S R Rathinam, Rajesh Vedhanayagi, Manoj Radhika, M S Balamurugan, K Balagiri, C Gowri Priya, G Jeya Kohila
{"title":"为什么医生会漏诊钩端螺旋体葡萄膜炎?新血清型的出现与诊断挑战。","authors":"S R Rathinam, Rajesh Vedhanayagi, Manoj Radhika, M S Balamurugan, K Balagiri, C Gowri Priya, G Jeya Kohila","doi":"10.1080/09273948.2023.2291477","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Leptospirosis is an endemic disease in India and uveitis is its late complication. Several Indian reports showed diversity of serovars, changing patterns and existence of new serovars. Failure to add new serovars in testing panel result in increased false-negativity in serology.</p><p><strong>Aim: </strong>To analyse seroprevalence, changing patterns and to discuss the resulting challenges in diagnosis.</p><p><strong>Methods: </strong>In this retrospective study covering the period from 1994 to 2020, we analysed data from laboratory records of patients diagnosed with leptospiral uveitis in South India. Microscopic agglutination Test (MAT) and/or Enzyme-Linked Immunosorbent Assay (ELISA) were performed on clinically diagnosed leptospiral uveitis cases from our hospital, as well as on systemic leptospirosis patients from government and private hospitals.</p><p><strong>Results: </strong>Out of a total of 87 216 new uveitis cases with varying causes over 27 years, 3,658 (4.1%) were clinically diagnosed as leptospiral uveitis. Among them, 1,268 (34.7%) patients were seropositive. In 1994, 92% of clinically diagnosed leptospirosis patients were seropositive in the MAT performed at the Centers for Disease Control and Prevention in Atlanta. However, the positivity rate gradually declined to 35% over the years. The predominant serovars identified were L. <i>autumnalis</i>, L. <i>icterohaemorrhagiae</i>, and L. <i>australis</i>. There were notable variations in the distribution of serovars over the years.</p><p><strong>Conclusions: </strong>The data suggest a declining sensitivity of MAT and ELISA, possibly due to the emergence of new serovars. Customizing the panel based on local isolates could enhance the performance of MAT. Critical need is the addition of advanced molecular techniques to improve the diagnosis.</p>","PeriodicalId":19406,"journal":{"name":"Ocular Immunology and Inflammation","volume":null,"pages":null},"PeriodicalIF":2.6000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Why do Doctors Miss the Diagnosis of Leptospiral Uveitis? 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Microscopic agglutination Test (MAT) and/or Enzyme-Linked Immunosorbent Assay (ELISA) were performed on clinically diagnosed leptospiral uveitis cases from our hospital, as well as on systemic leptospirosis patients from government and private hospitals.</p><p><strong>Results: </strong>Out of a total of 87 216 new uveitis cases with varying causes over 27 years, 3,658 (4.1%) were clinically diagnosed as leptospiral uveitis. Among them, 1,268 (34.7%) patients were seropositive. In 1994, 92% of clinically diagnosed leptospirosis patients were seropositive in the MAT performed at the Centers for Disease Control and Prevention in Atlanta. However, the positivity rate gradually declined to 35% over the years. The predominant serovars identified were L. <i>autumnalis</i>, L. <i>icterohaemorrhagiae</i>, and L. <i>australis</i>. 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引用次数: 0
摘要
目的:钩端螺旋体病是印度的地方病,葡萄膜炎是其晚期并发症。印度的一些报告显示了血清的多样性、模式的变化和新血清的存在。目的:分析血清流行率、变化模式并讨论由此带来的诊断挑战:在这项涵盖 1994 年至 2020 年的回顾性研究中,我们分析了南印度确诊为钩端螺旋体葡萄膜炎患者的实验室记录数据。我们对本院临床诊断的钩端螺旋体葡萄膜炎病例以及政府和私立医院的全身性钩端螺旋体病患者进行了显微凝集试验(MAT)和/或酶联免疫吸附试验(ELISA):结果:27年间,在87 216例不同病因的葡萄膜炎新病例中,有3658例(4.1%)被临床诊断为钩端螺旋体葡萄膜炎。其中,1268 名患者(34.7%)血清反应呈阳性。1994 年,在亚特兰大疾病控制和预防中心进行的 MAT 中,92% 的临床诊断为钩端螺旋体病的患者血清呈阳性。然而,多年来阳性率逐渐下降到 35%。鉴定出的主要血清型为秋淋球菌、冰血淋球菌和奥斯特淋球菌。多年来,血清型的分布存在明显差异:数据表明 MAT 和 ELISA 的灵敏度在下降,这可能是由于新血清型的出现。根据本地分离物定制检测板可提高 MAT 的性能。当务之急是增加先进的分子技术以改进诊断。
Why do Doctors Miss the Diagnosis of Leptospiral Uveitis? Emergence of New Serovars and Challenges in Diagnosis.
Purpose: Leptospirosis is an endemic disease in India and uveitis is its late complication. Several Indian reports showed diversity of serovars, changing patterns and existence of new serovars. Failure to add new serovars in testing panel result in increased false-negativity in serology.
Aim: To analyse seroprevalence, changing patterns and to discuss the resulting challenges in diagnosis.
Methods: In this retrospective study covering the period from 1994 to 2020, we analysed data from laboratory records of patients diagnosed with leptospiral uveitis in South India. Microscopic agglutination Test (MAT) and/or Enzyme-Linked Immunosorbent Assay (ELISA) were performed on clinically diagnosed leptospiral uveitis cases from our hospital, as well as on systemic leptospirosis patients from government and private hospitals.
Results: Out of a total of 87 216 new uveitis cases with varying causes over 27 years, 3,658 (4.1%) were clinically diagnosed as leptospiral uveitis. Among them, 1,268 (34.7%) patients were seropositive. In 1994, 92% of clinically diagnosed leptospirosis patients were seropositive in the MAT performed at the Centers for Disease Control and Prevention in Atlanta. However, the positivity rate gradually declined to 35% over the years. The predominant serovars identified were L. autumnalis, L. icterohaemorrhagiae, and L. australis. There were notable variations in the distribution of serovars over the years.
Conclusions: The data suggest a declining sensitivity of MAT and ELISA, possibly due to the emergence of new serovars. Customizing the panel based on local isolates could enhance the performance of MAT. Critical need is the addition of advanced molecular techniques to improve the diagnosis.
期刊介绍:
Ocular Immunology & Inflammation ranks 18 out of 59 in the Ophthalmology Category.Ocular Immunology and Inflammation is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and vision scientists. Published bimonthly, the journal provides an international medium for basic and clinical research reports on the ocular inflammatory response and its control by the immune system. The journal publishes original research papers, case reports, reviews, letters to the editor, meeting abstracts, and invited editorials.