Faine's Criteria Research Articles

Leptospirosis in Intensive Care Unit.

Tropical infections constitute 20 – 30% of intensive care unit (ICU) admissions in developing countries. Leptospirosis is a spectrum with mild form presenting as an acute febrile illness with jaundice, complicating in few as acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC), and multi-organ dysfunction syndrome (MODS). The poor prognostic markers are hemorrhagic ARDS, acute renal failure, DIC, severe metabolic acidosis, older age, chronic alcohol abuse, high SOFA score, and septic shock. The confirmatory diagnosis relies on antibody testing, such as microscopic agglutination test (MAT) and IgM ELISA, while the reverse transcription-polymerase chain reaction test being reserved for clinically suspected antibody negative cases. The spectrum of multi-organ involvement necessitates a complete hematological, biochemical workup, including electrocardiogram (ECG), chest X-ray, and two-dimensional echocardiography. Specific antimicrobial therapy consists of the following—benzylpenicillin, ceftriaxone, cefotaxime, and doxycycline. The reported mortality ranges from 6% to as high as 44%. Various ICU scores like SPiRO, THAI LEPTO score, and Faine's criteria have been useful in risk stratification. Optimizing intensive care treatment with appropriate antibiotics, lung protection ventilation strategies, strict fluid management, and if need be timely initiation of renal replacement therapy (RRT) helps in reducing mortality.How to cite this article: Karnik ND, Patankar AS. Leptospirosis in Intensive Care Unit. Indian J Crit Care Med 2021;25(Suppl 2): S134–S137.

Epidemiological, clinical and laboratory features of leptospirosis compared to other acute febrile illnesses.

Background Leptospirosis is a common zoonotic disease. Many waterborne diseases and mosquito-borne diseases are common causes of acute febrile illnesses in the southern Indian state of Kerala posing diagnostic challenges. The objective of this study was to describe the epidemiological, clinical and laboratory features of leptospirosis diagnosed using the modified Faine's criteria (with amendment) compared to other common acute febrile illnesses. In this prospective study, all consecutive patients with acute febrile illness, headache and myalgia presenting to our tertiary care hospital's single unit from March 2013 to February 2015 were subjected to detailed history taking and thorough clinical examination. Leptospiral immunoglobulin M (IgM) serology was confirmed by RecombiLISA ELISA and modified Faine's criteria were used for diagnosis of leptospirosis. Other diagnoses for acute febrile illnesses were assigned based on clinical and laboratory investigations. Bivariate and regression analysis was carried out to analyse epidemiological, clinical and laboratory parameters of both groups. A total of 389 patients were enrolled, out of which 110 patients had the presumptive diagnosis of leptospirosis. Among the 279 with non-leptospirosis acute febrile illness, dengue (39%) and other viral febrile illnesses (25%) were the most common diagnoses. Regression analysis identified several epidemiological (contact with contaminated animals or water and drinking unboiled water), clinical (conjunctival congestion and muscle tenderness) and laboratory investigations (leucocytosis, neutrophilia, elevated erythrocyte sedimentation rate [ESR] and aspartate aminotransferase) which were helpful in distinguishing leptospirosis from other acute febrile illnesses. Our study suggests that certain epidemiological, clinical and laboratory features in patients with leptospirosis may allow an early diagnosis. Our study also underscores the usefulness of confirming the leptospiral serology by enzyme-linked immunosorbent assay (ELISA) in combination with relevant epidemiological and clinical features in diagnosing leptospirosis using the modified Faine's criteria.

Restructuring the modified Faine's criteria for the diagnosis of leptospirosis in monsoon: A study from south Gujarat

Context:Clinical and epidemiological variables in the modified Faine's criteria offered low validity in our study setting.Aims:Restructuring and validating modified Faine's criteria for leptospirosis to better suit health scenario of south Gujarat.Subjects and Methods:Clinical, epidemiological, and laboratory features of derivation cohort (1216 suspected leptospirosis cases) admitted at a tertiary care hospital of south Gujarat (2007–2015) that significantly correlated with confirmed leptospirosis were used in binary logistic regression to derive scoring models and receiver operating characteristic to determine cutoff values. Validity and net reclassification improvement (NRI) were estimated in validation cohort (82 cases, 2016–2017) and algorithm for diagnosis was prepared.Results:Screening model consisted of the presence of conjunctival suffusion, calf tenderness, raised serum creatinine, headache with conjunctival suffusion and/or jaundice, and dyspnea/meningism. Area under curve (AUC) for screening model was 0.590 (standard error [SE] ±0.017) and cutoff score ≥9 gave sensitivity 79.16%, specificity 50%. The confirmatory model consisted of laboratory parameters, namely polymerase chain reaction, immunoglobulin M ELISA, and microscopic agglutination test and gave AUC 0.998 (SE ± 0.001), sensitivity 89.58%, specificity 85.29%, positive predictive value 89.58%, and negative predictive value 85.29% at cutoff score ≥100. Net sensitivity of algorithm was 98.27% at the point of screening (screening model and rapid test) and net specificity 87.89% at the point of confirmation (screening followed by confirmatory model) in validation cohort.Conclusions:Simultaneous use of screening model and rapid test gave NRI 81.25% and sequential use of confirmatory test gave NRI 47.18% compared to corresponding parts of the modified Faine's criteria.

