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Lagarde-Guerrero R, Navarro-Arias MDJ, Duran-Pérez SA, Osuna-Ramírez I, Osuna-Martínez LU, Gonzáles-Durán E, Rendon-Maldonado JG. Frequency of Leptospira in the Blood of Patients with Fever of Unknown Origin in Sinaloa, Mexico. Vector Borne Zoonotic Dis 2024. [PMID: 39023575 DOI: 10.1089/vbz.2024.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024] Open
Abstract
Background: Leptospira is a genus of bacteria that causes the zoonotic disease known as leptospirosis, which mainly affects countries with tropical and subtropical climates. Its prevalence may be underestimated because the initial stage of the infection is characterized by presenting a febrile condition that is easily confused with other diseases, such as dengue. This work reports the frequency of leptospirosis in the blood of patients with febrile symptoms of unknown origin. Materials and Methods: A total of 218 peripheral blood samples were analyzed from volunteer participants from Culiacan Sinaloa in June 2019, one half corresponded to patients with undiagnosed febrile symptoms and the other half to asymptomatic volunteers. Data collected included the age and sex of the participants. Leptospira was detected by qPCR using a fragment of the lipL32 gene from the bacteria's genome as a target. Fisher's exact test was used as a statistical method to estimate the relationship between the infection and the data collected. Results: The study group comprised 134 female and 84 male patients ranging from ages 1 to 92 years, averaging 41 years. In this study, Leptospira infection was identified in the blood of 22/218 participating volunteers (10.09%), of which 20/109 (18.34%) presented febrile symptoms, whereas 2/109 (1.83%) were asymptomatic. The most affected participants were women with ages between 27 and 59 years. However, the analysis of the relationship between infection and the variables studied did not show statistical significance. Conclusions: Leptospirosis was detected in blood samples from patients with undiagnosed febrile illness and asymptomatic symptoms in Sinaloa. The lipL32 gene is useful as a target in identifying Leptospira in human blood in the acute phase of the disease.
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Affiliation(s)
- Rogelio Lagarde-Guerrero
- Posgrado en Ciencias Biomedicas, Facultad de Ciencias Quimico Biologicas, UAS. Av de las Americas y Blvd., Universitarios, Ciudad Universitaria., Culiacán, 80010 México
| | - María de Jesús Navarro-Arias
- Posgrado en Ciencias Biomedicas, Facultad de Ciencias Quimico Biologicas, UAS. Av de las Americas y Blvd., Universitarios, Ciudad Universitaria., Culiacán, 80010 México
| | - Sergio Alonso Duran-Pérez
- Posgrado en Ciencias Biomedicas, Facultad de Ciencias Quimico Biologicas, UAS. Av de las Americas y Blvd., Universitarios, Ciudad Universitaria., Culiacán, 80010 México
| | - Ignacio Osuna-Ramírez
- Posgrado en Ciencias Biomedicas, Facultad de Ciencias Quimico Biologicas, UAS. Av de las Americas y Blvd., Universitarios, Ciudad Universitaria., Culiacán, 80010 México
| | - Lorenzo Ulises Osuna-Martínez
- Posgrado en Ciencias Biomedicas, Facultad de Ciencias Quimico Biologicas, UAS. Av de las Americas y Blvd., Universitarios, Ciudad Universitaria., Culiacán, 80010 México
| | - Elizabeth Gonzáles-Durán
- Instituto Nacional de Diagnóstico y Referencia Epidemiológicos "Dr. Manuel Martínez Báez" (InDRE), Culiacan, México
| | - José Guadalupe Rendon-Maldonado
- Posgrado en Ciencias Biomedicas, Facultad de Ciencias Quimico Biologicas, UAS. Av de las Americas y Blvd., Universitarios, Ciudad Universitaria., Culiacán, 80010 México
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Matthias MA, Lubar AA, Lanka Acharige SS, Chaiboonma KL, Pilau NN, Marroquin AS, Jayasundara D, Agampodi S, Vinetz JM. Culture-Independent Detection and Identification of Leptospira Serovars. Microbiol Spectr 2022; 10:e0247522. [PMID: 36445143 PMCID: PMC9769591 DOI: 10.1128/spectrum.02475-22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/21/2022] [Indexed: 12/03/2022] Open
Abstract
Pathogenic Leptospira, the causative agents of leptospirosis, comprise >200 serotypes (called serovars). Most have a restricted reservoir-host range, and some, e.g., serovar Copenhageni, are cosmopolitan and of public health importance owing to their propensity to produce severe, fatal disease in humans. Available serotyping approaches-such as multilocus sequence typing, core genome sequence typing, pulsed-field gel electrophoresis, and the cross-agglutination absorption test-are tedious and expensive, and require isolation of the organisms in culture media-a protracted and incredibly inefficient process-precluding their use in prospective studies or outbreak investigations. The unavailability of culture-independent assays capable of distinguishing Leptospira serotypes remains a crucial gap in the field. Here, we have developed