Indian Journal of Medical Microbiology Medknow Publications on behalf of Indian Association of Medical Microbiology ISSN: 0255-0857 EISSN: 1998-3646 Vol. 29, Num. 4, 2011, pp. 444-445

Indian Journal of Medical Microbiology, Vol. 29, No. 4, October-December, 2011, pp. 444-445

Correspondence

Spectrum of Leptospira species identified in patients with leptospiral uveitis in an ophthalmological institute in South India

V Batmanabane¹, GP Chidambaranathan², S Rathinam¹

¹ Departments of Ophthalmology, Head of Uveitis Service, Aravind Eye Hospital and PG Institute of Ophthalmology, Madurai 625 020, Tamil Nadu, India
² Departments of Immunology and Cell Biology, Aravind Medical Research Foundation, Dr. G. Venkataswamy Eye Research Institute, 1, Anna Nagar, Madurai 625 020, Tamil Nadu, India
Correspondence Address: V Batmanabane, Departments of Ophthalmology, Head of Uveitis Service, Aravind Eye Hospital and PG Institute of Ophthalmology, Madurai 625 020, Tamil Nadu, India, vaishb@gmail.com

Date of Submission: 10-May-2011
Date of Acceptance: 20-Jul-2011

Code Number: mb11111

PMID: 22120817
DOI: 10.4103/0255-0857.90198

Dear Editor,

Leptospiral uveitis is a common long-term complication of leptospirosis with an incidence of 3 to 92%. ^[1] Most cases of uveitis occur in the disease′s immune phase. ^[2],[3] Our retrospective study aimed at studying the serological prevalence of leptospirosis among patients presenting with leptospiral uveitis and noting any association with final visual outcome.

Records of 107 patients presenting to our uveitis services with characteristic clinical features of leptospiral uveitis ^[2] and confirmed to have leptospirosis using the MAT, the gold standard for leptospirosis diagnosis, ^[4] were studied. Serum samples had been tested with the genus-specific MAT using a panel of 20 serovars obtained from the Royal Tropical Institute (KIT), Amsterdam, The Netherlands. Patients′ vision was assigned scores at presentation and at final visit-lower scores for poorer and higher scores for better vision. Proportions were compared with Chi square test using SPSS 16.0 for Windows.

[Table - 1] shows the distribution of Leptospira serovars. Mixed infections were nearly as common (48.5%) as infections with single organisms (50.4%). L. interrogans serovar Australis had the highest overall incidence (35%), both in patients with a good visual outcome (42.6%) and those with poor final vision (85.7%), at final follow up (P=0.113, considered not significant). 92.5% (99) of the affected 107 eyes had good final vision.

Our study establishes that the most prevalent serovar still remains L. interrogans serovar Australis, 11 years after the initial report ^[2] from the population in this geographical location. Since most patients do not present to the ophthalmologist in the acute phase of leptospirosis, the etiology of uveitis is chiefly established by ocular clinical signs ^[2] and serology, but for the patient, vision recovery is the primary concern. Although visual recovery in leptospiral uveitis is reportedly good, ^[5] the visual outcome of patients and serological characteristics have not been correlated. Thus, an attempt at visual prognostication based on number and type of infecting serovars was also attempted in this study. Our study suggests that visual outcome is not linked to the number or type of infecting serovars, although several confounding factors like the treatment regime followed, complications of uveitis, etc., probably influenced the final visual outcome. A more targeted investigation will facilitate to establish if specific serovars result in a worse visual outcome in leptospiral uveitis.

References

1.	Feigin RD, Anderson DC. Human Leptospirosis. CRC Crit Rev Clin Lab Sci 1975;5:413-67.  Back to cited text no. 1  [PUBMED]
2.	Chu KM, Rathinam R, Namperumalsamy P. Identification of Leptospira species in the pathogenesis of uveitis and determination of clinical ocular characteristics in south India. J Infect Dis 1998;177:1314-21.  Back to cited text no. 2
3.	Priya CG, Rathinam SR, Muthukkaruppan V. Evidence for endotoxin as a causative factor for leptospiral uveitis in humans. Invest Ophthalmol Vis Sci 2008;49:5419-24.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.	Shukla D, Rathinam SR, Cunningham ET Jr. Leptospiral uveitis in the developing world. Int Ophthalmol Clin. 2010;50:113-24.  Back to cited text no. 4
5.	Pappachan JM, Mathew S, Thomas B, Renjini K, Scaria CK, Shukla J. The incidence and clinical characteristics of the immune phase eye disease in treated cases of human leptospirosis. Indian J Med Sci 2007;61:441-7.  Back to cited text no. 5  [PUBMED]

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