Abstract
BackgroundAlthough the assessment of disease burden should be a priority for allocating resources, leptospirosis is grossly underestimated despite its true burden in Sri Lanka. This study aimed to assess the morbidity and mortality of leptospirosis based on routine surveillance data, hospital reported data and scientific publications from Sri Lanka.MethodA systematic review was carried out, and Pub Med, MEDLINE®, BIOSIS Previews, Zoological Record, Web of Science Core Collection, Current Contents Connect, KCI-Korean Journal Database, BIOSIS Citation Index, Data Citation Index, SciELO Citation Index and Google Scholar databases were searched. Quarterly epidemiological bulletin (QEB), indoor morbidity & mortality returns (IMMR) and hand searches of local literature were performed in local libraries. Forty-two relevant full texts, 32 QEBs, and 8 IMMR were included in the full text review. Adjustments were made for under diagnosis, underreporting and chance variability.ResultsThe estimated annual caseload of leptospirosis in Sri Lanka from 2008 to 2015, was 10,423, and the cumulative annual incidence of leptospirosis that required hospitalization was 52.1 (95% CI 51.7–52.6) per 100,000 people. The estimated number of annual deaths due to leptospirosis was approximately 730 (95% CI 542–980), with an estimated pooled case fatality ratio of 7.0% (95% CI 5.2–9.4). The most common organs involved were the kidney, liver and heart, with median rates of 48.7, 30, and 14.2%, respectively.ConclusionOur systematic review shows gross underestimation of the true leptospirosis burden in the national statistics of Sri Lanka, and the hospitalization rates estimated in our study were compatible with the total burden estimate of 300·6 (95% CI 96·54–604·23) per 100,000 people published previously.
Highlights
The assessment of disease burden should be a priority for allocating resources, leptospirosis is grossly underestimated despite its true burden in Sri Lanka
Our systematic review shows gross underestimation of the true leptospirosis burden in the national statistics of Sri Lanka, and the hospitalization rates estimated in our study were compatible with the total burden estimate of 300·6 per 100,000 people published previously
We used four bibliographic references to search for local literature: Bibliography of medical publications related to Sri Lanka 1811–1976 [15] and its supplement Bibliography on health in Sri Lanka, 1977–1980 [16] by Peiris and Uragoda; Bibliography of Medical Literature 1980–2005 compiled by the Post Graduate Institute of Medicine (PGIM) Library, Colombo; and the Annotated Bibliography of dissertations and theses Presented to PGIM by Postgraduate Trainees, published by the PGIM
Summary
The assessment of disease burden should be a priority for allocating resources, leptospirosis is grossly underestimated despite its true burden in Sri Lanka. This study aimed to assess the morbidity and mortality of leptospirosis based on routine surveillance data, hospital reported data and scientific publications from Sri Lanka. Leptospirosis is recognized as one of the causes of pyrexia of unknown origin or undifferentiated fevers [6]. There are many unreported cases of leptospirosis classified as undifferentiated fevers. Leptospirosis mimics dengue, hantavirus, malaria, rickettsioses and viral sepsis [7, 8] which can cause delayed diagnosis and increased mortality. The microscopic agglutination test (MAT) was considered “standard” for diagnosing leptospirosis [9], Warnasekara et al BMC Infectious Diseases (2019) 19:119 it is no longer considered the “gold standard” due to its well documented low sensitivity and predictive values [9, 10]. Lack of point of care diagnostic facility severely affect the leptospirosis diagnosis; the global disease estimates may not be entirely valid for country level estimates
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