title: Discovery of a leptospirosis cluster amidst a pneumonic plague outbreak in a miners' camp in the Democratic Republic of the Congo.
abstract: Conditions in the Democratic Republic of the Congo provide an ideal environment for leptospirosis and plague, both of which can cause severe pulmonary manifestations. In December 2004, an outbreak of lethal pneumonia occurred in a local mining camp, affecting 130 persons and killing 57 of them. Clinical signs, fast disease spread, and initial laboratory investigations suggested pneumonic plague. While leptospirosis had not recently been described in the region, it was considered as a differential diagnosis. Anti-Leptospira antibodies were detected by microscopic agglutination test (MAT). A confirmed case of leptospirosis was defined as having consistent clinical signs and any one of the following: seroconversion or four-fold increase in MAT titre for paired serum samples, or a MAT titre ≥ 1:400 for acute-phase serum samples. Twenty-nine of the 54 patients or convalescents tested for leptospirosis were seropositive. Two cases showed a confirmed infection for both plague and leptospirosis. While evidence supports the plague nature of this outbreak, the results suggest that some of the suspected plague cases might be due to leptospirosis. In any case, this diagnosis will have to be evoked in the future if a similar outbreak occurs in this region of Africa.
authors: Pandemic and Epidemic Diseases, World Health Organization, Geneva 1202, Switzerland. bertherate@who.int.
authors: Eric
authors: E
authors: Bertherat
authors: Clinical and Translational Science Institute, University of Minnesota, 717 SE Delaware Street, Minneapolis, MN 55414, USA. muell661@umn.edu.
authors: Melissa J
authors: MJ
authors: Mueller
authors: Plague Reference Laboratory, Bunia, Democratic Republic of the Congo. shakochri@yahoo.fr.
authors: Jean-Christophe
authors: JC
authors: Shako
authors: Pasteur Institute, Biology of Spirochetes Unit, National Reference Center for Leptospirosis, WHO Collaborating Center for Leptospirosis, 75724 Paris Cedex 15, France. mathieu.picardeau@pasteur.fr.
authors: Mathieu
authors: M
authors: Picardeau
mesh_terms: D000293:Adolescent; D000328:Adult; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007922:Leptospirosis / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010930:Plague / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D055815:Young Adult