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CC BY-NC-ND 4.0 · J Lab Physicians 2019; 11(01): 011-016
DOI: 10.4103/JLP.JLP_121_18
Original Article

Serological evidence of human leptospirosis in patients with acute undifferentiated febrile illness from Uttarakhand, India: A pilot study

Mohit Bhatia
Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
,
Pradeep Kumar
Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
,
Pratima Gupta
Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
,
Puneet Kumar Gupta
Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
,
Minakshi Dhar
Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
,
Deepjyoti Kalita
Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
› Author Affiliations Financial support and sponsorship: Nil
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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. Salmonella 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.

Key words

Acute undifferentiated febrile illness - leptospirosis - modified Faine’s criteria - scrub typhus


Publication History

Received: 21 September 2018

Accepted: 07 January 2019

Article published online:
06 April 2020

© 2019.

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • References

  • 1 Vijayachari P. Introduction. In: Leptospirosis Laboratory Manual, Regional Medical Research centre, Port Blair, WHO Country office for India, WHO, 2007. p.1-3.
  • 2 Narita M, Fujitani S, Haake DA, Paterson DL. Leptospirosis after recreational exposure to water in the Yaeyama Islands, Japan. Am J Trop Med Hyg 2005;73:652-6.
  • 3 World Health Organization. Leptospirosis Fact Sheet. World Health Organization. Available from: http://www.searo.who.int/about/administration_structure/cds/CDS_leptospirosis-Fact_Sheet.pdf. [Last accessed on 2018 Sep 01].
  • 4 Sethi S, Sharma N, Kakkar N, Taneja J, Chatterjee SS, Banga SS, et al. Increasing trends of leptospirosis in Northern India: A clinico-epidemiological study. PLoS Negl Trop Dis 2010;4:e579.
  • 5 Uttarakhand. Available from: https://www.en.wikipedia.org/wiki/Uttarakhand. [Last accessed on 2018 Sep 01].
  • 6 Shivakumar S, Shareek PS. Diagnosis of leptospirosis utilizing modified Faine’s criteria. J Assoc Physicians India 2004;52:678-9.
  • 7 Sharma KK, Kalawat U. Early diagnosis of leptospirosis by conventional methods: One-year prospective study. Indian J Pathol Microbiol 2008;51:209-11.
  • 8 Betty AF, Daniel FS, Alice SW, editors. The spirochetes. In: Bailey & Scott’s Diagnostic Microbiology. 12th ed. St. Louis, Missouri: Mosby Elsevier; 2007. p. 539-40.
  • 9 Singh SS. Clinical Manifestations. In: Leptospirosis Laboratory Manual. Regional Medical Research centre, Port Blair, WHO Country office for India: WHO; 2007. p. 22-6.
  • 10 Kurup A, Issac A, Loh JP, Lee TB, Chua R, Bist P, et al. Scrub typhus with sepsis and acute respiratory distress syndrome. J Clin Microbiol 2013;51:2787-90.
  • 11 Mahajan SK. Scrub typhus. J Assoc Physicians India 2005;53:954-8.
  • 12 Bhargava A, Kaushik R, Kaushik RM, Sharma A, Ahmad S, Dhar M, et al. Scrub typhus in Uttarakhand & adjoining Uttar Pradesh: Seasonality, clinical presentations & predictors of mortality. Indian J Med Res 2016;144:901-9.
  • 13 Balamurugan V, Alamuri A, Bharathkumar K, Patil SS, Govindaraj GN, Nagalingam M, et al. Prevalence of leptospira serogroup-specific antibodies in cattle associated with reproductive problems in endemic states of India. Trop Anim Health Prod 2018;50:1131-8.
  • 14 Mittal V, Bhattacharya D, Chhabra M. Multi-state outbreak of scrub typhus. NCDC Newsl 2013;2:3-4.
  • 15 Anupriya A, Meera J, Uma A. Dual edge sword-leptospirosis and typhoid coinfection with rare complications – A case report. Sch J Med Case Rep 2016;4:363-5.
  • 16 Chaudhry R, Das A, Premlatha MM, Choudhary A, Chourasia BK, Chandel DS, et al. Serological and molecular approaches for diagnosis of leptospirosis in a tertiary care hospital in North India: A 10-year study. Indian J Med Res 2013;137:785-90.
  • 17 Mishra B, Singhal L, Sethi S, Ratho RK. Leptospirosis coexistent with dengue fever: A diagnostic dilemma. J Glob Infect Dis 2013;5:121-2.
  • 18 Chaudhry R, Pandey A, Das A, Broor S. Infection potpourri: Are we watching? Indian J Pathol Microbiol 2009;52:125.
  • 19 Sushi KM, Sivasangeetha K, Kumar AS, Shastri P, Ganesan A, Anitha D, et al. Seroprevalence of leptospirosis, enteric fever and dengue in patients with acute febrile illness in Tamil Nadu, India. Indian J Basic Appl Med Res 2014;3:615-23.
  • 20 Bhatia M, Umapathy BL, Navaneeth BV. An evaluation of dark field microscopy, culture and commercial serological kits in the diagnosis of leptospirosis. Indian J Med Microbiol 2015;33:416-21.
  • 21 Manappallil RG. Typh fevers: A combination of typhoid and typhus. Asian J Med Sci 2017;8:40-1.
  • 22 Mazumder RN, Pietroni MA, Mosabbir N, Salam MA. Typhus fever: An overlooked diagnosis. J Health Popul Nutr 2009;27:419-21.
  • 23 Basak R, Islam N. Typhus fever: An uncommon childhood infection-report of a case from northern region of Bangladesh. Chattagram Maa-O-Shishu Hosp Med Coll J 2013;12:49-51.
  • 24 Seow CW, Logarajah V, Tan NW. Typhoid and scrub typhus coinfection in a returned traveler. Glob Pediatr Health 2017;4:2333794X17726941.
  • 25 Gupta N, Chaudhry R, Mirdha B, Das B, Dar L, Kabra S, et al. Scrub typhus and leptospirosis: The fallacy of diagnosing with IGM enzyme linked immunosorbant assay. J Microb Biochem Technol 2016;8:71-5.
  • 26 Lim C, Paris DH, Blacksell SD, Laongnualpanich A, Kantipong P, Chierakul W, et al. 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:e0114930.
  • 27 Faine S. Guidelines for the control of Leptospirosis. WHO Offset Publ 1982;67:1–171.
  • 28 Brato DG, Mendoza MT, Coredero CP; Leptospirosis Study Group. Validation of the WHO criteria using the MAT as the gold standard in the diagnosis of leptospirosis. PJMID 1998;27:125-8.
  • 29 Jose LR, Sumana MN. Utilization of Faine’s criteria for the diagnosis of leptospirosis. IOSR J Dent Med Sci 2016;15:28-30.
  • 30 Sharma N, Sethi S, Bhalla A. Evaluation of the Modified WHO Faine’s Criteria for Diagnosing Human Leptospirosis in a Tertiary Care Hospital of North India, Open Forum Infectious Diseases, Oxford Academic. OUP Academic, Oxford University Press; 2016. Available from: https://www.academic.oup.com/ofid/article/3/suppl_1/1421/2635760. [Last accessed on 2018 Sep 01].
  • 31 Bhatia M, Umapathy BL, Navaneeth BV. Evaluation of diagnostic utility of modified Faine’s criteria in leptospirosis-experience from a tertiary care hospital. Natl J Integr Res Med 2018;6:20-6.