title: Unsuspected leptospirosis is a cause of acute febrile illness in Nicaragua.
abstract: BACKGROUND
  Epidemic severe leptospirosis was recognized in Nicaragua in 1995, but unrecognized epidemic and endemic disease remains unstudied.
  
  
  RESULTS
  To determine the burden of and risk factors associated with symptomatic leptospirosis in Nicaragua, we prospectively studied patients presenting with fever at a large teaching hospital. Epidemiologic and clinical features were systematically recorded, and paired sera tested by IgM-ELISA to identify patients with probable and possible acute leptospirosis. Microscopic Agglutination Test and PCR were used to confirm acute leptospirosis. Among 704 patients with paired sera tested by MAT, 44 had acute leptospirosis. Patients with acute leptospirosis were more likely to present during rainy months and to report rural residence and fresh water exposure. The sensitivity of clinical impression and acute-phase IgM detected by ELISA were poor.
  
  
  CONCLUSIONS
  Leptospirosis is a common (6.3%) but unrecognized cause of acute febrile illness in Nicaragua. Rapid point-of-care tests to support early diagnosis and treatment as well as tests to support population-based studies to delineate the epidemiology, incidence, and clinical spectrum of leptospirosis, both ideally pathogen-based, are needed.
authors: Division of Medical Microbiology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America; Hubert-Yeargan Center for Global Health, Durham, North Carolina, United States of America.
authors: Megan E
authors: ME
authors: Reller
authors: Yale University Schools of Public Health and Medicine, New Haven, Connecticut, United States of America.
authors: Elsio A
authors: EA
authors: Wunder
authors: Duke University School of Medicine, Durham, North Carolina, United States of America.
authors: Jeremy J
authors: JJ
authors: Miles
authors: Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors: Judith E
authors: JE
authors: Flom
authors: Hospital Escuela Oscar Danilo Rosales Arguello, Universidad Nacional Autonoma de Nicaragua, León, Nicaragua.
authors: Orlando
authors: O
authors: Mayorga
authors: Hubert-Yeargan Center for Global Health, Durham, North Carolina, United States of America; Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America.
authors: Christopher W
authors: CW
authors: Woods
authors: Yale University Schools of Public Health and Medicine, New Haven, Connecticut, United States of America.
authors: Albert I
authors: AI
authors: Ko
authors: University of Maryland School of Medicine, Baltimore, Maryland, United States of America.
authors: J Stephen
authors: JS
authors: Dumler
authors: Hospital Escuela Oscar Danilo Rosales Arguello, Universidad Nacional Autonoma de Nicaragua, León, Nicaragua.
authors: Armando J
authors: AJ
authors: Matute
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000907:Antibodies, Bacterial / Q000097:blood; D001431:Bacteriological Techniques; D002648:Child; D002675:Child, Preschool; D005260:Female; D005334:Fever / Q000382:microbiology*; D006801:Humans; D007922:Leptospirosis / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology / Q000382:microbiology; D008297:Male; D009527:Nicaragua / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000907:Antibodies, Bacterial