Leptospirosis occurs as frequently as malaria among adolescent and adult acute febrile patients in Hoima, Uganda: A prospective health facility-based study
- 1Section of Epidemiology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.
- 2College of Veterinary Medicine, Animal Resources and Biosecurity (CoVAB), Makerere University, Kampala, Uganda.
- 3Infectious Diseases Institute, Makerere University, Kampala, Uganda.
Abstract
Background: Leptospirosis is underdiagnosed across sub-Saharan Africa, with its contribution to acute undifferentiated fever (AUF) poorly characterized. We determined the prevalence, risk factors, and clinical profile of leptospirosis among adolescents and adults with AUF at a referral hospital and health centre in Hoima, Uganda. Methods: In a prospective health facility-based study with convalescent follow-up, blood and urine from AUF patients were tested by LipL32 real-time PCR (qPCR) and microscopic agglutination (MAT). Leptospirosis was confirmed by qPCR positivity, a single test MAT titre of ≥1:800, a fourfold titre rise or seroconversion (change from negative or 1:50 to ≥1:100 (lenient) or ≥1:200 (conservative)) in paired sera. Risk factors were identified by multivariable logistic regression. Results: Among 330 AUF patients, acute leptospirosis prevalence was 27.0% under the conservative definition (95% CI 22.3 to 32.1) and 32.7% under the lenient definition (95% CI 27.7 to 38.1). This was comparable to malaria at 30.3% (95% CI 25.3 to 35.3), and 8.8% of patients had both infections (95% CI 5.7 to 11.8). qPCR detected Leptospira DNA in 9.1% of patients. Agreement between qPCR and serology was low: 63.3% of qPCR-positive cases were confirmed by MAT, and only 24.4% of serologically confirmed cases were qPCR-positive. Seroprevalence (MAT titre 1:100 or above) was 35.8% (95% CI 30.6 to 41.2). L. interrogans serovar Bataviae was the predominant serovar, reported here for the first time in Uganda. Skinning animals (aOR 5.19, 95% CI 1.40 to 21.16) and mosquito exposure (aOR 2.31, 95% CI 1.17 to 4.70) were independent risk factors. Discussion: Leptospirosis occurs as frequently as malaria among AUF patients in Hoima warranting inclusion in Uganda’s national febrile illness guidelines. The association of leptospirosis with skinning suggests a role of animal exposure in leptospirosis transmission. Poor qPCR-MAT concordance confirms that accurate case ascertainment requires combined molecular and serological diagnostics. While findings are regional, their implications are broader, highlighting the need to include zoonotic diseases in diagnosis and surveillance. Targeted treatment can reduce morbidity, mortality, and economic burden, while limiting antimicrobial resistance by decreasing broad-spectrum antibiotic use. Author summary: Fever is one of the most common reasons people seek care in East Africa, and malaria is almost always the first diagnosis considered. But many patients with fever do not have malaria, and we wanted to understand what else might be causing their illness. We studied 330 patients with fever at two health facilities in Hoima, western Uganda, testing blood and urine for leptospirosis, a bacterial infection spread through contact with urine from infected animals such as cattle, pigs, and rodents. We found nearly one in three patients had leptospirosis, almost identical to malaria prevalence in the same patients. People who reported skinning animals were five times more likely to have leptospirosis, pointing to animal contact during slaughter as a key transmission route. We also identified a strain of the bacteria not previously documented in Uganda, with livestock as the most likely source. Leptospirosis is treatable with doxycycline, a widely available antibiotic, but it is not included in Uganda’s national treatment guidelines for fever. Our findings show it should be. Greater awareness and access to testing in Uganda and similar settings could prevent serious illness and death from a disease currently almost entirely missed.
