Talk:Leptospirosis

Untitled

http://www.leptospirosis.org/medical/infection.php "There is no human vaccine licenced for use in Europe, Asia or the USA."

I found this page quite hard to digest as the text comes as a large unbroken chunk. I would suggest adding a table of contents and splitting the page into various chapters (features, diagnosis, treatment) as for example, the meningitis page. --Anon September 07, 2005

I second that. A lot of information is mentioned several times, and it's quite messy. As far as I can make out, is also all correct (I work for the WHO/Royal Dutch Institute Lepto-dept). I'm willing to 'correct' any changes made, if somebody else starts the editing... --Bluuurgh 16:02 Thursday, October 13 2005 (UTC)

I cleaned up the page somewhat, maybe someone can go through and clean up my clean up? --CDN99 15:48, 14 October 2005 (UTC)

To me, the many jumps back and forth between Leptospirosis in humans & Leptospirosis in animals (dogs, primarily) was confusing. At several points it is hard to tell whether the information pertains to humans or dogs. I suggest overall organization along species lines. —Preceding unsigned comment added by 65.200.165.111 (talk) 01:39, 10 March 2011 (UTC)

Medical advice

Regarding the drug dosages you mention, perhaps you should mention where you have obtained these values? Very good article otherwise!

Leptospirosis in animals needs to be a separate article

Although there's good information in this article, it would be much more cohesive if the information about leptospirosis in animals were to be removed and placed in a separate article, perhaps entitled Leptospirosis (animals). It's not entirely clear whether some of the paragraphs in the current version of the article refers to leptospirosis in humans or animals or both. NighthawkJ (talk) 18:13, 10 October 2008 (UTC)

Also, it needs to be updated with modern information: there are new animal vaccinations out, which are supposed to actually be effective and longer-lasting. I can pick up a brochure from my vet next visit, but aside from the name of the manufacturer I don't think it's going to be an authoritative cite. Anybody? 207.178.110.185 (talk) 01:29, 20 November 2008 (UTC)

A sentence telling us approxiamtely nothing?

"Approximately 5-50% of severe leptospirosis cases are fatal; however, such cases only constitute about 10% of all registered incidents."

"Approximately 5 to 50%"?! This is an entire order of magnitude! Do half these people die, or just 1 in 20? If there's any data at all, it should be able to approximate a little better than this. But there's no citation. And, I suspect, no data. As is, it reads like hand-waving plucked-out-of-the-air space filler.

"... however, such cases only constitute about 10% of all registered incidents." Well, the approximation's more meaningful, but now we have a subsequent clause trying to tame the prior one, and forcing the reader to do all kinds of mental gymnastics to derive meaning.

I would re-write this in a kinder way, but with no data to support it... well, revert me if I'm wrong, but I think it's better gone.

Thanks The Zig (talk) 00:03, 6 April 2009 (UTC)

Content is overly technical for a general audience

I placed a {technical} tag at the beginning of this article. Even with a significant medical background, I had problems reading it. For the layperson, it probably seems like total gibberish. For example, it starts out discussing "serovars" when they could just as easily have been called "variations". Later on, "aetiotropic" is a nice $3 word that essentially means "antibiotic". There is a big difference between merely wikifying terminology and actually improving comprehension. Thus, the overall tone comes across as just a lot of WP:jargon: "Articles in Wikipedia should be understandable to the widest possible audience. For most articles, this means understandable to a general audience [emphasis in original]." — VoxLuna ☾ ^orbit_land   23:46, 30 August 2010 (UTC)

Season reference needs to be clarified

Can the reference to seasonal occurrence be updated, as the article specifically mentions "August–September/February–March". Are these Northern or Southern Hemisphere references.

