title: Environmental exposure and leptospirosis, Peru.
abstract: Human infection by leptospires has highly variable clinical manifestations, which range from subclinical infection to fulminant disease. We conducted a population-based, cross-sectional seroepidemiologic study in Peru to determine potential relationships of environmental context to human exposure to Leptospira and disease associated with seroconversion. Three areas were studied: a flooded, urban slum in the Peruvian Amazon city of Iquitos; rural, peri-Iquitos villages; and a desert shantytown near Lima. Seroprevalence in Belen was 28% (182/650); in rural areas, 17% (52/316); and in a desert shantytown, 0.7% (1/150). Leptospira-infected peridomestic rats were found in all locales. In Belen, 20 (12.4%) of 161 patients seroconverted between dry and wet seasons (an incidence rate of 288/1,000). Seroconversion was associated with history of febrile illness; severe leptospirosis was not seen. Human exposure to Leptospira in the Iquitos region is high, likely related both to the ubiquity of leptospires in the environment and human behavior conducive to transmission from infected zoonotic sources.
authors.affiliation: Asociación Benéfica Prisma, Lima, Peru.
authors.forename: Michael A S
authors.initials: MA
authors.lastname: Johnson
authors.forename: Hannah
authors.initials: H
authors.lastname: Smith
authors.forename: Priya
authors.initials: P
authors.lastname: Joeph
authors.forename: Robert H
authors.initials: RH
authors.lastname: Gilman
authors.forename: Christian T
authors.initials: CT
authors.lastname: Bautista
authors.forename: Kalina J
authors.initials: KJ
authors.lastname: Campos
authors.forename: Michelle
authors.initials: M
authors.lastname: Cespedes
authors.forename: Peter
authors.initials: P
authors.lastname: Klatsky
authors.forename: Carlos
authors.initials: C
authors.lastname: Vidal
authors.forename: Hilja
authors.initials: H
authors.lastname: Terry
authors.forename: Martiza M
authors.initials: MM
authors.lastname: Calderon
authors.forename: Carlos
authors.initials: C
authors.lastname: Coral
authors.forename: Lilia
authors.initials: L
authors.lastname: Cabrera
authors.forename: Paminder S
authors.initials: PS
authors.lastname: Parmar
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Vinetz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D000913:Antibodies, Protozoan / Q000097:blood; D002648:Child; D002675:Child, Preschool; D016054:DNA, Protozoan / Q000737:chemistry / Q000235:genetics; D004781:Environmental Exposure; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007223:Infant; D007919:Leptospira / Q000235:genetics / Q000302:isolation & purification*; D007922:Leptospirosis / Q000453:epidemiology* / Q000469:parasitology / Q000635:transmission; D008297:Male; D008875:Middle Aged; D010568:Peru / Q000453:epidemiology; D016133:Polymerase Chain Reaction; D011203:Poverty; D051381:Rats / Q000469:parasitology*; D016036:Seroepidemiologic Studies; D014329:Tropical Climate
chemical_list: D000913:Antibodies, Protozoan; D016054:DNA, Protozoan