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 ~  Abstract
 ~  Materials and me...
 ~  Results
 ~  Discussion
 ~  Acknowledgements
 ~  References

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Year : 2003  |  Volume : 21  |  Issue : 4  |  Page : 271-273
 

Prevalence of leptospirosis in various risk groups


Department of Microbiology, Government of Medical College, Nagpur - 440 003, Maharashtra, India

Correspondence Address:
Department of Microbiology, Government of Medical College, Nagpur - 440 003, Maharashtra, India

 ~ Abstract 

Two hundred and twenty seven patients were included in the study. The test group included 55 patients of pyrexia of unknown origin (PUO), 42 veterinary workers, 38 hepatitis patients and 25 village farmers. The control group comprised of 27 Syphilis controls and 40 healthy controls. Of the total study entrants, 186 were tested for Leptospira antibodies by IgM ELISA and 41 by microscopic agglutination test (MAT). ELISA results of 45 patients were further tested by MAT for comparative evaluation. Out of 160 patients of the test group 56(35.0%) were positive for Leptospira antibodies. The positivity was 18(32.73%) amongst PUO patients, 15(35.71%) of the farm workers, 15(39.47%) of hepatitis patients and 8(32.0%) farmers. Leptospira antibodies were not detected in any of the controls. The antibody positivity was seen in 33(32.04%) of the 103 urban patients and 23(40.35%) of 57 rural patients. Out of 56 Leptospira cases, in 39(69.64%) history of animal contact was present. The common clinical features in these patients included fever in 51(91.07%), myalgia 48(85.71%), headache 42(75.0%), Anorexia 31(55.35%), Jaundice 24(42.86%) and nausea/vomiting in 21(37.5%). Of the 45 ELISA results compared with that of MAT, there was 86.67% agreement between the tests.

How to cite this article:
Angnani R, Pathak A A, Mishra M. Prevalence of leptospirosis in various risk groups. Indian J Med Microbiol 2003;21:271-3


How to cite this URL:
Angnani R, Pathak A A, Mishra M. Prevalence of leptospirosis in various risk groups. Indian J Med Microbiol [serial online] 2003 [cited 2019 Dec 7];21:271-3. Available from: http://www.ijmm.org/text.asp?2003/21/4/271/8042


Leptospirosis has been recognized as an important emerging disease in the 1980s and 1990s in Andamans, Tamil Nadu and Kerala.[1] Today, it is widespread in farm and domestic animals in many parts of India.[2] Yet human leptospirosis is not commonly diagnosed in most of these places. It may have been under reported due to lack of awareness; its protean clinical manifestations and non-availability of the laboratory tests.
The present study was carried out to evaluate whether leptospirosis occurs in and around Nagpur and to determine its prevalence in the risk groups.

 ~ Materials and methods Top

Study population
A total of 227 study entrants were included in the study. They comprised of 160 cases from the risk groups, 40 healthy controls and 27 Syphilis controls. Of the 160 cases from risk groups, 55 were patients of pyrexia of unknown origin (PUO) admitted to the hospital and remained undiagnosed after peripheral blood smear test for malaria, chest X' ray, blood and urine culture, and negative serological tests of Widal, agglutination test for  Brucellosis More Details and Paul Bunnel test. There were 42 subjects working in the farms of Government veterinary college, Nagpur, 38 cases were suffering from hepatitis with negative HBsAg test and 25 farmers with history of fever during last six months from the village Hudkeshwar in which few cases of leptospirosis were detected four years back.
Specimens
From each study entrant 5 mL blood was taken in a plain sterile tube and allowed to clot. The serum was separated and stored at 40C till tested.
Tests
Of 227 specimens, 186 were tested by IgM ELISA and 41 by the microscopic agglutination test (MAT). ELISA was performed by INDX LEPTOSPIRA MICROWELL ELISA TEST for detection of IgM antibodies to  Leptospira biflexa  Patoc-I, 1: 40 dilution. The tests were performed as per the manufacturer's instructions. For MAT, the serum specimens were sent to Department of microbiology. BJ Medical College, Pune. The genus specific MAT was done using Leptospira biflexa serovar Patoc-I strain. A titre of more than or equal to 1: 200 was considered positive. Forty five samples were separately tested by ELISA and MAT for comparative evaluation.

 ~ Results Top

Out of 160 patients in various risk groups 56 (35.0%) tested positive for Leptospira antibodies either by ELISA or by MAT. Their distribution is shown in [Table - 1]. None of the study entrants from Syphilis controls and Healthy control groups tested positive for Leptospira antibody.
Of 160 patients, 87 were between the age of 21 and 40 years of which 38 had serological evidence of leptospirosis. Out of 160 cases 99 were males and 61 were females. The sex wise distribution showed 43(43.43%) out of 99 males and 13(21.31%) out of 61 females to be positive for leptospirosis. There were 103 urban and 57 rural patients of which 33(32.04%) and 23(40.35%) were positive for Leptospira antibodies respectively.
The frequency of occurrence of various clinical features in 56 Leptospira positive cases is shown in [Table - 2]. Of the 56 Leptospira positive cases, in 39 (69.64%) history of animal contact was present.
The correlation between ELISA and MAT tested simultaneously in 45 specimens is shown in [Table - 3].

