Diagnosis and Management of Leptospirosis Problems in Practi

8/10/2019 Diagnosis and Management of Leptospirosis Problems in Practi

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Diagnosis&

Management of Leptospirosis Problems in Practice

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Rodents (Urine)

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Domestic animals

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Leptospiremic PhaseLeptospiremic Phase

FeverFeverMyalgiaMyalgia

Immune PhaseImmune Phase

FeverFeverMeningitisMeningitis

( 0%)

HeadacheHeadacheEpistaxisEpistaxisAbdominal painAbdominal pain

UveitisUveitis

Anicteric - Mild / Severe

Incubation Period - 7 -14 days (2 21 days)


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ELISA/SATELISA/SAT MATMAT INTERPRETATIONINTERPRETATION

++ ++ Current InfectionCurrent Infection++ -- Current InfectionCurrent Infection

NANA Rising titresRising titres Current InfectionCurrent Infection

0 1 week 1 month 2 months 1 yr 5 yrs

ELISA/SAT

MAT


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Clinical features suggestive of current leptospirosis

Leptospiremic phase < 7days Immune phase > 7 days

Positive

PCR ELISA / MSAT

Negative MAT

Repeat ( > 3 days )

Blood culture

Confirm( if available )


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MAT

Positive Negative

Repeat (if low titre) Repeat

Approach ..

Rising titre SeroconversionHigh titre


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100 7 10

500

500 750

1.5 1


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H (F )

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Faine CriteriaFaine Criteria Modified Faine CriteriaModified Faine CriteriaPart A: Clinical dataPart A: Clinical data

ScoreScorePart A: Clinical dataPart A: Clinical data ScoreScore

HeadacheHeadache 22 HeadacheHeadache 22FeverFever 22 FeverFever 22Temp > 39Temp > 39 CC 22 Temp > 39Temp > 39 CC 22Conjuntival suffusionConjuntival suffusion 44 Conjuntival suffusionConjuntival suffusion 44MeningismMeningism 44 MeningismMeningism 44

Conjuntival suffusionConjuntival suffusion1010

Conjuntival suffusionConjuntival suffusion1010MeningismMeningism MeningismMeningism

Muscle painMuscle pain Muscle painMuscle pain

JaundiceJaundice 11 JaundiceJaundice 11Albuminuria, Nitrogen,Albuminuria, Nitrogen,RetentionRetention 11

Albuminuria, Nitrogen,Albuminuria, Nitrogen,RetentionRetention 11

Total scoreTotal score Total scoreTotal score


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Faine CriteriaFaine Criteria Modified Faine CriteriaModified Faine Criteria

Part B: EpidemiologicalPart B: Epidemiologicalfactorsfactors

Part B: EpidemiologicalPart B: Epidemiologicalfactorsfactors

Contact with animals orContact with animals orContact with knownContact with known 1010

RainfallRainfall 55

Contact with contaminatedContact with contaminatedenvironmentenvironment 44

Animal contactAnimal contact 11TotalTotal 1010

Part C : Bacteriological LabPart C : Bacteriological Labfindingsfindings


Isolation of leptospira inIsolation of leptospira inCultureCulture - -DiagnosisDiagnosiscertaincertain

Isolation of leptospiraIsolation of leptospirainin CultureCulture - -DiagnosisDiagnosiscertaincertain


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Faine CriteriaFaine Criteria Modified Faine CriteriaModified Faine Criteria



Positive Serology (MAT)Positive Serology (MAT) Positive SerologyPositive Serology

LeptospirosisLeptospirosis- -EndemicEndemicSingle positiveSingle positive - - Low titreLow titre22

ELISA IgMELISA IgM - - PositivePositive 1515SATSAT -- PositivePositive 1515

ng eng e pos vepos ve -- gg rere1010

-- ng e pos ve n gng e pos ve n gtitretitre 1515

LeptospirosisLeptospirosis NonNon endemicendemic

SingleSingle positivepositive - -LowLow titretitre 55 Rising titreRising titre

(paired sera)(paired sera) 2525SingleSingle positivepositive - -HighHigh titretitre 1515

Rising titreRising titre - - (paired sera)(paired sera) 2525

TotalTotal TotalTotal


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Presumptive diagnosis of leptospirosis is

made of 26 or more(Part A) or (Part A & Part B Score) : 26 or more

Faines Criteria - Score

Part A, B & C (Total) : 25 or more

A score between 20 and 25 suggests

leptospirosis as possible,but unconfirmed diagnosis.


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11. A

E A .

..

B.B.Rain fall+Contact withRain fall+Contact withcontaminated environmentcontaminated environment

99

C.C. ELISA IgM positiveELISA IgM positive 1515SCORESCORE == 2+9+152+9+15 == 2626

DIAGNOSISDIAGNOSIS Leptospirosis (confirmed)Leptospirosis (confirmed)


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2

2. A , A ( )

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SCORESCORE A.A. Fever, Headache, MyalgiaFever, Headache, Myalgia 2 +2+4 = 82 +2+4 = 8

B.B. No Contact with contaminatedNo Contact with contaminatedenvironmentenvironment

00

C.C. ELISA IgM positiveELISA IgM positive 1515

SCORESCORE ==8+158+15 == 2323DIAGNOSISDIAGNOSIS Possible LeptospirosisPossible Leptospirosis

( Confirm by MAT( Confirm by MAT raising titres)raising titres)


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2

2. A , A ( )

E A :


B.B. ContactContact withwith contaminatedcontaminatedenvironmentenvironment ++ (eg(eg..InfectedInfecteddogdog atat home)home) animalanimal contactcontact

4+14+1

C.C. ELISA IgM positiveELISA IgM positive 1515

SCORESCORE ==8+5+158+5+15 == 2828

DIAGNOSISDIAGNOSIS Leptospirosis (definite)Leptospirosis (definite)


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3

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B.B.RainfallRainfall ++ContactContact withwith contaminatedcontaminatedenvironmentenvironment

4+5=94+5=9

C.C. SATSAT-- NegativeNegative 00

SCORESCORE 8+98+9 ==1717

DIAGNOSISDIAGNOSIS LeptospirosisLeptospirosis- - NegativeNegative


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Diagnosis and Management of Leptospirosis Problems in Practi