The Utility of Blood Culture Fluid for the Molecular Diagnosis of Leptospira: A Prospective Evaluation

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningfagfællebedømt

  • Sabine Dittrich
  • William E. Rudgard
  • Kate L. Woods
  • Joy Silisouk
  • Weerawat Phuklia
  • Viengmon Davong
  • Manivanh Vongsouvath
  • Koukeo Phommasone
  • Sayaphet Rattanavong
  • Michael Knappik
  • Scott B. Craig
  • Steven L. Weier
  • Tulsiani, Suhella
  • David A. B. Dance
  • Paul N. Newton
Leptospirosis is an important zoonosis worldwide, with infections occurring after exposure to contaminated water. Despite being a global problem, laboratory diagnosis remains difficult with culture results taking up to 3 months, serology being retrospective by nature, and polymerase chain reaction showing limited sensitivity. Leptospira have been shown to survive and multiply in blood culture media, and we hypothesized that extracting DNA from incubated blood culture fluid (BCF), followed by quantitative real-time polymerase chain reaction (qPCR) could improve the accuracy and speed of leptospira diagnosis. We assessed this retrospectively, using preincubated BCF of Leptospira spp. positive (N = 109) and negative (N = 63) febrile patients in Vientiane, Lao PDR. The final method showed promising sensitivities of 66% (95% confidence interval [CI]: 55–76) and 59% (95% CI: 49–68) compared with direct or direct and indirect testing combined, as the respective reference standards (specificities > 95%). Despite these promising diagnostic parameters, a subsequent prospective evaluation in a Lao hospital population (N = 352) showed that the sensitivity was very low (∼30%) compared with qPCR on venous blood samples. The disappointingly low sensitivity does suggest that venous blood samples are preferable for the clinical microbiology laboratory, although BCF might be an alternative if leptospirosis is only suspected postadmission after antibiotics have been used.
OriginalsprogEngelsk
TidsskriftAmerican Journal of Tropical Medicine and Hygiene
Vol/bind94
Udgave nummer4
Sider (fra-til)736-740
Antal sider5
ISSN0002-9637
DOI
StatusUdgivet - apr. 2016

ID: 160973171