1,111
views
0
recommends
+1 Recommend
2 collections
    0
    shares

      2023 Scopus CiteScore is 2.3, SNIP 0.757, ranking 15/35 in Category "Veterinary (Miscellaneous)" and 219/344 "Medicine (Infectious Diseases)".  

      Interested in becoming a Zoonoses published author? Check out the call for papers on our website https://zoonoses-journal.org/index.php/2023/04/26/zoonoses-call-for-papers-2/

      • Platinum Open Access with no APCs & Fast peer review/Fast publication online after article acceptance
      scite_
       
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Leptospirosis in China: Current Status, Insights, and Future Prospects

      Published
      review-article
      Bookmark

            Abstract

            Leptospirosis is a re-emerging zoonotic disease that significantly impacts animals and human health worldwide. China has diverse climate types, providing a suitable environment for transmitting and surviving pathogenic Leptospira and its host animals. Despite the substantial reduction in the prevalence of leptospirosis, it continues to be a significant zoonotic disease of public health concern in China. This literature review aimed to provide a concise overview of the current status of leptospirosis in China, the findings from epidemiologic studies on leptospirosis, and the impact of animal and environmental factors on leptospirosis. Leptospirosis is commonly observed in subtropical and tropical cities in China, especially cities with ample water resources in the southern Yangtze River basin. Epidemiologic studies have identified Leptospira interrogans and L. borgpetersenii as the predominant pathogenic species responsible for leptospirosis in China. Leptospira serotypes prevalent in one part of China are related to the serotypes prevalent in the dominant local rodent species and these animals may threaten public health safety as carriers. Given the potential increase in the risk of leptospirosis due to extreme climate change, it is crucial to raise awareness among stakeholders and promote the adoption of a comprehensive approach to prevent and control the continuous transmission and sudden outbreaks of leptospirosis.

            Main article text

            INTRODUCTION

            Leptospirosis is one of the most widespread zoonotic infections worldwide. Leptospirosis is caused by pathogenic Leptospira, an infectious disease that is often overlooked [13]. Leptospira belongs to the genus Leptospira, family Leptospiraceae, and order Spirochaetales. The causative genospecies that are the leading cause of leptospirosis in humans and animals globally include L. interrogans, L. kirschneri, L. noguchii, L. borgpetersenii, L. weilii, L. santarosai, L. alexanderi, L. kmetyi, and L. alstonii, with the L. interrogans genospecies being the most common [4]. Leptospirosis is a naturally occurring disease, in which rodents serve as the primary reservoir host, with wild boars, domestic pigs, cattle, horses, sheep, dogs, and other wildlife and domestic animals also being important transmission hosts when infected [2, 3, 57]. Leptospira can colonize the kidneys of animals, is excreted in the urine, contaminates water and soil, and survives for months in water or wet soil [811]. Globally, >500,000 people are infected with Leptospira each year with a case fatality rate of >15% [1]. It has been reported that a wide range of animals are natural carriers of pathogenic Leptospira and 67 species of wild and domestic animals have been identified as hosts for pathogenic species [1214]. Therefore, leptospirosis endangers the development of animal husbandry and threatens public health and the safety of the global community.

            Chinese scientists published the first complete genome sequence of L. interrogans Lai strain (56601) in Nature in 2003 [15]. The sequence provides an essential scientific basis for studying the Leptospira genome. Molecular epidemiologic investigations of key outbreak sites of leptospirosis in Jiangxi and Fujian Provinces (China) have revealed that two genotypes, L. interrogans and L. borgpetersenii, are predominantly prevalent [5, 1618]. There have been several outbreaks of leptospirosis in China, most of which occurred after floods. Although the incidence of leptospirosis in China has decreased significantly in recent years compared to the last century, leptospirosis is still a zoonotic infection that cannot be ignored [13, 19].

            With globalization of the economy, the development of tourist attractions in China, and the abundance of outdoor activities, the spread of leptospirosis is often no longer limited to one epidemiologic factor [2023]. In the context of One Health, animal, environmental, social, and human factors can all influence the occurrence and spread of leptospirosis.

            Therefore, the objectives of this review were to examine the development and changes of leptospirosis in China in recent years, the animal and environmental factors in the transmission of leptospirosis in China, and the results of the molecular epidemiologic survey of Leptospira in China in recent years.

            MATERIALS AND METHODS

            Country of study

            China has a sizeable north-south span and a complex and varied climate with several tropical, subtropical, and temperate heat zones. From the southeast coast to the northwest interior, the continental character of the environment gradually increases with humid, semi-humid, semi-arid, and arid climatic zones appearing in that order. The monsoon strongly influences the climate, and the average annual temperature ranges from 4.4°C in the north to 23.8°C in the south [19]. The annual precipitation in the coastal areas of southeastern China ranges from 1500–2000 millimeters. The annual precipitation ranges from 100–200 millimeters in the inland regions of northwestern China and the annual precipitation decreases from the coast-to-the inland areas and from southeast-to-northwest. The rainy, humid, and warm climate of the tropical and subtropical regions in the southern part of the country is suitable for the survival of pathogenic Leptospira and the host animals, so leptospirosis is a relatively common zoonosis in south China. A map of climatic zones in China is shown in Fig. 1.

