Leptospirosis Cluster Following Recreational 4-Wheel Driving and Vehicle Recovery Exposure
Purpose: Leptospirosis, an emerging zoonotic disease caused by Leptospira spirochetes, has many pathogenic serovars endemic to northern Australia. The disease has potential for significant pulmonary, renal and hepatic dysfunction. Early case detection and timely antimicrobial therapy can reduce morb...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2022-03-01
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| Series: | International Journal of Infectious Diseases |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1201971221010638 |
| _version_ | 1819349486630076416 |
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| author | S. Cunningham T. Marquardt N. Moodley |
| author_facet | S. Cunningham T. Marquardt N. Moodley |
| author_sort | S. Cunningham |
| collection | DOAJ |
| description | Purpose: Leptospirosis, an emerging zoonotic disease caused by Leptospira spirochetes, has many pathogenic serovars endemic to northern Australia. The disease has potential for significant pulmonary, renal and hepatic dysfunction. Early case detection and timely antimicrobial therapy can reduce morbidity and mortality. Clusters of cases have been associated with workplace exposures such as abattoirs. Whilst water-based sporting and recreational activities are established individual risk factors; they are not typically recognised as clusters.This case series highlights the potential for cluster events linked to recreational 4-wheel driving. Following periods of heavy rain, this activity runs the risk of the vehicle becoming bogged – a state often requiring manual recovery. Methods & Materials: Leptospirosis is a notifiable disease in Queensland. Following a positive disease notification, detailed anamnesis, confirmation of exposure source and follow up of contacts is undertaken. Diagnosis with paired serology and microscopic agglutination titres (MAT) determines the causative serovar. Matching serovars across cases with a single exposure adds weight to a cluster event. Results: In 2021, a cluster of four Leptospirosis cases was associated with a single exposure event in north Queensland involving recreational 4-wheel driving. The index case presented with a febrile illness and acute renal dysfunction two weeks following exposure. The clinical diagnosis of Leptospirosis was confirmed serologically with positive IgM serology and MAT titres for Australis serovar.From the primary case a further seven exposures were identified. Three of these tested positive for Leptospirosis (Australis serovar), two returned a negative result and two were unable to be contacted. Of the four cases, three had significant symptoms and were only identified as potential cases following investigation of the first case. The fourth case had significant delay in diagnosis as a result.Further review of disease notifications demonstrated a similar cluster of three leptospirosis cases from a single point exposure of recreational 4-wheel driving in 2019. Conclusion: Recreational 4-wheel driving and vehicle recovery may result in potential Leptospirosis exposure, especially following heavy rainfall. Improved recognition of the risk of cluster events has implications for case finding and preventing potential severe complications. Consideration of prophylactic therapy for linked exposures may be appropriate. |
| first_indexed | 2024-12-24T19:01:17Z |
| format | Article |
| id | doaj.art-da0323747e03470caa90e0177ea85d29 |
| institution | Directory Open Access Journal |
| issn | 1201-9712 |
| language | English |
| last_indexed | 2024-12-24T19:01:17Z |
| publishDate | 2022-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Infectious Diseases |
| spelling | doaj.art-da0323747e03470caa90e0177ea85d292022-12-21T16:43:13ZengElsevierInternational Journal of Infectious Diseases1201-97122022-03-01116S72S73Leptospirosis Cluster Following Recreational 4-Wheel Driving and Vehicle Recovery ExposureS. Cunningham0T. Marquardt1N. Moodley2Townsville University Hospital, Townsville, Queensland, Australia; Corresponding author.Townsville Public Health Unit, Townsville, Queensland, AustraliaTownsville Public Health Unit, Townsville, Queensland, Australia; James Cook University, College of Medicine and Dentistry, Townsville, Queensland, AustraliaPurpose: Leptospirosis, an emerging zoonotic disease caused by Leptospira spirochetes, has many pathogenic serovars endemic to northern Australia. The disease has potential for significant pulmonary, renal and hepatic dysfunction. Early case detection and timely antimicrobial therapy can reduce morbidity and mortality. Clusters of cases have been associated with workplace exposures such as abattoirs. Whilst water-based sporting and recreational activities are established individual risk factors; they are not typically recognised as clusters.This case series highlights the potential for cluster events linked to recreational 4-wheel driving. Following periods of heavy rain, this activity runs the risk of the vehicle becoming bogged – a state often requiring manual recovery. Methods & Materials: Leptospirosis is a notifiable disease in Queensland. Following a positive disease notification, detailed anamnesis, confirmation of exposure source and follow up of contacts is undertaken. Diagnosis with paired serology and microscopic agglutination titres (MAT) determines the causative serovar. Matching serovars across cases with a single exposure adds weight to a cluster event. Results: In 2021, a cluster of four Leptospirosis cases was associated with a single exposure event in north Queensland involving recreational 4-wheel driving. The index case presented with a febrile illness and acute renal dysfunction two weeks following exposure. The clinical diagnosis of Leptospirosis was confirmed serologically with positive IgM serology and MAT titres for Australis serovar.From the primary case a further seven exposures were identified. Three of these tested positive for Leptospirosis (Australis serovar), two returned a negative result and two were unable to be contacted. Of the four cases, three had significant symptoms and were only identified as potential cases following investigation of the first case. The fourth case had significant delay in diagnosis as a result.Further review of disease notifications demonstrated a similar cluster of three leptospirosis cases from a single point exposure of recreational 4-wheel driving in 2019. Conclusion: Recreational 4-wheel driving and vehicle recovery may result in potential Leptospirosis exposure, especially following heavy rainfall. Improved recognition of the risk of cluster events has implications for case finding and preventing potential severe complications. Consideration of prophylactic therapy for linked exposures may be appropriate.http://www.sciencedirect.com/science/article/pii/S1201971221010638 |
| spellingShingle | S. Cunningham T. Marquardt N. Moodley Leptospirosis Cluster Following Recreational 4-Wheel Driving and Vehicle Recovery Exposure International Journal of Infectious Diseases |
| title | Leptospirosis Cluster Following Recreational 4-Wheel Driving and Vehicle Recovery Exposure |
| title_full | Leptospirosis Cluster Following Recreational 4-Wheel Driving and Vehicle Recovery Exposure |
| title_fullStr | Leptospirosis Cluster Following Recreational 4-Wheel Driving and Vehicle Recovery Exposure |
| title_full_unstemmed | Leptospirosis Cluster Following Recreational 4-Wheel Driving and Vehicle Recovery Exposure |
| title_short | Leptospirosis Cluster Following Recreational 4-Wheel Driving and Vehicle Recovery Exposure |
| title_sort | leptospirosis cluster following recreational 4 wheel driving and vehicle recovery exposure |
| url | http://www.sciencedirect.com/science/article/pii/S1201971221010638 |
| work_keys_str_mv | AT scunningham leptospirosisclusterfollowingrecreational4wheeldrivingandvehiclerecoveryexposure AT tmarquardt leptospirosisclusterfollowingrecreational4wheeldrivingandvehiclerecoveryexposure AT nmoodley leptospirosisclusterfollowingrecreational4wheeldrivingandvehiclerecoveryexposure |