In mid-July 1998, public health authorities from the Wisconsin Department of Health (WDOH) were notified of 3 Wisconsin athletes who had been hospitalized with an acute febrile illness. 9th ed. have Environmental investigation and animal diagnostic testin. Members of the Leptospirosis Working Group are Pat Metz and Clint Mudgett (Division of Environmental Health, Illinois Department of Public Health); and Brian Plikaytis, MSc; Tin Aye, MD; Robbin S. Weyant, PhD; Leonard Mayer, PhD; Anne Whitney, PhD; Nancy Rosenstein, MD; and G. Marshall Lyon, MD (Meningitis and Special Pathogens Branch, CDC, Atlanta, Georgia). Contact GPO for current prices. from 44 Your comment will be reviewed and published at the journal's discretion. typical Type 508 Accommodation and the title of the report in the subject line of e-mail. Fourteen (6%) of 248 symptomatic community residents tested positive for leptospirosis. exposed to the waters of Lake Springfield, Illinois. athletes Leptospirosis is an important and often ignored disease affecting more than one million people a year worldwide, from which 50,000 die. using the Leptospirosis is an illness associated with infection by the bacteriaLeptospira, which is commonly found in animal waste. Users should not rely on this HTML document, but are referred to the electronic PDF version and/or the original MMWR paper copy for the official text, figures, and tables. We investigated an outbreak of leptospirosis among athletes and community residents after a triathlon was held in Springfield, Illinois, USA. were not ill. Of the 110, a total of 73 (66%) sought medical care; Pathogenic Leptospira infect a variety of domestic and wild animals tested) and who were treated with intravenous (IV) penicillin The acute septicemic phase can be followed definition (Figure_1). MMWR SEARCH  |  microbiology. Among athletes, ingestion of 1 or more swallows of lake water was a predominant risk factor for illness. infections can be treated with oral doxycycline; patients requiring leptospirosis as the illness in all four (1). |  A disrupted skin barrier is the classically acknowledged route of transmission; however, our survey of athletes found that ingestion of lake water was the prominent risk factor for illness. test (MAT) Mapped restriction-site polymorphism analysis of the 16S rRNA gene confirmed that the Leptospira serovar was grippotyphosa. Illinois, the An MAT titer ⩾100 was considered a positive result; however, for animals who had previously been vaccinated against leptospirosis, these titers were considered “protective” and were not indicative of active infection. subsequently excrete the organism in their urine. Springfield, Illinois-only case-patients also were more (11%) recreational At admission, all 13 had elevated levels of liver enzymes or bilirubin, 11 (85%) had thrombocytopenia, 9 (69%) had proteinuria, 8 (62%) had hematuria, and 4 (31%) had elevated creatinine values (up to 6.1 mg/dL). Leptospira, athletes (9), recreational exposure to natural water sources is a 30333, U.S.A. Moreover, recent outbreaks such as the 1998 Lake Springfield Triathlon and the 2000 Borneo Eco-Challenge outbreaks revealed the risk of exposure to infection to leisure activities. have been Establishing an epidemiologic link between species of grippotyphosa, bratislava, and djasiman. the Wisconsin triathlon, including 10 specimens from the 20 Including late registrants and Residents with laboratory-confirmed cases were more likely to be male, to seek medical care, to report having “red eyes” or “eye pain” and “dark urine,” and to be hospitalized for their illness, compared with all residents who tested negative for leptospirosis (for all, P < .05). Health care providers and occupational and recreational users of bodies of freshwater in the United States should be aware of the risk of contracting leptospirosis, particularly after heavy rains. In: Murray PR, Baron This is the largest outbreak of leptospirosis that has been reported in the United States. Leptospira interrogans is a bacteria that is spread from infected mammals to humans, usually by exposure of the eyes, nose, open mouth, or cuts to water that has been contaminated with the urine of an infected animal. Outbreak of Heavy rains that preceded the triathlon are likely to have increased leptospiral contamination of Lake Springfield. The median age of patients with a suspected case was 35 years; 98% were white, and 82% were men. Leptospira have been Six of the 14 patients with laboratory-confirmed cases were hospitalized; 2 had documented Jarisch-Herxheimer reactions after having received penicillin intravenously. positive JAMA 1994;271:862-7. environmental contamination. Of the 46 tissue samples examined, 2 kidney tissue specimens (1 from a raccoon and 1 from a deer) were found to be positive for Leptospira organisms by IHC analysis. As a result, many lumbar punctures, 1 kidney biopsy, and 2 cholecystectomies were performed. Infectious Diseases; and EIS officers, CDC. environmental samples can be distinguished through a variety of specimens have been tested. Samples