Evaluation of Laboratory Techniques for the Diagnosis of Leptospira-Associated Equine Recurrent Uveitis (ERU) With Focus on the Goldmann-Witmer Coefficient.
Abstract: To evaluate different laboratory procedures for determining the etiologic diagnosis of equine recurrent uveitis regarding intraocular infection with Leptospira spp. and to establish a diagnostic guideline. Methods: Eighty horses with a history of ERU were ophthalmologically examined. Serum and aqueous humor were collected. Total protein, albumin level, and MAT against Leptospira spp. were evaluated on serum and aqueous humor. PCR for Leptospira spp., EHV-1 and -4 was performed on aqueous humor. Goldmann-Witmer coefficient (GWC) and C-value (CC) were calculated based on MAT. In 42 cases, an additional ELISA was initiated. Results: Forty-six female and 34 male horses of different breeds (mean age 10.9 years; range 3 to 31) were included. By MAT 56/80 horses (70.0%) were identified seropositive for Leptospira spp. MAT results were positive for Leptospira spp. in aqueous humor of 47/80 (58.8%) patients. PCR tested 16/80 (20.0%) positive, ELISA detected 13/42 (31.0%) positive. Neither EHV-1 nor EHV-4 were detected by PCR. Calculating GWC gives evidence suggestive of intraocular involvement with Leptospira spp. in 53/80 (66.3%) at the level ≥ 3. Setting GWC ≥ 3 as gold standard, ELISA and C ≥ 2 closely matched this threshold, showing high accuracy (95.2%; 91.3%), sensitivity (86.7%; 84.9%), and strong agreement (V = 0.90; V = 0.81). PCR was less accurate (53.8%) and sensitive (30.2%) compared to GWC. Conclusions: Within this setting, GWC achieved the highest number of positive results for detecting intraocular involvement of Leptospira spp. when compared to PCR, ELISA, and C-value.
The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.
Overview
This study evaluated various laboratory diagnostic methods to detect intraocular infection with Leptospira bacteria in horses suffering from Equine Recurrent Uveitis (ERU).
The Goldmann-Witmer Coefficient (GWC) was assessed alongside other tests to establish which method is most effective for identifying Leptospira-associated ERU.
Background
Equine Recurrent Uveitis (ERU) is a common eye disease in horses that causes repeated inflammation of the uveal tract and often leads to blindness.
A significant cause of ERU is believed to be infection with Leptospira spp., a type of bacteria.
Detecting intraocular infection accurately is crucial for effective diagnosis and treatment.
Various laboratory techniques exist to diagnose Leptospira-associated ERU, but their relative effectiveness had not been firmly established.
Study Objectives
To compare multiple laboratory methods for diagnosing Leptospira infection of the eye in horses with ERU.
To focus on evaluating the Goldmann-Witmer Coefficient (GWC) and its utility compared to other diagnostic tests.
To develop guidelines for reliable etiological diagnosis of Leptospira-associated ERU.
Methods
Sample Size and Subjects:
80 horses with a history of ERU were included (46 female, 34 male, various breeds).
Mean age was approximately 11 years, ranging from 3 to 31 years old.
Sample Collection:
Ophthalmological examination was performed on all subjects.
Both serum (blood) and aqueous humor (fluid from inside the eye) samples were collected.
Laboratory Tests Conducted:
Microscopic Agglutination Test (MAT) against Leptospira spp. on serum and aqueous humor to look for antibodies.
Measurement of total protein and albumin levels in serum and aqueous humor to assess blood-ocular barrier integrity.
Polymerase Chain Reaction (PCR) tests on aqueous humor to detect DNA of Leptospira spp. and Equine Herpesvirus types 1 and 4 (EHV-1 and EHV-4).
Goldmann-Witmer Coefficient (GWC) and C-value (CC) calculations based on MAT results to assess local antibody production in the eye.
An ELISA antibody test was additionally performed in 42 of the horses for comparison with other tests.
Key Findings
Seropositivity:
70% (56/80) of horses tested positive for Leptospira antibodies in serum via MAT.
58.8% (47/80) showed positive MAT results for Leptospira in aqueous humor.
PCR Results:
Only 20% (16/80) were PCR-positive for Leptospira DNA in aqueous humor.
None of the samples were positive for EHV-1 or EHV-4 by PCR.
