RESUMEN
Purpose: Leptospirosis is a waterborne zoonotic disease that primarily causes systemic illness, followed by uveitis. After heavy flooding in Madurai district, an epidemic outbreak of systemic and ocular leptospirosis occurred in 1994. Our data shows a transition to endemicity after each epidemic. Aim: The aim of this study is to report the clinical signs, epidemic outbreaks, and persistent endemicity of leptospiral uveitis, as well as the diagnostic dilemmas associated with it. Methods: A retrospective analysis of clinical signs was conducted using medical records of leptospiral uveitis patients over a period of 27 years (1994–2020) in a tertiary care eye hospital. The clinical workup of uveitis included a detailed clinical history, systemic, and ophthalmic examination. Microagglutination tests (MATs) was done at the Centers for Disease Control and Prevention (CDC) in Atlanta and later in our regional laboratory. Serum samples were collected from human systemic leptospirosis cases and a small group of animals in and around Madurai. Results: The first epidemic outbreak resulted in 200 seropositive patients. Subsequent epidemic outbreaks occurred in 1997, 1998, 2001, 2005, and 2012, with Madurai experiencing multiple outbreaks. However, the disease remained endemic, with 25–50 patients being observed per year in between the peaks. Ocular examination revealed acute non?granulomatous uveitis (94.9%), pan uveitis (59.8%), vitreous inflammatory reaction (55.4%), retinal vasculitis (29.5%), disc hyperemia (20.9%), and hypopyon. (16.2%). New serovars emerged every year, resulting in decreased sensitivity of the MAT. Over time, the MAT started to miss diagnoses. Conclusion: The persistent endemicity of leptospiral uveitis emphasizes the need for accessible diagnostic tests. The low performance of the MAT can be attributable to the use of an older panel. The incorporation of new isolates in the MAT by a national laboratory will improve the accuracy of diagnosis
RESUMEN
Purpose: Uveitis is an important complication of systemic leptospirosis that can occur months to years after systemic infection. The gold standard technique Microscopic Agglutination Test (MAT) is less sensitive and more complicated. All the commercial kits currently available are for early detection of acute systemic leptospiral infection. The purpose of this study is to evaluate the efficiency of two commercial kits in serodiagnosis of leptospiral uveitis, which is a late manifestation. Materials and Methods: Serum samples from leptospiral uveitis patients 20 MAT positive, 20 MAT negative, 15 non-leptospiral uveitis patients, 20 systemic leptospiral infected patients and 21 controls were selected. These samples were tested for the presence of leptospiral IgM antibodies by (i) MAT using a panel of 20 serovars, (ii) LEPTO IgM MICROLISA (J.Mitra & Co.Pvt. Ltd, India) and (iii) Leptocheck (Zephyr Biomedicals, India). The statistical analysis was carried out using stata 11.0. Results: Total of 96 samples were tested with two commercial kits, Lepto IgM MICROLISA and Leptocheck. The sensitivity and specificity of Lepto IgM MICROLISA was 60% and 55% and Leptocheck was 80% and 59% respectively in comparison to MAT. In comparison to clinical diagnosis the sensitivity of IgM Microlisa was 55%, Leptocheck 70% and specificity of IgM MICROLISA was 58.33% and leptocheck was 69.44%. Conclusion: Commercial kits though sensitive and specific for systemic leptospirosis, have limited diagnostic capacity for leptospiral uveitis. Therefore it is essential to develop an inhouse serodiagnostic method specific for leptospiral uveitis patients using local leptospiral isolates.