Cargando…

Restructuring the Modified Faine's Criteria for the Diagnosis of Leptospirosis in Monsoon: A Study from South Gujarat

CONTEXT: Clinical and epidemiological variables in the modified Faine's criteria offered low validity in our study setting. AIMS: Restructuring and validating modified Faine's criteria for leptospirosis to better suit health scenario of south Gujarat. SUBJECTS AND METHODS: Clinical, epidem...

Descripción completa

Detalles Bibliográficos
Autores principales: Samudyatha, U. C., Chaudhari, Vipul, Chauhan, Naresh, Damor, Rahul, Kosambiya, J. K., Munshi, Rikita
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer - Medknow 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6985959/
https://www.ncbi.nlm.nih.gov/pubmed/32029982
http://dx.doi.org/10.4103/ijcm.IJCM_180_19
_version_ 1783491882752409600
author Samudyatha, U. C.
Chaudhari, Vipul
Chauhan, Naresh
Damor, Rahul
Kosambiya, J. K.
Munshi, Rikita
author_facet Samudyatha, U. C.
Chaudhari, Vipul
Chauhan, Naresh
Damor, Rahul
Kosambiya, J. K.
Munshi, Rikita
author_sort Samudyatha, U. C.
collection PubMed
description CONTEXT: Clinical and epidemiological variables in the modified Faine's criteria offered low validity in our study setting. AIMS: Restructuring and validating modified Faine's criteria for leptospirosis to better suit health scenario of south Gujarat. SUBJECTS AND METHODS: Clinical, epidemiological, and laboratory features of derivation cohort (1216 suspected leptospirosis cases) admitted at a tertiary care hospital of south Gujarat (2007–2015) that significantly correlated with confirmed leptospirosis were used in binary logistic regression to derive scoring models and receiver operating characteristic to determine cutoff values. Validity and net reclassification improvement (NRI) were estimated in validation cohort (82 cases, 2016–2017) and algorithm for diagnosis was prepared. RESULTS: Screening model consisted of the presence of conjunctival suffusion, calf tenderness, raised serum creatinine, headache with conjunctival suffusion and/or jaundice, and dyspnea/meningism. Area under curve (AUC) for screening model was 0.590 (standard error [SE] ±0.017) and cutoff score ≥9 gave sensitivity 79.16%, specificity 50%. The confirmatory model consisted of laboratory parameters, namely polymerase chain reaction, immunoglobulin M ELISA, and microscopic agglutination test and gave AUC 0.998 (SE ± 0.001), sensitivity 89.58%, specificity 85.29%, positive predictive value 89.58%, and negative predictive value 85.29% at cutoff score ≥100. Net sensitivity of algorithm was 98.27% at the point of screening (screening model and rapid test) and net specificity 87.89% at the point of confirmation (screening followed by confirmatory model) in validation cohort. CONCLUSIONS: Simultaneous use of screening model and rapid test gave NRI 81.25% and sequential use of confirmatory test gave NRI 47.18% compared to corresponding parts of the modified Faine's criteria.
format Online
Article
Text
id pubmed-6985959
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Wolters Kluwer - Medknow
record_format MEDLINE/PubMed
spelling pubmed-69859592020-02-06 Restructuring the Modified Faine's Criteria for the Diagnosis of Leptospirosis in Monsoon: A Study from South Gujarat Samudyatha, U. C. Chaudhari, Vipul Chauhan, Naresh Damor, Rahul Kosambiya, J. K. Munshi, Rikita Indian J Community Med Original Article CONTEXT: Clinical and epidemiological variables in the modified Faine's criteria offered low validity in our study setting. AIMS: Restructuring and validating modified Faine's criteria for leptospirosis to better suit health scenario of south Gujarat. SUBJECTS AND METHODS: Clinical, epidemiological, and laboratory features of derivation cohort (1216 suspected leptospirosis cases) admitted at a tertiary care hospital of south Gujarat (2007–2015) that significantly correlated with confirmed leptospirosis were used in binary logistic regression to derive scoring models and receiver operating characteristic to determine cutoff values. Validity and net reclassification improvement (NRI) were estimated in validation cohort (82 cases, 2016–2017) and algorithm for diagnosis was prepared. RESULTS: Screening model consisted of the presence of conjunctival suffusion, calf tenderness, raised serum creatinine, headache with conjunctival suffusion and/or jaundice, and dyspnea/meningism. Area under curve (AUC) for screening model was 0.590 (standard error [SE] ±0.017) and cutoff score ≥9 gave sensitivity 79.16%, specificity 50%. The confirmatory model consisted of laboratory parameters, namely polymerase chain reaction, immunoglobulin M ELISA, and microscopic agglutination test and gave AUC 0.998 (SE ± 0.001), sensitivity 89.58%, specificity 85.29%, positive predictive value 89.58%, and negative predictive value 85.29% at cutoff score ≥100. Net sensitivity of algorithm was 98.27% at the point of screening (screening model and rapid test) and net specificity 87.89% at the point of confirmation (screening followed by confirmatory model) in validation cohort. CONCLUSIONS: Simultaneous use of screening model and rapid test gave NRI 81.25% and sequential use of confirmatory test gave NRI 47.18% compared to corresponding parts of the modified Faine's criteria. Wolters Kluwer - Medknow 2020 /pmc/articles/PMC6985959/ /pubmed/32029982 http://dx.doi.org/10.4103/ijcm.IJCM_180_19 Text en Copyright: © 2020 Indian Journal of Community Medicine http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Original Article
Samudyatha, U. C.
Chaudhari, Vipul
Chauhan, Naresh
Damor, Rahul
Kosambiya, J. K.
Munshi, Rikita
Restructuring the Modified Faine's Criteria for the Diagnosis of Leptospirosis in Monsoon: A Study from South Gujarat
title Restructuring the Modified Faine's Criteria for the Diagnosis of Leptospirosis in Monsoon: A Study from South Gujarat
title_full Restructuring the Modified Faine's Criteria for the Diagnosis of Leptospirosis in Monsoon: A Study from South Gujarat
title_fullStr Restructuring the Modified Faine's Criteria for the Diagnosis of Leptospirosis in Monsoon: A Study from South Gujarat
title_full_unstemmed Restructuring the Modified Faine's Criteria for the Diagnosis of Leptospirosis in Monsoon: A Study from South Gujarat
title_short Restructuring the Modified Faine's Criteria for the Diagnosis of Leptospirosis in Monsoon: A Study from South Gujarat
title_sort restructuring the modified faine's criteria for the diagnosis of leptospirosis in monsoon: a study from south gujarat
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6985959/
https://www.ncbi.nlm.nih.gov/pubmed/32029982
http://dx.doi.org/10.4103/ijcm.IJCM_180_19
work_keys_str_mv AT samudyathauc restructuringthemodifiedfainescriteriaforthediagnosisofleptospirosisinmonsoonastudyfromsouthgujarat
AT chaudharivipul restructuringthemodifiedfainescriteriaforthediagnosisofleptospirosisinmonsoonastudyfromsouthgujarat
AT chauhannaresh restructuringthemodifiedfainescriteriaforthediagnosisofleptospirosisinmonsoonastudyfromsouthgujarat
AT damorrahul restructuringthemodifiedfainescriteriaforthediagnosisofleptospirosisinmonsoonastudyfromsouthgujarat
AT kosambiyajk restructuringthemodifiedfainescriteriaforthediagnosisofleptospirosisinmonsoonastudyfromsouthgujarat
AT munshirikita restructuringthemodifiedfainescriteriaforthediagnosisofleptospirosisinmonsoonastudyfromsouthgujarat