Feebee06 (talk) 10:56, 7 November 2010 (UTC)

Veterinary data missing

This article is mostly based on human cases of leptospirosis, so there is no data on symptoms in animals; yet animals get this disease more often than humans IIRC... Arny (talk) 13:35, 28 July 2011 (UTC)

Placement of image

Since my change of relocating the life cycle figure to the History section was reverted, I thought that I should explain why I tried to place it there. The image was originally placed under History [1] by the author of the paper postulating that leptospirosis was the infectious disease that wiped out most of the Native Americans residing in present-day Massachusetts in the early 1600s. Most of the risk factors listed in the image are specific to the Native American lifestyle of the era. According to the caption of the image, "The Native American lifestyle exposed them to the leptospiral life cycle." This hypothesis is described in the History section. For an unknown reason, the image was later moved to the Prevention section [2]. To me, this location doesn't make sense for a figure listing risk factors specific to Native Americans of the 1600s. I believe that the image should be moved back to the History section, where the image was located originally. CatPath (talk) 16:14, 11 April 2014 (UTC)

These are still current causes/risk factors. Thus moved to the section on cause. Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:45, 12 April 2014 (UTC)

Lede and statistics

The prose is a bit rough and in the lede, there is mention of a 50% mortality rate in severe infections, but nothing to place context of numbers of severe infections vs mild to moderate infections. That is partially in the signs and symptoms section. Should we move the statistics of severity to the lede or move the mortality rate of severe infections down to the signs and symptoms section where it mentions 90% are mild and perhaps add moderate case data as well (with citations, of course)? The article in general has loads of good information, but it is somewhat hodgepodged together, I'll try to smooth that out later.Wzrd1 (talk) 02:34, 30 April 2014 (UTC)

Hideyo Noguchi

The Hideyo Noguchi article states that he created the vaccine for this disease but here that is not stated. Which is right? What did he do?

Assessment comment

The comment(s) below were originally left at Talk:Leptospirosis/Comments, and are posted here for posterity. Following several discussions in past years, these subpages are now deprecated. The comments may be irrelevant or outdated; if so, please feel free to remove this section.

Human and animal info is all mixed up, should be split, either into separate article or separate section. Also needs more references, and is missing info on horses, cattle, pigs, sheep, and pinnipeds. --Joelmills 14:27, 17 June 2007 (UTC)

Last edited at 14:27, 17 June 2007 (UTC). Substituted at 21:54, 29 April 2016 (UTC)

Tries to improve structure might have lead to unclear references.

@CatPath and Mathrick: Some time after this posting (where "this" obviously refers to the nearest preceding item, the 29 April 2014 substitution), CatPath indeed tried to separate human and (other) animal info, inter alia in this edit, moving much of the content of the Cause section to the Other animals one. Six weeks ago, here, Mathrick marked the remaining text as containing an unreferenced comparative more useful. I do not quite agree with Mathrick's assessment, since the section immediately preceding the 'offending' sentence indeed discussed some serogroup identification using MAT. In general, I think, that it should be permissible to refer to the immediately preceding text for a comparison, without repeating the item you compare to in the same sentence.

On the other hand, before CatPath's edit, the 'offending' sentence was part of a somewhat longer context, forming the following section:

Other (more common) lethal infectious strains exist. Genetically different leptospira organisms may be identical serologically and vice versa. Hence, some argue about strain identification. The traditional serologic system currently seems more useful from a diagnostic and epidemiologic standpoint—but this may change with further development and spread of technologies like polymerase chain reaction (PCR).

CatPath: You removed the two italised sentences completely (without reproducing them in Other animals or elsewhere), and just left the third one. I am a bit unsure of whether the discussion of the strain identification also covers humans or not. If it does, perhaps putting back the two italised sentences could solve the problem. Of course, the starting word "Other" then referred to the dog strains, I suppose, whence a slight rewording might be necessary. JoergenB (talk) 15:27, 3 February 2017 (UTC)

I removed the first sentence ("Other (more common) lethal infectious strains exist.") because it made no sense in its original and current context. The five most common dog serovars were listed immediately above the sentence before I made my edit. How can there be serovars (referred to as "strains" in the sentence in question) that are "more common" if the five most common dog serovars are already listed? Also, I'm not aware of any source claiming that there are pathogenic serovars that not lethal in dogs or humans.

The information in the second italicized sentence ("Genetically different...") is already present in the article in the previous paragraph, which states, "A given serogroup is often found in more than one species,...."

As for the third italicized sentence ("Hence, some argue about strain identification."), I had no idea what it meant, and I still don't.

I'm guessing that whoever wrote the sentence that got flagged by Mathrick meant to say that from a clinical and epidemiological viewpoint, it is more useful to determine an isolate's serovar/serogroup than its species. There are molecular typing methods being developed, many of which involve PCR. The offending sentence needs to be reworded, and a citation should be added.

