Study protocol: characterising the clinical, epidemiological and aetiological aspects of leptospirosis in Sri Lanka: a hospital based clinico-epidemiological study

Agampodi, Suneth; Warnasekara, Janith; Jayasundara, Dinesha; Senawirathna, Indika; Gamage, Chandika D.; Kularatne, S.A.M.; Siribaddana, Sisira; Maththias, Michael; Vinetz, Joseph M.

doi:10.1136/bmjopen-2018-027850

Cited by 16 publications

(20 citation statements)

References 37 publications

(36 reference statements)

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“…The present study was embedded in a larger clinical-epidemiological study on leptospirosis, in Sri Lanka and the study protocol was published elsewhere [22]. Specific details related to Leptospira diversity and methods in brief are given here.…”

Section: Methodsmentioning

confidence: 99%

“…Physician-diagnosed probable or definite acute bacterial meningitis or lower respiratory tract infections (e.g., consolidated lobar pneumonia), traumatic or post-operative fever per physician discretion, fever owing to nosocomial infections, and any patient with confirmed diagnosis as a cause for the fever were excluded. Epidemiological data were collected from each patient using a fully structured, interviewer administered questionnaire which was described in detail in the study protocol paper published elsewhere[22]…”

Section: Methodsmentioning

confidence: 99%

“…The procedure for qPCR on clinical samples is described elsewhere in the published protocol paper[22]. Culture tubes were inspected for consecutive 4 months before reporting as negative.…”

Section: Methodsmentioning

confidence: 99%

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12 Novel Clonal Groups of Leptospira Infecting Humans in Multiple Contrasting Epidemiological Contexts in Sri Lanka

Jayasundara

Senewirathna

Warnasekara

et al. 2020

Preprint

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Leptospirosis is a ubiquitous disease and a major clinical challenge owing to the multitude of clinical presentations and manifestations that are possibly attributable to the diversity of Leptospira, the understanding of which is key to study the epidemiology of this emerging global disease threat. Sri Lanka is a hotspot for leptospirosis with high levels of endemic disease as well as annual epidemics. We carried out a prospective study of Leptospira diversity in Sri Lanka, covering the full range of climatic zones, geography, and clinical severity. Samples were collected for leptospiral culture from 1192 patients from 15 of 25 districts in Sri Lanka over two and half years period. Twenty-five isolates belonging to four pathogenic Leptospira species were identified: L. interrogans, L. borgpetersenii, L. weilii, and L. kirschneri. At least six serogroups were identified among the isolates: Autumnalis (6), Pyrogenes (4), Icterohaemorrhagiae (2), Celledoni (1), Grippotyphosa (2) and Bataviae (1). Seven isolates did not agglutinate using available antisera panels, suggesting new serogroups. Isolates were sequenced by Illumina. These data add 25 new core genome sequence types and were clustered in 15 clonal groups, including 12 new clonal groups. L. borgpetersenii was found only in the dry zone and L. weilii only in the wet zone. Acute kidney injury and cardiovascular involvement was seen only with L. interrogans infections. Thrombocytopenia and liver impairment were seen in both L. interrogans and L. borgpetersenii infections. The inadequate sensitivity of culture isolation to identify infecting Leptospira species underscores the need for culture-independent typing methods for Leptospira.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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12 Novel Clonal Groups of Leptospira Infecting Humans in Multiple Contrasting Epidemiological Contexts in Sri Lanka

Jayasundara

Senewirathna

Warnasekara

et al. 2020

Preprint

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“…International Publisher published elsewhere [3]. Samples for cultures were obtained from febrile patients who were clinically classified as 'probable' leptospirosis cases who presented at hospital, two from Karawanalla (FMAS_KW1 and FMAS_KW2), and one from Awissawella (FMAS_AW1).…”

Section: Ivyspringmentioning

confidence: 99%

Complete Genome Sequence of Leptospira interrogans Strains FMAS_KW1, FMAS_KW2 and FMAS_AW1 Isolated from Leptospirosis Patients from Karawanalla and Awissawella, Sri Lanka

Senavirathna¹,

Jayasundara²,

Lefler³

et al. 2020

J. Genomics

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Leptospirosis is an important cause of acute undifferentiated fever and complex multisystem febrile diseases in the tropics and subtropics. Understanding the evolution of Leptospira especially as related to the clinical pathogenesis of leptospirosis is facilitated by systematic comparative genomic analysis of human-infecting isolates. Here, we announce the complete genome sequences of three Leptospira strains that were isolated from blood of humans with undifferentiated fever in Sri Lanka.

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“…Samples were transported to the public health research laboratory of the Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka. Testing for leptospirosis was done using the microscopic agglutination test (MAT) and quantitative polymerase chain reaction, as previously published in the study protocol 12 .…”

Section: Participants and Data Collectionmentioning

confidence: 99%

Improving the leptospirosis disease burden assessment by including ambulatory patients from outpatient departments: a cross-sectional study

Warnasekara

Aberathna

Nanayakkara³

et al. 2020

F1000Res

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Background: In Sri Lanka, the disease burden of leptospirosis is estimated based on a routine notification system, which is predominated by patients ill enough to be hospitalized. The notification system does not function well with ambulatory patients in outpatient departments (OPDs). The objective of this study was to determine the prevalence of leptospirosis in an OPD setting in a regional public hospital in Sri Lanka to provide further estimation of disease burden estimations Methods: This study was conducted in the OPD of the Rathnapura Provincial General Hospital from August to September 2017. Suspected leptospirosis patients were recruited based on standardized criteria and tested using the microscopic agglutination test and quantitative polymerase chain reaction. The number of OPD patients was compared with the reported patient numbers with leptospirosis from the hospital during the same period as the denominator, and the 95% confidence interval was calculated for the proportions using Poisson distribution. Results: During the study period, of 2,960 fever patients presenting to the OPD, 33 (1.1%) were suspected to have leptospirosis; 8/33 suspected (22.3%) cases were confirmed as being due to leptospirosis. There were 82 notifications of leptospirosis cases from hospital inpatients during the same period, none from the OPD. The total missing proportion from the surveillance system was 28.6% (95% CI, 19.4-40.4%). Among OPD patients, 12 (36.4%) had been given antibiotics from a primary care center prior to the OPD visit. No OPD patient was admitted to the hospital for inward care. Conclusions: More than 25% of cases of leptospirosis were not identified because they were not sick enough to be admitted nor subjected to routine leptospirosis diagnostic testing. Antibiotics given without a specific, treatable diagnosis interferes with leptospirosis disease burden assessment. These data have public health implications if the sources of leptospirosis transmission are to be controlled.

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Study protocol: characterising the clinical, epidemiological and aetiological aspects of leptospirosis in Sri Lanka: a hospital based clinico-epidemiological study

Cited by 16 publications

References 37 publications

12 Novel Clonal Groups of Leptospira Infecting Humans in Multiple Contrasting Epidemiological Contexts in Sri Lanka

12 Novel Clonal Groups of Leptospira Infecting Humans in Multiple Contrasting Epidemiological Contexts in Sri Lanka

Complete Genome Sequence of Leptospira interrogans Strains FMAS_KW1, FMAS_KW2 and FMAS_AW1 Isolated from Leptospirosis Patients from Karawanalla and Awissawella, Sri Lanka

Improving the leptospirosis disease burden assessment by including ambulatory patients from outpatient departments: a cross-sectional study

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