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Leptospirosis in India: insights on circulating serovars, research lacunae and proposed strategies to control through one health approach

One Health Outlook volume 6, Article number: 11 (2024) Cite this article

Abstract

Leptospirosis is one of the most neglected zoonotic infections of public health concern worldwide and a remerging infection in tropical countries such as India. The infection least explored disease and the epidemiological and other critical data are scarce for the disease rate reported and to control the infection. Leptospirosis as sapronosis is as underrated as the infection itself, and this article aims to explore the significance of this aspect of the disease. The research review aimed at the epidemiological understanding of the infection to control the negative impact of the disease. A mixed review and analysis were carried out to understand the knowledge published on the critical and understudied areas like epidemiology, transmission, diagnosis, treatment, and control of infection. A systematic analysis was carried out to extract information about the reported circulating strains, and research lacunae in India with the published data available in PubMed. The article elaborately discusses crucial inference areas of infection transmission and addresses lacunae in critically unacclaimed areas of infection to control the spread of infection using one health approach (OHA), and strategies to control leptospiral infection are proposed. The article also reviewed how and why Leptospirosis can be best studied and controlled by “One health approach” in India.

Graphical Abstract

Highlights

Leptospiral strains reported from one health domain source, human, animal, and environmental samples in India are listed to display the epidemiology of infection in India. This article discusses the lacunae in Leptospirosis research in crucial domains and one of the core areas of transmission and how it is the major target for the control of infection in animals and humans. The study has a list of recommendations for the establishment of a One Health working group and possible control strategies for transmission.

Introduction

Approximately 60% of human infections are zoonotic, and 75% of these zoonotic infections are emerging and remerging [1, 2]. Leptospirosis is one of 17 neglected tropical infections listed by the World Health Organization [2]. It is an endemic infection in tropical countries and in some temperate regions and is prevalent globally [3]. The disease cycle of the infection is complex and dynamic, comprising humans, animals, and contaminated soil and water bodies. Hence, this zoonoses requires a holistic approach to the control and prevention of infection [4]. The infection is not adequately understood in an endemic country like India, to control and prevent the infection. Hence, intervention or policy-making for controlling this disease with an intricate transmission cycle and epidemiology must involve distinctive and thriving approaches to control and prevent infection [5].

“One Health” (OH) is a holistic approach that has been in practice dating back to the 1800s and lately is gaining popularity among researchers due to the effectiveness of the concept of controlling diseases, especially sapronosis. The concept addresses and identifies the domains that are involved in the transmissions and domains/factors that complement the persistence of pathogens. This approach encompasses human, animal, and environmental health and facilitates better control by providing balanced significance to dominating areas(s) that contribute to the spread and burden of infection threats to public health [6,7,8]. The current study aimed to identify the epidemiology of the infection in India with the reported strains, the research gap, and the effective areas of infection to control infection involving multiple mediums involved in infection.

Leptospirosis is prevalent globally, and it has been estimated that over 1 million infections occur in humans, with a mortality rate of 60,000 deaths annually [9]. The disease has slowly created a sense of public health emergency among the scientific community towards control due to the sudden surge and reemergence of infection [10]. Leptospira is one of the major pathogens that cause A.U.F.I. (acute undifferentiated febrile illness) in humans, infects productive animals, and is majorly present in the environment soil, and waterbodies. The infection contributes to a 2.90 million D.A.L.Y score per year, which is relatively more than other tropical infections, such as malaria, tuberculosis, filariasis, rabies dengue, etc. [11, 12]. Leptospira is a thin, long, slender hair-like, gram-variable spirochete [13]. There are 30 serotypes, and more than 350 serovars of leptospires have been reported to date categorized into pathogenic, intermediate, and saprophytic groups based on the pathogenicity [14].

In humans, it is primarily transmitted from infected, and carrier animals, they also shed bacteria in the environmental soil and water bodies from where humans contract the infection. This indirect mode from “environmental reservoir” is reported more than direct infection from animal sources. The entry of pathogens is reported to be through cuts or abrasions, inhalation, ingestion, and rarely through vertical and interhuman transmission [14,15,16]. The infection ranges from a mild flu-like illness to life-threatening multiorgan failure and death. Common clinical manifestations, such as fever, arthralgia, myalgia, typical frontal headache, pain and tenderness confined to calf muscles, conjunctival suffusion, lymphadenopathy, and occasionally skin rashes, are seen in 90—95% of cases, and severe infections are reported in the remaining 5–10% of cases infecting the hepatorenal system, termed “icteric” infection. Additionally, the delay in antibiotic treatment could lead to infection in the respiratory system. Another typical and unnoticed sign of this infection is conjunctival suffusion or uveitis in patients. 2) The icteric phase involves the liver and causes hepatic infection, resulting in jaundice [17,18,19]. Recently, the disease was found to manifest varied atypical and nonspecific clinical signs due to changes in the molecular material and geographical origin of strains [20]. The pathogen forms a biofilm in the epithelial cells of renal tubules and survives there for many months, shedding in urine, and acts as the major transmission host [21, 22].

In animals, the infection continues to be of utmost economic importance, directly influencing the country's economy through its impact on productive livestock. There is a wide range of domestic and wild animal hosts for transmission and maintenance of the pathogen. Major animals found to be affected are bovines, equines, porcines, rodents, etc. Infecting bovines, of all animals, has the greatest impact on the country's economy, as they are interrelated and impact agricultural and livestock activities [23]. In cattle and goats, reports of infection and its impacts indicated stillbirths, weak siblings, premature birth, abortion, sterility, mastitis, decreased milk productivity, etc. [24, 25]. The infection like in humans ranges from mild to life-threatening in ruminants and manifests through fever, anemia, and jaundice. Despite sharing equal risk with other animals, the epidemiology of leptospirosis in swine is not well established [26,27,28].

Leptospires affect mammalian hosts to maintain their transmission cycle. Rats are permanent and lifetime carriers of pathogens in the renal tubules of the kidney and can shed approximately 107 to 108 leptospires into the environment per ml of urine and in their body fluids [29, 30]. Other animals were found to secrete 5.1 × 108 to 1.3 × 109 cells per day and 5.1 × 109 cells per day rats, as per a meta-analysis conducted by Barragan et al. [29]. Rodents are believed to be the carrier for diverse serogroups of Leptospira interrogans and Leptospira borgpetersenii serovars were also isolated from rodents in India [25].

Canines are notable transmitters of infection, chiefly, posing as asymptomatic infections where symptomatic infection presents with fever, lethargy, shivering, muscle tenderness, change in urination amount, dehydration, and loss of appetite. Depending on the mode of transmission, vomiting, diarrhea, indigestion, and dyspnea are caused by inhalation. The infection is mild, and the animals recover spontaneously with transient illness. Sparsely, kidney and liver infections are reported with jaundice and other life-threatening infections. Felines, however historically known to be resistant to Leptospirosis, were now reported with the infection due to the evolution of pathogens [31,32,33]. Wild faunal species such as deer, elephants, mongoose, and fish are also carriers of leptospires. The animal reservoir of leptospires in an area can be associated with the serovars in circulation. In other words, the serogroup of leptospires is confined to host animals.

