{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T04:58:18Z","timestamp":1765601898431,"version":"3.48.0"},"reference-count":41,"publisher":"BMJ","issue":"9","funder":[{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["U19AI115658"],"award-info":[{"award-number":["U19AI115658"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2019,8,19]]},"published-print":{"date-parts":[[2019,9]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>\n                      Sri Lanka has one of the highest incidences of leptospirosis worldwide. We hypothesised that different geographical locations and patient context will have a distinct molecular epidemiology of leptospirosis, based on microgeographical characteristics related to regiona-specific\n                      <jats:italic>Leptospira<\/jats:italic>\n                      predominance. Our objective is to characterise the clinical, epidemiological and molecular aspects of leptospirosis in Sri Lanka to understand disease progression, risk factors and obtain isolates of\n                      <jats:italic>Leptospira<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>\n                      We designed a multicentre prospective study in Sri Lanka to recruit undifferentiated febrile patients and conduct follow-ups during hospital stays. Patients will be recruited from outpatient departments and medical wards. This study will be conducted at two main sites (Anuradhapura and Peradeniya) and several additional sites (Awissawella, Ratnapura and Polonnaruwa). Blood and urine will be collected from patients on the day of admission to the ward or presentation to the outpatient department. Bedside inoculation of 2\u20134 drops of venous blood will be performed with Ellinghausen-McCullough-Johnson-Harris (EMJH) semisolid media supplemented with antibiotics. Regionally optimised microscopic agglutination test, culture and qPCR-evidence will be performed to confirm the presence of\n                      <jats:italic>Leptospira<\/jats:italic>\n                      in blood which in turn will confirm the presence of disease. Whole genome sequencing will be carried out for all isolates recovered from patients. Multilocus sequence typing (MLST) will be used for the genotyping of new isolates. Sri Lankan isolates will be identified using three published MLST schemes for\n                      <jats:italic>Leptospira<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethical clearance for the study was obtained from Ethics Review Committees (ERC), Medicine and Allied Sciences (FMAS), Rajarata University of Sri Lanka (RUSL) and University of Peradeniya. All genomic data generated through this project will be available at GenBank. Anonymised data will be deposited at the ERC, FMAS, RUSL.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2018-027850","type":"journal-article","created":{"date-parts":[[2019,9,11]],"date-time":"2019-09-11T08:54:07Z","timestamp":1568192047000},"page":"e027850","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Study protocol: characterising the clinical, epidemiological and aetiological aspects of leptospirosis in Sri Lanka: a hospital based clinico-epidemiological study"],"prefix":"10.1136","volume":"9","author":[{"given":"Suneth","family":"Agampodi","sequence":"first","affiliation":[{"name":"Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janith","family":"Warnasekara","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dinesha","family":"Jayasundara","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Indika","family":"Senawirathna","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chandika","family":"Gamage","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Senanayake","family":"Kularatne","sequence":"additional","affiliation":[{"name":"Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sisira","family":"Siribaddana","sequence":"additional","affiliation":[{"name":"Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Maththias","sequence":"additional","affiliation":[{"name":"Yale University School of Medicine, New Haven, Connecticut, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph","family":"Vinetz","sequence":"additional","affiliation":[{"name":"Yale University School of Medicine, New Haven, Connecticut, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,9,11]]},"reference":[{"key":"2025121220565665000_9.9.e027850.1","first-page":"237","article-title":"Leptospirosis worldwide, 1999","volume":"74","year":"1999","journal-title":"Wkly Epidemiol Rec"},{"key":"2025121220565665000_9.9.e027850.2","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0003898","article-title":"Global morbidity and mortality of leptospirosis: a systematic review","volume":"9","author":"Costa","year":"2015","journal-title":"PLoS Negl Trop Dis"},{"key":"2025121220565665000_9.9.e027850.3","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0003866","article-title":"A systematic review of the mortality from untreated leptospirosis","volume":"9","author":"Taylor","year":"2015","journal-title":"PLoS Negl Trop Dis"},{"key":"2025121220565665000_9.9.e027850.4","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(09)70211-7"},{"key":"2025121220565665000_9.9.e027850.5","unstructured":"Epidemiological unit: selected notifiable diseases reported by medical officers of health. 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