The Global Prevalence of Intermediate Leptospira spp. in Humans: A Meta-Analysis

Abd Rahman, Aina Nadheera (2021) The Global Prevalence of Intermediate Leptospira spp. in Humans: A Meta-Analysis. [Project Paper] (Submitted)

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Abstract

Leptospirosis is one of the most widespread zoonotic bacterial diseases caused by pathogenic spirochetes of the genus Leptospira. Humans infected with this disease are presented with a wide range of clinical manifestations due to varied pathogenicity of Leptospira spp. which can be classified into three clusters such as pathogenic, intermediate, and saprophytic. Intermediate Leptospira spp. can either be pathogenic or non-pathogenic and they have been reported to cause mild to severe human leptospirosis in several studies, contributing to the disease burden. As the findings of the pathogenic nature of intermediate Leptospira spp. were unclear, it is best to use meta-analysis approach because the prevalence estimates could aid in predicting the pathogenic role of intermediate Leptospira spp. Objective: This study aimed to estimate the global prevalence of intermediate Leptospira spp. in humans using meta-analysis with region-wise stratifications based on United Nations (UN) geo-scheme regions. Methodology: The articles were extensively searched according to PRISMA guideline, from three databases which include PubMed, Scopus, and ScienceDirect. Studies obtained were subjected to screening by title and abstract as well as full-text screening. The quality of the relevant studies that fit the pre-determined eligibility criteria were evaluated using the modified Critical Appraisal Checklist recommended by Joanna Briggs Institute. The prevalence data generated using RevMan were recorded after adjusting the effects model which was either random- or fixed-effect model according to the heterogeneity of the included studies. Results: There were seven studies included for the analysis involving two out of five United Nations regions, among 469 studies identified initially. Meta-analysis showed that the overall prevalence of intermediate Leptospira spp. in humans was 32% (95% CI: -0.09 – 0.73; I2= 99%; p = 0.12) and pooled prevalence for the American and Asian regions were 62% (95% CI: -0.07 – 1.32; I2= 96%; p = 0.08) and 17% (95% CI: 0.12 – 0.23; I2= 47% ; p < 0.00001), respectively. The findings also illustrated that Leptospira wolffii (n=223/225) was the most predominant species as compared to Leptospira inadai (n=1/225) and Leptospira broomii (n=1/225). Discussion: This is the first meta-analysis summarizing the prevalence of intermediate Leptospira spp. on a global scale. The overall prevalence estimate may not be very high, but it is still indicating that this species contributes to the disease burden. Pooled data based on UN regions also showed the prevalence difference between the two regions which are attributed to several factors including the health surveillance system, access to health care facilities, and diagnostic capabilities for leptospirosis. Meanwhile, the data from the selected studies suggested that L. wolffii had the highest pathogenicity than the other intermediates since it could be found in various countries and regions and that most of the samples were collected from the patients presented with common to the severe symptoms. Conclusion: The prevalence estimates from this study revealed the insight into the contribution of intermediate Leptospira spp. to human leptospirosis and suggested that these species are as important as pathogenic species. Therefore, the data obtained could provide the reference for the health professionals to develop better control and intervention strategies in reducing the burden of the disease.

Item Type:	Project Paper
Faculty:	Faculty of Medicine and Health Science
Depositing User:	Ms. Nor Safa'aton Saidin
Date Deposited:	22 Aug 2023 07:08
Last Modified:	22 Aug 2023 07:08
URI:	http://psaspb.upm.edu.my/id/eprint/1072

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