            Next follows the figure caption
            FIGURE 1 |

            A map of climatic zones in China (The available data was provided by The Resource and Environmental Science Data Platform (www.resdc.cn).

            Literature search and ethics

            A bibliographic search was performed using the following electronic literature databases: PubMed; ScienceDirect; and China National Knowledge Infrastructure. The published literature related to leptospirosis in Chinese and international journals was investigated. A combination of the following terms was screened in any given order: leptospirosis; Leptospira; China; epidemiologic investigation; animal factors; environmental factors; strain isolation and identification; and prevention strategies. The published literatures were reviewed with anonymous data, so this study did not require bioethical approval.

            RESULTS

            Published literature

            Forty-one articles were identified, of which 15 (36.59%), 16 (39.02%), 5 (12.20%), and 3 (7.32%) involved human infections, animal infections, the environment, and genotyping of L.interrogans prevalent in China, respectively. There were 35 (85.37%) and 6 (14.63%) English and Chinese original articles, respectively. From the perspective of One Health research, the 41 publications involving humans, animals, and the environment cover detailed information on leptospirosis research in China over the past 30 years.

            Incidence of leptospirosis in China

            Leptospirosis has been monitored by the Chinese Center for Disease Control and Prevention since 1955 [13, 19]. As a new type of zoonotic infectious disease, leptospirosis is like many febrile diseases with respect to early-stage symptoms and is often ignored by individuals who are infected. According to the available data provided by The Data-center of China Public Health Science (www.phsciencedata.cn), the total number of confirmed cases of leptospirosis from 2004–2023 was 10,581, with the highest number of cases recorded in 2004 and 2005 and the lowest number of cases in 2017. The average annual incidence of leptospirosis is 0.03691 cases/100,000 cases, which decreased significantly in 2011. It is worth noting that The incidence of leptospirosis between 2013 and 2023 (0.022 cases/100,000 cases) was lower than 2004–2012 (0.061 cases/100,000 cases).

            Over the past two decades, changes in ecological and social conditions in China may have had an essential role in the epidemiology of leptospirosis. Improvements in China’s rural human settlement environment may have helped reduce the risk of leptospirosis transmission [24]. During the construction of large-scale water conservancy projects, significant anthropogenic changes in the ecological environment have occurred and rodent densities have declined and remained low, which effectively controlled the spread of the disease by rodents [25]. In addition, improvement in waste management and on-farm biosecurity in the livestock sector of China may have contributed to lowering the transmission of Leptospira [13].

            Therefore, the incidence of leptospirosis in China during recent years has generally shown a decreasing trend and there may be a few cases that have not been counted. The incidence of leptospirosis in China from 2004–2023 is shown in Fig. 2.

            Next follows the figure caption
            FIGURE 2 |

            The incidence of leptospirosis in China from 2004–2023.

            Epidemic and transmission of Leptospira in China

            The epidemic and transmission of Leptospira in China are described in terms of animal and environmental factors. Animal factors include infection sources, transmission routes, and susceptible populations. Ecological factors are expressed in terms of natural geographic and socio-human factors.

            Animal factors
            Source of infection

            The host animals for Leptospira are more diverse with mammals dominating. Large mammals infected with Leptospira mainly include cattle, sheep, and pigs, which are primarily farmed. Wild rodents dominate among small mammals and epidemiologic investigations have shown that bats also carry Leptospira [2].

            Leptospirosis in large mammals can cause acute fever and jaundice for a short length of time and even cause death. Leptospirosis in female animals can lead to reproductive disorders, abortions, stillbirths, mummified fetuses, reduced milk production, and decreased farming productivity, which can cause significant losses to the farming industry [3]. Animals infected with Leptospira can become carrier hosts. For example, cattle are the maintenance host of L. borgpetersenii serovar and the urine of infected animals can contaminate soil and nearby water sources for a long time [6]. An epidemiologic survey of leptospirosis in cattle, sheep, and swine on a large provincial scale has not been conducted in China and there are only small epidemiologic surveys of swine and cattle in early individual leptospirosis endemic provinces.

