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J R Coll Physicians Edinb. 2018 Mar;48(1):9-15. doi: 10.4997/JRCPE.2018.102.

Challenges in the diagnosis of leptospirosis outwith endemic settings: a Scottish single centre experience.

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CD Russell, Regional Infectious, Diseases Unit, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK, Email:


Background Leptospirosis is a zoonotic infection occurring worldwide but endemic in tropical countries. This study describes diagnostic testing for leptospirosis at our institution in Scotland over a 10-year period. Method We identified patients with blood samples referred to the Public Health England reference laboratory for leptospirosis testing between 2006 and 2016. Results A total of 480 samples were sent for IgM ELISA testing with 26 positive results from 14 patients. Two patients met criteria for 'confirmed' leptospirosis (microscopic agglutination test > 1:320 in one case and a positive PCR in the other) and the remaining 12 were 'probable' on the basis of IgM ELISA positivity, though 9 did not have microscopic agglutination testing performed. Nine infections were imported, mostly from Asia and with a history of fresh water exposure. Three co-infections (respiratory syncytial virus, influenza B and Campylobacter sp.) were identified. Conclusions Practical issues with microscopic agglutination testing (insufficient blood sent to reference laboratory) and PCR (travellers returning > 7 days after illness onset) represent challenges to the laboratory confirmation of a clinical diagnosis of leptospirosis. Co-infection and infectious/auto-immune causes of false positive serology should be evaluated.


ELISA; Leptospira interrogans; Weil's disease; leptospirosis; microscopic agglutination test

[Indexed for MEDLINE]

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