Hii King-Ching, Robie Emily R, Saihidi Izreena, Berita Antoinette, Alarja Natalie A, Xiu Leshan, Merchant James A, Binder Raquel A, Goh Johnny Keh-Tun, Guernier-Cambert Vanina, Galán Diego, Gregory Michael J, Gray Gregory C
Department of Pediatrics, Kapit Hospital, Ministry of Health Malaysia, Kapit, Sarawak, Malaysia.
Duke Global Health Institute, Duke University, Durham, NC, USA.
Trop Dis Travel Med Vaccines. 2021 Nov 1;7(1):32. doi: 10.1186/s40794-021-00154-2.
Leptospirosis diagnoses have increased in Sarawak, Malaysia in recent years.
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.
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.
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.
近年来，马来西亚砂拉越州钩端螺旋体病的诊断病例有所增加。
为了更好地了解疾病负担及相关危险因素，我们对马来西亚砂拉越州当地医院收治的147例临床诊断为钩端螺旋体病的患者进行了评估，检测其是否存在钩端螺旋体及相关抗体。在急性发病期采集的血清和尿液标本通过一种商用快速诊断检测（Leptorapide，Linnodee有限公司，北爱尔兰安特里姆）、一种ELISA IgM检测（钩端螺旋体IgM ELISA，PanBio，澳大利亚昆士兰）和一种全钩端螺旋体实时PCR（qPCR）检测来评估，以估计每种方法的疾病患病率和诊断准确性。对一部分样本进行了显微凝集试验。
总体而言，147例患者中有45例（30.6%）通过qPCR在血清（20例患者）或尿液（33例患者）中检测到钩端螺旋体，另有10例（6.8%）通过血清学检测被判定为阳性，研究人群中总体患病率为37.4%。然而，每种诊断方法单独得出的患病率估计值各不相同：快速检测血清为42.2%，尿液为30.5%；ELISA血清为15.0%；qPCR血清为13.8%，尿液为23.4%。通过常规PCR对一部分阳性样本进行分子特征分析，在4份标本中鉴定出细菌种类为问号钩端螺旋体。对钩端螺旋体病结局进行多因素危险因素分析发现，与未完成小学教育的人相比，完成小学教育的人（比值比=2.5；95%置信区间1.0-6.4）以及每周在当地河流中洗衣服的人（比值比=10.6；95%置信区间1.4-214.8）感染钩端螺旋体病的可能性增加。
总体而言，数据表明研究人群中钩端螺旋体病患病率相对较高。快速诊断检测和ELISA检测相对于qPCR的低敏感性凸显了对更好筛查工具的需求。