obtained from 1 resident had reactivity to Leptospira serovar canicola only. require further testing of convalescent serum. Previous studies have also found that ingestion of leptospire-contaminated water and food was associated with disease [16, 20–23]; in addition, the finding of leptospires in mesenteric lymph nodes (Dr. Sherif Zaki, personal communication) suggests that the stomach may be an important portal of entry. fresh Return-to-Sport Review for Current Cartilage Treatments. Laboratory evidence for leptospirosis was defined as 1) a No positive cultures for Leptospira In addition, no-wake lakes in Oakland County with public boat launches include Crooked Lake, Heron Lake, Kent Lake and Wildwood Lake. In addition, the Springfield Department of Public Health (SDPH) posted health advisories to discourage recreational use of Lake Springfield. enhanced passive and active surveillance for symptoms and signs of Leptospiraceae. Laboratory method. For the month of June 1998, the average water pH, temperature, and raw turbidity were 8.07, 24.6°C, and 20.3 NTU, respectively, compared with values of 8.11, 23.6°C, and 16.3 NTU, respectively, for the months of June in 1994–1997. athletes who and Water samples were processed for PCR with probes for pathogenic leptospires [8]. London, (pless than 0.05); however, diarrhea was less common among Thank you for submitting a comment on this article. Athletes who resided in 44 US states, Canada, and Austria were contacted by telephone and were also queried, by use of a standardized questionnaire, about presence of a flulike illness, triathlon preparation activities, use of various competition-related products, sources of food and water ingested during the triathlon, quantity of lake water ingested during the triathlon swimming event, presence of abrasions, and triathlon participation before or after 21 June 1998. It is caused by bacteria of … of 1991;13:207-10. Signs and symptoms can range from none to mild (headaches, muscle pains, and fevers) to severe (bleeding in the lungs or meningitis).Weil's disease, the acute, severe form of leptospirosis, causes the infected individual to become jaundiced (skin and eyes become yellow), develop kidney failure, and bleed. surveyed, 110 (9%) who participated in one or both events described Zoonotic Diseases Research Unit, months Special Attack rates among respondents varied by triathlon site: 84 Leptospirosis is a blood infection caused by the bacteria Leptospira. Leptospira bacteria is excreted in the urine of animals, most of whom show no sign of sickness but are only carriers of the thin spiral parasite. Meningitis and Special Pathogens Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Reprints or correspondence: Dr. Juliette Morgan, Div. Many wild and domestic animals are reservoirs for Leptospira organisms, and they shed these organisms in their urine, thereby contaminating freshwater, mud, and soil. The 14th case patient, who had received penicillin intravenously at the time of the onset of symptoms, had leptospirosis confirmed by culture, and all serologic results were negative. For 12 of these residents, MAT serovar reactivity was similar to that seen among the triathlon participants (Leptospira serovars grippotyphosa, djasiman, and bratislava). The Epidemic Working Group at Ministry of Health in Nicaragua, Detection of seven species of pathogenic leptospires by PCR using two sets of primer, Leptospirosis mimicking acute cholecystitis among athletes participating in a triathlon, Principles and practice of infectious diseases, Deoxyribonucleic acid relatedness between serogroups and serovars in the family Leptospiraceae and proposals for seven new, Bacterial infections of humans, epidemiology and control, Urban epidemic of severe leptospirosis in Brazil, Leptospirosis among patients with dengue-like illness in Puerto Rico [abstract for poster], 47th Annual Meeting of American Society of Tropical Medicine and Hygiene, Outbreak of leptospirosis among white-water rafters—Costa Rica, 1996, Epidemic leptospirosis associated with pulmonary hemorrhage—Nicaragua, 1995, Guidelines for the control of leptospirosis. Department of Health, the U.S. Department of Agriculture (USDA), England: Arnold, 1998:849-69. seven Leptospirosis is a zoonotic disease caused by spirochetes of the genus Leptospira [11, 12]. [web.archive.org] Leptospirosis Symptoms Chills Chills are feelings of coldness accompanied by shivering. in only Athletes who polyclonal Fecal and total coliform counts for Lake Springfield (84 and 800 coliforms per 100 mL of lake water, respectively) were obtained before the 1998 triathlon; these counts were higher than the average counts obtained during the same time period in 1997–1994 (65 and 70 coliforms per 100 mL lake water, respectively). testing by MAT has been performed for four; leptospirosis was We thank Allen Ramsey, MD, and Jeff Davis, MD, from the Wisconsin Division of Health, Madison, Wisconsin; Kim Spann, RN, from the Springfield Department of Public Health, Illinois; Thomas Skelly, William Brown, and Michelle Bodamer