|Year : 2015 | Volume
| Issue : 2 | Page : 321-323
Urban leptospirosis: A report of two cases
P Sarguna1, M Raja Rao2, S Sivakolundu3, R Chaurasia3, M Sritharan3, K Shankar2
1 Department of Microbiology, Sir Ronald Ross Institute of Tropical and Communicable Diseases, Nallakunta, Hyderabad, Andhra Pradesh, India
2 Department of Medicine, Sir Ronald Ross Institute of Tropical and Communicable Diseases, Nallakunta, Hyderabad, Andhra Pradesh, India
3 Department of Animal Sciences, University of Hyderabad, Hyderabad, Andhra Pradesh, India
|Date of Submission||08-Nov-2013|
|Date of Acceptance||01-Aug-2014|
|Date of Web Publication||10-Apr-2015|
Department of Microbiology, Sir Ronald Ross Institute of Tropical and Communicable Diseases, Nallakunta, Hyderabad, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sarguna P, Rao M R, Sivakolundu S, Chaurasia R, Sritharan M, Shankar K. Urban leptospirosis: A report of two cases. Indian J Med Microbiol 2015;33:321-3
|How to cite this URL:|
Sarguna P, Rao M R, Sivakolundu S, Chaurasia R, Sritharan M, Shankar K. Urban leptospirosis: A report of two cases. Indian J Med Microbiol [serial online] 2015 [cited 2019 Aug 18];33:321-3. Available from: http://www.ijmm.org/text.asp?2015/33/2/321/154898
We report two cases of leptospirosis from urban areas of Hyderabad where the reporting is scarce.  A 16-year-old girl student (case 1) and a 27-year-old male, a cattle farm owner (case 2) reported to our institute during June-August 2013. The predominant clinical findings being icterus with or without subconjunctival haemorrhage [Figure 1] along with related non-specific signs and symptoms. General physical and systemic examination were, however, unremarkable. Information about exposure to potential sources of Leptospira spp. in contaminated water (case 1) and direct contact or possible infection from contaminated environment (case 2), narrowed the differential diagnosis.
|Figure 1: Photograph of a patient (case 2) showing icterus and sub-conjunctival hemorrhage|
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Both the cases were investigated after obtaining written informed consent. Hepatorenal parameters indicated deranged hepatic function (case 1) and involvement of kidneys manifested by acute renal failure, non-oliguric (case 2). Malaria, enteric fever, viral hepatitis and others were ruled out considering leptospirosis as the possibility in the differential diagnosis of acute febrile illness [Table 1]. The etiology was considered definite when: (1) serum tested positive for leptospiral specific IgM antibodies (Leptocheck) (2) presence of anti-leptospiral antibodies with the predominant serogroup being Tarassovi 1:1600 (case 1) and Autumnalis 1:3200 (case 2). This was confirmed by gold standard MAT (microscopic agglutination test)  using a panel of 19 live leptospiral serovars (3) positive anti-HbpA IgG antibodies, a test validated on several samples of leptospirosis earlier.  Culture confirmation of leptospirosis from blood and urine samples was unsuccessful. Over the next 5-7 days, clinical response (with remission of fever, normal hepatic and renal parameters) to 10-day course of doxycycline 100 mg/twice/day substantiated the clinical diagnosis.
Icterus is the predominant clinical feature of the severity of illness. Hence, detection of systemic leptospirosis by a rapid dipstick assay Leptocheck, with a high sensitivity of 86.8% and specificity of 92.7%  plays a pivotal role in early diagnosis. The global criterion for laboratory confirmation of current leptospiral infection is defined as seroconversion or a four-fold rise in titre in paired serum samples, or a single MAT titre ≥1:400 in the presence of clinical signs and history of animal contact.  High titre of anti-leptospiral antibodies and the identification of the serovar in both the cases proved that the patients were definite cases of leptospirosis. MAT suffers several disadvantages as routine clinical testing is expensive, requiring technical expertise and maintenance of strains for preparation of live antigens. The knowledge of prevalent serovars in a particular geographic area is required, and a reasonable number of serovars must be included in the panel for effective screening, as MAT-negative sample could be due to the omission of the particular serovar in the test panel.
There are now increasing reports of the use of ELISA-based techniques to replace MAT.  Indigenous kits, such as HbpA-IgG ELISA has shown considerable potential in the identification of positive cases of leptospirosis.  HbpA is an iron-regulated hemin-binding protein expressed only by pathogenic Leptospira spp. Its absence in the free-living non-pathogenic species and the expression of the protein in vivo, specifically under conditions of iron limitation (prevailing in the mammalian host in any bacterial infection), reflects active infection. It is presumed to contribute to the specificity of the test and prevent false positive results. As culture confirmation has not been easy to achieve, as seen here, screening for anti-leptospiral antibodies, using specific antigens such as HbpA would be useful.
In conclusion, timely diagnosis of leptospirosis by Leptocheck IgM, MAT and HbpA-IgG ELISA enabled confirmation and prompt treatment of the two patients effectively without further complications. There is a need for the development of a quick, economical and easy-to-do test, for which HbpA-IgG ELISA shows good promise. The availability of appropriate and affordable tests in routine laboratories will help in identification of more cases of leptospirosis.
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