Diagnostic accuracy of an IgM enzyme-linked immunosorbent assay and comparison with 2 polymerase chain reactions for early diagnosis of human leptospirosis

• IgM enzyme-linked immunosorbent assay (ELISA) showed the greatest diagnostic accuracy.
• Our results support the use of IgM ELISA and real-time PCR (rtPCR) for early diagnosis of leptospirosis.
• IgM ELISA and rtPCR could be useful to replace or supplement microscopic agglutination test as confirmatory test.

Enzyme-linked immunosorbent assay (ELISA) tests and polymerase chain reaction (PCR) may play a key role for early detection and treatment of human leptospirosis in developing countries. The aims of this study were to develop and validate an IgM ELISA under field conditions and to compare the diagnostic accuracy among IgG, IgM ELISAs, conventional PCR (cPCR), and real-time PCR (rtPCR) for early detection of human leptospirosis. Overall accuracy of IgM ELISA was sensitivity of 87.9%, specificity of 97.0%, and area under the curve of 0.940. When the 4 methods were compared, IgM ELISA showed the greatest diagnostic accuracy (J = 0.6) followed by rtPCR (J = 0.4), cPCR (J = 0.2) and IgG ELISA (J = 0.1). Our results support the use of IgM ELISA and rtPCR for early diagnosis of the disease. Moreover, due to their high specificity, they could be also useful to replace or supplement microscopic agglutination test as a confirmatory test, allowing more confirmations.