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Meta-Analysis
. 2013 Jan;141(1):22-32.
doi: 10.1017/S0950268812001951. Epub 2012 Sep 7.

Enzyme-linked immunosorbent assay to diagnose human leptospirosis: a meta-analysis of the published literature

M L Signorini  1 , J Lottersberger, H D Tarabla, N B Vanasco
Affiliations
Meta-Analysis

Enzyme-linked immunosorbent assay to diagnose human leptospirosis: a meta-analysis of the published literature

M L Signorini et al. Epidemiol Infect. 2013 Jan.

Abstract

We report an evaluation of the accuracy of ELISA for the detection of Leptospira-specific antibodies in humans. Eighty-eight studies published in 35 articles met all inclusion criteria and were submitted to meta-analysis. Pooled sensitivity and specificity were 0·779 (95% CI 0·770-0·789) and 0·913 (95% CI 0·908-0·917), respectively, and the area under the curve was 0·964. Heterogeneity across studies was statistically significant, but none of the sources of heterogeneity (disease stage, antigen used, antibody detected) could fully explain this finding. Although the convalescent stage of disease was significantly associated with higher diagnostic accuracy, IgM ELISA was the best choice, regardless of the stage of disease. Negative ELISAs (IgG or IgM) applied in the acute phase do not rule out leptospirosis due to the possibility of false-negative results. In this case it is advisable to request a second blood sample or to apply a direct method for leptospiral DNA.

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Figures

Fig. 1
Fig. 1
Study selection flow chart.
Fig. 2
Fig. 2
[color online]. Forest plot of sensitivity estimate for ELISA diagnosis of human leptospirosis. •, Point estimates of sensitivity from each study (proportional to size of the study); ——, 95% confidence intervals;◆, pooled sensitivity estimated.
Fig. 3
Fig. 3
[color online]. Forest plot of specificity estimate for ELISA diagnosis of human leptospirosis. •, Point estimates of specificity from each study (proportional to size of the study); ——, 95% confidence intervals;◆, pooled specificity estimated.
Fig. 4
Fig. 4
[color online]. Summary receiver-operating characteristic (SROC) plot for ELISA diagnosis of human leptospirosis. •, Each study in the meta-analysis, size proportional to size of study; ——, regression line that summarizes the overall diagnostic accuracy.
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