Under-Reporting of Human Leptospirosis Cases in Cities of Triângulo Mineiro, Minas Gerais, Brazil.

Leptospirosis is an infectious disease caused by the pathogenic species through direct or indirect contact with infected animals. Due to protean clinical manifestation in the early stages, leptospirosis is often difficult to distinguish from other common acute febrile illnesses, such as dengue. Thus, this study aimed to investigate the prevalence of leptospirosis in suspected dengue patients whose serological diagnosis was negative. A total of 449 serum samples from patients (negative IgM-ELISA dengue) with fever, headache, myalgia, and nausea were tested. The Dual-Path Platform (DPP) rapid test developed by the Instituto de Tecnologia em Imunobiológicos Bio-Manguinhos in the city of Rio de Janeiro, Brazil was used for screening IgM antibodies against in blood serum, and the microscopic agglutination test (MAT) was performed on samples positive in the DPP for leptospirosis, as well as on an equal number of negative samples. Results: The data obtained from the samples analyzed with the DPP assay showed 26 positive results (5.79%), of which 38.46% were male and 61.54% female, with a mean age of 41 years. We tested 52 samples using the MAT, including 26 reactive for IgM and 26 non-reactive in the DPP assay. Nine samples (17.31%) were reactive, and among them, six also showed reactivity in the DPP assay. Of the six samples reactive in both tests, 66.67% were female, living in urban areas in the city of Uberlândia, with a mean age of 50 years, being 50% white, 33.33% brown, and 16.67% black. The findings demonstrated that leptospirosis cases are underdiagnosed and undertreated in the study population and more attention needs to be paid for ruling out leptospirosis and other pathogens causing acute febrile illness in dengue-endemic areas.