            The spread of leptospirosis is associated with small mammalian rodents [7]. Small mammals, predominantly rodents, tend to be maintenance hosts for Leptospira. Rodents infected with Leptospira in the urogenital tract can be a source of infection, contaminating soil and water sources. Leptospira serotypes in one area of China are related to local rodent species [16]. The main rodent species carrying Leptospira are Apodemus agrarius, Rattus norvegicus, R. losea, and Mus musculus. The differences in Leptospira serogroups may be influenced by differences in rodents from place-to-place because of geographic factors, such as environment, climate, and altitude [5, 20]. The regions with a high prevalence of leptospirosis are mainly tropical and subtropical regions [21]. Epidemiologic investigations in recent years based on RT-PCR, nested PCR, and MLST have shown that Leptospira isolated from wild rodents are mainly L. interrogans and L. borgpetersenii [26] and the prevalence of Leptospira infections in rodents ranges from 4.8%–31.9% [26, 27]. South China has the highest prevalence of rodent leptospirosis infection and a high prevalence of leptospirosis in the Yangtze River basin [28].

            In addition rodents, dogs, and cats serve as host animals for Leptospira. For example, 1053 serum samples from dogs were collected in Changchun, China and the positive rate was 19.1% based on MAT in these cases [29]. Dogs and cats excrete Leptospira through the urine and humans may be at risk for Leptospira infection.

            It has also been reported that bats may be essential carriers of Leptospira. In 2019, sixty bats were captured in rural Xianning City, Hubei Province. Testing showed that 57% (34/60) of the bats were positive for Leptospira [12].

            Routes of transmission

            The transmission of leptospirosis is mainly by direct contact with Leptospira spp. Leptospira can be eliminated from the body in the urine of wild and domestic mammals, which contaminates the environment. Leptospira may invade the organisms and the animals may become infected with Leptospira [30]. The detection and isolation of Leptospira from aborted fetuses, placenta, milk, and amniotic fluid suggest that Leptospira may also be vertically transmissible [31].

            Susceptible population

            Specific occupational activities (e.g., agriculture, veterinary workers, and military training), recreational immersion in water, harsh living conditions, and seasonal rainfall in the tropics are often associated with leptospirosis. In general, human leptospirosis is more prevalent in tropical and subtropical regions. Leptospsirosis patients are usually 30–45 years of age, with a significantly higher incidence in men than women and the at-risk occupations are farming, outdoor work, livestock farming, and butchering [19, 3234]. Workers in these occupations will inevitably have skin injuries in their work and have a greater likelihood of exposure to contaminants and becoming infected with Leptospira, which increases the risk of the disease.

            Environmental factors
            Natural factors

            Natural environmental factors have been associated with the spread of Leptospira, with warm and humid climates and soil environments being more favorable for Leptospira survival [8, 9, 35]. Macrogenomic sequencing of soil from Tuo Lake in Bengbu, Anhui Province revealed that the risk of leptospiral pathogenicity is higher in submerged lands than dry lands [10]. Lake Taihu, one of the largest freshwater lakes in China, is an essential source of drinking water with pathogenic Leptospira detected in 33% and 13% of water and sediment samples, respectively [11]. Occupational workers engaged in agriculture are more likely than other occupations to be exposed to waterlogged soil for long periods, and the probability of developing leptospirosis increases.

            Severe natural disasters are also likely to increase the risk of leptospirosis, such as a significant increase in the prevalence of leptospirosis after floods. This finding may be related to the alteration of rivers and lakes, contamination of water resources, and subsequent small-scale migration of host animals [36, 37].

            Geographic factors

            The spread of leptospirosis in China has a distinct regional distribution, mainly in the southern part of China, in some provinces located in the Yangtze River basin, and in cities in provinces with tropical and subtropical climates [21, 38, 39]. Epidemiologic surveys in northern regions have also shown a high rate of Leptospira positivity in rodents [40, 41]. There are many substantial rivers and lakes with abundant water resources in the southern region of China, which may be contaminated by the faeces of host animals of pathogenic Leptospira and contaminated water increases the risk of infection in humans by direct contact with broken skin or by facilitating diffusion into the soil.

            Social and human factors

            Changing ecological and social conditions in China have a role in the prevalence of leptospirosis with the modernization of traditional farming and animal husbandry, increasing mechanized inputs into production, reduced probability of being able to access germ-carrying host animals and contaminated soils, and a reduction in the number of workers relying on traditional human labor, which has led to a decrease in the prevalence of leptospirosis. The prevalence of leptospirosis is related to local transport, farming practices, economic and traditional activities, and local physical geography [22].

            There has been an increased risk of importing and exporting pathogenic host animals and disease vectors with the globalization of trade, which has increased the risk of zoonotic diseases, such as leptospirosis [23]. In recent years, the incidence of leptospirosis in China has decreased compared to the last century [13, 4244]. However, leptospirosis should not be ignored because leptospirosis is still a significant zoonotic disease.

            Prevalence of Leptospira in China in recent years

            Leptospirosis is a zoonotic disease caused by pathogenic Leptospira and is one of the critical infectious diseases under surveillance in China. There are many serotypes of Leptospira and inactivated vaccines have poor or no cross-protection effect between different serotypes.

