Development of a simple serological method for diagnosing leptospirosis: a microcapsule agglutination test

Rapid tests for diagnosis of leptospirosis: current tools and emerging technologies

Leptospirosis is an emerging zoonosis with a worldwide distribution but is more commonly found in impoverished populations in developing countries and tropical regions with frequent flooding. The rapid detection of leptospirosis is a critical step to effectively manage the disease and to control outbreaks in both human and animal populations. Therefore, there is a need for accurate and rapid diagnostic tests and appropriate surveillance and alert systems to identify outbreaks. This review describes current in-house methods and commercialized tests for the rapid diagnosis of acute leptospirosis. It focuses on diagnostic tests that can be performed with minimal training and limited equipment in less-developed and newly industrialized countries, particularly in resource-limited settings and with results in minutes to less than 4 hours. We also describe recent technological advances in the field of diagnostic tests that could allow for the development of innovative rapid tests in the near future.

Early diagnosis of leptospirosis by immunoglobulin M immunoblot testing

There is an urgent need for the development of serodiagnostic approaches with improved sensitivity for patients with acute leptospirosis. Immunoblots were performed on 188 sera collected from 74 patients with laboratory-confirmed early leptospiral infection to detect immunoglobulin M (IgM) antibodies to antigens pooled from 10 leptospiral strains prevalent in Thailand. Sera from patients with other febrile diseases served as controls. IgM reactivity to seven distinct antigens, with apparent molecular masses of 14 to 18, 19 to 23, 24 to 30, 32, 35/36, 37, and 41/42 kDa, was observed. The low-molecular-mass 14- to 18-kDa band was the most frequently detected antigen, being recognized in sera from 82.4% of patients during the first 3 days after the onset of symptoms. We evaluated the accuracy of the IgM immunoblot (IgM-IB) test by using reactivity to the 14- to 18-kDa band and/or at least two bands among the 19- to 23-, 24- to 30-, 32-, 35/36-, 37-, and 41/42-kDa antigens as the diagnostic criterion. The sensitivities of the IgM-IB test and the microscopic agglutination test (MAT) were 88.2% and 2.0%, respectively, with sera from patients 1 to 3 days after the onset of symptoms. In contrast, the IgM-IB test was positive with only 2/48 (4.2%) sera from patients with other febrile illnesses. The high sensitivity and specificity of the IgM-IB test for acute leptospirosis would provide greatly improved diagnostic accuracy for identification of patients who would benefit from early antibiotic intervention. In addition, the antigens identified by the IgM-IB test may serve as components of a rapid, accurate, point-of-care diagnostic test for early leptospirosis.

Application of immunoproteomics to leptospirosis: towards clinical diagnostics and vaccine discovery

Each of the currently available methods for serodiagnosis of leptospirosis, including the microscopic agglutination test (MAT), has its own drawback(s) when used in clinical practice. A new diagnostic test is therefore required for an earlier and more accurate diagnosis of leptospirosis. We applied immunoproteomics to define potential immunogens from five serovars of Leptospira reference strains. A leptospiral whole cell lysate from each serovar was used as the antigen to react with IgG and IgM in the sera from four patients with a positive MAT. Sera from four non-leptospirosis patients with a negative MAT were pooled and used as the negative control. 2-D Western blot analysis showed that the degree of immunoreactivity corresponded with the MAT titers. No immunoreactive spots were detected when the pooled control sera were used. A total of 24 protein spots immunoreacted with IgM and/or IgG from patients with leptospirosis. These immunoreactive proteins were identified by MALDI-TOF MS and were classified into five groups, including flagellar proteins, chaperones/heat shock proteins, transport proteins, metabolic enzymes, and hypothetical proteins. More immunoreactive spots were detected with anti-human IgG in the sera of all patients and with all the serovars of leptospires used. Some of the identified proteins immunoreacted only with IgG, whereas the others were detectable with both IgM and IgG. Among the immunoreactive proteins identified, FlaB proteins (flagellin and flagellar core protein) have been shown to have a potential role in clinical diagnostics and vaccine development. These data underscore the significant impact of immunoproteomics in clinical applications.

