Philip and Ahmed ﻿
Journal of Physiological Anthropology(2023) 42:30
https://doi.org/10.1186/s40101-023-00347-y

Journal of
Physiological Anthropology

Open Access

REVIEW

Leptospirosis in Malaysia: current status,
insights, and future prospects
Noraini Philip1 and Kamruddin Ahmed2,3,4*   

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 agentof leptospirosis, are found in varied ecological niches and animal species, providing a significant source of humaninfection. This review aims to provide the current status of leptospirosis in Malaysia and the direction for futurestudies. 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.
Keywords Leptospirosis, Epidemiology, Risk factors, Serovars, Malaysia
Background
Leptospirosis is a zoonotic infection; the risk factors of
this infection are associated with human activities andthe 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.

*Correspondence:
Kamruddin Ahmed
ahmed@ums.edu.my
1
School of Biological Sciences, Universiti Sains Malaysia, Penang, Malaysia
2
Department of Pathology and Microbiology, Faculty of Medicine
and Health Sciences, University Malaysia Sabah, Kota Kinabalu, Malaysia
3
Borneo Medical and Health Research Centre, Faculty of Medicine
and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
4
Research Center for Global and Local Infectious Diseases, Oita University,
Oita, Japan

Human infection results from direct contact with theinfected 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 disseminatedby hematogenous routes into many organs, mainly thekidneys, liver, and lungs. Humans infected with leptospires typically manifest a broad clinical presentation,
ranging from asymptomatic [4] or mild to severe andlife-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 understandingof locally circulating serovars. Leptospira is detected in© The Author(s) 2023. 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 theoriginal author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images orother 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 thislicence, 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.

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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 ofthe equator. It is composed of two noncontiguous
regions: Peninsular Malaysia (Semanjung Malaysia) orWest 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 thesame tropical latitude and are affected by similar airstreams. From November to March, Malaysia is blessedwith 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 inwater supply, streams, and ponds; however, their serovars remained unidentified. After the discovery of
leptospires in Malaysia, studies were performed focusing on the military [11–13]. The prevalence of leptospirosis among military personnel ranged from 4.6 to34.7%, including two fatal cases which were detected in1969 and 1978 [13]. Several studies also reported thatworkers in rubber and oil palm plantations, hospitals,
sewage, and town cleanings were at high risk of infection [14–17]. 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 [21–23]. In humans, Malaya [24],Abramis, Biggis, Birkini, Coxi, Fugis, Gurungi, Hemolytica, Hamptoni, Mooris, Ricardi, Smithi, and Sumneri were isolated from leptospirosis patients [25]. Theseearlier reports showed that occupations determined theoccurrence of leptospirosis. The present review aims todescribe 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, andGoogle 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 thepreliminary 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 diseasein 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 to2019, with the peak of leptospirosis cases and deaths in2014 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 ofschools in compliance with the movement control order(MCO) due to COVID-19 [29]. The incidence and casefatality rates (CFR) of leptospirosis in Malaysia between
2010 and 2020 were 8.63–17.2 and 0.6–2.4%/100,000
populations, respectively [29–39]. In 2020, although theincidence rate was low, the CFR was high compared tothe previous year (2020: 1.3%, 2019: 0.6%). Leptospirosis outbreaks were also reported and mainly occurred inresidential areas. More than half of the infected patientswere men in the age group of 20–60 years [27, 29–39].
Among all states in Malaysia, Selangor, Kelantan, andSarawak 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.

