Serological Evidence of Human Leptospirosis in Patients with Acute Undifferentiated Febrile Illness from Uttarakhand, India: A Pilot Study

Overview

Journal J Lab Physicians

Specialty Pathology

Date 2019 Apr 16

PMID 30983796

Citations 1

Authors

Mohit Bhatia

Pradeep Kumar

Pratima Gupta

Puneet Kumar Gupta

Minakshi Dhar

Deepjyoti Kalita

Affiliations

Soon will be listed here.

Abstract

Context: To the best of our knowledge, there are no reports of serological evidence of human leptospirosis from Uttarakhand state in India.

Aims: The aim of this study was to screen for serological evidence of leptospirosis in patients with acute undifferentiated febrile illness at a tertiary care teaching hospital in Uttarakhand.

Settings And Design: A pilot study was conducted from March to November 2017.

Subjects And Methods: Fifty-three adult patients who presented in Medicine outpatient Department with a history of fever of ≥7 up to 14 days duration with or without other associated symptoms such as a headache, rashes, myalgia, arthralgia, and conjunctival suffusion were enrolled in the study using convenience sampling technique. Blood samples of these patients were collected and subjected to peripheral smear examination for malaria parasites, dengue immunoglobulin M (IgM) immunochromatographic card test, IgM Typhidot, Leptospira and Scrub typhus IgM ELISA, respectively. Aerobic blood culture was performed in 24 cases. Relevant clinico-epidemiological details were obtained as per the pro forma formulated in accordance with the modified Faine's criteria.

Statistical Analysis Used: Descriptive statistics.

Results: The study population consisted of 50.94% of males and 49.06% of females with a mean age ± standard deviation of 34.2 ± 15.2 years. Fifty febrile patients had additional symptoms of which myalgia was the most common (81.1%) followed by arthralgia (22.6%). Peripheral smears of all patients were negative for malaria parasites. Dengue and Typhidot IgM positivity was observed in two and eight patients, respectively. Six and five patients were tested positive by leptospira and scrub typhus IgM ELISA, respectively. Typhi was isolated from blood sample of only one patient. Serum samples of two patients showed dual positivity. All six leptospira seropositive patients satisfied modified Faine's criteria.

Conclusions: Leptospirosis is a seemingly unexplored infection in Uttarakhand and should be considered as a differential diagnosis in patients with acute undifferentiated febrile illness.

Citing Articles

Prevalence of anti-Leptospira antibodies and associated risk factors in the Malaysian refugee communities.

Mohd Hanapi I, Sahimin N, Maackara M, Annisa A, Abdul Mutalib R, Lewis J BMC Infect Dis. 2021; 21(1):1128.

PMID: 34724919 PMC: 8561983. DOI: 10.1186/s12879-021-06830-0.

References

Shivakumar S, Shareek P . Diagnosis of leptospirosis utilizing modified Faine's criteria. J Assoc Physicians India. 2005; 52:678-9. View

Narita M, Fujitani S, Haake D, Paterson D . Leptospirosis after recreational exposure to water in the Yaeyama islands, Japan. Am J Trop Med Hyg. 2005; 73(4):652-6. PMC: 2666279. View

Mahajan S . Scrub typhus. J Assoc Physicians India. 2006; 53:954-8. View

Sharma K, Kalawat U . Early diagnosis of leptospirosis by conventional methods: one-year prospective study. Indian J Pathol Microbiol. 2008; 51(2):209-11. DOI: 10.4103/0377-4929.41687. View

Chaudhry R, Pandey A, Das A, Broor S . Infection potpourri: are we watching?. Indian J Pathol Microbiol. 2009; 52(1):125. DOI: 10.4103/0377-4929.44990. View

Mazumder R, Pietroni M, Mosabbir N, Salam M . Typhus fever: an overlooked diagnosis. J Health Popul Nutr. 2009; 27(3):419-21. PMC: 2761786. DOI: 10.3329/jhpn.v27i3.3385. View

Sethi S, Sharma N, Kakkar N, Taneja J, Chatterjee S, Banga S . Increasing trends of leptospirosis in northern India: a clinico-epidemiological study. PLoS Negl Trop Dis. 2010; 4(1):e579. PMC: 2797087. DOI: 10.1371/journal.pntd.0000579. View

Chaudhry R, Das A, Premlatha M, Choudhary A, Chourasia B, Chandel D . Serological & molecular approaches for diagnosis of leptospirosis in a tertiary care hospital in north India: a 10-year study. Indian J Med Res. 2013; 137(4):785-90. PMC: 3724261. View

Kurup A, Issac A, Loh J, Lee T, Chua R, Bist P . Scrub typhus with sepsis and acute respiratory distress syndrome. J Clin Microbiol. 2013; 51(8):2787-90. PMC: 3719619. DOI: 10.1128/JCM.00463-13. View

10.

Mishra B, Singhal L, Sethi S, Ratho R . Leptospirosis coexistent with dengue Fever: a diagnostic dilemma. J Glob Infect Dis. 2013; 5(3):121-2. PMC: 3766336. DOI: 10.4103/0974-777X.116878. View

11.

Lim C, Paris D, Blacksell S, Laongnualpanich A, Kantipong P, Chierakul W . How to Determine the Accuracy of an Alternative Diagnostic Test when It Is Actually Better than the Reference Tests: A Re-Evaluation of Diagnostic Tests for Scrub Typhus Using Bayesian LCMs. PLoS One. 2015; 10(5):e0114930. PMC: 4449177. DOI: 10.1371/journal.pone.0114930. View

12.

Bhatia M, Umapathy B, Navaneeth B . An evaluation of dark field microscopy, culture and commercial serological kits in the diagnosis of leptospirosis. Indian J Med Microbiol. 2015; 33(3):416-21. DOI: 10.4103/0255-0857.158570. View

13.

Bhargava A, Kaushik R, Kaushik R, Sharma A, Ahmad S, Dhar M . Scrub typhus in Uttarakhand & adjoining Uttar Pradesh: Seasonality, clinical presentations & predictors of mortality. Indian J Med Res. 2017; 144(6):901-909. PMC: 5433283. DOI: 10.4103/ijmr.IJMR_1764_15. View

14.

Seow C, Logarajah V, Tan N . Typhoid and Scrub Typhus Coinfection in a Returned Traveler. Glob Pediatr Health. 2017; 4:2333794X17726941. PMC: 5574469. DOI: 10.1177/2333794X17726941. View

15.

Balamurugan V, Alamuri A, Bharathkumar K, Patil S, Govindaraj G, Nagalingam M . Prevalence of Leptospira serogroup-specific antibodies in cattle associated with reproductive problems in endemic states of India. Trop Anim Health Prod. 2018; 50(5):1131-1138. DOI: 10.1007/s11250-018-1540-8. View

16.

. Guidelines for the control of leptospirosis. WHO Offset Publ. 1982; (67):1-171. View