Materiały źródłowe

• #1 Leptospirosis Diagnosis: Competancy of Various Laboratory Tests

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3939550/

  Leptospiral infection often has minimal or no clinical manifestations; of the cases in which fever develops, as many as 90% are undifferentiated febrile illnesses. […] Despite being common, the diagnosis of leptospirosis is often not made unless a patient presents with textbook manifestations of the so called Weils disease, such as fever plus jaundice, renal failure and pulmonary haemorrhage. […] Therefore, diagnosis is based on laboratory tests rather than on clinical symptoms alone. […] The most common way to diagnose leptospirosis is through serological tests either the Microscopic Agglutination Test (MAT) which detects serovar-specific antibodies, or a solid-phase assay for the detection of Immunoglobulin M (IgM) antibodies. […] The MAT is the cornerstone of the serodiagnosis for leptospirosis, because this assay has a high sensitivity and allows for the detection of group specific antibodies.

• #1 Leptospirosis: Epidemiology, microbiology, clinical manifestations, and diagnosis – UpToDate

  https://www.uptodate.com/contents/leptospirosis-epidemiology-microbiology-clinical-manifestations-and-diagnosis

  Leptospirosis: Epidemiology, microbiology, clinical manifestations, and diagnosis […] The treatment and prevention of this disease are discussed separately. […] DIAGNOSIS […] Clinical suspicion — The level of suspicion for leptospirosis in a given patient depends primarily on the clinical syndrome and the local epidemiology of the infection. […] Leptospirosis should be suspected in patients who have a compatible systemic febrile illness and no clear alternative explanation, especially if they have exposures to endemic or outbreak settings or have engaged in high-risk activities. […] Confirming the diagnosis — A definitive diagnosis is made by laboratory-based tests. […] Approach to testing — When leptospirosis is suspected, we notify the microbiology laboratory prior to sending samples, so they can use specialized techniques.

• #1 Leptospirosis (Weil’s Disease): Symptoms and Diagnosis

  https://patient.info/infections/leptospirosis-and-weils-disease

  Leptospirosis diagnosis […] Tests are usually carried out to confirm the diagnosis. You may be asked to provide a urine sample to look for Leptospira in your urine. Blood testing can also confirm the diagnosis by looking for evidence of the germs (bacteria) in your bloodstream. Often, more than one test is required, as it can be difficult to diagnose leptospirosis with laboratory tests. Other tests may also be done to assess the severity of your illness. For example, blood tests to look for anaemia, to look at the clotting of your blood and to look at how your kidneys and liver are functioning. […] In the early stages of leptospirosis, it may be quite difficult to tell the symptoms apart from the flu. If you know that you have been in contact with water that was possibly contaminated with animal urine, or if you work with animals, you should tell your doctor and this can help to alert them to the possibility of leptospirosis.

• #1 Leptospirosis Diagnosis: Competancy of Various Laboratory Tests

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3939550/

  Therefore, serological tests remain suboptimal for clinical use in diagnosing leptospirosis as depicted in [Table/Fig-1]. […] The most promising diagnostic methods are those that demonstrate the presence of the organisms. […] Direct Polymerase Chain Reaction (PCR) on specimens enables rapid and direct diagnosis, at least in the early and convalescent stages of infection. […] A limitation of PCR-based diagnosis of leptospirosis is the inability of most PCR assays to identify the infecting serovar. […] Most cases of leptospirosis are diagnosed by serology. Antibodies can become detectable by the 6th to 10th day of disease and reach peak levels within three to four weeks. […] Though Microscopic agglutination test is considered to be the gold standard in the diagnosis of leptospirosis, its use as a routine diagnostic test in a clinical laboratory is limited.

• #1 Leptospirosis Workup: Approach Considerations, Culture, Microscopic Agglutination Testing

  https://emedicine.medscape.com/article/220563-workup

  Leptospires grow slowly in culture, and recovery rates are low. Serologic tests are available only in specialized laboratories, and the sensitivity of acute serologic tests is low. Consequently, those tests should not be the basis on which treatment is initiated. In a patient with compatible symptoms and a plausible exposure history, empiric therapy should be started. […] Laboratory studies are used for two purposes: to confirm the diagnosis and to determine the extent of organ involvement and severity of complications. Laboratory confirmation of leptospirosis can be accomplished through isolation of the pathogen or by serologic testing. […] Isolation of the leptospires from human tissue or body fluids is the criterion standard, but culture is not routinely available; thus, molecular assays such as DNA PCR are more commonly used, if available.

• #1 Leptospirosis Workup: Approach Considerations, Culture, Microscopic Agglutination Testing

  https://emedicine.medscape.com/article/220563-workup

  Microscopic agglutination testing (MAT) uses a battery of antigens taken from common (frequently locally endemic) leptospire serovars. MAT is available only at reference laboratories, such as the Centers for Disease Control and Prevention (CDC). […] A 4-fold rise in titer between acute and convalescent specimens is considered a positive result. […] An immunoglobulin M (IgM) enzyme-linked immunoabsorbent assay (ELISA) has been developed. […] Nucleic acid amplification (polymerase chain reaction [PCR]) based techniques have been developed to diagnose leptospirosis. […] Dark-field examination of blood or urine has been used to identify leptospires. However, this technique is insensitive and nonspecific on its own.

• #1 LifeAssay Diagnostics – Leptospirosis Tests for Humans

  http://www.lifeassay.com/products_rapid_diagnostic_leptospirosis-human.php

  Leptospirosis or Weils disease is caused by pathogenic spirochetes belonging to the genus Leptospira. […] Laboratory testing is essential because signs and symptoms may resemble those of other common infectious diseases. […] The microscopic agglutination test is the reference test for leptospirosis and detection of specific IgM antibodies may be used for the early diagnosis. […] The Leptospira IgM lateral flow assay is a relatively simple and rapid assay that may be used as a point-of-care assay in the field or at the bed-side. […] The test is able to detect all serovars of Leptospira that causes leptospirosis in humans. […] Results are obtained in 15 minutes. […] The Test-it Leptospira lateral flow device detects IgM antibodies in humans against Leptospira in whole blood or serum.