            Therefore, understanding the recent results of the isolation and identification of Leptospira in China can help in understanding the epidemiology of Leptospira and in preventing and controlling leptospirosis. The results of isolation and characterization of Leptospira in recent years are shown in Table 1.

            TABLE 1 |

            A separate table summarises the results of the identification of Leptospira in China in recent years.

            RegionEpidemiologic survey timeHost animalDetection methodPositivity rate Leptospira identification or isolation results
            Hubei province [26]2021 Rodent Nested PCR4.77% (46/964) L. interrogans, L. borgpetersenii
            Zhejiang province [14]2020 Rodent QPCR7.36% (99/1345) L. interrogans
            Fujian province [5]2018-2020 Rodent 16S rDNA gene sequencing, MAT, and MLST23.26% (90/387) L. borgpetersenii serogroup javanica strains (ST143), L. interrogans serogroup icterohaemorrhagiae strains (ST1 and ST17), L. interrogans serogroup bataviae strains (ST96 and ST333) and L. interrogans serogroup pyrogenes strains (ST332)
            Jiangxi province [17]2007-2015 Rodent 16S rRNA gene sequencing, MLST, and MAT9.35% (330/3531) L. icterohaemorrhagiae (61.1%), javanica (19.20%), and australis (9.73%)
            Yunnan province [45]2017-2021 Bat Nested PCR and MLST6.16% (17/276) L. kirschneri (FMAS_PN5) and L. interrogans (56639)
            Shandong province [46]2015 Bat Nested PCR and MLST50% (62/124) L. borgpetersenii and L. kirschneri
            Changchun city [29]2020-2021 Dog MAT19.08% (201/1053) L. icterohaemorrhagiae (8.1%), L. canicola (7.6%), L. australis (5.3%), L. ballum (4.7%), and L. pyrogenes (4.2%)
            Guangzhou city [27]2020-2021 Rattus norvegicus RT-PCR31.93% (38/119) L. interrogans
            Guangzhou city [47]2020 Rodent Nested PCR9.46% (28/296) L. interrogans, L. borgpetersenii, and L. kirschneri
            Guangzhou city [48]2018-2019 Rattus norvegicus and Rattus flavipectus PCR Rattus norvegicus: 57.89% (66/114) L. interrogans and L. borgpetersenii
            Risk factors and preventive strategies

            In the last decade, the incidence of leptospirosis in China has declined significantly relative to the beginning of the 21st century, which is due to improved living conditions, improvements in the environment, and increased health awareness of the population [13, 19]. However, the threat of leptospirosis has not disappeared with the emergence of global warming, the destruction of animal habitats, and tourism development. There are many rats in the city and rats often carry pathogens, including Leptospira, the urine of which is a source of infection [9, 11, 14, 28]. From July-to-September each year, people working in agriculture and outdoor activities have more exposure to contaminated water sources, which increases the risk of contracting leptospirosis [4951].

            Therefore, the following strategies should be implemented to prevent leptospirosis: workers in agriculture, and outdoor activities and people at high risk of leptospirosis should be vaccinated against leptospirosis; contact with fresh water and soil that may be contaminated by the urine of infected animals (especially rodents, such as rats, mice, pigs, dogs, and cows) should be avoided; keep food and water away from these animals that can easily carry the disease; and if symptoms consistent with leptospirosis occur in areas with a high incidence of leptospirosis, seek medical attention promptly.

            DISCUSSION

            The present review describes the current status of leptospirosis in China and provides insights into leptospirosis from the perspectives of animal and environmental factors. The review also focuses on the theme of One Health. Specifically, leptospirosis is still an infectious disease that cannot be ignored in China. Leptospirosis is a legally classified Class B infectious disease in China, which indicates that leptospirosis is a contagious disease with a degree of risk and is a significant public health problem.

            Epidemiologic investigations have revealed that leptospirosis is endemic in most urban areas in southern China, from tiny wild rodents-to-large domesticated animals, such as cattle, sheep, and pigs [28, 5254]. The prevalence of leptospirosis in southern China is closely related to climate [21, 22]. China is a large agricultural country. The Yangtze River basin to the south has more water resources, high precipitation in the summer and autumn, and a hot and humid climate, which are ideal for the growth of pathogenic Leptospira [14, 21, 28]. Agriculture and animal husbandry workers tend to be infected with Leptospira and are at greater risk of exposure [5558].