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Fig. 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 exponentiallyfrom 2013 to 2015. Then, it decreased in 2016 and 2017, increased in 2018 and 2019, and decreased again in 2020 and 2021. The incidenceof 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)

Fig. 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 suchas rodents. From 2000 to 2022, 21 studies have been
conducted in Malaysia to detect leptospires in wild anddomestic animals using serological, molecular, and/or
culture techniques (Table 1; Additional file 1). Detection of leptospires in wild animals (rodents, shrew, orangutan) was limited to those found in recreational spots[40–43], urban areas including human settlements andwet markets [40, 44–47], sub-urban areas [40, 48, 49],
agricultural regions such as oil-palm plantations [48]and paddy fields [50], conservation center [51], andNational 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 detectedin rodents of wet markets in Kelantan [44]. Leptospira
was also detected in domestic animals such as dogs
[53–57], cats [58], cattle [59, 60], and swine [57], as wellPhilip and Ahmed ﻿Journal of Physiological Anthropology(2023) 42:30

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

Semi-urbans

Agricultural regions

Recreational spots

Other areas

Rodents [40, 44–47]; shrew [40]Rodents [40, 48, 49]

Rodents [48, 50]

Rodents [40–43]
Neela et al., 2019

Orang Utan (conservation center) [51]Rat (National Service Training Centre) [52]Water and soil [50, 61]

Water and soil [43, 62, 63]
Soil [64]Water and soil (conservation center) [51];Residential areas of patients [65](National Service Training Centre) [51, 66]

Water and soil [47, 61]

as goat and sheep [59]. The prevalence rate of leptospiresin 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 riskof leptospires transmission to humans in Malaysia.
Environments

Water and soil sampling provides essential information that enhances our understanding of the leptospiralhuman–environment–animal relationship. Ten studies have described the distribution of Leptospira in theenvironment (Table 1; Additional file 1). The study sites
included residential areas of patients with leptospirosis [65], recreational spots [43, 62–64], 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 fromwater 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 [67–70]. Several of these Leptospira species havebeen 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, 43–47, 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, 63–65]. 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, andL. congkakensis [69]. In humans, L. weilii, L. kirschneri, L.
wolffii, and L. interrogans [71–74] 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) werealso 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 suchas 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, 52–71,
76–81]. 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 acontinuous detection and isolation of new Leptospira
species, serovars, and strains in Malaysia since leptospirosis was reported in 1925. The recent detection ofnovel Leptospira species indicates that there could be
more new Leptospira species, serovars, and strains as thelocations and hosts studied are scarce. The detection ofsimilar Leptospira species and serovars in animals, environments, and humans (Table 2) supports the transmission of leptospires from animals and environments tohumans.

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 casesin Kelantan at the end of 2014 and early 2015 [83]. From2010 to 2020, several local newspapers reported humandeaths from leptospirosis as a result of recreational
water activities such as swimming in different localities in Malaysia [84–90] (Fig. 3). It was also reported in2010 that six people died of leptospirosis after a searchand rescue operation in Hutan Lipur, Lubuk Yu, andPhilip and Ahmed ﻿Journal of Physiological Anthropology(2023) 42:30

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

Environment

HumansWild animals

Pet animals

Farm animals

L. interrogans
L. borgpetersenii
L. kirschneri
L. kmetyi
L. wolffii
L. weilii
L. noguchii
L. meyeri

L. interrogans
L. borgpetersenii
L. kirschneri
L. kmetyi
L. biflexa

L. interrogans

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
L. yanagawaeL. semungkisensis L.
fletcheri
L. langatensis
L. selangorensis
L. jelokensis
L. perdikensis

L. interrogans
L. kirschneri
L. wolffii
L. weilii

Autumnalis
Javanica
Bataviae
Icterohaemorrhagiae
Australis
Canicola
Copenhageni
BallumPyrogenes
Celledoni
PanamaTarassovi
Shermani
Hebdomadis

Autumnalis
Javanica
Bataviae
Icterohaemorrhagiae
Australis
Canicola
Copenhageni
BallumPyrogenes
Celledoni
Grippotyphosa
Lai
Hardjobovis
HardjoPomonaBratislava