Identification and evaluation of LPS antigen for serodiagnosis of uveitis associated with leptospirosis

Leptospirosis is a widespread zoonotic disease that affects all mammals in different parts of the world. Though there are many commercial kits available for the diagnosis of systemic leptospirosis, the nature of the antigen has not been described. Therefore, identification of a specific antigen is important. Since ocular involvement in leptospirosis has been reported, there is a need to identify and characterize the leptospiral antigen for diagnosis of uveitis associated with past leptospiral infection (leptospiral uveitis) and for confirming the clinical diagnosis. Seven-day-old culture of Leptospira biflexa serovar Patoc was used for preparing the antigen. The present study included serum samples from 81 patients with clinical criteria for leptospiral uveitis, 15 cataract controls and 15 non-leptospiral uveitis controls. Serum samples were assayed by ELISA using our antigenic preparation and by a microscopic agglutination test (MAT) using 19 serovars. The antigen prepared had 280 micro g LPS ml(-1) and no detectable amount of protein. Silver-staining of SDS-PAGE for protein and LPS, dot blot and Western blot analysis and proteinase K and periodate treatment showed that LPS (13-21 kDa and 28 kDa) in our preparation was the relevant antigen for serodiagnosis. IgG antibodies showed reactivity in both leptospiral uveitis patients and controls. However, on the basis of IgM response to LPS, 48 % of the leptospiral uveitis patients were significantly positive compared with controls; 58 % of leptospiral uveitis patients and none of the controls were positive for MAT. When MAT and IgM ELISA results were considered together, 77 % were significantly positive. LPS is identified as a candidate antigen for serodiagnosis of leptospiral uveitis and has sensitivity and specificity of 48 and 90 %, respectively, in ELISA for IgM antibodies. Confirmation of clinical diagnosis with a specific laboratory test would help to initiate the most appropriate treatment for leptospiral uveitis.

Leptospiral proteins recognized during the humoral immune response to leptospirosis in humans

Leptospirosis is an emerging zoonosis caused by pathogenic spirochetes belonging to the genus Leptospira. An understanding of leptospiral protein expression regulation is needed to develop new immunoprotective and serodiagnostic strategies. We used the humoral immune response during human leptospirosis as a reporter of protein antigens expressed during infection. Qualitative and quantitative immunoblot analysis was performed using sera from 105 patients from Brazil and Barbados. Sera from patients with other diseases and healthy individuals were evaluated as controls. Seven proteins, p76, p62, p48, p45, p41, p37, and p32, were identified as targets of the humoral response during natural infection. In both acute and convalescent phases of illness, antibodies to lipopolysaccharide were predominantly immunoglobulin M (IgM) while antibodies to proteins were exclusively IgG. Anti-p32 reactivity had the greatest sensitivity and specificity: positive reactions were observed in 37 and 84% of acute- and convalescent-phase sera, respectively, while only 5% of community control individuals demonstrated positive reactions. Six immunodominant antigens were expressed by all pathogenic leptospiral strains tested; only p37 was inconsistently expressed. Two-dimensional immunoblots identified four of the seven infection-associated antigens as being previously characterized proteins: LipL32 (the major outer membrane lipoprotein), LipL41 (a surface-exposed outer membrane lipoprotein), and heat shock proteins GroEL and DnaK. Fractionation studies demonstrated LipL32 and LipL41 reactivity in the outer membrane fraction and GroEL and DnaK in the cytoplasmic fraction, while p37 appeared to be a soluble periplasmic protein. Most of the other immunodominant proteins, including p48 and p45, were localized to the inner membrane. These findings indicate that leptospiral proteins recognized during natural infection are potentially useful for serodiagnosis and may serve as targets for vaccine design.

Leptospirosis

Leptospirosis is a worldwide zoonotic infection with a much greater incidence in tropical regions and has now been identified as one of the emerging infectious diseases. The epidemiology of leptospirosis has been modified by changes in animal husbandry, climate, and human behavior. Resurgent interest in leptospirosis has resulted from large outbreaks that have received significant publicity. The development of simpler, rapid assays for diagnosis has been based largely on the recognition that early initiation of antibiotic therapy is important in acute disease but also on the need for assays which can be used more widely. In this review, the complex taxonomy of leptospires, previously based on serology and recently modified by a genotypic classification, is discussed, and the clinical and epidemiological value of molecular diagnosis and typing is also evaluated.

