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Nattachai Srisawat - One of the best experts on this subject based on the ideXlab platform.
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Human, animal, water source interactions and Leptospirosis in Thailand
Scientific Reports, 2021Co-Authors: Udomsak Narkkul, Nattachai Srisawat, Janjira Thaipadungpanit, James W. Rudge, Metawee Thongdee, Rungrawee Pawarana, Wirichada Pan-ngumAbstract:In Thailand, Leptospirosis is primarily associated with those who work in agricultural occupations. Leptospirosis control is hampered by a poor understanding of the complex interactions between humans, animal reservoirs, Leptospira , and the variable spatial environment in which these factors coexist. We aimed to address key knowledge gaps concerning Leptospirosis disease dynamics and the human–animal–water-source interface in two high-risk areas in Thailand. We conducted a cross-sectional survey among 746 study participants in two high-risk areas for Leptospirosis in Thailand: Sisaket (SSK) and Nakhon Si Thammarat (NST). Interactions among humans, animals and water sources were quantified and analyzed. The presence of different animal species and thus contact patterns were different in NST and SSK. The consumption of water from the shared sources between the two areas was different. Those whose occupations were related to animals or environmental water and those who consumed water from more than two sources were more likely to have been infected with Leptospirosis, with adjusted odds ratios 4.31 (95% CI 1.17–15.83) and 10.74 (95% CI 2.28–50.53), respectively. Understanding specific water-source sharing networks and human–animal contact patterns is useful when designing national and area-specific control programmes to prevent and control Leptospirosis outbreaks.
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Thai-Lepto-on-admission probability (THAI-LEPTO) score as an early tool for initial diagnosis of Leptospirosis: Result from Thai-Lepto AKI study group
PLoS Neglected Tropical Diseases, 2018Co-Authors: Theerapon Sukmark, Nuttha Lumlertgul, Sadudee Peerapornratana, Kamol Khositrangsikun, Kriang Tungsanga, Visith Sitprija, Nattachai SrisawatAbstract:Background Leptospirosis is one of the most important zoonosis in the tropics. Currently, specific laboratory diagnostic test for Leptospirosis such as polymerase chain reaction (PCR) or direct culture cannot be applied at the primary care setting especially in the resource- limited countries. Therefore, clinical presentation and laboratory examination are still the primary diagnostic tools for Leptospirosis. Objectives To detect clinical factors for predicting Leptospirosis in suspected cases, and to create a clinical prediction score (THAI-LEPTO) that is practical and easy to use in general practice while awaiting laboratory results. Materials & methods We performed a prospective multicenter study with a development and a validation cohort of patients presenting with clinical suspicion of Leptospirosis as per the WHO clinical criteria. The development cohort was conducted at 11 centers in 8 provinces around Thailand. The validation cohort was conducted at 4 centers in 1 province from the Northeastern part of Thailand. Leptospirosis confirmed cases were defined if any one of the tests were positive: microscopic agglutination test, direct culture, or PCR technique. Multivariable logistic regression was used to identify predictors of Leptospirosis. The clinical prediction score was derived from the regression coefficients (original) or from the odds ratio values (simplified). We used receiver operating characteristic (ROC) curve analysis to evaluate the diagnostic ability of our score and to find the optimal cutoff values of the score. We used a validation cohort to evaluate the accuracy of our methods. Results In the development cohort, we enrolled 221 Leptospirosis suspected cases and analyzed 211. Among those, 105 (50%) were Leptospirosis confirmed cases. In logistic regression adjusted for age, gender, day of fever, and one clinical factor at a time, Leptospirosis group had more hypotension OR = 2.76 (95% CI 1.07–7.10), jaundice OR = 3.40 (95%CI 1.48–8.44), muscle pain OR = 2.12 (95%CI 1.06–4.26), acute kidney injury (AKI) OR = 2.90 (95%CI 1.31–6.15), low hemoglobin OR = 3.48 (95%CI 1.72–7.04), and hypokalemia with hyponatremia OR = 3.56 (95%CI 1.17–10.84) than non-Leptospirosis group. The abovementioned factors along with neutrophilia and pulmonary opacity were used in the development of the score. The simplified score with 7 variables was the summation of the odds ratio values as follows: hypotension 3, jaundice 2, muscle pain 2, AKI 1.5, low hemoglobin 3, hypokalemia with hyponatremia 3, and neutrophilia 1. The score showed the highest discriminatory power with area under the curve (AUC) 0.82 (95%CI 0.67–0.97) on fever day 3–4. In the validation cohort we enrolled 96 Leptospirosis suspected cases and analyzed 92. Of those, 69 (75%) were Leptospirosis confirmed cases. The performance of the simplified score with 7 variables at a cutoff of 4 was AUC 0.78 (95%CI 0.68–0.89); sensitivity 73.5; specificity 73.7; positive predictive value 87.8; negative predictive value 58.3. Conclusions THAI-LEPTO score is a newly developed diagnostic tool for early presumptive diagnosis of Leptospirosis in patients presenting with severe clinical suspicion of the disease. The score can easily be applied at the point of care while awaiting confirmatory laboratory results. Each predictor used has been supported by evidence of clinical and pathophysiological correlation.