Environmental waterbodies and soil play crucial roles in the existence, survival, and transmission of pathogens and are understudied, underestimated, and underrated [34,35,36]. Pathogenic Leptospires washed away from the soil with fertilizer during natural disasters like heavy rain and flooding, can increase the alkalinity of water bodies, and promote the growth and spread of disease-causing pathogens, posing a dual threat to ecosystems. Agricultural lands with stagnant water and wet soil reinforce the pathogens to thrive more and act as a source for the transmission of infection in the major occupational risk group, agricultural field workers [37]. Recent studies have indicated that leptospires can aggregate and aggregate with other bacteria, such as Azospirillum brasilense, Sphingomonas, and Micrococcus, to survive and exist against environmental stressors. Survival and multiplication of leptospires are complemented by the pH, soil moisture, minerals, and salt concentration of the environment [38, 39]. Leptospira has been found in various water sources, including freshwater bodies, agricultural areas, sewage systems, ornamental water features, and even the ocean. While pathogenic and intermediate strains need a host to spread the infection, the saprophytic biflexa group can cause infection without relying on a transmission host, as it feeds on organic matter [34,35,36, 40, 41].

Methodology

Leptospirosis is endemic to India due to a tropical climate that complements the transmission of infection. Scientists believe that the first disease outbreak in the 1920s among convicts of Andaman with a pulmonary hemorrhage outbreak three years after the successful culturing of organisms [41]. To understand the circulating serogroups and knowledge gap we planned to carry out mixed methods to acquire information on the reported circulating serovars of the pathogens like systematic review and literature review. We collected 566 articles available in PubMed with the keywords “Leptospirosis” and “India” published until February 2023 systematically. The articles that published research data about circulating serovars through serological and molecular techniques were included. Data extraction was done for information on authors, year of publication, study region, the technique used for the identification, and source of sample without geographical restrictions and characteristics. With this systematic analysis and literature review of the research gap analysis, data on the circulating serogroups in humans, animals, and the environment were tabulated and discussed in the respective sections. The proposed intervention for the control of infection concerning the research gap also was given concerning the OH concept.

Results and discussion

The literature review indicates that Leptospirosis was first suspected among convicts in the Andaman and Nicobar Islands in the early 1900s. However, critical aspects such as disease patterns, transmission mechanisms, and pathogenesis still lack comprehensive understanding. The spatial–temporal characteristics of the Indian subcontinent contribute to its status as a leptospirosis hotspot [36, 42]. Most of the serogroups of L. interrogans found in animals are known to cause infections in humans, but the reverse scenario is not reported. Also, other pathogenic species of Leptospira than interrogans in the analysis are not found except for the rodent population. Human infection from animal sources was reported, but the transmission pattern and the dynamics among animals, humans, and the environment are unclear. Understanding the transmission of infection and the role of different domains in zoonotic infections is crucial to determining the disease rate. Our review found that few studies studied two domains of the disease cycle and no study encompasses all three major domains of infection, hence the transmission pattern of the infection cannot be defined in India among animals, humans, and the environment [43, 44].

Spatially, Southern states of India, particularly Tamil Nadu, Karnataka, Kerala, and Puducherry, are endemic for leptospirosis, with a high number of reported cases. The Andaman and Nicobar Islands are notable hotspots for both infections and reporting on leptospirosis. Conversely, Maharashtra, Gujarat, Kolkata, and Orissa are also endemic, but with less reported information on leptospirosis [45,46,47]. Research articles on epidemiology show that over 50% of studies originate from Tamil Nadu, Kerala, Karnataka, Andhra Pradesh, Orissa, and the Andaman and Nicobar Islands. While the prevalent serogroups historically included were still found to infect the hosts, recent years have seen a shift in serogroups affecting both humans and animals [28, 48, 49].

Generally, humans are the major studied research domain in zoonotic diseases; in contrast, this research found that animal leptospirosis is a well-studied domain over humans in India. On the other hand, infection status in the human and animal populations needs to be studied well for the effective control of infection. Apart from domestic animals, the role of wild animals, especially at the human and wildlife ecological interface, crucial role in maintaining leptospiral infection has yet to be explored [50]. Environmental studies on leptospirosis are the least explored domain of zoonotic pathogens in India. [51,52,53]. Detecting and surveilling leptospirosis is complex and requires expertise, making the infection often overlooked due to insufficient awareness and negligence among healthcare workers, risk groups, veterinarians, public health scientists, and epidemiologists [23, 45].

To address the shortcomings of details about the epidemiology of leptospirosis in India, we also systematically analyzed the literature to identify the serovars circulating in India with the reported research. The Leptospira serovars reported in India from 1992 to date in animals and humans in different regions are shown in Table 1 [24, 32, 45, 54,55,56,57,58,59,60,61,62].

Table 1 Prevalent serogroups of leptospira in india reported by researchers around the country
Full size table

With the systematic analysis, we also found that the serovars specifically affected hosts from the data of included studies and presented in Table 1. With the mixed review, we found that Critical data on the infection like epidemiology, and transmission patterns and dynamics, the pathogenicity of the infection in humans and animals, the ability of the pathogen against environmental stressors are not reported. It is evident from the data Table 2 that L. interrogans is the most commonly reported species found to infect humans and in animals, serovars affecting cattle are reported more may be attributed to their economic impact on the country. It is also observed that the rodents carry diverse species including L. borgepetersenii, a human infection that is not reported in India [71]. A considerable number of investigations utilized MAT for the diagnosis by detection of antibodies against Leptospira infection using reference Leptospira serovar panel, molecular detection report is sparse. Though MAT is a sophisticated and cumbersome technique it is the basic and efficient tool in the diagnosis of leptospirosis [87]. Molecular typing techniques used were FAFLP and MLST with the STs of Leptospira strains reported in India are ST145 and ST27 from Tamil Nadu, which again proves that the data on molecular epidemiology is limited [69, 76].

Table 2 Leptospira serogroups reported and their hosts in India
Full size table

Table 1 projects the epidemiology by presenting the serovars circulating in India over time and there is not much change found in their trends over time through systematic search and data analysis. Recently, Leptospira borgepetersenii, a non-native serogroup in India, has been isolated from rats [69]. Nevertheless, its zoonotic potential has not been explored to advance the knowledge of the transmission of the infection [88]. Regarding collaboration, there is limited recognition of interdisciplinary, multi-center, international, and public–private collaborations in Leptospirosis. Limitations in the number and heterogeneity of research data exacerbate the research gaps. Hence we propose,

One health coordination committee to understand transmission and improve diagnosis and surveillance of infection

