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Leptospirosis in Northeastern Malaysia: Misdiagnosed or Coinfection?

Background: For the past decade leptospirosis has been re-emerging as an important disease and can be a serious public health issue in a humid tropical and subtropical country such as Malaysia. Leptospirosis also known as “the Great Mimicker” and may be overlooked and under diagnosed due to its varied clinical presentations.

Objective: Since leptospirosis is a significant cause of undifferentiated fever and frequently not recognized, this study was conducted to determine the prevalence of this disease among febrile patients in northeastern Malaysia hospitals.

Design: A hospital-based cross sectional study was conducted among 999 of febrile patients admitted in 10 hospitals in northeastern Malaysia.

Materials and methods: An interviewer-guided proforma sheet on sociodemographic and final hospital diagnosis data was distributed to all adult patients with fever on admission. Serum sample for leptospirosis was screened by IgM Enzyme-linked Immunosorbent Assay test (IgM ELISA) and confirmed by Microscopic Agglutination Test (MAT). The cut-off point for positive MAT was ≥1:400 titre in single acute specimen. Results: The seroprevalence of leptospirosis was 8.4% (95% CI: 6.8, 10.3) (n=84) by MAT. In our study, only 31.0% of the confirmed leptospirosis cases by MAT in northeastern Malaysia hospitals were diagnosed as leptospirosis for the final diagnosis on discharge. About 38.1%, 14.3% and 7.1% of the confirmed leptospirosis cases by MAT were diagnosed as dengue fever or dengue hemorrhagic fever, pneumonia and typhoid fever respectively.

Conclusion: This study showed that the prevalence of leptospirosis is probably high among febrile patients in northeastern Malaysia hospitals. Awareness and knowledge regarding this disease should be strengthened, especially among public and health care personnel due to the clinical symptoms of leptospirosis mimicking other tropical diseases.

Author(s): AA Noor Rafizah, BD Aziah , YN Azwany, M Kamarul Imran1, A Mohamed Rusli, S Mohd Nazri, I Nabilah, H Siti Asma, W M Zahiruddin, I Zaliha

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