Right of reply The Medical Research Institute (MRI) has sent a response to the article ‘Deadly leptospirosis not spread exclusively by rats — New research on disease by local doctor gains international recognition’ by Kumudini Hettiarachchi which appeared in the Sunday Times of April 27. Dr. Lilani Karunanayake, the MRI’s Head, Reference Laboratory for the [...]


Research on leptospirosis was carried out as early as 1971: MRI


Right of reply
The Medical Research Institute (MRI) has sent a response to the article ‘Deadly leptospirosis not spread exclusively by rats — New research on disease by local doctor gains international recognition’ by Kumudini Hettiarachchi which appeared in the Sunday Times of April 27.

Dr. Lilani Karunanayake, the MRI’s Head, Reference Laboratory for the Diagnosis of Leptospirosis, Department of Bacteriology & Consultant Clinical Microbiologist has expressed her concerns regarding the article which was based on an interview with Dr. Suneth Agampodi, on the grounds that the reader will be biased that research had not been carried out earlier regarding transmission and the reservoir host of leptospirosis in Sri Lanka and the reader will be carried away with incorrect facts which will tarnish the image of the MRI and the Ministry of Health and Nutrition.

Dr. Karunanayake states:
1.In 1971, Dr. K. Nithyananda at the MRI published in the Ceylon Journal of Medical Sciences the pioneering research carried out with the collaboration of CDC, Atlanta, USA, on the possibility of other animals as reservoir hosts for leptospirosis in Sri Lanka. For the first time in Sri Lanka, he showed the presence of different serovars in dogs, rats and other rodents, cattle and swine. In 2007, Dr. M. Thammitiyagoda, Dr. P. Chandrasiri from the MRI and others have demonstrated the same serovar from both humans and buffaloes in the Homagama district, adding buffaloes as a reservoir of leptospirosis. In scientific matters such as this, there cannot be another first time, even after 30 years.

2.Quite contrary to what the article suggests, rats have never been considered the only reservoir host for leptospirosis but only as its main reservoir host. A study done by us as recently as in 2012 at the MRI, showed that the majority of human leptospirosis was still due to the serovars Pyrogenes and Icterohaemorrhagiae, which are commonly present in rats.

3.The National Reference Laboratory for the Diagnosis of Leptospirosis at the MRI has facilities for the identification of Leptospira by both culture and serology. The Microscopic Agglutination Test (MAT), the ‘gold standard’ serological method, is done by trained Medical Laboratory Technologists. This is offered to all clinicians who need this service, to both state and private sectors throughout the island. There is therefore no lack of diagnostic facilities.

4.The selection of the best serovar panel for the MAT is done by an expert in Laboratory Medicine, considering the common circulating serovars in a country. We use six to ten different serovars, not “using only one serovar” as the article states, for the routine diagnostic panel for clinical samples. No laboratory in the world uses all of the 200-plus serovars in such MAT panels. Dr. Agampodi, a specialist in community medicine, should have checked with me regarding the laboratory aspect before passing an opinion or comment to the public on the currently available diagnostic tests for leptospirosis. The Ministry of Health had already identified the ‘urgent need of the hour’ and supported us with laboratory requirements.

5.Since the currently used, imported ELISA kits are made from strains of the manufacturing country, their sensitivity and specificity for our patients need validation. Preliminary research to select a locally useful ELISA is underway. The WHO had grouped ELISA as a supportive test method, not as a confirmatory test, for the diagnosis of leptospirosis. While research work is being done on the ELISA, the much more useful MAT is already available to clinicians to support patient care.

6.The development of clinical guidelines, health education programmes and clinical and laboratory surveillance on leptospirosis are already being addressed by the Steering Committee for the Prevention and Control of Leptospirosis, Ministry of Health and Nutrition under the chairmanship of the Director-General of Health Services. This Committee consists of epidemiologists, microbiologists, clinicians and representatives from the field of animal health.

7.Home grown research in the field of clinical and laboratory diagnosis of human leptospirosis with local expertise is under way as collaborative studies at the MRI. They are supported by the Ministry of Health, Sri Lanka and the National Science Foundation (NSF).

Reporter’s note: The article on leptospirosis was based on an interview with Community Physician Dr. Suneth Agampodi who gave the Dr. P.B. Fernando Oration at last year’s inauguration of the sessions of the Ceylon College of Physicians and whose findings have been published in important international scientific journals.
Dr. Suneth Agampodi states:

The Sunday Times made available the MRI concerns to Dr. Suneth Agampodi and he states: “I’m extremely happy to learn that at least six years after the largest ever-outbreak of leptospirosis in Sri Lanka, the MRI is developing standard diagnostic facilities with six serovars in the MAT panel. I hope that they will have a broad and adequate serovar panel soon for routine diagnosis and get the International MAT proficiency certificate from ILS to do MAT testing, without which, these tests are not valid or accepted by the international community.

“I would also like to congratulate the MRI, the premier institute for health research in Sri Lanka and Dr. Lilani for initiating leptospirosis research work at the MRI and look forward to seeing the results in indexed, high impact journals. It is unfortunate that there is not a single MRI-led leptospirosis research publication in indexed journals in the last 20 years. One might think that this is a crime as millions of public money was used to maintain the leptospirosis lab in the MRI without high quality research output. I think that the mentioned ongoing work will overcome this issue.

“I also hope that someone who is knowledgeable on leptospirosis diagnosis with proven track records on leptospirosis research will support Dr. Lilani to develop clinician friendly early diagnosis facilities using newer antigen detection and advanced molecular methods. ”Most importantly I’m eager to see the clinical guidelines mentioned in the reply, because at present, there are no agreed-upon guidelines even in the international community, because this disease is so complex and studies are still being done in several leading leptospirosis research centres.

“I had no intention of tarnishing the image of the MRI and would like to offer my congratulations again for all good work done!”

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