• #1 Leptospirosis Diagnosis: Competancy of Various Laboratory Tests

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3939550/

  A single serum sample taken during an acute febrile illness with symptoms of leptospirosis is presumptive evidence of infection, and therefore requires confirmation by further testing. […] Therefore use of PCR in combination with IgM ELISA would improve the sensitivity of the diagnosis of leptospirosis in the first phase of the disease. […] When using a single sample collected during the early, acute phase of the disease, results of Pan Bio IgM ELISA can give us a presumptive diagnosis of leptospirosis.

• #1 Leptospirosis: An important zoonosis acquired through work, play and travel

  https://www1.racgp.org.au/ajgp/2018/march/leptospirosis

  Leptospirosis is sometimes misdiagnosed because clinical presentation can be non-specific and overlap with many other causes of acute febrile illnesses. […] In patients with risk factors for leptospirosis, a high index of clinical suspicion is important to ensure early diagnosis and treatment. […] Delays in treatment could increase the risk of severe complications, including pulmonary haemorrhage, acute renal failure and acute liver failure. […] Multiple diagnostic tests are available, and it is important to order the appropriate test(s) and understand their interpretation for each phase of the illness. […] Tests that detect the presence of bacteria (eg polymerase chain reaction [PCR], culture) will only yield positive results in the acute/bacteraemic phase. […] Tests that detect antibodies will produce positive results later, from days six to eight from illness onset for immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA), and from day 10 to 12 from illness onset for microscopic agglutination test (MAT).

• #1 Leptospirosis: Epidemiology, microbiology, clinical manifestations, and diagnosis – UpToDate

  https://www.uptodate.com/contents/leptospirosis-epidemiology-microbiology-clinical-manifestations-and-diagnosis

  The diagnosis is confirmed by a positive PCR of blood or urine or by positive serologic testing; rarely, a diagnosis is made by a positive culture of blood or urine. […] Molecular tests (eg, PCR) — Molecular tests, such as PCR, can provide rapid, accurate diagnosis of leptospirosis, especially early in the course of illness (ie, the acute phase). […] A single positive PCR is confirmatory of leptospirosis infection. […] Serology — Serologic tests measure specific immunoglobulin (Ig)M and IgG antibodies against Leptospira organisms. […] To diagnose leptospirosis by serologic testing, one blood sample should be obtained upon presentation (ie, an acute sample) and a second sample should be obtained 7 to 14 days after the first antibody test is sent (ie, a convalescent sample). […] The diagnosis is not ruled out by negative test results because the sensitivity of leptospirosis testing is suboptimal.

• #1 Leptospirosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441858/

  Leptospirosis, also called Weil disease, is the most common zoonotic infection in the world. […] This activity describes the evaluation and management of leptospirosis and reviews the role of the interprofessional team in managing patients with this condition. […] The diagnosis of leptospirosis is made by growth in a specialized culture or microscopic agglutination test (only available at the Centers for Disease Control [CDC] in Atlanta). […] If there is a concern for aseptic meningitis in the immune phase, a lumbar puncture to sample the CSF is necessary. […] If questions or concerns arise about how best to make this diagnosis, do not delay treatment if suspected. […] Culture can confirm the diagnosis, but if the disorder is suspected, treatment should be initiated without delay.

• #1 Weil’s disease as a differential diagnosis of jaundice: A case report | Revista de Gastroenterología de México

  https://www.revistagastroenterologiamexico.org/en-weils-disease-as-differential-diagnosis-avance-S2255534X22000895

  The most characteristic severe form is Weils disease. It can appear after the acute phase and is characterized by altered liver function, and pulmonary and renal involvement. […] Patients present with a characteristic liver profile: marked direct hyperbilirubinemia (up to 80 mg/dL), associated with a slight increase (2-3 times the normal value) in other enzymes that indicate cholestasis (ALP, GGT) and a slight increase in transaminases. […] Direct and indirect detection methods are available. The direct detection methods include dark-field microscopy and the polymerase chain reaction technique, in both blood and urine. […] The standard indirect method is the microscopic agglutination test, in which live antigens react with antibodies in the blood sample, with 77.4% sensitivity and 97.6% specificity.

• #1 Leptospirosis – Wikipedia

  https://en.wikipedia.org/wiki/Leptospirosis

  Rapid detection of Leptospira can be done by quantifying the IgM antibodies using an enzyme-linked immunosorbent assay (ELISA). […] The microscopic agglutination test (MAT) is the reference test for the diagnosis of leptospirosis. […] Leptospiral DNA can be amplified by using polymerase chain reaction (PCR) from serum, urine, aqueous humour, CSF, and autopsy specimens. […] In 1982, the World Health Organization (WHO) proposed the Faine’s criteria for the diagnosis of leptospirosis.

• #1 Leptospirosis: An important zoonosis acquired through work, play and travel

  https://www1.racgp.org.au/ajgp/2018/march/leptospirosis

  The NNDSS definition of a confirmed case is based on culture or MAT, the gold standard tests in the acute/bacteraemic and late/immune phases respectively. […] Positive PCR alone or IgM ELISA alone are considered probable rather than confirmatory, but are nevertheless valuable for guiding clinical diagnosis in patients who present with suspected leptospirosis. […] In the acute/bacteraemic phase, blood should be collected for PCR (in a serum-separating tube) and IgM ELISA before commencing antibiotics. […] During the late/immune phase, when antibodies are present, both IgM ELISA and MAT tests should be requested. […] Diagnosis is confirmed by serology or culture, but PCR is valuable in the early phase of the infection.

