Skip to main content

Leptospirosis in Malaysia: current status, insights, and future prospects

Abstract

Among zoonotic infections, leptospirosis has a worldwide distribution and high prevalence in tropical regions. It has a broad clinical presentation from mild to severe, life-threatening infection. Leptospires, the etiological agent of leptospirosis, are found in varied ecological niches and animal species, providing a significant source of human infection. This review aims to provide the current status of leptospirosis in Malaysia and the direction for future studies. The literature search for this review was performed using PubMed, Web of Sciences, and Google Scholar databases. The incidence of leptospirosis in Malaysia from 2004 to 2020 varied; however, a large number of cases occurred during floods. Leptospira has been isolated from wild and domestic animals as well as from the environment; among them, several novel species have been identified. In Malaysia, leptospirosis infection and death were mostly associated with recreational and non-recreational water activities. Despite the endemicity of leptospirosis, the public’s knowledge, attitude, and practice level are relatively low in this country. More studies are needed in Malaysia to explore the extent of leptospirosis in different settings and locations.

Background

Leptospirosis is a zoonotic infection; the risk factors of this infection are associated with human activities and the environment [1]. It is widely distributed, infecting more than one million people worldwide and causing 60,000 deaths yearly [2]. A helical and highly motile spirochete belonging to the genus Leptospira causes leptospirosis. Leptospires in nature are maintained by chronic carrier hosts, primarily rodents, in their renal tubules and excreted into the environment through their urine. Human infection results from direct contact with the infected reservoir animals or indirect exposure to contaminated environments. Leptospires enter the hosts through cuts and bruises on skin and mucus membranes such as the conjunctival, oral, or genital surfaces [3]. Once inside the hosts, the leptospires are disseminated by hematogenous routes into many organs, mainly the kidneys, liver, and lungs. Humans infected with leptospires typically manifest a broad clinical presentation, ranging from asymptomatic [4] or mild to severe and life-threatening infection. Multi-organ injuries and pulmonary hemorrhage characterize the severity. Its progression from mild to severe is rapid, as shown in human [5, 6] and animal studies [7, 8]. Severe leptospirosis has been associated with pathogen virulence, host susceptibility, and epidemiological conditions [3].

Leptospirosis is diagnosed by microscopic agglutination test (MAT), and polymerase chain reaction (PCR) targeting genes specific for pathogenic leptospires. The former method requires an understanding of locally circulating serovars. Leptospira is detected in broad ranges of animal reservoirs and in various ecological niches. The knowledge of ecological niche harboring leptospires, as well as their species and serovar distribution, is critical not only for implementing prevention and control policies but also for diagnosing leptospirosis.

The burden of leptospirosis is mainly in countries with humid subtropical and tropical climates such as South America, Southern Asia, and Southeast Asia. Malaysia is located in Southeast Asia in the north of the equator. It is composed of two noncontiguous regions: Peninsular Malaysia (Semanjung Malaysia) or West Malaysia (Malaysia Barat), which is located in the Malay Peninsula, and East Malaysia (Malaysia Timur), which is on Borneo Island, contains two states, Sabah and Sarawak. Peninsular and East Malaysia lie in the same tropical latitude and are affected by similar airstreams. From November to March, Malaysia is blessed with heavy rainfall and humidity during the northeast monsoon season. Leptospirosis in Malaysia has a long history, reaching almost a century.

Ten years after Leptospira was discovered in Japan [9], Fletcher first reported leptospirosis in Malaysia in 1925 among rubber plantation workers and people residing in rural areas [10]. Fletcher also identified two Leptospira interrogans serovars—namely, Icterohaemorrhagiae and Hebdomadis—isolated from humans, rats, and dogs [9]. Leptospires were also detected in water supply, streams, and ponds; however, their serovars remained unidentified. After the discovery of leptospires in Malaysia, studies were performed focusing on the military [11,12,13]. The prevalence of leptospirosis among military personnel ranged from 4.6 to 34.7%, including two fatal cases which were detected in 1969 and 1978 [13]. Several studies also reported that workers in rubber and oil palm plantations, hospitals, sewage, and town cleanings were at high risk of infection [14,15,16,17]. Several outbreaks were reported from Sarawak state among those involved in cave explorations [18, 19] and chamber visitations [20]. Leptospires were also detected in domestic animals such as cattle, buffaloes, and pigs with L. interrogans, Unipertama, Canicola, Australis, Javanica, Ballum, Pomona, Hardjo, Sejroe, and Tarassovi as the infecting Leptospira species and serovars [21,22,23]. In humans, Malaya [24], Abramis, Biggis, Birkini, Coxi, Fugis, Gurungi, Hemolytica, Hamptoni, Mooris, Ricardi, Smithi, and Sumneri were isolated from leptospirosis patients [25]. These earlier reports showed that occupations determined the occurrence of leptospirosis. The present review aims to describe the current status of leptospirosis in Malaysia, surveyed from 2000 to 2021, define research gaps, and update the importance of developing prevention measures.

Literature search and ethics

The published literature related to leptospirosis in Malaysia was searched in PubMed, Web of Sciences, and Google Scholar databases. The search terms utilized were “Leptospirosis”, “Leptospira,” “Prevalence,” “Seroprevalence,” “Human,” and “Animal” with no restriction on language or publication date. Non-indexed local journals, bulletins, newspapers, clinical cases, and data from the Ministry of Health Malaysia were included in our results and discussion. Additional papers were identified from reference lists of retrieved articles to find appropriate studies that might not have been identified during the preliminary search. We reviewed the published literature with anonymized data; thus, the study does not require any bioethical approval.

Leptospirosis in Malaysia

Leptospirosis is endemic in Malaysia and is the third most fatal infection after dengue and malaria [26]. In 2010, leptospirosis was gazetted as a notifiable disease in this country [27]. Since then, the number of reported cases and their mortality have been recorded. A higher number of leptospirosis was recorded from 2010 to 2019, with the peak of leptospirosis cases and deaths in 2014 and 2015, respectively (Fig. 1). In 2020 and 2021, the incidence of leptospirosis decreased, and a similar trend was also observed in European countries during the same period [28]. This decline could be attributed to the changes in population behaviors, such as reduced outdoor and recreational activities and the closure of schools in compliance with the movement control order (MCO) due to COVID-19 [29]. The incidence and case fatality rates (CFR) of leptospirosis in Malaysia between 2010 and 2020 were 8.63–17.2 and 0.6–2.4%/100,000 populations, respectively [29,30,31,32,33,34,35,36,37,38,39]. In 2020, although the incidence rate was low, the CFR was high compared to the previous year (2020: 1.3%, 2019: 0.6%). Leptospirosis outbreaks were also reported and mainly occurred in residential areas. More than half of the infected patients were men in the age group of 20–60 years [27, 29,30,31,32,33,34,35,36,37,38,39].

