Usefulness of serologic analysis as a predictor of the infecting serovar in patients with severe leptospirosis
Usefulness of serologic analysis as a predictor of the infecting serovar in patients with severe leptospirosis
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DOI：
10.1086/346208
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发表时间：
2003-02-15
影响因子：
11.8
通讯作者：
Levett, PN
中科院分区：
文献类型：
--
作者：
Levett, PN
钩端螺旋体病的诊断通常使用显微镜凝集试验(MAT)，即代表20个血清型的活抗原与患者血清样本发生反应，以检测凝集抗体。从这项检测得出的数据经常被用来推断感染钩端螺旋体的血清型或血清组的身份；然而，血清组之间的矛盾反应和交叉反应是常见的。为了评估这种方法的有效性，回顾了1980年1月至1998年12月巴巴多斯发生的培养证实的钩端螺旋体病病例的数据。共鉴定出4个血清型151株。测定了MAT对感染血清型预测的敏感性。总体而言，滴度大于或等于100的主要血清组正确预测了所有分离的血清型的46.4%。如果以滴度大于或等于800为界值，则敏感度略降至44.4%。所有血清型的总特异性为64.8%。血清学分析似乎对确定人类钩端螺旋体病个别病例的感染血清型没有什么价值。推定的血清群反应性数据只能用来对人群水平上存在的血清群有一个大致的了解。
The diagnosis of leptospirosis is often made using the microscopic agglutination test (MAT), in which live antigens representing >20 serogroups undergo reaction with patient serum samples to detect agglutinating antibodies. Data derived from this assay are often used to infer the identity of the infecting leptospiral serovar or serogroup; however, paradoxical reactions and cross-reactions between serogroups are common. To evaluate the usefulness of this approach, data on culture-proven cases of leptospirosis that occurred in Barbados from January 1980 through December 1998 were reviewed. A total of 151 isolates of 4 serovars were identified. The sensitivity of MAT for the prediction of the infecting serovar was determined. Overall, the predominant serogroup at a titer of greater than or equal to100 correctly predicted 46.4% of all serovars isolated. If a titer of greater than or equal to800 was used as the cutoff, sensitivity decreased slightly to 44.4%. The overall specificity for all serogroups was 64.8%. Serologic analysis appeared to be of little value for the identification of the infecting serovar in individual cases of leptospirosis in humans. Presumptive serogroup reactivity data should be used only to gain a broad idea of the serogroups present at the population level.