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Thai-Lepto-on-admission probability (THAI-LEPTO) score as an early tool for initial diagnosis of Leptospirosis: Result from Thai-Lepto AKI study group.
Public Library of Science (PLoS), 2018Co-Authors: Theerapon Sukmark, Nuttha Lumlertgul, Sadudee Peerapornratana, Kamol Khositrangsikun, Kriang Tungsanga, Visith Sitprija, Nattachai SrisawatAbstract:Leptospirosis is one of the most important zoonosis in the tropics. Currently, specific laboratory diagnostic test for Leptospirosis such as polymerase chain reaction (PCR) or direct culture cannot be applied at the primary care setting especially in the resource- limited countries. Therefore, clinical presentation and laboratory examination are still the primary diagnostic tools for Leptospirosis.To detect clinical factors for predicting Leptospirosis in suspected cases, and to create a clinical prediction score (THAI-LEPTO) that is practical and easy to use in general practice while awaiting laboratory results.We performed a prospective multicenter study with a development and a validation cohort of patients presenting with clinical suspicion of Leptospirosis as per the WHO clinical criteria. The development cohort was conducted at 11 centers in 8 provinces around Thailand. The validation cohort was conducted at 4 centers in 1 province from the Northeastern part of Thailand. Leptospirosis confirmed cases were defined if any one of the tests were positive: microscopic agglutination test, direct culture, or PCR technique. Multivariable logistic regression was used to identify predictors of Leptospirosis. The clinical prediction score was derived from the regression coefficients (original) or from the odds ratio values (simplified). We used receiver operating characteristic (ROC) curve analysis to evaluate the diagnostic ability of our score and to find the optimal cutoff values of the score. We used a validation cohort to evaluate the accuracy of our methods.In the development cohort, we enrolled 221 Leptospirosis suspected cases and analyzed 211. Among those, 105 (50%) were Leptospirosis confirmed cases. In logistic regression adjusted for age, gender, day of fever, and one clinical factor at a time, Leptospirosis group had more hypotension OR = 2.76 (95% CI 1.07-7.10), jaundice OR = 3.40 (95%CI 1.48-8.44), muscle pain OR = 2.12 (95%CI 1.06-4.26), acute kidney injury (AKI) OR = 2.90 (95%CI 1.31-6.15), low hemoglobin OR = 3.48 (95%CI 1.72-7.04), and hypokalemia with hyponatremia OR = 3.56 (95%CI 1.17-10.84) than non-Leptospirosis group. The abovementioned factors along with neutrophilia and pulmonary opacity were used in the development of the score. The simplified score with 7 variables was the summation of the odds ratio values as follows: hypotension 3, jaundice 2, muscle pain 2, AKI 1.5, low hemoglobin 3, hypokalemia with hyponatremia 3, and neutrophilia 1. The score showed the highest discriminatory power with area under the curve (AUC) 0.82 (95%CI 0.67-0.97) on fever day 3-4. In the validation cohort we enrolled 96 Leptospirosis suspected cases and analyzed 92. Of those, 69 (75%) were Leptospirosis confirmed cases. The performance of the simplified score with 7 variables at a cutoff of 4 was AUC 0.78 (95%CI 0.68-0.89); sensitivity 73.5; specificity 73.7; positive predictive value 87.8; negative predictive value 58.3.THAI-LEPTO score is a newly developed diagnostic tool for early presumptive diagnosis of Leptospirosis in patients presenting with severe clinical suspicion of the disease. The score can easily be applied at the point of care while awaiting confirmatory laboratory results. Each predictor used has been supported by evidence of clinical and pathophysiological correlation
Visith Sitprija - One of the best experts on this subject based on the ideXlab platform.
