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UPDATE
International Leptospirosis Society Meeting 2017
New Zealand, November 2017
INTRODUCTION
Clinical manifestation of Leptospirosis range :
shock
jaundice
The Netherlands
Classic Weil Disease : kidney and liver
Exposure history
Clinical Presentation
• Molecular test
– PCR
• Isolation
– Insensitive, slow growing ≠ early diagnosis
RAPID DETECTION TESTS
Inexpensive
Easy to use
Simple
High – throughout
• Specimen collection
Leptospiremia
– <7 days post onset : blood for PCR
Antibodies
– 7 days post onset : Serum (RDT, ELISA, MAT),
urine for PCR
– CSF for PCR : collect if symptomatic
– Due to transient nature of Leptospira in
Week 1 Week 2 Week 3 Week 4
bloodstream, window of optimal specimen
collection is very narrow for DNA detection
I N T E R P R E TAT I O N O F L A B T E S T
Serology
• Positive rapid test or screening test – presumptive,
needs confirmation
• MAT – 4x rise or seroconversion is confirmatory
no rise in titer or low titer in single specimen - inconclusive
PCR
• Positive – confirmatory
• Negative – will not rule out leptospirosis
• Some studies reference standard test
Best practice – run multiple test on multiple specimens
LIMITATIONS
Serological test cannot make an
early diagnosis as the antibody titers
rise in 2nd or 3rd week
Headache 84,21 %
Myalgia 97,37 %
Conjunctival suffusion 76,32 %
Meningism 21,05 %
Renal Dysfunction 63,12 %
Icteric Presentation 57,89 %
Abdominal pain 47,37 %
Rash 10,52 %
Hypotension 5,26 %
Table 4. Characteristic Performance of
Modified Faine’s (2012) Criteria
Characteristic Performance A + B only
Sensitivity (%) 18,42
Specificity (%) 94,50
(+) Likelihood Ratio 3,35
(-) Likelihood Ratio 0,86
PPV (%) 53,85
NPV (%) 76,87
CONCLUSION
Modified Faine Criteria (2012) : useful and simple guideline esp in
poor resources area, featuring : clinical features, exppsure history,
lab outcomes
Cohort study : patients admitted with febrile illness, headache and myalgia.
History, clinical examination, lab investigations, and IgM Leptospira antibody
test by ELISA were collected.
110 (28,3 %) from 389 AUF were Leptospirosis vs other fevers (dengue
fever, viral hepatitis, Acute diarrheal disease, enteric fever, UTI, cellulitis)
Symptoms include : Joint pain, Catarrhal symptoms, Cough, Hemoptysis,
Abdominal pain, Diarrhea, Oliguria
Physical signs : Jaundice, conj. Suffusion, skin rashes, muscle
tenderness, hepatomegaly, tachypnea, skin ulcers
Lab investigation : anemia, leukositosis, thrombocytopenia,
neutophilia, elevated urea, elevated creatinine, elevated bilirubine,
elevated SGOT, elevated SGPT, elevated Alk. Phospatase,
Hypoalbuminemia
(Padma Kumar. 2017. A Study on the Clinical and Laboratory profile of Leptospirosis with a view to
develop a Prediction Model in India. ILS 2017)
D I S T R I B U T I O N O F L E P T O S P I R A S E R O VA R S
A M O N G R AT S A S T H E P O T E N T I A L R E S E RVO I R
OF LEPTOSPIROSIS IN INDONESIA
(Claudia Toma et al. 2017. Evaluation of a Leptospiral Enzyme for Diagnosis of Acute
Leptospirosis in Japan. ILS 2017)
SUMMARY
Testing is imperfect
• Awareness
• Interpret using multiple sources (clinical presentation, lab values,
exposure history)
Thank
You