a simple yet specific real-time qPCR assay-targeting a Leptospira-unique gene encoding a putative polysaccharide flippase-that provides intraspecies, serotype-defining (i.e., epidemiologically useful) information, and improves upon the sensitivity of preferred lipL32-based qPCR-based diagnostic tests. The assay, dubbed RAgI ("rage one"), is rapid and affordable, and reliably and specifically detects group I pathogenic Leptospira in culture, serum, and urine, with no detectable off-target amplification-even of the genetically related but low virulence group II pathogenic (formerly "intermediate") or nonpathogenic Leptospira. It retained 100% diagnostic specificity when tested against difficult sample types, including field-collected dog urine samples and environmental samples containing varied and complex microbial species-consortia. This assay holds considerable promise in the clinical setting, and for routine epidemiological and environmental surveillance studies. IMPORTANCE Leptospirosis is caused by a diverse group of pathogenic spirochetes comprising over 200 different serotypes. Some are widely reported and of public health importance owing to their propensity to produce severe, fatal disease in humans. Apart from their tedium and expense, current serotyping approaches require isolation of the organisms in culture media-a protracted and incredibly inefficient process-rendering them useless clinically and limiting their utilization in prospective studies or outbreak investigations. The unavailability of culture-independent assays capable of distinguishing Leptospira serotypes remains a crucial gap in the field. The 11108 qPCR-assay overcomes this barrier to progress via direct taxonomic and serotype classification of Leptospira from urine and serum samples, and hence, is the first qPCR-based prognostic test for human leptospirosis.
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Affiliation(s)
- Michael A. Matthias
- Department of Medicine, Division of Infectious Diseases, University of California, San Diego, California, USA
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut, USA
| | - Aristea A. Lubar
- Department of Medicine, Division of Infectious Diseases, University of California, San Diego, California, USA
| | - Shalka S. Lanka Acharige
- Leptospirosis Research Laboratory, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Mihintale, Sri Lanka
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kira L. Chaiboonma
- Department of Medicine, Division of Infectious Diseases, University of California, San Diego, California, USA
| | - Nicholas N. Pilau
- Department of Medicine, Division of Infectious Diseases, University of California, San Diego, California, USA
- Faculty of Veterinary Medicine, Usmanu Danfodiyo University, Sokoto, Nigeria
| | - Alan S. Marroquin
- Department of Medicine, Division of Infectious Diseases, University of California, San Diego, California, USA
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut, USA
| | - Dinesha Jayasundara
- Leptospirosis Research Laboratory, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Mihintale, Sri Lanka
- Department of Microbiology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Mihintale, Sri Lanka
| | - Suneth Agampodi
- Leptospirosis Research Laboratory, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Mihintale, Sri Lanka
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Mihintale, Sri Lanka
| | - Joseph M. Vinetz
- Department of Medicine, Division of Infectious Diseases, University of California, San Diego, California, USA
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut, USA
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Molecular Diagnostic Methods For The Detection of Leptospirosis. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2022. [DOI: 10.22207/jpam.16.2.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Leptospirosis is a widespread infectious disease caused by the spirochete Leptospira. The clinical features of leptospirosis are fever, headache, vomiting, jaundice, and the acute form of the disease is commonly called Weil’s disease. The microscopic agglutination test (MAT) is a gold standard method used to detect leptospirosis. However, it requires 14 days of time and skilled personnel to detect leptospirosis. Various molecular methods were developed for the rapid detection process, including polymerase chain reaction (PCR), multiplex PCR, nested PCR, real-time PCR, and Loop-mediated isothermal amplification (LAMP). Other immuno-based biosensor kits are readily available for the diagnosis of leptospirosis. Though these methods claim to be highly sensitive and specific, each method has its drawbacks. This review discusses the different molecular diagnostic techniques applied for the diagnosis of leptospirosis; elaborating on each method’s sensitivity, specificity, and detection time and the different samples of water, blood, and urine used.
