Optimizing the microscopic agglutination test (MAT) panel for the diagnosis of Leptospirosis in a low resource, hyper-endemic setting with varied microgeographic variation in reactivity

Abstract

The microscopic agglutination test (MAT) is the standard serological reference test for the diagnosis of leptospirosis, despite being a technically demanding and laborious procedure. The use of a locally optimised MAT panel is considered essential for proper performance and interpretation of results. This paper describes the procedure of selecting such an optimised panel for Sri Lanka, a country hyper-endemic for leptospirosis. MAT was performed using 24 strains on 1132 serum samples collected from patients presenting with acute undifferentiated fever. Of 24 strains, 15 were selected as the optimised panel, while only 11% of serum samples showed positivity. A geographical variation in predominantly reactive serovars was observed, whereas reactivity was low with the saprophytic strain Patoc. Testing with paired sera yielded a higher sensitivity but provided only a retrospective diagnosis. Serological tests based on ELISA with complimentary molecular diagnosis using PCR are a feasible and robust alternative approach to diagnose leptospirosis in countries having a higher burden of the disease.

Changing Trends in the Seroprevalence of Leptospirosis in Kelambakkam: A Ten-Year Retrospective Study

“…This highly neglected, tropical infectious disease should always be handled with a high degree of suspicion and care, for both diagnosis and treatment, keeping in mind the dangerous complications it can lead to. 15 Source of Funding: None Conflict of Interest: None…”

Demographic, exposure, clinical, biochemical and diagnostic data of febrile patients recruited for the largest field study on leptospirosis in Sri Lanka

“…The initial study protocol for this data was published in 2019. The MAT data, the experimental design, material and methods were also published in the protocol paper and subsequent results papers [1] , [2] , [3] , [4] .…”

“…In addition, strains isolated from Sri Lanka were obtained from the Department of Medical Microbiology of the Academic Medical Centre (AMC) in Amsterdam and included ( Table 1 ). The MAT procedure was done using the standard protocol described in the published article [2] . Only a single antiserum was used as a positive control.…”

Ocular leptospirosis: lack of awareness among ophthalmologists and challenges in diagnosis

“…One Health approach is necessary for reducing zoonotic leptospira infections, in which interactions between humans, animals, and the environment play a critical role [1 ▪▪ ]. There is a huge diversity in pathogenic leptospira species worldwide, and our knowledge of the currently circulating species is deficient owing to limited isolation and identification of leptospira species from endemic countries [10 ▪▪ ]. The same strain leads to different clinical outcomes on canine leptospirosis.…”

“…It also remains endemic in economically challenged sectors like farmers, who cannot access tertiary care for etiological diagnosis. Hence, such endemic but life-threatening cases are often labeled as ‘Idiopathic’ in farmers [10 ▪▪ ]. It is a significant public health challenge affecting populations across the world and needs global attention.…”