Title:A review of ten years of Leptospira serology and PCR testing

Author:Tégan A. Hall, Andrew W. Soepnel and Michael Addidle

Abstract:Objective: To evaluate the use of diagnostic Leptospira laboratory testing within the Midlands region of New Zealand and identify the most sensitive testing strategy.
Method: Leptospira serology and polymerase chain reaction (PCR) testing performed within the Pathlab remit in 2013-2022 were reviewed by comparing methodologies and request origins to identify trends over time and evaluate the relative performance of serology and PCR testing.
Results: 81% of the cases tested by both serology and PCR that were confirmed infections were detected by either blood PCR, urine PCR, or serology alone. No significant difference was observed between the detection rates of blood PCR and urine PCR. Serology was the most frequently requested methodology, though PCR testing quadrupled in 2017 and uptake has continued to increase since then, becoming the favoured methodology amongst hospital-based requestors in 2022. Appropriately timed paired serological testing was rarely performed.
Conclusions: No single methodology can be relied on to consistently detect leptospirosis infections. Follow-up serology was under-utilised. A combination of PCR and serology testing was the most effective testing strategy.
Key words: Leptospirosis, ELISA, microscopic agglutination test (MAT), serology, PCR.
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