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      Leptospirosis in the Republic of Korea: Historical Perspectives, Current Status and Future Challenges

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          Abstract

          Leptospirosis is an important public health problem in the Republic of Korea (ROK), occurring sporadically or in outbreaks during the autumn season. Wild rodents, Apodemus agrarius, have been mainly involved in human leptospirosis. The majority of carrier animals are infected with Leptospira interrogans serovar lai. The characteristic pulmonary involvement or hemorrhage may increase the clinical severity or result in fatal outcomes, and these aspects continue to be a threat to people in endemic areas. While the disease incidence has been relatively low in recent years, there have been newer findings of livestock (zoo animals and racing horses) and rats ( Rattus norvegicus) captured in urban environments as potential animal carriers. Many avenues of research are still open to define current changes in ecology, epidemiology, and the disease burden in both humans and animals in the ROK, together with global warming and climate change issues. In addition, national policy regarding the weighted wildlife monitoring system and the enhanced disease surveillance program is required to facilitate better monitoring and understanding of this disease.

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          Most cited references60

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          Leptospira and leptospirosis.

          Leptospirosis is the most wide spread zoonosis worldwide; it is present in all continents except Antarctica and evidence for the carriage of Leptospira has been found in virtually all mammalian species examined. Humans most commonly become infected through occupational, recreational, or domestic contact with the urine of carrier animals, either directly or via contaminated water or soil. Leptospires are thin, helical bacteria classified into at least 12 pathogenic and 4 saprophytic species, with more than 250 pathogenic serovars. Immunity following infection is generally, but not exclusively, mediated by antibody against leptospiral LPS and restricted to antigenically related serovars. Vaccines currently available consist of killed whole cell bacterins which are used widely in animals, but less so in humans. Current work with recombinant protein antigens shows promise for the development of vaccines based on defined protective antigens. The cellular and molecular basis for virulence remains poorly understood, but comparative genomics of pathogenic and saprophytic species suggests that Leptospira expresses unique virulence determinants. However, the recent development of defined mutagenesis systems for Leptospira heralds the potential for gaining a much improved understanding of pathogenesis in leptospirosis. Copyright 2009 Elsevier B.V. All rights reserved.
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            Climate change, flooding, urbanisation and leptospirosis: fuelling the fire?

            Flooding and heavy rainfall have been associated with numerous outbreaks of leptospirosis around the world. With global climate change, extreme weather events such as cyclones and floods are expected to occur with increasing frequency and greater intensity and may potentially result in an upsurge in the disease incidence as well as the magnitude of leptospirosis outbreaks. In this paper, we examine mechanisms by which climate change can affect various ecological factors that are likely to drive an increase in the overall incidence as well as the frequency of outbreaks of leptospirosis. We will discuss the geographical areas that are most likely to be at risk of an increase in leptospirosis disease burden owing to the coexistence of climate change hazard risk, environmental drivers of leptospirosis outbreaks, local socioeconomic circumstances, and social and demographic trends. To reduce this disease burden, enhanced surveillance and further research is required to understand the environmental drivers of infection, to build capacity in emergency response and to promote community adaptation to a changing climate. Copyright © 2010 Royal Society of Tropical Medicine and Hygiene.
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              Isolation of the etiologic agent of Korean Hemorrhagic fever.

              Lung tissues from 73 rodents (Apodemus agrarius coreae) gave specific immunofluorescent reactions when they reacted with sera from patients convalescing from Korean hemorrhagic fever. Similar staaining was observed in the lungs of A. agrarius inoculated with acute-phase sera obtained from two patients with this disease. The unidentified agent was successfully propagated in adult A. agrarius through eight passages representing a cumulative dilution of greater than 10(-17). Experimentally inoculated rodents developed specific fluorescent antigen in the lung, kidney, liver, parotid glands, and bladder. Organs, especially lungs, were positive beginning 10 days and continuing through 69 days after inoculation. The agent could not be cultivated in several types of cell cultures nor in laboratory animals. No fluorescence was observed when infected A. agrarius lung tissues were reacted with antisera to Marburg virus, Ebola virus, and serval arenaviruses. Diagnostic increases in immunofluorescent antibodies occurred in 113 of 116 severe and 11 of 34 milder cases of clinically suspected Korean hemorrhagic fever. Antibodies were present during the first week of symptoms, reached a peak at the end of the second week, and persisted for up to 14 years. Convalescent-phase sera from four persons suffering a similar disease in the Soviet Union were also positive for antibodies.
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                Author and article information

                Journal
                Infect Chemother
                Infect Chemother
                IC
                Infection & Chemotherapy
                The Korean Society of Infectious Diseases and Korean Society for Chemotherapy
                2093-2340
                2092-6448
                June 2013
                26 June 2013
                : 45
                : 2
                : 137-144
                Affiliations
                Division of Infectious Diseases, Department of Internal Medicine, Korea Univseristy College of Medicine, Seoul, Korea.
                Author notes
                Corresponding Author: Min Ja Kim, MD, PhD. Department of Internal Medicine, Korea University College of Medicine, 126-1, 5Ga, Anam-dong, Seongbuk-Gu, Seoul 136-705, Korea. Tel: +82-2-920-5685, Fax: +82-2-920-5616, macropha@ 123456korea.ac.kr
                Article
                10.3947/ic.2013.45.2.137
                3780959
                24265962
                aece5841-0d0f-41d7-911d-2249e994bae2
                Copyright © 2013 by The Korean Society of Infectious Diseases and Korean Society for Chemotherapy

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 05 June 2013
                Categories
                Review Article

                leptospira,epidemiology,reservoirs,pulmonary hemorrhage
                leptospira, epidemiology, reservoirs, pulmonary hemorrhage

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