{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T09:29:36Z","timestamp":1791019776933,"version":"4.1.0"},"reference-count":54,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>Leptospirosis is a waterborne zoonotic disease that primarily causes systemic illness, followed by uveitis. After heavy flooding in Madurai district, an epidemic outbreak of systemic and ocular leptospirosis occurred in 1994. Our data shows a transition to endemicity after each epidemic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim:<\/jats:title>\n                    <jats:p>The aim of this study is to report the clinical signs, epidemic outbreaks, and persistent endemicity of leptospiral uveitis, as well as the diagnostic dilemmas associated with it.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A retrospective analysis of clinical signs was conducted using medical records of leptospiral uveitis patients over a period of 27 years (1994\u20132020) in a tertiary care eye hospital. The clinical workup of uveitis included a detailed clinical history, systemic, and ophthalmic examination. Microagglutination tests (MATs) was done at the Centers for Disease Control and Prevention (CDC) in Atlanta and later in our regional laboratory. Serum samples were collected from human systemic leptospirosis cases and a small group of animals in and around Madurai.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The first epidemic outbreak resulted in 200 seropositive patients. Subsequent epidemic outbreaks occurred in 1997, 1998, 2001, 2005, and 2012, with Madurai experiencing multiple outbreaks. However, the disease remained endemic, with 25\u201350 patients being observed per year in between the peaks. Ocular examination revealed acute non-granulomatous uveitis (94.9%), pan uveitis (59.8%), vitreous inflammatory reaction (55.4%), retinal vasculitis (29.5%), disc hyperemia (20.9%), and hypopyon. (16.2%). New serovars emerged every year, resulting in decreased sensitivity of the MAT. Over time, the MAT started to miss diagnoses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The persistent endemicity of leptospiral uveitis emphasizes the need for accessible diagnostic tests. The low performance of the MAT can be attributable to the use of an older panel. The incorporation of new isolates in the MAT by a national laboratory will improve the accuracy of diagnosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ijo.ijo_61_23","type":"journal-article","created":{"date-parts":[[2023,8,1]],"date-time":"2023-08-01T03:33:05Z","timestamp":1690860785000},"page":"3031-3038","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":9,"title":["Leptospiral uveitis- \u201cTransition \u2018from epidemic to endemic form\u201d difficulties in laboratory confirmation"],"prefix":"10.4103","volume":"71","author":[{"given":"SR.","family":"Rathinam","sequence":"first","affiliation":[{"name":"Aravind Eye Hospital and PG. Institute of Ophthalmology, Aravind Medical Research Foundation, Madurai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. Jeya","family":"Kohila","sequence":"additional","affiliation":[{"name":"Aravind Eye Hospital and PG. Institute of Ophthalmology, Aravind Medical Research Foundation, Madurai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P Chidambaranathan","family":"Gowri","sequence":"additional","affiliation":[{"name":"Department of Immunology, Aravind Medical Research Foundation, Madurai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"KS.","family":"Balagiri","sequence":"additional","affiliation":[{"name":"Biostatistics, Aravind Medical Research Foundation, Madurai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,8,1]]},"reference":[{"key":"R1-20240828","doi-asserted-by":"crossref","first-page":"e0003898","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":"R2-20240828","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1007\/s10096-019-03797-4","article-title":"Leptospirosis:A neglected tropical zoonotic infection of public health importance-an updated review","volume":"39","author":"Karpagam","year":"2020","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"R3-20240828","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1097\/ICU.0000000000000896","article-title":"Ocular leptospirosis:Lack of awareness among ophthalmologists and challenges in diagnosis","volume":"33","author":"Rathinam","year":"2022","journal-title":"Curr Opin Ophthalmol"},{"key":"R4-20240828","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/S0002-9394(14)71646-0","article-title":"Uveitis associated with an epidemic outbreak of leptospirosis","volume":"124","author":"Rathinam","year":"1997","journal-title":"Am J Ophthalmol"},{"key":"R5-20240828","doi-asserted-by":"crossref","first-page":"173","DOI":"10.4103\/0301-4738.31936","article-title":"Global variation and pattern changes in epidemiology of uveitis","volume":"55","author":"Rathinam","year":"2007","journal-title":"Indian J Ophthalmol"},{"key":"R6-20240828","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/S0002-9394(14)74235-7","article-title":"International Uveitis Study Group recommendations for the evaluation of intraocular inflammatory disease","volume":"103","author":"Bloch-Michel","year":"1987","journal-title":"Am J Ophthalmol"},{"key":"R7-20240828","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1016\/j.ajo.2005.03.057","article-title":"Standardization of uveitis nomenclature for reporting clinical data. 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