CatPath (talk) 22:01, 3 February 2017 (UTC)

Puerto Rico 2017

According to CNN, the break down of fresh water supply in the US colony Puerto Rico by the latest hurricane and the post-Hurricane lack of repair are causing an outbreak of Leptospitosis on the island. This should be covered in this artcle. --L.Willms (talk) 08:09, 29 October 2017 (UTC)

The outbreak is already covered in the Hurricane Maria article. It doesn't belong here. CatPath (talk) 09:05, 29 October 2017 (UTC)

Pathogenesis

While the flurry of recent changes to the article is welcome, I question some of the content in the Pathogenesis section. The section starts off with a lengthy paragraph detailing results from a number of old experiments demonstrating the activities of various Leptospira proteins in vitro. There is little discussion of how these activities lead to tissue damage. Ditto for the second paragraph: how does the antibody response to LPS/leptospira proteins relate to disease? In my opinion, most of the first two paragraphs should be removed. If the consensus is to retain the two paragraphs, they should at least be updated to reflect more recent research findings. CatPath (talk) 13:33, 1 March 2019 (UTC)

Thanks for your opinion. The "pathogenesis" section is trimmed down.Cerevisae (talk) 22:43, 1 March 2019 (UTC)

GA Review

This review is transcluded from Talk:Leptospirosis/GA1. The edit link for this section can be used to add comments to the review.

I'll get to this ASAP. Reviewer: Ajpolino (talk · contribs) 22:31, 7 August 2019 (UTC)

GA review (see here for what the criteria are, and here for what they are not)

1. It is reasonably well written.

   a (prose, spelling, and grammar):

Working on the prose. First pass complete:

• "These symptoms are non-specific to leptopsirosis and can occur in other infectious diseases" - Is this sentence necessary? Feel free to ignore this comment and leave it in, but to me it seems removable...  Done I agree with you. Sentence removed.
• "The headache in leptospirosis is characteristaclly located at the bilaterial temporal regions, or frontal headache with throbbing pain, associated with pain behind the eyes and sensitivity to light." - This sentence is confusing. Maybe it could be broken into two sentences? Also for readers unfamiliar with "bilateral temporal regions" you wikilink to temporal bone. Is Temporal lobe more appropriate? Unfortunately there's no article or subsection I can find that covers regional headaches...  Done I replaced temporal bone with temple (anatomy). Broken the sentences into two parts.
• "However rashes can be found in front of the shinbone in the case of "Fort Bragg Fever" which was recorded among soldiers at Fort Bragg, North Carolina in 1942." - Seems a bit unecessary to say "Rash is rare, but it did happen this one time..." Are we sure this is necessary info? Maybe you could just slightly rephrase the two sentences before to emphasize that rash is rare but not impossible?... On a related note, there seems to be some sources about Fort Bragg fever on a quick web search. If it's a highly atypical leptospirosis outbreak, perhaps it merits an article of its own? Writing such a thing is certainly not necessary for this to pass GA review, but would be a nice to-do list item.  Done Moved "Fort Bragg fever" to "History" section.
• "Besides, gastrointestinal symptoms such as nausea, vomiting, abdomoinal pain, and dirrhea frequently occurs." - Reads confusingly. Maybe just remove the word "Besides", or change it to "Additionally"?  Done
• Can "high-output kidney failure" link somewhere? May be an unfamiliar term to most readers. Removed "high-output". "Kidney failure due to excessive urine output" sufficed to explain this. Done
• It can be anything from meningitis.. muscle pain." - Confusing sentence. As a reader, I expect a sentence like that to read "It can be anything from [some things] to [other things]", or just setup the sentence differently. Done Changed to "It can be anything from brain to kidney complications."
• In the last paragraph of the symptoms section, you often use the form: technical term (explanation). Perhaps you could consider replacing some with [[technical term|explanation]], e.g. [[epistaxis|nose bleeding]] for clarity and concision. Also, there's no need to introduce acronyms that you don't use later (e.g. ARDS, PT).  Done
• I think the first sentence of the "Bacteria" subsection is a little unclear. It sounds as if you're saying leptospirosis is caused by the subset of bacteria in Leptospira that are both aerobic and right-handed helices. I think what you instead mean is that leptospirosis is caused by Leptospira, all of which happen to be both aerobic and helical. If my interpretation is correct, could you reword to clarify?  Done. Rearrnaged the sentence.
• "right-handed helical" - Is there a wikilink target that would be appropriate for this, just in case a reader isn't familiar with describing helices by handedness?  Done Wikilined "right-handed" and "helix"
• The first paragraph of the Transmission sub-section is confusing to read. Maybe re-ordering the sentences would make it flow better? At the very least a topic sentence of some kind might help to set the reader's expectations. Let me know if my meaning here is unclear. Done
• The second paragraph of the Transmission sub-section seems to mostly repeat information in the Pathogenesis section. You can probably remove it. Done
• A little bit of reorganization in the Pathogenesis section would go a long way. "Leptospire is well adapted to oxidative environment" reads like a non-sequitur (presumably most readers won't connect that with being well-suited to surviving inflammation); the "Transmission" heading does not have a clear purpose to me (You just had a "Transmission" subsection above); You defined the acronym LPS above (if you're worried readers will forget you can wikilink it); you should link TLR4 or make it clear from context clues why it's important; you go back and forth between using Leptospira as a stand-in for "Leptospira species", and using Leptospires. It might be nice if you stuck to one. Done
• Diagnosis section - As above, the section would read a bit clearer if you replaced some instances of "concept (jargon)" with "[[jargon|concept]]". Maybe move to the "Pathogenesis" section the fact that "The bacteria then move into kidneys after 10 days." Also no need to introduce acronyms that you don't use later. Done. Moved the sentences to kidneys investigations.
• "This leads to a lower number of registered cases than likely exists" is unclear to me. The annual infection rate leads to an underreporting of cases? Or the fact that it's higher in tropical regions? Not sure what it's supposed to mean... Done Sentence removed
• "Between 1995 and 2005, a single successful clone of L. interrogans caused a sustained leptospirosis outbreak in Thailand." - this sentence seems out of place in the Epidemiology section. If the Thai outbreak was particularly severe, perhaps a brief discussion of leptospirosis in SE Asia would fit nicely, rather than a note about the successful strain that caused it. Done Sentence removed
• It's a little awkward that the naming material is split between the beginning of the history section and the end of that section, especially as several of the names you cover at the end are also based on occupations (as you highlight at the beginning of that section). Perhaps you could merge them somehow? Or if you prefer it remain as is, that's fine too. Certainly not a deal breaker for this. Done. Merged into the main article. Only important names mentioned.
• The opening of the section "Other Animals" is a bit jarring. I know you've stated as much above, but could you add a topic sentence of some kind? That would help the section flow more smoothly. Done Added an opening sentence.