Establishing an influential one health committee (O.H.C.) with profound knowledge and interest is the critical prospect of controlling infectious disease. Ideally, it should comprise veterinarians, environmental biologists, healthcare workers, physicians, army officers, social workers, and data scientists. An ideal OH concept should pass the following criteria: 1) As far as leptospires are concerned, the process should begin with the development methodology and conceptual framework that attributes detection, surveillance, and regular monitoring of the infection rate in humans and animals within an environment to get the basic knowledge about the epidemiology of infection in India [61, 89]. 2) The data collected from the previous process should be transferred to all the members of the committee to share ideas, concept modifications, and changes in methodology. 3) Acquisition of current knowledge about the interference of three domains and the epidemiological data obtained policies should be designed in a manner that welcomes research knowledge from every member of the committee. This team should validate the M.A.T. panel used in each region. The LipL32 is employed to detect pathogenic leptospires by serological and molecular detection must be revised with the more sensitive SecY gene, which should be further proceeded by updating the team alongside imposing the necessary protocol to be followed, wherever needed [90]. Appropriate intervention strategies include a) using appropriate PPE to risk groups that hinder the propagation of infection from the water-host interface, followed by preventative strategies towards control, sterilization, and vaccination of reservoirs against opportunistic carriers such as rodents and domestic animals such as cattle, dogs, goats, pigs, and wild animals [68, 74]. B) Vaccine design devised following the vast epidemiological knowledge acquired about infections among humans and animals. C) Approach towards altering the diagnosis criteria with an updated clinical presentation and diagnostic techniques to limit against the imposed differential diagnosis [91]. D) Minimize or clear misconceptions and propagate misleading information about the infection among and other than committee members. 4) At this point, the committee must ensure that devising policies, processes, and protocols are effective. The data should be circulated among them, considering every member to be significant and to be treated unanimously, irrespective of their domain. 5) Creating awareness about the infection by training social workers to create awareness among the target population [92]. 6) The committee should monitor the process continuously and update the process whenever required and wherever necessary until the goal of the committee is reached. 7) It should also keep an eye on the nonendemic area for any leptospirosis outbreak and control using doxycycline as a chemoprophylactic drug at the earliest to avoid mortality. Since little is known about the infection, the development of information technology and data science could be regarded as the foremost significant steps for O.H. processes, as it can be replaced by the following process for generating the current data acquired in real-time data [93].

Forecasting disease transmission and epidemiology

Due to the inadequacy, data acquisition on the significant areas of the infection throughout the country especially in Northern India where the disease is least suspected due to the spatiotemporal characteristics. A vast pool of knowledge about the disease aspect of leptospirosis is beyond the bounds of possibility throughout India. Hence, forecasting the transmission rate and pattern will aid in defining whether there exists a similar condition/scenario or change in transmission reported in the Andaman and Nicobar Islands. This is feasible by employing computational biology tools such as ADEPTUS with the data acquired on the circulating serovars reported from different parts of India. [94,95,96]. Most importantly, this will leverage the achieved data on epidemiology and environmental reservoirs of leptospirosis, which needs crucial understanding. This will present scientists with knowledge about possible circulating serovars regionally and allow epidemiologists to make inferences and apply appropriate intervention strategies.

Functional attributes of public/private organizations involved in disease control

Numerous control programs targeting leptospirosis have been conducted and documented. Expert researchers with an extensive understanding of the infection have advocated for various strategies, including surveillance enhancements and policy revisions, to curb its spread. In 2000, a collaborative effort was initiated, linking national centers across India, to establish a multi-task force aimed at estimating the disease burden associated with leptospirosis in the country. [97, 98]. Notably, an Informal Expert consultation on Surveillance, Diagnosis, and Risk Reduction of Leptospirosis held at ICMR-National Institute of Epidemiology conducted by WHO recommended a multisectoral and multidisciplinary approach to control infection back then in 2009. Following disease outbreaks, several endemic states like Kerala and Orissa established surveillance systems to monitor and respond to the disease but there is no Multi-centric, multidisciplinary, and National program throughout the country reported for surveillance and control [47, 99].

But in India, the presence of various boards overseeing different aspects of the One Health concept-encompassing humans, animals, and the environment, poses a challenge in coordinating committees aimed at controlling zoonotic diseases. Occasionally, these committees overlook the necessity of amending stringent national One Health policies for effective disease control [75]. There is a pressing need for an overarching organization to facilitate collaboration across these domains at a national level. Such an initiative is essential to combat the re-emergence, emergence, and persistence of infectious diseases. It is imperative to establish robust infrastructure, governance structures, and policies, allocate human resources, and provide effective leadership in India to effectively tackle the re-emergence of infectious diseases. [47, 100].

Risk assessment and deduction

Understanding the infection rate and risk in one health domain will significantly aid in the control and prevention of reemergence of infection. In leptospirosis, the key and major area of transmission is where contaminated water surfaces interfere with human and animal hosts and should be monitored to observe whether this transmission rate enhances the transmission rate, infection rate, infection by multiple strains, etc. In India risk people who have a greater risk population of contracting the disease, including pets and domestic animals, should also be monitored for the same by trained veterinarians, healthcare providers, and medical officers without negligence.

Detecting and intervening with pathogenic leptospires, as well as identifying diversity among strains, will yield insights into local transmission at the community level. This knowledge is crucial for understanding the domains that facilitate and support transmission, addressing significant gaps in disease treatment. These data about the environment, animals, and humans at risk will help reduce the risk of infection. This should also include identifying the contaminated area and continuous, systematic environmental surveillance, as it is comparatively the least studied domain of one health approach in India and globally [101]. Abduction and treatment of suspected and confirmed animals with leptospirosis. Sterilization and vaccinating suspected permanent carriers such as rodents can be considered for the same. Proper sanitation and good hygienic practice training for the urban risk group of people living in slums can also control the infection [102].

Proposed actions required by the public/private organizations

Collaboration of multiple sectors of public, private, and government bodies to control infection must be encouraged by organizations. It should ensure that the control program and intervention strategies implemented are followed up continuously through periodic discussion, continual review, and regular surveillance, including geographical and epidemiological aspects. It should support finances to disseminate the research information to the desired population through appropriate and trained professionals. Scientists, researchers, and activists should invest their knowledge equally in animals and the environment as humans and conduct “one health” research by providing fund schemes [103]. Public awareness education, providing PPE to the risk group, vaccinating animals, and controlling rodents will directly help strengthen India's economic status [104].

Conclusion

Leptospirosis is a special and fastidious pathogen that requires sophisticated laboratory requirements for diagnosis and research; hence, it is traditionally neglected, and research data on the bacteria are scarce to control the infection [92]. The increase in the incidence of infection, emergence, and the reemergence of the disease in India could be attributed to the delayed report on infection, followed by a lack of process, and the medium of transmission as well followed by the lack of transferability of knowledge concerning the infection and its nature [105]. The review explored the lacunae to control infection and epidemiology in India. Epidemiology is crucial data to accurately diagnose and treat the infection and for the effective control of infection. Systematic analysis of data from the articles to extract cumulative data on circulating strains of pathogenic leptospires for the first time complements the comprehensive understanding and efforts to mitigate infection. Leptospira interrogans are the circulating genomospecies reported primarily from humans and animals. However, there is evidence of Leptospira borgepetersenii from rats, and their transmission to the other two domains of the disease requires more attention and exploration for a deeper knowledge of the epidemiology of the infection in India [69, 71]. The holistic, One Health approach will add insightful information on the crucial, dynamic, and significant areas of infection, transmission, and epidemiology of leptospirosis.

The study also discussed the mechanism through which pathogens in environmental stressors persist in infectious diseases, specifically zoonoses. However, as a sapronosis, the infection cannot be controlled only through conventional and regular strategies. Water bodies and soil/environmental domains act as the “environmental reservoirs” and key inference areas that complement the survival, maintenance, and proliferation of pathogens and the transmission of infection [106]. Hence, disease control intervention in this area of one health domain transmission should be considered pivotal and targeted with greater attention by emphasizing one health concept discussed for effective control of the infection.

OH lab aid towards diagnosis and surveillance of infection, followed by providing simultaneous or timely information, could effectively restrain the spread of infection in nonendemic regions [107]. Furthermore, it minimizes the cost of diagnosis, treatment, and prevention of disease by utilizing the supportive data imparted by OH. The database aids in sharing known data about infection. It provides room for trained professionals to report the most relevant and supporting data about a disease that will be established as a suitable approach in medical centers available in the vicinity of hotspots. Additionally, the database accessibility will be available for the public's disposal, which might plausibly step up for the betterment of repercussions.