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Thai-Lepto-on-admission probability (THAI-LEPTO) score as an early tool for initial diagnosis of Leptospirosis: Result from Thai-Lepto AKI study group
PLoS Neglected Tropical Diseases, 2018Co-Authors: Theerapon Sukmark, Nuttha Lumlertgul, Sadudee Peerapornratana, Kamol Khositrangsikun, Kriang Tungsanga, Visith Sitprija, Nattachai SrisawatAbstract:Background Leptospirosis is one of the most important zoonosis in the tropics. Currently, specific laboratory diagnostic test for Leptospirosis such as polymerase chain reaction (PCR) or direct culture cannot be applied at the primary care setting especially in the resource- limited countries. Therefore, clinical presentation and laboratory examination are still the primary diagnostic tools for Leptospirosis. Objectives To detect clinical factors for predicting Leptospirosis in suspected cases, and to create a clinical prediction score (THAI-LEPTO) that is practical and easy to use in general practice while awaiting laboratory results. Materials & methods We performed a prospective multicenter study with a development and a validation cohort of patients presenting with clinical suspicion of Leptospirosis as per the WHO clinical criteria. The development cohort was conducted at 11 centers in 8 provinces around Thailand. The validation cohort was conducted at 4 centers in 1 province from the Northeastern part of Thailand. Leptospirosis confirmed cases were defined if any one of the tests were positive: microscopic agglutination test, direct culture, or PCR technique. Multivariable logistic regression was used to identify predictors of Leptospirosis. The clinical prediction score was derived from the regression coefficients (original) or from the odds ratio values (simplified). We used receiver operating characteristic (ROC) curve analysis to evaluate the diagnostic ability of our score and to find the optimal cutoff values of the score. We used a validation cohort to evaluate the accuracy of our methods. Results In the development cohort, we enrolled 221 Leptospirosis suspected cases and analyzed 211. Among those, 105 (50%) were Leptospirosis confirmed cases. In logistic regression adjusted for age, gender, day of fever, and one clinical factor at a time, Leptospirosis group had more hypotension OR = 2.76 (95% CI 1.07–7.10), jaundice OR = 3.40 (95%CI 1.48–8.44), muscle pain OR = 2.12 (95%CI 1.06–4.26), acute kidney injury (AKI) OR = 2.90 (95%CI 1.31–6.15), low hemoglobin OR = 3.48 (95%CI 1.72–7.04), and hypokalemia with hyponatremia OR = 3.56 (95%CI 1.17–10.84) than non-Leptospirosis group. The abovementioned factors along with neutrophilia and pulmonary opacity were used in the development of the score. The simplified score with 7 variables was the summation of the odds ratio values as follows: hypotension 3, jaundice 2, muscle pain 2, AKI 1.5, low hemoglobin 3, hypokalemia with hyponatremia 3, and neutrophilia 1. The score showed the highest discriminatory power with area under the curve (AUC) 0.82 (95%CI 0.67–0.97) on fever day 3–4. In the validation cohort we enrolled 96 Leptospirosis suspected cases and analyzed 92. Of those, 69 (75%) were Leptospirosis confirmed cases. The performance of the simplified score with 7 variables at a cutoff of 4 was AUC 0.78 (95%CI 0.68–0.89); sensitivity 73.5; specificity 73.7; positive predictive value 87.8; negative predictive value 58.3. Conclusions THAI-LEPTO score is a newly developed diagnostic tool for early presumptive diagnosis of Leptospirosis in patients presenting with severe clinical suspicion of the disease. The score can easily be applied at the point of care while awaiting confirmatory laboratory results. Each predictor used has been supported by evidence of clinical and pathophysiological correlation.
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Thai-Lepto-on-admission probability (THAI-LEPTO) score as an early tool for initial diagnosis of Leptospirosis: Result from Thai-Lepto AKI study group.
