Bandara Kanchana, Weerasekera Manjula Manoji, Gunasekara Chinthika, Ranasinghe Nilantha, Marasinghe Chamil, Fernando Neluka
General Sir John Kotelawala Defense University, Rathmalana, Sri Lanka.
Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Tangalle, Sri Lanka.
BMC Infect Dis. 2016 Aug 24;16(1):446. doi: 10.1186/s12879-016-1791-9.
Leptospirosis is a globally emerging zoonotic disease and an important public health threat in developing countries. Diagnosis of leptospirosis is mainly based on clinical presentations in resource poor countries. World Health Organization (WHO) has introduced "Faine's criteria" for diagnosis of leptospirosis. This study was conducted to evaluate the usefulness of modified Faine's criteria (with amendment) 2012 to detect leptospirosis in resource poor settings.
Blood samples of 168 patients who fulfilled the inclusion criteria admitted between January 2013 to January 2014 were tested by a commercial immunochromatographic assay (Leptocheck WB, India), microscopic agglutination test (MAT) and polymerase chain reaction (PCR) methods. Leptospirosis was confirmed by a single MAT titre ≥1:400 and / or by a positive PCR. Diagnosis of leptospirosis was made using the clinical, epidemiological and laboratory data according to modified Faine's criteria (with amendment) 2012.
Leptospirosis was confirmed in 39 % (n = 66) by MAT and/or PCR. When modified Faine's criteria (MAT ≥ 1.400 &/ or PCR), was evaluated against LERG confirmed cases sensitivity, specificity, positive predictive value and negative predictive values were 95.45 %, 56.86 %, 58.88 %, 95.08 % respectively. The modified Faine's criteria with rapid immunochromatographic assay only had a sensitivity, specificity, positive predictive value and negative predictive value 89.39 %, 58.82 %, 58.42 %, and 89.55 % respectively.
The modified Faine's criteria which utilized only immunochromatographic assay (leptocheck IgM) in Part C was found to be useful tool for diagnosing leptospirosis in a resource poor setting.
钩端螺旋体病是一种在全球范围内新出现的人畜共患病，对发展中国家的公共卫生构成重大威胁。在资源匮乏的国家，钩端螺旋体病的诊断主要基于临床表现。世界卫生组织（WHO）已引入“费恩标准”用于钩端螺旋体病的诊断。本研究旨在评估2012年改良费恩标准（有修订）在资源匮乏地区检测钩端螺旋体病的实用性。
对2013年1月至2014年1月期间入院的168例符合纳入标准的患者的血样进行了商业免疫层析检测（印度Leptocheck WB）、显微镜凝集试验（MAT）和聚合酶链反应（PCR）检测。钩端螺旋体病通过单次MAT滴度≥1:400和/或PCR阳性得以确诊。根据2012年改良费恩标准（有修订），利用临床、流行病学和实验室数据对钩端螺旋体病进行诊断。
通过MAT和/或PCR确诊钩端螺旋体病的比例为39%（n = 66）。当将改良费恩标准（MAT≥1:400和/或PCR）与LERG确诊病例进行比较时，其敏感性、特异性、阳性预测值和阴性预测值分别为95.45%、56.86%、58.88%、95.08%。仅采用快速免疫层析检测的改良费恩标准的敏感性、特异性、阳性预测值和阴性预测值分别为89.39%、58.82%、58.42%和89.55%。
发现在C部分仅使用免疫层析检测（leptocheck IgM）的改良费恩标准是在资源匮乏地区诊断钩端螺旋体病的有用工具。
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