Availability of data and materials

Not applicable.

Abbreviations

OH:

One Health

MAT:

Microscopic agglutination test

PPE:

Personal protective equipment

AUFI:

Acute undifferentiated febrile illness

OHC:

One health committee

FAFLP:

Fluorescent amplified fragment length polymorphism

MLST:

Multi Locus Sequence Typing

STs:

Sequence Types ADEPTUS

References

  1. WHO EMRO | Zoonotic disease: emerging public health threats in the Region | RC61 | About WHO . Available from: https://www.emro.who.int/about-who/rc61/zoonotic-diseases.html.

  2. WHO. Neglected zoonotic tropical diseases. [cited 2021 Oct 18]. Available from: https://www.who.int/news-room/facts-in-pictures/detail/neglected-zoonotic-tropical-diseases

  3. CDC. Leptospirosis | CDC . [cited 2023 Feb 10]. Available from: https://www.cdc.gov/leptospirosis/index.html

  4. Chadsuthi S, Chalvet-Monfray K, Kodjo A, Wiratsudakul A, Bicout DJ. Modeling of the combined dynamics of leptospirosis transmission and seroconversion in herds. Sci Rep. 2022;12(1):15620. https://doi.org/10.1038/s41598-022-19833-x. (PMID:36114406 PMCID:PMC9481562).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Moola S, Beri D, Salam A, Jagnoor J, Teja A, Bhaumik S. Leptospirosis prevalence and risk factors in India: Evidence gap maps. Trop Doct. 2021;51(3):415–21. https://doi.org/10.1177/00494755211005203. (Epub 2021 Apr 9 PMID: 33832378).

    Article  PubMed  Google Scholar 

  6. Rabozzi G, Bonizzi L, Crespi E, Somaruga C, Sokooti M, Tabibi R, Vellere F, Brambilla G, Colosio C. Emerging zoonoses: the "one health approach". Saf Health Work. 2012 ;3(1):77–83. doi: https://doi.org/10.5491/SHAW.2012.3.1.77. Epub 2012 Mar 8. PMID: 22953235; PMCID: PMC3430925.

  7. CDC. One Health | CDC . Available from: https://www.cdc.gov/onehealth/index.html

  8. Degeling C, Johnson J, Kerridge I, Wilson A, Ward M, Stewart C, Gilbert G. Implementing a One Health approach to emerging infectious disease: reflections on the socio-political, ethical and legal dimensions. BMC Public Health. 2015;29(15):1307. https://doi.org/10.1186/s12889-015-2617-1. (PMID:26715066 PMCID:PMC4696140).

    Article  Google Scholar 

  9. Costa F, Hagan JE, Calcagno J, Kane M, Torgerson P, Martinez-Silveira MS, Stein C, Abela-Ridder B, Ko AI. Global Morbidity and Mortality of Leptospirosis: A Systematic Review. PLoS Negl Trop Dis. 2015;9(9): e0003898. https://doi.org/10.1371/journal.pntd.0003898. (PMID:26379143 PMCID:PMC4574773).

    Article  PubMed  PubMed Central  Google Scholar 

  10. Thibeaux R, Iraola G, Ferrés I, Bierque E, Girault D, Soupé-Gilbert ME, Picardeau M, Goarant C. Deciphering the unexplored Leptospira diversity from soils uncovers genomic evolution to virulence. Microb Genom. 2018 ;4(1):e000144. doi: https://doi.org/10.1099/mgen.0.000144. Epub 2018 Jan 3. PMID: 29310748; PMCID: PMC5857368.

  11. Torgerson PR, Hagan JE, Costa F, Calcagno J, Kane M, Martinez-Silveira MS, Goris MG, Stein C, Ko AI, Abela-Ridder B. Global Burden of Leptospirosis: Estimated in Terms of Disability Adjusted Life Years. PLoS Negl Trop Dis. 2015;9(10): e0004122. https://doi.org/10.1371/journal.pntd.0004122. (PMID:26431366 PMCID:PMC4591975).

    Article  PubMed  PubMed Central  Google Scholar 

  12. CDC.Table 2 - Estimating the Public Health Impact of Rabies - Volume 10, Number 1—January 2004 - Emerging Infectious Diseases journal - CDC [Internet]. [cited 2023 Feb 10]. Available from: https://wwwnc.cdc.gov/eid/article/10/1/02-0744-t2

  13. Rajapakse S. Leptospirosis: clinical aspects. Clin Med (Lond). 2022;22(1):14–7. https://doi.org/10.7861/clinmed.2021-0784. (PMID:35078790 PMCID:PMC8813018).

    Article  PubMed  Google Scholar 

  14. Rahimi R, Omar E, Tuan Soh TS, MohdNawi SFA, Md NS. Leptospirosis in pregnancy: A lesson in subtlety. Malays J Pathol. 2018;40(2):169–73 (PMID: 30173235).

    CAS  PubMed  Google Scholar 

  15. Sharma KK, Kalawat U. Early diagnosis of leptospirosis by conventional methods: one-year prospective study. Indian J Pathol Microbiol. 2008;51(2):209–11. doi: https://doi.org/10.4103/0377-4929.41687. PMID: 18603683.

  16. Levett PN. Leptospirosis. Clin Microbiol Rev. 2001;14(2):296–326. https://doi.org/10.1128/CMR.14.2.296-326.2001. (PMID:11292640 PMCID:PMC88975).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Leptospirosis | CDC [Internet]. [cited 2019 Apr 4]. Available from: https://www.cdc.gov/leptospirosis/index.html

  18. Lin PC, Chi CY, Ho MW, Chen CM, Ho CM, Wang JH. Demographic and clinical features of leptospirosis: three-year experience in central Taiwan. J Microbiol Immunol Infect. 2008;41(2):145–50 (PMID: 18473102).

    PubMed  Google Scholar 

  19. Tullu MS, Karande S. Leptospirosis in children: a review for family physicians. Indian J Med Sci. 2009;63(8):368–78 (PMID: 19770531).

    Article  PubMed  Google Scholar 

  20. Bal AM. Unusual clinical manifestations of leptospirosis. J Postgrad Med. 2005;51(3):179–83. PMID: 16333189.

  21. Herman HS, Mehta S, Cárdenas WB, Stewart-Ibarra AM, Finkelstein JL. Micronutrients and Leptospirosis: A Review of the Current Evidence. PLoS Negl Trop Dis. 2016;10(7): e0004652. https://doi.org/10.1371/journal.pntd.0004652. (PMID:27387046 PMCID:PMC4936698).

    Article  PubMed  PubMed Central  Google Scholar 

  22. Witchell TD, Eshghi A, Nally JE, Hof R, Boulanger MJ, Wunder EA Jr, Ko AI, Haake DA, Cameron CE. Post-translational modification of LipL32 during Leptospira interrogans infection. PLoS Negl Trop Dis. 2014;8(10): e3280. https://doi.org/10.1371/journal.pntd.0003280. (PMID:25356675 PMCID:PMC4214626).

    Article  PubMed  PubMed Central  Google Scholar 

  23. Xiao D, Zhang C, Zhang H, Li X, Jiang X, Zhang J. A novel approach for differentiating pathogenic and non-pathogenic Leptospira based on molecular fingerprinting. J Proteomics. 2015;24(119):1–9. https://doi.org/10.1016/j.jprot.2014.10.023. (Epub 2014 Nov 20 PMID: 25464365).

