Referral pattern of leptospirosis cases during a large urban epidemic of dengue.

Flannery, Brendan; Pereira, Martha María; de, F Velloso L; De, Chandrav; Codes, Lina Góes de; De, Saumyen; Dourado, Cibele Maria Ribeiro; Riley, Lee W.; Reis, Mitermayer Galvão dos; Ko, Albert I.

doi:10.4269/ajtmh.2001.65.657

Cited by 56 publications

(57 citation statements)

References 22 publications

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“…Yet, early phase leptospirosis is often not identified or is diagnosed as other causes of acute febrile disease due to its nonspecific clinical presentation (26). Misdiagnosis of leptospirosis has become a significant problem as diseases with similar early symptoms, such as dengue, have reemerged in the same places (8,21,29). Identification of leptospirosis will therefore need to rely on a high index of clinical suspicion and the use of a rapid and specific laboratory test (21,31).…”

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Leptospira Immunoglobulin-Like Proteins as a Serodiagnostic Marker for Acute Leptospirosis

et al. 2007

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There is an urgent need for improved diagnosis of leptospirosis, an emerging infectious disease which imparts a large disease burden in developing countries. We evaluated the use of Leptospira immunoglobulin (Ig)-like (Lig) proteins as a serodiagnostic marker for leptospirosis. Lig proteins have bacterial immunoglobulin-like (Big) tandem repeat domains, a moiety found in virulence factors in other pathogens. Sera from patients identified during urban outbreaks in Brazil reacted strongly with immunoblots of a recombinant fragment comprised of the second to sixth Big domains of LigB from L. interrogans serovar Copenhageni, the principal agent for transmission in this setting. Furthermore, the sera recognized an analogous LigB fragment derived from L. kirschneri serovar Grippotyphosa, a pathogenic serovar which is not endemic to the study area. The immunoblot assay detected anti-LigB IgM antibodies in sera from 92% (95% confidence interval, 85 to 96%) of patients during acute-phase leptospirosis. The assay had a sensitivity of 81% for sera from patients with less than 7 days of illness. Anti-LigB antibodies were found in sera from 57% of the patients who did not have detectable anti-whole-Leptospira responses as detected by IgM enzyme-linked immunosorbent assay and microagglutination test. The specificities of the assay were 93 to 100% and 90 to 97% among sera from healthy individuals and patients with diseases that have clinical presentations that overlap with those of leptospirosis, respectively. These findings indicate that the antibody response to this putative virulence determinant is a sensitive and specific marker for acute infection.

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Leptospira Immunoglobulin-Like Proteins as a Serodiagnostic Marker for Acute Leptospirosis

et al. 2007

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“…Por ejemplo, se ha documentado ampliamente la asociación de leptospirosis y dengue en diferentes regiones del mundo, algunas veces asociada con brotes después de desastres naturales (25)(26)(27)(28)(29) En Colombia es poco lo que se ha informado sobre leptospirosis en humanos, o sobre su comportamiento epidemiológico y serológico (20,(30)(31)(32)(33)(34)(35)(36). Lo anterior se debe posiblemente a que no existen pruebas serológicas de amplia distribución para confirmar el diagnóstico etiológico.…”

Section: Discussionunclassified

Evaluación de la prueba de inmunofluorescencia indirecta para el diagnóstico de leptospirosis humana.

