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Comparative Study
. 2018 Feb 20;12(2):e0006285.
doi: 10.1371/journal.pntd.0006285. eCollection 2018 Feb.

Prospective evaluation of accuracy and clinical utility of the Dual Path Platform (DPP) assay for the point-of-care diagnosis of leptospirosis in hospitalized patients

Affiliations
Comparative Study

Prospective evaluation of accuracy and clinical utility of the Dual Path Platform (DPP) assay for the point-of-care diagnosis of leptospirosis in hospitalized patients

Scott A Nabity et al. PLoS Negl Trop Dis. .

Abstract

Early detection of leptospirosis with field-ready diagnostics may improve clinical management and mitigate outbreaks. We previously validated the point-of-care Dual Path Platform (DPP) for leptospirosis with sera in the laboratory. This prospective study compares the diagnostic accuracy and clinical utility of the DPP using finger stick blood (FSB) against the serum DPP, venous whole blood (VWB) DPP, IgM-ELISA, and clinical impression. We sequentially enrolled 98 patients hospitalized for acute febrile illnesses, of which we confirmed 32 by leptospirosis reference tests. Among syndromes consistent with classic leptospirosis, the FSB DPP showed similar sensitivity and specificity (Se 93% and Sp 80%), and positive and negative predictive values (PPV 74% and NPV 95%), to VWB DPP (Se 96%, Sp 75%, PPV 68%, and NPV 97%), serum DPP (Se 85%, Sp 87%, PPV 79%, and NPV 91%) and IgM-ELISA (Se 81%, Sp 100%, PPV 100%, and NPV 90%). The FSB DPP provided a favorable likelihood ratio profile (positive LR 4.73, negative LR 0.09) in comparison to other assays and clinical impression alone. Additionally, we identified four of five leptospirosis-associated meningitis patients by whole blood DPP, none of which clinicians suspected. This demonstrates potential for the DPP in routine detection of this less common syndrome. The FSB DPP demonstrated similar discrimination for severe human leptospirosis compared with serum assays, and it is a simpler option for diagnosing leptospirosis. Its performance in other epidemiological settings and geographic regions, and for detecting atypical presentations, demands further evaluation.

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Conflict of interest statement

AIK and MGR are holders of the U.S. patent 8,124,110 for the proteins with repetitive bacterial-Ig-like (Big) domains present in Leptospira species used as antigens in the DPP assay.

Figures

Fig 1
Fig 1. Recruitment of patients hospitalized for acute febrile illness compatible with leptospirosis–Salvador, Brazil 2012.
* Undifferentiated fever includes any other febrile illness consistent with acute clinical leptospirosis not elsewhere categorized. EBV = Epstein-Barr virus. HUS/TTP = hemolytic uremic syndrome/thrombotic thrombocytopenic purpura.

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