Leptospirosis and human immunodeficiency virus co-infection among febrile inpatients in northern Tanzania.
Abstract
BACKGROUND: Leptospirosis and human immunodeficiency virus (HIV) infection are prevalent
in many areas, including northern Tanzania, yet little is known about their interaction.
METHODS: We enrolled febrile inpatients at two hospitals in Moshi, Tanzania, over
1 year and performed HIV antibody testing and the microscopic agglutination test (MAT)
for leptospirosis. Confirmed leptospirosis was defined as ≥ four-fold rise in MAT
titer between acute and convalescent serum samples, and probable leptospirosis was
defined as any reciprocal MAT titer ≥ 800. RESULTS: Confirmed or probable leptospirosis
was found in 70 (8.4%) of 831 participants with at least one serum sample tested.
At total of 823 (99.0%) of 831 participants had HIV testing performed, and 203 (24.7%)
were HIV infected. Among HIV-infected participants, 9 (4.4%) of 203 had confirmed
or probable leptospirosis, whereas among HIV-uninfected participants 61 (9.8%) of
620 had leptospirosis. Leptospirosis was less prevalent among HIV-infected as compared
to HIV-uninfected participants [odds ratio (OR) 0.43, p=0.019]. Among those with leptospirosis,
HIV-infected patients more commonly presented with features of severe sepsis syndrome
than HIV-uninfected patients, but differences were not statistically significant.
Among HIV-infected patients, severe immunosuppression was not significantly different
between those with and without leptospirosis (p=0.476). Among HIV-infected adolescents
and adults, median CD4 percent and median CD4 count were higher among those with leptospirosis
as compared to those with other etiologies of febrile illness, but differences in
CD4 count did not reach statistical significance (p=0.015 and p=0.089, respectively).
CONCLUSIONS: Among febrile inpatients in northern Tanzania, leptospirosis was not
more prevalent among HIV-infected patients. Although some indicators of leptospirosis
severity were more common among HIV-infected patients, a statistically significant
difference was not demonstrated. Among HIV-infected patients, those with leptospirosis
were not more immunosuppressed relative to those with other etiologies of febrile
illness.
Type
Journal articleSubject
AdolescentAdult
Aged
Animals
Antibodies, Bacterial
Antibodies, Viral
Child
Child, Preschool
Coinfection
Female
Fever
HIV Infections
HIV-1
HIV-2
Humans
Infant
Inpatients
Leptospira
Leptospirosis
Male
Middle Aged
Tanzania
Young Adult
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https://hdl.handle.net/10161/13780Published Version (Please cite this version)
10.1089/vbz.2012.1205Publication Info
Biggs, Holly M; Galloway, Renee L; Bui, Duy M; Morrissey, Annie B; Maro, Venance P;
& Crump, John A (2013). Leptospirosis and human immunodeficiency virus co-infection among febrile inpatients
in northern Tanzania. Vector Borne Zoonotic Dis, 13(8). pp. 572-580. 10.1089/vbz.2012.1205. Retrieved from https://hdl.handle.net/10161/13780.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
John Andrew Crump
Adjunct Professor in the Department of Medicine
I am based in northern Tanzania where I am Site Leader for Duke University’s
collaborative research program based at Kilimanjaro Christian Medical Centre and Director
of Tanzania Operations for the Duke Global Health Institute. I oversee the design
and implementation of research studies on infectious diseases, particularly febrile
illness, invasive bacterial disease, HIV-associated opportunistic infections, clinical
trials of antiretroviral therapy and prevention of mother-to-child tr

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