Fig. 1
figure 1

Leptospirosis cases and deaths in Malaysia from 2004 to 2021. The yearly distribution of leptospirosis cases and deaths in Malaysia from 2004 to 2021. The number of cases from 2004 to 2009 (green horizontal bar) does not represent the actual number of cases as leptospirosis disease notification only became mandatory in 2010 (purple horizontal bar). The cases increased gradually from 2010 to 2013 and then exponentially from 2013 to 2015. Then, it decreased in 2016 and 2017, increased in 2018 and 2019, and decreased again in 2020 and 2021. The incidence of leptospirosis cases remained similar from 2004 to 2007 and sharply increased in 2008 and peaked in 2010, declined till 2012 and peaked again in 2014, gradually declined till 2017, and increased a little in 2018 and continued a similar trend. Data on leptospirosis incidence in 2021 was not available. Source of data: Ministry of Health Malaysia, Annual Report 2010–2021. Estimated number of cases (2004–2009); Purple bar: The recorded number of cases (2010–2021)

Among all states in Malaysia, Selangor, Kelantan, and Sarawak recorded the higher number of leptospirosis (Fig. 2). In 2014, 2015, and 2019, leptospirosis peaked in Selangor, Kelantan, and Sarawak, respectively. These contributed to the peaks in the year-wise distribution of leptospirosis cases in Malaysia. Perak state and the Federal Territory of Labuan recorded fewer cases throughout the 17 years.

Fig. 2
figure 2

Number of cases in each state of Malaysia from 2004 to 2021. Yearly distribution of leptospirosis cases in each state of Malaysia from 2004 to 2021. Data from 2010 was not available. Source: data.gov.my

Potential reservoirs of Leptospira spp

Animals

Leptospira can be isolated from a broad spectrum of animal hosts, but the primary hosts are wild animals such as rodents. From 2000 to 2022, 21 studies have been conducted in Malaysia to detect leptospires in wild and domestic animals using serological, molecular, and/or culture techniques (Table 1; Additional file 1). Detection of leptospires in wild animals (rodents, shrew, orang utan) was limited to those found in recreational spots [40,41,42,43], urban areas including human settlements and wet markets [40, 44,45,46,47], sub-urban areas [40, 48, 49], agricultural regions such as oil-palm plantations [48] and paddy fields [50], conservation center [51], and National Service Training Center [52] (Table 1). The prevalence rate of leptospires in rodents varies from 5.6 to 72% (median = 14.3%), with the highest rate detected in rodents of wet markets in Kelantan [44]. Leptospira was also detected in domestic animals such as dogs [53,54,55,56,57], cats [58], cattle [59, 60], and swine [57], as well as goat and sheep [59]. The prevalence rate of leptospires in these domestic animals ranged from 3.1 to 81.7% (median = 15.2%), with high prevalence occurring in cattle. The detection of Leptospira in both wild and domestic animals indicates the prevalence of Leptospira circulating in animals which infest the areas related to human activities as well as pets and farm animals, increasing the risk of leptospires transmission to humans in Malaysia.

Table 1 Detection of leptospires in animals and environments according to settings in Malaysia

Environments

Water and soil sampling provides essential information that enhances our understanding of the leptospiral human–environment–animal relationship. Ten studies have described the distribution of Leptospira in the environment (Table 1; Additional file 1). The study sites included residential areas of patients with leptospirosis [65], recreational spots [43, 62,63,64], urban areas [47], the market [64], the National Service Training Centre [66], the Conservation Centre [51], and the agricultural regions such as rice fields, oil palm, and rubber plantations [61]. Pathogenic, intermediate, and saprophyte Leptospira species had been detected and isolated from water and soils in these environments in the 5–33.60% (median = 15%) of the samples. The presence of leptospires in each of the studied settings shows that leptospires occupy a range of ecological niches in Malaysia.

Leptospira diversity

Currently, 66 species of Leptospira have been identified globally [67,68,69,70]. Several of these Leptospira species have been identified to be circulating among wild and domestic animals in Malaysia. The identified species are L. interrogans, L. borgpetersenii, L. kirschneri, L. kmetyi, L. wolffii, L. weilii, L. noguchii, L. meyeri, and L. biflexa [40, 41, 43,44,45,46,47, 50, 51, 54, 58]. In the environments, the Leptospira species that had been detected were L. interrogans, L. borgpetersenii, L. wolffii, L. kmetyi, L. noguchii, L. meyeri, L. biflexa, L. licerasiae, L. fainei, L. inadai, L. alstonii, L. congkakensis, L. idonii, L. broomii, L. barantonii, L. putramalaysiae, and L. yanagawae [43, 47, 50, 51, 63,64,65]. Several novel intermediate and saprophytic Leptospira species have also been isolated in the environments in Malaysia such as L. semungkisensis, L. fletcheri, L. langatensis, L. selangorensis, L. jelokensis, L. perdikensis, and L. congkakensis [69]. In humans, L. weilii, L. kirschneri, L. wolffii, and L. interrogans [71,72,73,74] were detected.

New serovars are also continuously being discovered. A serovar known as Malaysia was isolated from the soil samples of Johor state in 2009 [75]. Other than that, serovars Melaka (prototype strain: IMR LEP 1), Terengganu (IMR LEP 115), Sarawak (IMR LEP 175), Hardjobovis (IMR LEP 27), and Copenhagani (IMR LEP 803/11) were also isolated (Institute for Medical Research, Malaysia). Seroprevalence studies in humans and animals revealed the circulation of local serovars (Sarawak, Melaka, Terrenganu) and serovars isolated from other countries such as Autumnalis, Javanica, Bataviae, Icterohaemorrhagiae, Australis, Canicola, Ballum, Pyrogenes, Celledoni, Panama, Tarassovi, Shermani, Hebdomadis, Grippotyphosa, Hardjo, Pomona, Cynopteri, Patoc, Djasiman, Sejroe, Hardjoprajitno, and Bratislava [4, 43, 44, 49, 52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71, 76,77,78,79,80,81]. The most frequently (1.0–82.1%) detected serovars in these studies were Hardjo-bovis, Hebdomadis, Pomona, Icterohaemorrhagie, Ballum, Bataviae, Javanica, Grippotyphosa, Autumnalis, Sarawak, Patoc, Djasiman, Shermani, Pomona, and Sejroe. There has been a continuous detection and isolation of new Leptospira species, serovars, and strains in Malaysia since leptospirosis was reported in 1925. The recent detection of novel Leptospira species indicates that there could be more new Leptospira species, serovars, and strains as the locations and hosts studied are scarce. The detection of similar Leptospira species and serovars in animals, environments, and humans (Table 2) supports the transmission of leptospires from animals and environments to humans.

