Albanian j. agric. sci. ISSN: 2218-2020, (2012), (Special Edition) Copyright © Agricultural University of Tirana

RETROSPECTIV STUDIES OF LEPTOSPIROSIS IN ALBANIA LULJETA ALLA1*, XHELIL KOLECI3, ARTAN SIMAKU2, ERJONA ABAZAJ2 , EGON ANDONI3, SILVA BINO1 1

Institute of Public Health. Departament of Control of Infection Diseases

2

University Hospital Center “Mother Tereza”

3

Faculty of Veterinary Medicine, Agricultural University of Tirana

*Author of correspondence; Email: [email protected]

Abstract This study present epidemiological data of human leptospirosis disease for last seven year (2005-2011). Leptospirosis is an bacterial infectious disease which is quite spread disease in both human and animal. Leptospirosis is an endemic zoonotic disease in Albania and it is part of notification disease list. Despite it is a neglected zoonotic disease, and not all cases are reported, it represent 2% of all reported zoonotic disease in Albania. According to the epidemiological data provided by Institute of Public Health during last two year it is an obviously increase of its frequency in 2011 it is reported 1 case/10⁵ inhabitants compare 0.2 case/105 in 2005. The main animal reservoirs are rodents, and livestock animals. The disease in humans is consequence of accidental contact with urine of infected animal and professional occupations by contact with infected animals and contaminated materials. In all cases professional exposure and re-creative activity were identified as main risk factors of Leptospirosis disease. Social and cultural factors such as food habits play a important role, too. The disease seems to have seasonal pattern, and it is more frequent during summer and autumn seasons. Laboratory diagnosis is based on ELISA test. Sporadically, some very severe cases are implicated as fatality ones. Further investigation must be carry out for understanding the reasons of increasing incidence, in order to identify sources of infection, changing in epidemiological behavior, and possible risk factors and transmission methods. Keywords: Leptospirosis, endemic, domestic animal.

1. Introduction Leptospirosis is a worldwide zoonotic infection with a much greater incidence in tropical regions and recently it has been identified as one of the emerging infectious diseases [9, 14]. Leptospirosis is a bacterial zoonotic disease of global importance. The epidemiology of leptospirosis has been modified by changes in animal husbandry, climate, and human behavior. Leptospirosis is a zoonotic bacterial disease with endemic character in Albania [8, 12]. Clinical manifestation of the disease ranges from mild to severe forms, depending on the serovars involved. Often not correctly diagnosed cases identified as meningitis, encephalitis. The disease is caused by Leptospira spp. They are identified more than 200 different pathogenic serovars. The disease has worldwide distributions, except of the polar regions. In general the disease is related with risk factor, and it is an defined as an occupational hazard [1, 16]. Seroepidemiological surveys carried out by the Institute of Public Health (IPH) in the period 1980-1990 in Albania have demonstrated a predominant circulation International Conference 31 October 2012, Tirana

of species, Leptospira Pomona and Leptospira ichterohaemorrhagica. Cattle has been proved to be the main natural host of infection [8, 16]. 2. Material and Methods: Leptospirosis, as part of Disease Mandatory Reporting System, is routinely reported by local health authorities in each district in Albania as suspected or laboratory confirmed cases for each individual case. The information, which contains comprehensive demographic data (name, address, sex, age, occupation) and detailed case history, is transmitted to Tirana on paper by fax or post, or Email and it is computerized within a central database dedicated to leptospirosis prepared in EPINFO 2004. The questionnaire examined potential risk factors associated with demographic and socioeconomic data; residential sanitary conditions; work-related, recreational, and domestic activities; and exposure to contaminated environmental sources and potential animal reservoirs [6, 7, 12]. Aim : To present an epidemiological overview of Leptospirosi in Albania during the five last years.

