Leptospirosis infections among hospital patients, Sarawak, Malaysia

Tropical Diseases, Travel Medicine and Vaccines

James A. Merchant¹  Johnny Keh-Tun Goh²  Izreena Saihidi²  Antoinette Berita²  King-Ching Hii²  Diego Galán³  Emily R. Robie⁴  Natalie A. Alarja⁴  Raquel A. Binder⁴  Gregory C. Gray⁵  Leshan Xiu⁶  Vanina Guernier-Cambert⁷  Michael J. Gregory⁸ 

[1] Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA;Department of Pediatrics, Kapit Hospital, Ministry of Health Malaysia, Kapit, Sarawak, Malaysia;Division of Infectious Diseases, Duke University School of Medicine, DUMC Box 102359, 27710, Durham, NC, USA;Duke Global Health Institute, Duke University, Durham, NC, USA;Division of Infectious Diseases, Duke University School of Medicine, DUMC Box 102359, 27710, Durham, NC, USA;Duke Global Health Institute, Duke University, Durham, NC, USA;Division of Infectious Diseases, Duke University School of Medicine, DUMC Box 102359, 27710, Durham, NC, USA;Emerging Infectious Disease Program, Duke-NUS Medical School, Singapore, Singapore;Global Health Center, Duke Kunshan University, Kunshan, China;Duke Global Health Institute, Duke University, Durham, NC, USA;Division of Infectious Diseases, Duke University School of Medicine, DUMC Box 102359, 27710, Durham, NC, USA;National Health Commission Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China;Present address: Agricultural Research Service, National Animal Disease Center, United States Department of Agriculture, Ames, IA, USA;United States Naval Medical Research Center- Asia, Singapore, Singapore;

关键词: Leptospirosis;    Sarawak;    Malaysia;    Diagnostics;   

DOI  :  10.1186/s40794-021-00154-2

来源: Springer

【 摘 要 】

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.

【 授权许可】

CC BY