ELISA Results:
In the subset of 42 horses tested, 31% were ELISA-positive for Leptospira antibodies in the eye fluid.
Goldmann-Witmer Coefficient (GWC):
Suggestive intraocular involvement was found in 66.3% (53/80) at a threshold GWC ≥ 3.
GWC identified more positive cases compared to PCR and ELISA.
Diagnostic Performance:
When using GWC ≥ 3 as the gold standard:
ELISA and C-value with threshold ≥ 2 showed high accuracy (95.2% and 91.3%) and sensitivity (86.7% and 84.9%).
Strong agreement was observed between GWC and ELISA (V = 0.90) and between GWC and C-value (V = 0.81).
PCR demonstrated lower accuracy (53.8%) and sensitivity (30.2%), indicating it was less effective at detecting intraocular Leptospira infection compared to antibody-based tests.
Conclusions and Clinical Implications
The Goldmann-Witmer Coefficient (GWC) was the most sensitive and effective test for diagnosing intraocular Leptospira infection in horses with ERU in this study.
Compared to PCR, which detects bacterial DNA, antibody detection methods (GWC, ELISA, C-value, MAT) performed better, likely because antibodies persist and are more abundant than bacterial DNA in the eye fluid.
GWC and related measurements provide a useful diagnostic guideline for veterinarians assessing Leptospira involvement in ERU, aiding targeted treatment decisions.
Testing for EHV-1 and EHV-4 by PCR was negative, suggesting these viruses are not common causes of intraocular inflammation in ERU cases studied.
Summary
This study highlights the importance of antibody-based diagnostics, especially the Goldmann-Witmer Coefficient, to identify intraocular Leptospira infection in horses with ERU.
Results support use of GWC as a gold standard reference to guide diagnosis and treatment.
The findings help clarify which laboratory methods are most reliable for equine uveitis diagnosis related to leptospiral infection.
Cite This Article
APA
Kirmse L, Thieme K, Doherr MG, Eule JC.
(2026).
Evaluation of Laboratory Techniques for the Diagnosis of Leptospira-Associated Equine Recurrent Uveitis (ERU) With Focus on the Goldmann-Witmer Coefficient.
Vet Ophthalmol, 29(1), e70132.
https://doi.org/10.1111/vop.70132
Ophthalmology Unit, Centre for Veterinary Clinical Services, Freie Universität Berlin, Berlin, Germany.
Tierärztliche Praxis für Pferde Stefanie Süß, Deinste, Lower Saxony, Germany.
Thieme, Katharina
Equine Clinic Seeburg, Dallgow-Döberitz, Germany.
Doherr, Marcus Georg
Institute of Veterinary Epidemiology and Biostatistics, School of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany.
Eule, Johanna Corinna
Ophthalmology Unit, Centre for Veterinary Clinical Services, Freie Universität Berlin, Berlin, Germany.
MeSH Terms
Animals
Horses
Horse Diseases / diagnosis
Horse Diseases / microbiology
Leptospirosis / veterinary
Leptospirosis / diagnosis
Uveitis / veterinary
Uveitis / diagnosis
Uveitis / microbiology
Female
Leptospira / isolation & purification
Male
Aqueous Humor / microbiology
Enzyme-Linked Immunosorbent Assay / veterinary
Polymerase Chain Reaction / veterinary
Grant Funding
Dahlem Research School and Elsa-Neumann-Stipendium
Conflict of Interest Statement
The authors have not used AI to generate any part of the manuscript. The authors declare no conflicts of interest.
References
This article includes 121 references
Gerhards H, Wollanke B. Diagnosis and Therapy of Uveitis in Horses. Pferdeheilkunde Equine Medicine 17, no. 4 (2001): 319–329.
Gilger B C, Hollingsworth S R. Diseases of the Uvea, Uveitis, and Recurrent Uveitis. in Equine Ophthalmology, 3rd ed., ed. Gilger B. C. (John Wiley & Sons, Inc., 2017), 369–415.
Verma A, Kumar P, Babb K, Timoney J F, Stevenson B. Cross‐Reactivity of Antibodies Against Leptospiral Recurrent Uveitis‐Associated Proteins A and B (LruA and LruB) With Eye Proteins. PLoS Neglected Tropical Diseases 4, no. 8 (2010): e778.