            Therefore, the best measure to reduce leptospirosis is to prevent infection with Leptospira. However, wild rodents are highly abundant in the urban areas of China and carry many pathogens, including Leptospira, that are difficult to eradicate [28, 40, 47, 48]. Animals carrying pathogens, including Leptospira, may be imported and exported to-and-from the coast with the globalization of trade, which further increases the risk of transmission [23]. Tourism development in some areas of China may have caused ecological damage and an influx of wildlife into urban areas, which also increases the risk of exposure to leptospirosis [5, 14, 17, 26, 27, 4548]. Traditional manual agricultural work is still practiced in some areas of China and workers are more likely to be exposed to Leptospira in the summer, autumn and the rainy season [20]. Therefore, the best way to prevent leptospirosis is to vaccinate occupational groups susceptible to leptospirosis with the Leptospira vaccine [13, 19]. However, there are many serotypes of Leptospira and there is little cross-protection between Leptospira vaccines targeting specific serotypes [59, 60].

            Leptospirosis is prevalent in subtropical and tropical areas of China. Epidemiologic survey results were integrated based on the theme of One Health, which showed that the two main endemic species in China are L. interrogans and L. borgpetersenii. In future scientific studies, it will be crucial to identify one or more proteins that L. interrogans and L. borgpetersenii share and are conserved and immunogenic to facilitate development of a Leptospira vaccine based on this protein that provides good protection against Leptospira.

            Finally, although the incidence of leptospirosis in China has decreased in recent years, due to the diversity of pathogenic Leptospira species, the wide distribution of host animals, and the natural environment suitable for pathogenic Leptospira and host animals, leptospirosis is still an infectious disease that cannot be ignored in China.

            CONCLUSIONS

            Leptospirosis is an emerging zoonosis of global public concern but the symptoms of leptospirosis are like the symptoms of many febrile illnesses and are often overlooked. From the One Health perspective, leptospirosis transmission causes are multifactorial and related to animal, environmental, and socio-human factors. The best preventive measures against leptospirosis are to raise awareness of leptospirosis prevention in leptospirosis-prone areas of China and to vaccinate against Leptospira. Developing a Leptospira vaccine with cross-immunoprotection is essential for further prevention and control of leptospirosis.

            CONFLICTS OF INTEREST

            None of the authors have financial interests in any of the products, devices, or materials mentioned in this manuscript. The authors declare that they have no conflicts of interest.

            REFERENCES

            1. Ko AI, Goarant C, Picardeau M. Leptospira: the dawn of the molecular genetics era for an emerging zoonotic pathogen. Nat Rev Microbiol. 2009. Vol. 7(10):736–747

            2. Bharti AR, Nally JE, Ricaldi JN, Matthias MA, Diaz MM, Lovett MA, et al.. Peru-United States Leptospirosis Consortium. Leptospirosis: a zoonotic disease of global importance. Lancet Infect Dis. 2003. Vol. 3(12):757–771

            3. Ellis WA. Animal leptospirosis. Curr Top Microbiol Immunol. 2015. Vol. 387:99–137

            4. Calvopiña M, Romero-Alvarez D, Vasconez E, Valverde-Muñoz G, Trueba G, Garcia-Bereguiain MA, et al.. Leptospirosis in Ecuador: current status and future prospects. Trop Med Infect Dis. 2023. Vol. 8(4):202

            5. Xu G, Qiu H, Liu W, Jiang X, Chang YF, Wang J, et al.. Serological and molecular characteristics of pathogenic Leptospira in rodent populations in Fujian province, China, 2018-2020. BMC Microbiol. 2022. Vol. 22(1):151

            6. Hamond C, Dirsmith KL, LeCount K, Soltero FV, Rivera-Garcia S, Camp P, et al.. Leptospira borgpetersenii serovar Hardjo and Leptospira santarosai serogroup Pyrogenes isolated from bovine dairy herds in Puerto Rico. Front Vet Sci. 2022. Vol. 9:1025282

            7. Sluydts V, Sarathchandra SR, Piscitelli AP, Van Houtte N, Gryseels S, Mayer-Scholl A, et al.. Ecology and distribution of Leptospira spp., reservoir hosts and environmental interaction in Sri Lanka, with identification of a new strain. PLoS Negl Trop Dis. 2022. Vol. 16(9):e0010757

            8. Yanagihara Y, Villanueva SYAM, Nomura N, Ohno M, Sekiya T, Handabile C, et al.. Leptospira is an environmental bacterium that grows in waterlogged soil. Microbiol Spectr. 2022. Vol. 10(2):e0215721

            9. Miller E, Barragan V, Chiriboga J, Weddell C, Luna L, Jiménez DJ, et al.. Leptospira in river and soil in a highly endemic area of Ecuador. BMC Microbiol. 2021. Vol. 21(1):17

            10. Li X, Zhu L, Zhang SY, Li J, Lin D, Wang M. Characterization of microbial contamination in agricultural soil: a public health perspective. Sci Total Environ. 2024. Vol. 912:169139

