{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T01:27:09Z","timestamp":1793410029699,"version":"4.5.0"},"reference-count":42,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2019,5,16]],"date-time":"2019-05-16T00:00:00Z","timestamp":1557964800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Department of Disease Control, Ministry of Public Health, Thailand","award":["\u0e367\/59078"],"award-info":[{"award-number":["\u0e367\/59078"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["TropicalMed"],"abstract":"<jats:p>A nationwide prevention and control campaign for leptospirosis in Thailand has led to a decreased incidence rate, but the mortality and case fatality rates have remained stable. Regarding the limited knowledge of risk factors, a case-control study of the association between environmental and behavioral exposure with severe leptospirosis was implemented to identify the risk factors among adults in Thailand. The study was conducted in 12 hospital-based sites. Hospitalized patients with suspected clinical symptoms of leptospirosis were tested for leptospirosis by culture, loop mediated isothermal amplification (LAMP), real-time PCR, and the microscopic agglutination test (MAT). All participants answered a standardized questionnaire about potential risk factors. Risk factors were identified by univariable and multivariable logistic regression. Of the 44 confirmed cases, 33 (75.0%) presented with severe illness, as determined by clinical criteria, and were categorized as severe cases. Non-severe cases were defined as patients with non-severe symptoms of leptospirosis. Living nearby a rubber tree plantation (adjusted OR 11.65, 95% CI 1.08\u2013125.53) and bathing in natural bodies of water (adjusted OR 10.45, 95% CI 1.17\u201393.35) were both significantly associated with an increased risk of severe leptospirosis. We recommend designating rubber plantations in Thailand as high-risk zones and closely monitoring hospitalized patients in those areas.<\/jats:p>","DOI":"10.3390\/tropicalmed4020079","type":"journal-article","created":{"date-parts":[[2019,5,16]],"date-time":"2019-05-16T11:21:22Z","timestamp":1558005682000},"page":"79","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["Environmental and Behavioral Risk Factors for Severe Leptospirosis in Thailand"],"prefix":"10.3390","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6127-2665","authenticated-orcid":false,"given":"Soawapak","family":"Hinjoy","sequence":"first","affiliation":[{"name":"Office of International Cooperation, Department of Disease Control, Ministry of Public Health, Nonthaburi 11000, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Somkid","family":"Kongyu","sequence":"additional","affiliation":[{"name":"Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health, Nonthaburi 11000, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pawinee","family":"Doung-Ngern","sequence":"additional","affiliation":[{"name":"Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health, Nonthaburi 11000, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Galayanee","family":"Doungchawee","sequence":"additional","affiliation":[{"name":"Department of Pathobiology, Faculty of Science, Mahidol University, Bangkok 10400, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soledad D.","family":"Colombe","sequence":"additional","affiliation":[{"name":"Center for Global Health, Weill-Cornell Medical College, 1300 York Ave, New York, NY 10065, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Royce","family":"Tsukayama","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease and Vaccinology, School of Public Health, University of California, Berkeley, CA 94720, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duangjai","family":"Suwancharoen","sequence":"additional","affiliation":[{"name":"National Institute of Animal Health, Department of Livestock Development, Ministry of Agriculture and Cooperatives, Bangkok 10900, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,5,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Barry, P., Morris, K., and Ali, T. 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