Wollanke B, Rohrbach B W, Gerhards H. Serum and Vitreous Humor Antibody Titers in and Isolation of From Horses With Recurrent Uveitis. Journal of the American Veterinary Medical Association 219, no. 6 (2001): 795–800.
Pearce J W, Galle L E, Kleiboeker S B. Detection of DNA and Antigen in Fixed Equine Eyes Affected With End‐Stage Equine Recurrent Uveitis. Journal of Veterinary Diagnostic Investigation 19, no. 6 (2007): 686–690.
Tömördy E, Haessig M, Spiess B M. The Outcome of Pars Plana Vitrectomy in Horses With Equine Recurrent Uveitis With Regard to the Presence or Absence of Intravitreal Antibodies Against Various Serovars of. Pferdeheilkunde 26, no. 2 (2010): 251–254.
Kulbrock M, von Borstel M, Rohn K, Distl O, Ohnesorge B. Occurrence and Severity of Equine Recurrent Uveitis in Warmblood Horses ‐ A Comparative Study. Pferdeheilkunde Equine Medicine 29, no. 1 (2013): 27–36.
Polle F, Storey E, Eades S. Role of Intraocular Leptospira Infections in the Pathogenesis of Equine Recurrent Uveitis in the Southern United States. Journal of Equine Veterinary Science 34, no. 11–12 (2014): 1300–1306.
Baake E I A, von Borstel M, Rohn K, Ohnesorge B. Intraokularer Leptospirennachweis Mittels PCR, MAT, ELISA und Kultur von Pferden mit equiner rezidivierender Uveitis (ERU) in verschiedenen Laboren. Pferdeheilkunde 32, no. 4 (2016): 346–356.
Dorrego‐Keiter E, Toth J, Dikker L, Sielhorst J, Schusser G F. Detection of Leptospira by Culture of Vitreous Humor and Detection of Antibodies Against Leptospira in Vitreous Humor and Serum of 225 Horses With Equine Recurrent Uveitis. Berliner Und Munchener Tierarztliche Wochenschrift 129, no. 5–6 (2016): 209–215.
Dorrego‐Keiter E, Toth J, Dikker L, Sielhorst J, Schusser G F. Long‐Term Results of Pars Plana Vitrectomy in Relationship to Leptospiral Antibody Detection in Vitreous Humor in 118 Horses With Equine Recurrent Uveitis (ERU). Pferdeheilkunde 33, no. 2 (2017): 112–118.
Wollanke B, Gerhards H, Schinagl C. Results of 654 Trans‐Pars Plana Vitrectomies of Equine Eyes With Recurrent Uveitis‐Follow‐Up Until 18 Years After Surgery. Pferdeheilkunde 37, no. 3 (2021): 204–214.
Chu KM, Rathinam R, Namperumalsamy P, Dean D. Identification of Leptospira Species in the Pathogenesis of Uveitis and Determination of Clinical Ocular Characteristics in South India. Journal of Infectious Diseases 177, no. 5 (1998): 1314–1321.
Wollanke B, Geiger T, Gerhards H. Evaluation of “SNAP Lepto”‐ELISA and Comparison With MAT and PCR Results for Diagnosis of Leptospiral Uveitis in Horses Using Intraocular Samples. Pferdeheilkunde Equine Medicine 34, no. 6 (2018): 508–516.
WHO. Human Leptospirosis: Guidance for diagnosis, surveillance and control. World Health Organization, 2003, 5–16.
Verma V, Goyal M, Kala D, Gupta S, Kumar D, Kaushal A. Recent Advances in the Diagnosis of Leptospirosis. Frontiers in Bioscience 25, no. 9 (2020): 1655–1681.
Lizer J, Velineni S, Weber A, Krecic M, Meeus P. Evaluation of 3 Serological Tests for Early Detection of Leptospira‐Specific Antibodies in Experimentally Infected Dogs. Journal of Veterinary Internal Medicine 32, no. 1 (2018): 201–207.
Gesell‐May S, Brem S, Wollanke B, Gerhards H. Untersuchung Gesunder Pferdeaugen auf eine intraokulare Leptospireninfektion. Pferdeheilkunde 37 (2021): 215–224.