Agudelo‐Flórez¹,

Restrepo²,

Lotero³

2006

biomedica

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Introducción. El diagnóstico de la leptospirosis es difícil debido al amplio espectro de síntomas clínicos que presenta. Varias pruebas diagnósticas serológicas se han desarrollado, pero su aplicación y utilidad en Colombia no han sido determinadas. Objetivos. Evaluar la prueba de inmunofluorescencia indirecta para el diagnóstico de leptospirosis humana y determinar así los anticuerpos de las clases inmunoglobulina G y M producidos contra Leptospira. Materiales y métodos. Se establecieron tres grupos de estudio. El primero incluyó 19 muestras positivas para leptospirosis de pacientes con diagnóstico clínico y prueba de microaglutinación positiva; el segundo, 40 muestras de personas sin antecedentes de leptospirosis y con microaglutinación negativa, y el tercero con 96 muestras de pacientes con otras enfermedades diferentes a leptospirosis. Todas las muestras fueron procesadas por inmunofluorescencia indirecta. Resultados. Se determinó que la inmunofluorescencia indirecta tiene sensibilidad de 89,47%, especificidad de 100%, valor predictivo negativo de 95,2% (IC95% 82,6 a 99,2) y valor predictivo positivo de 100%. En forma paralela, un estudio exploratorio en 27 muestras de suero que habían sido remitidas para diagnóstico de diferentes síndromes febriles encontró que 11% de ellas fueron positivas por inmunofluorescencia indirecta para anticuerpos IgM contra Leptospira. Conclusiones. La inmunofluorescencia indirecta es una alternativa que complementa el diagnóstico de leptospirosis y los estudios seroepidemiológicos. La presencia de anticuerpos dirigidos contra Leptospira en las muestras de síndrome febril del estudio indica que la leptospirosis es una de las causas de este síndrome que el clínico debe explorar.Palabras clave: Leptospira, leptospirosis, enfermedad de Weil, anticuerpos, serología, técnica del anticuerpo fluorescente indirecta. Evaluation of Indirect Inmunofluorescence assay for diagnosis of human leptospirosisIntroduction. The diagnosis of leptospirosis is difficult because it presents an extremely broad spectrum of symptoms. A number of diagnostic serological assays have been developed, but their performance and utility have not been evaluated in Colombia. Objectives. To evaluate the IgM-IgG-indirect inmunofluorescence assay to detect antibodies against Leptospira in human serum samples and to diagnose leptospirosis. Materials and methods. A panel of 19 sera from leptospirosis cases with clinical diagnosis and positive microscopic agglutination test, 40 samples from individuals without history of leptospirosis and negative microscopic agglutination test, and 96 samples from patients with other infectious diseases were evaluated. Results.The sensitivity of the indirect inmunofluorescence assay was 89.47%, its specificity was 100%, the negative predictive value was 95.2% (CI 95% 82.6-99.2), and its positive predictive value was 100%. At the same time an exploratory study of 27 samples from different febrile syndromes, 11% were positive by IgM-indirect inmunofluorescence assay against Leptospira. Con...

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“…Recent outbreaks of dengue and leptospirosis have highlighted the importance of a specific diagnosis, particularly as earlier diagnosis of leptospirosis facilitates prompt antibiotic treatment (Flannery et al, 2001;Levett et al, 2000;Sanders et al, 1999). In many outbreak investigations, specimens are shipped long distances under less than optimal conditions.…”

Section: Sensitivity and Specificity Of The Real-time Pcr Assaymentioning

confidence: 99%

Detection of pathogenic leptospires by real-time quantitative PCR

Levett

Morey

Galloway

et al. 2005

Journal of Medical Microbiology

244

165

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Definitive diagnosis of leptospirosis has traditionally depended upon the isolation of leptospires from clinical specimens or the demonstration of seroconversion in paired acute and convalescent serum samples. Both of these approaches require expertise not routinely available in clinical laboratories and usually result in delayed diagnosis. Conventional PCR assays have been developed, but all have limitations which have restricted their widespread use. In order to overcome these limitations, a realtime PCR assay was developed using a 423 bp target on the lipL32 gene, which is conserved among pathogenic serovars of Leptospira. Reactions were monitored by SYBR green fluorescence and melting curve analysis. Representative serovars from 16 species of Leptospira and over 40 species of other bacteria and fungi were tested. Positive results were obtained with all pathogenic leptospiral serovars, with the exception of Leptospira fainei serovar Hurstbridge. The analytical sensitivity of this assay was 3 genome equivalents per reaction; approximately 10 genome equivalents were detectable in human urine. Leptospiral DNA was amplified from blood containing EDTA or citrate anticoagulants, but heparin, sodium polyanetholesulfonate and saponin were inhibitory. The assay successfully detected leptospiral DNA from serum and urine samples of patients with leptospirosis. This assay has the potential to facilitate rapid, sensitive diagnosis of acute leptospirosis.

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Referral pattern of leptospirosis cases during a large urban epidemic of dengue.

Cited by 56 publications

References 22 publications

Leptospira Immunoglobulin-Like Proteins as a Serodiagnostic Marker for Acute Leptospirosis

Leptospira Immunoglobulin-Like Proteins as a Serodiagnostic Marker for Acute Leptospirosis

Evaluación de la prueba de inmunofluorescencia indirecta para el diagnóstico de leptospirosis humana.

Detection of pathogenic leptospires by real-time quantitative PCR

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