Leptospirosis is an endemic zoonosis in Nicaragua, as seen by the statistics of the disease in the country. In 1995 there were 2,252 cases with clinical features of pulmonary hemorrhagic fever without jaundice that caused 48 deaths. With the support of the Centers for Disease Control and Prevention (CDC), the leptospira strain causing the outbreak was isolated and a new serovar was found: Australis Nicaragua.
In 1998, after Hurricane Mitch, outbreaks were reported in the Local Integrated Health Care Systems (in Spanish, Sistemas Locales de Atención Integral en Salud – SILAIS), of Estelí and Chinandega. In 1999, outbreaks were reported in the SILAIS of Río San Juan and Matagalpa; and in the municipalities Morrito, San Carlos, El Almendro and Waslala. Clear evidence of high rodent infestation was reported in crop fields of rice and other staples. Until approximately 2000 and 2002, the diagnosis of leptospirosis was based on clinical management and the laboratory confirmation was made using the microscopic agglutination test (MAT), conducted by the National Diagnostic and Reference Center (in Spanish, Centro Nacional de Diagnóstico y Referencia – CNDR).
Starting in 2003 and 2004, 78 positive cases and no deaths were reported; an active surveillance of febrile cases was initiated using the enzyme-linked immunosorbent assay (ELISA) IgM, developed and standardized by Nicaragua and approved by the Royal Tropical Institute of the Netherlands, which is used until today.
For the years 2005 and 2006, resources were strengthened and the quality of laboratory diagnosis was improved using a comprehensive clinical form to manage case of dengue and leptospirosis. In 2005, 91 positive cases were reported and in 2006, 104 positive cases and no deaths were reported.
|Credits: O. Chavez, Nicaragua|
During 2007 three outbreaks were reported in different territories. The most significant one with the highest number of cases and deaths reported was in November, after Hurricane Felix, in the SILAIS of León and Chinandega, which began during epidemiological weeks 43 and 44.
During the years 2008 and 2009, cases were reported by active surveillance in the country, which continued to use the same type of reagents for screening and confirmatory diagnostic tests. Sampling from the School of Veterinary Medicine in 2009 reported infection in domestic animals.
In 2009, 136 cases of leptospirosis were reported; in addition, the Technical Cooperation among Countries (TCC) was implemented with an ecosystem approach. The following activities were performed:
§ Urine sampling from different species of domestic animals (cattle, swine, equine, canine) for the isolation and identification of serovars, as well as the expansion of activities for animal medication in municipalities reporting positive cases. The study was expanded to 7 SILAIS, within 15 municipalities, and isolation of leptospira in domestic animals reported: canine (30.7%), equine (29.7%), swine (27.5%) and cattle (26.9%). In coordination with the SILAIS Chinandega and the School of Veterinary Medicine, treatment of domestic animals was conducted in communities that reported human cases of leptospirosis.
§ Strengthening of training activities for municipal multidisciplinary teams in different aspects, among which stands out the "early community warning" on febrile syndromes
|Credits: W. Jiron|
Besides having the ELISA IgM laboratory diagnosis test, Nicaragua utilizes, in municipal laboratories, the rapid latex agglutination test for presumptive diagnosis based on clinical and epidemiological data, allowing for early detection and adequate management of outbreaks at primary care level. For both methods of diagnosis, the confirmatory laboratory test is the microscopic agglutination test, MAT, performed at the central level in the National Diagnostic and Reference Center.