Utility of modified Faine's criteria in diagnosis of leptospirosis.

Kanchana Bandara,Manjula Manoji Weerasekera,Chamil Marasinghe,Neluka Fernando,Nilantha Ranasinghe,Chinthika Gunasekara

doi:10.1186/s12879-016-1791-9

Abstract

BackgroundLeptospirosis is a globally emerging zoonotic disease and an important public health threat in developing countries. Diagnosis of leptospirosis is mainly based on clinical presentations in resource poor countries. World Health Organization (WHO) has introduced “Faine’s criteria” for diagnosis of leptospirosis. This study was conducted to evaluate the usefulness of modified Faine’s criteria (with amendment) 2012 to detect leptospirosis in resource poor settings.MethodsBlood samples of 168 patients who fulfilled the inclusion criteria admitted between January 2013 to January 2014 were tested by a commercial immunochromatographic assay (Leptocheck WB, India), microscopic agglutination test (MAT) and polymerase chain reaction (PCR) methods. Leptospirosis was confirmed by a single MAT titre ≥1:400 and / or by a positive PCR. Diagnosis of leptospirosis was made using the clinical, epidemiological and laboratory data according to modified Faine’s criteria (with amendment) 2012.ResultsLeptospirosis was confirmed in 39 % (n = 66) by MAT and/or PCR. When modified Faine’s criteria (MAT ≥ 1.400 &/ or PCR), was evaluated against LERG confirmed cases sensitivity, specificity, positive predictive value and negative predictive values were 95.45 %, 56.86 %, 58.88 %, 95.08 % respectively. The modified Faine’s criteria with rapid immunochromatographic assay only had a sensitivity, specificity, positive predictive value and negative predictive value 89.39 %, 58.82 %, 58.42 %, and 89.55 % respectively.ConclusionThe modified Faine’s criteria which utilized only immunochromatographic assay (leptocheck IgM) in Part C was found to be useful tool for diagnosing leptospirosis in a resource poor setting.

Highlights

Leptospirosis is a globally emerging zoonotic disease and an important public health threat in developing countries
Prompt treatment with antibiotics can reduce the severity of leptospirosis, diagnosis is often delayed resulting in high mortality
Two hundred and three patients having acute febrile illness were recruited and 168 patients had clinically suspected leptospirosis according to the inclusion criteria (Fig. 1)

Summary

Introduction

Leptospirosis is a globally emerging zoonotic disease and an important public health threat in developing countries. Diagnosis of leptospirosis is mainly based on clinical presentations in resource poor countries. World Health Organization (WHO) has introduced “Faine’s criteria” for diagnosis of leptospirosis. Leptospirosis is a globally emerging zoonotic disease, and an estimated one million severe cases occur each year, with a case fatality up to 40 % [1]. In Sri Lanka the annual disease incidence is reported to vary between 31 to 164 per 100, 000 population [3] with high mortality rate among severe cases [4]. Prompt treatment with antibiotics can reduce the severity of leptospirosis, diagnosis is often delayed resulting in high mortality. Increasing incidence of the disease in resource poor countries like Sri Lanka highlights the need

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