• #1 Leptospirosis (Weil’s Disease) | Doctor

  https://patient.info/doctor/leptospirosis-weils-disease

  Leptospirosis is a zoonosis, an infection transmitted to humans from animals. […] Infection occurs as two syndromes: anicteric (which is self-limiting, and may present as a flu-like illness) and icteric leptospirosis (a potentially severe condition also known as Weil’s disease). […] The diagnosis of leptospirosis requires a high degree of clinical suspicion because the disease’s numerous manifestations can mimic other tropical infections or other nonspecific febrile illnesses, as well as non-infectious diseases – eg, small-vessel vasculitis, systemic lupus erythematosus or malignancies. […] Always consider leptospirosis in anybody with flu-like symptoms who has been in contact with rat urine via infected water, or who is in contact with cattle or cattle products. […] The initial diagnosis of leptospirosis is based on clinical features, although it is often misdiagnosed.

• #1 Weil’s disease as a differential diagnosis of jaundice: A case report | Revista de Gastroenterología de México

  https://www.revistagastroenterologiamexico.org/en-weils-disease-as-differential-diagnosis-avance-S2255534X22000895

  In patients with acute kidney failure and acute marked direct hyperbilirubinemia, with no major alterations in the remaining liver function tests and with imaging studies that are negative for obstructive biliary disease, rodent exposure should be searched for and leptospirosis added to the differential diagnosis, for the consequent study and early management of the disease, resulting in a decrease in mortality, as occurred in the case of our patient.

• #1 Global teamwork brings low-cost test for Weil’s disease a step closer | University of Cambridge

  https://www.cam.ac.uk/research/news/global-teamwork-brings-low-cost-test-for-weils-disease-a-step-closer

  An on-the-spot, low-cost diagnostic test for leptospirosis (Weil’s disease), a bacterial infection recognised as a neglected disease by the World Health Organization, could save lives in developing countries where there is little or no access to medical pathology laboratories and specialist technicians. […] Diagnosis of leptospirosis presents problems: the infection shares symptoms with other diseases, including dengue, malaria and viral hepatitis. The only way to confirm the illness is to take a blood sample and run specialised diagnostic tests. This process can be time-consuming and expensive. […] Health practitioners need a simple test that enables them to detect the difference between bacterial and viral infections such as leptospirosis and dengue because they require very different treatments, says Professor Hall.

• #1 Leptospirosis | Nature Reviews Disease Primers

  https://www.nature.com/articles/s41572-025-00614-5

  The benefit of antibiotics during late disease is doubtful. […] Current immunological and molecular tools for leptospirosis: diagnostics, vaccine design, and biomarkers for predicting severity. […] Evaluation of two immunodiagnostic tests for early rapid diagnosis of leptospirosis in Sri Lanka: a preliminary study. […] Prospective evaluation of three rapid diagnostic tests for diagnosis of human leptospirosis. […] Diagnosis and epidemiology of leptospirosis. […] Usefulness of serologic analysis as a predictor of the infecting serovar in patients with severe leptospirosis. […] Evaluation of real-time PCR targeting the lipL32 gene for diagnosis of Leptospira infection. […] A diagnostic scoring model for leptospirosis in resource limited settings. […] A simple score to predict severe leptospirosis.

• #1 Leptospirosis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/220563-overview

  Leptospirosis is an infectious disease of humans and animals that is caused by pathogenic spirochetes of the genus Leptospira. […] Laboratory studies used to screen for the diagnosis of leptospirosis include the following: Leptospira immunoglobulin M (IgM) ELISA or IgM/immunoglobulin G (IgG) enzyme-linked immunosorbent assay (ELISA), including rapid diagnostic kits usable in the field. […] Laboratory studies used to confirm the diagnosis of leptospirosis include the following: Microscopic agglutination testing (MAT; criterion standard for serologic identification of leptospires, available at reference laboratories). […] Treatment of leptospirosis should be started as soon as possible. Treatment is begun empirically in patients with a plausible exposure history and compatible symptoms, as culture times for Leptospira are long and recovery rates are low.

• #1 Weil’s Disease Early Diagnosis and Management: a Case Report, Ni Komang Rani Juli Antari, Dwiputra Yogi Pramarta, International Journal of Healthcare Sciences, ISSN 2348-5728 (Online), Research Publish Journals, DOI: https://doi.org/10.5281/zenodo.1526921

  https://www.researchpublish.com/papers/weils-disease-early-diagnosis-and-management-a-case-report

  Leptospirosis, or Weil’s disease, is the most common zoonotic infection. […] Although there is no definite consensus on renal replacement therapy (RRT) in severe leptospirosis patients, early diagnosis allows for earlier hemodialysis, which appears to be associated with a better prognosis. […] The patient was diagnosed with Weil’s disease, acute kidney injury (AKI), with a differential diagnosis of acquired cystic kidney disease (ACKD) and anuria. […] Therefore, early diagnosis and management in the form of hemodialysis is needed to improve quality of life and reduce mortality.

• #2 Leptospirosis: Epidemiology, microbiology, clinical manifestations, and diagnosis – UpToDate

  https://www.uptodate.com/contents/leptospirosis-epidemiology-microbiology-clinical-manifestations-and-diagnosis

  Leptospirosis: Epidemiology, microbiology, clinical manifestations, and diagnosis […] The treatment and prevention of this disease are discussed separately. […] DIAGNOSIS […] Clinical suspicion — The level of suspicion for leptospirosis in a given patient depends primarily on the clinical syndrome and the local epidemiology of the infection. […] Leptospirosis should be suspected in patients who have a compatible systemic febrile illness and no clear alternative explanation, especially if they have exposures to endemic or outbreak settings or have engaged in high-risk activities. […] Confirming the diagnosis — A definitive diagnosis is made by laboratory-based tests. […] Approach to testing — When leptospirosis is suspected, we notify the microbiology laboratory prior to sending samples, so they can use specialized techniques.

