Estimating the burden of leptospirosis in Sri Lanka; a systematic review

Abstract

BackgroundAlthough the assessment of disease burden should be a priority for allocating resources, leptospirosis is grossly underestimated despite its true burden in Sri Lanka. This study aimed to assess the morbidity and mortality of leptospirosis based on routine surveillance data, hospital reported data and scientific publications from Sri Lanka.MethodA systematic review was carried out, and Pub Med, MEDLINE®, BIOSIS Previews, Zoological Record, Web of Science Core Collection, Current Contents Connect, KCI-Korean Journal Database, BIOSIS Citation Index, Data Citation Index, SciELO Citation Index and Google Scholar databases were searched. Quarterly epidemiological bulletin (QEB), indoor morbidity & mortality returns (IMMR) and hand searches of local literature were performed in local libraries. Forty-two relevant full texts, 32 QEBs, and 8 IMMR were included in the full text review. Adjustments were made for under diagnosis, underreporting and chance variability.ResultsThe estimated annual caseload of leptospirosis in Sri Lanka from 2008 to 2015, was 10,423, and the cumulative annual incidence of leptospirosis that required hospitalization was 52.1 (95% CI 51.7–52.6) per 100,000 people. The estimated number of annual deaths due to leptospirosis was approximately 730 (95% CI 542–980), with an estimated pooled case fatality ratio of 7.0% (95% CI 5.2–9.4). The most common organs involved were the kidney, liver and heart, with median rates of 48.7, 30, and 14.2%, respectively.ConclusionOur systematic review shows gross underestimation of the true leptospirosis burden in the national statistics of Sri Lanka, and the hospitalization rates estimated in our study were compatible with the total burden estimate of 300·6 (95% CI 96·54–604·23) per 100,000 people published previously.Electronic supplementary materialThe online version of this article (10.1186/s12879-018-3655-y) contains supplementary material, which is available to authorized users.

Farmers’ occupational health, perception and practices towards leptospirosis: A cause for concern

“…A recent systematic review of the burden of leptospirosis in Sri Lanka showed that the disease is grossly underestimated and the true burden of disease within the country is cannot be ascertained due to lack of accurate data reporting. 6 Since the disease is highly endemic and carries a high morbidity and mortality, it is imperative to investigate the knowledge, attitudes and practices regarding leptospirosis, and awareness regarding prevention of the disease among farmers who are the primary risk group.…”

Multilocus sequence typing reveals diverse known and novel genotypes of Leptospira spp. circulating in Sri Lanka

“…Leptospirosis is a re-emerging disease in Sri Lanka and has gained much attention since the large outbreak in 2008 [6]. A recent systematic review indicated that the cumulative annual incidence of leptospirosis that required hospitalization from 2008 to 2015 was 52.1 per 100,000 people, with an estimated case fatality ratio of 7.0% [7]. A wide array of new clinical entities such as pulmonary hemorrhage, pancreatitis, and myocarditis with high case fatality were seen in recent outbreaks [8][9][10][11].…”

Circulating microtranscriptome profiles reveal distinct expression of microRNAs in severe leptospirosis

“…Nearly 30% of severe, leptospirosis infections are severe and these patients usually require intensive care unit (ICU) admission [5][6][7][8], with a mortality rate as high as 40% [6]. These patients often developed kidney failure, liver failure, or cardiopulmonary failure, and required high level of care.…”