Leptospirosis as a still unknown and underappreciated disease.

DEAR EDITOR,

We read the paper by Agampodi et al., entitled “Do people Know Adequately about Leptospirosis? A Knowledge Assessment Survey in Post-outbreak Situation in Sri Lanka”[1] with great interest. First of all, we reach the manuscript by NCBI service of Pub-Med. In the conclusion section of the paper, as seen in the summary on Pub-Med, there is a statement “Although there is not adequate information on MDD prevalence in some areas of Iran, the overall current prevalence of MDD in the country is high and females are at the greater risk of disease”. According to us this statement is copied here from another paper inadvertently by miswriting or technical error etc. The (incorrect knowledge about) paper “Sadeghirad B et al., Epidemiology of major depressive disorder in Iran: a systematic review and meta-analysis. Int J Prev Med 2010 Spring;1:81-91” must be corrected immediately. Because Pub-Med is one of the most commonly used electronic library sources and one of the best important references for medical professionals and authors in the world.

We congratulate the authors due to represent their experiences in this survey study about leptospirosis cases which causes significant morbidities and even death due to the heavy rains in Sri Lanka, knowledge and attitudes to leptospirosis symptoms, reservoir and vectors, important risk factors, method for protection in different regions. According to the survey results, 14% of the subjects do not know the cardinal symptom of “fever” and 70% of the subjects do not know the symptoms of weakness, myalgia which may occur frequently in this disease. Another important point is, 97% of the subjects in the survey think that rats are the only vector for leptospirosis. But in fact most of the subjects do not know that the buffalo and cattle are also vectors for leptospirosis.[1]

This survey study reflects the knowledge, attitudes and manners of the study group about leptospirosis. But in fact, nowadays around the world, knowledge about leptospirosis is usually insufficient or wrong even among some healthcare professionals. Misinformation of “Jaundice is prerequisite for leptospirosis” is one of the most important one about leptospirosis. In reality, jaundice seems only in 5–10% of the patients with leptospirosis. This misinformation is one of the products of classical medical education and training.[2] Any leptospirosis case was not reported in our hospital (in Istanbul- TR), which is a third-step hospital, during the previous 20-year period. In 2005 we developed a form named as “leptospirosis diagnosis and follow-up form” to be able to catch probable leptospirosis cases. This form was composed of one sheet - two faces. This form includes important laboratory findings as well as pathognomonic clinical symptoms. After that form, 22 cases were diagnosed as leptospirosis in just six months, despite the fact that this diagnosis was never reported during the previous 20 years in the same hospital.[3]

Leptospirosis became an important disease as one of the leading causes (24-32%) of acute renal failure (ARF) in Thailand and Singapore[4] and nearly one-third of ARFs in India.[56] Leptospirosis with its common popularity and widespread reported diagnosis gained importance all over the world. For example, in India, not only infectious disease specialists but also respiratory disease specialists, ophthalmologists, internal medicine, nephrology, neurology, hepatology specialists and family practitioners’ agenda is occupied with that disease. Studies to develop vaccine and immune-biological studies against leptospirosis gained more importance in research centers. The reason for awareness of leptospirosis in India is heavy rains and flooding, chronic infrastructure problems, absence or poor sanitary sewerage, potable and utility water problems.[7-9]

In spite of developments, even in hyperendemic regions like Sri Lanka there is deficiency in people's knowledge and attitudes about leptospirosis. For example 60% of the people in Agampodi's study were not aware of chemoprophylaxis.[1] One of the most important results of this study is by Agombadi et al. denied effect of doxycycline which is the well known and agreed prophylaxis agent by healthcare professionals where from the “Panama channel experience” at 1984.[1011] It is obvious that we need at least more characterization and more studies to obtain the ideal prophylaxis agent and regimens regarding leptospirosis chemoprophylaxis.