Leptospirosis infections among hospital patients, Sarawak, Malaysia

Abstract Background Leptospirosis diagnoses have increased in Sarawak, Malaysia in recent years. Methods To 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 o...

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Autores principales:	King-Ching Hii, Emily R. Robie, Izreena Saihidi, Antoinette Berita, Natalie A. Alarja, Leshan Xiu, James A. Merchant, Raquel A. Binder, Johnny Keh-Tun Goh, Vanina Guernier-Cambert, Diego Galán, Michael J. Gregory, Gregory C. Gray
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Leptospirosis Sarawak Malaysia Diagnostics Arctic medicine. Tropical medicine RC955-962
Acceso en línea:	https://doaj.org/article/20658af84b9b4d8588d9c2fe7d2e497f
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spelling	oai:doaj.org-article:20658af84b9b4d8588d9c2fe7d2e497f2021-11-08T10:45:37ZLeptospirosis infections among hospital patients, Sarawak, Malaysia10.1186/s40794-021-00154-22055-0936https://doaj.org/article/20658af84b9b4d8588d9c2fe7d2e497f2021-11-01T00:00:00Zhttps://doi.org/10.1186/s40794-021-00154-2https://doaj.org/toc/2055-0936Abstract Background Leptospirosis diagnoses have increased in Sarawak, Malaysia in recent years. Methods To 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. Results Overall, 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. Conclusion Overall, 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.King-Ching HiiEmily R. RobieIzreena SaihidiAntoinette BeritaNatalie A. AlarjaLeshan XiuJames A. MerchantRaquel A. BinderJohnny Keh-Tun GohVanina Guernier-CambertDiego GalánMichael J. GregoryGregory C. GrayBMCarticleLeptospirosisSarawakMalaysiaDiagnosticsArctic medicine. Tropical medicineRC955-962ENTropical Diseases, Travel Medicine and Vaccines, Vol 7, Iss 1, Pp 1-13 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Leptospirosis Sarawak Malaysia Diagnostics Arctic medicine. Tropical medicine RC955-962
spellingShingle	Leptospirosis Sarawak Malaysia Diagnostics Arctic medicine. Tropical medicine RC955-962 King-Ching Hii Emily R. Robie Izreena Saihidi Antoinette Berita Natalie A. Alarja Leshan Xiu James A. Merchant Raquel A. Binder Johnny Keh-Tun Goh Vanina Guernier-Cambert Diego Galán Michael J. Gregory Gregory C. Gray Leptospirosis infections among hospital patients, Sarawak, Malaysia
description	Abstract Background Leptospirosis diagnoses have increased in Sarawak, Malaysia in recent years. Methods To 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. Results Overall, 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. Conclusion Overall, 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.
format	article
author	King-Ching Hii Emily R. Robie Izreena Saihidi Antoinette Berita Natalie A. Alarja Leshan Xiu James A. Merchant Raquel A. Binder Johnny Keh-Tun Goh Vanina Guernier-Cambert Diego Galán Michael J. Gregory Gregory C. Gray
author_facet	King-Ching Hii Emily R. Robie Izreena Saihidi Antoinette Berita Natalie A. Alarja Leshan Xiu James A. Merchant Raquel A. Binder Johnny Keh-Tun Goh Vanina Guernier-Cambert Diego Galán Michael J. Gregory Gregory C. Gray
author_sort	King-Ching Hii
title	Leptospirosis infections among hospital patients, Sarawak, Malaysia
title_short	Leptospirosis infections among hospital patients, Sarawak, Malaysia
title_full	Leptospirosis infections among hospital patients, Sarawak, Malaysia
title_fullStr	Leptospirosis infections among hospital patients, Sarawak, Malaysia
title_full_unstemmed	Leptospirosis infections among hospital patients, Sarawak, Malaysia
title_sort	leptospirosis infections among hospital patients, sarawak, malaysia
publisher	BMC
publishDate	2021
url	https://doaj.org/article/20658af84b9b4d8588d9c2fe7d2e497f
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Leptospirosis infections among hospital patients, Sarawak, Malaysia

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