile illness to life-threatening complications like acute renal failure, acute hepatic failure, pulmonary hemorrhages and cardiac arrhythmias. Cardiac manifestations of leptospirosis are not uncommon but are underdiagnosed. Cardiac manifestations may vary from minor rhythm abnormalities to fatal ventricular arrhythmias. We report an unusual presentation of leptospirosis in a patient who presented to the Emergency Department with epigastric pain and congestive cardiac failure with rhythm disturbances and selective myocardial involvement mimicking as Non ST elevation Inferior wall myocardial infarction (NSTEMI). The Cardiac manifestations of Leptospirosis need meticulous intensive care management as the mortality rate is very high in this subset of patients. Index suspicion and early treatment remains the mainstay of this life threatening zoonotic disease.

Do Occupational Factors Render Army Service a High-Leptospirosis-Risk Occupation?

Objective: Leptospirosis is a known zoonotic disease which is closely related to certain high-risk occupational group. This study aimed to identify the risk factors associated with seropositive leptospirosis among army personnel. Methodology: A cross sectional study was conducted involving 616 army personnel using a self-administered questionnaire. The questionnaire consisted of sociodemographic, occupational and environmental data as well as recreational activities history. Serum sample for leptospirosis was taken for screening with IgM Enzyme-linked Immunosorbent Assay (IgM ELISA) test. Positive tests were confirmed by Microscopic Agglutination Test (MAT). Results: All respondents were male, Malays and married with the mean age of 29.28 (7.15) years old. The mean duration of working was 11.50 (7.75). Majority of the respondents were non-officer and riflemen, smokers (455 (73.9%), stayed inside the camp and engaged in recreational activities. The mean duration of employment was 11.50 (7.75) years. The overall seroprevalence of leptospirosis was 16.2% (95% CI: 13.32, 19.15) and the predominant pathogenic serovar identified was Terengganu (38.2%). Those who had lower educational levels were more protective for positive leptospirosis compared to those who have only primary education (OR: 0.32;95% CI: 0.14, 0.76;p = 0.009). Conclusion: Despite being named as one of the high-risk occupations for leptospirosis, this study found no significant occupational factors related to leptospirosis seropositivity among army personnel.