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The role of small ruminants in the epidemiology of leptospirosis. Sci Rep 2022; 12:2148. [PMID: 35140240 PMCID: PMC8828929 DOI: 10.1038/s41598-022-05767-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 01/18/2022] [Indexed: 01/25/2023] Open
Abstract
Leptospirosis is a common global zoonotic disease of man and all farm animals. Although most leptospiral infections in sheep and goats are asymptomatic, they may play a role in the epidemiology of the disease by the spread of Leptospira through the urine. This study was carried out to evaluate the role of sheep and goats in the epidemiology of leptospirosis. Blood and urine samples were taken from 210 goats and 246 sheep. To detect antibodies, sera samples were tested with 8 live serovars of L. interrogans (Hardjo, Pomona, Grippotyphosa, Canicola, Ballum, Icterhemorrhagiae, Tarasovi, and Australis) by MAT. Then, urine samples were tested by Nested PCR targeting 16S rRNA gene for detection of pathogenic Leptospira. Results of MAT showed that 10.95% of goats and 8.53% of sheep had antibodies against at least one examined serovars. In both species, the highest reacting was L. i. Pomona with a rate of 68.18% and 56% in sheep and goats, respectively. Moreover, in PCR, 2 (0.95%) urine samples of goat and 12 (4.87%) urine samples of sheep were positive. All of the MAT positive studied animals were PCR negative and, statistical analysis showed that there was no relationship and agreement between the results of PCR and MAT in sheep (kappa = − 0.07, p > 0.05) and goats (kappa = − 0.02, p > 0.05). Finally, it is concluded that sheep and goats can excrete L. interrogans in the urine and thus transmit them to other animals and humans.
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Chaudhry GES, Akim AM, Safdar N, Yasmin A, begum S, Sung YY, Muhammad TST. Cancer and Disease Diagnosis - Biosensor as Potential Diagnostic Tool for Biomarker Detection. J Adv Pharm Technol Res 2022; 13:243-247. [PMID: 36568055 PMCID: PMC9784037 DOI: 10.4103/japtr.japtr_106_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/16/2022] [Accepted: 05/23/2022] [Indexed: 12/27/2022] Open
Abstract
Analysis of cancer biomarkers has enormous promise for advancing our molecular understanding of illness and facilitating more precise and timely diagnosis and follow-up care. MicroRNA, exosomes, ctDNA, CTCs, and proteins are only some of the circulating biomarkers that can be detected by liquid biopsy instead of the more intrusive and time-consuming process of doing a tissue biopsy. As the cancer diagnosis bio-markers reveal ultra-low levels in the early stages of the disease, highly sensitive approaches are urgently required. Researchers have taken an interest in a optical biosensor for detecting cancer biomarkers as a potential tool for early disease diagnosis. These techniques have the potential to aid in the development of effective treatments, ultimately leading to a higher rate of patient survival. This review briefly discuss the i) understanding of cancer and biomarkers for early diagonosis purpose ii) Molecular methods and ii) biosensor-based diagnostics. The reseach primary focus on advancement in biosensor design using various concepts ie., Electrochemical, Chemiluminescence and Colorimetric, Surface plasmons (SP), Surface plasmon resonance (SPR), localized surface plasmon resonance (LSPR), Fluorescence, Fiber-based sensors, Terahertz based biosensors, and Surface enhanced Raman spectroscopy (SERS). As a result of the local electric field amplification around plasmonic (usually gold and silver) nanostructures, surface-enhanced Raman spectroscopy (SERS) has emerged as a rapid, selective, and sensitive alternative to conventional laboratory analytical methods, making significant strides in a number of biosensing applications but still under developing stage to be used as diagnostic tool in clinical research.