Public Library of Science (PLoS), 2018Co-Authors: Theerapon Sukmark, Nuttha Lumlertgul, Sadudee Peerapornratana, Kamol Khositrangsikun, Kriang Tungsanga, Visith Sitprija, Nattachai SrisawatAbstract:Leptospirosis is one of the most important zoonosis in the tropics. Currently, specific laboratory diagnostic test for Leptospirosis such as polymerase chain reaction (PCR) or direct culture cannot be applied at the primary care setting especially in the resource- limited countries. Therefore, clinical presentation and laboratory examination are still the primary diagnostic tools for Leptospirosis.To detect clinical factors for predicting Leptospirosis in suspected cases, and to create a clinical prediction score (THAI-LEPTO) that is practical and easy to use in general practice while awaiting laboratory results.We performed a prospective multicenter study with a development and a validation cohort of patients presenting with clinical suspicion of Leptospirosis as per the WHO clinical criteria. The development cohort was conducted at 11 centers in 8 provinces around Thailand. The validation cohort was conducted at 4 centers in 1 province from the Northeastern part of Thailand. Leptospirosis confirmed cases were defined if any one of the tests were positive: microscopic agglutination test, direct culture, or PCR technique. Multivariable logistic regression was used to identify predictors of Leptospirosis. The clinical prediction score was derived from the regression coefficients (original) or from the odds ratio values (simplified). We used receiver operating characteristic (ROC) curve analysis to evaluate the diagnostic ability of our score and to find the optimal cutoff values of the score. We used a validation cohort to evaluate the accuracy of our methods.In the development cohort, we enrolled 221 Leptospirosis suspected cases and analyzed 211. Among those, 105 (50%) were Leptospirosis confirmed cases. In logistic regression adjusted for age, gender, day of fever, and one clinical factor at a time, Leptospirosis group had more hypotension OR = 2.76 (95% CI 1.07-7.10), jaundice OR = 3.40 (95%CI 1.48-8.44), muscle pain OR = 2.12 (95%CI 1.06-4.26), acute kidney injury (AKI) OR = 2.90 (95%CI 1.31-6.15), low hemoglobin OR = 3.48 (95%CI 1.72-7.04), and hypokalemia with hyponatremia OR = 3.56 (95%CI 1.17-10.84) than non-Leptospirosis group. The abovementioned factors along with neutrophilia and pulmonary opacity were used in the development of the score. The simplified score with 7 variables was the summation of the odds ratio values as follows: hypotension 3, jaundice 2, muscle pain 2, AKI 1.5, low hemoglobin 3, hypokalemia with hyponatremia 3, and neutrophilia 1. The score showed the highest discriminatory power with area under the curve (AUC) 0.82 (95%CI 0.67-0.97) on fever day 3-4. In the validation cohort we enrolled 96 Leptospirosis suspected cases and analyzed 92. Of those, 69 (75%) were Leptospirosis confirmed cases. The performance of the simplified score with 7 variables at a cutoff of 4 was AUC 0.78 (95%CI 0.68-0.89); sensitivity 73.5; specificity 73.7; positive predictive value 87.8; negative predictive value 58.3.THAI-LEPTO score is a newly developed diagnostic tool for early presumptive diagnosis of Leptospirosis in patients presenting with severe clinical suspicion of the disease. The score can easily be applied at the point of care while awaiting confirmatory laboratory results. Each predictor used has been supported by evidence of clinical and pathophysiological correlation
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renal magnesium wasting and tubular dysfunction in Leptospirosis
Nephrology Dialysis Transplantation, 2007Co-Authors: Sookkasem Khositseth, Visith Sitprija, Niwatchai Sudjaritjan, Paiboon Tananchai, Sompong Ongajyuth, Visith ThongboonkerdAbstract:BACKGROUND Tubulo-interstitial nephritis is the main cause of acute renal injury in Leptospirosis. The aim of this study was to evaluate renal tubular function and excretion of solutes in Leptospirosis patients during a recent outbreak of Leptospirosis in Nan province, Thailand. METHODS Clinical manifestations were recorded and routine laboratory tests were performed upon admission. Renal tubular functions including tubular reabsorption of phosphate (TRP), fractional excretion of magnesium (FE(Mg)), urinary calcium to creatinine ratio (Uca/cr), urine N-acetyl-beta-D glucosaminidase (NAG) and urine beta(2)-microglobulin were serially monitored during 2 weeks after admission. RESULTS A total of 20 Leptospirosis patients were recruited. Nine (45%) patients had acute renal failure (ARF). Increased urine NAG and beta(2)-microglobulin, which indicate proximal tubular dysfunction, were demonstrated in all 20 (100%) patients. Fifteen (75%) patients had hypermagnesuria, whereas 10 (50%) patients had decreased TRP. Renal magnesium (Mg) and phosphate (P) wasting caused hypomagnesaemia and hypophosphataemia in nine and three patients with ARF, respectively. These abnormal findings significantly improved within 2 weeks after admission. CONCLUSIONS We conclude that renal Mg and P wasting commonly occur in patients with Leptospirosis. The measurement of Mg and P levels in both serum and urine of Leptospirosis patients, especially those with ARF, is therefore highly recommended.
Theerapon Sukmark - One of the best experts on this subject based on the ideXlab platform.