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3. Results R and Discussion . The dissease in humans h is consequencee of aaccidental coontact with urine u of infected animalss and p professional contact withh infected aniimals [10]. Social S a cultural factors and f such as food habiits play an crrucial r role, too [9]. The most aff ffected areas are located in i the N North and Ceentral part of o Albania. During D the period 2 2005-2012 thhe number of people thatt were confirrmed a affected byy leptospirossis disease was as w 94 cases.. The 5 inncidence rate varies 1.0 cases /10 poopulation in 2011 to 0.2 cases /105 populaation in 20055. The inciddence w estimatedd in ~0.5/1000.000 populaation in eachh year was (Figure 1). Th he highest perrcentage of infected i peopple is a among 15-444 years old annd 45-59 yeaars old (Figuure 2). S Several casess have been reported spooradically as fatal c cases. The most m diagnosttic test used is i ELISA meethod b based on eithher IgM, IgG G. From pattients suffer from icterohemorrhhagic form of leptosppirosis a single s s serum samplle 3-14 dayss (mean = 7 days) after the o onset of symptoms s w was collectted and tested s serologically [2, 4, 13, 155]. Forty fivee (48%) of cases, c r resulted posittive for IgM M and 24 (25%) of cases have r resulted posiitive for IgG G. In twelve (13%) cases the d diagnosis waas establisheed based onn clinical criteria o only. In totall 13 (14%) cases c were negative n for both I IgM and IgG G [14]. The men resuult most infe fected ( (65.3%) thann females, p< <0.01 [5]. D During the period from m 2005 to 2011, 17 of o 36 d districts in Albania (47.2%) ( weere affectedd by leptospirosis mainly in north n and thhe central paart of b incidencee (0.4 thhe country. Respectivelyy Shkodra, by c cases/10.000) ) populatioon) Lezhaa, Tirana (0.3 c cases/10.000) ) population [7, 12] (Fig 1). 30

Fig gure 2. Geogrraphic distribuution of Lepto ospirosis acccording to disttrict in Albaniia

hum man popullation is mainly related to the occcupational exxplosions [6,, 7, 12]. The disease is more frrequent durin ng summer and a auttumn seasonns, but the cases had been reporrted durring all year around [1] (Figure 3).

21%

28%

20%

31%

1 0.8

20

0.6 0.4

10

0.2 0

0 2 2007 2008 2 2009 2010 2 2011 2005 2006 cases s

incidence

F Figure 1. Inciddence of Lepttospirosis accoording to y years (total nuumber of casess 2005-2011).

According to age, thhe people thaat belong agee 15444 years oldd and group 45-59 yearrs old are higher a affected by leptospira l disease. One such s feature ages specific and gender-speci g ific of the dissease in the International Conference C 3 October 2012, Tirana 31

Sprin ng 

Summerr

Autumn

Winter 

Fig gure 3: Hum man leptospiroosis percentaage accordingg to seaasonality

People onn rural areass were mostt affected with w 63.2% of the total t cases reported. Thee ratio betweeen u areas aand rural areeas (the ruraal / thee cases in urban urb ban) was 2:11. Apparentlyy, this is relaated to the high h pro obability of exposure e to ssources of in nfection on ruural areeas [1, 7] Based on individual form, Stock kbreeder 12.5% and d about 56. % in classiffication the other o ( workkers fish heries, ditchher, constructtion worker ) resulted most m [7, 12]. On afffected with leptospirosis l ne potential risk r facctor is consiidered contaact persons who w have deealt

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Reetrospectiv stuudies of leptosspirosis in Albbania

with the mannipulation off dead animals, contaminnation w o food with urine of infeected animals during floooding of [1, 3].

5. 5 Hospital date Center for Disease Control C and Preventioon, 2000. Lep ptospirosis outbreak o in Eco Chaallenge 2000 participantts. Rep CDR Wkly 10:: 341.

