Mild leptospirosis with three-year persistence of IgG- and IgM-antibodies, initially manifesting as carpal tunnel syndrome

Finsterer, Josef; Stöllberger, Claudia; Sehnal, Ernst; Stanek, Gerold

doi:10.1016/j.jinf.2004.08.019

Cited by 10 publications

(8 citation statements)

References 16 publications

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“…We included sera from healthy slum residents without regard to MAT status, whereas sera from residents with acute fever were screened for negative MAT titers in both the acute and convalescent phases. These observations suggest that the presence of low-level agglutinating antibody titers, which may persist for months to years [4], [46], even after mild disease [47], affected test performance in this group.…”

Section: Discussionmentioning

confidence: 83%

Accuracy of a Dual Path Platform (DPP) Assay for the Rapid Point-of-Care Diagnosis of Human Leptospirosis

et al. 2012

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BackgroundDiagnosis of leptospirosis by the gold standard serologic assay, the microscopic agglutination test (MAT), requires paired sera and is not widely available. We developed a rapid assay using immunodominant Leptospira immunoglobulin-like (Lig) proteins in a Dual Path Platform (DPP). This study aimed to evaluate the assay's diagnostic performance in the setting of urban transmission.MethodologyWe determined test sensitivity using 446 acute and convalescent sera from MAT-confirmed case-patients with severe or mild leptospirosis in Brazil. We assessed test specificity using 677 sera from the following groups: healthy residents of a Brazilian slum with endemic transmission, febrile outpatients from the same slum, healthy blood donors, and patients with dengue, hepatitis A, and syphilis. Three operators independently interpreted visual results without knowing specimen status.ResultsThe overall sensitivity for paired sera was 100% and 73% for severe and mild disease, respectively. In the acute phase, the assay achieved a sensitivity of 85% and 64% for severe and mild leptospirosis, respectively. Within seven days of illness onset, the assay achieved a sensitivity of 77% for severe disease and 60% for mild leptospirosis. Sensitivity of the DPP assay was similar to that for IgM-ELISA and increased with both duration of symptoms (chi-square regression P = 0.002) and agglutinating titer (Spearman ρ = 0.24, P<0.001). Specificity was ≥93% for dengue, hepatitis A, syphilis, febrile outpatients, and blood donors, while it was 86% for healthy slum residents. Inter-operator agreement ranged from very good to excellent (kappa: 0.82–0.94) and test-to-test reproducibility was also high (kappa: 0.89).ConclusionsThe DPP assay performed acceptably well for diagnosis of severe acute clinical leptospirosis and can be easily implemented in hospitals and health posts where leptospirosis is a major public health problem. However, test accuracy may need improvement for mild disease and early stage leptospirosis, particularly in regions with high transmission.

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Section: Discussionmentioning

confidence: 83%

Accuracy of a Dual Path Platform (DPP) Assay for the Rapid Point-of-Care Diagnosis of Human Leptospirosis

et al. 2012

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“…However, we found that 50.0% of patients had detectable IgM ELISA reactivity up to five years after hospitalization for leptospirosis (Table 1 and Figure 1). Although re-infection cannot be excluded, these findings provide additional evidence for prolonged persistence of anti-whole Leptospira antibodies after infection (Abdulkader et al, 2002,Cumberland et al, 2001,Everard and Bennett, 1990,Finsterer et al, 2005,Lupidi et al, 1991 which in turn, may adversely affect the applicability of the assay in regions of high endemic transmission. In fact, high false positive rates have been reported for whole Leptospira-based assays in settings of rural leptospirosis (Cumberland et al, 2001,da Silva et al, 1997.…”

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confidence: 90%

Evaluation of the EIE-IgM-Leptospirose assay for the serodiagnosis of leptospirosis

McBride¹,

Pereira²,

Silva³

et al. 2007

Acta Tropica

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Access to low-cost, effective diagnosis for leptospirosis is urgently needed in developing countries. The EIE-IgM-Leptospirose, a kit produced for public health laboratories in Brazil, was shown to have a sensitivity of 76% (77 of 102 patients) and 100% (102 of 102 patients) during acute and convalescent-phase leptospirosis, respectively, and a specificity of 93-100% (total healthy and patient control subjects evaluated, 486). These findings indicate that the assay will be useful for diagnosis of this emerging infectious disease in Brazil and other developing countries.

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“…Presence of rLipL32 specific IgG among our study population has shown that leptospiral infection is prevalent both in rural and urban areas of Bangladesh. Anti-leptospiral IgG remains persistent for several years following acute infection [15][16]. Persistence of antibody may create problem in interpreting the serological tests detecting IgG antibodies in acute cases unless rising IgG antibody or Leptospira specific IgM is detected.…”

Section: Discussionmentioning

confidence: 99%

Seroprevalence of Leptospira infection in selected rural and urban areas of Bangladesh by rLipL32 based ELISA

Tamanna

Rahman

et al. 2017

IMC J Med Sci

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Background and objectives: Leptospirosis is a zoonotic infection with worldwide distribution caused by the Leptospira species and predominant in the tropical and subtropical regions. Information on leptospirosis in Bangladesh is limited. The present study was designed to detect anti-leptospiral antibodies in human serum samples in Bangladeshi population by developing an in-house ELISA using recombinant LipL32 (rLipL32) antigen. The study was conducted from April 2014 to December 2014.Method: Healthy individuals from two rural areas and fever cases from one urban healthcare center were enrolled in the study. Rural health centers were located at Sonargoan and Bajitpur sub-district (Upozilla) of Narayaganj and Kishorganj districts. Sonargoan health center is located 26 km south-east and Bajitpur is located 71 km north-east of Dhaka city. About 1-2 ml of blood was collected with aseptic measure and serum was separated and stored at -200C until used. Anti-leptospiral IgG antibody was determined by recombinant LipL32 (rLipL32) antigen based indirect enzyme linked immunosorbent assay (ELISA). Seropositive cases were further confirmed by commercial Leptospira IgG ELISA.Results: The study included 250 febrile cases and 376 healthy individuals from urban and rural areas, respectively. Out of total 626 study population, anti-LipL32 specific IgG antibody was detected in 70 individuals (11.2%). The rate of positivity of anti-LipL32 antibody among the healthy individuals from rural area was 10.6% while the rate was 12.0% in urban febrile population. The rate of positivity in rural and urban population was not significantly (p>0.05) different. Among the urban population, the rate of seropositivity was 9.1% and 16.4% in 21- 40 yrs and above 40 years age group respectively while the rate was 7.2% and 14.0% in rural population respectively. Out of 70 seropositive cases detected by LipL32 ELISA, 65 (92.9%) were positive by commercial ELISA.Conclusion: The present study has revealed that leptospirosis is prevalent in Bangladesh and should be looked for in febrile and clinically suspected cases. The study has also demonstrated that rLipL32 protein may be used as a candidate antigen for the serodiagnosis of leptospirosis.IMC J Med Sci 2017; 11(2): 50-55

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Mild leptospirosis with three-year persistence of IgG- and IgM-antibodies, initially manifesting as carpal tunnel syndrome

Cited by 10 publications

References 16 publications

Accuracy of a Dual Path Platform (DPP) Assay for the Rapid Point-of-Care Diagnosis of Human Leptospirosis

Accuracy of a Dual Path Platform (DPP) Assay for the Rapid Point-of-Care Diagnosis of Human Leptospirosis

Evaluation of the EIE-IgM-Leptospirose assay for the serodiagnosis of leptospirosis

Seroprevalence of Leptospira infection in selected rural and urban areas of Bangladesh by rLipL32 based ELISA

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