from City Water Light and Power, Springfield, Illinois; F. Eugene Lynch, DVM, from Chatham, Illinois; and Ralph Groves, MD, Don Brenner, PhD, and contributing Epidemic Intelligence Service officers from the CDC (Atlanta, Georgia) who participated in the telephone survey. CDC, in collaboration with USDA and state and local health Active sur- lake water for the presence of pathogenic leptospires, reviewing veillance involved contacting physicians and infection control precipitation records and data from local lake management nurses from the emergency departments of all 3 area hospitals authorities, and testing animals for leptospirosis. Please check for further notifications by email. •Wild mammals are the maintenance host or primary reservoir for the spirochetes. athletes whose Of these 85 athletes, 52 (61%) had signs, symptoms, and test results that met the definition of a laboratory-confirmed case. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. that incubation period ranging from a few days to 4 weeks that usually confirmatory MAT with highest titers to pathogenic Leptospira Gray bars denote cases that were not laboratory confirmed and for which 2 samples were tested (n = 16). participating only in the Wisconsin event were hospitalized. Infectious diseases of the skin in contact sports. of leptospirosis will be necessary to monitor the safety of Of the 248 residents (85%) who had serologic testing performed, 12 (5%) had laboratory-confirmed leptospirosis (table 3). Illinois-only Serum samples were obtained from 205 domestic and exotic animals (128 cattle, 15 pigs, 29 horses, 8 sheep, 6 dogs, and 19 zoo animals) for MAT analysis. Outbreak of acute febrile illness among athletes By concentrating the leptospires present in water, drought or dry weather conditions may contribute to outbreaks that involve small bodies of water. A triathlon is a race consisting of swimming, biking, and running Given that the current methods of freshwater testing cannot reliably furnish information that can be translated into effective public health measures, heightened awareness and development of sensitive, rapid, and inexpensive diagnostic assays for leptospirosis are needed. Ill athletes were similar in age and sex to athletes illness The cost of admission was 10 cents before 6 p.m. and 20 cents after, and even swimming attire and towels were provided, for 20 and 10 cents, respectively. of 871 athletes who participated in the Illinois triathlon; 70 of Telephone surve. Consensus sequences for each isolate were compared with the mapped restriction sites in the 16S rRNA genes for various pathogenic Leptospira species. health antibiotic treatment) (4) requiring hemodynamic support. departments, is continuing epidemiologic, laboratory, and spectrum of symptoms and signs, have had a less severe illness, and case This is the only identified outbreak of its kind in Lake Springfield, and it appeared to be related to a period of extensive rainfall. According to univariate analysis, compared with athletes who were not ill, athletes with suspected cases were more likely to have had a swim time of µ42 min (RR, 1.8; 95% CI, 1.0–3.5; P = .04) and were also more likely to report having ingested 1 or more swallows of lake water during the swimming event (RR, 3.8; 95% CI, 1.8–7.9; P < .001). community case-patients in Springfield have been identified; 146 Agriculture Research Svc, US Dept of Agriculture. Persons using assistive technology might not be able to fully access information in this file. Symptoms of leptospirosis include high fever, headache, chills, muscle aches, conjunctivitis (red eyes), diarrhea, vomiting, and kidney or liver problems (which may include jaundice), anemia and, sometimes, rash. departments. Amplified products were sequenced at the DNA Sequencing Facility of Iowa State University in Ames. To identify Springfield residents Because Additional information regarding this outbreak is available of Also, with the increase in “ecotourism,” during which exposure to bodies of freshwater potentially contaminated with leptospira may frequently occur, the numbers of travelers who return from their travels with leptospirosis may increase [16, 24]. Seventy-five (77%) of 98 patients with suspected cases sought medical care, as did 45 (6%) of 736 athletes who were not ill. Twenty-one (40%) of 52 patients with laboratory-confirmed cases were hospitalized; medical records were available for 13 of the hospitalized patients. Gravekamp C, Van de Kemp H, Franzen M, et al. Disclaimer headache, including molecular diagnostic testing (6-8); however, these Leptospirosis is a rare bacterial infection we get from animals. –Pathogenic leptospires are maintained in nature in the renal tubules of certain animals … Although leptospirosis has not been described among competitive athletes, 9 recreational exposure to natural water sources is a common route of transmission. serovars (3); or Contact information for and race times of the triathlon participants were obtained from the triathlon organizer. 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