{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T06:04:40Z","timestamp":1790748280847,"version":"4.1.0"},"reference-count":20,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2014,2,7]],"date-time":"2014-02-07T00:00:00Z","timestamp":1391731200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/3.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Conditions in the Democratic Republic of the Congo provide an ideal environment for leptospirosis and plague, both of which can cause severe pulmonary manifestations. In December 2004, an outbreak of lethal pneumonia occurred in a local mining camp, affecting 130 persons and killing 57 of them. Clinical signs, fast disease spread, and initial laboratory investigations suggested pneumonic plague. While leptospirosis had not recently been described in the region, it was considered as a differential diagnosis. Anti-Leptospira antibodies were detected by microscopic agglutination test (MAT). A confirmed case of leptospirosis was defined as having consistent clinical signs and any one of the following: seroconversion or four-fold increase in MAT titre for paired serum samples, or a MAT titre \u2265 1:400 for acute-phase serum samples. Twenty-nine of the 54 patients or convalescents tested for leptospirosis were seropositive. Two cases showed a confirmed infection for both plague and leptospirosis. While evidence supports the plague nature of this outbreak, the results suggest that some of the suspected plague cases might be due to leptospirosis. In any case, this diagnosis will have to be evoked in the future if a similar outbreak occurs in this region of Africa.<\/jats:p>","DOI":"10.3390\/ijerph110201824","type":"journal-article","created":{"date-parts":[[2014,2,10]],"date-time":"2014-02-10T02:45:25Z","timestamp":1392000325000},"page":"1824-1833","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Discovery of a Leptospirosis Cluster Amidst a Pneumonic Plague Outbreak in a Miners\u2019 Camp in the Democratic Republic of the Congo"],"prefix":"10.3390","volume":"11","author":[{"given":"Eric","family":"Bertherat","sequence":"first","affiliation":[{"name":"Pandemic and Epidemic Diseases, World Health Organization, Geneva 1202, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa","family":"Mueller","sequence":"additional","affiliation":[{"name":"Clinical and Translational Science Institute, University of Minnesota, 717 SE Delaware Street, Minneapolis, MN 55414, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Christophe","family":"Shako","sequence":"additional","affiliation":[{"name":"Plague Reference Laboratory, Bunia, Democratic Republic of the Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathieu","family":"Picardeau","sequence":"additional","affiliation":[{"name":"Pasteur Institute, Biology of Spirochetes Unit, National Reference Center for Leptospirosis, WHO Collaborating Center for Leptospirosis, 75724 Paris Cedex 15, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2014,2,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S5","DOI":"10.1016\/j.ijantimicag.2010.06.012","article-title":"Estimating the burden of human leptospirosis","volume":"36","author":"Sikkema","year":"2010","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_2","unstructured":"World Health Organization and International Leptospirosis Society (2003). Human Leptospirosis: Guidance for Diagnosis, Surveillance and Control, WHO."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1007\/s00408-004-2541-0","article-title":"Respiratory manifestations of leptospirosis: A retrospective study","volume":"183","author":"Tattevin","year":"2005","journal-title":"Lung"},{"key":"ref_4","unstructured":"Leptospirosis Burden Epidemiology Reference Group (LERG) Leptospirosis: Systematic Review of the Global Burden of Disease. Available online:http:\/\/www.who.int\/zoonoses\/diseases\/lerg\/en\/."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Stenseth, N.C., Atshabar, B.B., Begon, M., Belmain, S.R., Bertherat, E., Carniel, E., Gage, K.L., Leirs, H., and Rahalison, L. (2008). Plague: Past, present, and future. PLoS Med., 5.","DOI":"10.1371\/journal.pmed.0050003"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"778","DOI":"10.3201\/eid1705.100029","article-title":"Lessons learned about pneumonic plague diagnosis from two outbreaks, Democratic Republic of the Congo","volume":"17","author":"Bertherat","year":"2011","journal-title":"Emerg. Infect. Dis."},{"key":"ref_7","unstructured":"World Health Organization (2006). International meeting on preventing and controlling plague: The old calamity still has a future. Wkly Epidemiol Rec., 81, 278\u2013284."},{"key":"ref_8","first-page":"197","article-title":"Le foyer centro-africain de leptospirose (Contribution au probl\u00e8me de l\u2019unit\u00e9 ou de la pluralit\u00e9 des leptospires du type L. icterohaemorrhagiae)","volume":"26","year":"1946","journal-title":"Ann. Soc. Belg. Med. Trop."},{"key":"ref_9","first-page":"118","article-title":"Etude clinique, bact\u00e9riologique et \u00e9pid\u00e9miologique d\u2019un nouveau foyer de leptospirose au Congo Belge","volume":"26","author":"Szpajshendler","year":"1956","journal-title":"Ann. Soc. Belg. Med. Trop."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"610","DOI":"10.4269\/ajtmh.1999.60.610","article-title":"Leptospirosis and Ebola virus infection in five gold-panning villages in the North East of Gabon","volume":"60","author":"Bertherat","year":"1999","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1016\/S1473-3099(03)00830-2","article-title":"Leptospirosis: A zoonotic disease of global importance","volume":"3","author":"Bharti","year":"2003","journal-title":"Lancet Infect. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1017\/S0950268800067868","article-title":"Serological prevalence of leptospiral infection in domestic animals in West Malaysia","volume":"99","author":"Bahaman","year":"1987","journal-title":"Epidemiol. Infect."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1136\/vr.99.20.387","article-title":"Bovine leptospirosis: A serological and clinical study","volume":"99","author":"Ellis","year":"1976","journal-title":"Vet. Rec."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1136\/vr.130.20.446","article-title":"Isolation of leptospira interrogans from kidneys of Zimbabwe beef cattle","volume":"130","author":"Feresu","year":"1992","journal-title":"Vet. Rec."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1007\/BF02356985","article-title":"Leptospiral agglutinins among cattle in the Republic of Guyana","volume":"17","author":"Myers","year":"1985","journal-title":"Trop. Anim. Health Prod."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"695","DOI":"10.4269\/ajtmh.2009.09-0252","article-title":"The microscopic agglutination test (Mat) is an unreliable predictor of infecting leptospira serovar in Thailand","volume":"81","author":"Smythe","year":"2009","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_17","unstructured":"Poeppl, W., Orola, M.J., Herkner, H., Muller, M., Tobudic, S., Faas, A., Mooseder, G., Allerberger, F., and Burgmann, H. High prevalence of antiobodies against Leptospira spp. in male Austrian adults: A cross-sectional survey, April to June 2009. Available online:http:\/\/www.eurosurveillance.org\/ViewArticle.aspx?ArticleId=20509."},{"key":"ref_18","unstructured":"Dennis, D.T., Gage, K.L., Gratz, N., Poland, J.D., and Tikhomirov, E. (1999). Plague Manual-Epidemiology, Distribution, Surveillance and Control, World Health Organization."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"4882","DOI":"10.1128\/AEM.00775-10","article-title":"Antibiotic resistance markers for genetic manipulations of Leptospira spp.","volume":"76","author":"Poggi","year":"2010","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_20","unstructured":"World Health Organization (2010). Yellow fever in the WHO African and American Regions, 2010. Wkly Epidemiol Rec., 86, 370\u2013376."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/11\/2\/1824\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T21:07:58Z","timestamp":1760216878000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/11\/2\/1824"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,2,7]]},"references-count":20,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2014,2]]}},"alternative-id":["ijerph110201824"],"URL":"https:\/\/doi.org\/10.3390\/ijerph110201824","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,2,7]]}}}