Abstract:
Objective: To determine the clinical presentations and disease outcomes of suspected and
confirmed cases of leptospirosis from 3 high endemic districts of Sri Lanka, during outbreaks
reported between 2013 and 2017.
Methods: The retrospective multi-center study was carried out during 2013-2017 in 5 selected
hospitals representing 3 high endemic districts in Sri Lanka. Clinically suspected leptospirosis
patients were recruited according to the Communicable Disease Epidemiology Profile Sri
Lanka, WHO. Leptospirosis was confirmed by either single microscopic agglutination test titre
1: 400 or by positive polymerase chain reaction (PCR) test result.
Results: Out of 372 clinically suspected cases, 29.00% were confirmed as leptospirosis cases
by either microscopic agglutination test (50.00%) or positive polymerase chain reaction
(52.77%) and 12.90% were presumptively identified as leptospirosis. Clinical symptoms
(headache, vomiting, jaundice and dyspnoea) and variations in haematological parameters
(haemoglobin, platelet count) and biochemical parameters (serum creatinine, serum urea,
serum bilirubin and C-reactive protein) were associated with confirmed leptospirosis (P<0.05).
Acute kidney injury, meningitis, myocarditis, pulmonary haemorrhage and acute liver failure
was seen among 21.30%, 12.04%, 6.48%, 6.48%, 5.56%, respectively with 4.63% fatality
among the leptospirosis confirmed patients. The sensitivity, specificity, positive predictive
value and negative predictive value of the case definition of Ministry of Health, Sri Lanka were
96.29%, 9.09%, 31.13%and 85.71%, respectively, when benchmarked against either positive
polymerase chain reaction or microscopic agglutination test as the gold standard.
Conclusions: Acute kidney injury is the predominant complication observed among the
leptospirosis confirmed patients. However, pulmonary haemorrhage is predominantly
associated with mortality. The case definition of Ministry of Health, Sri Lanka is found to have
higher sensitivity and enabled the screening of all probable cases of leptospirosis.