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Affiliation(s)
- Gul-e-Saba Chaudhry
- Institute of Marine Biotechnology, Universiti Malaysia Terengganu, 21300 Kuala Nerus, Kuala Terengganu, Malaysia,Address for correspondence: Dr. Gul-e-Saba Chaudhry, Institute of Marine Biotechnology, Universiti Malaysia Terengganu, 21300 Kuala Nerus, Kuala Terengganu, Malaysia. E-mail: ,
| | - Abdah Md Akim
- Department of Biomedical Sciences, Universiti Putra Malaysia, Seri Kembangan, Selangor, Malaysia
| | - Naila Safdar
- Microbiology and Biotechnology Research Laboratory, Department of Biotechnology, Fatima Jinnah Women University, Rawalpindi, Punjab, Pakistan
| | - Azra Yasmin
- Microbiology and Biotechnology Research Laboratory, Department of Biotechnology, Fatima Jinnah Women University, Rawalpindi, Punjab, Pakistan
| | - Shaheen begum
- Department of Environmental Sciences, Fatima Jinnah Women University, Rawalpindi, Punjab, Pakistan
| | - Yeong Yik Sung
- Institute of Marine Biotechnology, Universiti Malaysia Terengganu, 21300 Kuala Nerus, Kuala Terengganu, Malaysia
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Richard E, Bourhy P, Picardeau M, Moulin L, Wurtzer S. Effect of disinfection agents and quantification of potentially viable Leptospira in fresh water samples using a highly sensitive integrity-qPCR assay. PLoS One 2021; 16:e0251901. [PMID: 34038443 PMCID: PMC8153454 DOI: 10.1371/journal.pone.0251901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/05/2021] [Indexed: 12/13/2022] Open
Abstract
Leptospirosis is an emerging worldwide zoonotic disease, but the general biology of the causative agents is still poorly understood. Humans are an occasional host. The main risk factors are water-associated exposure during professional or recreational activities or during outbreaks in endemic areas. Detecting the presence of pathogenic bacteria in aquatic environments and their capacity to resist various inactivation processes are research fields that need to be further developed. In addition, the methods used for detecting and enumerating Leptospira still need to be improved. We aimed to describe a new quantitative polymerase chain reaction coupled to propidium monoazide treatment (PMAqPCR) that targets not only total Leptospira but also discriminates pathogenic from non-pathogenic Leptospira while also addressing PCR inhibitors, a frequently encountered problem when studying environmental water. In a second step, the killing efficiency of Leptospira to different treatments was tested and PMAqPCR compared to culture-based enumeration. This provided information about the effects of temperature, as well as ultraviolet and chlorine disinfection, that are both related to water treatment processes, in particular for the production of drinking water, on the persistence of both saprophytic and pathogenic Leptospira. Finally, PMAqPCR was used for the detection of Leptospira in freshwater samples for a proof-of-concept. In conclusion, our method could be used for routine freshwater monitoring and allows better evaluation of the presence of Leptospira, allowing evaluation of the bacterial dynamics in a designated area or assessment of the efficacy of water disinfection processes.
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Affiliation(s)
- Elise Richard
- Eau de Paris, DRDQE, Ivry-Sur-Seine, France
- Institut Pasteur, Unité Biologie des Spirochètes, Paris, France
| | - Pascale Bourhy
- Institut Pasteur, Unité Biologie des Spirochètes, Paris, France
| | - Mathieu Picardeau
- Institut Pasteur, Unité Biologie des Spirochètes, Paris, France
- * E-mail: (MP); (LM)
| | - Laurent Moulin
- Eau de Paris, DRDQE, Ivry-Sur-Seine, France
- * E-mail: (MP); (LM)
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Gunasegar S, Neela VK. Evaluation of diagnostic accuracy of loop-mediated isothermal amplification method (LAMP) compared with polymerase chain reaction (PCR) for Leptospira spp. in clinical samples: a systematic review and meta-analysis. Diagn Microbiol Infect Dis 2021; 100:115369. [PMID: 33845305 DOI: 10.1016/j.diagmicrobio.2021.115369] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/20/2021] [Accepted: 03/06/2021] [Indexed: 12/29/2022]
Abstract
Loop-mediated isothermal amplification (LAMP) test is widely used in molecular diagnostics as a point-of-care technique alternative to traditional PCR especially in resource-limited countries. LAMP has been recently used to diagnose leptospirosis. Therefore, we undertook a systematic review and meta-analysis to compare the accuracy of LAMP with PCR in the diagnosis of leptospirosis. Sixty-one studies were extracted from three international databases and analyzed throughout using the PRISMA guideline. The pooled sensitivity of LAMP and PCR technique was 0.80 (95% CI: 0.58-0.90) and 0.54 (95% CI: 0.35-0.67) respectively indicating that LAMP is more sensitive than PCR. The Q* value of LAMP and PCR-based technique is 274.61 and 397.95, respectively. Among the analyzed studies, significant heterogeneity was observed where I2 is 90.90% for LAMP-based and 86.18% for PCR-based. Our study suggests that LAMP has better diagnostic accuracy than PCR. However, future work should be carried out to reduce heterogeneity as well as to improve and develop effective intervention strategies.
