Leptospirosis a result of infection by pathogenic spirochetes of the genus
The clinical course is variable and ranges from those who have a subclinical illness followed by seroconversion or a self-limited systemic infection to a severe, fatal illness with multiorgan failure . Due to the nonspecific nature of clinical features, many patients present with acute febrile illnesses and tests need to be planned to arrive at a probable diagnosis . In a review of diagnosis of acute febrile illnesses, the use of 5–22 tests per patient was needed to evaluate acute undifferentiated febrile illness with nonspecific symptoms. Among possible causes include malaria, dengue, scrub typhus, enteric fever, and leptospirosis .
There is high demand for suitable point-of-care diagnostic tests for leptospirosis because its incidence varies between geographic areas [5, 6]. Confirmation of the disease includes not only the most widely used reference standard method of a microscopic agglutination test for antibody detection, but also direct microscopic demonstration and culture to isolate leptospires . However, high costs, poor standardization, elaborate sample preparation, or all of these factors prevent routine use at the point of care . Therefore, in most clinical settings, health care practitioners have to depend on insensitive and less-specific serological methods, which dominate the diagnostic landscape in the developing world . Serology is nevertheless an important tool for a quick diagnosis of leptospirosis so that appropriate therapy can be administered . However, there is an urgent need for improvement toward greater compliance with some of the point-of-care criteria. Loop-mediated isothermal amplification (LAMP), a method for amplifying DNA, could be useful for diagnosis of leptospirosis during the first week of illness before substantial numbers of antibodies are generated, whereas an IgM enzyme-linked immunoassay (ELISA) could be used as the mainstay of diagnosis from the second week onward. Further studies, especially those community based, comparing ELISAs, polymerase chain reaction (PCR), LAMP, culture isolation, and microscopic agglutination tests are required to evaluate the veracity of this recommendation .
Control of leptospirosis requires a One Health approach, and improvement of diagnostic tools to detect
However, the new premixed LAMP reagents with sucrose stabilizer should be compared with criterion standards of diagnosis of leptospirosis in a blinded and independent fashion. Currently, the best reference standards for diagnosis of leptospirosis are the microscopic agglutination test and isolation by culture, although both are acknowledged as imperfect, either alone or in combination . Nevertheless, the result of a comparison could render more confidence in the application of LAMP as a point-of-care technique in our quest for cost effective control of this important zoonotic infection in resource-limited countries.