Master's graduate, Molecular Epidemiology and Public Health Laboratory, School of Veterinary Science, Massey University, Palmerston North.
PhD graduate, Molecular Epidemiology and Public Health Laboratory, School of Veterinary Science, Massey University, Palmerston North.
N Z Med J. 2021 Jul 30;134(1539):33-43.
This study describes 47 presentations of suspected leptospirosis in general practice in New Zealand. Our primary aim was to assess the laboratory diagnosis of leptospirosis in these patients, by comparing polymerase chain reaction (PCR) tests, microscopic agglutination test (MAT) and culture results.
Patients suspected of leptospirosis were recruited from general practices in the Waikato (n=17) and Wairoa (n=30) between August 2011 and June 2015. Blood and urine samples were tested for leptospirosis at two diagnostic laboratories and one research laboratory using PCR tests, MAT and culture.
Forty-seven patients were recruited for this study: 37 during the acute phase of the illness (within 10 days of symptom onset) and 10 after the acute phase. Eleven of the acute phase patients (11/37, 30%) and two of the later phase patients (2/10, 20%) returned positive leptospirosis test results. The 11 acute phase leptospirosis positive patients had the following positive diagnostic tests: PCR and paired MAT (+/- blood culture) (n=3), PCR only (+/- blood culture) (n=4), paired MAT only (n=3) and blood culture only (n=1). Urine PCR (performed only on Wairoa patients) was the only positive test for two of these patients.
About a quarter of farm workers and meat workers presenting to general practice with flu-like symptoms will have leptospirosis, but they will not be diagnosed unless appropriately tested, and then they may only test positive for some of the tests available. To increase the likelihood of making a diagnosis, clinicians should order multiple laboratory tests, including blood and urine PCR and a paired MAT.
本研究描述了在新西兰普通诊所中疑似钩端螺旋体病的 47 例表现。我们的主要目的是通过比较聚合酶链反应（PCR）检测、显微镜凝集试验（MAT）和培养结果，评估这些患者的钩端螺旋体病的实验室诊断。
2011 年 8 月至 2015 年 6 月，从怀卡托（n=17）和怀劳阿（n=30）的普通诊所招募疑似钩端螺旋体病的患者。两家诊断实验室和一家研究实验室使用 PCR 检测、MAT 和培养法检测血液和尿液样本中的钩端螺旋体病。
本研究共招募了 47 例患者：37 例在疾病的急性期（症状出现后 10 天内），10 例在急性期后。11 例急性钩端螺旋体病阳性患者（11/37，30%）和 2 例后期患者（2/10，20%）的钩端螺旋体病检测结果为阳性。11 例急性钩端螺旋体病阳性患者的阳性诊断检测结果如下：PCR 和配对 MAT（+/-血培养）（n=3）、PCR 检测阳性（+/-血培养）（n=4）、配对 MAT 阳性（n=3）和血培养阳性（n=1）。其中 2 例患者仅尿液 PCR（仅在怀劳阿患者中进行）检测阳性。
约四分之一出现流感样症状就诊于普通诊所的农场工人和肉类工人将患有钩端螺旋体病，但除非进行适当的检测，否则他们不会被诊断出来，而且他们可能只有部分可用的检测结果呈阳性。为了提高诊断的可能性，临床医生应订购多种实验室检测，包括血液和尿液 PCR 以及配对 MAT。
