Evaluation of Asymptomatic Family Members for Leptospirosis in Patients with Symptomatic Leptospirosis

Bharath, J (2009) Evaluation of Asymptomatic Family Members for Leptospirosis in Patients with Symptomatic Leptospirosis. Masters thesis, Stanley Medical College, Chennai.


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INTRODUCTION: Leptospirosis has long been considered a rare zoonotic disease in India with only sporadic cases being reported. Since 1980, the disease has been reported from various States especially during monsoon months. This disease is endemic in Tamil Nadu and few other States. In Tamil Nadu, more number of cases are reported from Chennai, especially North Chennai. Still the disease is underdiagnosed and underreported in other parts of Tamil Nadu. Increasing availability of laboratory tests and very clear clinical criteria such as modified Faine’s criteria help to diagnose the disease easily. Due to this diagnostic ease and availability of lab tests, this study has been undertaken to study the Asymptomatic Leptospiral infection among family members and close contacts of the Leptospirosis patients who are living in a same environment, and also to analyse the environmental risk factors associated with the symptomatic and asymptomatic leptospiral infection. AIMS OF THE STUDY: 1. To study the clinical profile of symptomatic leptospirosis and to evaluate the asymptomatic family members of confirmed leptospirosis patients with diagnostic test for leptospiral infection. 2. To analyze the epidemiological risk factors associated with the leptospiral infection. PATIENTS AND METHODS: Patients aged >12 years admitted with fever suggestive of infectious etiology in medical wards of Stanley Medical College and Hospital, Chennai were investigated with Microscopic Slide Agglutination Test (MSAT) and Microscopic Agglutination Test (MAT) for Leptospirosis. Leptospirosis was diagnosed by using modified Faine’s criteria score of 26 (or) more with MSAT 2+ or above positive patients. Leptospirosis was confirmed using MAT with titer 1:80 (or) above. Asymptomatic family members who are living with the patients with confirmed leptospirosis were screened for leptospiral infection by using MSAT and MAT. Environmental factors of the living places predisposing leptospirosis were also analysed. The period of this study was from January 2007 to June 2008. Ethical Committee approval was obtained for this study. Criteria for Diagnosis: Leptospirosis was diagnosed utilizing Modified Faine’s Criteria – Clinical (A), Epidemiological (B), Laboratory data (C) (Score >25). RESULTS: In this study, 55 patients with leptospirosis were analyzed for their clinical features and environmental risk factors. 107 asymptomatic family members of these patients, who were living in the same environment were also screened for the leptospiral infection. SUMMARY: 1. Total patients analyzed 55 – 40 males and 15 females with a mean age of 31.3. 2. Labourers are the most common occupation group affected. 3. Environmental risk factors - poor sanitation 47.2%, inadequate drainage facilities 41.8%, barefoot walking 76.3%, presence of rodents in the environment 89%, rainfall 61.8% played major role in leptospiral infection and disease. 4. Anicteric leptospirosis was the most common type – 68.4%, complications seen in 22% patients, without any mortality. 5. All the cases are from North Chennai Veyasarpadi, Thiruvottiur, Tondiarpet, Pulianthope, contribute to large number of cases. 6. Asymptomatic family members of 55 patients were screened. 31 families showed positivity among their members at 56.4%. This indicates 56.4% families in North Chennai having asymptomatic leptospiral infections, while there is a symptomatic leptospirosis in the family, indicating a poor environment around their residence. 7. Among the 107 asymptomatic family members screened, 39 (Male 15, Female 24) showed a positive test for leptospiral infections at 36.5%. 8. Since environment played the most important role in leptospiral infection, interventions to improve the standard of environment, by providing 1) adequate drainage, 2) avoiding flooding, 3) safe disposal of solid waste (Garbage) 4) Rodent control, will definitely reduce the leptospiral infection. CONCLUSION: This study identified significant household clustering of leptospirosis among North Chennai people, where the disease is endemic. The finding support the hypothesis that household environment is an important transmission determinant in North Chennai. Prevention, therefore, needs to target sources of contamination and risk activities in the places required.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Asymptomatic Family Members ; Leptospirosis ; Symptomatic Leptospirosis.
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 23 Mar 2018 16:20
Last Modified: 24 Mar 2018 08:33
URI: http://repository-tnmgrmu.ac.in/id/eprint/6506

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