1. b (MoS for lead, layout, word choice, fiction, and lists):

   Laid out per WP:MEDMOS; looks great!

2. It is factually accurate and verifiable.

   a (reference section): b (citations to reliable sources): c (OR): d (copyvio and plagiarism):

• I was a bit confused by the 22 species, 21 of which can be divided into three clades bit. Glanced at your source, the Nature Micro review. In box 1, it looks like the authors are saying all 22 can be divided into three clades (10 pathogens, 5 intermediate, 7 saprophytes, although only 6 of saprophytes are shown on their tree...). Maybe I'm misunderstanding this or missing some update, but could you take a look and clarify?  Done Clarified. Thanks for pointing out.

I believe that the edit done to fix this issue introduced a factual error. Two of the 10 species within the "pathogens" clade have not been shown to cause disease in humans or any animal models of leptospirosis (unless there is a more recent study that I'm not aware of). The Nature Micro review is confusing because it contradicts itself on this matter. Box 1 states, "In one clade, there are 10 pathogens thatcan infect and cause disease in humans and animals." However, according to the paragraph that spans pages 301 and 302, strains of L. alstonii, one of the 10 "pathogens," were isolated from amphibians. The same paragraph also states explicitly that another member of the pathogens clade, L. kmetyi, is not virulent in animal models or associated with disease in humans. CatPath (talk) 18:05, 11 August 2019 (UTC)

I think the way it is currently worded is good enough for the purposes of this review: the "pathogens" clade is only referred to in quotes as a name, never as just "the pathogens clade". And it's noted explicitly in the text that two of the subgroups cause human disease (though the position of the remaining two species in that poorly named subgroup is not discussed). Another sentence or two might improve the section. I'll take a crack at it later this week if no one beats me to it; let me know if I make it worse. Ajpolino (talk) 18:53, 19 August 2019 (UTC)