Comparison of antibody titers against borrelial strains isolated in Japan by the microcapsule agglutination test for serological studies of early Lyme disease

Results of a passive microcapsule agglutination test using 2 Japanese strains, Borrelia garinii and Borrelia afzelii, were comparable to that of the passive microcapsule agglutination test using a Swiss strain Borrelia burgdorferi IRS in detecting antibodies of an early stage of Lyme disease patients in Japan. MCAT with microcapsule sensitized strain IRS seems likely to become one of the important tools for the early diagnosis of Lyme disease in the world. The highest titer of MCAT was detected in the serum samples of patients which were taken around 2 weeks after erythema chronicum migrants. The test is very simple and can be employed easily in diagnostic laboratories.

Evaluation of the one-point microcapsule agglutination test for diagnosis of leptospirosis

We have developed a one-point microcapsule agglutination test (MCAT) for the serodiagnosis of leptospirosis. The MCAT kit was evaluated for use in humans by six WHO Collaborating Centres for Reference and Research on Leptospirosis. The laboratories classified their serum samples on the basis of the microscopic agglutination test (MAT) and the following screening tests: enzyme-linked immunosorbent assay (ELISA), macroscopic (slide) agglutination test, or the complement fixation test. The MCAT may in some instances give a positive result earlier in the course of the disease than MAT or the ELISA IgM; on the other hand, it did not detect antibodies against some serovars, for example, those of the Sejroe or Australis serogroup in Slovakia. In contrast, however, the MCAT detected antibodies to serovar hardjo (the same serogroup as Sejroe) in patients from the United Kingdom and the Russian Federation.

Evaluation of a passive microcapsule agglutination test for the screening of human leptospirosis

Microcapsules, absorbed with two mixed antigens--each composed of 3 sonicated leptospira serovars--were developed in the past as a microcapsule agglutination test (MCA-LS) for the screening of clinical leptospirosis. For this study, fifty serum samples, taken at an earlier and at a later stage of illness from 25 Italian in-patients with clinical symptoms of leptospirosis, were tested with both the MCA-LS one-dilution test and the microscopic agglutination (MA) test, the confirmatory test for leptospirosis, with 18 leptospira strains circulating in Italy. Compared with MA, MCA-LS showed a sensitivity of 91.7%, and a specificity of 92.3%, including leptospirosis not sustained by the diagnostic strains used in the MCA-LS kit.

Evaluation of an immunoenzymatic test (ELISA) for the diagnosis of leptospirosis in Italy

An enzyme-linked immunosorbent assay (ELISA) was assessed to detect in humans IgM and IgG against the main serogroups/serovars of Leptospira present in Italy. Sonicated antigens from strain Wijnberg, serogroups Icterohaemorrhagiae and Riccio 2, serogroup Australis, were used in ELISA and the results were compared to microagglutination test (MAT). IgM were confirmed to be the predominant class of antibodies; the total sensitivity obtained by Wijnberg/ELISA with the sera of patients infected by different serogroups was 81.5% in relation to MAT, better sensitivity was achieved by the use of Riccio 2/ELISA; no reaction occurred with the control sera. Cross-reactivity was noted with some sera of patients with Lyme disease (IgM) and with few sera of patients with autoimmune disease (IgM and IgG). To improve the sensitivity of the ELISA both antigens Wijnberg and Riccio 2 must be employed in the immunoenzymatic assay, since serogroup Australis must be considered as a new emerging serogroup causing human leptospirosis in our country.

Further evaluation of one-point microcapsule agglutination test for diagnosis of leptospirosis

A total of 100 serum samples including 22 acute phase sera and 39 paired sera collected from clinically diagnosed cases of leptospirosis in Ming-shan County, Sichuan Province, China were examined by the one-point microcapsule agglutination test (MCAT), which was developed in Japan, and by conventional microscopic agglutination tests (MAT). The one-point MCAT is more reactive to IgM antibody than MAT and is superior in detecting antibodies in the early stages of the disease.

Distribution of leptospirosis among stray dogs in the Okinawa Islands, Japan: comparison of the microcapsule and microscopic agglutination tests

Three hundred and thirty-eight sera collected from stray dogs in the Okinawa islands were examined for antibodies against Leptospira interrogans using the microscopic agglutination test (MAT) and the one-point microcapsule agglutination test (MCAT). Seventy-eight sera (23%) showed a positive reaction to at least one of the six serovar antigens, and 69 of these reacted with serovar canicola by microcapsule agglutination test. The mixed microcapsule agglutination test detected 68 of the microscopic agglutination test-positive sera, and the 10 remaining were negative by microcapsule agglutination test. On the other hand, a single microcapsule agglutination test which was sensitized with serovar canicola detected 77 of the microscopic agglutination test-positive sera and the remaining one was microcapsule agglutination test-negative.

