Leptospirosis as Frequent Cause of Acute Febrile Illness in Southern Sri Lanka

Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
Emerging Infectious Diseases (Impact Factor: 6.75). 09/2011; 17(9):1678-84. DOI: 10.3201/eid1709.100915
Source: PubMed


To determine the proportion of fevers caused by leptospirosis, we obtained serum specimens and epidemiologic and clinical data from patients in Galle, Sri Lanka, March-October 2007. Immunoglobulin M ELISA was performed on paired serum specimens to diagnose acute (seroconversion or 4-fold titer rise) or past (titer without rise) leptospirosis and seroprevalence (acute). We compared (individually) the diagnostic yield of acute-phase specimens and clinical impression with paired specimens for acute leptospirosis. Of 889 patients with paired specimens, 120 had acute leptosoirosis and 241 had past leptospirosis. The sensitivity and specificity of acute-phase serum specimens were 17.5% (95% confidence interval [CI] 11.2%-25.5%) and 69.2% (95% CI 65.5%-72.7%), respectively, and of clinical impression 22.9% (95% CI 15.4%-32.0%) and 91.7% (95% CI 89.2%-93.8%), respectively. For identifying acute leptospirosis, clinical impression is insensitive, and immunoglobulin M results are more insensitive and costly. Rapid, pathogen-based tests for early diagnosis are needed.

Download full-text


Available from: Christopher Woods, Jun 20, 2014
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We studied rickettsioses in southern Sri Lanka. Of 883 febrile patients with paired serum samples, 156 (17.7%) had acute rickettsioses; rickettsioses were unsuspected at presentation. Additionally, 342 (38.7%) had exposure to spotted fever and/or typhus group rickettsioses and 121 (13.7%) scrub typhus. Increased awareness of rickettsioses and better tests are needed.
    Emerging Infectious Diseases 05/2012; 18(5):825-9. DOI:10.3201/eid1805.111563 · 6.75 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: According to statistical unit of the Karapitiya Teaching Hospital, Galle, the main tertiary care institution of the Southern Province serving approximately three million population, in 2008, there were 459 patients with clinical diagnosis of leptospirosis, with 25 fatalities, 21 out of which were referred for autopsy examination. Objectives: The present study to study and correlate pathological changes in deaths associated with pulmonary form of leptospirosis with clinico-diagnostic aspects of the infection. There had been 21 leptospirosis related autopsy examinations performed at forensic medicine unit of the Karapitiya Teaching Hospital from January to December 2008. The clinical, laboratory and autopsy findings of these cases were recorded in detail and analyzed. The characteristic autopsy feature of all these cases was a moderate to severe pulmonary haemorrhage in association with hepato-renal, myocardial and cerebral lesions. The histology of the lung tissues in most cases showed extensive alveolar haemorrhages, hyaline like deposits, neutrophilic infiltrations, swollen septa with congested blood vessels. Severe pulmonary complications are mostly responsible for all fatalities due to leptospirosis in our series. Though there are no reliable clinical indicators that suggest probability of developing pulmonary haemorrhages, we emphasize that respiratory functions and haematological parameters need to be closely monitored in all hospitalized patients with leptospirosis for early detection and prevention of haemorrhagic complications.
    The Medical journal of Malaysia 12/2012; 67(6):595-600.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The recent roll-out of rapid diagnostic tests (RDTs) for malaria has highlighted the decreasing proportion of malaria-attributable illness in endemic areas. Unfortunately, once malaria is excluded, there are few accessible diagnostic tools to guide the management of severe febrile illnesses in low resource settings. This review summarizes the current state of RDT development for several key infections, including dengue fever, enteric fever, leptospirosis, brucellosis, visceral leishmaniasis and human African trypanosomiasis, and highlights many remaining gaps. Most RDTs for non-malarial tropical infections currently rely on the detection of host antibodies against a single infectious agent. The sensitivity and specificity of host-antibody detection tests are both inherently limited. Moreover, prolonged antibody responses to many infections preclude the use of most serological RDTs for monitoring response to treatment and/or for diagnosing relapse. Considering these limitations, there is a pressing need for sensitive pathogen-detection-based RDTs, as have been successfully developed for malaria and dengue. Ultimately, integration of RDTs into a validated syndromic approach to tropical fevers is urgently needed. Related research priorities are to define the evolving epidemiology of fever in the tropics, and to determine how combinations of RDTs could be best used to improve the management of severe and treatable infections requiring specific therapy.
    Clinical Microbiology and Infection 01/2013; 19(5). DOI:10.1111/1469-0691.12154 · 5.77 Impact Factor
Show more