• #2 Leptospirosis (Weil’s Disease) | Doctor

  https://patient.info/doctor/leptospirosis-weils-disease

  Leptospirosis is a zoonosis, an infection transmitted to humans from animals. […] Infection occurs as two syndromes: anicteric (which is self-limiting, and may present as a flu-like illness) and icteric leptospirosis (a potentially severe condition also known as Weil’s disease). […] The diagnosis of leptospirosis requires a high degree of clinical suspicion because the disease’s numerous manifestations can mimic other tropical infections or other nonspecific febrile illnesses, as well as non-infectious diseases – eg, small-vessel vasculitis, systemic lupus erythematosus or malignancies. […] Always consider leptospirosis in anybody with flu-like symptoms who has been in contact with rat urine via infected water, or who is in contact with cattle or cattle products. […] The initial diagnosis of leptospirosis is based on clinical features, although it is often misdiagnosed.

• #2 Leptospirosis – PAHO/WHO | Pan American Health Organization

  https://www.paho.org/en/topics/leptospirosis

  Leptospirosis may present with a wide variety of clinical manifestations, from a mild illness that may progress to a serious and sometimes fatal disease. […] making the correct diagnosis (clinical and laboratory) at the onset of symptoms is important to prevent severe cases and save lives, primarily in outbreak situations. […] The diagnosis of leptospirosis should be considered in any patient presenting with an abrupt onset of fever, chills, conjunctival suffusion, headache, myalgia and jaundice. […] Diagnosis is usually based on serology in conjunction with the clinical presentation and epidemiological data (a history of possible exposure, presence of risk factors). […] The microscopic agglutination test (MAT) and the enzyme linked immunosorbent assay (ELISA) are two serologic tests used for laboratory diagnosis of leptospirosis. […] Isolation of leptospires is the only direct and definitive proof of infection. […] For postmortem diagnosis, in addition to serology and culture, leptospires can be detected in tissues using PCR or immunohistochemical staining, especially by direct immunofluorescence.

• #2 Leptospirosis: Epidemiology, microbiology, clinical manifestations, and diagnosis – UpToDate

  https://www.uptodate.com/contents/leptospirosis-epidemiology-microbiology-clinical-manifestations-and-diagnosis

  The diagnosis is confirmed by a positive PCR of blood or urine or by positive serologic testing; rarely, a diagnosis is made by a positive culture of blood or urine. […] Molecular tests (eg, PCR) — Molecular tests, such as PCR, can provide rapid, accurate diagnosis of leptospirosis, especially early in the course of illness (ie, the acute phase). […] A single positive PCR is confirmatory of leptospirosis infection. […] Serology — Serologic tests measure specific immunoglobulin (Ig)M and IgG antibodies against Leptospira organisms. […] To diagnose leptospirosis by serologic testing, one blood sample should be obtained upon presentation (ie, an acute sample) and a second sample should be obtained 7 to 14 days after the first antibody test is sent (ie, a convalescent sample). […] The diagnosis is not ruled out by negative test results because the sensitivity of leptospirosis testing is suboptimal.

• #2 Leptospirosis | Yellow Book | CDC

  https://wwwnc.cdc.gov/travel/yellowbook/2024/infections-diseases/leptospirosis

  Healthcare professionals should know how to diagnose, treat, and prevent leptospirosis in international travelers. […] A clinical laboratory certified in high complexity testing; state health department; or contact CDCs Bacterial Special Pathogens Branch ([email protected]) for diagnostic testing. […] Submit a combination of samples for leptospirosis testing, including blood, serum, and urine samples; whenever possible, obtain paired acute and convalescent serum samples. […] During early disease, polymerase chain reaction (PCR) analysis of whole blood (collected in the first week of illness) and urine (collected after the first week of illness) can be helpful. […] Diagnosis of leptospirosis is often based on serology; microscopic agglutination test (MAT) is the reference standard and can only be performed at certain reference laboratories.

• #2 Leptospirosis (Weil’s Disease) | Doctor

  https://patient.info/doctor/leptospirosis-weils-disease

  Isolation of the organism by culture of clinical specimens (blood, CSF, urine) is difficult. […] Most cases of leptospirosis are mild and resolve spontaneously without treatment and indeed often without being identified. […] Antibiotic treatment is widely used but a Cochrane review found insufficient evidence to recommend for or against the use of antibiotics for leptospirosis. […] The first-choice of antibiotic in adults who are not critically ill is usually oral doxycycline or azithromycin, starting within 48 hours of illness. […] Most cases recover fully within two to six weeks but some may take up to three months. […] The vast majority of leptospiral infections are self-limiting. However, Weil’s disease has a mortality rate of up to 22% in developing countries and around 5% in the UK. […] Infection in pregnant women may be grave leading to severe fetal and maternal morbidity and mortality.

• #2 Leptospirosis Workup: Approach Considerations, Culture, Microscopic Agglutination Testing

  https://emedicine.medscape.com/article/220563-workup

  Microscopic agglutination testing (MAT) uses a battery of antigens taken from common (frequently locally endemic) leptospire serovars. MAT is available only at reference laboratories, such as the Centers for Disease Control and Prevention (CDC). […] A 4-fold rise in titer between acute and convalescent specimens is considered a positive result. […] An immunoglobulin M (IgM) enzyme-linked immunoabsorbent assay (ELISA) has been developed. […] Nucleic acid amplification (polymerase chain reaction [PCR]) based techniques have been developed to diagnose leptospirosis. […] Dark-field examination of blood or urine has been used to identify leptospires. However, this technique is insensitive and nonspecific on its own.

• #2 Leptospirosis Diagnosis: Competancy of Various Laboratory Tests

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3939550/

  A single serum sample taken during an acute febrile illness with symptoms of leptospirosis is presumptive evidence of infection, and therefore requires confirmation by further testing. […] Therefore use of PCR in combination with IgM ELISA would improve the sensitivity of the diagnosis of leptospirosis in the first phase of the disease. […] When using a single sample collected during the early, acute phase of the disease, results of Pan Bio IgM ELISA can give us a presumptive diagnosis of leptospirosis.