Table 2 Leptospires species and serovars detected and isolated in animals, environment, and humans in Malaysia

Risk factors

Heavy rainfall and flood are well-known risk factors for leptospirosis [82]. Flood is one of the contributing factors that led to the high number of leptospirosis cases in Kelantan at the end of 2014 and early 2015 [83]. From 2010 to 2020, several local newspapers reported human deaths from leptospirosis as a result of recreational water activities such as swimming in different localities in Malaysia [84,85,86,87,88,89,90] (Fig. 3). It was also reported in 2010 that six people died of leptospirosis after a search and rescue operation in Hutan Lipur, Lubuk Yu, and Pahang state [91]. A few people also experienced severe leptospirosis after swimming in a waterfall [92] and kayaking in a river [93]. In Sarawak, the weekly washing of clothes in local rivers was associated with leptospirosis among hospital patients [73]. Among wet market workers in two locations were 33.6% [76] and 46.3% [78]. In Sabah, two outbreaks were reported in 2000 [71] and 2004 [94], which were related to water activities such as kayaking and swimming in Segama River and swimming in the creek near an oil palm plantation in Beaufort, respectively.

Fig. 3
figure 3

Death from leptospirosis caused by water activities. The symbols indicate locations where people died of leptospirosis due to involvement with recreational and water activities during 2000–2020

Occupations such as urban sweepers, landscapers, garbage collectors, and lorry drivers are also risk factors for leptospirosis [95]. One of the major industries in Malaysia is the palm oil sector, and the seroprevalence of Leptospira among these workers is 28.6% [79]. Likewise, workers in animal farms also have a high (72.5%) seroprevalence for leptospires [77]. Owning pets such as dogs and cats increases the likelihood of the owner in acquiring leptospirosis [53,54,55,56,57,58]. The social conditions, such as poor urban communities, also contribute to the incidence of leptospirosis [96]. A number of risk factors have been identified to be associated with leptospirosis in Malaysia with activities involving waters contributing the most to the occurrence of leptospirosis.

Level of leptospirosis knowledge

The knowledge and attitude towards leptospirosis influence individuals’ behavior in practicing preventive measures against this infection. Hence, assessing people’s knowledge, attitude, and practices (KAP) toward leptospirosis is crucial. This information is critical to developing strategies for behavior changes toward safer practices. Several studies have been conducted in different communities and workplaces in Malaysia between 2018 and 2022. Such a study conducted in rural communities in Selangor showed that more than half of the participants had poor knowledge, and it was associated with unacceptable attitudes and practices towards leptospirosis [97]. In urban communities in the same locality, the majority of the participants (> 80%) had poor knowledge and practices on leptospirosis prevention despite having a positive attitude toward waste management [98]. In another study conducted in urban and rural communities in northeastern Malaysia, more than half of the participants had good knowledge and a positive attitude towards leptospirosis [99]. However, the level of knowledge and attitude were insufficient to translate into good behavior practices. A study on visitors to a recreational forest in Terengganu state showed higher knowledge, positive attitudes, and good practices toward preventing leptospirosis [100]. However, most of them still had limited knowledge of the route of transmission and prevention measures. In the workplace environment, studies conducted in northeastern Malaysia on town service workers [101] and army personnel [102], as well as dog handlers [103] showed that the majority of them had a relatively low level of KAP toward leptospirosis. Another study in agricultural communities showed that despite their good attitude towards the infection and moderate knowledge, they had unsatisfactory practices preventing leptospirosis [61]. Overall, these studies show that public awareness toward leptospirosis is still low in Malaysia.

Discussion

Leptospirosis is endemic in Malaysia, and the cases increased from 2004 to 2015, with the peak in 2015, then decreasing till 2017, and increasing till 2019. The decline in cases in 2020 and 2021 was presumably associated with behavioral changes due to the MCO. As the MCO has been lifted, it is expected that the cases might increase again as more people are involved in outdoor and recreational activities. Recently, local newspapers reported that a prisoner died [104] and a boy had a coma due to leptospirosis [105].

This review compiled the studies of leptospirosis in Malaysia focusing on the isolation and detection of leptospires in animals, environment, and humans as well as leptospirosis cases reported in the local newspapers. Most of the studies performed independent research which either focused on animals or environment or humans (Additional file 1). Only one study [43] included animals, environment, and humans. However, this study used a different method of detection of leptospires in animals (culture and PCR), environment (culture and PCR), and humans (MAT), and the species identified in animals and environment differed. Three studies [47, 50, 51] included both animals and environments and detected similar Leptospira species. One study [55] included both domestic animals and humans and detected similar serovars. Based on these few studies, it might be difficult to establish a direct transmission of similar genetic profiles of infecting Leptospira species or strains between animals, environments, and humans. Nevertheless, it still can be concluded that the detection of similar Leptospira species and serovars in human, animal, and environmental samples showed human-animal-environment interconnection. L. interrogans could be the predominant circulating species as it is detected in rodents infesting a range of ecological settings as well as in domestic animals, environments, and humans. L. interrogans was also the earliest detected Leptospira species in Malaysia [9]. Autumnalis, Javanica, Bataviae, Icterohaemorrhagiae, Australis, Canicola, Copenhageni, Ballum, and Pyrogenes are the predominant serovars as these serovars were detected in both wild and domestic animals and humans.

Based on the risk factors, leptospirosis cases, and death are mainly associated with recreational and non-recreational water activities. In other countries such as Brazil and Thailand, the occurrence of leptospirosis is largely associated with animal farming and agriculture [106, 107]. The low public’s awareness toward leptospirosis might be also one of the contributing factors to the likelihood of leptospirosis infections in humans in Malaysia.

