Study of Evaluation of Faine’s Criteria and IgM Elisa in the Diagnosis of Leptospirosis

Parthiban, B (2012) Study of Evaluation of Faine’s Criteria and IgM Elisa in the Diagnosis of Leptospirosis. Masters thesis, Madras Medical College, Chennai.

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Abstract

INTRODUCTION: Leptospirosis is a worldwide public health problem. In humid tropical and subtropical areas, where most developing countries are found, it is a greater problem than in those with a temperate climate. It is difficult to confirm the diagnosis, because of lack of availability of cultures which is considered as the gold standard.3 Wide variety of serological tests are available with varying sensitivity and specificity. ELISA IgM , IgM-specific dot-ELISA, LEPTO Dipstick, slide agglutination method, Dri-Dot assay, complement fixation assay, latex agglutination, indirect hemagglutination test, and indirect immunofluorescent test are to name a few.1, 2, 4-12Among these tests ELISA IgM has been considered the ideal one.13 Clinical manifestations are non-specific in the early stages of illness. The early institution of antibiotic therapy has been found to be beneficial in studies. 1, 2, 14 Faines criteria has been recommended by the world health organization as a useful clinical tool in the diagnosis of Leptospirosis.15 However, there is paucity of data in literature regarding the usefulness of Faine’s criteria in pediatrics. Hence, a study to assess the usefulness of Faines and modified Faines criteria has been attempted. AIM OF THE STUDY: Aim of the study was to evaluate Faine’s, modified Faine’s criteria and IgM Elisa in the diagnosis of leptospirosis. In our study out of 91 children 14 were diagnosed as leptospirosis using IgM ELISA, 23 and 39 were diagnosed as leptospirosis using Faine’s and modified Faine’s criteria respectively. The results were compared with MAT. Modified Faine’s criteria had high sensitivity and specificity compared to Faine’s criteria in our series, this suggests that modified Faine’s criteria might be more useful in the diagnosis of leptospirosis. OBJECTIVES OF THE STUDY: To assess the sensitivity and specificity of Faine’s, Modified Faine’s criteria and IgM Elisa in diagnosing pediatric Leptospirosis. DISCUSSION: In our study of 91 children, 14(15%) of them were diagnosed to have Leptospirosis on the basis of positive IgM ELISA test. Sunil Karande S et al in Mumbai has reported a diagnosis of leptospirosis in 30 out of 93 (32%) children who were suspected to have the same.23 This increase in positivity of Mumbai study might have been because these cases were evaluated in children living in slums and immediately following floods. Clinical diagnosis of leptospirosis is difficult, hence a high index of suspicion is required for the diagnosis when a patient presents with fever, headache, and myalgia.81 Similar observations in the differential diagnosis of Leptopsirosis have been made in earlier studies. AGE GROUP: Majority of cases with leptospirosis in our series were between 2-6 years of age (51.6%) which was similar to karande S et al. GENDER DISTRIBUTION: Male: female ratio in our series was 1.7:1. It was reported to be 1.6:1 by karande S et al.23 There was a similar male preponderance 88 (63%) in the study by Rajajee S et al.82 In adults the disease is 5 times more common in males, probably because of the occupation and activity. CONCLUSION: 1. Diagnosis of Leptospirosis was made by positive Leptospira IgM ELISA test in nearly 15.38% of children with suspected leptospirosis. 2. Leptospirosis infection may masquerade as multiplicity of separate diseases whose clinical features vary considerably. 3. Headache and myalgia were the predominant symptoms in addition to fever. 4. The sensitivity & specificity of IgM Elisa were 33.3 % and 89 % respectively. 5. The sensitivity & specificity of modified Faine’s criteria were 94.4 % and 69.9 % respectively which was significantly higher than Faines criteria 6. The sensitivity & specificity of Faine’s criteria were 11.1 % & 71.2 % respectively. 7. All the three serological tests (MAT, MSAT & IgM ELISA) were positive only in about 3.29% of children. 8. The occurrence of cases was higher during the monsoon. 9. There was no mortality in our series of children with Leptospirosis.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Faine’s Criteria ;d IgM Elisa ; Diagnosis ; Leptospirosis
Subjects: MEDICAL > Orthopaedics
Depositing User: Ravindran C
Date Deposited: 16 Apr 2018 06:00
Last Modified: 16 Apr 2018 06:00
URI: http://repository-tnmgrmu.ac.in/id/eprint/7001

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