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LEPTOSPIRA DNA DETECTION BY PCR BLOOD

Bacterial/ Viral
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Details

Detects leptospira DNA.

₹2,442₹3,489

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LEPTOSPIRA DNA DETECTION BY PCR BLOOD

  • Why is it done?
    • Detects Leptospira species DNA in blood samples using polymerase chain reaction (PCR) technology to diagnose acute leptospirosis infection
    • Ordered when patients present with symptoms suggestive of leptospirosis including high fever, severe headache, muscle pain, jaundice, renal insufficiency, or pulmonary hemorrhage
    • Performed during the first 7-10 days of illness (leptospiremic phase) when bacterial DNA is present in blood at detectable levels
    • Indicated in patients with occupational exposure risk (farmers, veterinarians, sewer workers, military personnel) or environmental exposure (flood-affected areas, contaminated water sources)
    • Provides rapid confirmation of leptospirosis diagnosis with high specificity compared to culture methods which are slow and difficult
    • Helps guide appropriate antibiotic therapy and management decisions in acute cases where early treatment is critical
  • Normal Range
    • Negative Result: No Leptospira DNA detected in blood sample; indicates absence of active leptospirosis infection
    • Positive Result: Leptospira DNA detected in blood sample; confirms acute leptospirosis infection
    • Units of Measurement: Qualitative result (Detected/Not Detected); may include semi-quantitative information such as cycle threshold (Ct) values indicating bacterial load
    • Interpretation: In the acute phase (first 7-10 days), negative results do not exclude leptospirosis if clinical suspicion remains high; repeat testing or alternative diagnostic methods may be considered
    • False negatives may occur if blood sample is collected after day 10 of illness when spirochetes clear from bloodstream; serology would be more appropriate
    • Lower Ct values indicate higher bacterial load and more recent/active infection
  • Interpretation
    • Positive Result Interpretation: Confirms acute leptospirosis infection; indicates presence of viable Leptospira organisms in bloodstream; consistent with clinical presentation in first 1-2 weeks of illness
    • Requires immediate clinical evaluation and initiation of appropriate antibiotic therapy (typically doxycycline or penicillin depending on severity)
    • High Ct values or weak positives suggest lower bacterial burden but still indicate active infection requiring treatment
    • Negative Result Interpretation: Does not rule out leptospirosis if collected beyond day 10 of illness; at this stage, bacteria clear from blood and serological testing becomes more sensitive
    • If obtained during first week with high clinical suspicion, negative result suggests alternative diagnoses should be considered or testing repeated
    • Factors Affecting Results: Timing of sample collection relative to symptom onset is critical; optimal sensitivity occurs days 1-10 of illness
    • Prior antibiotic administration may reduce bacterial DNA in circulation and cause false negative results
    • Severity of infection and host immune response may influence bacterial load and detectability
    • Different Leptospira serovars may have varying PCR detection sensitivity depending on primer specificity
    • Immunocompromised patients may have higher and more prolonged bacteremia
    • Clinical Significance: Early positive PCR result allows rapid diagnosis and timely initiation of antibiotics, reducing morbidity and mortality in severe cases
    • Helps differentiate leptospirosis from other causes of acute fever with similar presentation (dengue, malaria, hepatitis)
    • Particularly valuable in areas of high leptospirosis endemicity for epidemiological surveillance and outbreak identification
  • Associated Organs
    • Primary Organ Systems: Hepatic (liver), Renal (kidneys), Pulmonary (lungs), Cardiovascular system, Central nervous system
    • Associated Organ Involvement: Acute renal failure (most common serious complication); occurs in 16-40% of hospitalized patients
    • Jaundice and hepatic dysfunction; elevated liver enzymes; hepatomegaly; liver biopsies show parenchymal necrosis
    • Pulmonary hemorrhage syndrome; acute respiratory distress syndrome (ARDS); accounts for significant mortality in severe cases
