Abstract
INTRODUCTION: Leptospirosis is a worldwide zoonotic disease caused by pathogenic Leptospira species. Microscopic agglutination test (MAT) has been used as a gold standard test for the diagnosis of Leptospirosis. MKAKB has the capability to run the test for Kelantan and Terengganu. The two (2) years pattern of the positive rate for MAT is decreasing from 21.6% (2015-2016) to 3.4% (2019-2020). Here, we would like to share our experienced in optimizing the leptospirosis microscopic agglutination test.
METHODOLOGY: A cross-sectional study was conducted in July 2021 to May 2022. Pre-intervention, 30 samples with positive, equivocal, and negative MAT results have been chosen randomly for 3 cycles for rechecking at MKAK Sungai Buloh. As a result, about 66.7% showed discordance results. We have implemented few control measures since January 2022. One Medical Laboratory Technologist (MLT) was assigned to do attachment in MKAK Sungai Buloh for 1 week. To sustain his competency and performance, he will be permanently work at the MAT unit. He will monitor and supervise the other staff by doing result rechecking especially for the new rotation staff. Some amendments done such as using disposable sterile loop 1µL instead of using nichrome wire loop to maintain the viability of the bacteria. They need to ensure the volume of samples that transfer onto the glass slide were consistently 1?l to avoid inaccurate reading. The procedures on serovar maintenance and on EMJH media preparation were revised according to the standard and latest update. All serovars are maintained in EMJH liquid media and sub-cultured weekly to maintain their viability. The live serovars also will be replaced every year with the new culture.
RESULT: A total of 104 samples were received in April and May 2022. Majority of them were male (70.2%) and the age were range between 2 to 83 years of age. The samples predominantly from Kelantan (83.7%) and only 1 sample was categorized as second sample. All the samples were tested for MAT with the positivity of 35.6% (37). About 8 samples give negative results while 59 samples released as equivocal that require convalescent sample for confirmation. DISCUSSION: All suspected samples with inconclusive or positive Lepto Rapid IgM were subjected to do MAT for confirmation. The MAT was performed by incubating patient serum with the 20 various serovars of leptospiral. Positive agglutination was considered when at least 50% of the leptospiral agglutinate with the serum antibodies. A confirmed case of leptospirosis should have a single MAT titer of > 1 in 400 or a four-fold rise in titer between acute and convalescent samples. There was 82% of sample reduction in the year 2021(848) from the year 2019(4729) due to COVID-19 pandemic. The positive rate in April and May 2022 was increasing to 35.6% from 3.1% (17) in 2019 for the same months. In conclusion, MAT is technically demanding and requiring laborious procedure especially in maintaining the live serovars. Having a dedicated with great skills and experienced staff with a good supervision from higher authority will give the optimum MAT result.
Links
- https://apcph.cphm.my/wp-content/uploads/2022/07/APCPH2022-P-77.pdf
- https://apcph.cphm.my/wp-content/uploads/wpforms/1176-1e04940bb5d885bf8711ed1909[...]
BibTeX (Download)
@proceedings{APCPH2022-P-77,
title = {Optimizing the Leptospirosis Microscopic Agglutination Test (MAT) in Makmal Kesihatan Awam Kota Bharu (MKAKB)},
author = {Suhana H and Aliyaisma A and Muhammad Mawardi J and Siti Norsuhada AM and Noor Hafizan MS},
url = {https://apcph.cphm.my/wp-content/uploads/2022/07/APCPH2022-P-77.pdf
https://apcph.cphm.my/wp-content/uploads/wpforms/1176-1e04940bb5d885bf8711ed19095a89ed/APCPH_P_77-LEPTO-MAT-091919e3bd6fb20d8b84e8f88df31ca9.pdf},
year = {2022},
date = {2022-08-02},
urldate = {2022-08-02},
issue = {7},
abstract = {INTRODUCTION: Leptospirosis is a worldwide zoonotic disease caused by pathogenic Leptospira species. Microscopic agglutination test (MAT) has been used as a gold standard test for the diagnosis of Leptospirosis. MKAKB has the capability to run the test for Kelantan and Terengganu. The two (2) years pattern of the positive rate for MAT is decreasing from 21.6% (2015-2016) to 3.4% (2019-2020). Here, we would like to share our experienced in optimizing the leptospirosis microscopic agglutination test.
METHODOLOGY: A cross-sectional study was conducted in July 2021 to May 2022. Pre-intervention, 30 samples with positive, equivocal, and negative MAT results have been chosen randomly for 3 cycles for rechecking at MKAK Sungai Buloh. As a result, about 66.7% showed discordance results. We have implemented few control measures since January 2022. One Medical Laboratory Technologist (MLT) was assigned to do attachment in MKAK Sungai Buloh for 1 week. To sustain his competency and performance, he will be permanently work at the MAT unit. He will monitor and supervise the other staff by doing result rechecking especially for the new rotation staff. Some amendments done such as using disposable sterile loop 1µL instead of using nichrome wire loop to maintain the viability of the bacteria. They need to ensure the volume of samples that transfer onto the glass slide were consistently 1?l to avoid inaccurate reading. The procedures on serovar maintenance and on EMJH media preparation were revised according to the standard and latest update. All serovars are maintained in EMJH liquid media and sub-cultured weekly to maintain their viability. The live serovars also will be replaced every year with the new culture.
RESULT: A total of 104 samples were received in April and May 2022. Majority of them were male (70.2%) and the age were range between 2 to 83 years of age. The samples predominantly from Kelantan (83.7%) and only 1 sample was categorized as second sample. All the samples were tested for MAT with the positivity of 35.6% (37). About 8 samples give negative results while 59 samples released as equivocal that require convalescent sample for confirmation. DISCUSSION: All suspected samples with inconclusive or positive Lepto Rapid IgM were subjected to do MAT for confirmation. The MAT was performed by incubating patient serum with the 20 various serovars of leptospiral. Positive agglutination was considered when at least 50% of the leptospiral agglutinate with the serum antibodies. A confirmed case of leptospirosis should have a single MAT titer of \> 1 in 400 or a four-fold rise in titer between acute and convalescent samples. There was 82% of sample reduction in the year 2021(848) from the year 2019(4729) due to COVID-19 pandemic. The positive rate in April and May 2022 was increasing to 35.6% from 3.1% (17) in 2019 for the same months. In conclusion, MAT is technically demanding and requiring laborious procedure especially in maintaining the live serovars. Having a dedicated with great skills and experienced staff with a good supervision from higher authority will give the optimum MAT result.},
howpublished = {published online at https://apcph.cphm.my},
note = {Type: POSTER PRESENTATION; Organisation: Makmal Kesihatan Awam Kota Bharu, Kelantan},
keywords = {Leptospirosis, Microscopic Agglutination Test, MKAKB, Serovar},
pubstate = {published},
tppubtype = {proceedings}
}