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Thai-Lepto-on-admission probability (THAI-LEPTO) score as an early tool for initial diagnosis of Leptospirosis: Result from Thai-Lepto AKI study group
PLoS Neglected Tropical Diseases, 2018Co-Authors: Theerapon Sukmark, Nuttha Lumlertgul, Sadudee Peerapornratana, Kamol Khositrangsikun, Kriang Tungsanga, Visith Sitprija, Nattachai SrisawatAbstract:Background Leptospirosis is one of the most important zoonosis in the tropics. Currently, specific laboratory diagnostic test for Leptospirosis such as polymerase chain reaction (PCR) or direct culture cannot be applied at the primary care setting especially in the resource- limited countries. Therefore, clinical presentation and laboratory examination are still the primary diagnostic tools for Leptospirosis. Objectives To detect clinical factors for predicting Leptospirosis in suspected cases, and to create a clinical prediction score (THAI-LEPTO) that is practical and easy to use in general practice while awaiting laboratory results. Materials & methods We performed a prospective multicenter study with a development and a validation cohort of patients presenting with clinical suspicion of Leptospirosis as per the WHO clinical criteria. The development cohort was conducted at 11 centers in 8 provinces around Thailand. The validation cohort was conducted at 4 centers in 1 province from the Northeastern part of Thailand. Leptospirosis confirmed cases were defined if any one of the tests were positive: microscopic agglutination test, direct culture, or PCR technique. Multivariable logistic regression was used to identify predictors of Leptospirosis. The clinical prediction score was derived from the regression coefficients (original) or from the odds ratio values (simplified). We used receiver operating characteristic (ROC) curve analysis to evaluate the diagnostic ability of our score and to find the optimal cutoff values of the score. We used a validation cohort to evaluate the accuracy of our methods. Results In the development cohort, we enrolled 221 Leptospirosis suspected cases and analyzed 211. Among those, 105 (50%) were Leptospirosis confirmed cases. In logistic regression adjusted for age, gender, day of fever, and one clinical factor at a time, Leptospirosis group had more hypotension OR = 2.76 (95% CI 1.07–7.10), jaundice OR = 3.40 (95%CI 1.48–8.44), muscle pain OR = 2.12 (95%CI 1.06–4.26), acute kidney injury (AKI) OR = 2.90 (95%CI 1.31–6.15), low hemoglobin OR = 3.48 (95%CI 1.72–7.04), and hypokalemia with hyponatremia OR = 3.56 (95%CI 1.17–10.84) than non-Leptospirosis group. The abovementioned factors along with neutrophilia and pulmonary opacity were used in the development of the score. The simplified score with 7 variables was the summation of the odds ratio values as follows: hypotension 3, jaundice 2, muscle pain 2, AKI 1.5, low hemoglobin 3, hypokalemia with hyponatremia 3, and neutrophilia 1. The score showed the highest discriminatory power with area under the curve (AUC) 0.82 (95%CI 0.67–0.97) on fever day 3–4. In the validation cohort we enrolled 96 Leptospirosis suspected cases and analyzed 92. Of those, 69 (75%) were Leptospirosis confirmed cases. The performance of the simplified score with 7 variables at a cutoff of 4 was AUC 0.78 (95%CI 0.68–0.89); sensitivity 73.5; specificity 73.7; positive predictive value 87.8; negative predictive value 58.3. Conclusions THAI-LEPTO score is a newly developed diagnostic tool for early presumptive diagnosis of Leptospirosis in patients presenting with severe clinical suspicion of the disease. The score can easily be applied at the point of care while awaiting confirmatory laboratory results. Each predictor used has been supported by evidence of clinical and pathophysiological correlation.
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Thai-Lepto-on-admission probability (THAI-LEPTO) score as an early tool for initial diagnosis of Leptospirosis: Result from Thai-Lepto AKI study group.
