No abstract available.
Leptospirosis*

No abstract available.
Leptospirosis*

Introduction: Leptospirosis is an infectious and zoonotic disease caused by pathogenic bacteria called leptospires which can be transmitted through the exposure to the urine or excretion of infected animals, and also water or soil that being contaminated with secretion of the infected animals. Leptospirosis remains a concern in Malaysia, as the number of cases had steadily increased. This study aims to determine the knowledge, attitude and practice (KAP) among final year students of selected programmes in Universiti Putra Malaysia (UPM). Methods: A cross sectional study was conducted among students of Environmental and Occupational Health (ENVOCH) (57 students), Nursing (22 students) and Veterinary Medicine (97 students). Thus, the total sample sizes were 170, however the response rate were 81.76%. Questionnaire was used as the study instrumentation. Results: There was a significant association between race and knowledge, also gender and attitude with p<0.05, (p=0.008) and (p=0.001) respectively. Furthermore, there was also an association between attitude and practice (p<0.05). Meanwhile, there was a significant difference on the knowledge between students of ENVOCH with Veterinary Medicine and Nursing with Veterinary Medicine (p<0.05). Conclusion: Most of the final year students in this study had moderate level of KAP towards Leptospirosis disease. Thus, improvement in education and training must be done to face this issue.
Leptospirosis

We described a case of positive molecular detection of leptospirosis in urine sample following prolonged hospitalization. Relevant clinical history had raised suspicion to leptospirosis infection. A significantly high level of creatinine kinase suggested possibility of rhabdomyolysis. Blood and urine samples collected on 4th day of admission were negative for leptospires culture and serological method showed no significant evidences of positive infection. Molecular detection of Leptospira spp. in blood sample was positive but not in urine sample. After seven weeks of infection, leptospiral DNA was detected in urine sample using molecular method
Leptospirosis

Introduction: Leptospirosis is endemic to tropical regions of the world and is re-emerging as a new danger to public health in Malaysia. the purpose of this particular study was to determine the common leptospiral serovars present in human communities living around wildlife reserves/disturbed forest habitats. the objective of this study was to estimate the seroprevalence of leptospirosis and finding infecting serovars in villages surrounded habitats where wildlife lives in Sarawak, Malaysia. Methods: A cross-sectional serological survey of 198 humans was conducted in four villages around Kuching, Sarawak between January 2011 and March 2012. results: A seroprevalence of 35.9% (95%cI 29.2-43.0) to the MAt was detected in the tested humans. Antibodies to serovar Lepto 175 Sarawak were most commonly detected (31.3%; 95%cI 24.9-38.3) and were detected in individuals at all four locations. the presence of skin wounds (Or 3.1), farm animals (Or 2.5) and rats (Or 11.2) were all significantly associated with seropositivity in a multivariable logistic regression model. conclusions: the results of the current study are important as wildlife may act as reservoirs of leptospires for humans. Health authorities should expand disease control measures to minimise the spill-over from wildlife to humans visiting, living or working in the sampled locations. the pathogenic status of serovar Lepto 175 Sarawak also requires further investigation.
Leptospirosis

Background: In the Philippines, Leptospirosis is a seasonal but common and prevalent disease with an average of 680 cases and 40 deaths annually. Cases result from exposure to contaminated flood, water, or soil. Several studies showed that males are more commonly affected, who are believed to be more exposed to the outdoor environment. In terms of pediatric population, early diagnosis is based mainly on clinical and epidemiological factors. Objective: This study was conducted to determine the clinical features and outcomes of pediatric leptospirosis, as well as determine the prognostic factors associated with mortality. Methodology: A descriptive retrospective study was done in a tertiary hospital from January 2007 – December 2019. Review of all cases that satisfy the diagnosis of Leptospirosis by WHO Criteria (2003) was done. The data extracted from the chart were encoded using Microsoft Excel; processed and analyzed using STATA SE 15 to generate the required output. Results & Conclusion In this 12-year study, a total of 85 cases of leptospirosis in children, aged 0-18 years, were reported. Leptospirosis predominates in males in the adolescent age group. It is noted all year round but noted mostly during the rainy months which increases the risk to exposure to contaminated water through wading, especially in the cities of Navotas, Malabon and Tondo. The mean duration of symptoms was 3.6 days. The most common clinical findings noted in this study were fever, gastrointestinal symptoms, conjunctival suffusion, oliguria, calf tenderness and headache. Abnormal laboratory findings were leukocytosis, neutrophilia, thrombocytosis, elevated BUN and creatinine, hypokalemia and hyponatremia. Significant correlation with poor outcome was found in patients who have had pulmonary hemorrhage.
Leptospirosis

