Diagnostic Advances in Leptospirosis: A Comparative Analysis of Paraclinical Tests with a Focus on PCR

Abstract

Leptospirosis is a zoonotic disease with a varied clinical presentation that can mimic other infectious diseases, posing diagnostic challenges. While the Microscopic Agglutination Test (MAT) remains the gold standard for serological diagnosis, its limitations have led to increasing interest in polymerase chain reaction (PCR) as a rapid and sensitive diagnostic tool. This systematic review evaluates the role and clinical applications of PCR for diagnosing human leptospirosis. We analyzed the sensitivity and specificity of PCR, compared its performance with other diagnostic tests, and assessed the comparative utility of blood and urine samples for PCR testing. Our findings demonstrate that PCR has a high sensitivity and specificity, particularly in the early stages of the disease. Combining PCR with serological tests like MAT can maximize the diagnostic accuracy across different stages of illness. We recommend that PCR be considered a first-line diagnostic test for suspected leptospirosis, especially when rapid diagnosis is crucial. Further research is needed to standardize PCR protocols and explore its potential in differentiating Leptospira species and serotypes. By leveraging the strengths of PCR and combining it with other diagnostic methods, we can significantly improve the diagnosis and management of leptospirosis.

Keywords: Leptospira; MAT; Microscopic Agglutination Test; PCR; Weil’s disease; leptospirosis; leptospirosis diagnosis; polymerase chain reaction.

Figure 1

PRISMA flowchart of the study selection process.

Figure 2

PCR methods used in the included studies.

Figure 3

Main molecular markers in the diagnosis of leptospirosis.