Although previous studies provided insight into the human-animal-environment relationship in the occurrence of leptospirosis, more is needed to provide a complete understanding and knowledge of the epidemiology of leptospirosis in Malaysia as the studies were only performed in a limited number of settings and states. Hence, more studies on humans, animals, and environments are needed covering various locations in Malaysia. In other countries, Leptospira has also been isolated from “unconventional” hosts such as elephants, porcupines, bats, snakes, and frogs [108]. It would be comprehensive to determine “unconventional” hosts in Malaysia to understand the epidemiology of leptospirosis as these animals are abundant in this country.

It is of paramount importance not only to identify but also to isolate the local Leptospira species, serovars, and strains. The current gold standard, MAT, for diagnosing leptospirosis requires a panel of locally prevalent serovars. Local serovars such as Sarawak and Terengganu have been detected in humans [4, 76, 79] and cattle [60]. Therefore, the inclusion of local serovars can avoid the possibility of misdiagnosis. Only a few serovars have been isolated in Malaysia, which are restricted to a few locations. Hence, more studies are needed to identify and isolate locally circulating new serovars, especially in states where leptospirosis study is scarce, such as Sabah.

Furthermore, the Leptospira species, serovars, and strains have different virulence levels and are associated with a broad spectrum of clinical presentations. It is worth noting that some people who died of leptospirosis in Malaysia had pulmonary hemorrhage [93], coughing of blood, and breathing difficulty [93]. Leptospirosis with pulmonary hemorrhage was also observed in patients and returned travelers from Malaysia [109,110,111,112]. The infecting Leptospira species or serovars are not known for most of these patients except for one case caused by serovar Lai: Langkawi [107], showing that the leptospires circulating in Malaysia can cause severe disease with hemorrhagic manifestations. In vivo, a study in an animal model showed that the local L. interrogans can cause severe infection and pulmonary hemorrhage in hamsters [113]. Hence, identification and isolation of circulating Leptospira from animals, environments, and humans in Malaysia are necessary to understand the virulence potential of this bacteria.

The limited studies in assessing public awareness toward leptospirosis urge the need to do more studies in different communities, workplaces, and localities are needed to assess the overall level of knowledge and awareness regarding leptospirosis in Malaysia.

KAP studies have been performed only in Peninsular Malaysia, and conducting similar studies in Sabah and Sarawak, which recorded many leptospiroses, is paramount. Nevertheless, previous studies also showed that more campaigns are needed to generate awareness of leptospirosis and dissemination of information.

Conclusion

Leptospirosis is endemic in Malaysia. This review highlighted the need to perform more studies on leptospires in animals and environments in different places for prevention strategies and improving diagnosis and early treatment. Assessing people’s awareness of leptospirosis is needed to implement the strategy that could help them perform good practices toward leptospirosis prevention.

Availability of data and materials

Not applicable.

Abbreviations

MAT:

Microscopic agglutination test

PCR:

Polymerase chain reaction

MCO:

Movement control order

CFR:

Case fatality rates

KAP:

Knowledge, attitude, and practices

References

  1. Wasinski B, Dutkiewicz J. Leptospirosis-current risk factors connected with human activity and the environment. Ann Agric Environ Med. 2013;20(2):239–44.

    PubMed  Google Scholar 

  2. Costa F, Hagan JE, Calcagno J, Kane M, Torgerson P, Martinez-Silveira MS. Global morbidity and mortality of leptospirosis: a systematic review. PloS Negl Trop Dis. 2015;9:e0003898.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Haake DA, Levett PN. Leptospirosis in humans. Curr Top Microbiol Immunol. 2015;387:65–97.

    CAS  PubMed  PubMed Central  Google Scholar 

  4. Jeffree MS, Mori D, Yusof NA, Atil AB, Lukman KA, Othman R, et al. High incidence of asymptomatic leptospirosis among urban sanitation workers from Kota Kinabalu, Sabah. Malaysian Borneo Sci Rep. 2020;10:19442.

    CAS  PubMed  Google Scholar 

  5. Chaikajornwat J, Rattanajiajaroen P, Srisawat N, Kawkitinarong K. Leptospirosis manifested with severe pulmonary haemorrhagic syndrome successfully treated with venovenous extracorporeal membrane oxygenation. BMJ Case Rep. 2020;13:e230075.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Kim MJ. Historical review of leptospirosis in the Korea (1945–2015). Infect Chemother. 2019;51:315–29.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Philip N, Priya SP, Jumah Badawi AH, Mohd Izhar MH, Mohtarrudin N, Tengku Ibrahim TA, Sekawi Z, Neela VK. Pulmonary haemorrhage as the earliest sign of severe leptospirosis in hamster model challenged with Leptospira interrogans strain HP358. PLoS Negl Trop Dis. 2022;16:e0010409.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Coutinho ML, Matsunaga J, Wang LC, de la Peña MA, Lewis MS, Babbitt JT, et al. Kinetics of Leptospira interrogans infection in hamsters after intradermal and subcutaneous challenge. PLoS Negl Trop Dis. 2014;8:e3307.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Inada R, Ido Y, Hoki R, Kaneko R, Ito H. The etiology mode of infection and specific therapy of Weil’s disease. J Exp Med. 1916;23:377–402.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Fletcher W. Recent work on leptospirosis, tustsugamushi disease and tropical typhus in the Federal Malay States. Trans R Soc Trop Med Hyg. 1928;21:265–88.

    Article  Google Scholar 

  11. McCrumb FR, Stockard JL, Robinson CR, Turner LH, Levis DG, Maisey CW, et al. Leptospirosis in Malay. 1. Sporadic cases among military and civilian personnel. Am J Trop Med Hyg. 1957;6:238–56.

    Article  PubMed  Google Scholar 

  12. Tan DSK, Lopes DA. A preliminary study of the status of leptospirosis in the Malaysian armed forces. Southeast Asian J Trop Med Public Health. 1972;3:208–11.

