Leptospirosis in Indonesia: diagnostic challenges associated with atypical clinical manifestations and limited laboratory capacity

BMC Infectious Diseases

Ketut Tuti Parwati Merati¹  Pratiwi Sudarmono²  Muhammad Hussein Gasem³  Endang Sri Lestari³  M. M. D. E. A. H. Hapsari³  Abu Tholib Aman⁴  Usman Hadi⁵  Mansyur Arif⁶  Bachti Alisjahbana⁷  Gustiani Salim⁸  Herman Kosasih⁸  Kanti Laras⁸  Nurhayati Lukman⁸  Aaron Neal⁹  Chuen-Yen Lau⁹  Muhammad Karyana^1,10  Emiliana Tjitra^1,10  Vivi Lisdawati^1,11  Dewi Lokida^1,12 

[1] Department of Internal Medicine, Udayana University;Dr. Cipto Mangunkusumo Hospital;Dr. Kariadi Hospital – Faculty of Medicine, Diponegoro University;Dr. Sardjito Hospital – Faculty of Medicine, Public Health and Nursing, Gadjah Mada University;Dr. Soetomo Academic General Hospital, Faculty of Medicine Airlangga University;Dr. Wahidin Sudirohusodo Hospital;Hasan Sadikin Hospital – Faculty of Medicine, Padjadjaran University;Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Badan Litbangkes;National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health;National Institute of Health Research and Development (NIHRD), Ministry of Health Republic of Indonesia;Prof. Dr. Sulianti Saroso Hospital;Tangerang District Hospital;

关键词: Leptospirosis;    Diagnostic challenge;    Atypical manifestations;    Indonesia;   

DOI  :  10.1186/s12879-020-4903-5

来源: DOAJ

【 摘 要 】

Abstract Background The burden of leptospirosis in Indonesia is poorly understood. Data from an observational study conducted from 2013 to 2016 in seven cities across Indonesia was used to estimate the incidence of leptospirosis and document its clinical manifestations in patients requiring hospitalization. Methods Specimens from patients hospitalized with acute fever were collected at enrollment, 14–28 days, and 3 months. Demographic and clinical information were collected during study visits and/or retrieved from medical records and double-entered into clinical report forms. After initially screening for dengue virus and other pathogens, specimens were tested at a central Reference Laboratory for anti-Leptospira IgM using commercial ELISA kits and for Leptospira DNA using an in-house quantitative real-time PCR assay. Results Of 1464 patients enrolled, 45 (3.1%) confirmed cases (by PCR and/or sero-coversion or four-fold increase of IgM) and 6 (0.4%) probable cases (by high titer IgM) of leptospirosis were identified by the Reference Laboratory. Disease incidence at sites ranged from 0 (0%) cases in Denpasar to 17 (8.9%) cases in Semarang. The median age of patients was 41.2 years (range of 5.3 to 85.0 years), and 67% of patients were male. Twenty-two patients (43.1%) were accurately diagnosed at sites, and 29 patients (56.9%) were clinically misdiagnosed as having another infection, most commonly dengue fever (11, 37.9%). Clinically, 20 patients (39.2%) did not present with hyperbilirubinemia or increased creatinine levels. Two patients (3.9%) died, both from respiratory failure. Fifteen patients (29.4%) clinically diagnosed with leptospirosis at sites were negative based on IgM ELISA and/or PCR at the Reference Laboratory. Conclusions Leptospirosis remains an important cause of hospitalization in Indonesia. It can have diverse clinical presentations, making it difficult to differentiate from other common tropical infections. PCR combined with ELISA is a powerful alternative to the cumbersome gold-standard microscopic agglutination test, particularly in resource-limited settings.

【 授权许可】

Unknown