    • Myocarditis and cardiac arrhythmias; can lead to cardiogenic shock in severe infections
    • Meningitis and encephalitis; neurological manifestations including seizures and altered consciousness
    • Common Associated Diseases: Weil's disease (severe form with jaundice, renal failure, hemorrhage); mortality rates 5-15% in severe cases
    • Leptospirosis-associated pulmonary hemorrhage syndrome (LPHS); rapidly progressive and often fatal
    • Mild form presenting as flu-like illness without multi-organ involvement
    • Potential Complications: Chronic renal disease following acute kidney injury; long-term renal dysfunction in 5-10% of survivors
    • Uveitis and posterior segment eye inflammation; can occur months after acute infection
    • Aseptic meningitis with long-term neurological sequelae in some patients
    • Hemorrhagic manifestations including gastrointestinal bleeding, intracranial hemorrhage
    • Septic shock and multi-organ failure in fulminant infections
  • Follow-up Tests
    • Serological Tests: Microscopic agglutination test (MAT) - gold standard for confirmation and serovar identification; perform after day 7-10 when antibodies appear
    • IgM ELISA - detects early immunoglobulin M antibodies; positive by day 5-7 of illness
    • IgG antibodies - appear later in infection; indicate convalescent phase or past exposure
    • Blood Culture: Culture on specialized media during first 10 days of illness; provides organism identification but takes 2-4 weeks; complements PCR results
    • Renal Function Tests: Creatinine and BUN levels - monitor for acute kidney injury; obtain at initial presentation and repeat regularly
    • Urinalysis - may show proteinuria, casts, and microscopic hematuria indicating renal involvement
    • Urine culture - may yield Leptospira during second and third weeks of illness (leptospiruria phase)
    • Liver Function Tests: AST, ALT, bilirubin, alkaline phosphatase - assess hepatic involvement and severity
    • Platelet Count and Coagulation Studies: Assess for thrombocytopenia and bleeding risk; monitor PT/INR if hemorrhagic manifestations present
    • Pulmonary Assessment: Chest X-ray if respiratory symptoms present; assess for infiltrates, pulmonary hemorrhage, or ARDS
    • CSF Analysis: Perform lumbar puncture if meningitis suspected; CSF typically shows lymphocytic pleocytosis with elevated protein
    • Cardiac Evaluation: EKG and troponin levels if myocarditis suspected or patient presents with arrhythmias
    • Monitoring Frequency: Daily monitoring of renal function and liver function during acute phase; repeated testing every 2-3 days until stabilization
    • Post-recovery follow-up for patients with severe illness to assess for chronic renal dysfunction or other sequelae
    • Differential Diagnosis Testing: Dengue serology, malaria screening, hepatitis panel, typhoid serology - help exclude other tropical febrile illnesses with similar presentation
  • Fasting Required?
    • Fasting: No - Fasting is NOT required for Leptospira DNA PCR blood test
    • Sample Collection: Blood sample can be collected at any time of day without regard to food intake
    • Medications: No specific medication restrictions; however, prior antibiotic therapy may reduce bacterial DNA detection and produce false negative results
    • Inform laboratory if antibiotics have been started before blood collection to help interpret results appropriately
    • Patient Preparation: No special preparation required; patient can eat and drink normally before the test
    • Patient should be well-hydrated if possible (may be challenging in acute illness); adequate hydration improves blood quality for testing
    • Inform patient of importance of timing - sample should be collected during first 10 days of illness for optimal sensitivity
    • Special Considerations: Proper specimen collection technique is critical - blood should be drawn into sterile EDTA (purple-top) tubes according to laboratory protocol
    • Specimens should be kept at 4°C if transport to laboratory is delayed; avoid freezing unless instructed by laboratory
    • Rapid transport to laboratory is recommended to preserve DNA integrity and bacterial viability
    • Do not use serum separator tubes (SST) - EDTA tubes must be used for PCR testing

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