• I'm a little uncomfortable with the statement "A person is more likely to get leptospirosis when he is exposed environmentally rather than through their immunocompropmised status." That seems like a strong claim; in the ref given, the authors seem to go out of their way to state this only as an opinion rather than an observation ("We believe that the occurrence of leptopsirosis is related more to epidemiologic exposure than to an immunosuppressed state", N.B. this is the only claim in the discussion they state this way). Any chance you've seen this assertion elsewhere? It'd be nice if it was in a bona fide review of some kind, rather than the discussion section of a case report... Done
• In the prognosis section, there is a [vague] tag next to "For those with altered mental status, they have a high risk of death." I haven't looked at your ref there, but however you choose to interpret the tag and clarify the sentence is fine by me.
• In the "Prognosis" section you note a case fatality rate of 1% to 5%. In the "Epidemiology" section you note "The risk of death is 5 to 10%." Can you clarify which is true or how those two things are different?  Done Replaced with Evangelista 2010. The 2010 one has a citation. The 2013 fact sheet has no citation.
• The reference currently numbered 38 ([3], at the end of "...contaminated water into their eyes or nose, or exposing open wounds to infected water") looks like maybe it's a surfing blog? Can you find a more reliable reference for that material? Done Reference removed. It is basically a repitition of the first few sentences in the same paragraph.

2. It is broad in its coverage.

   a (major aspects): b (focused):

   Goes well beyond the level of the average GA

3. It follows the neutral point of view policy.

   Fair representation without bias:

4. It is stable.

   No edit wars, etc.:

5. It is illustrated by images and other media, where possible and appropriate.

   a (images are tagged and non-free content have fair use rationales): b (appropriate use with suitable captions):

6. Overall:

   Pass/Fail:

   Thank you both for your comments. It has been great to see some attention turned towards this article. Sorry for such a long wait for GA review. Happy editing! Ajpolino (talk) 18:59, 19 August 2019 (UTC)

Lead image

Conjunctival suffusion (red conjunctiva) together with jaundice is a specific feature of leptospirosis. The cross eye is unrelated.

User:Cerevisae not sure about this as a lead image. My concern is the cross eyes which I imagine is unrelated which sort of confuses things. Have clarified the caption a bit. I guess the question is do we just use one eye? Doc James (talk · contribs · email) 14:05, 28 December 2019 (UTC)

Yes, I think using one eye is better. Cerevisae (talk) 07:42, 29 December 2019 (UTC)

Sounds good User:Cerevisae. Centered it. Feel free to use it in the lead if you wish. Doc James (talk · contribs · email) 12:40, 29 December 2019 (UTC)

References

Not sure why the references are being removed User:Chhandama? You can comment them out but no justification for removal.

We already say this " It is a zoonotic disease transmitted by mammals." in slightly different works a bit lower.

This does not make sense "As a biphasic disease, with the first phase (acute or septic phase) ends after 3 to 7 days of illness." The fact that it is biphasic has no effect on the length of the first phase.

Doc James (talk · contribs · email) 11:41, 14 January 2020 (UTC)

Sorry about that. I was interrupted while reading and editing that I overlooked that part. I was thinking of simplifying to make a smooth sentence like "As a biphasic disease, it consists of two sequential episodes of fever, with the the first phase (acute or septic phase) ending..." I hope I at least did some other helpful edits . Chhandama (talk) 02:48, 15 January 2020 (UTC)

User:Chhandama a bunch of the changes look good. Just adjusted a few others. Best Doc James (talk · contribs · email) 12:25, 15 January 2020 (UTC)

Table, modified Faine's criteria

The table showing the modified version of Faine's criteria was copied almost verbatim from Table 2 in the cited source. Should we be concerned about copyright even though it's a table? CatPath ^{meow to me} 06:40, 4 September 2020 (UTC)

I removed the table for now until this question can be resolved. Better to be safe than sorry. CatPath ^{meow at me} 18:14, 4 September 2020 (UTC)

WP:VET

This is one of the most popular pages in Wikipedia:WikiProject Veterinary medicine's scope. Very few editors watch WT:VET's pages, which means that questions may not be answered in a timely manner. If you are an active editor and interested in animals or veterinary medicine, please put WT:VET on your watchlist. Thank you, WhatamIdoing (talk) 19:59, 11 January 2021 (UTC)