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      An outbreak of leptospirosis among kayakers in Brittany, North-West France, 2016

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          Abstract

          In September 2016, a cluster of seven kayakers with clinical symptoms of leptospirosis with onset since July 2016 was reported to French health authorities. Human and animal investigations were undertaken to describe the outbreak, identify the likely place and source of infection and implement necessary control measures. We identified 103 patients with clinical symptoms of leptospirosis between 1 June and 31 October 2016 who lived in the Ille-et-Vilaine district in Brittany. Of these, 14 (including the original seven) reported contacts with the river Vilaine during the incubation period and were defined as outbreak cases: eight were confirmed by serology tests or PCR and six were probable without a laboratory confirmation for leptospirosis. All 14 cases were kayakers. Three distinct contamination sites were identified on a 30 km stretch of the river Vilaine. Nine cases reported having skin wounds while kayaking. None were vaccinated against leptospirosis. The outbreak was attributed to Leptospira kirschneri serogroup Grippotyphosa. Animal investigations did not allow identifying the possible reservoir. Leptospirosis outbreaks associated with freshwater sports are rare in temperate climates. The prevention of such outbreaks requires control of potential animal reservoirs in zones such as the Vilaine valley and that kayakers adopt the recommended individual prevention measures.

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          Most cited references27

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          Leptospirosis: a zoonotic disease of global importance

          In the past decade, leptospirosis has emerged as a globally important infectious disease. It occurs in urban environments of industrialised and developing countries, as well as in rural regions worldwide. Mortality remains significant, related both to delays in diagnosis due to lack of infrastructure and adequate clinical suspicion, and to other poorly understood reasons that may include inherent pathogenicity of some leptospiral strains or genetically determined host immunopathological responses. Pulmonary haemorrhage is recognised increasingly as a major, often lethal, manifestation of leptospirosis, the pathogenesis of which remains unclear. The completion of the genome sequence of Leptospira interrogans serovar lai, and other continuing leptospiral genome sequencing projects, promise to guide future work on the disease. Mainstays of treatment are still tetracyclines and beta-lactam/cephalosporins. No vaccine is available. Prevention is largely dependent on sanitation measures that may be difficult to implement, especially in developing countries.
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            Virulence of the zoonotic agent of leptospirosis: still terra incognita?

            Pathogenic leptospires are the bacterial agents of leptospirosis, which is an emerging zoonotic disease that affects both animals and humans worldwide. In this Review, the recent advances in our understanding of the epidemiology, taxonomy, genomics and the molecular basis of virulence in leptospires, and of how these properties contribute to the pathogenesis of leptospirosis, are discussed.
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              Polymerase chain reaction for detection of Leptospira spp. in clinical samples.

              A sensitive assay for Leptospira spp., the causative agent of leptospirosis, was developed on the basis of the polymerase chain reaction (PCR). A 331-bp sequence from the Leptospira interrogans serovar canicola rrs (16S) gene was amplified, and the PCR products were analyzed by DNA-DNA hybridization by using a 289-bp fragment internal to the amplified DNA. Specific PCR products also were obtained with DNA from the closely related nonpathogenic Leptospira biflexa but not with DNA from other spirochetes, such as Borrelia burgdorferi, Borrelia hermsii, Treponema denticola, Treponema pallidum, Spirochaeta aurantia, or more distant organisms such as Escherichia coli, Staphylococcus aureus, Mycobacterium tuberculosis, and Proteus mirabilis. The assay was able to detect as few as 10 bacteria. Leptospira DNA was detected in urine from experimentally infected mice. In addition, the test was found to be suitable for diagnosing leptospirosis in humans. Cerebrospinal fluid and urine from patients with leptospirosis were positive, whereas samples from control uninfected patients were negative.
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                Author and article information

                Journal
                Euro Surveill
                Euro Surveill
                eurosurveillance
                Eurosurveillance
                European Centre for Disease Prevention and Control (ECDC)
                1025-496X
                1560-7917
                29 November 2018
                : 23
                : 48
                : 1700848
                Affiliations
                [1 ]Santé publique France, Rennes, France
                [2 ]Centre National de Référence de la leptospirose, Institut Pasteur, Paris, France
                [3 ]VetAgro Sup, Université de Lyon, Marcy l'Etoile, France
                [4 ]Office National de la Chasse et de la Faune sauvage, Auffargis, France
                [5 ]Agence régionale de santé de Bretagne, Rennes, France
                [6 ]Direction générale de l’alimentation, Ministère de l’agriculture et de l’alimentation, Paris, France
                [7 ]Entente de lutte interdépartementale contre les zoonoses, Malzéville, France
                [8 ]Anses (French Agency for Food, Environmental and Occupational Health and Safety), Nancy laboratory for rabies and wildlife, Malzéville, France
                [9 ]Santé publique France, Saint-Maurice, France
                [10 ]European Programme for Intervention Epidemiology Training, European Centre for Disease Prevention and Control, Stockholm, Sweden
                Author notes

                Correspondence: Yvonnick Guillois ( yvonnick.guillois@ 123456santepubliquefrance.fr )

                Article
                1700848 1700848 1700848
                10.2807/1560-7917.ES.2018.23.48.1700848
                6280422
                30621819
                220c4d48-a6cf-43c5-bd80-950455f911ac
                This article is copyright of The Authors, 2018.

                This is an open-access article distributed under the terms of the Creative Commons Attribution (CC BY 4.0) Licence. You may share and adapt the material, but must give appropriate credit to the source, provide a link to the licence, and indicate if changes were made.

                History
                : 08 December 2017
                : 04 June 2018
                Categories
                Outbreaks
                Custom metadata
                3

                outbreak,leptospirosis,descriptive study,kayak,animal reservoir,france

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