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In the current genomic era, knowledge of diversity of  Leptospira , the spirochetal agents of leptospirosis, is changing rapidly. Next-generation sequencing has decreased in price and increased in scale, with the potential to democratize large-scale analysis of pathogens in resource-limited, low/middle-income (LMIC) regions. Consequently, the molecular classification of  Leptospira , a pathogen disproportionately affecting LMIC countries, has changed dramatically over the last decade.  Leptospira  classification and molecular understandings of pathogen diversity have rapidly evolved, now most precisely based on core genome analysis supplemented by new insights provided by culture-independent methods directly using body fluids such as blood and urine. In places where leptospirosis disease burden is highest, genomic technologies have not been available, and serology-based methods remain the mainstay of leptospiral classification. Understanding the epidemiology, pathogenesis, and ultimately new approaches to treating and preventing leptospirosis requires detailed knowledge of regionally circulating  Leptospira  in highly endemic settings. Next-generation sequencing–based, culture-independent typing overcomes the limitation of culture isolation of  Leptospira  from clinical samples, with promise of providing public health-actionable information applicable to leptospirosis-endemic LMIC settings.

the american journal of tropical medicine and hygiene

Next-Generation Sequencing Analysis of Pathogenic Leptospira: A Way Forward for Understanding Infectious Disease Dynamics in Low/Middle-Income, Disease-Endemic Settings