ICMR to begin research on leptospirosis to help early diagnosis & timely treatment

In order to improve the understanding of the disease to facilitate early diagnosis and timely treatment, the Indian Council of Medical Research (ICMR) will soon begin research on leptospirosis, which is emerging as a serious public health problem in India. The research will focus on Understanding risk factors and clinical spectrum and of leptospiral infections in the country; KAP studies on risk factors and using KAP as parameter of impact evaluation of intervention programmes; understanding association of infecting serovars with clinical manifestations; virulence factors in leptospira especially those causing pulmonary manifestations; efficacy of pre- and post- exposure chemoprophylaxis in endemic areas; understand the factors that lead to variable case fatality rate across the country; evaluate commercially available diagnostic kits using a pool of samples obtained from states; and copare the existing diagnostic tests to identify gold standard for diagnostic test evaluations in relation to first and second week of fever. The study will also focus on Improving upon PCR and antigen detection tests in blood during first week of fever; standardize clinical and laboratory diagnostic criteria to make data across states comparable; evaluate immuno-fluorescence as a diagnostic tool during early phase of disease and improvements in existing immunofluorescence techniques and materials; development and evaluation of serological tests, including screening tests for use with sera from domestic livestock and other animals; immunoglobulin classes of leptospiral antibodies in man and various animals; and understanding the roles of leptospiral and host factors in the pathogenesis and manifestations of leptospiral infection and their utility as biomarker for early detection. The initiative of the ICMR in this regard is of great significance as the disease, which was confined to Andaman and Nicobar Islands and a few Southern States, has shown a rapid rise in other parts of the country, including northern states. Senior ICMR officials said that several outbreaks have been reported from Tamilnadu, Kerala, Maharashtra and Gujarat during the past few years. Heavy rainfall and the resulting flashfloods often trigger outbreaks. Timely diagnosis and specific therapy can reduce severity of illness and mortality. The majority of patients are usually from a rural background. Poor hygiene, contact with animals, rat infestation of houses, and contact with stagnant dirty water are the major determinants of disease. Leptospirosis is often not suspected by physicians in patients with acute febrile illnesses reporting from supposedly “non-endemic areas,” including north India. Morbidity and mortality reduction depends on early case detection and initiation of specific therapy. But there is difficulty in clinically distinguishing leptospirosis from other infectious diseases such as dengue, malaria, viral haemorrhagic fevers and viral hepatitis making early case detection rather unrealistic unless good laboratory support is available. Hence there is an urgent need for reliable diagnostics for Leptospirosis in the country. As of now the majority of clinical cases are confirmed using serological tests. Paired sera have to be obtained since antibodies may not appear early in the disease and seroconversion may take as long as 30 days. The reference standard serological test is the MAT (microagglutination test) which allows for the detection of the infecting serogroup. The panel of antigens in MAT must reflect the prevalent serogroups in the country. Late suspicion among primary level physicians, nonavailability of appropriate rapid diagnostic tests and the resulting inappropriate therapy leads to severe complications resulting in high mortality.

Source:Pharmabiz