Public Library of Science (PLoS), 2018Co-Authors: Theerapon Sukmark, Nuttha Lumlertgul, Sadudee Peerapornratana, Kamol Khositrangsikun, Kriang Tungsanga, Visith Sitprija, Nattachai SrisawatAbstract:Leptospirosis is one of the most important zoonosis in the tropics. Currently, specific laboratory diagnostic test for Leptospirosis such as polymerase chain reaction (PCR) or direct culture cannot be applied at the primary care setting especially in the resource- limited countries. Therefore, clinical presentation and laboratory examination are still the primary diagnostic tools for Leptospirosis.To detect clinical factors for predicting Leptospirosis in suspected cases, and to create a clinical prediction score (THAI-LEPTO) that is practical and easy to use in general practice while awaiting laboratory results.We performed a prospective multicenter study with a development and a validation cohort of patients presenting with clinical suspicion of Leptospirosis as per the WHO clinical criteria. The development cohort was conducted at 11 centers in 8 provinces around Thailand. The validation cohort was conducted at 4 centers in 1 province from the Northeastern part of Thailand. Leptospirosis confirmed cases were defined if any one of the tests were positive: microscopic agglutination test, direct culture, or PCR technique. Multivariable logistic regression was used to identify predictors of Leptospirosis. The clinical prediction score was derived from the regression coefficients (original) or from the odds ratio values (simplified). We used receiver operating characteristic (ROC) curve analysis to evaluate the diagnostic ability of our score and to find the optimal cutoff values of the score. We used a validation cohort to evaluate the accuracy of our methods.In the development cohort, we enrolled 221 Leptospirosis suspected cases and analyzed 211. Among those, 105 (50%) were Leptospirosis confirmed cases. In logistic regression adjusted for age, gender, day of fever, and one clinical factor at a time, Leptospirosis group had more hypotension OR = 2.76 (95% CI 1.07-7.10), jaundice OR = 3.40 (95%CI 1.48-8.44), muscle pain OR = 2.12 (95%CI 1.06-4.26), acute kidney injury (AKI) OR = 2.90 (95%CI 1.31-6.15), low hemoglobin OR = 3.48 (95%CI 1.72-7.04), and hypokalemia with hyponatremia OR = 3.56 (95%CI 1.17-10.84) than non-Leptospirosis group. The abovementioned factors along with neutrophilia and pulmonary opacity were used in the development of the score. The simplified score with 7 variables was the summation of the odds ratio values as follows: hypotension 3, jaundice 2, muscle pain 2, AKI 1.5, low hemoglobin 3, hypokalemia with hyponatremia 3, and neutrophilia 1. The score showed the highest discriminatory power with area under the curve (AUC) 0.82 (95%CI 0.67-0.97) on fever day 3-4. In the validation cohort we enrolled 96 Leptospirosis suspected cases and analyzed 92. Of those, 69 (75%) were Leptospirosis confirmed cases. The performance of the simplified score with 7 variables at a cutoff of 4 was AUC 0.78 (95%CI 0.68-0.89); sensitivity 73.5; specificity 73.7; positive predictive value 87.8; negative predictive value 58.3.THAI-LEPTO score is a newly developed diagnostic tool for early presumptive diagnosis of Leptospirosis in patients presenting with severe clinical suspicion of the disease. The score can easily be applied at the point of care while awaiting confirmatory laboratory results. Each predictor used has been supported by evidence of clinical and pathophysiological correlation
David M Sasaki - One of the best experts on this subject based on the ideXlab platform.
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assessment of the clinical presentation and treatment of 353 cases of laboratory confirmed Leptospirosis in hawaii 1974 1998
Clinical Infectious Diseases, 2001Co-Authors: Alan R Katz, Vernon Ansdell, Paul V Effler, Charles R Middleton, David M SasakiAbstract:Leptospirosis is frequently misdiagnosed as a result of its protean and nonspecific presentation. Leptospirosis, a zoonosis with global distribution, commonly occurs in tropical and subtropical regions; most reported cases in the United States occur in Hawaii. All laboratory-confirmed Leptospirosis cases in the State of Hawaii from 1974 through 1998 (n=353) were clinically evaluated. The most common presentation involved nonspecific signs or symptoms, including fever, myalgia, and headache. Jaundice occurred in 39% of cases; conjunctival suffusion was described in 28% of these cases. Initiation of antibiotics before the seventh day of symptoms was associated with a significantly shortened duration of illness. Because early recognition and initiation of antibiotic therapy are important, clinicians should familiarize themselves with the clinical presentation of Leptospirosis, and when evaluating a patient with a febrile illness, they should obtain exposure and travel histories and entertain the possibility of Leptospirosis in the differential diagnosis.