Objective: Leptospirosis in children is one of the most common diagnostic dilemmas, hence this study was performed to determine the clinical profile, outcome and risk factors associated with mortality in patients seen at tertiary government hospitals from January 2008 to December 2012. Methods: A case-control retrospective study was done among admitted patients at UP-PGH, SLH, and RITM. Descriptive statistics and multiple logistic regressions were utilized. Results: Among the 404 leptospirosis cases included in the study, 94% were male, with 43% belonging to 16-18-year-old age group (age range 3 to 18 years old). A higher occurrence was noted during the rainy season and in Manila. Clinical findings include fever, abdominal pain, calf tenderness, vomiting and conjunctival suffusion. Significant correlation was noted in patients with jaundice (p-value 0.014; OR 6.293, CI 1.449-27.335), dyspnea (p-value 0.004; OR 7.880, CI 1.967-31.561) and cardiac abnormality (p-value 0.042; OR 15.343, CI 1.106-212.853). Abnormal laboratory findings include neutrophilia, azotemia, creatinemia, anemia, elevated bilirubin levels and thrombocytopenia. Prolonged prothrombin time was associated with poor outcome (p-value 0.004, OR 23, CI 2.79-189.67). Penicillin was the drug of choice given to 96.8%. 94.6% of cases who had oliguric renal failure were conservatively converted to non-oliguric type. 5.4% underwent peritoneal dialysis and survived. Inotropes were used in 93% of non-survivors. The case fatality rate was 3.5% with the cause of death mostly due to Weil’s disease. The average hospital stay among survivors was 6.8+3.3 days as compared with 1.8+1.9 days in non survivors. Shorter hospital stay (p-value 0.00; OR 3.514, CI 2.115-5.839), as well as inotropic support (p-value 0.035; OR 62.511, CI 1.33-2949.134), were associated with poorer outcome, but these findings can be attributed to late presentation of cases at the hospital for admission. Conclusion A5 year review of patients with leptospirosis showed that jaundice, dyspnea, cardiac abnormality and prolonged prothrombin time were predictive of mortality.
Leptospirosis

Objective: This study aimed to validate the modified Faine’s criteria (Parts A and B) proposed by Brato in the early diagnosis of leptospirosis in children using the microscopic agglutination test (MAT) as gold standard. Methodology: This diagnostic validity study was conducted at the Philippine General Hospital. It included all pediatric patients who were admitted between September 2009 to December 2010 and who satisfied the presumptive and suggestive criteria in the diagnosis of leptospirosis based on the modified Faine’s criteria. A fourfold or greater rise in paired MAT titers was used as the gold standard. Calculations for sensitivity, specificity, positive and negative predictive values, and likelihood ratios of positive and negative tests were computed. Results Thirty-three patients satisfied the diagnosis of leptospirosis based on the criteria; however, only 20 of these had paired MAT titers and were included. The modified Faine’s criteria had a sensitivity of 60%, specificity of 73%, positive predictive value (PPV) of 43%, negative predictive value (NPV) of 85%, positive likelihood ratio of 2 and negative likelihood ratio of 0.4 . Modifying the clinical criteria by revision of the point allocation to create a “Pediatric Locally Modified Criteria” increased the sensitivity to 80%, PPV to 50%, NPV to 92%, positive likelihood ratio to 3 and negative likelihood ratio to 0.3. Conclusion The Modified Faine’s criteria had poor sensitivity and low positive predictive value and cannot be recommended as a screening test for the early diagnosis of leptospirosis in children. A proposed modification of the clinical criteria for local application increased diagnostic accuracy but must be further validated in a larger number of pediatric patients in the Philippines.
Leptospirosis

The purpose of this advice is to provide guidelines for physicians and parents on the prevention of leptospirosis in the pediatric age group. Leptospirosis is an infectious disease caused by pathogenic bacteria called leptospires. The main carriers of leptospires are animals such as rats, mice, dogs, cats and livestock. Human leptospiral infections can occur when mucus membranes and skin are contaminated by the urine of infected animals, or upon ingestion of contaminated food and water, all of which may occur when an individual is exposed to flood waters. Thus the occurrence of freshwater flooding after typhoons or increased rainfall can lead to an increased risk of leptospirosis. Initial symptoms of leptospirosis may range from mild to severe, or may even be fatal. Manifestations of the disease include: (1) a mild influenza-like illness; (2) Weil’s syndrome, characterized by jaundice, renal failure, hemorrhage, and arrhythmias; (3) meningitis/meningoencephalitis; or (4) pulmonary hemorrhage with respiratory failure. Case fatality rates range from 12-14% in the Philippines. In studies in India, case fatality rates were lower in the pediatric age group compared to adults.
Leptospirosis

Introduction: Leptospirosis is a zoonotic disease caused by spirochaete of the genus Leptospira. Human infection occurs after exposure to water or soil contaminated by urine from an infected animal. Most patients manifest as self-limited systemic illness. However 10% of patients manifest as severe disease associated with high fatality. The disease affects mostly men, cases involving pregnant women are uncommon. We presented a case of leptospirosis in a pregnant woman leading to mortality of both mother and foetus. Case Report: A 28-year-old woman at 18 weeks of gestation, had shortness of breath and collapsed. She was brought unconscious to the emergency department and died shortly after arrival. A week prior to this, she had presented to the same hospital with pain on both thighs. Examination of the patient and ultrasound of the foetus revealed normal findings. Post mortem examination revealed hepatosplenomegaly and congested lungs; no jaundice, meningeal inflammation or cardiac abnormalities was evident. Histopathology examination of the lungs revealed pulmonary haemorrhages and oedema. Multiple infarcts were seen in the spleen and the kidneys showed foci of acute tubular necrosis. Laboratory investigations revealed Leptospira IgM antibody and PCR for leptospira were positive. This case illustrates the subtleness of clinical presentation of leptospirosis. The diagnosis was obscure even at post-mortem and was only suspected following histopathological examination, leading to further investigations. Conclusion: Leptospirosis may have a subtle presentation and a high index of suspicion for this infection is required for early identification of the disease.
Leptospirosis