Prevalence and risk factors for human leptospirosis at a hospital serving a pastoralist community, Endulen, Tanzania

by Michael J. Maze, Gabriel M. Shirima, Abdul-Hamid S. Lukambagire, Rebecca F. Bodenham, Matthew P. Rubach, Shama Cash-Goldwasser, Manuela Carugati, Kate M. Thomas, Philoteus Sakasaka, Nestory Mkenda, Kathryn J. Allan, Rudovick R. Kazwala, Blandina T. Mmbaga, Joram J. Buza, Venance P. Maro, Renee L. Galloway, Daniel T. Haydon, John A. Crump, Jo E. B. Halliday

Leptospirosis is suspected to be a major cause of illness in rural Tanzania associated with close contact with livestock. We sought to determine leptospirosis prevalence, identify infecting Leptospira serogroups, and investigate risk factors for leptospirosis in a rural area of Tanzania where pastoralist animal husbandry practices and sustained livestock contact are common.

We enrolled participants at Endulen Hospital, Tanzania. Patients with a history of fever within 72 hours, or a tympanic temperature of ≥38.0°C were eligible. Serum samples were collected at presentation and 4–6 weeks later. Sera were tested using microscopic agglutination testing with 20 Leptospira serovars from 17 serogroups. Acute leptospirosis cases were defined by a ≥four-fold rise in antibody titre between acute and convalescent serum samples or a reciprocal titre ≥400 in either sample. Leptospira seropositivity was defined by a single reciprocal antibody titre ≥100 in either sample. We defined the predominant reactive serogroup as that with the highest titre. We explored risk factors for acute leptospirosis and Leptospira seropositivity using logistic regression modelling.

Of 229 participants, 99 (43.2%) were male and the median (range) age was 27 (0, 78) years. Participation in at least one animal husbandry practice was reported by 160 (69.9%). We identified 18 (7.9%) cases of acute leptospirosis, with Djasiman 8 (44.4%) and Australis 7 (38.9%) the most common predominant reactive serogroups. Overall, 69 (31.1%) participants were Leptospira seropositive and the most common predominant reactive serogroups were Icterohaemorrhagiae (n = 21, 30.0%), Djasiman (n = 19, 27.1%), and Australis (n = 17, 24.3%). Milking cattle (OR 6.27, 95% CI 2.24–7.52) was a risk factor for acute leptospirosis, and milking goats (OR 2.35, 95% CI 1.07–5.16) was a risk factor for Leptospira seropositivity.

We identified leptospirosis in approximately one in twelve patients attending hospital with fever from this rural community. Interventions that reduce risks associated with milking livestock may reduce human infections.