Detection of antibodies to leptospirosis in experimentally infected dogs using the microcapsule agglutination test

Six puppies were infected with a virulent strain of Leptospira interrogans serovar icterohaemorrhagiae and another five animals with a virulent strain of Leptospira interrogans serovar canicola, respectively. Antibodies were examined at 3, 5, 7, 11 and 14 days after infection, using the microcapsule agglutination test (MCAT) and the conventional microscopic agglutination test (MAT). Compared with the MAT, the MCAT detected early specific IgM antibody with high sensitivity. The MCAT titres reached a peak at the 7th day after infection and declined gradually after the 11th day, while the MAT titres increased up to the 14th day.

Broad reacting surface antigens in Leptospira biflexa serovar andamana

Previous investigations had demonstrated that genus-specific and species-specific antigens of leptospires are deep-seated within the leptospiral cell. Conversely, the present study has shown that strain CH11, serovar andamana of the non-pathogenic species of Leptospira biflexa is endowed on its surface with two cross-reacting antigens; a newly recognized antigen common to L. interrogans and L. biflexa spp. and an antigenic determinant common to a previously described genus-specific protein antigen (GP-Ag). The serovar andamana, when thimerosal-treated, behaved like an interspecies-specific antigen, cross-reacting in the complement fixation test with sera from rabbits immunized with L. interrogans and L. biflexa spp. and with sera from subjects with leptospirosis from various serovars. In the immuno electron microscopic test, human leptospirotic sera bound to the surface of thimerosal-treated andamana and not to the surface of untreated andamana showing that an interspecies-specific antigen was located underneath the outermost layer of this serovar. In the same test, the monoclonal antibody GP-7 against the GP-Ag bound to the surface of untreated andamana and not to the surface of thimerosal-treated andamana, showing that an antigenic determinant, common to GP-Ag and different from the first one, was located on the outer membrane of andamana. In human leptospirotic sera, antibodies against the cross-reacting antigen of thimerosal-treated andamana demonstrated by the complement fixation test were formed earlier and in a higher percentage of sera than the serovar-specific antibodies against 16 L. interrogans serovars demonstrated by the microagglutination test.

One-point method for serological diagnosis of leptospirosis: a microcapsule agglutination test

This paper describes a simple and rapid microcapsule agglutination (MCA) test. The results obtained by this new test have been compared with those obtained by the microtitre MCA and the microscopic agglutination (MA) test. The procedures required for the new test are easier and can be performed more rapidly than those necessary for the microtitre MCA test. Furthermore, the new test is more sensitive than the MA test in the early stages of leptospirosis. This new test appears satisfactory as a screening test for the early diagnosis of leptospirosis.

Serodiagnosis of leptospirosis in China by the one-point MCA method

The one-point MCA method is very simple to perform and useful as a screening test in diagnosing leptospirosis in routine clinical laboratories. The kit, sensitized with six serovars occurring in Japan, was also useful in detecting serum antibodies of patients with leptospirosis in China.

Studies on microcapsules to replace erythrocytes in the passive agglutination reaction

Two kinds of microcapsules were made from polyurethane and polyurea. Each capsule had a mean diameter of 6 microns, a specific gravity of 1.10, and was red in color. The capsules were coated with ovalbumin condensed with glutaraldehyde. The coated capsules were agglutinated with anti-ovalbumin antibody. The polyurethane capsule (positive charge) bound more ovalbumin and showed a higher sensitivity than did the polyurea capsule (negative charge) or erythrocytes.

Microcapsule agglutination test for Treponema pallidum antibodies. A new serodiagnostic test for syphilis

For the serodiagnosis of syphilis a quantitative passive agglutination (MCA-TP) test for antibodies to Treponema pallidum was performed with chemically stable microcapsules with no antigenic activity instead of with conventional sheep erythrocytes. The microcapsules were easily sensitised with the antigen of sonicated Treponema pallidum by treatment with glutaraldehyde. Compared with the Treponema pallidum haemagglutination test (TPHA) the MCA-TP test was superior for detecting cases of primary syphilis. Furthermore, the decrease in antibody titre during treatment was more evident in this test than in the FTA-ABS or the TPHA tests. The MCA-TP test performed on IgM and IgG gel-filtered fractions of sera from patients with syphilis proved that the sensitised microcapsule antigen reacted sharply with the IgM antibodies specific to syphilis.