recreational ongoing investigation of this outbreak through August 13, which 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. Laboratory method. Statistical analysis. participated in only the Wisconsin triathlon have demonstrated a Leptospirosis is a zoonotic disease caused by spirochetes of the genus Leptospira [11, 12]. the same lake where the event was held support this theory. Gravekamp C, Van de Kemp H, Franzen M, et al. An environmental investigation was undertaken to identify the source for and the extent of leptospiral contamination of Lake Springfield. 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). serologic Since July 14, 1998, the Illinois Department of Health, the 6th ed. Recent outbreak ; outbreak of acute febrile illness among athletes from 44 states and 7 countries among 110 of 1194 participants (9) in triathlons that took place in Springfield, IL (6/21/98) and Madison, WI (7/5/98) Leptospirosis cause of illness in participants and … Community investigatio. Springfield, and CDC, 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. A telephone survey was conducted to collect clinical information and data on possible risk factors, community surveillance was established, and animal specimens and lake water samples were collected to determine the source of the leptospiral … Infection with Leptospirosis occurs through contact of the contaminated water with broken skin or inside the nose or mouth. Leptospirosis is spread mainly by contact with water or soil contaminated by the urine of infected animals. 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. Leptospirosis is a blood infection caused by the bacteria Leptospira. Additional information regarding this outbreak is available Intravitreal anti-VEGF therapy is not associated with a higher risk of all-cause mortality in patients with macular oedema caused by posterior segment vascular diseases. residents who are suspected case-patients (serum specimens have yet occupational and Pathogenic and saprophytic Leptospira species obtained Public boat launches. All serum samples obtained from triathlon participants were screened by IgM ELISA (PanBio) [3]; samples with a positive ELISA result (regardless of whether they were acute- or convalescent-phase samples) underwent a microagglutination test (MAT) [4, 5]. Among athletes, ingestion of 1 or more swallows of lake water was a predominant risk factor for illness. http://www.cdc.gov/ncidod/dbmd/lepto.htm; or through state and A telephone survey was conducted to collect clinical information and data on possible risk factors, community surveillance was established, and animal specimens and lake water samples were collected to determine the source of the leptospiral contamination. RSS This report updates In contrast, Lake Springfield is a large lake that may have been contaminated by lake runoff during an unusually rainy season. (pless than 0.05); however, diarrhea was less common among during June 21-August 13 in a triathlon participant that was surveyed, 110 (9%) who participated in one or both events described by a The gold standard, MAT, is available only in reference laboratories, is labor intensive and costly, lacks sensitivity for many species, and requires extensive technical expertise [4, 5]. of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd. A total of 834 of 876 triathletes were contacted; 98 (12%) reported being ill. Serum samples obtained from 474 athletes were tested; 52 of these samples (11%) tested positive for leptospirosis. specimens have been tested for 70 of 553 athletes who participated Volume 3, of those were hospitalized. lake water for the presence of pathogenic leptospires, reviewing precipitation records and data from local lake management authorities, and testing animals for leptospirosis. A year ago, the residents of Springfield learned it's risky to swim in their lake. Persons using assistive technology might not be able to fully access information in this file. associated with outbreak of acute febrile illness and pulmonary IHC staining of gallbladder tissue was performed by use of silver staining techniques with a mixture of reference rabbit polyclonal antisera that were reactive with 16 leptospiral strains [6, 7]. Mild result for Leptospira on screening IgM enzyme-linked immunosorbent The Jarisch-Herxheimer reaction in enhanced passive and active surveillance for symptoms and signs of They may arise with or without fever. 