Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 28 , ISSUE 3 ( March, 2024 ) > List of Articles

Original Article

Relevance of Polymerase Chain Reaction in Early Diagnosis of Leptospirosis

TV Sreevalsan, Rohitha Chandra

Keywords : Intensive care unit patients, Immunoglobulin M, Leptospirosis, Polymerase chain reaction, Serology

Citation Information : Sreevalsan T, Chandra R. Relevance of Polymerase Chain Reaction in Early Diagnosis of Leptospirosis. Indian J Crit Care Med 2024; 28 (3):290-293.

DOI: 10.5005/jp-journals-10071-24649

License: CC BY-NC 4.0

Published Online: 29-02-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Aim and background: Leptospirosis is common in India, especially in the southern states. Mortality is high among untreated cases. Diagnosis of leptospirosis remains a challenge in India as polymerase chain reaction (PCR), which is more sensitive than Immunoglobulin M (IgM) is not widely available. This study aimed to find out the difference in diagnostic yield with PCR and IgM in early leptospirosis. Materials and methods: This retrospective, single-center study included 67 adults with laboratory-confirmed leptospirosis (IgM, PCR, or both) who presented within 7 days of symptom onset and were admitted to the intensive care unit (ICU). The difference in the diagnostic yield with PCR and IgM ELISA was studied. Results: About 77.6% of the patients tested positive by PCR and 55.2% tested positive by IgM. There was a statistically significant difference in the detection of leptospirosis by PCR and IgM (p-value = 0.036). In the subgroup of patients who presented within 3 days of onset of symptoms, PCR positivity was 90.32% whereas IgM positivity was only 25.8%. Conclusion: Our study showed that the sensitivity of leptospira PCR is significantly higher than IgM in the first week of illness. It also showed that among the subset of patients who died, a majority were detected only by PCR. Since PCR is not widely available, leptospirosis remains underdiagnosed and mortality from the same is underestimated. Polymerase chain reaction, if routinely done along with IgM for all suspected cases of leptospirosis that present within the first week of illness helps in prompt diagnosis and treatment.


PDF Share
  1. Levett PN. Leptospirosis. Clin Microbiol Rev 2001;14(2):296–326. DOI: 10.1128/CMR.14.2.296-326.2001.
  2. Morgan J, Bornstein SL, Karpati AM, Bruce M, Bolin CA, Austin CC, et al. Outbreak of leptospirosis among triathlon participants and community residents in Springfield, Illinois, 1998. Clin Infect Dis 2002;34(12):1593–1599. DOI: 10.1086/340615.
  3. Sejvar J, Bancroft E, Winthrop K, Bettinger J, Bajani M, Bragg S, et al. Leptospirosis in “Eco-Challenge” athletes, Malaysian Borneo, 2000. Emerg Infect Dis 2003;9(6):702–707. DOI: 10.3201/eid0906.020751.
  4. Aparna Chaudhary. Leptospirosis in India: A forgotten tropical disease. Transactions of the Royal Society of Tropical Medicine and Hygiene. 2021. Available from: https://www.rstmh.org/news-blog/blogs/leptospirosis-in-india-a-forgotten-tropical-disease.
  5. Costa F, Hagan JE, Calcagno J, Kane M, Torgerson P, Martinez-Silveira MS, et al. Global morbidity and mortality of leptospirosis: A systematic review. PLoS Negl Trop Dis 2015;9(9):e0003898. DOI: 10.1371/journal.pntd.0003898.
  6. Haake DA, Levett PN. Leptospirosis in humans. Curr Top Microbiol Immunol 2015;387:65–97. DOI: 10.1007/978-3-662-45059-8_5.
  7. Taylor AJ, Paris DH, Newton PN. A systematic review of the mortality from untreated leptospirosis. PLoS Negl Trop Dis 2015;9(6):e0003866. DOI: 10.1371/journal.pntd.0003866.
  8. Torgerson PR, Hagan JE, Costa F, Calcagno J, Kane M, Martinez-Silveira MS, et al. Global burden of leptospirosis: Estimated in terms of disability adjusted life years. PLoS Negl Trop Dis 2015;9(10):e0004122. DOI: 10.1371/journal.pntd.0004122.
  9. Waggoner JJ, Pinsky BA. Molecular diagnostics for human leptospirosis. Curr Opin Infect Dis 2016;29(5):440–445. DOI: 10.1097/QCO.0000000000000295.
  10. Picardeau M. Diagnosis and epidemiology of leptospirosis. Med Mal Infect 2013;43(1):1–9. DOI: 10.1016/j.medmal.2012.11.005.
  11. Mullan S, Panwala TH. Polymerase chain reaction: An important tool for early diagnosis of leptospirosis cases. J Clin Diagn Res 2016;10(12):DC08–DC11. DOI: 10.7860/JCDR/2016/22462.9010.
  12. Musso D, La Scola B. Laboratory diagnosis of leptospirosis: A challenge. J Microbiol Immunol Infect 2013;46(4):245–252. DOI: 10.1016/j.jmii.2013.03.001.
  13. Effler PV, Bogard AK, Domen HY, Katz AR, Higa HY, Sasaki DM. Evaluation of eight rapid screening tests for acute leptospirosis in Hawaii. J Clin Microbiol 2002;40(4):1464–1469. DOI: 10.1128/JCM.40.4.1464-1469.2002.
  14. World Health Organization. Human Leptospirosis: Guidance for diagnosis, surveillance and control. World Health Organization, 2023. Available at: https://iris.who.int/bitstream/handle/10665/42667/WHO_CDS_CSR_EPH_2002.23.pdf?sequence=1.
  15. Cerqueira GM, Picardeau M. A century of Leptospira strain typing. Infect Genet Evol 2009;9(5):760–768. DOI: 10.1016/j.meegid.2009.06.009.
  16. Katz AR. Quantitative polymerase chain reaction: Filling the gap for early leptospirosis diagnosis. Clin Infect Dis 2012;54(9):1256–1258. DOI: 10.1093/cid/cis037.
  17. Levett PN. Leptospira. In: Versalovic J, Carroll KC, Funke G, Jorgensen JH, Landry ML, Warnock DW (Eds). Manual of clinical microbiology, 10th edition. Washington, DC: ASM Press; 2011. pp. 916–923.
  18. Karnik ND, Patankar AS. Leptospirosis in intensive care unit. Indian J Crit Care Med 2021;25(Suppl 2):S134–S137. DOI: 10.5005/jp-journals-10071-23852.
  19. Karnad DR, Amin P. An approach to a patient with tropical infection in the intensive care unit. Indian J Crit Care Med 2021;25(Suppl 2):S118–S121. DOI: 10.5005/jp-journals-10071-23867.
  20. Basu S, Shetty A. Laboratory diagnosis of tropical infections. Indian J Crit Care Med 2021;25(Suppl 2):S122–S126. DOI: 10.5005/jp-journals-10071-23813.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.