Background Leptospirosis is a zoonotic infection occurring worldwide but endemic in tropical countries. This study describes diagnostic testing for leptospirosis at our institution in Scotland over a 10-year period. Method We identified patients with blood samples referred to the Public Health England reference laboratory for leptospirosis testing between 2006 and 2016. Results A total of 480 samples were sent for IgM ELISA testing with 26 positive results from 14 patients. Two patients met criteria for 'confirmed' leptospirosis (microscopic agglutination test > 1:320 in one case and a positive PCR in the other) and the remaining 12 were 'probable' on the basis of IgM ELISA positivity, though 9 did not have microscopic agglutination testing performed. Nine infections were imported, mostly from Asia and with a history of fresh water exposure. Three co-infections (respiratory syncytial virus, influenza B and Campylobacter sp.) were identified. Conclusions Practical issues with microscopic agglutination testing (insufficient blood sent to reference laboratory) and PCR (travellers returning > 7 days after illness onset) represent challenges to the laboratory confirmation of a clinical diagnosis of leptospirosis. Co-infection and infectious/auto-immune causes of false positive serology should be evaluated.

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BackgroundThe clinical signifi cances of small intestinal bacterial overgrowth (SIBO) in patients with bloating is still confl icting. Goal To evaluate the prevalence of SIBO in patients with bloating, and to assess the clinical characteristics according to the presence or subtypes of SIBO. Study The patients with abdominal bloating undergoing the lactulose breath test (LBT) were investigated to evaluate the prevalence and subtypes of SIBO. Rome III positive IBS and bowel symptoms were surveyed according to the presence or subtypes of SIBO. Results The prevalence of IBS and SIBO in the patients was 24.0% (86/358) and 37.4% (134/358), respectively. The prevalence and subtypes of SIBO were not different between the IBS and non-IBS patients. Among the 134 SIBO positive (+) patients, 79 (59.0%), 31 (23.1%), 24 (17.9%) were in the SIBO (H 2 ) +, (CH 4 ) +, (both) + groups, respectively. The bloating score in the SIBO (H 2 ) + group was signifi cantly higher than that in the SIBO negative (−) group. The SIBO (CH 4 ) + group was older, and had higher scores of hard stool and strain than those of the SIBO − group. In the fasting SIBO (H 2 ) + group (n = 32) diagnosed by increased baseline H 2 , the scores for bloating and fl atus were higher than those for the SIBO (H 2 ) + or SIBO − groups. Conclusions SIBO is associated with patients with a predominance of bloating regardless of IBS. The subtypes of SIBO by the gas pattern and fasting H 2 using the LBT may have effects on the characteristic bowel symptoms.

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