 ~ Discussion Top

The prevalence of leptospirosis reported from studies from different regions show a wide variation.[3],[4],[5],[6] In the present study, it is 35%, which is comparable to earlier studies.[7],[8] Leptospirosis accounted for 32.73% PUO cases, which is a substantial number, and it correlates with that of Ratnam et al report.[9] The persons handling animals are usually at a higher risk. In the veterinary group, out of 42 patients, 15(35.71%) showed the evidence of leptospirosis of which 10 were live stock farm workers, two each were veterinary doctors and attendants and one laboratory technician. Jaundice is an important feature of leptospirosis. Amongst the jaundice patients, 39.47% patients tested positive for leptospirosis which is higher than that reported by Prabhakar et al,[3] but lower percentage has also been documented by Cacciagnati et al.[10] The age and sex distribution of patients in this study indicates that leptospirosis is the disease of occupationally active age group i.e., young to middle age adults with male preponderance. The prevalence of leptospirosis is higher in rural as compared to the urban population, mainly due to greater exposure to livestock. In urban population too the livestock farm workers showed higher prevalence. Besides this, in as many as 39 out of 56 Leptospira positive cases a certain history of animal contact was present. The frequency of clinical features among Leptospira positive patients showed a wide variation. Similar variations in symptoms of leptospirosis have been reported earlier.[8],[9],[10],[11] The results of the study indicate that leptospirosis is not uncommon in this region. Its diagnosis on clinical grounds alone is difficult. It should be suspected more frequently and in patients of PUO with jaundice, especially in presence of history of animal contact, diagnosis be established by laboratory investigations.
The two tests, ELISA and MAT, used in this study, show an excellent agreement. Both the tests are rapid and easy to perform. ELISA is more useful than MAT in early phase of the disease. The choice of test rests upon individual laboratory according to the availability of staff, technical expertise, facilities for maintenance of different serovars of Leptospira in the medium, dark field microscope, ELISA reader etc. and financial resources.

 ~ Acknowledgements Top

The authors are grateful to Dr. Renu Bharadwaj, Department of Microbiology, BJ Medical College, Pune, for testing specimens by MAT test. 

 ~ References Top

1.Jacob John. Emerging and re-emerging bacterial pathogens in India. Indian J Med Res 1996;104:4-18.  Back to cited text no. 1    
2.Ratnam S. (Ed) A manual on Leptospirosis. (SR Publications, Madras) 1994:101-109.  Back to cited text no. 2    
3.Prabhakar PK, Harish BN, Rao RS, et al. Seroprevalence of Leptospirosis among febrile and jaundice patients. Indian J Med Microbiol 1995;13(4):189-191.  Back to cited text no. 3    
4.Ratnam S, Everard COR, Alex JC, Suresh B, Thangaraju P. Prevalence of Leptospiral agglutinins among conservancy workers in Madras city. Indian J Tropical Med Hyg 1993;96:41-45.  Back to cited text no. 4    
5.Muthusethupati MA, Shivkumar S, Suguna R, et al. Leptospirosis in Madras - A Clinical and Serological study. J Asso Phys India 1995;43:456-458.  Back to cited text no. 5    
6.Sehgal SC, Sugunan AP. Leptospirosis in Andamans. In: Souvenir of the First National Leptospira Conference, Bangalore. 1999.  Back to cited text no. 6    
7.Everard CO, Hayes RJ, Fraser CGM. A serosurvey for leptospirosis in Trinidad among urban and rural dwellers and persons occupationally at risk. Trans Roy Soc Trop Med Hyg 1985;79:192-195.  Back to cited text no. 7    
8.Sumathi G, Subudhi CHPK, Manuel HPS, et al. Serodiagnosis of Leptospirosis- A Madras study. Indian J Med Microbial 1995;13(4):192-195.  Back to cited text no. 8    
9.Ratnam S, Sunderaraj T, Thyagarajan SP, et al. Serological evidence of Leptospirosis in Jaundice and Pyrexia of Unknown Origin. Indian J Med Res 1983;77:427-430.  Back to cited text no. 9    
10.Cacciapuati B, Nuti M, Pinto A, Sabrie AM. Human Leptospirosis in Somalia, a Serological survey. Trans R Soc Trop Med Hyg 1982;76(2):178-182.  Back to cited text no. 10    
11.Park SK, Ha CY, Lee SH, et al. Leptospirosis in Chonbuk province of Korea in 1987: A study of 93 patients. Am J Trop Med Hyg 1989;41(3):345-351.  Back to cited text no. 11    
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