Leptospirosis: Seroprevalence, risk factors, and diagnostic view in a tertiary care center in North India

INTRODUCTION: Leptospirosis is a zoonotic disease with clinical manifestations, ranging from subclinical infection to fulminant disease. OBJECTIVE: To study the seroprevalence, various epidemiological risk factors, and diagnostic aspects of leptospirosis. MATERIALS AND METHODS: One hundred and seventy-one clinically suspected individuals were enrolled in the study at Jawaharlal Nehru Medical College and Hospital, AMU, Aligarh, during January 2013–May 2014. A detailed history of patients was taken on a predesigned pro forma. Blood sample was collected from the patients, and immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA), polymerase chain reaction (PCR), and microscopic agglutination test (MAT) were done for diagnosis. The patients' details were also scored according to the modified Faine's criteria. RESULTS: Of 171 patients, 24 (14.1%) cases were diagnosed positive by IgM ELISA. Contact with dirty surroundings, fieldworkers, history of animal contact, and use of public bathing facilities/ponds were associated with 20 (83.3%), 20 (83.3%) 19 (79.2%), and 18 (75%) cases, respectively. Fifteen (62.5%) cases were diagnosed during July–September (P = 0.004). Fever, myalgia, and abdominal pain were the common symptoms. Calf tenderness was seen in 22 cases (P 25. CONCLUSIONS: Dirty surroundings, fieldworkers, animal contact, and heavy rainfall are the major epidemiological risk factors for leptospirosis. Modified Faine's criteria may play a useful role in diagnosis for a patient with low clinical score.

Decreasing trend of seroprevalence of leptospirosis at All India Institute of Medical Sciences New Delhi: 2014-2018.

Background:Leptospirosis is an important emerging public health problem in India. There is limited information regarding the seroprevalence of leptospirosis in population from northern states of India. This study reports result of a 4-year-retrospective sero-epidemiological survey of leptospirosis conducted in a teaching tertiary care hospital in New Delhi, India. The aim of our study was to explore seroprevalence and clinical pattern of disease occurrence in suspected cases of leptospirosis and to search for any co-existing infections in northern areas such as New Delhi, India.Methods:The patients with clinically suspected leptospirosis who attended outpatient or admitted to the Departments of Medicine, Gastroenterology, Pediatrics and Neurology, etc. of our hospital were retrospectively analyzed. The qualitative determination of anti-leptospira-specific immunoglobulin (IgM) antibodies was carried out using commercially available enzyme-linked immunosorbent assay (ELISA) kit (Panbio Diagnostics, Brisbane, Australia).Results:Of these 1545 patients, 6.47% (100/1545) were seropositive for anti-leptospira-specific immunoglobulin (IgM) antibodies. Using modified Faine's criteria, a diagnosis of presumptive and possible leptospirosis was made in 79/100 (79%) and 21/100 (21%) patients. Significant declining trend of seroprevalence rate of leptospirosis from 26.90% in 2000–2010 and 20% in 2011–2014 to 6.47% in 2014–2018 (P value <0.05) in our referral tertiary care center. Seventeen patients showed co-infection with other common pathogen prevailing locally.Conclusion:There is a need to increase awareness among public and clinicians, however, more region/province-wise studies on seroprevalence of leptospirosis are required to improve our understanding of the actual burden.

Utility of loop-mediated isothermal amplification assay, polymerase chain reaction, and elisa for diagnosis of leptospirosis in South Indian patients

Background:Leptospirosis is a zoonotic disease which requires laboratory diagnosis for confirmation.Materials and Methods:In this study serum samples from adults with acute undifferentiated fever (duration ≤15 days) were tested for IgM antibodies to Leptospira by ELISA, PCR for rrs gene and loop-mediated isothermal amplification (LAMP) assay for LipL32 and LipL41.Results:Among the 150 sera tested, three were positive by PCR, LAMP and IgM ELISA/modified Faines’ criteria, two by only PCR; seven only by LAMP assay and forty fulfilled modified Faine's criteria (illness clinically compatible and IgM ELISA positive for leptospirosis). Clinical correlation revealed renal compromise, low platelet count and severe jaundice were significantly related to leptospirosis (P < 0.05).Conclusion:This study suggests that LAMP assay could be useful for diagnosis of leptospirosis during the 1st week of illness whereas IgM ELISA forms the mainstay of diagnosis from the 2nd week onward. Further studies especially community based, comparing ELISA, PCR, LAMP, culture and microscopic agglutination test are required to evaluate the veracity of these findings.