• #2 Leptospira – Serology and PCR | Public Health Ontario

  https://www.publichealthontario.ca/en/Laboratory-Services/Test-Information-Index/Leptospira-Serology

  In the acute phase of illness, leptospires are present in the blood for approximately the first 46 days of illness. For PCR testing, whole blood should be collected in the first week of illness (ideally in the first 4 days). […] Initiation of antibiotic treatment prior to testing may result in decreased antibody production which will affect the outcome of serological testing. […] As with any laboratory test, results of the test should be interpreted with consideration of all available laboratory and clinical findings. […] Leptospira serology testing is initially performed at NML using a Commercial IgM Enzyme-Linked ImmunoSorbent Assay (ELISA) kit. […] Samples that are positive or equivocal by ELISA, are further tested by a Microagglutination test (MAT), for confirmation. […] Criteria required for a confirmed diagnosis include a MAT titre of 1:800 in one or more serum samples or a four-fold or greater increase in a MAT titre between acute and convalescent serum samples.

• #2 Leptospirosis – Health New Zealand | Te Whatu Ora

  https://www.tewhatuora.govt.nz/for-health-professionals/clinical-guidance/communicable-disease-control-manual/leptospirosis

  Laboratory definitive evidence for a confirmed case requires at least one of the following: […] It is recommended that both nucleic acid testing (NAT) and MAT testing be undertaken to improve diagnostic accuracy. MAT is the current gold standard serological test and is used to identify the probable causative serovar/serogroup. […] NAT is highly sensitivity for diagnosis of leptospirosis. NAT can be used to detect leptospires in blood during the acute leptospiraemic phase of the disease typically before an antibody response is mounted. […] Leptospires can be excreted intermittently in the urine. Therefore, a negative result in the context of a compatible clinical illness cannot exclude the diagnosis of leptospirosis. […] In cases of high clinical suspicion, a second urine sample should be submitted if the initial specimen tested negative by NAT.

• #2 Leptospirosis Workup: Approach Considerations, Culture, Microscopic Agglutination Testing

  https://emedicine.medscape.com/article/220563-workup

  Most often, paired acute and convalescent serum specimens are used to confirm the diagnosis. Again, this is a delayed means of confirmation because the acute sera are collected 1-2 weeks after onset of symptoms, and the convalescent sera are collected 2 weeks afterward. […] Antileptospire antibodies in these samples are detected using the microscopic agglutination test (MAT). […] A 4-fold rise in MAT titer between acute and convalescent sera with any of these antigens confirms the diagnosis of leptospirosis. […] Faster laboratory methods may strongly suggest the diagnosis of leptospirosis, but they may be no more readily available than the CDC laboratory in Atlanta. […] In suspected leptospirosis, further laboratory studies should be routinely performed to determine the extent and severity of organ involvement after the acute phase of illness.

• #2 Leptospirosis – Wikipedia

  https://en.wikipedia.org/wiki/Leptospirosis

  Leptospirosis is a blood infection caused by the bacterium Leptospira that can infect humans, dogs, rodents and many other wild and domesticated animals. […] Diagnosis is typically by testing for antibodies against the bacteria or finding bacterial DNA in the blood. […] The classic form of severe leptospirosis, known as Weil’s disease, is characterised by liver damage (causing jaundice), kidney failure, and bleeding, which happens in 5-10% of those infected. […] For those with severe headaches who show signs of meningitis, a lumbar puncture can be attempted. If infected, cerebrospinal fluid (CSF) examination shows lymphocytic predominance with a cell count of about 500/mm3, protein between 50 and 100 mg/mL and normal glucose levels. These findings are consistent with aseptic meningitis.

• #2

  https://journals.lww.com/ajim/fulltext/2022/12010/weil_s_disease__a_diagnostic_dilemma.7.aspx

  Leptospirosis is a zoonotic disease that predominantly occurs in tropical and subtropical areas. […] This is a case report on a 52-year-old farmer who had presented with upper gastrointestinal (GI) bleed. […] However, he was later found to have icterus, renal failure, and hemorrhagic manifestations and his IgM ELISA for leptospira was positive. […] The occurrence of Weil’s disease in the month of November and its occurrence in the state of Assam, India was unpredictable and hence posed as a diagnostic dilemma. […] Weil’s disease is characterized by multiorgan involvement presenting with significant jaundice (mostly conjugated hyperbilirubinemia), very high fever, acute renal failure, hepatic necrosis, pulmonary involvement, cardiovascular complications (arrhythmias and heart failure), neurologic changes, and hemorrhagic diathesis.

• #2 Weil’s disease as a differential diagnosis of jaundice: A case report | Revista de Gastroenterología de México

  https://www.revistagastroenterologiamexico.org/en-weils-disease-as-differential-diagnosis-avance-S2255534X22000895

  In patients with acute kidney failure and acute marked direct hyperbilirubinemia, with no major alterations in the remaining liver function tests and with imaging studies that are negative for obstructive biliary disease, rodent exposure should be searched for and leptospirosis added to the differential diagnosis, for the consequent study and early management of the disease, resulting in a decrease in mortality, as occurred in the case of our patient.

• #2 Leptospirosis: An important zoonosis acquired through work, play and travel

  https://www1.racgp.org.au/ajgp/2018/march/leptospirosis

  The NNDSS definition of a confirmed case is based on culture or MAT, the gold standard tests in the acute/bacteraemic and late/immune phases respectively. […] Positive PCR alone or IgM ELISA alone are considered probable rather than confirmatory, but are nevertheless valuable for guiding clinical diagnosis in patients who present with suspected leptospirosis. […] In the acute/bacteraemic phase, blood should be collected for PCR (in a serum-separating tube) and IgM ELISA before commencing antibiotics. […] During the late/immune phase, when antibodies are present, both IgM ELISA and MAT tests should be requested. […] Diagnosis is confirmed by serology or culture, but PCR is valuable in the early phase of the infection.

