Addressing the burden of leptospirosis in Africa

In this review, we give a synopsis of lepto spirosis in Africa and suggest a One Health approach of bringing the disease under control. This concept encom passes interventions at human, animal and environmen tal levels. Additional information for safety of travellers coming to Africa from non-endemic temperate climates is presented at the end.

Leptospirosis is a zoonosis of global distribution. The U.S. Centers for Disease Control and Prevention has designated leptospirosis a nationally notifiable disease. There is need to raise awareness of the burden of leptospirosis among health care givers and policy makers in Africa. The aim of this review was to highlight the current situation of leptospirosis in Africa and suggest a One Health approach of addressing its status as a leading zoonosis. In tropical regions, the nonspecific symptoms of fever, myalgia and arthralgia result in misdiagnosis of leptospirosis with malaria, yellow fever, typhoid fever, dengue fever, brucellosis, rickettsiosis, and babesiosis. Urinalysis presents an inexpensive diagnostic aid for leptospirosis. Humans with leptospirosis exhibit proteinuria, glucosuria, pyuria, haematuria and granular casts resulting from acute kidney injury. Therapeutic guidelines for empirical treatment of febrile patients should be considered. Febrile patients who test negative for malaria and yellow fever can benefit from doxycycline, which also treats brucellosis, rickettsiosis and typhoid fever. Control of leptospirosis should also address Leptospira infection in domestic animal reservoirs through vaccination of cattle, sheep, goats, pigs and dogs in endemic areas. Treatment of sick animals with streptomycin eliminates the carrier status, curbing leptospiruria and spread of infection. Rodents are important in transmission of Leptospira to humans in urban slums and rural settings therefore rodent control strategies help in reducing transmission of leptospirosis. Indirect transmission of Leptospira occurs through contact with water, vegetation, or soil contaminated with infected urine. Drinking water should be drawn from protected sources or chlorinated before household use