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ORIGINAL ARTICLE Table of Contents   
Year : 2020  |  Volume : 45  |  Issue : 1  |  Page : 36-42
Restructuring the modified Faine's criteria for the diagnosis of leptospirosis in monsoon: A study from south Gujarat

Department of Community Medicine, Government Medical College, Surat, Gujarat, India

Correspondence Address:
Dr. U C Samudyatha
Department of Community Medicine, Government Medical College, Surat, Gujarat, India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijcm.IJCM_180_19

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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.

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  2007 - Indian Journal of Community Medicine | Published by Wolters Kluwer - Medknow
  Online since 15th September, 2007