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Affiliation(s)
- Shan Gunasegar
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Vasantha Kumari Neela
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.
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Lam JY, Low GKK, Chee HY. Diagnostic accuracy of genetic markers and nucleic acid techniques for the detection of Leptospira in clinical samples: A meta-analysis. PLoS Negl Trop Dis 2020; 14:e0008074. [PMID: 32049960 PMCID: PMC7041858 DOI: 10.1371/journal.pntd.0008074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 02/25/2020] [Accepted: 01/18/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Leptospirosis is often difficult to diagnose because of its nonspecific symptoms. The drawbacks of direct isolation and serological tests have led to the increased development of nucleic acid-based assays, which are more rapid and accurate. A meta-analysis was performed to evaluate the diagnostic accuracy of genetic markers for the detection of Leptospira in clinical samples. METHODOLOGY AND PRINCIPLE FINDINGS A literature search was performed in Scopus, PubMed, MEDLINE and non-indexed citations (via Ovid) by using suitable keyword combinations. Studies evaluating the performance of nucleic acid assays targeting leptospire genes in human or animal clinical samples against a reference test were included. Of the 1645 articles identified, 42 eligible studies involving 7414 samples were included in the analysis. The diagnostic performance of nucleic acid assays targeting the rrs, lipL32, secY and flaB genes was pooled and analyzed. Among the genetic markers analyzed, the secY gene showed the highest diagnostic accuracy measures, with a pooled sensitivity of 0.56 (95% CI: 0.50-0.63), a specificity of 0.98 (95% CI: 0.97-0.98), a diagnostic odds ratio of 46.16 (95% CI: 6.20-343.49), and an area under the curve of summary receiver operating characteristics curves of 0.94. Nevertheless, a high degree of heterogeneity was observed in this meta-analysis. Therefore, the present findings here should be interpreted with caution. CONCLUSION The diagnostic accuracies of the studies examined for each genetic marker showed a significant heterogeneity. The secY gene exhibited higher diagnostic accuracy measures compared with other genetic markers, such as lipL32, flaB, and rrs, but the difference was not significant. Thus, these genetic markers had no significant difference in diagnostic accuracy for leptospirosis. Further research into these genetic markers is warranted.
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Affiliation(s)
- Jia-Yong Lam
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Gary Kim-Kuan Low
- Clinical Research Team, Rapid Response Revival Research Ltd, Riverwood, Sydney, Australia
| | - Hui-Yee Chee
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
- * E-mail:
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Yang B, de Vries SG, Ahmed A, Visser BJ, Nagel IM, Spijker R, Grobusch MP, Hartskeerl RA, Goris MGA, Leeflang MMG. Nucleic acid and antigen detection tests for leptospirosis. Cochrane Database Syst Rev 2019; 8:CD011871. [PMID: 31425612 PMCID: PMC6699653 DOI: 10.1002/14651858.cd011871.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Early diagnosis of leptospirosis may contribute to the effectiveness of antimicrobial therapy and early outbreak recognition. Nucleic acid and antigen detection tests have the potential for early diagnosis of leptospirosis. With this systematic review, we assessed the sensitivity and specificity of nucleic acid and antigen detection tests. OBJECTIVES To determine the diagnostic test accuracy of nucleic acid and antigen detection tests for the diagnosis of human symptomatic leptospirosis. SEARCH METHODS We searched electronic databases including MEDLINE, Embase, the Cochrane Library, and regional databases from inception to 6 July 2018. We did not apply restrictions to language or time of publication. SELECTION CRITERIA We included diagnostic cross-sectional studies and case-control studies of tests that made use of nucleic acid and antigen detection methods in people suspected of systemic leptospirosis. As reference standards, we considered the microscopic agglutination test alone (which detects antibodies against leptospirosis) or in a composite reference standard with culturing or other serological tests. Studies were excluded when the controls were healthy individuals or when there were insufficient data to calculate sensitivity and specificity. DATA COLLECTION AND ANALYSIS At least two review authors independently extracted data from each study. We used the revised Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2) to assess risk of bias. We calculated study-specific values for sensitivity and specificity with 95% confidence intervals (CI) and pooled the results in a meta-analysis when appropriate. We used the bivariate model for index tests with one positivity threshold, and we used the hierarchical summary receiver operating characteristic model for index tests with multiple positivity thresholds. As possible