ALAPPUZHA: Dr B. Padmakumar, who got a PhD from Kerala University the other day, claims the ‘score based’ guideline he developed can predict the early diagnosis of leptospirosis. The study, which lasted two years, was conducted on 389 patients including 110 leptospirosis cases. Now the head of the department (HoD) of medicine at the Government Medical College, Parippally, he started the research as serological tests by doctors at primary health centres (PHC) could not make early conclusions on diagnosis as the antibody titres swung into action in at least three weeks of the illness.
"At present, he said, infrastructure for conducting detailed investigations including culture, dark field microscopy and polymerase chain reaction is unavailable in the primary and secondary level hospitals." "So I did find the need for a simple and practical diagnostic criteria which can be utilised in both clinical features and epidemiological factors along with basic lab features predicting the early diagnosis." In a bid to achieve it, the study went on for last 24 months, largely investigating sociodemographic variables including gender, occupation, contact with animals and dirty waters and consumption of unboiled water.
"When I took a deep dive into active cases through the clinical examination, I did understand that abdominal pain, oliguria, jaundice, conjunctival congestion, subconjunctival haemorrhage, oedema, muscle tenderness, elevated jugular venous pressure (JVP), hepatomegaly tachypnoea and the absence of skin rashes and catarrhal symptoms were significant," he says. "Then I did a univariate analysis which had made me realise that albuminuria, leucocytosis, neutrophilia, lymphocytopenia, elevation of erythrocyte sedimentation rate (ESR), thrombocytopenia, deranged renal function, elevated serum bilirubin and liver enzymes, hypoproteinemia and hypoalbuminemia were too important."
"Regardless to say, he said, it was a breaking point. Leptospirosis was unique among other febrile illnesses. It inspired me to go through various guidelines prevailed in the world for its treatment. As a result, I realised the fact that clinicians should not wait for the results of serology testing before starting the treatment." Thus, he says, his study took to the idea of developing a ‘score based’ guideline to be set for local level medical practitioners.
"Upon the task, I gave strategic points or scores to each variable connected to the sociodemographic factors as per criteria (Faine’s) stipulated World Health Organisation (WHO). The scores were allocated to each variable as contact with dirty water-3, animal-3 and drinking unboiled water-4. “Under physical examination, conjunctival congestion-2 and muscle tenderness-2.
Under laboratory findings, leucocytosis-2, Neutrophilia-2, mild to moderate elevation of ESR-4, hiked Serum Glutamic- Oxaloacetic Transaminase (SGOT)-3. “With the total range of the variables marked as 25, the next task was the cutoff point. For that, I did the validation process one by one. When I reached 12, it gave the maximum specificity of (97.1 percent) sensitivity (96.4), positive predictive value (PPV- 93) and negative predictive value (NPV- 98.5). The total accuracy was 96.9.”
