Diagnostic accuracy of genetic markers and nucleic acid techniques for the detection of Leptospira in clinical samples: A meta-analysis

Leptospirosis is often difficult to diagnose because of its nonspecific symptoms. The drawbacks of direct isolation and serological tests have led to the increased development of nucleic acid-based assays, which are more rapid and accurate. A meta-analysis was performed to evaluate the diagnostic ac...

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Bibliographic Details
Published in:PLoS neglected tropical diseases 2020-02, Vol.14 (2), p.e0008074-e0008074
Main Authors: Lam, Jia-Yong, Low, Gary Kim-Kuan, Chee, Hui-Yee
Format: Article
Language:English
Subjects:
Accuracy
Acids
Analysis
Animals
Anopheles
Assaying
Biology and Life Sciences
Detection
Diagnostic systems
Diagnostic tests
Disease
DNA, Bacterial - genetics
Genes
Genetic Markers
Gram-negative bacteria
Health sciences
Heterogeneity
Humans
Isolation
Laboratories
Leptospira
Leptospira - genetics
Leptospira - isolation & purification
Leptospirosis
Leptospirosis - diagnosis
Markers
Medicine and Health Sciences
Meta-analysis
Methods
Nucleic Acid Amplification Techniques - methods
Nucleic acids
Parasitology
Performance evaluation
Physical Sciences
Research and Analysis Methods
Samples
SecY gene
Serological tests
Specificity
Studies
Symptoms
Tropical diseases
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Summary:Leptospirosis is often difficult to diagnose because of its nonspecific symptoms. The drawbacks of direct isolation and serological tests have led to the increased development of nucleic acid-based assays, which are more rapid and accurate. A meta-analysis was performed to evaluate the diagnostic accuracy of genetic markers for the detection of Leptospira in clinical samples. A literature search was performed in Scopus, PubMed, MEDLINE and non-indexed citations (via Ovid) by using suitable keyword combinations. Studies evaluating the performance of nucleic acid assays targeting leptospire genes in human or animal clinical samples against a reference test were included. Of the 1645 articles identified, 42 eligible studies involving 7414 samples were included in the analysis. The diagnostic performance of nucleic acid assays targeting the rrs, lipL32, secY and flaB genes was pooled and analyzed. Among the genetic markers analyzed, the secY gene showed the highest diagnostic accuracy measures, with a pooled sensitivity of 0.56 (95% CI: 0.50-0.63), a specificity of 0.98 (95% CI: 0.97-0.98), a diagnostic odds ratio of 46.16 (95% CI: 6.20-343.49), and an area under the curve of summary receiver operating characteristics curves of 0.94. Nevertheless, a high degree of heterogeneity was observed in this meta-analysis. Therefore, the present findings here should be interpreted with caution. The diagnostic accuracies of the studies examined for each genetic marker showed a significant heterogeneity. The secY gene exhibited higher diagnostic accuracy measures compared with other genetic markers, such as lipL32, flaB, and rrs, but the difference was not significant. Thus, these genetic markers had no significant difference in diagnostic accuracy for leptospirosis. Further research into these genetic markers is warranted.
ISSN:1935-2735
1935-2727
1935-2735
DOI:10.1371/journal.pntd.0008074