sources of heterogeneity, we explored: timing of index test, disease prevalence, blood sample type, primers or target genes, and the real-time polymerase chain reaction (PCR) visualisation method. These were added as covariates to the meta-regression models. MAIN RESULTS We included 41 studies evaluating nine index tests (conventional PCR (in short: PCR), real-time PCR, nested PCR, PCR performed twice, loop-mediated isothermal amplification, enzyme-linked immunosorbent assay (ELISA), dot-ELISA, immunochromatography-based lateral flow assay, and dipstick assay) with 5981 participants (1834 with and 4147 without leptospirosis). Methodological quality criteria were often not reported, and the risk of bias of the reference standard was generally considered high. The applicability of findings was limited by the frequent use of frozen samples. We conducted meta-analyses for the PCR and the real-time PCR on blood products.The pooled sensitivity of the PCR was 70% (95% CI 37% to 90%) and the pooled specificity was 95% (95% CI 75% to 99%). When studies with a high risk of bias in the reference standard domain were excluded, the pooled sensitivity was 87% (95% CI 44% to 98%) and the pooled specificity was 97% (95% CI 60% to 100%). For the real-time PCR, we estimated a summary receiver operating characteristic curve. To illustrate, a point on the curve with 85% specificity had a sensitivity of 49% (95% CI 30% to 68%). Likewise, at 90% specificity, sensitivity was 40% (95% CI 24% to 59%) and at 95% specificity, sensitivity was 29% (95% CI 15% to 49%). The median specificity of real-time PCR on blood products was 92%. We did not formally compare the diagnostic test accuracy of PCR and real-time PCR, as direct comparison studies were lacking. Three of 15 studies analysing PCR on blood products reported the timing of sample collection in the studies included in the meta-analyses (range 1 to 7 days postonset of symptoms), and nine out of 16 studies analysing real-time PCR on blood products (range 1 to 19 days postonset of symptoms). In PCR studies, specificity was lower in settings with high leptospirosis prevalence. Other investigations of heterogeneity did not identify statistically significant associations. Two studies suggested that PCR and real-time PCR may be more sensitive on blood samples collected early in the disease stage. Results of other index tests were described narratively. AUTHORS' CONCLUSIONS The validity of review findings are limited and should be interpreted with caution. There is a substantial between-study variability in the accuracy of PCR and real-time PCR, as well as a substantial variability in the prevalence of leptospirosis. Consequently, the position of PCR and real-time PCR in the clinical pathway depends on regional considerations such as disease prevalence, factors that are likely to influence accuracy, and downstream consequences of test results. There is insufficient evidence to conclude which of the nucleic acid and antigen detection tests is the most accurate. There is preliminary evidence that PCR and real-time PCR are more sensitive on blood samples collected early in the disease stage, but this needs to be confirmed in future studies.
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Affiliation(s)
- Bada Yang
- Amsterdam University Medical Centers, University of AmsterdamDepartment of Clinical Epidemiology, Biostatistics and BioinformaticsMeibergdreef 9AmsterdamNoord‐HollandNetherlands1105 AZ
| | - Sophia G de Vries
- Amsterdam University Medical Centers, location AMC, University of AmsterdamCenter of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal MedicineMeibergdreef 9AmsterdamNoord‐HollandNetherlands1105 AZ
| | - Ahmed Ahmed
- Academic Medical Centre (AMC), University of AmsterdamMedical Microbiology, OIE and National Collaborating Centre for Reference and Research on LeptospirosisMeibergdreef 39AmsterdamNetherlands1105 AZ
| | - Benjamin J Visser
- Amsterdam University Medical Centers, location AMC, University of AmsterdamCenter of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal MedicineMeibergdreef 9AmsterdamNoord‐HollandNetherlands1105 AZ
| | - Ingeborg M Nagel
- Amsterdam UMC, University of AmsterdamMedical LibraryMeibergdreef 9AmsterdamNetherlands1105 AZ
| | - René Spijker
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht UniversityCochrane NetherlandsRoom Str. 6.127P.O. Box 85500UtrechtNetherlands3508 GA
- Amsterdam UMC, University of Amsterdam, Amsterdam Public HealthMedical LibraryMeibergdreef 9AmsterdamNetherlands
| | - Martin P Grobusch
- Amsterdam University Medical Centers, location AMC, University of AmsterdamCenter of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal MedicineMeibergdreef 9AmsterdamNoord‐HollandNetherlands1105 AZ
| | - Rudy A Hartskeerl
- OIE and National Collaborating Centre for Reference and Research on LeptospirosisMeibergdreef 39AmsterdamNetherlands1105 AZ
| | - Marga GA Goris
- Academic Medical Centre (AMC), University of AmsterdamMedical Microbiology, OIE and National Collaborating Centre for Reference and Research on LeptospirosisMeibergdreef 39AmsterdamNetherlands1105 AZ
