title: Leptospira Seroprevalence and Risk Factors in Health Centre Patients in Hoima District, Western Uganda.
abstract: The burden of human leptospirosis in Uganda is unknown. We estimated the seroprevalence of Leptospira antibodies, probable acute/recent leptospirosis, and risk factors for seropositivity in humans in rural Western Uganda.
  
  
  
  359 non-pregnant adults visiting the Kikuube and Kigorobya Health Centers were sequentially recruited during March and April 2014. A health history survey and serum were collected from consented participants. Overall, 69% reported having fever in the past year, with 49% reporting malaria, 14% malaria relapse, 6% typhoid fever, 3% brucellosis, and 0% leptospirosis. We tested sera by microscopic agglutination test (MAT) against eight Leptospira serovars representing seven serogroups. Leptospira seroprevalence was 35% (126/359; 95%CI 30.2-40.3%) defined as MAT titer ≥ 1:100 for any serovar. The highest prevalence was against L. borgpetersenii Nigeria (serogroup Pyrogenes) at 19.8% (71/359; 95%CI 15.9-24.4%). The prevalence of probable recent leptospirosis (MAT titer ≥1:800) was 1.9% (95%CI 0.9-4.2%) and uniquely related to serovar Nigeria (serogroup Pyrogenes). Probable recent leptospirosis was associated with having self-reported malaria within the past year (p = 0.048). Higher risk activities included skinning cattle (n = 6) with 12.3 higher odds (95%CI 1.4-108.6; p = 0.024) of Leptospira seropositivity compared with those who had not. Participants living in close proximity to monkeys (n = 229) had 1.92 higher odds (95%CI 1.2-3.1; p = 0.009) of seropositivity compared with participants without monkeys nearby.
  
  
  
  The 35% prevalence of Leptospira antibodies suggests that exposure to leptospirosis is common in rural Uganda, in particular the Nigeria serovar (Pyrogenes serogroup). Leptospirosis should be a diagnostic consideration in febrile illness and "smear-negative malaria" in rural East Africa.
authors.affiliation: Section of Epidemiology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.
authors.forename: Anou
authors.initials: A
authors.lastname: Dreyfus
authors.affiliation: Section of Emergency Medicine, Baylor College of Medicine, Houston, United States of America.
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Dyal
authors.affiliation: Massey University, Palmerston North, New Zealand.
authors.forename: Raewynne
authors.initials: R
authors.lastname: Pearson
authors.affiliation: College of Veterinary Medicine, Animal Resources & Biosecurity, Makerere University, Kampala, Uganda.
authors.forename: Clovice
authors.initials: C
authors.lastname: Kankya
authors.affiliation: Hoima District Local Government, Hoima, Uganda.
authors.forename: Charles
authors.initials: C
authors.lastname: Kajura
authors.affiliation: Central Diagnostic Laboratory, College of Veterinary Medicine, Animal Resources & Biosecurity, Makerere University, Kampala, Uganda.
authors.forename: Lordrick
authors.initials: L
authors.lastname: Alinaitwe
authors.affiliation: Central Diagnostic Laboratory, College of Veterinary Medicine, Animal Resources & Biosecurity, Makerere University, Kampala, Uganda.
authors.forename: Steven
authors.initials: S
authors.lastname: Kakooza
authors.affiliation: Department of Veterinary Population Medicine, College of Veterinary Medicine, University of Minnesota, Minneapolis, United States of America.
authors.forename: Katharine M
authors.initials: KM
authors.lastname: Pelican
authors.affiliation: Department of Veterinary Population Medicine, College of Veterinary Medicine, University of Minnesota, Minneapolis, United States of America.
authors.forename: Dominic A
authors.initials: DA
authors.lastname: Travis
authors.affiliation: Department of Veterinary Population Medicine, College of Veterinary Medicine, University of Minnesota, Minneapolis, United States of America.
authors.forename: Michael
authors.initials: M
authors.lastname: Mahero
authors.affiliation: Department of Medicine, University of Minnesota, Minneapolis, United States of America.
authors.forename: David R
authors.initials: DR
authors.lastname: Boulware
authors.affiliation: College of Veterinary Medicine, Animal Resources & Biosecurity, Makerere University, Kampala, Uganda.|Conservation & Ecosystem Health Alliance (CEHA), Kampala, Uganda.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Mugisha
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000372:Agglutination Tests; D000818:Animals; D000907:Antibodies, Bacterial / Q000097:blood*; D002417:Cattle; D005260:Female; D006801:Humans; D007919:Leptospira / Q000145:classification*; D007922:Leptospirosis / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D012424:Rural Population; D016036:Seroepidemiologic Studies; D065288:Serogroup; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000907:Antibodies, Bacterial