Abstract
BackgroundLeptospirosis diagnoses have increased in Sarawak, Malaysia in recent years.MethodsTo better understand the burden of disease and associated risk factors, we evaluated 147 patients presenting with clinical leptospirosis to local hospitals in Sarawak, Malaysia for the presence of Leptospira and associated antibodies. Sera and urine specimens collected during the acute illness phase were assessed via a commercially available rapid diagnostic test (Leptorapide, Linnodee Ltd., Antrim, Northern Ireland), an ELISA IgM assay (Leptospira IgM ELISA, PanBio, Queensland, Australia) and a pan-Leptospira real-time PCR (qPCR) assay to estimate disease prevalence and diagnostic accuracy of each method. Microagglutination testing was performed on a subset of samples.ResultsOverall, 45 out of 147 patients (30.6%) showed evidence of leptospires through qPCR in either one or both sera (20 patients) or urine (33 patients), and an additional ten (6.8%) were considered positive through serological testing, for an overall prevalence of 37.4% within the study population. However, each diagnostic method individually yielded disparate prevalence estimates: rapid test 42.2% for sera and 30.5% for urine, ELISA 15.0% for sera, qPCR 13.8% for sera and 23.4% for urine. Molecular characterization of a subset of positive samples by conventional PCR identified the bacterial species as Leptospira interrogans in 4 specimens. A multivariate risk factor analysis for the outcome of leptospirosis identified having completed primary school (OR = 2.5; 95 CI% 1.0–6.4) and weekly clothes-washing in local rivers (OR = 10.6; 95 CI% 1.4–214.8) with increased likelihood of leptospirosis when compared with those who had not.ConclusionOverall, the data suggest a relatively high prevalence of leptospirosis in the study population. The low sensitivities of the rapid diagnostic test and ELISA assay against qPCR highlight a need for better screening tools.
Highlights
IntroductionLeptospirosis has been on the rise in Malaysia in recent years [1, 2], where it has been designated a notifiable disease since 2010
Leptospirosis diagnoses have increased in Sarawak, Malaysia in recent years
Leptospirosis has been on the rise in Malaysia in recent years [1, 2], where it has been designated a notifiable disease since 2010
Summary
Leptospirosis has been on the rise in Malaysia in recent years [1, 2], where it has been designated a notifiable disease since 2010. Leptospirosis is a zoonotic bacterial infection that causes widespread morbidity and disproportionately impacts people in regions with warm, humid climates in which the bacteria can proliferate [3, 6]. It is caused by a gram-negative spirochete of the genus Leptospira, which has 64 known genomic species and 300 identified serovars [7, 8]. Identification and treatment of leptospirosis is challenging as symptoms of infection are non-specific and confused with other more common causes of acute febrile illness
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