# Deciphering Microscopic Agglutination Test (MAT) Serogroup Cross-Reactivity in Leptospirosis: The Influence of Age and Antibody Titers

## TL;DR

This study explores how age and antibody levels affect cross-reactivity in a common leptospirosis test, showing older people react to more serogroups despite lower antibody levels.

## Contribution

The study identifies age and antibody titer as key factors influencing serogroup cross-reactivity in the microscopic agglutination test for leptospirosis.

## Key findings

- Older individuals and those with higher antibody titers showed reactivity to more serogroups.
- Maximum antibody titer was the strongest predictor of serogroup breadth.
- Mean titer decreased with age, suggesting broader reactivity in older individuals reflects cumulative exposure.

## Abstract

Leptospirosis is a zoonotic disease caused by Leptospira spp., with over 250 serovars classified into 24 serogroups. Control measures depend on understanding serovar-specific epidemiology, yet the microscopic agglutination test (MAT) is only serogroup specific, and classification is complicated by cross-reactivity. While MAT is the reference standard for leptospirosis serodiagnosis and seroepidemiological studies, factors influencing serogroup cross-reactivity remain poorly characterized. We investigated the relationship between age, antibody titer, and serogroup diversity among seropositive individuals in a population-based serosurvey in the Dominican Republic. Between June and October 2021, we conducted a multistage national serosurvey, enrolling 6683 participants across 134 clusters. MAT was performed on sera from 2091 participants in two provinces using a 20-serovar panel. MAT positivity was defined as titers ≥ 1:100. Generalized Additive Models were used to assess associations between age, maximum titer, and serogroup diversity. Of 2091 tested samples, 237 (11.3%) were seropositive. Older individuals and those with higher titers reacted to a greater number of serogroups (p = 0.005 and p < 0.0001, respectively). However, mean maximum titer decreased with age, suggesting that broader serogroup reactivity in older individuals reflects cumulative exposure rather than higher titers. Maximum titer was the strongest predictor of serogroup breadth, while gender, study region, and urban/rural setting were not significant. Overall, our findings demonstrate that serogroup cross-reactivity in MAT was significantly influenced by antibody titer and prior exposure, with older individuals displaying broader serogroup reactivity despite lower titers. These findings highlight key considerations for interpreting MAT results in seroepidemiological studies and underscore the limitations of MAT in serogroup-level classification.