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evaluation of the indirect hemagglutination assay for diagnosis of acute Leptospirosis in hawaii
Journal of Clinical Microbiology, 2000Co-Authors: Paul V Effler, Harry Y Domen, Sandra L Bragg, Tin Aye, David M SasakiAbstract:Timely diagnosis of Leptospirosis is important to ensure a favorable clinical outcome. The definitive serologic assay, the microscopic agglutination test (MAT), requires paired sera and is not useful for guiding early clinical management. The only screening test approved for use in the United States, the indirect hemagglutination assay (IHA), has not undergone extensive field evaluation. To assess the performance of the Leptospirosis IHA in Hawaii, serum from patients evaluated for Leptospirosis between 1992 and 1997 were tested with the IHA at the Hawaii State Laboratories Division and with the MAT at the Centers for Disease Control and Prevention. Leptospirosis was considered confirmed by a fourfold rise in MAT titer and/or a positive culture. A total of 92 (41%) of 226 specimens from 114 persons with confirmed Leptospirosis were found positive by IHA. Only 18 (15%) of 119 specimens obtained within 14 days of onset were IHA positive, compared to 74 (69%) of 107 specimens collected more than 14 days after onset (P <0.001). Repeat testing ultimately resulted in 78 (68%) of the confirmed cases having at least one specimen found positive by IHA. Thirteen different presumptive infecting serogroups were identified among 251 specimens with an MAT titer of ≥200 and obtained from persons with confirmed or probable Leptospirosis. Fifty (68%) of 73 specimens with Icterohaemorrhagiae as the presumptive infecting serogroup were found positive by IHA, compared to 44 (47%) of 93 specimens with Australis as the presumptive infecting serogroup (P, 0.01). The IHA test was positive for 3 (1%) of 236 specimens from 154 persons without Leptospirosis. The sensitivity of the Leptospirosis IHA in Hawaii was substantially below figures reported previously, particularly early in the course of illness, limiting its usefulness for diagnosing acute infection. Since the presumptive infecting serogroup affected IHA results and the prevalence of serovars varies with geography, the performance of the IHA should be assessed locally. More sensitive Leptospirosis screening tests are needed in Hawaii.
Sadudee Peerapornratana - One of the best experts on this subject based on the ideXlab platform.
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Thai-Lepto-on-admission probability (THAI-LEPTO) score as an early tool for initial diagnosis of Leptospirosis: Result from Thai-Lepto AKI study group
PLoS Neglected Tropical Diseases, 2018Co-Authors: Theerapon Sukmark, Nuttha Lumlertgul, Sadudee Peerapornratana, Kamol Khositrangsikun, Kriang Tungsanga, Visith Sitprija, Nattachai SrisawatAbstract:Background Leptospirosis is one of the most important zoonosis in the tropics. Currently, specific laboratory diagnostic test for Leptospirosis such as polymerase chain reaction (PCR) or direct culture cannot be applied at the primary care setting especially in the resource- limited countries. Therefore, clinical presentation and laboratory examination are still the primary diagnostic tools for Leptospirosis. Objectives To detect clinical factors for predicting Leptospirosis in suspected cases, and to create a clinical prediction score (THAI-LEPTO) that is practical and easy to use in general practice while awaiting laboratory results. Materials & methods We performed a prospective multicenter study with a development and a validation cohort of patients presenting with clinical suspicion of Leptospirosis as per the WHO clinical criteria. The development cohort was conducted at 11 centers in 8 provinces around Thailand. The validation cohort was conducted at 4 centers in 1 province from the Northeastern part of Thailand. Leptospirosis confirmed cases were defined if any one of the tests were positive: microscopic agglutination test, direct culture, or PCR technique. Multivariable logistic regression was used to identify predictors of Leptospirosis. The clinical prediction score was derived from the regression coefficients (original) or from the odds ratio values (simplified). We used receiver operating characteristic (ROC) curve analysis to evaluate the diagnostic ability of our score and to find the optimal cutoff values of the score. We used a validation cohort to evaluate the accuracy of our methods. Results In the development cohort, we enrolled 221 Leptospirosis suspected cases and analyzed 211. Among those, 105 (50%) were Leptospirosis confirmed cases. In logistic regression adjusted for age, gender, day of fever, and one clinical factor at a time, Leptospirosis group had more hypotension OR = 2.76 (95% CI 1.07–7.10), jaundice OR = 3.40 (95%CI 1.48–8.44), muscle pain OR = 2.12 (95%CI 1.06–4.26), acute kidney injury (AKI) OR = 2.90 (95%CI 1.31–6.15), low hemoglobin OR = 3.48 (95%CI 1.72–7.04), and hypokalemia with hyponatremia OR = 3.56 (95%CI 1.17–10.84) than non-Leptospirosis group. The abovementioned factors along with neutrophilia and pulmonary opacity were used in the development of the score. The simplified score with 7 variables was the summation of the odds ratio values as follows: hypotension 3, jaundice 2, muscle pain 2, AKI 1.5, low hemoglobin 3, hypokalemia with hyponatremia 3, and neutrophilia 1. The score showed the highest discriminatory power with area under the curve (AUC) 0.82 (95%CI 0.67–0.97) on fever day 3–4. In the validation cohort we enrolled 96 Leptospirosis suspected cases and analyzed 92. Of those, 69 (75%) were Leptospirosis confirmed cases. The performance of the simplified score with 7 variables at a cutoff of 4 was AUC 0.78 (95%CI 0.68–0.89); sensitivity 73.5; specificity 73.7; positive predictive value 87.8; negative predictive value 58.3. Conclusions THAI-LEPTO score is a newly developed diagnostic tool for early presumptive diagnosis of Leptospirosis in patients presenting with severe clinical suspicion of the disease. The score can easily be applied at the point of care while awaiting confirmatory laboratory results. Each predictor used has been supported by evidence of clinical and pathophysiological correlation.
