Leptospira Seroprevalence and Risk Factors in Health Centre Patients in Hoima District,Western Uganda

Background: the burden of human leptospirosis in uganda is unknown. we estimated the seroprevalence of leptospira antibodies,probable acute/recent leptospirosis,and risk factors for seropositivity in humans in rural western uganda. methodology and principal findings: 359 non-pregnant adults visiting the kikuube and kigorobya health centers were sequentially recruited during march and april 2014. a health history survey and serum were collected from consented participants. overall,69% reported having fever in the past year,with 49% reporting malaria,14% malaria relapse,6% typhoid fever,3% brucellosis,and 0% leptospirosis. we tested sera by microscopic agglutination test (mat) against eight leptospira serovars representing seven serogroups. leptospira seroprevalence was 35% (126/359; 95%ci 30.2–40.3%) defined as mat titer ≥ 1:100 for any serovar. the highest prevalence was against l. borgpetersenii nigeria (serogroup pyrogenes) at 19.8% (71/359; 95%ci 15.9–24.4%). the prevalence of probable recent leptospirosis (mat titer ≥1:800) was 1.9% (95%ci 0.9–4.2%) and uniquely related to serovar nigeria (serogroup pyrogenes). probable recent leptospirosis was associated with having self-reported malaria within the past year (p = 0.048). higher risk activities included skinning cattle (n = 6) with 12.3 higher odds (95%ci 1.4–108.6; p = 0.024) of leptospira seropositivity compared with those who had not. participants living in close proximity to monkeys (n = 229) had 1.92 higher odds (95%ci 1.2–3.1; p = 0.009) of seropositivity compared with participants without monkeys nearby. conclusions/significance: the 35% prevalence of leptospira antibodies suggests that exposure to leptospirosis is common in rural uganda,in particular the nigeria serovar (pyrogenes serogroup). leptospirosis should be a diagnostic consideration in febrile illness and “smear-negative malaria” in rural east africa. © 2016 dreyfus et al.