    Article  CAS  Google Scholar 

  24. Balamurugan V, Alamuri A, Bharathkumar K, Patil SS, Govindaraj GN, Nagalingam M, Krishnamoorthy P, Rahman H, Shome BR. Prevalence of Leptospira serogroup-specific antibodies in cattle associated with reproductive problems in endemic states of India. Trop Anim Health Prod. 2018;50(5):1131–8. https://doi.org/10.1007/s11250-018-1540-8. (Epub 2018 Feb 14 PMID: 29445929).

    Article  PubMed  Google Scholar 

  25. Natarajaseenivasan K, Vedhagiri K, Sivabalan V, Prabagaran SG, Sukumar S, Artiushin SC, Timoney JF. Seroprevalence of Leptospira borgpetersenii serovar javanica infection among dairy cattle, rats, and humans in the Cauvery River valley of southern India. Southeast Asian J Trop Med Public Health. 2011;42(3):679–86 (PMID: 21706947).

    PubMed  Google Scholar 

  26. WHO. Leptospirosis situation in the WHO South-East Asia Region. World Health Organisation [Internet]. 2009;3–4. Available from: http://www.searo.who.int/entity/emerging_diseases/topics/Communicable_Diseases_Surveillance_and_response_SEA-CD-216.pdf

  27. Balamurugan V, Thirumalesh SRA, Veena S, Alamuri A, Nagalingam M, Sridevi R, et al. Investigation on the distribution of leptospira serovars and its prevalence in bovine in Konkan region, Maharashtra. India Adv Anim Vet Sci. 2016;4:19–26.

    Article  Google Scholar 

  28. Vinayagamurthy, Balamurugan. (2016). Investigation on the Distribution of Leptospira Serovars and its Prevalence in Bovine in Konkan Region, Maharashtra, India. Advances in Animal and Veterinary Sciences. 4. 19–26. https://doi.org/10.14737/journal.aavs/2016/4.2s.19.26.

  29. Barragan V, Nieto N, Keim P, Pearson T. Meta-analysis to estimate the load of Leptospira excreted in urine: beyond rats as important sources of transmission in low-income rural communities. BMC Res Notes. 2017;10(1):71. https://doi.org/10.1186/s13104-017-2384-4. (PMID:28129788 PMCID:PMC5273803).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Monahan AM, Callanan JJ, Nally JE. Proteomic analysis of Leptospira interrogans shed in the urine of chronically infected hosts. Infect Immun. 2008;76(11):4952–8. doi: https://doi.org/10.1128/IAI.00511-08. Epub 2008 Sep 2. PMID: 18765721; PMCID: PMC2573331.

  31. Priya CG, Hoogendijk KT, Berg M, Rathinam SR, Ahmed A, Muthukkaruppan VR, Hartskeerl RA. Field rats form a major infection source of leptospirosis in and around Madurai, India. Journal of Postgraduate Medicine. 2007; 53(4): 236–40.

  32. Saravanan R, Rajendran P, Thyagarajan SP, Smythe LD, Norris MA, Symonds ML, Dohnt MF. Leptospira autumnalis isolated from a human case from Avadi, India, and the serovar’s predominance in local rat and bandicoot populations. Ann Trop Med Parasitol. 2000;94(5):503–6. https://doi.org/10.1080/00034983.2000.11813569. (PMID: 10983563).

    Article  CAS  PubMed  Google Scholar 

  33. . Ramakrishnan J, Thavamani K. Indian Contributions to the Field of Leptospirosis (2006-2013): A Bibliometric Study. 2015;9:235–49. https://doi.org/10.1080/0973776620151069962.

  34. Lara JM, Von Zuben A, Costa JV, Donalisio MR, Francisco PMSB. Leptospirosis in Campinas, São Paulo, Brazil: 2007–2014. Rev Bras Epidemiol. 2019;22:e190016. Portuguese, English. doi: https://doi.org/10.1590/1980-549720190016. PMID: 30942326.

  35. Schneider AG, Casanovas-Massana A, Hacker KP, Wunder EA Jr, Begon M, Reis MG, Childs JE, Costa F, Lindow JC, Ko AI. Quantification of pathogenic Leptospira in the soils of a Brazilian urban slum. PLoS Negl Trop Dis. 2018;12(4): e0006415. https://doi.org/10.1371/journal.pntd.0006415. (PMID:29624576 PMCID:PMC5906024).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Otsuka Y, Agestika L, Harada H, Sriwuryandari L, Sintawardani N, Yamauchi T. Comprehensive assessment of handwashing and fecal contamination among elementary school children in an urban slum of Indonesia. Trop Med Int Health. 2019;24(8):954–61. https://doi.org/10.1111/tmi.13279. (Epub 2019 Jun 30 PMID: 31192489).

    Article  PubMed  Google Scholar 

  37. Rawlins J, Portanova A, Zuckerman I, Loftis A, Ceccato P, Willingham AL, Verma A. Molecular detection of leptospiral DNA in environmental water on St. Kitts. Int J Environ Res Public Health. 2014;11(8):7953–60. doi: https://doi.org/10.3390/ijerph110807953. PMID: 25105546; PMCID: PMC4143842.

  38. Kumar KV, Lall C, Raj RV, Vedhagiri K, Vijayachari P. Coexistence and survival of pathogenic leptospires by formation of biofilm with Azospirillum. FEMS Microbiol Ecol. 2015;91(6):fiv051. doi: https://doi.org/10.1093/femsec/fiv051. Epub 2015 May 10. PMID: 25962762.

  39. Casanovas-Massana A, Pedra GG, Wunder EA Jr, Diggle PJ, Begon M, Ko AI. Quantification of Leptospira interrogans Survival in Soil and Water Microcosms. Appl Environ Microbiol. 2018;84(13):e00507-e518. https://doi.org/10.1128/AEM.00507-18. (PMID:29703737 PMCID:PMC6007094).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Hagan JE, Moraga P, Costa F, Capian N, Ribeiro GS, Wunder EA Jr, Felzemburgh RD, Reis RB, Nery N, Santana FS, Fraga D, Dos Santos BL, Santos AC, Queiroz A, Tassinari W, Carvalho MS, Reis MG, Diggle PJ, Ko AI. Spatiotemporal Determinants of Urban Leptospirosis Transmission: Four-Year Prospective Cohort Study of Slum Residents in Brazil. PLoS Negl Trop Dis. 2016;10(1): e0004275. https://doi.org/10.1371/journal.pntd.0004275. (PMID:26771379 PMCID:PMC4714915).

    Article  PubMed  PubMed Central  Google Scholar 

  41. Vijayachari P, Sugunan AP, Singh SS, Mathur PP. Leptospirosis among the self-supporting convicts of Andaman Island during the 1920s--the first report on pulmonary hemorrhage in leptospirosis? Indian J Med Res. 2015;142(1):11–22. doi: https://doi.org/10.4103/0971-5916.162087. PMID: 26261162; PMCID: PMC4557245.

  42. Bharti AR, Nally JE, Ricaldi JN, Matthias MA, Diaz MM, Lovett MA, Levett PN, Gilman RH, Willig MR, Gotuzzo E, Vinetz JM; Peru-United States Leptospirosis Consortium. Leptospirosis: a zoonotic disease of global importance. Lancet Infect Dis. 2003;3(12):757–71. doi: https://doi.org/10.1016/s1473-3099(03)00830-2. PMID: 14652202.

