Evaluation of the Panbio Leptospira IgM ELISA among Outpatients Attending Primary Care in Southeast Asia

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  • 1 Mahidol-Oxford Tropical Research Medicine Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;
  • 2 Nuffield Department of Medicine, Nuffield Department of Medicine Research Building, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom;
  • 3 Department of Livestock Development, National Institute of Animal Health, Ministry of Agriculture and Cooperatives, Thailand;
  • 4 Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic

Despite estimates suggesting Leptospira spp. being endemic in Southeast Asia, evidence remains limited. Diagnostic accuracy evaluations based on Leptospira ELISA mainly rely on hospitalized and severe patients; therefore, studies measuring the pathogen burden may be inaccurate in the community. We evaluated the Panbio Leptospira ELISA IgM among 656 febrile outpatients attending primary care in Chiangrai, Thailand, and Hlaing Tha Yar, Yangon, Myanmar. ELISA demonstrated limited diagnostic accuracy for the detection of acute leptospiral infection using the manufacturer recommended cutoff, with a sensitivity of 71.4% and specificity of 36.4%, and an area under the receiver operator characteristic curve value of 0.65 (95% CI: 0.41–0.89), compared with our reference test, the PCR assay. ELISA also performed poorly as a screening tool for detecting recent exposure to Leptospira spp. compared with the “gold-standard” microscopic agglutination test, with a specificity of 42.7%. We conclude that the utility of the Leptospira IgM ELISA for both serodiagnosis and seroprevalence is limited in our setting.

Author Notes

Address correspondence to Stuart D. Blacksell, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand. E-mail: stuart@tropmedres.ac

Disclosure: S. D. B. and Yoel Lubell are supported by the Wellcome Trust of the United Kingdom.

Authors’ addresses: Sandhya Dhawan, Mahidol-Oxford Tropical Research Medicine Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand, E-mail: xxx. Thomas Althaus and Yoel Lubell, Mahidol-Oxford Tropical Research Medicine Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand, and Nuffield Department of Medicine, Nuffield Department of Medicine Research Building, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom, E-mails: xxx and xxx. Duangjai Suwancharoen, Department of Livestock Development, National Institute of Animal Health, Ministry of Agriculture and Cooperatives, Thailand, E-mail: xxx. Stuart D. Blacksell, Mahidol-Oxford Tropical Research Medicine Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand, Nuffield Department of Medicine, Nuffield Department of Medicine Research Building, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom, and Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic, E-mail: stuart@tropmedres.ac.

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