Abstract
BackgroundLeptospirosis is a potentially life-threatening but curable zoonosis whose prognosis depends on accurate and timely diagnosis. Because of its non-specific clinical presentation, laboratory testing is essential to confirm the diagnosis. Here, we aimed to assess the performance of two enzyme-linked immunosorbent assays (ELISAs) (ELISA Serion and ELISA-Hb Pasteur) and one immunodot (GenBio) using quantitative PCR (qPCR) as gold standard, instead of the traditional microscopic agglutination test, for the diagnosis of acute leptospirosis in an endemic area.Methodology/Principal findingsBetween January 2011 and December 2012, a total of 122 patients were diagnosed with leptospirosis, as confirmed by qPCR at the University Hospital of Martinique. Among them, 103 had at least one serum sample available for analysis. Performance of each serological assay was evaluated according to days' post onset of symptoms (DPO) and local species diversity (which included L. santarosai, L. interrogans, L. kirschneri, L. borgpetersenii, L. noguchii, and L. kmetyi). Several thresholds were tested to optimize accuracy. When considering the manufacturer's threshold, the sensitivity of ELISA Serion, ELISA-Hb Pasteur and GenBio immunodot was 75%, 67% and 64%, while specificity was 92%, 98% and 100%, respectively. Moreover, the threshold optimization allowed a significant improvement in specificity for the ELISA Serion from 92% to 99% (p<0.05). During the first 5 DPO, sensitivities were 35%, 30% and 42% for ELISA Serion, ELISA-Hb Pasteur and GenBio immunodot, respectively. However, between 6─10 DPO, these sensitivities dramatically increased to reach 86%, 76% and 67%, respectively. Performances of the three assays were not affected by the species studied.Conclusions/SignificanceAll these serological assays showed the potential for diagnosing leptospirosis after (but not before) 6 days’ post onset of symptoms. In a high prevalence setting, where highest specificities are needed, threshold optimizing should be performed for this purpose.
Highlights
Leptospirosis is a ubiquitous zoonosis caused by pathogenic spirochetes of the genus Leptospira
Leptospirosis is a ubiquitous zoonosis caused by spirochetes
To find a suitable alternative to quantitative polymerase chain reaction (PCR) (qPCR) and microagglutination test (MAT) in the early phase of the disease, we compared 3 serological assays (2 enzyme-linked immunosorbent assays (ELISAs) plus one immunodot) using sera collected from patients with a qPCR-confirmed diagnosis of leptospirosis
Summary
Leptospirosis is a ubiquitous zoonosis caused by pathogenic spirochetes of the genus Leptospira. With an estimated 1.03 million cases and 58,900 deaths occurring each year, leptospirosis represents a major threat to public health worldwide [1]. This is true in the Caribbean where morbidity and mortality rates are up to 50 and 2.90 percent, respectively [2,3,4,5]. Laboratory tests are of paramount importance for a timely diagnosis (and subsequent treatment) of leptospirosis. Leptospirosis is a potentially life-threatening but curable zoonosis whose prognosis depends on accurate and timely diagnosis. Because of its non-specific clinical presentation, laboratory testing is essential to confirm the diagnosis. We aimed to assess the performance of two enzyme-linked immunosorbent assays (ELISAs) (ELISA Serion and ELISAHb Pasteur) and one immunodot (GenBio) using quantitative PCR (qPCR) as gold standard, instead of the traditional microscopic agglutination test, for the diagnosis of acute leptospirosis in an endemic area
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