Loibl JK, Gerhards H, Brem S, Wollanke B. Improving the Laboratory Diagnosis of Leptospiral Uveitis in Horses by Using an Indirect ELISA for the Detection of Antibodies Against Leptospira spp. in Intraocular Samples. Pferdeheilkunde Equine Medicine 34, no. 3 (2018): 267–277.
De Groot‐Mijnes JD, Rothova A, Van Loon AM. Polymerase Chain Reaction and Goldmann‐Witmer Coefficient Analysis Are Complimentary for the Diagnosis of Infectious Uveitis. American Journal of Ophthalmology 141, no. 2 (2006): 313–318.
de‐la‐Torre A, Valdés‐Camacho J, de Mesa CL. Coinfections and Differential Diagnosis in Immunocompetent Patients With Uveitis of Infectious Origin. BMC Infectious Diseases 19, no. 1 (2019): 91.
Fekkar A, Bodaghi B, Touafek F, Le Hoang P, Mazier D, Paris L. Comparison of Immunoblotting, Calculation of the Goldmann‐Witmer Coefficient, and Real‐Time PCR Using Aqueous Humor Samples for Diagnosis of Ocular Toxoplasmosis. Journal of Clinical Microbiology 46, no. 6 (2008): 1965–1967.
Mathis T, Beccat S, Sève P, Peyron F, Wallon M, Kodjikian L. Comparison of Immunoblotting (IgA and IgG) and the Goldmann‐Witmer Coefficient for Diagnosis of Ocular Toxoplasmosis in Immunocompetent Patients. British Journal of Ophthalmology 102, no. 10 (2018): 1454–1458.
Rebhun W. Diagnosis and Treatment of Equine Uveitis [Moon Blindness, Periodic Ophthalmia]. Journal of the American Veterinary Medical Association 175, no. 8 (1979): 803–808.
Arbeitsgemeinschaft Deutsches Sportpferd D. Grundsätze für die Zucht der Rasse ‘Deutsches Sportpferd’ gemäß der VO (EU) 2016/1012 Anhang I, Teil 2 und 3. Grundsätze für das Deutsche Sportpferd Web site. 2021.
Featherstone HJ, Heinrich CL. The Eye Examination and Diagnostic Procedures. in Veterinary Ophthalmology, 6th ed., ed. Gelatt KN (Wiley Blackwell, 2021), 564–661.
WOAH. Leptospirosis. Manual of Diagnostic Tests and Vaccines for Terrestrial Animals Web Site. 2021.
Gesell‐May S. Die Equine Rezidivierende Uveitis (ERU): Diskussion von Untersuchungs‐Und Therapieergebnissen, Insbesondere in Bezug auf die Vitrektomie Und den Einsatz von Gentamicin und Cyclosporin. Der Praktische Tierarzt 101 (2020): 560–566.
Wollanke B. Die Equine Rezidivierende Uveitis (ERU) als Intraokulare Leptospirose [Equine Recurrent Uveitis (ERU) as an intraocular Leptospirosis] [Habilitation]. Ludwig‐Maximilians‐University, 2002.
Wollanke B. Untersuchungen zur Ätiologie der equinen rezidivierenden Uveitis (ERU). Inaugural Dissertation, Faculty of Veterinary Medicine at the Ludwig‐Maximilians‐Universität, 1995.
Pikalo J, Sattler T, Eichinger M. Occurrance of Antibodies Against Leptospira in Horses in Middle Germany. Berliner Und Munchener Tierarztliche Wochenschrift 129, no. 5–6 (2016): 202–208.
Ebani VV, Bertelloni F, Pinzauti P, Cerri D. Seroprevalence of Leptospira spp. and Sensu Lato in Italian Horses. Annals of Agricultural and Environmental Medicine 19, no. 2 (2012): 237–240.
Sohail M L, Khan M S, Avais M. Seroprevalence of Leptospira spp. in Horses of Distinct Climatic Regions of Punjab, Pakistan. Journal of Equine Veterinary Science 44 (2016): 82–89.
Robert‐Gangneux F, Binisti P, Antonetti D, Brezin A, Yera H, Dupouy‐Camet J. Usefulness of Immunoblotting and Goldmann‐Witmer Coefficient for Biological Diagnosis of Toxoplasmic Retinochoroiditis. European Journal of Clinical Microbiology & Infectious Diseases 23, no. 1 (2004): 34–38.