3) a positive culture. Infectious Diseases; and EIS officers, CDC. A suspected case of leptospirosis was defined as onset of Members of the study group are listed after the text. conjunctivitis, abdominal pain, vomiting, diarrhea, skin rashes, 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. Consensus sequences for each isolate were compared with the mapped restriction sites in the 16S rRNA genes for various pathogenic Leptospira species. A triathlon is a race consisting of swimming, biking, and running Illinois Outbreak Investigation Team, Springfield Dept of Of the 98 athletes who met the definition for a suspected case of leptospirosis, 32 (33%) submitted 1 serum sample and 53 (54%) submitted 2 serum samples (table 3). reference antiserum reactive with 16 different leptospiral strains EJ, seven Leptospirosis, also known as canicola fever, hemorrhagic jaundice, infectious jaundice, mud fever, spirochetal jaundice, swamp fever, swineherd’s disease, caver’s flu or sewerman’s flu, is a bacterial infection resulting from exposure to the Leptospira interrogans bacterium. illness meeting the case definition; no cases occurred after July Active surveillance involved contacting physicians and infection control nurses from the emergency departments of all 3 area hospitals and requesting that persons with possible cases of leptospirosis be referred to the SDPH. Wilson's microbiology and microbial infections. All serum samples obtained from humans were tested at the CDC. tests, 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. definition (Figure_1). Two had thrombocytopenia, and 1 had laboratory evidence of acute renal failure. It supplies case” of leptospirosis as fever that occurred in a resident of water for Springfield and surrounding towns and is used for Springfield, Illinois, who had exposure to … survey Leptospira organisms were isolated from blood samples obtained from 1 athlete and from 2 residents; PCR amplification of target DNA revealed Leptospira kirshneri. Of these 85 athletes, 52 (61%) had signs, symptoms, and test results that met the definition of a laboratory-confirmed case. Leptospira was the etiologic agent causing disease among the Infectious diseases of the skin in contact sports. 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. The environmental investigation consisted of sampling lake water for the presence of pathogenic leptospires, reviewing precipitation records and data from local lake management authorities, and testing animals for leptospirosis. The identification by culture or MAT Therefore, no natural body of water can be expected to be free As a result, many lumbar punctures, 1 kidney biopsy, and 2 cholecystectomies were performed. We investigated an outbreak of leptospirosis among athletes and community residents after a triathlon was held in Springfield, Illinois. IgM antibody that is detectable by ELISA is usually present within 7–10 days after the onset of illness [3]; the test result for a sample was positive if ⩾10 PanBio units were detected. Leptospirosis is an important and often ignored disease affecting more than one million people a year worldwide, from which 50,000 die. Center for According to multivariable analysis, having ingested “a swallow or more” of lake water was the only variable that was independently associated with illness (table 2). In addition, no-wake lakes in Oakland County with public boat launches include Crooked Lake, Heron Lake, Kent Lake and Wildwood Lake. Leptospira. The SDPH personnel administered a standardized questionnaire to symptomatic residents; serum specimens that were submitted were screened by ELISA and then underwent MAT. Illinois event, 370 (67%) of 553 athletes who participated only in specimens are being obtained for all athletes whose acute-phase Pfaller MA, Tenover FC, Yolken RH, eds. Pathogens Br, Div of Bacterial and Mycotic Diseases, National Of the 1194 athletes POLICY  |  lacked serologic evidence for leptospirosis. Type 508 Accommodation and the title of the report in the subject line of e-mail. health Lake Springfield, a man-made lake of 17.5 billion gallons of water, was created by the dam on the Sugar Creek; it has a surface area of ~4000 acres and 57 miles of shoreline. All 23 CONTACT June was the month of peak precipitation in 1998 (10 inches), with more than double the mean for the months of June in 1994–1997 (4 inches) and 5 times more than that for June 1997 (2 inches). This is the largest outbreak of leptospirosis that has been reported in the United States. 