| | - Mariska MG Leeflang
- Amsterdam University Medical Centers, University of AmsterdamDepartment of Clinical Epidemiology, Biostatistics and BioinformaticsMeibergdreef 9AmsterdamNoord‐HollandNetherlands1105 AZ
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Widiyanti D, Djannatun T, Astuti IIP, Maharsi ED. Leptospira detection in flood-prone environment of Jakarta, Indonesia. Zoonoses Public Health 2019; 66:597-602. [PMID: 31173480 DOI: 10.1111/zph.12610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 04/12/2019] [Accepted: 05/20/2019] [Indexed: 12/01/2022]
Abstract
The study about Leptospira, particularly pathogenic strain, was conducted in the flood-prone area in the Special Capital Region of Jakarta. The aim of this study was to discover and identify the serovars of pathogenic Leptospira in the environment, which might infect human during flooding. Seventy-three samples, consisted of 36 samples of environmental water and 37 samples of soil, were collected from 5 districts of Jakarta. Their pH was measured, and the samples were then cultured in a modified Korthof's medium with 5-fluorouracil (5-FU) addition. Polymerase chain reaction, targeted on 23S rDNA (rrl), FlaB and LipL32 genes, was performed to identify Leptospira genus and differentiate the pathogenic. Identification of the pathogenic Leptospira was done utilising DNA sequencing. Seven samples showed amplification of rrl-gene. flaB and lipl32-PCR assay indicated one positive amplification band, each. Confirmation of flaB and lipl32 amplicons by DNA sequencing and BLAST analysis showed flaB amplicon (G1B; GenBank accession number MK006031.1) had 94% similarity with L. licerasiae (LC005426.1), while lipl32 amplicon was not identified as lipl32 of Leptospira. Based on those results, one intermediate pathogenic and six saprophytic Leptospira were obtained from the environment in Jakarta.
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Affiliation(s)
- Dian Widiyanti
- Department of Microbiology, Faculty of Medicine, YARSI University, Jakarta, Indonesia
| | - Titiek Djannatun
- Department of Microbiology, Faculty of Medicine, YARSI University, Jakarta, Indonesia
| | | | - Eri Dian Maharsi
- Department of Microbiology, Faculty of Medicine, YARSI University, Jakarta, Indonesia
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Monica N, Rathinasabapathi P, Ramya M. Development of real-time loop-mediated isothermal amplification (RealAmp) method for sensitive and rapid detection of pathogenic and nonpathogenicLeptospira. Lett Appl Microbiol 2019; 68:196-203. [DOI: 10.1111/lam.13108] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 12/16/2018] [Accepted: 12/17/2018] [Indexed: 11/28/2022]
Affiliation(s)
- N.I. Monica
- Department of Genetic Engineering; School of Bioengineering; SRM Institute of Science and Technology; Kattankulathur Tamil Nadu India
| | - P. Rathinasabapathi
- Department of Genetic Engineering; School of Bioengineering; SRM Institute of Science and Technology; Kattankulathur Tamil Nadu India
| | - M. Ramya
- Department of Genetic Engineering; School of Bioengineering; SRM Institute of Science and Technology; Kattankulathur Tamil Nadu India
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Jose LR, Mahadeviah SN, Balamurugan V, Kini KR. Evaluation of an in-house LipL32 polymerase chain reaction for diagnosis of leptospirosis and its correlation with various serological diagnostic techniques. Indian J Med Microbiol 2018; 36:385-390. [PMID: 30429392 DOI: 10.4103/ijmm.ijmm_17_355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Leptospirosis is a zoonotic disease of ubiquitous distribution. During rainy seasons, in spring and summer and also during harvest times, the risk of leptospirosis increases as there are chances of frequent contact with infected rat population which is common in Karnataka as farming is a main source of income to the people here. There is a paucity of data regarding the prevalent serovars from Karnataka. This study was undertaken as an attempt to compare a battery of tools such as immunochromatographic test (ICT), microscopic agglutination test (MAT), immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA) and in-house polymerase chain reaction (PCR) to detect leptospirosis. Settings and Design This study using consecutive sampling technique was conducted in a tertiary care centre, Mysore, Karnataka. Subjects and Methods Samples from 783 suspected cases of leptospirosis in and around Mysore between April 2013 and April 2016 were processed. Samples from 783 patients suspected of leptospirosis were subjected to ICT, IgM ELISA, MAT and in-house PCR. Statistical Analysis Used The statistical analysis was carried out using SPSS software version. Results Among 783 samples tested, only 14 (1.7%) were positive by ICT, 341 (44%) were positive by IgM ELISA, 368 (47%) were positive by MAT and 393 (50.2%) were positive by in-house PCR. Conclusions Mysore can be considered endemic for leptospirosis. The in-house PCR based on LipL32 gene proved to be useful in the early diagnosis of leptospirosis.
