San Antonio Military Medical Center, Brooke Army Medical Center, 3851 Roger Brooke Drive, Fort Sam Houston, TX 78234, USA.
Trans R Soc Trop Med Hyg. 2011 Apr;105(4):209-13. doi: 10.1016/j.trstmh.2010.12.004. Epub 2011 Feb 19.
Given the protean manifestations of leptospirosis, adequate laboratory support for diagnosis is necessary. Traditionally, the gold standard is the microscopic agglutination test (MAT) using a panel of Leptospira isolates representing a broad range of serogroups and serovars. It has been proposed that screening with serovars circulating in a region would enhance test performance. We assessed the diagnostic usefulness of MAT using both regionally obtained clinical Leptospira isolates and the specific isolates recovered from the tested patients. Serum obtained from 41 acute febrile patients (obtained on average 7.2 days [SD±5.2] after onset of fever) was tested using a standard panel of 24 serovars along with regional isolates recovered from human and animal blood cultures from different regions in Egypt and a patient's own isolate, if available, to establish additional MAT panels. Serum samples tested by a standard 24 panel with a cut-off of >1:800 revealed five patients with positive serology. Only one patient had a positive result using a regional panel or patient's own culture developed MAT. However, the serovar with the highest titers did not match the cultured serovar. Region-specific MATs did not appear to be reliable in detection of infection or in identifying the infecting serovar.
鉴于钩端螺旋体病的多种表现形式，充分的实验室支持对于诊断是必要的。传统上，金标准是使用代表广泛血清群和血清型的一组钩端螺旋体分离物的显微镜凝集试验（MAT）。有人提出，用在该地区流行的血清型进行筛选可以提高试验性能。我们评估了使用从地区获得的临床钩端螺旋体分离物和从测试患者中回收的特定分离物进行 MAT 的诊断有用性。从埃及不同地区的人和动物血液培养物中获得的区域分离物以及患者自身的分离物（如果有），除了标准的 24 血清型面板外，还建立了额外的 MAT 面板，从 41 例急性发热患者（平均在发热后 7.2 天[SD±5.2]获得血清）中检测到血清。用>1:800 的截值对标准 24 组进行血清样本检测，发现五例血清学阳性患者。只有一名患者使用地区性面板或患者自身培养物开发的 MAT 获得阳性结果。然而，效价最高的血清型与培养的血清型不匹配。针对特定地区的 MAT 似乎无法可靠地检测感染或确定感染的血清型。