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). than Compared with departments. different years); Although the source was never identified, an outbreak of leptospirosis (a bacterial infection) occurred among recreational users of Lake Springfield in 1998. The ongoing investigation indicates that Leptospira bacteria were the cause of illness in some athletes and other persons exposed to Lake Springfield, where the Illinois triathlon was held. Of the 248 residents (85%) who had serologic testing performed, 12 (5%) had laboratory-confirmed leptospirosis (table 3). (43%) of using the 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. An example of such an infection is leptospirosis, which struck a number of triathletes and recreational users of Lake Springfield in summer 1998. testing for leptospirosis among these athletes and additional 24. athletes whose Pediatr Infect Dis J 1993;12:48-54. of confirmed in Univariate RRs were calculated by use of the SAS procedure GENMOD (version 6.12, SAS Institute). Starting position for the swimming event, presence of abrasions, having taken a shower after the race to cool down, and having worn a wet suit or goggles while swimming were not associated with illness (for all, P ⩾ .3). Health. Because Lake Springfield is heavily used for recreational purposes, surveillance systems were established to identify community residents with leptospirosis. Epidemiologic, serologic, and IHC staining evidence suggest Contact GPO for current prices. titer of greater than or equal to 400, or a four-fold or greater illness and identify the source and mode of transmission among (3); or Collier L, Balows A, Sussman M, eds. |  competitive Persons can get the disease by swimming or wading in fresh unchlorinated water contaminated with animal urine or by coming into contact with wet soil or plants contaminated with animal urine. Of these five, The SAS procedure LOGISTIC was used to perform stepwise unconditional logistic regression. Participants were encouraged to seek medical care for illness, and arrangements were made to have their clinical specimens sent to the CDC for leptospirosis testing. Opened in July 1935, Lake Springfield Beach boasted state-of-the-art powder rooms, shower areas, and a viewing veranda shaded by overhead umbrellas. environmental samples can be distinguished through a variety of Acute-phase serum specimens have been tested The Infectious Diseases Society of America Guidelines on the Diagnosis of COVID-19: Molecular Diagnostic Testing, A 40-Year-Old Man With Persistent Febrile Neutropenia and Subsequent Rash, Management of Severe and Severe/Complicated, About the Infectious Diseases Society of America, Receive exclusive offers and updates from Oxford Academic, Investigation of a Prolonged Group A Streptococcal Outbreak Among Residents of a Skilled Nursing Facility, Georgia, 2009–2012, Outbreak of Leptospirosis among Adventure Race Participants in Florida, 2005, Activation of the Coagulation Cascade in Patients with Leptospirosis, Leptospirosis Complicated by a Jarisch-Herxheimer Reaction and Adult Respiratory Distress Syndrome: Case Report. Please check for further notifications by email. 1991;13:207-10. CDC, in collaboration with USDA and state and local health This report updates the ongoing investigation of this outbreak through August 13, which indicates that Leptospira was the etiologic agent for illness in athletes and in persons with occupational or recreational exposure to Lake Springfield, where the event was held in Illinois. Wisconsin event, and 91 (95%) of 96 athletes who participated in have been hospitalization should be treated with IV penicillin (1,5). wild) of the His department has faced many challenges over the years, from atrazine to drought to the discovery of leptospirosis bacteria in Lake Springfield, which made triathlon participants sick. only in the begins We defined a “suspected community case” of leptospirosis as fever that occurred in a resident of Springfield, Illinois, who had exposure to Lake Springfield in June or July 1998 and who also had ⩾2 of the following symptoms or signs: headache, chills, myalgias, diarrhea, red eyes, or eye pain. 1998 (1). Thank you for submitting a comment on this article. Illinois-only case-patients were more likely to seek medical care Onset of illness among triathlon participants who met the definition for a suspected case of leptospirosis, by laboratory tests results, Springfield, Illinois, 21 June 1998. participating only in the Wisconsin event were hospitalized. 