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S Shiva Kumar
features and epidemiological risk factors to make a possible diagnosis Sethi et al. from PGI, Chandigarh had utilized modified Faines
of leptospirosis. For example, a patient with fever, headache, myalgia criteria in their study of leptospirosis and have recommended
and conjunctival suffusion during the monsoon month who gives that this criteria can be utilized as a useful guide for diagnosis of
the history of wading through flood water would have a score of 21 leptospirosis by clinicians.3 Chauhan et al. from Himachal Pradesh
which would be diagnostic of possible leptospirosis. Therefore, in the in their study of 13 patients of leptospirosis have stated that only 7
first week clinical and epidemiological factors (A + B) should be used out of 13 can be diagnosed by Faines criteria but all 13 cases could
to diagnose leptospirosis, while in the second week, laboratory tests be diagnosed by modified Faines criteria.4 ND Mandal et al. from
should be used to confirm the diagnosis.1 Kolkata have also utilized modified Faines criteria in the diagnosis
24
Section 1 Chapter 7 Indian Guidelines for the Diagnosis and Management ...
Serosurvey1:50
Repeat titer
Four-fold rise/seroconversion
Abbreviations: CSF, Cerebrospinal fluid; PCR, Polymerase chain reaction; MAT, Microscopic agglutination test; MSAT, Macroscopic slide agglutination test
Inadequate drainage facilities and open drains Veterinarians, laboratory staff Adventure travel
of 214 cases of leptospirosis.5 Toyakawa et al. have stated that the Modified Faines Criteria (with Amendment) 2012
modified Faines criteria have produced statistically higher specificity
Certain additions have been made to the modified Faines criteria
and positive predictive values than those of standard Faines criteria.
2004 to make it more user friendly (Table 5).
These criteria have high negative values which may help to exclude
Since pulmonary hemorrhage is an important complication, hem-
leptospirosis from the differential diagnosis of febrile patients.11-15
optysis and dyspnea have been included in the clinical criteria.
Other workers have also utilized modified Faines criteria to diagnose
Since many other rapid tests have become available, they have
leptospirosis.16-19
been included in the laboratory criteria.20-28
25
Infectious Diseases Section 1
Abbreviations: PCR, Polymerase chain reaction; MAT, Microscopic agglutination test; SAT, Slide agglutination test
Since polymerase chain reaction (PCR) is available for diagnosis Cardiac arrhythmias
of leptospirosis in the first week, this has been included in the Skin rashes.
diagnostic criteria.27-28
Probable (At Secondary and Tertiary Health Care Levels)
Guidelines of the Regional Medical Research Center Based on availability of laboratory facilities a probable case of
(ICMR) and WHO Regional Office for South-East Asia2,8 leptospirosis is a suspect case with a positive rapid IgM test. And/
Or
Case Definition Supportive serologic findings (i.e. a MAT titer equal to 200 in a
Considering the changing clinical manifestation of leptospirosis, single sample) And/Or
limitation of available diagnostic test methods and need of early case Any three of the following:
detection and early treatment, the following case definition has been Urinary findings: Proteinuria, pus cells, blood
adopted. In these guidelines, the case definition has three categories: Relative neutrophilia (> 80%) with lymphopenia
1. Suspect: Which consists of only clinical features Platelets less than 100,000/cu mm
2. Probable: Which consists of clinical features + Rapid diagnostic Elevated serum bilirubin more than 2 mg%; liver enzymes
tests moderately raised (Serum alkaline phosphatase, S amylase,
3. Confirmed: Which consists of clinical features + positive MAT/ CPK).
PCR/Culture.
Confirmed
Suspect A confirmed case of leptospirosis is a suspect or probable case with
Acute febrile illness ( 38.5C) and/or severe headache with: any one of the following:
Myalgia Isolation of leptospires from clinical specimens
Prostration and/or Positive PCR result
Conjunctival suffusion Seroconversion from a negative to positive or fourfold rise in titer
History of exposure to leptospira-contaminated environment. by MAT
Titer by MAT of 400 and greater in a single sample.
Probable Where laboratory capacity not well established:
Probable (At primary health care level) Positive by two different rapid diagnostic tests could be considered
Suspect case with any two of the following: as laboratory confirmed case.
Calf tenderness
Cough with or without hemoptysis Guidelines for Prevention and Control of
Jaundice
Leptospirosis: National Institute of Communicable
Hemorrhagic manifestations
Meningeal irritation Diseases (Zoonosis Division) 20069
Anuria/oliguria and/or proteinuria This includes only two categories viz. suspect and confirmed. A
Breathlessness confirmed case is a suspect case with positive laboratory report.
26
Section 1 Chapter 7 Indian Guidelines for the Diagnosis and Management ...
27
Infectious Diseases Section 1
28
Section 1 Chapter 7 Indian Guidelines for the Diagnosis and Management ...
13. Shivakumar S, Krishnakumar B. Diagnosis ofLeptospirosisRole of 26. Shekatkar S, Acharya NS, Harish BN, et al. Comparison of an in-house
MAT. J Assoc Phys India. 2006;54:338-9. latex agglutination test with IgM ELISA and MAT in the diagnosis of
14. Kamath SA, Joshi SR. Re-emerging of infections in urban IndiaFocus leptospirosis. Indian J Med Microbiol. 2010;28(3):238-40.
Leptospirosis. J Assoc Phys India. 2003;51:247-8. 27. Shekatkar S, Harish BN, Parija SC. Diagnosis of Leptospirosis by Polymerase
15. Takao Toyokawa, Makoto Ohnishi, Nobuo Koizumi. Diagnosis of acute Chain Reaction. Intern J Pharma Bio Sci. 2010;1(3):1-6.
leptospirosis. Expert Rev Anti Infect Ther. 2011;9(1):111-21. 28. Baburaj P, Nandakumar VS, Khanna LV. PCR in the diagnosis of
16. Peter George. Two uncommon manifestations of leptospirosis: Sweets leptospiral infection. J Assoc Phys India. 2006;54:339-40.
syndrome and central nervous system vasculitis. Asian Pacific J Trop 29. Srinivas R, Agarwal R, Gupta D. Severe sepsis due to severe Falciparum
Med. 2011;83-84. Malaria and leptospirosis co-infection treated with activated Protein C.
17. Shivaraj B, Anithraj RB, Bayari R. A study on prophylactic doxycycline Malaria J. 2007;6:42.
to reduce the incidence of leptospirosis among paddy field farmers in 30. Loganathan N, Sudha R, Ravishankar D, et al. Co-infection of Malaria
a coastal district of India. 15th International Congress on Infectious and LeptospirosisA Hospital Based Study from South India. Nat J Res
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Microbiol. 2006;24:320-2 Leptospirosis and Dengue in Mumbai, India, 2002. J Trop Pediatr.
22. Sehgal SC, Vijayachari P, Sugunan AP, et al. Field application of Lepto 2005;51:174-81.
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2003;52:897-901. in the tropics: co-infection of malaria and leptospirosis. J Infect
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