A Review of the Leptospirosis Diagnostic Modalities: From Bench to Bedside
Abstract
Leptospirosis is a major cause of acute febrile illness in tropical regions, particularly in flood-prone settings. Accurate diagnosis remains challenging, especially during the early phase of infection, because of the nonspecific clinical manifestations and stage-dependent limitations of the available diagnostic tests. Consequently, delayed recognition and treatment continue to contribute to adverse outcomes.
This review aims to summarize and critically appraise the current diagnostic modalities for leptospirosis, encompassing both clinical prediction scores (the THAI-LEPTO and OPD Lepto scores) and laboratory techniques (microscopy, culture, molecular assays, and serology), emphasizing the integration of clinical assessment with laboratory testing across different stages of the disease. The diagnostic implications of the biphasic course are highlighted, underscoring the importance of aligning test selection with illness timing. Clinical diagnosis and structured scoring systems are reviewed as tools to support presumptive diagnosis when confirmatory testing is unavailable or inconclusive. Conventional laboratory methods, including dark-field microscopy, culture, and serological assays, are discussed alongside molecular techniques such as polymerase chain reaction–based testing. By clarifying the strengths and limitations of each modality, this review aims to assist clinicians in selecting appropriate tests, interpreting results within clinical contexts, and initiating timely therapy.
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