            11. Vadde KK, McCarthy AJ, Rong R, Sekar R. Quantification of microbial source tracking and pathogenic bacterial markers in water and sediments of Tiaoxi River (Taihu watershed). Front Microbiol. 2019. Vol. 10:699

            12. Zhao M, Xiao X, Han HJ, Wang LJ, Lei SC, Liu JW, et al.. Leptospira in Bats from Hubei province, China, 2018. J Wildl Dis. 2019. Vol. 55(4):940–943

            13. Hu W, Lin X, Yan J. Leptospira and leptospirosis in China. Curr Opin Infect Dis. 2014. Vol. 27(5):432–436

            14. Wu Y, Wang J, Liu Q, Li T, Luo M, Gong Z. Practice of integrated vector surveillance of arthropod vectors, pathogens and reservoir hosts to monitor the occurrence of tropical vector-borne diseases in 2020 in Zhejiang province, China. Front Vet Sci. 2022. Vol. 9:1003550

            15. Ren SX, Fu G, Jiang XG, Zeng R, Miao YG, Xu H, et al.. Unique physiological and pathogenic features of Leptospira interrogans revealed by whole-genome sequencing. Nature. 2003. Vol. 422(6934):888–893

            16. Xu GY, Zhu HS, Liu WJ, Zeng ZW, Wang JX, Han TW, et al.. [Incidence of leptospirosis in Fujian province, 2015-2020]. Zhonghua Liu Xing Bing Xue Za Zhi. 2022. Vol. 43(4):548–553.

            17. Zhang C, Xu J, Zhang T, Qiu H, Li Z, Zhang E, et al.. Genetic characteristics of pathogenic Leptospira in wild small animals and livestock in Jiangxi province, China, 2002-2015. PLoS Negl Trop Dis. 2019. Vol. 13(6):e0007513

            18. Song N, Zhang W, Ding Y, Wu D, Dai Z, Xu L, et al.. Preliminary characterization of dog derived pathogenic strains of Leptospira interrogans serovar Australis in Nanchang of Jiangxi province, China. Front Vet Sci. 2021. Vol. 7:607115

            19. Zhang C, Wang H, Yan J. Leptospirosis prevalence in Chinese populations in the last two decades. Microbes Infect. 2012. Vol. 14(4):317–323

            20. Cucchi K, Liu R, Collender PA, Cheng Q, Li C, Hoover CM, et al.. Hydroclimatic drivers of highly seasonal leptospirosis incidence suggest prominent soil reservoir of pathogenic Leptospira spp. in rural western China. PLoS Negl Trop Dis. 2019. Vol. 13(12):e0007968

            21. Dhewantara PW, Mamun AA, Zhang WY, Yin WW, Ding F, Guo D, et al.. Epidemiological shift and geographical heterogeneity in the burden of leptospirosis in China. Infect Dis Poverty. 2018. Vol. 7(1):57

            22. Dhewantara PW, Hu W, Zhang W, Yin WW, Ding F, Mamun AA, et al.. Climate variability, satellite-derived physical environmental data and human leptospirosis: a retrospective ecological study in China. Environ Res. 2019. Vol. 176:108523

            23. Pavlin BI, Schloegel LM, Daszak P. Risk of importing zoonotic diseases through wildlife trade, United States. Emerg Infect Dis. 2009. Vol. 15(11):1721–1726

            24. Sun X, Chu D, Li Q, Shi Y, Lu L, Bi A. Dynamic successive assessment of Rural Human Settlements Environment in China. Ecol Indic. 2023. Vol. 157:111177

            25. Chang ZR, Lu L, Mao DQ, Pan HM, Feng LG, Yang XB, et al.. Dynamics of rodent and rodent-borne disease during construction of the three Gorges Reservoir from 1997 to 2012. Biomed Environ Sci. 2016. Vol. 29(3):197–204

            26. Xu J, Chen J, Xiong C, Qin L, Hu B, Liu M, et al.. Pathogenic Leptospira infections in Hubei province, Central China. Microorganisms. 2022. Vol. 11(1):99

            27. Zhao J, Pang B, Liu C, Wang X, Chen S, Feng H, et al.. Infections and influencing factors of pathogens in Rattus norvegicus along the Zengjiang River in Guangzhou, China. Vector Borne Zoonotic Dis. 2024. Vol. 24(1):46–54

            28. Li JM, Li LM, Shi JF, Li T, Wang Q, Ma QX, et al.. Prevalence of Leptospira in murine in China: a systematic review and meta-analysis. Front Vet Sci. 2022. Vol. 9:944282

            29. Ding Y, Zhang W, Xie X, Zhang S, Song N, Liu Z, et al.. Seroepidemiological analysis of Canine Leptospira species infections in Changchun, China. Pathogens. 2023. Vol. 12(7):930