  43. Sugunan AP, Vijayachari P, Sharma S, Roy S, Manickam P, Natarajaseenivasan K, Gupte MD, Sehgal SC. Risk factors associated with leptospirosis during an outbreak in Middle Andaman. India Indian J Med Res. 2009;130(1):67–73 (PMID: 19700804).

    CAS  PubMed  Google Scholar 

  44. Minter A, Diggle PJ, Costa F, Childs J, Ko AI, Begon M. Evidence of multiple intraspecific transmission routes for Leptospira acquisition in Norway rats (Rattus norvegicus). Epidemiol Infect. 2017;145(16):3438–3448. doi: https://doi.org/10.1017/S0950268817002539. Epub 2017 Nov 27. PMID: 29173242; PMCID: PMC6252042.

  45. Ratnam S, Sundararaj T, Subramanian S. Serological evidence of leptospirosis in a human population following an outbreak of the disease in cattle. Trans R Soc Trop Med Hyg. 1983;77:94–8. https://doi.org/10.1016/0035-9203(83)90027-5. (PMID: 6679368).

    Article  CAS  PubMed  Google Scholar 

  46. Patil D, Dahake R, Roy S, Mukherjee S, Chowdhary A, Deshmukh R. Prevalence of leptospirosis among dogs and rodents and their possible role in human leptospirosis from Mumbai, India. Indian J Med Microbiol. 2014;32(1):64–7. doi: https://doi.org/10.4103/0255-0857.124319. PMID: 24399392.

  47. John TJ. Emerging & re-emerging bacterial pathogens in India. Indian J Med Res. 1996;103:4–18 (PMID: 8926026).

    CAS  PubMed  Google Scholar 

  48. Rohilla P, Khurana R, Kumar A, Batra K, Gupta R. Detection of Leptospira in urine of apparently healthy dogs by quantitative polymerase chain reaction in Haryana, India. Vet World. 2020;13(11):2411–2415. doi: https://doi.org/10.14202/vetworld.2020.2411-2415. Epub 2020 Nov 12. PMID: 33363334; PMCID: PMC7750226.

  49. Himani D, Suman MK, Mane BG. Epidemiology of leptospirosis : an Indian perspective. 2013;1:6–13.

    Google Scholar 

  50. Wilkinson DA, Edwards M, Benschop J, Nisa S. Identification of pathogenic Leptospira species and serovars in New Zealand using metabarcoding. PLoS ONE. 2021;16(9): e0257971. https://doi.org/10.1371/journal.pone.0257971. (PMID:34587213 PMCID:PMC8480790).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Holla R, Darshan B, Pandey L, Unnikrishnan B, Kumar N, Thapar R, Mithra P, Kulkarni V. Leptospirosis in Coastal South India: A Facility Based Study. Biomed Res Int. 2018;15(2018):1759125. https://doi.org/10.1155/2018/1759125. (PMID:29862254.PMCID:PMC5976951).

    Article  Google Scholar 

  52. Natarajaseenivasan K, Raja V, Narayanan R. Rapid diagnosis of leptospirosis in patients with different clinical manifestations by 16S rRNA gene based nested PCR. Saudi J Biol Sci. 2012;19(2):151–5. doi: https://doi.org/10.1016/j.sjbs.2011.11.005. Epub 2011 Dec 3. PMID: 23961174; PMCID: PMC3730726.

  53. Balassiano IT, Vital-Brazil JM, Pereira MM. Leptospirosis diagnosis by immunocapture polymerase chain reaction: a new tool for early diagnosis and epidemiologic surveillance. Diagn Microbiol Infect Dis. 2012;74(1):11–5. https://doi.org/10.1016/j.diagmicrobio.2012.05.028. (Epub 2012 Jul 7 PMID: 22770775).

    Article  CAS  PubMed  Google Scholar 

  54. Vimal Raj R, Vinod Kumar K, Lall C, Vedhagiri K, Sugunan AP, Sunish IP, Sharma S, Vijayachari P. Changing trend in the seroprevalence and risk factors of human leptospirosis in the South Andaman Island. India Zoonoses Public Health. 2018;65(6):683–9. https://doi.org/10.1111/zph.12478. (Epub 2018 Jun 6 PMID: 29873192).

    Article  CAS  PubMed  Google Scholar 

  55. Jacob SM, Geethalakshmi S, Karthikeyan S, Durairaj A, Gopal P, Ramamoorthy V, Arumugam G, Elumalai S. A 3-year retrospective analysis on the prevalence of anti leptospiral antibodies among children in Chennai City. India J Med Microbiol. 2018;67(12):1706–10. https://doi.org/10.1099/jmm.0.000825. (Epub 2018 Oct 29 PMID: 30372412).

    Article  PubMed  Google Scholar 

  56. Bhatia M, Umapathy BL, Navaneeth BV. An evaluation of dark field microscopy, culture, and commercial serological kits in the diagnosis of leptospirosis. Indian J Med Microbiol. 2015;33(3):416–21. doi: https://doi.org/10.4103/0255-0857.158570. PMID: 26068347.

  57. Arumugam G, Jacob SM, Anitha D, Rajappa SM. Occurrence of leptospirosis among suspected cases in Chennai, Tamil Nadu. Indian J Pathol Microbiol. 2011;54(1):100–2. doi: https://doi.org/10.4103/0377-4929.77340. PMID: 21393887.

  58. Shekatkar SB, Harish BN, Menezes GA, Parija SC. Clinical and serological evaluation of leptospirosis in Puducherry. India J Infect Dev Ctries. 2010;4:139–43.

    Article  PubMed  Google Scholar 

  59. Sohan L, Shyamal B, Kumar TS, Malini M, Ravi K, Venkatesh V, et al. Studies on leptospirosis outbreaks in Peddamandem Mandal of Chittoor district. Andhra Pradesh J Commun Dis. 2008;40:127–32.

    Google Scholar 

  60. Vijayachari P, Sugunan AP, Shriram AN. Leptospirosis: an emerging global public health problem. J Biosci. 2008;33(4):557–69. https://doi.org/10.1007/s12038-008-0074-z. (PMID: 19208981).

    Article  CAS  PubMed  Google Scholar 

  61. Singh SS, Vijayachari P, Sinha A, Sugunan AP, Rasheed MA, Sehgal SC. Clinico-epidemiological study of hospitalized cases of severe leptospirosis. Indian J Med Res. 1999;109:94–9 (PMID: 10489743).

    CAS  PubMed  Google Scholar 

  62. Venkataraman KS, Nedunchelliyan S. Epidemiology of an outbreak of leptospirosis in man and dog. Comp Immunol Microbiol Infect Dis. 1992;15(4):243–7. https://doi.org/10.1016/0147-9571(92)90003-a. (PMID: 1424559).

    Article  CAS  PubMed  Google Scholar 

  63. Shukla S, Mittal V, Karoli R, Singh P, Singh A. Leptospirosis in central & eastern Uttar Pradesh, an underreported disease: A prospective cross-sectional study. Indian J Med Res. 2022;155(1):66–72. https://doi.org/10.4103/ijmr.IJMR_1811_19. (PMID:35859430 PMCID:PMC9552366).

    Article  PubMed  PubMed Central  Google Scholar 

  64. Mathesh K, Thankappan S, Deneke Y, Vamadevan B, Siddappa CM, Sharma AK, Selvaraj I, Sha A, Kumar A. A multipronged approach for the detection of leptospirosis in captive sloth bears (Melursus ursinus) in Agra and Bannerghatta sloth bear rescue centers in India. J Vet Med Sci. 2021;83(7):1059–1067. doi: https://doi.org/10.1292/jvms.21-0082. Epub 2021 May 17. PMID: 33994428; PMCID: PMC8349803.