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Thai-Lepto-on-admission probability (THAI-LEPTO) score as an early tool for initial diagnosis of Leptospirosis: Result from Thai-Lepto AKI study group.
Public Library of Science (PLoS), 2018Co-Authors: Theerapon Sukmark, Nuttha Lumlertgul, Sadudee Peerapornratana, Kamol Khositrangsikun, Kriang Tungsanga, Visith Sitprija, Nattachai SrisawatAbstract:Leptospirosis is one of the most important zoonosis in the tropics. Currently, specific laboratory diagnostic test for Leptospirosis such as polymerase chain reaction (PCR) or direct culture cannot be applied at the primary care setting especially in the resource- limited countries. Therefore, clinical presentation and laboratory examination are still the primary diagnostic tools for Leptospirosis.To detect clinical factors for predicting Leptospirosis in suspected cases, and to create a clinical prediction score (THAI-LEPTO) that is practical and easy to use in general practice while awaiting laboratory results.We performed a prospective multicenter study with a development and a validation cohort of patients presenting with clinical suspicion of Leptospirosis as per the WHO clinical criteria. The development cohort was conducted at 11 centers in 8 provinces around Thailand. The validation cohort was conducted at 4 centers in 1 province from the Northeastern part of Thailand. Leptospirosis confirmed cases were defined if any one of the tests were positive: microscopic agglutination test, direct culture, or PCR technique. Multivariable logistic regression was used to identify predictors of Leptospirosis. The clinical prediction score was derived from the regression coefficients (original) or from the odds ratio values (simplified). We used receiver operating characteristic (ROC) curve analysis to evaluate the diagnostic ability of our score and to find the optimal cutoff values of the score. We used a validation cohort to evaluate the accuracy of our methods.In the development cohort, we enrolled 221 Leptospirosis suspected cases and analyzed 211. Among those, 105 (50%) were Leptospirosis confirmed cases. In logistic regression adjusted for age, gender, day of fever, and one clinical factor at a time, Leptospirosis group had more hypotension OR = 2.76 (95% CI 1.07-7.10), jaundice OR = 3.40 (95%CI 1.48-8.44), muscle pain OR = 2.12 (95%CI 1.06-4.26), acute kidney injury (AKI) OR = 2.90 (95%CI 1.31-6.15), low hemoglobin OR = 3.48 (95%CI 1.72-7.04), and hypokalemia with hyponatremia OR = 3.56 (95%CI 1.17-10.84) than non-Leptospirosis group. The abovementioned factors along with neutrophilia and pulmonary opacity were used in the development of the score. The simplified score with 7 variables was the summation of the odds ratio values as follows: hypotension 3, jaundice 2, muscle pain 2, AKI 1.5, low hemoglobin 3, hypokalemia with hyponatremia 3, and neutrophilia 1. The score showed the highest discriminatory power with area under the curve (AUC) 0.82 (95%CI 0.67-0.97) on fever day 3-4. In the validation cohort we enrolled 96 Leptospirosis suspected cases and analyzed 92. Of those, 69 (75%) were Leptospirosis confirmed cases. The performance of the simplified score with 7 variables at a cutoff of 4 was AUC 0.78 (95%CI 0.68-0.89); sensitivity 73.5; specificity 73.7; positive predictive value 87.8; negative predictive value 58.3.THAI-LEPTO score is a newly developed diagnostic tool for early presumptive diagnosis of Leptospirosis in patients presenting with severe clinical suspicion of the disease. The score can easily be applied at the point of care while awaiting confirmatory laboratory results. Each predictor used has been supported by evidence of clinical and pathophysiological correlation