    CAS  PubMed  Google Scholar 

  13. Supramaniam V. Leptospirosis in the Malaysian army. Malays J Pathol. 1979;2:11–4.

    CAS  PubMed  Google Scholar 

  14. Tan DSK. The importance of leptospirosis in Malaya. Med J Malaysia. 1964;18:164–71.

    CAS  Google Scholar 

  15. Tan DSK. Leptospirosis in rural West Malaysia. Med J Malaysia. 1970;24:261–5.

    CAS  Google Scholar 

  16. Tan DSK. Occupational distribution of leptospiral (SEL) antibodies in West Malaysia. Med J Malaysia. 1973;27:253–7.

    CAS  PubMed  Google Scholar 

  17. Ungku OA. Veterinary public health with particular reference to Malaysia. Kajian Veterinar. 1967;1:54–62.

    Google Scholar 

  18. Waitkins SA. Leptospirosis in man, British Isles: 1984. Br Med J (Clin Res Ed). 1986;292:1324.

    Article  CAS  PubMed  Google Scholar 

  19. Self CA, Iskrzynska WI, Waitkins SA, Whicher JW, Whicher JT. Leptospirosis among British cavers. Cave Sci. 1987;14:131–4.

    Google Scholar 

  20. Sheena A, Buchan J. Leptospirosis in British cavers in Malaysia: the Sarawak experience. Isr J Vet Med. 1987;43:346.

    Google Scholar 

  21. Bahaman AR, Ibrahim AL, Adam H. Serological prevalence of leptospiral infection in domestic animals in West Malaysia. Epidemiol Infect. 1987;99:379–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Bahaman AR, Ibrahim AL, Stallman ND, Tinniswood RD. The bacteriological prevalence of leptospiral infection in cattle and buffaloes in West Malaysia. Epidemiol Infect. 1988;100:239–46.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Bahaman AR, Ibrahim AL, Stallman ND. Leptospira interrogans serovar Unipertama isolated in Malaysia. Int J Syst Bacteriol. 1990;40:98–9.

    Article  CAS  PubMed  Google Scholar 

  24. Alexander AD, Wetmore PW, Evans LB, Jeffries H, Gleiser CA. Classification of leptospiral isolates from Malaya, Thailand and North-Borneo. Am J Trop Med Hyg. 1955;4:492–506.

    Article  CAS  PubMed  Google Scholar 

  25. Alexander AD, Evans LB, Toussaint AJ, Marchwicki RH, McCrumb FR Jr. Leptospirosis in Malaya Il. Antigenic analysis of 110 leptospiral strains and other serologic studies. Am J Trop Med Hyg. 1957;6:871–89.

    Article  CAS  PubMed  Google Scholar 

  26. New Straits Times. Leptospirosis third deadliest after dengue and malaria. 2020. https://www.nst.com.my/news/nation/2020/03/573627/leptospirosis-third-deadliest-after-dengue-and-malaria. Accessed 31 Mar 2023.

  27. MOH Malaysia. Annual Report Ministry of Health Malaysia. Malaysia: 2010. 2011.

  28. European Centre for Disease Prevention and Control. Leptospirosis. In: ECDC. Annual Epidemiological Report for 2020. Stockholm: ECDC; 2022.

  29. MOH Malaysia. Annual Report Ministry of Health Malaysia. Malaysia; 2021. 2022.

  30. MOH Malaysia. Annual Report Ministry of Health Malaysia. Malaysia; 2011. 2012.

  31. MOH Malaysia. Annual Report Ministry of Health Malaysia. Malaysia; 2012. 2013.

  32. MOH Malaysia. Annual Report Ministry of Health Malaysia. Malaysia; 2013. 2014.

  33. MOH Malaysia. Annual Report Ministry of Health Malaysia. Malaysia; 2014. 2015.

  34. MOH Malaysia. Annual Report Ministry of Health Malaysia. Malaysia; 2015. 2016.

  35. MOH Malaysia. Annual Report Ministry of Health Malaysia. Malaysia; 2016. 2017.

  36. MOH Malaysia. Annual Report Ministry of Health Malaysia. Malaysia; 2017. 2018.

  37. MOH Malaysia. Annual Report Ministry of Health Malaysia. Malaysia; 2018. 2019.

  38. MOH Malaysia. Annual Report Ministry of Health Malaysia. Malaysia; 2019. 2020.

  39. MOH Malaysia. Annual Report Ministry of Health Malaysia. Malaysia; 2020. 2021.

  40. Azhari NN, Ramli SN, Joseph N, Philip N, Mustapha NF, Ishak SN, et al. Molecular characterization of pathogenic Leptospira sp. in small mammals captured from the human leptospirosis suspected areas of Selangor state, Malaysia. Acta Trop. 2018;188:68–77.

    Article  PubMed  Google Scholar 

  41. Shafie NJ, Halim NS, Awoniyi AM, Zalipah MN, Md-Nor S, Nazri MU, et al. Prevalence of pathogenic Leptospira spp. in non-volant small mammals of Hutan Lipur Sekayu, Terengganu, Malaysia. Pathogens. 2022; 11:1300.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Rahmat MS, MIMLS KH, Paramasvaran S, Azizah MR, Imran F. Prevalence of leptospiral DNA among wild rodents from a selected area in Beguk Dam Labis, Segamat, Johor, Malaysia. Malays J Pathol. 2012;34:157–9.

    PubMed  Google Scholar 

  43. Neela VK, Azhari NN, Joseph N, Mimie NP, Ramli SN, Mustapha NF, et al. An outbreak of leptospirosis among reserve military recruits, Hulu Perdik, Malaysia. Eur J Clin Microbiol Infect Dis. 2019;38:523–8.

    Article  PubMed  Google Scholar 

  44. Kamaruzaman IN, Mokhtar MA, Ting HW, Yuan YK, Shah AW, Loong TW, et al. Molecular detection of pathogenic Leptospira spp. in urban rodents from wet markets in northeast Malaysia. J Adv Vet Anim Res. 2022;9:275–81.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Benacer D, Zain SNM, Amran F, Galloway RL, Thong KL. Isolation and molecular characterization of Leptospira interrogans and Leptospira borgpetersenii isolates from the urban rat populations of Kuala Lumpur. Malaysia Am J Trop Med Hyg. 2013;88:704–9.

    Article  CAS  PubMed  Google Scholar 

  46. Blasdell KR, Morand S, Perera D, Firth C. Association of rodent-borne Leptospira spp. with urban environments in Malaysian Borneo. PLoS Negl Trop Dis. 2019;13:e0007141.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Pui CF, Bilung LM, Apun K, Su’ut L. Diversity of Leptospira spp. in rats and environment from urban areas of Sarawak, Malaysia. J Trop Med. 2017;2017:3760674.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Mohamed-Hassan SN, Bahaman AR, Mutalib AR, Khairani-Bejo S. Prevalence of pathogenic leptospires in rats from selected locations in Peninsular Malaysia. Res J Anim Sci. 2012;69:12–25.

