title: Risk factors of leptospirosis among febrile hospital admissions in northeastern Malaysia.
abstract: BACKGROUND
  Leptospirosis is a worldwide zoonotic disease. Risk factors for the disease may vary among countries.
  
  
  OBJECTIVE
  This study was conducted to determine the risk factors of leptospirosis among febrile cases.
  
  
  METHODS
  A hospital-based cross-sectional study was conducted among 999 febrile patients admitted to 10 hospitals in northeastern Malaysia, from August 2010 to February 2011. An interviewer-guided proforma sheet on sociodemography, type of occupation and social history data was distributed to all adult patients with fever on admission. Serum sample for leptospirosis was screened by IgM Enzyme-linked Immunosorbent Assay (IgM ELISA) test and confirmed by Microscopic Agglutination Test (MAT). The cut-off point for positive MAT was ≥ 1:400 titer in single acute specimens.
  
  
  RESULTS
  Seroprevalence of leptospirosis was 8.4% (95% CI: 6.8, 10.3) (n=84/999) by MAT. Multiple logistic regression analysis showed that the high risk occupation group (OR: 1.95, 95% CI: 1.22, 3.13) (p=0.005) and history of recent recreational activity (OR: 2.36, 95% CI: 1.46, 3.85) (p<0.001) were significant associated factors for leptospirosis.
  
  
  CONCLUSIONS
  This study shows a relatively high seroprevalence of leptospirosis in northeastern Malaysia. Identification of high risk occupational group and history of recent recreational activity will help to increase the index of suspicion to diagnose leptospirosis among febrile inpatients due to its mimicking other common febrile illnesses in Malaysia.
authors.affiliation: Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Malaysia.
authors.forename: A A Noor
authors.initials: AA
authors.lastname: Rafizah
authors.forename: B D
authors.initials: BD
authors.lastname: Aziah
authors.forename: Y N
authors.initials: YN
authors.lastname: Azwany
authors.forename: M Kamarul
authors.initials: MK
authors.lastname: Imran
authors.forename: A Mohamed
authors.initials: AM
authors.lastname: Rusli
authors.forename: S Mohd
authors.initials: SM
authors.lastname: Nazri
authors.forename: A Mohd
authors.initials: AM
authors.lastname: Nikman
authors.forename: I
authors.initials: I
authors.lastname: Nabilah
authors.forename: H Siti
authors.initials: HS
authors.lastname: Asma'
authors.forename: W M
authors.initials: WM
authors.lastname: Zahiruddin
authors.forename: I
authors.initials: I
authors.lastname: Zaliha
mesh_terms: D000328:Adult; D000367:Age Factors; D003430:Cross-Sectional Studies; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005334:Fever / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007922:Leptospirosis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D016015:Logistic Models; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D016273:Occupational Exposure / Q000706:statistics & numerical data; D011998:Recreation; D012307:Risk Factors; D016036:Seroepidemiologic Studies; D012737:Sex Factors
keywords: Enzyme-linked Immunosorbent Assay; Leptospirosis; Microscopic Agglutination Test