Evaluation Of Diagnostic Utility Of Modified Faine’s Criteria In Leptospirosis- Experience From A Tertiary Care Hospital.

ABSTRACT

Abstracts Background & Objective: Leptospirosis is an emerging infectious disease, for the diagnosis of which clinical, epidemiological and laboratory parameters may be evaluated as per modidified Faine’s criteria suggested by several authors. The objective of this study was to validate the utility of modified Faine’s criteria in the diagnosis of leptospirosis. Methodology: This study was carried out at a tertiary care hospital in Bengaluru, India from January 2011 to April 2012. Blood, urine and paired sera from one hundred patients with clinical suspicion of leptospirosis were collected. Relevant clinical and epidemiological details of these patients were also obtained as per modified Faine’s criteria. Blood and urine samples of these patients were subjected to Dark Field Microscopy (DFM) and culture, whereas, their sera were subjected to Immuno chromatography (IgM Leptocheck), IgM Enzyme Linked Immuno Sorbent Assay (IgM ELISA) and Macroscopic Slide Agglutination Test (MSAT). All the leptospira seropositive samples were subjected to Microscopic Agglutination Test (MAT) which was also used as the gold standard to validate all the aforementioned serological tests and modified Faine’s criteria. Results: Positive Predictive Values (PPV) of all the aforementioned serological screening tests and modified Faine’s criteria were calculated. PPV of IgM Leptocheck, MSAT, IgM ELISA and modified Faine’s criteria were found to be 14.3%, 6.5%, 8.7% and 21% respectively. Conclusion: The diagnosis of leptospirosis (both laboratory & clinical) is an uphill task. A high index of suspicion is needed in endemic areas & leptospirosis must be considered when a patient presents with acute onset of fever, headache & myalgia. From the results obtained in our study, it seems that modified Faine’s criteria may not be as useful a diagnostic tool as it has traditionally been thought to be. More studies should be carried out to evaluate its diagnostic utility.