Reference laboratory in Portugal (IHMT) for the diagnosis of leptospirosis , according to the guidelines of the International Leptospirosis Society (ILS) / WHO
OPPORTUNITY TO BE PROMOTED
Service Provision / Expertise
Leptospirosis is a reemergent zoonosis of worldwide distribution often linked to climate changes. Pathogenic spirochetes of Leptospira genus are its etiological agent. Rodents, mainly rats and mice, are the most common reservoirs of these bacteria. Transmission to humans occurs primarily through direct contact with urine, soil or water containing leptospires.
The disease often occurs with peaks seasonally, sometimes in outbreaks and related to occupation or recreational activities. The clinical course in humans ranges from mild to lethal, with a broad spectrum of symptoms and clinical signs. Leptospirosis is underreported in many countries because of difficult clinical diagnosis and the lack of diagnostic laboratory services. In Portugal, leptospirosis is a mandatory declaration disease. It is endemic on the Azores Archipelago, with a high incidence (11.1/100 000 population) about ten times higher than the mainland, accompanied by an increased number of deaths.
The Lab is responsible for diagnosing leptospirosis in biological samples (blood, serum, urine or CSF) from users/patients admitted to hospitals or outpatient clinics. The evaluation of these fluids, according to the evolution time of disease, can be done by indirect tests (detection of anti-Leptospira antibodies) namely: i) MACROLepto – a screening test; and ii) MAT – Microscopic Agglutination Test. This last is the reference test from WHO, which includes a battery of 28 live antigens (Leptospira serovars) maintained in vitro, representing all over the world, and strains (serovars) isolated by us (over time) in Portugal, to increase the sensitivity of the test. Regarding the direct tests, the lab also performs, in addition to culture in a selective medium for Leptospira isolation, molecular tests, using conventional and nested PCR and real-time PCR, for Leptospira DNA detection. These approaches are an asset, especially in the early stage of the disease, when there is still no production of antibodies.
Leptospirosis Lab at the IHMT was created in the last years of the 80s, by a young researcher Margarida Colllares-Pereira (1st PhD leptospirologist in Portugal). She relaunched the work and research in this area conducted until the 60s, by the unforgettable Professor Fraga de Azevedo. Since then, the Lab has always had a pioneering intervention in the community, being unique in the country to carry out the MAT, the reference test recommended, even today, by WHO, among other approaches. One of the advantages is its insertion in a NOVA Organic Unit – the IHMT, where research and teaching are developed in this scientific area. This fact provides a permanent update of knowledge reflected in the improvement of the diagnostic offer.
An example of this interaction was the development of the project “”Epidemiology and Control of Leptospirosis in the Autonomous Azorean Region”. Between 2004-2008 it was possible to overcome a severe health situation due to leptospirosis, where the increasing morbidity and mortality were a constant concern of the local Health Authorities. Fortunately in the Azores, since 2009, no deaths from leptospirosis have been reported.
In recent years, the Lab has provided technology transfer (at the serologic and molecular level) mainly to the Hospitals of S. Miguel and Terceira islands.
Also, as a result of a collaboration with the industry (under the Prime Program), the Lab developed and optimized a screening test (MACROLepto) that allows a previous diagnosis of the disease, which is later confirmed by the reference test (MAT).
The Lab is subject to external Quality Control, carried out annually by ILS (International Leptospirosis Society – Netherlands and Australia).