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. 2024 Jun 1;72(6):869-877.
doi: 10.4103/IJO.IJO_1376_23. Epub 2024 Mar 8.

Utility of demographic and clinical signs as diagnostic predictors for leptospiral uveitis: A retrospective study

S R Rathinam  1 , Jeya G Kohila  2 , Balagiri K Sundar  3 , Chidambaranathan P Gowri  3 , Rajesh Vedhanayagi  3 , Manoj Radhika  3 , Venu Nadella  4
Affiliations

Utility of demographic and clinical signs as diagnostic predictors for leptospiral uveitis: A retrospective study

S R Rathinam et al. Indian J Ophthalmol. .

Abstract

Purpose: Leptospirosis is a waterborne zoonotic disease prevalent in tropical regions, causing significant morbidity and mortality. It can involve any organ in its primary stage, and uveitis is its late complication. While advanced laboratory diagnosis is available only in tertiary care centers globally, a cost-effective bedside assessment of clinical signs and their scoring could offer a provisional diagnosis.

Aim: To analyze the diagnostic potential of demographic and clinical signs in a large cohort of serologically confirmed leptospiral uveitis patients.

Methods: In this retrospective study, demographic and clinical parameters of 876 seropositive leptospiral uveitis patients and 1042 nonleptospiral uveitis controls were studied. Multivariable logistic regression analysis with bootstrap confidence interval (CI) characterized the diagnostic predictors. The performance of the model was evaluated using the area under the receiver operating curve (AUROC).

Results: Presence of nongranulomatous uveitis (odds ratio [OR] = 6.9), hypopyon (OR = 4.6), vitreous infiltration with membranous opacities (OR = 4.3), bilateral involvement (OR = 4), panuveitis (OR = 3.3), vasculitis (OR = 1.9), disc hyperemia (OR = 1.6), absence of retinochoroiditis (OR = 15), and absence of cystoid macular edema (OR = 8.9) emerged as predictive parameters. The AUROC value was 0.86 with 95% CI of 0.846-0.874. At a cut-off score of 40, the sensitivity and specificity were 79.5 and 78.4, respectively.

Conclusion: The study demonstrates that ocular signs can serve as diagnostic predictors for leptospiral uveitis, enabling primary care ophthalmologists to make bedside diagnosis. This can be further confirmed by laboratory methods available at tertiary care centers.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Total number of patients and controls recruited over 27 years
Figure 2
Figure 2
Various clinical signs in leptospiral uveitis. (a) Unilateral leptospiral cataract in a young female. (b) Pearly white cataract with hypopyon. (c) Absorbing cataract. (d) Vitreous membranes and disc hyperemia. (e) Vitreous membranes above and vitreous exudates below. (f) Retinal vasculitis and vitreous membranes
Figure 3
Figure 3
Receiver operating characteristic curve in diagnostic prediction of leptospiral uveitis using scores
See this image and copyright information in PMC

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