Leptospirosis is considered as one of the most common zoonotic diseases globally and now is identified as one of the emerging infectious diseases. The spectrum of human disease is extremely wide, ranging from subclinical infection to a severe syndrome of multiorgan infection with high mortality rate.(1);(4) More than 200 Leptospira serovars have been identified. For most serovars, the epidemiology is poorly understood, as there are more serovars than known animal reservoir species, but certain serovars have been linked strongly to specific animal reservoirs. A few of the more common serovar-reservoir relationships are L. interrogans serovars Pomona (swine), Bratislava (swine), Canicola (dogs), Bovis (cattle), Autumnalis (raccoo In 21st century etiological structure of leptospirosis has being changed somehow. In 20th century - L. autumnalis, L. mankarso, L. wolffii and others are mostly observed. Dogs are also considered maintenance hosts for serovar Canicola. (3)The disease occurs worldwide, but it is most common in temperate regions in the late summer and early fall and in tropical regions during rainy seasons. In the United States, outbreaks are increasingly being reported among those participating in recreational water activities (Centers for Disease Control and Prevention [CDC], 1996, 1998, and 2001) and sporadic cases are often underdiagnosed. (2)

In Soviet Georgia formal registration of the infection began in 1950s. Single cases were reported annually in the country with the exception of 1986, when water-borne outbreak broke out in Sukhumi with 21 detected cases. Low morbidity level of disease was reported during 2001-2005. Since 2006 significant increase of leptospirosis has been observed. The highest incidence was reported in 2011-1.81 per 100 000 population. At present leptospirosis is widely spread in the country, especially in Ajara region, where indicators of morbidity recently reached 11.4 per 100 thousand population (5)

Methods and Objectives: In 2013-2015 we studied 56 hospitalized patients with leptospirosis . The research was conducted at the Center of Infectious Diseases, Aids and Clinical Immunology Center. The aim of the research was to reveal clinical and epidemiological features of leptospirosis in Georgia. Patients were diagnosed based on serological tests (ELISA). In every case leptospira -IgM was positive. Lethality is 3.5 %

Results and discussion: Among 56 hospitalized patients with diagnose of leptospirosis 44 (78.6 %) patients were male, 12 (21.4 %) patients were female, cases are reported among age group of 15-75. 36 patients (64.3 %) were urban residents; 20 cases (35.7 %) were rural residents. The fact of bathing in lakes and reservoirs revealed in 5 cases (8.9 %); the source of infection was unknown in other 51 cases (91.1 %).

In every case the onset of the disease was severe with high fever, severe headache, myalgia,

arthralgia, fatigue, nausea, vomiting (100 %); almost every patient was brought to the hospital on 6-7-th day of their disease.

Jaundice was revealed in 25 cases (44.6 %); in 31 patients (55.4%) clinical course of leptospirosis was without jaundice. In cases with jaundice total bilirubin level was high at the expense of conjugated bilirubin. Oliguria in 13 cases (23.2 %); elevation of ALT and AST was established in most of cases - 45 cases (80.3 %); polymorphic rash was revealed in 8 cases (14.3 %); dark urine was revealed in 16 cases (28.6 %); oligo-anuria revealed in 13 cases (23.2 %); creatinemia and elevation of urea -in 27 patients ( 48.2 %); in most of patients (almost 100 %) elevated ESR, leukocytosis and elevated CRP were revealed.

2 patients (3.6 %) developed pneumonia and mechanical ventilation was required, in 3 cases there was hemorrhagic syndrome (Epistaxis ,bleeding from gums; hemoptysis)( 5.3 %); in 2 patients (3.6 %) revealed meningeal syndrome ( neck stiffness. Kerning's sign);

Conclusion: Thus, received results show that the number of leptospirosis cases has abruptly increased in the city (20 cases). In past, leptospirosis was mainly associated with village, but nowadays it is seen almost with the same frequency in the city; besides, males are more frequently infected with the leptospirosis then women. it needs to be noted that the source of infection in most cases cannot be determined, namely, spreading of various serovars of leptospirosis; increase of the number of cases in the city, polymorphic clinical signs, delayed diagnosis and hospitalization contributes towards developing of severe forms of the disease and accordingly, the increase of the rate of lethality.

REFERENCE:

1. Mamuchishvili N, Kuchuloria T, Mchedlishvili I, Imnadze P, Mirzashvili D. ETHIOLOGY OF LEPTOSPIROSIS IN GEORGIA, Georgian Med News. 2015 Jul-Aug; (244-245):106-10

2. Epidemiology Bulletin, National Center for Disease Control and Public Health, Ministry of Labour, Health And Social Affairs of Georgia, 2016/Vol.20 N2

3. Federico Costa, José E. Hagan, Juan Calcagno, Michael Kane, Paul Torgerson, Martha S. Martinez-Silveira, Claudia Stein, Bernadette Abela-Ridder, Global Morbidity and Mortality of Leptospirosis, PLoS Negl Trop Dis. 2015 Sep; 9(9)

4. Paul R. Torgerson, José E. Hagan, Federico Costa, Juan Calcagno, Michael Kane, Martha S. Martinez-Silveira, Marga G. A. Goris, Claudia Stein, Albert I. Ko,, Bernadette Abela-Ridder Global Burden of Leptospirosis: Estimated in Terms of Disability Adjusted Life Years. Published: October 2, 2015, http://dx.doi.org/10.1371/journal.pntd.0004122

5. Ridalva D. M. Felzemburgh, Guilherme S. Ribeiro, Federico Costa, Renato B. Reis, José E. Hagan, Astrid X. T. O. Melendez, Deborah Fraga, Francisco S. Santana, Sharif Mohr, Balbino L. dos Santos, Adriano Q. Silva, Andréia C. Santos, Romy R. Ravines, Albert I. Ko, Prospective Study of Leptospirosis Transmission in an Urban Slum Community: Role of Poor Environment in Repeated Exposures to the Leptospira Agent Published: May 29, 2014, http://dx.doi.org/10.1371/journal.pntd.0002927

Vashakidze E; Megrelishivli T; Mikadze I; Pachkoria E; Kipiani N; Tbilisi State Medical University; Department of Infectious Diseases

LEPTOSPIROSIS IN GEORGIA

Pic.1 The incidence of leptospirosis in Georgia in 1970-2014 years