• #2

  https://ejournal.unisayogya.ac.id/index.php/ijhst/article/view/3030

  Leptospirosis is a zoonotic disease with clinical manifestations that range from mild acute febrile illness that resolves on its own to severe, life-threatening conditions with multiple organ dysfunction. Clinical features and various diagnostic tests establish leptospirosis diagnosis, such as bacterial isolation and serological examination. […] Often, patients present with obvious clinical symptoms of leptospirosis but have negative serological test results. This study aimed to determine how to establish the clinical diagnosis of leptospirosis in leptospirosis cases with negative serology test results. […] The result of this study is that some cases of leptospirosis have obvious symptoms, but serological examination shows negative results. This can happen because new antibodies can be detected on day 6 to day 10 of the illness and reach their peak in 3-4 weeks so that the establishment of a clinical diagnosis of leptospirosis can be established from clear clinical symptoms and other laboratory tests. Establishing the clinical diagnosis of leptospirosis with negative serology can be done with the Faine scoring system.

• #2 Fulminant Leptospirosis (Weil’s disease) in an urban setting as an overlooked cause of multiorgan failure: a case report | Journal of Medical Case Reports | Full Text

  https://jmedicalcasereports.biomedcentral.com/articles/10.1186/1752-1947-5-7

  Leptospirosis has recently come to international attention as a globally important re-emerging infectious disease. […] The case of fulminant leptospirosis presented here should serve to alert health care providers and the general public to the clinical importance of this severe, sometimes fatal, disease. Leptospirosis should be considered early in the diagnosis of any patient with acute, non-specific febrile illness with multiorgan system involvement or high fever in a returning traveler. […] The diagnosis of leptospirosis requires a high degree of clinical suspicion because the disease’s numerous manifestations can mimic other tropical infections or other nonspecific febrile illnesses, as well as noninfectious diseases such as small vessel vasculitides, systemic lupus erythematosus or even malignancies. The initial diagnosis of leptospirosis remains a clinical one, a presumed analysis in the appropriate epidemiologic and clinical context.

• #2 Global teamwork brings low-cost test for Weil’s disease a step closer | University of Cambridge

  https://www.cam.ac.uk/research/news/global-teamwork-brings-low-cost-test-for-weils-disease-a-step-closer

  Our target is to develop a diagnostic test requiring a blood sample from a finger prick at a cost of less than $0.50 per test. The test has the potential to transform the way we diagnose and treat the one million people who contract leptospirosis every year. […] The team is also developing a novel technique to extract the pathogens DNA/RNA directly from the blood sample. Both the DNA/RNA extraction system and the enzyme will be contained on a diagnostic card that can be manufactured locally and ultimately from local materials, says Professor Hall. […] The various elements of the test are currently being developed in the lab, with the first protoype expected to be produced in 2018.

• #2 Leptospirosis | Nature Reviews Disease Primers

  https://www.nature.com/articles/s41572-025-00614-5

  Development and validation of a simple machine learning tool to predict mortality in leptospirosis. […] Early identification of leptospirosis-associated pulmonary hemorrhage syndrome by use of a validated prediction model. […] A scoring tool to predict pulmonary complications in severe leptospirosis with kidney failure. […] A short review on leptospirosis: clinical manifestations, diagnosis and treatment.

• #2 Fulminant Leptospirosis (Weil’s disease) in an urban setting as an overlooked cause of multiorgan failure: a case report | Journal of Medical Case Reports | Full Text

  https://jmedicalcasereports.biomedcentral.com/articles/10.1186/1752-1947-5-7

  Isolation of the organism by culture of clinical specimens (blood, CSF, urine) during the first seven to 10 days of the illness is considered the gold standard of diagnosis. However, this method is difficult, requires longer than 16 weeks because initial growth may be slow and has a low sensitivity and specificity. The majority of leptospirosis cases are diagnosed by serologic testing of which MAT is most common. […] An accurate and quick diagnostic test is warranted in the interest of the individual patient, as well as public health. Recognition of fulminant leptospirosis is especially important because antimicrobial agents can reduce its severity and duration as well as lead to a favorable outcome of this potentially lethal condition.

• #2 Leptospirosis Causes, Symptoms, Diagnosis, Treatment, Vaccine

  https://www.medicinenet.com/leptospirosis/article.htm

  How do physicians diagnose leptospirosis? Physicians make a presumptive diagnosis based on the patient’s history and physical exam. Only specialized labs perform serological serology tests for leptospirosis serogroups (specific types of bacteria that react with certain antibodies). Healthcare professionals may perform definitive tests by isolating the bacteria from the patient (blood or CSF) or by a positive microscopic agglutination test (MAT). […] Other tests (ELISA, PCR, urine dipsticks) may provide additional evidence of infection. Patients with severe symptoms should be treated as confirmatory tests are time-consuming. […] What is the treatment for leptospirosis? Although there is controversy about using antibiotics in the first phase of leptospirosis, antibiotics (penicillin – penicillin G, ampicillin [Omnipen, Polycillin, Principen], amoxicillin [Amoxil, Trimox, Moxatag, Larotid], or erythromycin [E-Mycin, Eryc, Ery-Tab, PCE, Pediazole, Ilosone]) are recommended for treatment of patients with phase two or more severe symptoms. Some patients may require IV antibiotics and supportive hospital care such as rehydration.

• #3 Leptospirosis (Weil’s Disease) | Doctor

  https://patient.info/doctor/leptospirosis-weils-disease

  Leptospirosis is a zoonosis, an infection transmitted to humans from animals. […] Infection occurs as two syndromes: anicteric (which is self-limiting, and may present as a flu-like illness) and icteric leptospirosis (a potentially severe condition also known as Weil’s disease). […] The diagnosis of leptospirosis requires a high degree of clinical suspicion because the disease’s numerous manifestations can mimic other tropical infections or other nonspecific febrile illnesses, as well as non-infectious diseases – eg, small-vessel vasculitis, systemic lupus erythematosus or malignancies. […] Always consider leptospirosis in anybody with flu-like symptoms who has been in contact with rat urine via infected water, or who is in contact with cattle or cattle products. […] The initial diagnosis of leptospirosis is based on clinical features, although it is often misdiagnosed.