Autumnalis
Javanica
Bataviae
Icterohaemorrhagiae
Australis
Canicola
Copenhageni
BallumPyrogenes
Tarassovi
Hebdomadis
Grippotyphosa
Lai
Hardjobovis
HardjoPomonaMalaysia
Cynopteri
Sarawak
Patoc
MelakaTerengganu
Djasiman
SejroeHardjoprajitno

Hebdomadis

Autumnalis
Javanica
Bataviae
Icterohaemorrhagiae
Australis
Canicola
Copenhageni
BallumPyrogenes
Celledoni
PanamaTarassovi
Shermani
Hebdomadis
Grippotyphosa
Lai
Hardjobovis
HardjoPomonaMalaysia
Cynopteri
Sarawak
Patoc
MelakaTerengganu
Djasiman
SejroeHardjoprajitno

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 ofclothes 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] and2004 [94], which were related to water activities suchas kayaking and swimming in Segama River and swimming in the creek near an oil palm plantation in Beaufort,
respectively.
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,

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Fig. 3 Death from leptospirosis caused by water activities. The symbols indicate locations where people died of leptospirosis due to involvementwith recreational and water activities during 2000–2020

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 inacquiring leptospirosis [53–58]. The social conditions,such as poor urban communities, also contribute to theincidence of leptospirosis [96]. A number of risk factors
have been identified to be associated with leptospirosis in
Malaysia with activities involving waters contributing themost 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 todeveloping 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 theparticipants had poor knowledge, and it was associatedwith 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 theparticipants 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 arelatively low level of KAP toward leptospirosis. Anotherstudy in agricultural communities showed that despite
their good attitude towards the infection and moderateknowledge, they had unsatisfactory practices preventing
leptospirosis [61]. Overall, these studies show that publicawareness 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 researchwhich either focused on animals or environment orhumans (Additional file 1). Only one study [43] included

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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 detectedsimilar Leptospira species. One study [55] included both
domestic animals and humans and detected similar serovars. Based on these few studies, it might be difficult toestablish a direct transmission of similar genetic profilesof 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 weredetected 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 thehuman-animal-environment relationship in the occurrence of leptospirosis, more is needed to provide a complete understanding and knowledge of the epidemiologyof 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 areneeded covering various locations in Malaysia. In othercountries, Leptospira has also been isolated from “unconventional” hosts such as elephants, porcupines, bats,snakes, and frogs [108]. It would be comprehensive todetermine “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, andstrains. 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 afew locations. Hence, more studies are needed to identify and isolate locally circulating new serovars, especially in states where leptospirosis study is scarce, suchas Sabah.
Furthermore, the Leptospira species, serovars, andstrains 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 observedin patients and returned travelers from Malaysia[109–112]. 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 thatthe local L. interrogans can cause severe infection andpulmonary hemorrhage in hamsters [113]. Hence, identification and isolation of circulating Leptospira fromanimals, environments, and humans in Malaysia arenecessary to understand the virulence potential of thisbacteria.
The limited studies in assessing public awarenesstoward leptospirosis urge the need to do more studies in different communities, workplaces, and localities
are needed to assess the overall level of knowledge andawareness regarding leptospirosis in Malaysia.
KAP studies have been performed only in Peninsular
Malaysia, and conducting similar studies in Sabah andSarawak, 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.
Abbreviations
MAT	Microscopic agglutination test
PCR	Polymerase chain reaction
MCO	Movement control order
CFR	Case fatality rates
KAP	Knowledge, attitude, and practices

Philip and Ahmed ﻿Journal of Physiological Anthropology(2023) 42:30

Supplementary Information
The online version contains supplementary material available at https://​doi.​
org/​10.​1186/​s40101-​023-​00347-y.
Additional file 1: Summary of studies on animals, environment andhumans in Malaysia.
Acknowledgements
Not applicable.
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 andediting of this manuscript. NP and KA read and approved the final manuscript.
Funding
Not applicable.
Availability of data and materials
Not applicable.

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.
Received: 31 July 2023 Accepted: 16 November 2023

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