    Article  Google Scholar 

  49. Suut L, Mazlan A, Arif MT, Katip T, Nor Aliza AR, Haironi Y. Serovar diversity of Leptospira sp. infecting wild rodents in Sarawak, Malaysia. Trop Biomed. 2018;35:252–8.

    CAS  PubMed  Google Scholar 

  50. Pui CF, Bilung LM, Su’ut L, Chong YL, Apun K. Detection of Leptospira spp. in selected National Service Training Centres and paddy fields of Sarawak, Malaysia using polymerase chain reaction technique. Pertanika J Trop Agric Sci. 2017; 40(1):99–110.

    Google Scholar 

  51. Shamsusah NA, Md Zain BM, Dharmalingam S, Amran F, Agustar HK. Detection and characterization of Leptospira spp. in wildlife and the environment at the ex-situ conservation centre. Sains Malays. 2021;50:35–43.

    Article  Google Scholar 

  52. Mohamed-Hassan SN, Bahaman AR, Mutalib AR, Khairani-Bejo S. Serological prevalence of leptospiral infection in wild rats at the National Service Training Centres in Kelantan and Terengganu. Trop Biomed. 2010;27:30–2.

    CAS  PubMed  Google Scholar 

  53. Lau SF, Low KN, Khor KH, Roslan MA, Bejo SK, Radzi R, et al. Prevalence of leptospirosis in healthy dogs and dogs with kidney disease in Klang Valley. Malaysia Trop Biomed. 2016;33:469–75.

    CAS  PubMed  Google Scholar 

  54. Rahman SA, Khor KH, Khairani-Bejo S, Lau SF, Mazlan M, Roslan A, et al. Detection and characterization of Leptospira spp. in dogs diagnosed with kidney and/or liver disease in Selangor, Malaysia. J Vet Diagn Invest. 2021;33:834–43.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Goh SH, Khor KH, Ismail R, Rani MA, Mohd Mohidin TB, Bahaman AR, et al. Detection and distribution of anti-leptospiral antibody among dogs and their handlers. Trop Biomed. 2020;37:1074–82.

    Article  CAS  PubMed  Google Scholar 

  56. Lau SF, Wong JY, Khor KH, Roslan MA, Rahman MA, Bejo SK, et al. Seroprevalence of leptospirosis in working dogs. Top Companion Anim Med. 2017;32:121–5.

    Article  CAS  PubMed  Google Scholar 

  57. Benacer D, Thong KL, Ooi PT, Souris M, Lewis JW, Ahmed AA, et al. Serological and molecular identification of Leptospira spp. in swine and stray dogs from Malaysia. Trop Biomed. 2017;34:89–97.

    CAS  PubMed  Google Scholar 

  58. Alashraf AR, Lau SF, Khairani-Bejo S, Khor KH, Ajat M, Radzi R, et al. First report of pathogenic Leptospira spp. isolated from urine and kidneys of naturally infected cats. PLoS One. 2020;15:e023004.

    Article  Google Scholar 

  59. Rahman MS, Bejo SK, Zakaria Z, Hassan L, Roslan MA. Seroprevalence and distribution of leptospiral serovars in livestock (cattle, goats, and sheep) in flood-prone Kelantan. Malaysia J Vet Res. 2021;65:53–8.

    Article  Google Scholar 

  60. Daud A, Fuzi NM, Arshad MM, Kamarudin S, Mohammad WM, Amran F, et al. Leptospirosis seropositivity and its serovars among cattle in Northeastern Malaysia. Vet World. 2018;11:840–4.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Halim NM, Yatim SR, Zaki MA, Camalxaman SN. Leptospirosis occurrence in agricultural communities in Setiu. Terengganu Int J Recent Technol Eng. 2019;8:259–63.

    Google Scholar 

  62. Yap ML, Chew LJ, Pritpal Singh SS, Sekawi Z, Chee HY, Ong HK, et al. Distribution of pathogenic Leptospira in environmental water and soils of selected recreational forests in Perak. Malaysia Trop Biomed. 2021;38:122–8.

    Article  CAS  PubMed  Google Scholar 

  63. Zaki AM, Hod R, Shamsusah NA, Isa ZM, Bejo SK, Agustar HK. Detection of Leptospira kmetyi at recreational areas in Peninsular Malaysia. Environ Monit Assess. 2020;192:703.

    Article  CAS  PubMed  Google Scholar 

  64. Azali MA, Yean Yean C, Harun A, Aminuddin Baki NN, Ismail N. Molecular characterization of Leptospira spp. in environmental samples from north-eastern Malaysia revealed a pathogenic strain, Leptospira alstonii. J Trop Med. 2016; 2016:2060241.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Ali MR, Safiee AW, Yusof NY, Fauzi MH, Yean CY, Ismail N. Isolation of Leptospira kmetyi from residential areas of patients with leptospirosis in Kelantan. Malaysia J Infect Public Health. 2018;11:578–80.

    Article  Google Scholar 

  66. Ridzlan FR, Bahaman AR, Khairani-Bejo S, Mutalib AR. Detection of pathogenic Leptospira from selected environment in Kelantan and Terengganu. Malaysia Trop Biomed. 2010;27:632–8.

    CAS  PubMed  Google Scholar 

  67. Masuzawa T, Sakakibara K, Saito M, Hidaka Y, Villanueva SYAM, Yanagihara Y, et al. Characterization of Leptospira species isolated from soil collected in Japan. Microbiol Immunol. 2018;62:55–9.

    Article  CAS  PubMed  Google Scholar 

  68. Thibeaux R, Iraola G, Ferres I, Bierque E, Girault D, Soupe-Gilbert ME, et al. Deciphering the unepxlored Leptospira diversity from soils uncovers genomic evolution to virulence. Microb Genom. 2018;4:e000144.

    PubMed  PubMed Central  Google Scholar 

  69. Vincent AT, Schiettekatte O, Goarant C, Neela VK, Bernet E, Thibeaux R, et al. Revisiting the taxanomy and evolution of pethogenicity of the genus Leptospira through the prism of genomics. PLoS Negl Trop Dis. 2019;13:e0007270.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  70. Casanovas-Massana A, Hamond C, Santos LA, de Oliveira D, Hacker KP, Balassiano I. Leptospira yasudae sp. nov. and Leptospira stimsonii sp. nov., two new species of the pathogenic group isolated from environmental sources. Int J Syst Evol Microbiol. 2020;70:1450–6.