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BibTeX
@article{kirabo2026leptospirosis,
title = {{Leptospirosis occurs as frequently as malaria among adolescent and adult acute febrile patients in Hoima, Uganda: A prospective health facility-based study}},
author = {Andrew Vivian Kirabo and Lordrick Alinaitwe and Kenneth Kobba and Edgar Charles Ndawula and Joel Ogwang and Moses Kirungi and Angella Ndagire and Clovice Kankya and Francis Kakooza and Mohammed Lamorde and Jonathan Mayito and Anou Dreyfus},
journal = {PLOS Neglected Tropical Diseases},
year = {2026},
month = oct,
doi = {10.1371/journal.pntd.0014772},
url = {https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014772},
note = {CC BY},
}
RIS
TY - JOUR
TI - Leptospirosis occurs as frequently as malaria among adolescent and adult acute febrile patients in Hoima, Uganda: A prospective health facility-based study
AU - Andrew Vivian Kirabo
AU - Lordrick Alinaitwe
AU - Kenneth Kobba
AU - Edgar Charles Ndawula
AU - Joel Ogwang
AU - Moses Kirungi
AU - Angella Ndagire
AU - Clovice Kankya
AU - Francis Kakooza
AU - Mohammed Lamorde
AU - Jonathan Mayito
AU - Anou Dreyfus
PY - 2026
DA - 2026/10/29
JO - PLOS Neglected Tropical Diseases
DO - 10.1371/journal.pntd.0014772
UR - https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014772
AB - Background: Leptospirosis is underdiagnosed across sub-Saharan Africa, with its contribution to acute undifferentiated fever (AUF) poorly characterized. We determined the prevalence, risk factors, and clinical profile of leptospirosis among adolescents and adults with AUF at a referral hospital and health centre in Hoima, Uganda. Methods: In a prospective health facility-based study with convalescent follow-up, blood and urine from AUF patients were tested by LipL32 real-time PCR (qPCR) and microscopic agglutination (MAT). Leptospirosis was confirmed by qPCR positivity, a single test MAT titre of ≥1:800, a fourfold titre rise or seroconversion (change from negative or 1:50 to ≥1:100 (lenient) or ≥1:200 (conservative)) in paired sera. Risk factors were identified by multivariable logistic regression. Results: Among 330 AUF patients, acute leptospirosis prevalence was 27.0% under the conservative definition (95% CI 22.3 to 32.1) and 32.7% under the lenient definition (95% CI 27.7 to 38.1). This was comparable to malaria at 30.3% (95% CI 25.3 to 35.3), and 8.8% of patients had both infections (95% CI 5.7 to 11.8). qPCR detected Leptospira DNA in 9.1% of patients. Agreement between qPCR and serology was low: 63.3% of qPCR-positive cases were confirmed by MAT, and only 24.4% of serologically confirmed cases were qPCR-positive. Seroprevalence (MAT titre 1:100 or above) was 35.8% (95% CI 30.6 to 41.2). L. interrogans serovar Bataviae was the predominant serovar, reported here for the first time in Uganda. Skinning animals (aOR 5.19, 95% CI 1.40 to 21.16) and mosquito exposure (aOR 2.31, 95% CI 1.17 to 4.70) were independent risk factors. Discussion: Leptospirosis occurs as frequently as malaria among AUF patients in Hoima warranting inclusion in Uganda’s national febrile illness guidelines. The association of leptospirosis with skinning suggests a role of animal exposure in leptospirosis transmission. Poor qPCR-MAT concordance confirms that accurate case ascertainment requires combined molecular and serological diagnostics. While findings are regional, their implications are broader, highlighting the need to include zoonotic diseases in diagnosis and surveillance. Targeted treatment can reduce morbidity, mortality, and economic burden, while limiting antimicrobial resistance by decreasing broad-spectrum antibiotic use. Author summary: Fever is one of the most common reasons people seek care in East Africa, and malaria is almost always the first diagnosis considered. But many patients with fever do not have malaria, and we wanted to understand what else might be causing their illness. We studied 330 patients with fever at two health facilities in Hoima, western Uganda, testing blood and urine for leptospirosis, a bacterial infection spread through contact with urine from infected animals such as cattle, pigs, and rodents. We found nearly one in three patients had leptospirosis, almost identical to malaria prevalence in the same patients. People who reported skinning animals were five times more likely to have leptospirosis, pointing to animal contact during slaughter as a key transmission route. We also identified a strain of the bacteria not previously documented in Uganda, with livestock as the most likely source. Leptospirosis is treatable with doxycycline, a widely available antibiotic, but it is not included in Uganda’s national treatment guidelines for fever. Our findings show it should be. Greater awareness and access to testing in Uganda and similar settings could prevent serious illness and death from a disease currently almost entirely missed.
SN - 1935-2735
SN - 1935-2727
ER -