  65. Saranya P, Goswami C, Sumathi K, Balasundareshwaran AH, Bothammal P, Dutta LJ, et al. Prevalence of leptospirosis among animal herds of northeastern provinces of India. Comp Immunol Microbiol Infect Dis. 2021, 79:101698. DOI: https://doi.org/10.1016/j.cimid.2021.101698

  66. Chandy S, Kirubanandhan L, Hemavathy P, Khadeeja AM, Kurian SJ, Venkataraman K, Mørch K, Mathai D, Manoharan A. Serovar prevalence of Leptospira in semirural India and the development of an IgM-based indirect ELISA. J Infect Dev Ctries. 2017;11(3):234–41. https://doi.org/10.3855/jidc.8067. (PMID: 28368857).

    Article  CAS  PubMed  Google Scholar 

  67. Narayanan R, Sumathi G, Prabhakaran SG, Shanmughapriya S, Natarajaseenivasan K. Paediatric leptospirosis: A population based case-control study from Chennai, India. Indian J Med Microbiol. 2016;34(2):228–32. doi: https://doi.org/10.4103/0255-0857.180353. PMID: 27080780.

  68. Parveen SM, Suganyaa B, Sathya MS, Margreat AA, Sivasankari K, Shanmughapriya S, Hoffman NE, Natarajaseenivasan K. Leptospirosis Seroprevalence Among Blue Metal Mine Workers of Tamil Nadu, India. Am J Trop Med Hyg. 2016;95(1):38–42. doi: https://doi.org/10.4269/ajtmh.16-0095. Epub 2016 Apr 4. PMID: 27044567; PMCID: PMC4944705.

  69. Kanagavel M, PrincyMargreat AA, Arunkumar M, Prabhakaran SG, Shanmughapriya S, Natarajaseenivasan K. Multilocus sequence typing (MLST) of leptospiral strains isolated from two geographic locations of Tamil Nadu. India Infect Genet Evol. 2016;37:123–8. https://doi.org/10.1016/j.meegid.2015.11.008. (Epub 2015 Nov 11 PMID: 26577860).

    Article  CAS  PubMed  Google Scholar 

  70. Bhatia M, Umapathy BL, Navaneeth BV. An evaluation of dark field microscopy, culture and commercial serological kits in the diagnosis of leptospirosis. Indian J Med Microbiol. 2015;33(3):416–21. doi: https://doi.org/10.4103/0255-0857.158570. PMID: 26068347.

  71. Vedhagiri K, Natarajaseenivasan K, Prabhakaran SG, Selvin J, Narayanan R, Shouche YS, Vijayachari P, Ratnam S. Characterization of leptospira borgpetersenii isolates from field rats (rattus norvegicus) by 16s rrna and lipl32 gene sequencing. Braz J Microbiol. 2010;41(1):150–7. doi: https://doi.org/10.1590/S1517-838220100001000022. Epub 2010 Mar 1. PMID: 24031475; PMCID: PMC3768625

  72. Mathur M, De A, Turbadkar D. Leptospirosis outbreak in 2005: L.T.M.G. hospital experience. Indian J Med Microbiol. 2009;27(2):153–5. doi: https://doi.org/10.4103/0255-0857.49431. PMID: 19384041.

  73. Velineni S, Asuthkar S, Umabala P, Lakshmi V, Sritharan M. Serological evaluation of leptospirosis in Hyderabad Andhra Pradesh: a retrospective hospital-based study. Indian J Med Microbiol. 2007;25(1):24–7. https://doi.org/10.4103/0255-0857.31057. (PMID: 17377348).

    Article  CAS  PubMed  Google Scholar 

  74. Sharma S, Vijayachari P, Sugunan AP, Natarajaseenivasan K, Sehgal SC. Seroprevalence of leptospirosis among high-risk population of Andaman Islands, India. Am J Trop Med Hyg. 2006;74(2):278–83. PMID: 16474084. \

  75. Jena AB, Mohanty KC, Devadasan N. An outbreak of leptospirosis in Orissa, India: the importance of surveillance. Trop Med Int Health. 2004;9(9):1016–21. https://doi.org/10.1111/j.1365-3156.2004.01293.x. (PMID: 15361116).

    Article  PubMed  Google Scholar 

  76. Vijayachari P, Ahmed N, Sugunan AP, Ghousunnissa S, Rao KR, Hasnain SE, Sehgal SC. Use of fluorescent amplified fragment length polymorphism for molecular epidemiology of leptospirosis in India. J Clin Microbiol. 2004;42(8):3575–80. https://doi.org/10.1128/JCM.42.8.3575-3580.2004. (PMID:15297500 PMCID:PMC497643).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  77. Srivastava S, Kumar A. Seroprevalence of leptospirosis in animals and human beings in various regions of the country. Indian Journal of Comparative Microbiology, Immunology and Infectious Diseases. 2003;24:155–9.

    Google Scholar 

  78. Sethi S, Sood A, Pooja, Sharma S, Sengupta C, Sharma M. Leptospirosis in northern India: a clinical and serological study. Southeast Asian J Trop Med Public Health. 2003;34(4):822–5. PMID: 15115094.

  79. Ramakrishnan R, Patel MS, Gupte MD, Manickam P, Venkataraghavan S. An institutional outbreak of leptospirosis in Chennai. South India J Commun Dis. 2003;35(1):1–8 (PMID: 15239298).

    CAS  PubMed  Google Scholar 

  80. Vijayachari P, Sehgal SC, Goris MGA, Terpstra WJ, Hartskeerl RA. Leptospira interrogans serovar Valbuzzi: a cause of severe pulmonary haemorrhages in the Andaman Islands. J Med Microbiol. 2003;52(Pt 10):913–8. https://doi.org/10.1099/jmm.0.05094-0. (PMID: 12972588).

    Article  CAS  PubMed  Google Scholar 

  81. Sharma S, Vijayachari P, Sugunan AP, Sehgal SC. Leptospiral carrier state and seroprevalence among animal population–a cross-sectional sample survey in Andaman and Nicobar Islands. Epidemiol Infect. 2003;131(2):985–9. https://doi.org/10.1017/s095026880300880x. (PMID:14596541 PMCID:PMC2870044).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  82. Bharadwaj R, Bal AM, Joshi SA, Kagal A, Pol SS, Garad G, et al. An Urban Outbreak of Leptospirosis in Mumbai. India. 2002;60:194–6.

    Google Scholar 

  83. Kuriakose M, Eapen CK, Paul R. Leptospirosis in Kolenchery, Kerala, India: epidemiology, prevalent local serogroups and serovars and a new serovar. Eur J Epidemiol. 1997;13(6):691–7. https://doi.org/10.1023/a:1007300729615. (PMID: 9324217).

    Article  CAS  PubMed  Google Scholar 

  84. Muthusethupathi MA, Shivakumar S, Suguna R, Jayakumar M, Vijayakumar R, Everard CO, Carrington DG. Leptospirosis in Madras–a clinical and serological study. J Assoc Physicians India. 1995;43(7):456–8 (PMID: 8713215).

    CAS  PubMed  Google Scholar 

  85. Sehgal SC, Murhekar MV, Sugunan AP. Outbreak of leptospirosis with pulmonary involvement in north Andaman. Indian J Med Res. 1995;102:9–12 (PMID: 7558211).