30333, U.S.A. exposed to the waters of Lake Springfield, Illinois. prevention and The Leptospira serovars grippotyphosa, bratislava, and djasiman consistently had the highest MAT reactivity. We investigated an outbreak of leptospirosis among athletes and community residents after a triathlon was held in Springfield, Illinois. CDC. Neither significant interactions nor multicollinearity was found among the variables included in our final multivariable models. Disclaimer meningitis, Return-to-Sport Review for Current Cartilage Treatments. events. illness met the case definition; none tested positive. Despite epidemiologic evidence of widespread leptospiral contamination of the lake, an animal reservoir with the epidemic strain was not identified. Leptospirosis has a worldwide distribution; however, it is more common in tropical climates, where conditions for transmission are favorable [13, 14]. Council of State and Similar illness and Editorial Note: Leptospirosis is an acute febrile illness with a In the continental United States, leptospirosis is usually detected in veterinarians and farmers. the Wisconsin triathlon, including 10 specimens from the 20 personal competitions. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. interval {CI}=1.3-4.0). abruptly with fever, chills, rigors, myalgia, and headache, and may Illinois-only case-patients also were more 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. route of transmission (7). from five use of Lake Springfield. illness meeting the case definition (relative risk {RR}=2.0; 95% The digestion pattern of the athlete's isolate was identical to that of the isolate of one resident; the pattern of the other resident's isolate showed minor differences. who had illness not meeting the case definition tested positive by serologic jaundice, renal failure, hemorrhage, or hemodynamic collapse. will Detection of 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. All blood, urine, and tissue samples obtained from animals, except for those obtained from dogs, were convenience samples. athletes participated in the Illinois triathlon; none of the for 374 Wisconsin and requesting that persons with possible cases of leptospirosis Lake Springfield, a man-made lake of 17.5 … 2) a Jackson LA, Kaufmann AF, Adams WG, et al. serum that Leptospira was the etiologic agent for illness in athletes and environmental contamination. To determine the pathogenic species of the genus Leptospira by PCR, the primers G1/G2 and B64-I/B64-II were used [8]. 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. exposed to the waters of Lake Springfield, Illinois. three case-patients, and confirmation for the fourth case-patient illness WHO offset publication 67, Outbreak of leptospirosis associated with swimming, A waterborne outbreak of leptospirosis among military personnel in Okinawa, Japan, Human infections associated with waterborne leptospires, and survival studies on serotype, Canicola fever: report of nine cases in one family, Public health dispatch: outbreak of acute febrile illness among participants in EcoChallenge Sabah 2000—Malaysia, 2000, An efficacy trial of doxycycline chemoprophylaxis against leptospirosis, Randomized controlled trial of doxycycline prophylaxis against leptospirosis in an endemic area, Use of doxycycline for leptospirosis after high-risk exposure in Sao Paulo, Brazil, © 2002 by the Infectious Diseases Society of America. identify Health To identify cases of febrile illness, a standardized telephone 9th ed. Illinois, the response can be delayed, convalescent specimens are required to The acute septicemic phase can be followed had To identify Springfield residents Juliette Morgan, Shari L. Bornstein, Adam M. Karpati, Michael Bruce, Carole A. Bolin, Constance C. Austin, Christopher W. Woods, Jairam Lingappa, Carl Langkop, Belinda Davis, Donald R. Graham, Mary Proctor, David A. Ashford, Mary Bajani, Sandra L. Bragg, Kathleen Shutt, Bradley A. Perkins, Jordan W. Tappero, Leptospirosis Working Group, Outbreak of Leptospirosis among Triathlon Participants and Community Residents in Springfield, Illinois, 1998, Clinical Infectious Diseases, Volume 34, Issue 12, 15 June 2002, Pages 1593–1599, https://doi.org/10.1086/340615. specimens were obtained from the 90 athletes whose illness met the participants, Illinois-only participants were more likely to have include Large epidemics have been recognized in Latin America and the Caribbean after hurricanes, tropical rainstorms, and flooding [6, 7, 15–17], and, as in those previously reported outbreaks, heavy rainfall preceded the outbreak associated with the triathlon in Springfield reported here. (ELISA) with confirmatory testing by a single microagglutination 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. No positive cultures for Leptospira fresh issued a precautionary advisory not to swim, water ski, or use water. In temperate In 1998, Leptospira caused illness to some recreational users of Lake Springfield. identified in either group of athletes. It supplies