• #3 Fulminant Leptospirosis (Weil’s disease) in an urban setting as an overlooked cause of multiorgan failure: a case report | Journal of Medical Case Reports | Full Text

  https://jmedicalcasereports.biomedcentral.com/articles/10.1186/1752-1947-5-7

  Leptospirosis has recently come to international attention as a globally important re-emerging infectious disease. […] The case of fulminant leptospirosis presented here should serve to alert health care providers and the general public to the clinical importance of this severe, sometimes fatal, disease. Leptospirosis should be considered early in the diagnosis of any patient with acute, non-specific febrile illness with multiorgan system involvement or high fever in a returning traveler. […] The diagnosis of leptospirosis requires a high degree of clinical suspicion because the disease’s numerous manifestations can mimic other tropical infections or other nonspecific febrile illnesses, as well as noninfectious diseases such as small vessel vasculitides, systemic lupus erythematosus or even malignancies. The initial diagnosis of leptospirosis remains a clinical one, a presumed analysis in the appropriate epidemiologic and clinical context.

• #3 Leptospirosis: Epidemiology, microbiology, clinical manifestations, and diagnosis – UpToDate

  https://www.uptodate.com/contents/leptospirosis-epidemiology-microbiology-clinical-manifestations-and-diagnosis/print

  Nucleic acid detection (eg, PCR) is most sensitive during the bacteremic phase (ie, the first week) of infection, with antibodies becoming detectable by serology after the first week. […] Molecular tests, such as PCR, can provide rapid, accurate diagnosis of leptospirosis, especially early in the course of illness (ie, the acute phase). […] To diagnose leptospirosis by serologic testing, one blood sample should be obtained upon presentation (ie, an acute sample) and a second sample should be obtained 7 to 14 days after the first antibody test is sent (ie, a convalescent sample). […] The MAT is the historical reference standard for leptospirosis. […] The diagnosis is not ruled out by negative test results because the sensitivity of leptospirosis testing is suboptimal.

• #3 Fulminant Leptospirosis (Weil’s disease) in an urban setting as an overlooked cause of multiorgan failure: a case report | Journal of Medical Case Reports | Full Text

  https://jmedicalcasereports.biomedcentral.com/articles/10.1186/1752-1947-5-7

  Isolation of the organism by culture of clinical specimens (blood, CSF, urine) during the first seven to 10 days of the illness is considered the gold standard of diagnosis. However, this method is difficult, requires longer than 16 weeks because initial growth may be slow and has a low sensitivity and specificity. The majority of leptospirosis cases are diagnosed by serologic testing of which MAT is most common. […] An accurate and quick diagnostic test is warranted in the interest of the individual patient, as well as public health. Recognition of fulminant leptospirosis is especially important because antimicrobial agents can reduce its severity and duration as well as lead to a favorable outcome of this potentially lethal condition.

• #3 Leptospirosis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/220563-overview

  Leptospirosis is an infectious disease of humans and animals that is caused by pathogenic spirochetes of the genus Leptospira. […] Laboratory studies used to screen for the diagnosis of leptospirosis include the following: Leptospira immunoglobulin M (IgM) ELISA or IgM/immunoglobulin G (IgG) enzyme-linked immunosorbent assay (ELISA), including rapid diagnostic kits usable in the field. […] Laboratory studies used to confirm the diagnosis of leptospirosis include the following: Microscopic agglutination testing (MAT; criterion standard for serologic identification of leptospires, available at reference laboratories). […] Treatment of leptospirosis should be started as soon as possible. Treatment is begun empirically in patients with a plausible exposure history and compatible symptoms, as culture times for Leptospira are long and recovery rates are low.

• #3 Leptospirosis – PAHO/WHO | Pan American Health Organization

  https://www.paho.org/en/topics/leptospirosis

  Leptospirosis may present with a wide variety of clinical manifestations, from a mild illness that may progress to a serious and sometimes fatal disease. […] making the correct diagnosis (clinical and laboratory) at the onset of symptoms is important to prevent severe cases and save lives, primarily in outbreak situations. […] The diagnosis of leptospirosis should be considered in any patient presenting with an abrupt onset of fever, chills, conjunctival suffusion, headache, myalgia and jaundice. […] Diagnosis is usually based on serology in conjunction with the clinical presentation and epidemiological data (a history of possible exposure, presence of risk factors). […] The microscopic agglutination test (MAT) and the enzyme linked immunosorbent assay (ELISA) are two serologic tests used for laboratory diagnosis of leptospirosis. […] Isolation of leptospires is the only direct and definitive proof of infection. […] For postmortem diagnosis, in addition to serology and culture, leptospires can be detected in tissues using PCR or immunohistochemical staining, especially by direct immunofluorescence.

• #3 Leptospirosis – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/leptospirosis/

  Leptospirosis is a zoonotic disease caused by gram-negative Leptospira bacteria. […] Diagnosis is based on patient history, clinical findings, and laboratory tests. […] The initial diagnosis of leptospirosis requires a high index of suspicion because the clinical features are nonspecific. Do not delay treatment to obtain confirmatory studies. […] Laboratory findings are nonspecific but may help assess for end-organ damage. […] A definitive diagnosis may be made based on direct detection or serology. […] The thin Leptospira spirochetes cannot be visualized by light microscopy. […] Leptospirosis is a notifiable disease in the US; report confirmed cases to the CDC.

• #3 Leptospira – Serology and PCR | Public Health Ontario

  https://www.publichealthontario.ca/en/Laboratory-Services/Test-Information-Index/Leptospira-Serology

  In the acute phase of illness, leptospires are present in the blood for approximately the first 46 days of illness. For PCR testing, whole blood should be collected in the first week of illness (ideally in the first 4 days). […] Initiation of antibiotic treatment prior to testing may result in decreased antibody production which will affect the outcome of serological testing. […] As with any laboratory test, results of the test should be interpreted with consideration of all available laboratory and clinical findings. […] Leptospira serology testing is initially performed at NML using a Commercial IgM Enzyme-Linked ImmunoSorbent Assay (ELISA) kit. […] Samples that are positive or equivocal by ELISA, are further tested by a Microagglutination test (MAT), for confirmation. […] Criteria required for a confirmed diagnosis include a MAT titre of 1:800 in one or more serum samples or a four-fold or greater increase in a MAT titre between acute and convalescent serum samples.

