Abstract
The persistence of anti-leptospiral IgM and IgG antibodies and agglutinating antibodies was studied in serologically confirmed cases of severe leptospirosis during the acute illness and over periods of several years after recovery. The antibody response in non-leptospirosis patients presenting to hospital with similar symptoms over the same period of time was used to estimate the background antibody level to leptospirosis in the community. All patients enrolled in the study had blood samples collected twice in the acute stage of illness, once during convalescence and then annually from the time of initial hospitalisation until the end of the study period. Six hundred and thirty-eight patients presented to hospital with acute febrile illness, of whom 321 were diagnosed with leptospirosis. Patients who had severe leptospirosis commonly remained seropositive, with IgM, IgG and agglutinating antibodies detectable for several years after infection. A significant proportion of cases had high titres of agglutinating antibody detectable by the microscopic agglutination test (≥ 800). There were marked differences in the magnitude and duration of persistence of agglutinating antibodies directed against different serogroups. More than 20% of cases with evidence of infection with serogroup Autumnalis retained titres of > 800, 4 years after the acute illness. In one case a titre of 800 was detected 11 years after infection. Persistence of agglutinating antibody titres can create problems in interpretation of serological results and make it impossible to estimate the time of infection, given a specific titre. This study demonstrates that in endemic areas where seroprevalence is high, use of a single elevated titre is not reliable to define a current infection.
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References
Levett PN. Leptospirosis. Clin Micro Rev 2001; 14: 296–326.
World Health Organization. Leptospirosis worldwide, 1999. Wkly Epidemiol Rec 1999; 74: 237–242.
Pérolat P, Chappel RJ, et al. Leptospira fainei sp. nov., isolated from pigs in Australia. Int J Syst Bact 1998; 48: 851–858.
Brenner DJ, Kaufmann AF, et al. Further determination of DNA relatedness between serogroups and serovars in the family Leptospiraceae with a proposal for Leptospira alexanderi sp. nov. and four new Leptospira genomospecies. Int J Syst Bact 1999; 49: 839–858.
Sanders EJ, Rigau-Perez JG, et al. Increase of leptospirosis in dengue-negative patients after a hurricane in Puerto Rico in 1966. Am J Trop Med Hyg 1999; 61: 399–404.
Levett PN, Branch SL, et al. Detection of dengue infection in patients investigated for leptospirosis in Barbados. Am J Trop Med Hyg 2000; 62: 112–114.
Brandã AP, Camargo ED, et al. Macroscopic agglutination test for rapid diagnosis of human leptospirosis. J Clin Micro 1998; 36: 3138–3142.
Levett PN, Whittington CU. Evaluation of the indirect hemagglutination assay for diagnosis of acute leptospirosis. J Clin Micro 1998; 36: 11–14.
Adler BA, Murphy M, et al. Detection of specific antileptospiral immunoglobulins M and G in human serum by solid-phase enzyme-linked immunosorbent assay. J Clin Micro 1980; 11: 452–457.
Terpstra WJ, Ligthart GS, et al. ELISA for the detection of speci.c IgM and IgG in human leptospirosis. J Gen Micro 1985; 131: 377–385.
Winslow WE, Merry DJ, et al. Evaluation of a commercial enzyme-linked immunosorbent assay for detection of immunoglobulin M antibody in diagnosis of human leptospiral infection. J Clin Micro 1997; 35: 1938–1942.
Smits HL, Ananyina YV, et al. International multicenter evaluation of the clinical utility of a dipstick assay for detection of Leptospira-specific immunoglobulin M antibodies in human serum specimens. J Clin Micro 1999; 37: 2904–2909.
Levett PN, Branch SL, Whittington CU, Edwards CN, Paxton H. Two methods for rapid serological diagnosis of acute leptospirosis. Clin Diag Lab Immunol 2001; 8: 349–351.
Faine S. Guidelines for the control of leptospirosis 1982. Geneva, World Health Organization.
Turner LH. Leptospirosis II. Serology. Trans Royal Soc Trop Med Hyg 1968; 62: 880–889.
Romero EC, Caly CR, et al. The persistence of leptospiral agglutinins titers in human sera diagnosed by the microscopic agglutination test. Rev Inst Med Trop S Paulo 1998; 40: 183–184.
Alston JM, Broom JC. Leptospirosis in man and animals. Edinburgh: E. & S. Livingstone, 1958.
Cursons RTM, Pyk PA, et al. The serological diagnosis of leptospirosis. NZ Med J 1982; 95: 36–37.
Blackmore DK, Schollum LM, et al. The magnitude and duration of titres of leptospiral agglutinins in human sera. NZ Med J 1984; 97: 83–86.
Everard COR, Bennett S. Persistence of leptospiral agglutinins in Trinidadian survey subjects. Eur J Epi 1990; 6: 40–44.
Adler B, Faine S. The antibodies involved in the human immune response to leptospiral infection. J Med Micro 1978; 11: 387–400.
Silva MV, Camargo ED, et al. Behaviour of speci.c IgM, IgG and IgA class antibodies in human leptospirosis during the acute phase of the disease and during convalescence. J Trop Med Hyg 1995; 98: 268–272.
Lupidi R, Cinco M, et al. Serological follow-up of patients in a localized outbreak of leptospirosis. J Clin Micro 1991; 29: 805–809.
Centers for Disease Control and Prevention. Case definitions for infectious conditions under public health surveillance. Morb Mortal Wkly Rep 1997; 46(no. RR-10): 49.
Faine S. Leptospirosis. In: Balows A, Hausler WJ, Ohashi M, Turano A. (eds), Laboratory Diagnosis of Infectious Diseases. Principles and Practice. New York: Springer-Verlag. 1988; 1: 344–352.
Alexander AD. Serological diagnosis of leptospirosis. In: Rose NR, Friedman H, Fahey JL. (eds), Manual of clinical laboratory immunology. Washington, DC: Am Soc for Micro, 1986; 435–439.
Galton MM, Powers DK, et al. A rapid macroscopic slide agglutination test for the serodiagnosis of leptospirosis. Am J Vet Res 1958; 19: 505–512.
Edwards CN, Nicholson GD, et al. Leptospirosis in Barbados: A clinical study. West Indian Med J 1990; 39: 27–34.
Cumberland P, Everard COR, et al. Assessment of the e.cacy of the IgM enzyme-linked immunosorbent assay ELISA and microscopic agglutination test MAT in the diagnosis of acute leptospirosis. Am J Trop Med Hyg 1999: 61: 731–734.
Terpstra WJ. Typing leptospira from the perspective of a reference laboratory. Acta Leidensia 1992; 60: 79–87.
Levett PN. Utility of serology as a predictor of infecting serovar in severe leptospirosis. Abstract presented at 2nd meeting of the International Leptospirosis Society, Australia, 1999.
Silva MV, Nakamura PM, et al. Immunodiagnosis of human leptospirosis by dot-ELISA for the detection of IgM, IgG, and IgA antibodies. Am J Trop Med Hyg 1997; 56: 650–655.
Everard JD, Everard COR. Leptospirosis in the Caribbean. Rev Med Micro 1993; 4: 114–122.
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Cumberland, P., Everard, C., Wheeler, J. et al. Persistence of anti-leptospiral IgM, IgG and agglutinating antibodies in patients presenting with acute febrile illness in Barbados 1979–1989. Eur J Epidemiol 17, 601–608 (2001). https://doi.org/10.1023/A:1015509105668
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DOI: https://doi.org/10.1023/A:1015509105668