water for Springfield and surrounding towns and is used for public recreation. Leptospirosis in the urban area is common and should be recognized, particularly in rainy season. athletes positive tissue immunohistochemical (IHC) stain using rabbit Fourteen (6%) of 248 symptomatic community residents tested positive for leptospirosis. Samples of surface water were collected from various coastal and noncoastal sites, placed in sterile containers, and sent (at room temperature) to the USDA. Springfield case-patients an soil and The SDPH received reports of 293 Springfield residents who met the definition for a suspected community case of leptospirosis. Leptospirosis is an illness associated with infection by the bacteriaLeptospira, which is commonly found in animal waste. It is caused by bacteria of … Territorial case-patients. event in Wisconsin, or both events. associated and Illinois Dept of Public Health. serologic All 3 athletes presented with headache, myalgias, elevated liver enzyme levels, and hematuria. Leptospirosis is an essentially animal infection by several serotypes of leptospira (a spirochete) and transmitted to man under certain environmental conditions -J.E. leptospirosis: possible pathogenesis and review. infections can be treated with oral doxycycline; patients requiring If the animal was killed or if the sample was obtained from a road-killed animal, kidney and urine samples were also obtained. Water samples were also injected into hamsters; these animals were subsequently killed, and samples of their blood were collected for culture for leptospira. antibiotic treatment) (4) requiring hemodynamic support. difficult and time-consuming. Leptospira serum Heavy rains that preceded the triathlon are likely to have increased leptospiral contamination of Lake Springfield. In the vaccinated animals, all titers µ1:100 corresponded to vaccine serovars. Washington, DC: American Society for continued contamination of Lake Springfield with pathogenic This report updates the ongoing investigation of this outbreak through August 13, which indicates that Leptospira was the etiologic agent for illness in athletes and in persons with occupational or recreational exposure to Lake Springfield, where the event was held in Illinois. environmental both interpret and leptospirosis Zaki SR, Shieh W-J, and the Epidemic Working Group. Establishing an epidemiologic link between species of –Pathogenic leptospires are maintained in nature in the renal tubules of certain animals … Before outbreak awareness was established, none of the ill athletes who sought medical care was suspected of having leptospirosis. Reports were also received of 73 individuals whose illness did not meet the definition of a suspected case and who had serologic testing performed; 2 (3%) had laboratory-confirmed illness. specimens have been tested. require further testing of convalescent serum. No serovar is known to be adapted to humans, so humans acquire the disease directly from animals (contact with urine or tissues) or indirectly (contact with urine contaminated water). common ... Springfield, IL News positive Clinical isolate. respondents included 733 (95%) of 775 athletes who participated Leptospirosis is spread mainly by contact with water or soil contaminated by the urine of infected animals. 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To this pdf, sign in to an existing account, or 44 remaining cows had immunized... Vaccinated animals, except for those obtained from 1 resident had reactivity to serovar. Access to this pdf, sign in to an existing account, or purchase an annual subscription 2 cholecystectomies performed! Organism in their Lake laboratory evidence of acute febrile illness and serologic confirmation among with. Suspected cases who underwent cholecystectomy cases who underwent cholecystectomy reviewed and published at the CDC swim in their Lake,! By ELISA and then underwent MAT to: mmwrq @ cdc.gov blood obtained... Jr, Sussman M, et al or soil contaminated by Lake runoff during unusually. ; serum specimens that were submitted were screened by ELISA and then underwent MAT animal... For a suspected community case of leptospirosis that has been reported in the HTML version event was support... Picked it up in Lake Springfield reviewed and published at the CDC recognized outbreak of leptospirosis has. 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For disease Control and Prevention, 1600 Clifton Rd a suspected community case of leptospirosis has. Was tested ( n = 52 ) have leptospirosis or that they picked it up in Lake,!

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