Preliminary survey of Leptospirosis and Lyme disease amongst febrile patients attending community hospital ambulatory care in Maputo, Mozambique.

OBJECTIVES

To evaluate the importance of the spirochetes Leptospira interrogans s.l. and Borrelia burgdorferi s.l., as causes of human diseases (leptospirosis and Lyme borreliosis), in order to guide the development of laboratory services and patient management and to identify the appropriateness of future epidemiological studies.

DESIGN

Cross sectional serological survey.

SETTING

Maputo, the capital city of Mozambique.

SUBJECTS: 160 adult patients (18 to 50 years of age) presenting, sequentially and for the first time, with a febrile illness at the outpatient's department of a community hospital.

METHODS

All sera were examined for L. interrogans s.l. antibodies by the standard microtiter technique (MAT), using as live culture antigens a battery of serovars representing 20 pathogenic serogroups. The IgM and IgG antibody response to B. burgdorferi s.l. was determined in all sera with an indirect IgG ELISA. In order to study potential serological cross-reactivity in malaria positive sera, all samples were further examined for antibodies against Plasmodium falciparum by indirect immunofluorescence. This was complemented with a standardised clinical history and physical examination.

MAIN OUTCOME MEASURES: Presence of antibodies to Leptospira interrogans s.l. and to Borrelia burgdorferi s.l..

RESULTS AND

CONCLUSIONS

Although not conclusive, because of the inability to attempt rising serology and positive cultures, the results suggest that 10% of non-specific febrile illnesses could be attributed to leptospirosis. This study may thus form the background for a definitive Leptospira research in the same location. We confirm reports from other African countries that Lyme disease is an unlikely occurrence. We further suggest that some of the seropositivity observed for Lyme disease in Maputo could be attributed to serological cross reactivity with antibodies to P. falciparum malaria, leptospirosis or syphilis.