            30. Chikeka I, Dumler JS. Neglected bacterial zoonoses. Clin Microbiol Infect. 2015. Vol. 21(5):404–415

            31. Nogueira DB, da Costa FTR, de Sousa Bezerra C, Soares RR, da Costa Barnabé NN, Falcão BMR, et al.. Leptospira sp. vertical transmission in ewes maintained in semiarid conditions. Anim Reprod Sci. 2020. Vol. 219:106530

            32. Lu J, Hu J, Yu S, Li L. Next generation sequencing for diagnosis of Leptospirosis Combined with multiple organ failure: a Case Report and Literature Review. Front Med (Lausanne). 2022. Vol. 8:756592

            33. Chen SX, Han DK, Liu Y, Ye ZH, Lu K, Xu B, et al.. Leptospira infection complicated by demyelinating disease: a case report. Front Neurol. 2022. Vol. 13:1021364

            34. Shi J, Wu W, Wu K, Ni C, He G, Zheng S, et al.. The diagnosis of leptospirosis complicated by pulmonary tuberculosis complemented by metagenomic next-generation sequencing: a case report. Front Cell Infect Microbiol. 2022. Vol. 12:922996

            35. Yang W, Pang J, Li C. [An investigation on the distribution of Leptospirae interrogans in water and soil in southwest of Yunnan province]. Zhonghua Liu Xing Bing Xue Za Zhi. 1994. Vol. 15(5):289–291.

            36. Rehan ST, Ali E, Sheikh A, Nashwan AJ. Urban flooding and risk of leptospirosis; Pakistan on the verge of a new disaster: a call for action. Int J Hyg Environ Health. 2023. Vol. 248:114081

            37. Zhu Z, Feng J, Dong Y, Jiang B, Wang X, Li F. Cerebral infarct induced by severe leptospirosis-a case report and literature review. BMC Neurol. 2022. Vol. 22(1):506

            38. Dhewantara PW, Zhang W, Al Mamun A, Yin WW, Ding F, Guo D, et al.. Spatial distribution of leptospirosis incidence in the Upper Yangtze and Pearl River Basin, China: tools to support intervention and elimination. Sci Total Environ. 2020. Vol. 725:138251

            39. Li S, Wang D, Zhang C, Wei X, Tian K, Li X, et al.. Source tracking of human leptospirosis: serotyping and genotyping of Leptospira isolated from rodents in the epidemic area of Guizhou province, China. BMC Microbiol. 2013. Vol. 13:75

            40. Wang C, He H. Leptospira spp. in commensal rodents, Beijing, China. J Wildl Dis. 2013. Vol. 49(2):461–463

            41. Wang ZD, Wang SS, Liu LJ, Yang Y, Li M, Guo TY, et al.. [The infection status of Leptospira in rodents on the Heixiazi island of Heilongjiang province, China, in 2011]. Zhonghua Yu Fang Yi Xue Za Zhi. 2013. Vol. 47(6):510–513.

            42. Zhao M. [The serogroup and serotype distribution of Leptospira in Sichuan province from 1958-1987]. Zhonghua Liu Xing Bing Xue Za Zhi. 1991. Vol. 12(4):226–230.

            43. Pan ZA, He QY. [The sero-epidemiological investigation of leptospirosis in Hainan province]. Zhonghua Liu Xing Bing Xue Za Zhi. 1995. Vol. 16(6):369–371.

            44. Liu RY, Zeng YX, Yang CH, Wang LP. [Epidemiological characteristics of leptospirosis in Sichuan province, 2004-2018]. Zhonghua Liu Xing Bing Xue Za Zhi. 2020. Vol. 41(5):695–699.

            45. Yang T, Yang W, Kuang G, Pan H, Han X, Yang L, et al.. Prevalence and characteristics of novel pathogenic Leptospira species in bats in Yunnan province, China. Microorganisms. 2023. Vol. 11(6):1619

            46. Han HJ, Wen HL, Liu JW, Qin XR, Zhao M, Wang LJ, et al.. Pathogenic Leptospira species in insectivorous bats, China, 2015. Emerg Infect Dis. 2018. Vol. 24(6):1123–1126

            47. Shao JW, Wei YH, Yao XY, Chen HY, Liu H, Sun J, et al.. Pathogenic Leptospira species are widely disseminated among wild rodents in urban areas of Guangzhou, Southern China. Microorganisms. 2022. Vol. 10(5):873

            48. Su Q, Chen Y, Wang B, Huang C, Han S, Yuan G, et al.. Epidemiology and genetic diversity of zoonotic pathogens in urban rats (Rattus spp.) from a subtropical city, Guangzhou, southern China. Zoonoses Public Health. 2020. Vol. 67(5):534–545

            49. Li D, Liang H, Yi R, Xiao Q, Zhu Y, Chang Q, et al.. Clinical characteristics and prognosis of patient with leptospirosis: a multicenter retrospective analysis in south of China. Front Cell Infect Microbiol. 2022. Vol. 12:1014530