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Affiliation(s)
- Linda Rose Jose
- Department of Microbiology, JSS Medical College, Mysore, Karnataka, India
| | | | - V Balamurugan
- Department of Microbiology, ICAR-NIVEDI, Bengaluru, Karnataka, India
| | - K Ramachandra Kini
- Department of Biotechnology, University of Mysore, Mysore, Karnataka, India
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Meny P, Menéndez C, Quintero J, Hernández E, Ríos C, Balassiano IT, Trindade CNDR, Vital-Brazil JM, Ramos TMV, Ashfield N, Feble C, Avila E, Schelotto F, Varela G. Characterization of Leptospira isolates from humans and the environment in Uruguay. Rev Inst Med Trop Sao Paulo 2017; 59:e79. [PMID: 29267587 PMCID: PMC5738764 DOI: 10.1590/s1678-9946201759079] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 09/12/2017] [Indexed: 01/30/2023] Open
Abstract
Laboratory diagnosis of human leptospirosis usually relies on indirect methods exploring specific immune response. Isolation and identification of the involved strains are cumbersome, but can provide biological resources for pathogenic studies and relevant information for guiding prevention and control measures. The aim of the research we are hereby reporting was the characterization of Leptospira isolates obtained from humans and the environment in Uruguay. Blood cultures were performed from early samples of 302 Uruguayan patients, mainly rural workers, and from 36 water samples taken from their living or working environments. Eight human isolates and seven environmental isolates were obtained and analyzed by end point Polymerase Chain Reaction (PCR), Multilocus Variable Number of Tandem Repeat Analysis (MLVA) and other molecular methods. Human isolates corresponded to several serogroups and serovars of Leptospira interrogans and Leptospira kirschneri species, probably reflecting the infection with similar involved Leptospira species and serovars of an extended animal reservoir in rural settings of the country, mostly dedicated to meat and dairy production. Culture-positive patients were older than usually affected workers, and presented signs and symptoms of severe illness. A high organic and circulating bacterial burden may explain an easier positive result from these workers’ samples. Environmental isolates were mainly identified as Leptospira biflexa strains, with a single L. meyeri isolate of uncertain significance.
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Affiliation(s)
| | | | | | | | | | - Ilana Teruszkin Balassiano
- Instituto Osvaldo Cruz, Centro de Referência Nacional para Leptospirose, WHO Collaborating Center for Leptospirosis, Laboratório de Zoonoses Bacterianas, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Camilla Nunes Dos Reis Trindade
- Instituto Osvaldo Cruz, Centro de Referência Nacional para Leptospirose, WHO Collaborating Center for Leptospirosis, Laboratório de Zoonoses Bacterianas, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Juliana Magalhães Vital-Brazil
- Instituto Osvaldo Cruz, Centro de Referência Nacional para Leptospirose, WHO Collaborating Center for Leptospirosis, Laboratório de Zoonoses Bacterianas, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Tatiane Mendes Varela Ramos
- Instituto Osvaldo Cruz, Centro de Referência Nacional para Leptospirose, WHO Collaborating Center for Leptospirosis, Laboratório de Zoonoses Bacterianas, Rio de Janeiro, Rio de Janeiro, Brazil
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