• #3 One Health Resource Center

  https://www.healio.com/news/infectious-disease/20191114/leptospirosis-a-challenging-diagnosis

  Leptospirosis is a bacterial infection produced by spirochetes in the genus Leptospira. […] The clinical diagnosis of leptospirosis is challenging, and it can easily be missed unless there is an epidemic or the patient develops Weils disease. […] Laboratory diagnosis of leptospirosis is difficult and usually retrospective. Serological testing for antibodies using acute and convalescent blood is the classical way of making the diagnosis. […] A significant rise in antibody titer in serum is considered diagnostic. […] A single high titer (eg, 1/800) suggests recent leptospirosis infection. […] Antigen detection tests have been developed and show promise for diagnosis using serum, urine or spinal fluid. […] PCR testing is also available at the CDC and some specialized labs. […] A negative PCR of serum, urine or spinal fluid does not rule out leptospirosis because the Leptospira are present in blood for only the initial days of infection, and in the urine, the presence of the organisms is intermittent. […] Although culture techniques are available, the organisms are fastidious and grow very slowly, requiring many days of incubation. […] Commercially available rapid diagnostic serologic tests are available, but these are considered only screening tests, and infection should be confirmed by the MAT.

• #3 Leptospirosis Diagnosis: Competancy of Various Laboratory Tests

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3939550/

  Therefore, serological tests remain suboptimal for clinical use in diagnosing leptospirosis as depicted in [Table/Fig-1]. […] The most promising diagnostic methods are those that demonstrate the presence of the organisms. […] Direct Polymerase Chain Reaction (PCR) on specimens enables rapid and direct diagnosis, at least in the early and convalescent stages of infection. […] A limitation of PCR-based diagnosis of leptospirosis is the inability of most PCR assays to identify the infecting serovar. […] Most cases of leptospirosis are diagnosed by serology. Antibodies can become detectable by the 6th to 10th day of disease and reach peak levels within three to four weeks. […] Though Microscopic agglutination test is considered to be the gold standard in the diagnosis of leptospirosis, its use as a routine diagnostic test in a clinical laboratory is limited.

• #3

  https://journals.lww.com/ajim/fulltext/2022/12010/weil_s_disease__a_diagnostic_dilemma.7.aspx

  A high level of suspicion is required to diagnose such cases as they mimic septicemia, acute on chronic liver failure (ACLF), chronic kidney disease (CKD), and other febrile illnesses with multisystem involvement. […] A high degree of suspicion is required to diagnose this condition. Timely initiation of antibiotics may prevent its progression to severe forms and prevent mortality of patients. […] Clinical as well as serological diagnosis of this condition are the prerequisites for saving one’s life. […] This is a curable disease and hence proper treatment should be started at the earliest. […] A high clinical suspicion with the help of serological investigation can help us to diagnose this condition. […] Moreover, an improvement in public health measures are of utmost importance.

• #4

  https://www.gov.uk/guidance/leptospirosis

  Leptospirosis diagnosis is provided by the Rare and Imported Pathogens Laboratory (RIPL) at UKHSA Porton. RIPL provides PCR testing for direct detection, and EIA testing for IgM. Testing is done Monday to Friday. […] Appropriate samples for leptospirosis diagnosis are blood and urine. Urine is particularly useful for leptospirosis as it remains PCR positive longer than blood samples. All diagnostic samples should be sent to RIPL with a leptospirosis request form. Precise information regarding the date of exposure and clinical features (symptoms, severity and onset) is important to ensure the appropriate initial tests are selected. […] Leptospirosis is diagnosed by either: PCR in the acute stage of infection, within 5 days of symptoms onset in blood, and longer in urine. serological IgM detection (EIA) later in illness. This is performed on all samples of suspected leptospirosis cases.

• #4 Weil’s disease as a differential diagnosis of jaundice: A case report | Revista de Gastroenterología de México

  https://www.revistagastroenterologiamexico.org/en-weils-disease-as-differential-diagnosis-avance-S2255534X22000895

  The most characteristic severe form is Weils disease. It can appear after the acute phase and is characterized by altered liver function, and pulmonary and renal involvement. […] Patients present with a characteristic liver profile: marked direct hyperbilirubinemia (up to 80 mg/dL), associated with a slight increase (2-3 times the normal value) in other enzymes that indicate cholestasis (ALP, GGT) and a slight increase in transaminases. […] Direct and indirect detection methods are available. The direct detection methods include dark-field microscopy and the polymerase chain reaction technique, in both blood and urine. […] The standard indirect method is the microscopic agglutination test, in which live antigens react with antibodies in the blood sample, with 77.4% sensitivity and 97.6% specificity.

• #4 Leptospirosis – PAHO/WHO | Pan American Health Organization

  https://www.paho.org/en/topics/leptospirosis

  Leptospirosis may present with a wide variety of clinical manifestations, from a mild illness that may progress to a serious and sometimes fatal disease. […] making the correct diagnosis (clinical and laboratory) at the onset of symptoms is important to prevent severe cases and save lives, primarily in outbreak situations. […] The diagnosis of leptospirosis should be considered in any patient presenting with an abrupt onset of fever, chills, conjunctival suffusion, headache, myalgia and jaundice. […] Diagnosis is usually based on serology in conjunction with the clinical presentation and epidemiological data (a history of possible exposure, presence of risk factors). […] The microscopic agglutination test (MAT) and the enzyme linked immunosorbent assay (ELISA) are two serologic tests used for laboratory diagnosis of leptospirosis. […] Isolation of leptospires is the only direct and definitive proof of infection. […] For postmortem diagnosis, in addition to serology and culture, leptospires can be detected in tissues using PCR or immunohistochemical staining, especially by direct immunofluorescence.

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