Evaluation of the Modified WHO Faine's Criteria for Diagnosing Human Leptospirosis in a Tertiary Care Hospital of North India

Evaluation of the Modified WHO Faine's Criteria for Diagnosing Human Leptospirosis in a Tertiary Care Hospital of North India

Clinical profile and outcome of leptospirosis at tertiary care centre in western Maharashtra

Background: Leptospirosis is an emerging spirochetal zoonosis world wide. Leptospirosis is common zoonosis that is under reported and under diagnosed in India. The aim of this study was to study the clinical profile outcome and prognostic factors in human leptospirosis at tertiary care centre. Settings and Design: This was a retrospective study of leptospira positive patients who were admitted in tertiary care centre. The study was conducted in 2010, over a period of 6 month from July to December. Materials and Methods: All patients who presented with clinical features and tested IgM positive for leptospirosis were taken into the study and analyzed based on modified Faine's criteria. Results: Out of total 23 patients there were 21 males and 2 females, with mean age was 32 years. Maximum incidence of cases was found in month of July and August. Out of total 23 patients, 18 (78.26%) were farmers and 5 (21.73%) were laborers. Predominant complaints were fever, jaundice, myalgia, and headache. All 23 had positive results for IgM against leptospira. Liver function tests were deranged in 16 (69.56%) and renal functions were deranged in 12 (52.17%). Total 7 (30.43%) patients had Weil's syndrome and 7 (30.43%) had acute respiratory distress syndrome (ARDS). Total 7 (30.43%) patients had neuroleptospirosis, out of which 5 (21.73%) had aseptic meningitis, one had paraparesis secondary to lumbar radiculopathy and one had meningoencephalitis. Hyperkalemia was present in 6 (26.08%) patients, 7 (30.43%) patients had hypokalemia. Total 11 (47.82%) patients had metabolic acidosis (pH Conclusions: Leptospirosis was unexpectedly found to be positive in many of our patients who were having pyrexia with multiorgan dysfunction during the monsoons. Hepatic dysfunction, acute renal failure, ARDS, and neuroleptospirosis in decreasing frequency were the commonest complication. Daily dialysis, ventilatory support and intensive care management has definitely reduced morbidity and mortality associated with leptospirosis with multi-organ failure.

Increasing Trends of Leptospirosis in Northern India: A Clinico-Epidemiological Study

BackgroundLeptospirosis, a zoonosis associated with potentially fatal consequences, has long been a grossly underreported disease in India. There is no accurate estimate of the problem of leptospirosis in non-endemic areas such as north India.Methods/Principal FindingsIn order to understand the clinical spectrum and risk factors associated with leptospirosis, we carried out a retrospective study in patients with acute febrile illness in north India over the last 5 years (January 2004 to December 2008). There was increased incidence of leptospirosis (11.7% in 2004 to 20.5% in 2008) as diagnosed by IgM ELISA and microscopic agglutination titer in paired acute and convalescent sera. The disease showed a peak during the rainy season (August and September). We followed up 86 cases of leptospirosis regarding their epidemiological pattern, clinical features, laboratory parameters, complications, therapy, and outcome. Mean age of patients was 32.6 years (2.5 years to 78 years) and males (57%) outnumbered females (43%). Infestation of dwellings with rats (53.7%), working in farm lands (44.2%), and contact with animals (62.1%) were commonly observed epidemiological risk factors. Outdoor workers including farmers (32.6%), labourers (11.6%), para-military personnel (2.3%), and sweepers (1.2%) were commonly affected. Modified Faine's criteria could diagnose 76 cases (88.3%). Renal failure (60.5%), respiratory failure (20.9%), the neuroleptospirosis (11.6%), and disseminated intravascular coagulation (DIC) (11.6%) were the commonest complications. Five patients died, giving a case fatality rate of 5.9%.Conclusions/SignificanceThere has been a rapid rise in the incidence of leptospirosis in north India. Severe complications such as renal failure, respiratory failure, neuroleptospirosis, and DIC are being seen with increasing frequency. Increased awareness among physicians, and early diagnosis and treatment, may reduce mortality due to leptospirosis.