    CAS  PubMed  Google Scholar 

  86. Ratnam S, Everard CO, Alex JC, Suresh B, Thangaraju P. Prevalence of leptospiral agglutinins among conservancy workers in Madras City. India J Trop Med Hyg. 1993;96(1):41–5 (PMID: 8429573).

    CAS  PubMed  Google Scholar 

  87. Musso D, La Scola B. Laboratory diagnosis of leptospirosis: A challenge. J Microbiol Immunol Infect. 2013;46:245–52.

    Article  CAS  PubMed  Google Scholar 

  88. Durrance-Bagale A, Rudge JW, Singh NB, Belmain SR, Howard N. Drivers of zoonotic disease risk in the Indian subcontinent: A scoping review. One Health. 2021;14(13): 100310. https://doi.org/10.1016/j.onehlt.2021.100310. (PMID:34458546 PMCID:PMC8379342).

    Article  Google Scholar 

  89. Chaudhry R, Saigal K, Bahadur T, Kant K, Chourasia B, Gupta N. Varied presentations of leptospirosis: experience from a tertiary care hospital in north India. Trop Doct. 2017;47(2):128–32. https://doi.org/10.1177/0049475516687431. (Epub 2017 Jan 16 PMID: 28092222).

    Article  PubMed  Google Scholar 

  90. Lam JY, Lowid GKK, Cheeid HY. Diagnostic accuracy of genetic markers and nucleic acid techniques for the detection of Leptospira in clinical samples: A meta-analysis. PLoS Negl Trop Dis. 2020;14: e0008074.

    Article  PubMed  PubMed Central  Google Scholar 

  91. Deodhar D, John M. Leptospirosis: experience at a tertiary care hospital in northern India. Natl Med J India. 2011;24(2):78–80 PMID: 21668048.

    CAS  PubMed  Google Scholar 

  92. Sethi S, Sharma N, Kakkar N, Taneja J, Chatterjee SS, Banga SS, Sharma M. Increasing trends of leptospirosis in northern India: a clinico-epidemiological study. PLoS Negl Trop Dis. 2010;4(1): e579. https://doi.org/10.1371/journal.pntd.0000579.PMID:20084097. (PMCID:PMC2797087).

    Article  PubMed  PubMed Central  Google Scholar 

  93. Yasobant S, Bruchhausen W, Saxena D, Falkenberg T. One health collaboration for a resilient health system in India: Learnings from global initiatives. One Health. 2019;10(8): 100096. https://doi.org/10.1016/j.onehlt.2019.100096. (PMID:31304229 PMCID:PMC6606562).

    Article  Google Scholar 

  94. Amar D, Vizel A, Levy C, Shamir R. Systems biology ADEPTUS : a discovery tool for disease prediction , enrichment and network analysis based on profiles from many diseases. 2018;34:1959–61

  95. Ma L, Li H, Lan J, Hao X, Liu H, Wang X, et al. Comprehensive analyses of bioinformatics applications in the fight against COVID-19 pandemic. Comput Biol Chem 2021;95:107599. Available from: /pmc/articles/PMC8560182/

  96. Saeb ATM. Current Bioinformatics resources in combating infectious diseases. Bioinformation. 2018;14:31. Available from: /pmc/articles/PMC5818640/

  97. Sehgal SC, Sugunan AP, Vijayachari P. Leptospirosis disease burden estimation and surveillance networking in India. Southeast Asian J Trop Med Public Health. 2003;34(Suppl 2):170–7 (PMID: 19238671).

    PubMed  Google Scholar 

  98. WHO. Informal Expert consultation on Surveillance, Diagnosis and Risk Reduction of Leptospirosis. World Health Organization, 2009 September:17–8. Retrieved from http://origin.searo.who.int/entity/emerging_diseases/topics/Communicable_Diseases_Surveillanc.

  99. Asaaga FA, Young JC, Oommen MA, Chandarana R, August J, Joshi J, Chanda MM, Vanak AT, Srinivas PN, Hoti SL, Seshadri T, Purse BV. Operationalising the “One Health” approach in India: facilitators of and barriers to effective cross-sector convergence for zoonoses prevention and control. BMC Public Health. 2021;21(1):1517. https://doi.org/10.1186/s12889-021-11545-7.PMID:34362321. (PMCID:PMC8342985).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  100. John TJ. The Prevention and Control of Human Leptospirosis. J Postgrad Med. 2005;51:205–9.

    CAS  PubMed  Google Scholar 

  101. Gupta N, Wilson W, Ravindra P. Leptospirosis in India: a systematic review and meta-analysis of clinical profile, treatment and outcomes. Infez Med. 2023;31:290. Available from: /pmc/articles/PMC10495047/

  102. Lehmann JS, Matthias MA, Vinetz JM, Fouts DE. Leptospiral Pathogenomics. 2014;280–308.

  103. Liguori G, Costagliola A, Lombardi R, Paciello O, Giordano A. Human-Animal Interaction in Animal-Assisted Interventions (AAI)s: Zoonosis Risks, Benefits, and Future Directions—A One Health Approach. Animals. 2023;13.

  104. Karpagam KB, Ganesh B. Leptospirosis: a neglected tropical zoonotic infection of public health importance-an updated review. Eur J Clin Microbiol Infect Dis. 2020;39:835–46. Available from: https://pubmed.ncbi.nlm.nih.gov/31898795/

  105. Dikid T, Jain SK, Sharma A, Kumar A, Narain JP. Emerging & re-emerging infections in India: An overview. Indian J Med Res. 2013;138:19. Available from: /pmc/articles/PMC3767269/

  106. Bradley EA, Lockaby G. Leptospirosis and the Environment: A Review and Future Directions. Pathogens [Internet]. 2023 [cited 2024 Feb 16];12. Available from: /pmc/articles/PMC10538202/

  107. O’Brien E, Xagoraraki I. A water-focused one-health approach for early detection and prevention of viral outbreaks. One Health. 2019;20(7): 100094. https://doi.org/10.1016/j.onehlt.2019.100094. (PMID:31080867;PMCID:PMC6501061).

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Health Research (D.H.R.), ICMR-National Institute of Epidemiology (ICMR-NIE), Indian Council of Medical Research, Ministry of Health & Family Welfare, Government of India, R-127, 2Nd Main Road, T.N.H.B. Layout, Ayapakkam, Chennai, Tamil Nadu, 600 077, India

    Baby Karpagam Krishnan & Ganesh Balasubramanian

  2. Department of Veterinary Public Health and Epidemiology, Faculty of Veterinary and Animal Sciences, Rajiv Gandhi South Campus, Banaras Hindu University, Mirzapur, UP, 231001, India

    Pesingi Pavan Kumar

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B.G. and K.B.K. conceptualized the work; K.B.K. performed the literature search, and K.B.K. wrote the first draft of the manuscript. B.G. revised the draft. PPK provided critical inputs. K.B.K. and PPK performed the editing of the manuscript and revisions by all the authors. The decision of the final version to be published was agreed upon by all the authors.

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Correspondence to Baby Karpagam Krishnan.

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Krishnan, B.K., Balasubramanian, G. & Kumar, P.P. Leptospirosis in India: insights on circulating serovars, research lacunae and proposed strategies to control through one health approach. One Health Outlook 6, 11 (2024). https://doi.org/10.1186/s42522-024-00098-5

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One Health Outlook

ISSN: 2524-4655