Risk factors for humanLeptospiraseropositivity in South Germany.
We analyzed risk factors forLeptospiraseropositivity in humans, using data from a population-based cross-sectional zoonosis survey in South Germany (2008/9). Out of 1007 participants 42 (4.2 %) were sero-positive (19/446 men; 23/561 women), indicating thatLeptospiraexposure and sero-conversion is much more frequent than commonly assumed. Relative risks (RR) for seropositivity with exact 95 % confidence intervals (CI; adjusted for specificity and sensitivity of the ELISA test) were calculated for various exposure factors. Contact with pet rats (RR = 13.9 CI [4.8; 25.3]), guinea pigs (3.0[1.1; 7.4]), cattle (3.7[1.3; 9.6]), poultry (3.6[1.3; 8.6]) or livestock (2.3[1.1; 4.9]) as well as occupation as forestry worker (9.2[2.6; 21.4]) were identified as important exposure factors. None of the participants has ever been diagnosed with leptospirosis, yet 45 had experienced symptoms which may have been caused byLeptospirainfection (12 with scleral icterus, 25 dark urine, 8 liver inflammation, 7 kidney failure). Three times as many participants with prior symptoms were seropositive as participants without symptoms (RR = 3.4[1.3; 8.3]), suggesting that sero-positive patients with severe symptoms may frequently not be diagnosed as leptospirosis cases. Physicians should consider leptospirosis as a differential diagnosis. Currently, the vast majority of symptomatic leptospirosis patients may neither be diagnosed nor reported.
Local Public Health Office, Landratsamt Reutlingen, Reutlingen, Germany.
Stefan O
SO
Brockmann
Department of Clinical Epidemiology and Applied Biometry, University of Tübingen, Silcherstr. 5, 72076 Tübingen, Germany.
Lena
L
Ulrich
Ministry of Health Baden-Württemberg, Stuttgart, Germany.
Isolde
I
Piechotowski
Baden-Württemberg State Health Office Stuttgart, Stuttgart, Germany.
Christiane
C
Wagner-Wiening
Federal Institute for Risk Assessment, Berlin, Germany.
Karsten
K
Nöckler
Federal Institute for Risk Assessment, Berlin, Germany.
Anne
A
Mayer-Scholl
Department of Clinical Epidemiology and Applied Biometry, University of Tübingen, Silcherstr. 5, 72076 Tübingen, Germany.
Martin
M
Eichner