13% 6%

13% 56% 12%

Stockbreed der Retired Others

Adult No data

F Figure 4: Disttributation of human h leptosiirosis p percentage acccording population group att rick

4. Conclusion: C Despite the fact that there is som me underrepoorting c cases in the last l two receent years havve an increaase of thhis disease as confirmeed in IPH. The increasse of c cases duringg the last years 2009 [7,12] [ shoulld be f further investtigated relateed to climatee change or other f factors. There is a need to t strengthenn join action with v veterinary system too promotee intersecttorial c collaboration n and supportt the successsful realizatioon of a national conntrol program m at communnity [11, 16]. 5. Reeferences 1. Andre-F Fontaine G, Peslerbe X, Ganiere JP. Occupaational hazaard of unnotticed leptosp pirosis in waater ways maaintenance staff. s Eur. J. Epidemiol E 1992: 8:228-2232 2. Angela P, Brandγo AP, Camarggo ED, da Sillva ED, Maarcos V, Silvva MV. Macrroscopic Agglutination Testt for Rapid Diagnosis D off Human n Leptospiroosis. J Clin Microbiol M 1998;366:3138-42 3. Clerke AM, Leuva AC, Joshi C, Trivedi SV V. l is in South Clinicaal profile of leptospirosi gujaratt. J Postgradd Med 2002;448:117-8. 4. Flannerry B, Costa D, D Carvalho FP, F Guerreirro H, Matsunnaga J, Da Silva ED. Evaaluation of Recom mbinant Lepttospira Antiigen-Based International Conference C 3 October 2012, Tirana 31

Enzyme--Linked Imm munosorben nt Assays forr the Serod diagnosis off Leptospiro osis. J Clin Microbiool 2001; 39: 33303-10.

6. 6 Hospital date, Univerrsity Hospital Center “Mother Tereza” Deppartment of Statistic S (200052011). 7. 7 Individuaal reporting form for Lep ptospirosis (period 2005-2011) inn Albania (IP PH). 8. 8 Kakarriqii E .Epidemiological Ba ackground of o Infection n Diseases in n Albania (1960-2001) and a control in the Conteext of Natura al Disasters And Infeectiosus Diseeases. 9. 9 Ko AI. Leptospirosis L s. In Goldmaan L, Schaferr AI, eds. Cecil C Mediciine. 24th ed. Philadelphiaa, Pa: Saundders Elsevierr; 2011:chap 331. 10. 1 Kohn B, Steinicke K,, Arndt G, Grruber AD, Guerra B, B Jansen A, K Kaser-Hotz B, B Klopfleiscch R, Lotz F, F Luge E, Nööckler K. Pu ulmonary abnormaalities in doggs with lepto ospirosis. J Vet V Intern Meed. 2010: 24 (6): 791–80 07 11. 1 Levett PN N, Haake DA A. Leptospirra species (leptospiirosis). In:Mandell GL, Bennett B JE, Dolin R, eds. Principlles and Practtice of Infectious Diseases. 77th ed. Philad delphia, Pa: Elsevier Churchill C Livvingstone; 2009:chap 240 12. 1 Monthly reporting forrms for infecction diseases (Departam ment of conttrol infection n Diseases in Institute of o Public Heealth) 2005-2 2011. 13. 1 O'Keefe JS. J A brief rreview on th he laboratory diagnosiss of leptospiirosis. New Zeland Veterinarry Journal 2002; 50:9-13 3. 14. 1 Paul N. Levett L . Lepttospirosis. Clinical C microbioology review ws, Journal off American Society Vol. V 14, No. 22: 2001: 296 6–332 15. 1 Silva MV V, Camargo E ED, Batista L, L Vaz AJ, Brandão AP, Nakamuura PM, Neg grão Behavioour ass antibodies of specifiic IgM, IgG and IgA cla in human n leptospiroosis during the acute phase of the disease and during convalescence.JM. T Trop. Med Hy yg. 1995 98 (4) ( :268-72. 16. 1 Tappero JW, J Ashfordd DA, Perkin ns BA. Leptospiira species (lleptospirosis), p. In: Mandell GL, Bennettt JE, Dolin R, R editors. Principles and practicce of infectio ous diseases. 5th edn. Philadelphia P :Churchill Livingstone; 2000:24995-501.

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