Introduction of a rapid dipstick assay for the detection of Leptospira-specific immunoglobulin m antibodies in the laboratory diagnosis of leptospirosis in a hospital in Makassar, Indonesia.

An easy, rapid and robust dipstick assay for detection of leptospira-specific immunoglobulin M (IgM) antibodies was evaluated on 403 patients admitted for hospitalization because of fever. The clinical symptoms and signs of 35 patients were consistent with leptospirosis. The final diagnosis for the remaining patients was as follows: 136 with typhoid fever, 82 with hepatitis, 74 with malaria, 48 with infections of the respiratory tract, and 20 with fever of unknown origin. The clinical diagnosis of leptospirosis was confirmed for 24 (68.6%) patients by the combined results of the microscopic agglutination test (MAT), the reference test for leptospirosis, and of IgM ELISA, a standard laboratory test for the serodiagnosis of leptospirosis. In addition, serum specimens from 8 (2.2%) patients with a final clinical diagnosis other than leptospirosis were found to be positive in MAT and/or IgM ELISA. Compared with the results of MAT and IgM ELISA a sensitivity of 91.6% and specificity of 93.6% was calculated for the dipstick assay. Most of the serum samples from the laboratory confirmed patients gave a moderate to strong staining intensity of the antigen band of the dipstick and were easy to read. The results demonstrate that the dipstick assay is convenient to use and allows the rapid and accurate confirmation of patients with clinical suspicion of leptospirosis in areas where the disease is endemic.

Aetiological assessment of congenital cataract

Most of the theories attribute congenital cataract to hereditary, idiopathic metabolic and systemic diseases. In a trial to clarify the situation, 40 children presenting with cataract were studied. This work was designed to explain various etiological factors and to identify the common risk factors for its occurrence. Complete medical and ophthalmic evaluation in addition to laboratory investigation [rubella and toxoplasma IgG and IgM titer, aminogram, reducing substances in urine] were done. 80% of the cases had bilateral congenital cataract, while 20% had unilateral cataract. History of exposure to maternal infection was present in 30% of cases. 50% of cases had associated neurological abnormalities in the form of spastic diplegia, spastic paraplegia, cranial nerve affection and mental retardation. The study showed that the two commonest causative factors were familial cataract and congenital infection, especially rubella eye disease in the cases. Other metabolic diseases and perinatal risk factors, especially prematurity and anoxia, were of less importance. Most of these congenital cataracts were potentially remediable. Genetic cause through genetic counseling, congenital rubella infection through investigation of susceptible mothers and better care of preterm infants as well as good communication between ophthalmologist and the pediatrician is the appropriate way to reduce the number of cases