    Article  PubMed  Google Scholar 

  71. Sejvar J, Bancroft E, Winthrop K, Bettinger J, Bajani M, Bragg S, et al. Leptospirosis in “Eco-Challenge” athletes. Malaysian Borneo Emerg Infect Dis. 2003;9:702–7.

    Article  PubMed  Google Scholar 

  72. Philip N, Bahtiar Affendy N, Ramli SN, Arif M, Raja P, Nagandran E, et al. Leptospira interrogans and Leptospira kirschneri are the dominant Leptospira species causing human leptospirosis in Central Malaysia. PLoS Negl Trop Dis. 2020;14:e0008197.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Hii KC, Robie ER, Saihidi I, Berita A, Alarja NA, Xiu L, et al. Leptospirosis infections among hospital patients, Sarawak. Malaysia Trop Dis Travel Med Vaccines. 2021;7:32.

    Article  PubMed  Google Scholar 

  74. Loong SK, Abd-Majid MA, Teoh BT, Cheh MJ, Khor CS, Chao CC, et al. Leptospirosis among dengue-negative febrile patients in Selangor. Malaysia Am J Trop Med Hyg. 2022;107(2):397–400.

    Article  CAS  PubMed  Google Scholar 

  75. Slack AT, Khairani-Bejo S, Symonds ML, Dohnt MF, Galloway RL, Steigerwalt A, et al. Leptospira kmetyi sp. nov., isolated from an environmental source in Malaysia. Int J Syst Evol Microbio. 2009;59:705–8.

    Article  CAS  Google Scholar 

  76. Rahman MH, Hairon SM, Hamat RA, Jamaluddin TZ, Shafei MN, Idris N, et al. Seroprevalence and distribution of leptospirosis serovars among wet market workers in northeastern, Malaysia: a cross sectional study. BMC Infect Dis. 2018;18:569.

    Article  PubMed  PubMed Central  Google Scholar 

  77. Daud A, Fuzi NM, Mohammad WM, Amran F, Ismail N, Arshad MM, et al. Leptospirosis and workplace environmental risk factors among cattle farmers in northeastern Malaysia. Int J Occup Environ Med. 2018;9:88–96.

    Article  PubMed  Google Scholar 

  78. Samsudin S, Sakinah SN, Malina O, Norliza BA, Noh MA, Fairuz A, et al. Seroprevalence of leptospiral antibodies among market workers and food handlers in the central state of Malaysia. Trop Med Int Health. 2018;23:327–33.

    Article  CAS  PubMed  Google Scholar 

  79. Ridzuan JM, Aziah BD, Zahiruddin WM. Work environment-related risk factors for leptospirosis among plantation workers in tropical countries: evidence from Malaysia. Int J Occup Environ Med. 2016;7:156–63.

    Article  Google Scholar 

  80. Suut L, Mazlan MN, Arif MT, Yusoff H, Abdul Rahim NA, Safii R, et al. Serological prevalence of leptospirosis among rural communities in the Rejang Basin, Sarawak. Malaysia Asia Pac J Public Health. 2016;28:450–7.

    Article  PubMed  Google Scholar 

  81. Rafizah AN, Aziah BD, Azwany YN, Imran MK, Rusli AM, Nazri SM, et al. A hospital-based study on seroprevalence of leptospirosis among febrile cases in northeastern Malaysia. Int J Infect Dis. 2013;17:e394–7.

    Article  PubMed  Google Scholar 

  82. Goarant C. Leptospirosis: risk factors and management challenges in developing countries. Res Rep Trop Med. 2016;7:49–62.

    PubMed  PubMed Central  Google Scholar 

  83. Radi MF, Hashim JH, Jaafar MH, Hod R, Ahmad N, Nawi AM, et al. Leptospirosis outbreak after the 2014 major flooding event in Kelantan, Malaysia: a spatial-temporal analysis. Am J Trop Med Hyg. 2018;98:1281–95.

    Article  Google Scholar 

  84. Astro Awani. [Kencing tikus: Empat individu masih dirawat di HSNZ]. 2020. https://www.astroawani.com/berita-malaysia/kencing-tikus-empat-individu-masih-dirawat-di-hsnz-247505. Accessed 23 Apr 2023.

  85. Berita Harian. [Kematian Mohd Thaqif akibat kencing tikus]. 2019. https://www.bharian.com.my/berita/kes/2019/03/543682/kematian-mohd-thaqif-akibat-kencing-tikus. Accessed 23 Apr 2023.

  86. Astro Awani. [Lelaki meninggal dunia akibat kencing tikus]. 2017. https://www.astroawani.com/berita-malaysia/lelaki-meninggal-dunia-akibat-kencing-tikus-143222. Accessed 23 Apr 2023.

  87. Malaysiakini. [Pelajar kolej maut akibat jangkitan kencing tikus]. 2016. https://www.malaysiakini.com/news/341606. Accessed 23 April 2023.

  88. Malaysiakini. [Pelajar maut disyaki akibat kencing tikus]. 2016. https://www.malaysiakini.com/news/349448. Accessed 23 Apr 2023.

  89. Astro Awani. [Suasana pilu selubungi rumah mangsa korban kencing tikus]. 2014. https://www.astroawani.com/berita-malaysia/suasana-pilu-selubungi-rumah-mangsa-korban-kencing-tikus-49848. Accessed 23 Apr 2023.

  90. Medical Xpress. Malaysia warns of waterborne disease after deaths. 2010. https://medicalxpress.com/news/2010-08-malaysia-waterborne-disease-deaths.html. Accessed 23 Apr 2023.

  91. Malasysiakini. [Enam maut akibat jangkitan 'air kencing tikus']. 2010. https://www.malaysiakini.com/news/136974. Accessed 23 Apr 2023.

  92. Sinar Harian. [Seperti mati hidup semula]. 2019. https://www.sinarharian.com.my/article/34071/edisi/selangor-kl/seperti-mati-hidup-semula. Accessed 23 Apr 2023.

  93. Astro Awani. [Guru koma selepas dijangkiti kuman akibat kencing tikus]. 2016. https://www.astroawani.com/berita-malaysia/guru-koma-selepas-dijangkiti-kuman-akibat-kencing-tikus-113615. Accessed 23 Apr 2023.

