title: Concomitant leptospirosis-hantavirus co-infection in acute patients hospitalized in Sri Lanka: implications for a potentially worldwide underestimated problem.
abstract: Two global (re-)emerging zoonoses, leptospirosis and hantavirus infections, are clinically indistinguishable. Thirty-one patients, hospitalized in Sri Lanka for acute severe leptospirosis, were after exclusion of other potentially involved pathogens, prospectively screened with IgM ELISA for both pathogens. Of these, nine (29·0%) were positive for leptospirosis only, one (3·2%) for hantavirus only, seven (22·5%) for both pathogens concomitantly, whereas 13 (41·9%) remained negative for both. Moreover, in a retrospective study of 23 former patients, serologically confirmed for past leptospirosis, six (26·0%) were also positive in two different IgG ELISA hantavirus formats. Surprisingly, European Puumala hantavirus (PUUV) results were constantly higher, although statistically not significantly different, than Asian Hantaan virus (HTNV), suggesting an unexplained cross-reaction, since PUUV is considered absent throughout Asia. Moreover, RT-PCR on all hantavirus IgM ELISA positives was negative. Concomitant leptospirosis-hantavirus infections are probably heavily underestimated worldwide, compromising epidemiological data, therapeutical decisions, and clinical outcome.
authors.affiliation: Department of Medical Microbiology,Faculty of Medicine,University of Kelaniya,Ragama,Sri Lanka.
authors.forename: N P
authors.initials: NP
authors.lastname: Sunil-Chandra
authors.affiliation: National Reference Centre for Hantaviruses, Clinical and Epidemiological Virology, University of Leuven,Leuven,Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Clement
authors.affiliation: National Reference Centre for Hantaviruses, Clinical and Epidemiological Virology, University of Leuven,Leuven,Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Maes
authors.affiliation: Department of Medical Microbiology,Faculty of Medicine,University of Kelaniya,Ragama,Sri Lanka.
authors.forename: H J
authors.initials: HJ
authors.lastname: DE Silva
authors.affiliation: National Reference Laboratory for Leptospira,Department of Clinical Sciences,Institute of Tropical Medicine,Antwerp,Belgium.
authors.forename: M
authors.initials: M
authors.lastname: VAN Esbroeck
authors.affiliation: National Reference Centre for Hantaviruses, Clinical and Epidemiological Virology, University of Leuven,Leuven,Belgium.
authors.forename: M
authors.initials: M
authors.lastname: VAN Ranst
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000907:Antibodies, Bacterial / Q000097:blood; D000914:Antibodies, Viral / Q000097:blood; D060085:Coinfection / Q000453:epidemiology*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D018778:Hantavirus Infections / Q000453:epidemiology*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D007922:Leptospirosis / Q000150:complications* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D013188:Sri Lanka / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000907:Antibodies, Bacterial; D000914:Antibodies, Viral; D007074:Immunoglobulin G; D007075:Immunoglobulin M
keywords: Acute kidney injury (AKI); Sri Lanka; co-infections; hantavirus; leptospirosis; rodents; scrub typhus