            50. Ji J, Wang W, Xiang S, Wei X, Pang G, Shi H, et al.. Diagnosis of Leptospira by metagenomics next-generation sequencing with extracorporeal membrane oxygenation support: a case report. BMC Infect Dis. 2023. Vol. 23(1):788

            51. Zheng X, He P, Zhong R, Chen G, Xia J, Li C. Weil’s disease in an HIV-infected patient: a case report and literature review. Diagnostics (Basel). 2023. Vol. 13(20):3218

            52. Yalin W, Lingbing Z, Hongliang Y, Jianmin X, Xiangyan Z, Xiaokui G, et al.. High prevalence of pathogenic Leptospira in wild and domesticated animals in an endemic area of China. Asian Pac J Trop Med. 2011. Vol. 4(11):841–845

            53. Zhang Q, Han S, Liu K, Luo J, Lu J, He H. Occurrence of selected zoonotic fecal pathogens and first molecular identification of Hafnia paralvei in wild Taihangshan Macaques (Macaca mulatta tcheliensis) in China. Biomed Res Int. 2019. Vol. 2019:2494913

            54. Ma XJ, Gong XQ, Xiao X, Liu JW, Han HJ, Qin XR, et al.. Detection of Leptospira interrogans in Hedgehogs from Central China. Vector Borne Zoonotic Dis. 2020. Vol. 20(6):427–431

            55. Shi Y, Guo W, Hu M, Wang Y, Li J, Hu W, et al.. A case of severe leptospirosis with Jarisch-Herxheimer reaction presenting as respiratory failure. Front Public Health. 2023. Vol. 11:1125306

            56. Dai J, Yao C, Ling H, Li B, Chen R, Shi F. A rare case of severe leptospirosis infection presenting as septic shock in a non-endemic area: a case report and literature review. BMC Infect Dis. 2023. Vol. 23(1):503

            57. Zhang Y, Zheng Y. Leptospirosis-associated meningitis in a patient with sjögren’s syndrome: a case report. BMC Infect Dis. 2023. Vol. 23(1):778

            58. Jin Y, Lan W, Chen X, Liu W, Luo W, Chen S. A rare case of anti-DPPX encephalitis combined with neuroleptospirosis. BMC Neurol. 2024. Vol. 24(1):34

            59. Zhang C, Yang H, Li X, Cao Z, Zhou H, Zeng L, et al.. Molecular typing of pathogenic Leptospira serogroup icterohaemorrhagiae strains circulating in China during the past 50 years. PLoS Negl Trop Dis. 2015. Vol. 9(5):e0003762

            60. Zhang C, Li Z, Xu Y, Zhang Y, Li S, Zhang J, et al.. Genetic diversity of Leptospira interrogans circulating isolates and vaccine strains in China from 1954-2014. Hum Vaccin Immunother. 2019. Vol. 15(2):381–387

            Author and article information

            Journal
            Zoonoses
            Zoonoses
            Zoonoses
            Compuscript (Shannon, Ireland )
            2737-7466
            2737-7474
            12 December 2024
            : 4
            : 1
            : e964
            Affiliations
            [1 ]Department of Clinical Veterinary Medicine, College of Veterinary Medicine, Jilin University, Changchun, China
            [2 ]State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Key Laboratory for Zoonosis Research of the Ministry of Education, College of Veterinary Medicine, Jilin University, Changchun, China
            [3 ]Population Medicine and Diagnostic Sciences, Cornell University, College of Veterinary Medicine, Ithaca, NY, USA
            Author notes
            *Corresponding author: yc42@ 123456cornell.edu (YFC); ygcao82@ 123456jlu.edu.cn (YC)

            #These authors contributed equally to this work.

            Article
            10.15212/ZOONOSES-2024-0040
            b004ea6f-aeaf-46fa-8584-4515da49628c
            2024 The Authors.

            This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY) 4.0, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.

            History
            : 29 August 2024
            : 12 November 2024
            : 22 November 2024
            Page count
            Figures: 2, Tables: 1, References: 60, Pages: 8
            Funding
            Funded by: National Key R&D Program of China
            Award ID: 2023YFE0122700
            Funded by: National Natural Science Foundation of China
            Award ID: 32302879
            Funded by: National Natural Science Foundation of China
            Award ID: 32172872
            This research was funded by the National Key R&D Program of China (Grant No. 2023YFE0122700) and the National Natural Science Foundation of China (Grant Nos. 32302879 and 32172872).
            Categories
            Review Article

            Parasitology,Animal science & Zoology,Molecular biology,Public health,Microbiology & Virology,Infectious disease & Microbiology
            leptospirosis,environmental factors,epidemiology,China,animal factors

            Comments

            Comment on this article