  94. Koay TK, Nirmal S, Noitie L, Tan E. An epidemiological investigation of an outbreak of leptospirosis associated with swimming, Beaufort. Sabah Med J Malaysia. 2004;59:455–9.

    CAS  PubMed  Google Scholar 

  95. Atil A, Jeffree MS, Syed Abdul Rahim SS, Hassan MR, Awang Lukman K, Ahmed K. Occupational determinants of leptospirosis among urban service workers. Int J Environ Res Public Health. 2020;17:427.

    Article  PubMed  PubMed Central  Google Scholar 

  96. Sahimin N, Sharif SA, Hanapi IR, Chuan SN, Lewis JW, Douadi B, et al. Seroprevalence of anti-Leptospira IgG and IgM antibodies and risk assessment of leptospirosis among urban poor communities in Kuala Lumpur. Malaysia AM J Trop Med Hyg. 2019;101:1265–71.

    Article  PubMed  Google Scholar 

  97. Nozmi N, Samsudin S, Sukeri S, Shafei MN, Wan Mohd WM, Idris Z, et al. Low levels of knowledge, attitudes and preventive practices on leptospirosis among a rural community in Hulu Langat District, Selangor, Malaysia. Int J Environ Res Public Health. 2018;15:693.

    Article  PubMed  PubMed Central  Google Scholar 

  98. Abdullah NM, Mohammad WM, Shafei MN, Sukeri S, Idris Z, Arifin WN, et al. Leptospirosis and its prevention: knowledge, attitude and practice of urban community in Selangor. Malaysia BMC Public Health. 2019;19:1–8.

    Google Scholar 

  99. Pathman A, Aziah BD, Zahiruddin WM, Mohd Nazri S, Sukeri S, Tengku Zetty TJ, et al. Knowledge, attitudes, practices and health beliefs toward leptospirosis among urban and rural communities in Northeastern Malaysia. Int J Environ Res Public Health. 2018;15:1–9.

    Google Scholar 

  100. Shafie NJ, Halim NS, Zalipah MN, Amin NA, Esa SM, Md-Nor S, et al. Knowledge, attitude, and practices regarding leptospirosis among visitors to a recreational forest in Malaysia. Am J Trop Med Hyg. 2021;104:1290–6.

    Article  PubMed  PubMed Central  Google Scholar 

  101. Azfar ZM, Nazri SM, Rusli AM, Maizurah O, Zahiruddin WM, Azwany YN, et al. Knowledge, attitude and practice about leptospirosis prevention among town service workers in northeastern Malaysia: a cross sectional study. J Prev Med Hyg. 2018;59:E92–8.

    PubMed  PubMed Central  Google Scholar 

  102. Aziah BD, Azwany YN, Zahiruddin WM, Nabilah A, Zaliha I. Unsatisfactory knowledge, attitude and practice on leptospirosis among army personnels in northeastern Malaysia. Health. 2020;12:281–92.

    Article  Google Scholar 

  103. Goh SH, Khor KH, Lau SF, Ismail R, Khairani-Bejo S, Radzi R. Evaluation of leptospirosis knowledge, attitude and practice among dog handlers. J Vet Malaysia. 2019;31:17–27.

    Google Scholar 

  104. Astro Awani. [Tahanan parol hilangkan diri meninggal dunia akibat kencing tikus]. 2022. https://www.astroawani.com/berita-malaysia/tahanan-parol-hilangkan-diri-meninggal-dunia-akibat-kencing-tikus-381040. Accessed 23 Apr 2023.

  105. Sinarplus. [Budak kecil terpaksa ditidurkan akibat jangkitan kencing tikus]. 2022. https://sinarplus.sinarharian.com.my/lifestyle/medik/budak-kecil-terpaksa-ditidurkan-akibat-jangkitan-kencing-tikus-ini-fakta-penting-ramai-kena-ambil-tahu/. Accessed 23 Apr 2023.

  106. Galan DI, Roess AA, Pereira SV, Schneider MC. Epidemiology of human leptospirosis in urban and rural areas of Brazil, 2000–2015. PLoS ONE. 2021;16(3):e0247763.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  107. Narkkul U, Thaipadungpanit J, Srisawat N, Rudge JW, Thongdee M, Pawarana R, et al. Human, animal, water source interactions and leptospirosis in Thailand. Sci Rep. 2021;11(1):3215.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  108. Cilia G, Bertelloni F, Albini S, Fratini F. Insight into the epidemiology of leptospirosis: a review of Leptospira isolations from “unconventional” hosts. Animals. 2021;11:191.

  109. Wagenaar JFP, de Vries PJ, Hartskeerl RA. Leptospirosis with pulmonary hemorrhage, caused by a new strain of serovar Lai: Langkawi. J Travel Med. 2004;11:379–82.

    Article  PubMed  Google Scholar 

  110. Leung V, Luong ML, Libman M. Leptospirosis: pulmonary hemorrhage in a returned traveller. CMAJ. 2011;183:E423–7.

    Article  PubMed  PubMed Central  Google Scholar 

  111. Nor MBM, Ralib AM, Ibrahim NA, Abdul-Ghani MR. High frequency oscillatory ventilation in leptospirosis pulmonary hemorrhage syndrome: a case series study. Indian J Crit Care Med. 2016;20:342–8.

    Article  CAS  Google Scholar 

  112. Lim TSC, Jun TY, Fah TR. Pulmonary hemorrhage associated with severe leptospirosis – the role of low dose intravenous methylprednisolone. Mal J Med Health Sci. 2018;14:69–72.

    Google Scholar 

  113. Philip N, Jani J, Azhari NN, Sekawi Z, Neela VK. In vivo and in silico virulence analysis of Leptospira species isolated from environments and rodents in leptospirosis outbreak areas in Malaysia. Front Microbiol. 2021;12:753328.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

Not applicable.

Funding

Not applicable.

Author information

Authors and Affiliations

Authors

Contributions

KA had the original idea for the review study. NP contributed to the research, writing, and editing of this manuscript. KA contributed to the correction and editing of this manuscript. NP and KA read and approved the final manuscript.

Corresponding author

Correspondence to Kamruddin Ahmed.

Ethics declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Additional file 1: 

Summary of studies on animals, environment and humans in Malaysia.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Philip, N., Ahmed, K. Leptospirosis in Malaysia: current status, insights, and future prospects. J Physiol Anthropol 42, 30 (2023). https://doi.org/10.1186/s40101-023-00347-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s40101-023-00347-y

Keywords