Pinard C, Piètrement E, Macieira S, Tremblay D. Intravitreal Injections of Gentamicin for the Treatment of Leptospira‐Associated Equine Recurrent Uveitis. Veterinary Ophthalmology 8, no. 6 (2005): 445.
Sugita S, Ogawa M, Inoue S, Shimizu N, Mochizuki M. Diagnosis of Ocular Toxoplasmosis by Two Polymerase Chain Reaction (PCR) Examinations: Qualitative Multiplex and Quantitative Real‐Time. Japanese Journal of Ophthalmology 55, no. 5 (2011): 495–501.
Bourdin C, Busse A, Kouamou E. PCR‐Based Detection of Toxoplasma Gondii DNA in Blood and Ocular Samples for Diagnosis of Ocular Toxoplasmosis. Journal of Clinical Microbiology 52, no. 11 (2014): 3987–3991.
Gesell S. Gibt es Eine Asymptomatische Intraokulare Leptospireninfektion Beim Pferd?. Inaugural‐Dissertation, Tierärztliche Fakultät, LMU, 2004.
Eldin C, Jaulhac B, Mediannikov O, Arzouni J P, Raoult D. Values of Diagnostic Tests for the Various Species of Spirochetes. Médecine et Maladies Infectieuses 49, no. 2 (2019): 102–111.
Himebaugh N E, Gilger B C. Role of Leptospira spp. Testing and Ocular Examination in Horses With Equine Recurrent Uveitis: A Retrospective Study of 63 Horses. Equine Veterinary Education 34, no. 11 (2022): e509–e518.
Tömördy E. Verlaufsstudie nach Vitrektomie bei Equiner Rezidivierender Uveitis. Inaugural‐Dissertation, Vetsuisse Fakultät, Universität Zürich, 2009.
Roczek A, Forster C, Raschel H. Severe Course of Rat Bite‐Associated Weil's Disease in a Patient Diagnosed With a New Leptospira‐Specific Real‐Time Quantitative LUX‐PCR. Journal of Medical Microbiology 57, no. 5 (2008): 658–663.
Ahmed A, Engelberts M F, Boer K R, Ahmed N, Hartskeerl R A. Development and Validation of a Real‐Time PCR for Detection of Pathogenic Leptospira Species in Clinical Materials. PLoS One 4, no. 9 (2009): e7093.
Silva M V, Camargo E D, Batista L. Behaviour of Specific IgM, IgG and IgA Class Antibodies in Human Leptospirosis During the Acute Phase of the Disease and During Convalescence. Journal of Tropical Medicine and Hygiene 98, no. 4 (1995): 268–272.
Morter R L, Herschler R C, Fessler J F, Lavignette A. Experimental Equine Leptospirosis. Proceedings, Annual Meeting of the United States Animal Health Association 68 (1964): 147–152.
Rollins D F, Tabbara K F, O'Connor G R, Araujo F G, Remington J S. Detection of Toxoplasmal Antigen and Antibody in Ocular Fluids in Experimental Ocular Toxoplasmosis. Archives of Ophthalmology 101, no. 3 (1983): 455–457.
Garweg J G, Ventura A C, Halberstadt M. Specific Antibody Levels in the Aqueous Humor and Serum of Two Distinct Populations of Patients With Ocular Toxoplasmosis. International Journal of Medical Microbiology 295, no. 4 (2005): 287–295.
Truccolo J, Serais O, Merien F, Perolat P. Following the Course of Human Leptospirosis: Evidence of a Critical Threshold for the Vital Prognosis Using a Quantitative PCR Assay. FEMS Microbiology Letters 204, no. 2 (2001): 317–321.
Agampodi S B, Matthias M A, Moreno A C, Vinetz J M. Utility of Quantitative Polymerase Chain Reaction in Leptospirosis Diagnosis: Association of Level of Leptospiremia and Clinical Manifestations in Sri Lanka. Clinical Infectious Diseases 54, no. 9 (2012): 1249–1255.
Behera S K, Sabarinath T, Ganesh B. Diagnosis of Human Leptospirosis: Comparison of Microscopic Agglutination Test With Recombinant LigA/B Antigen‐Based In‐House IgM Dot ELISA Dipstick Test and Latex Agglutination Test Using Bayesian Latent Class Model and MAT as Gold Standard. Diagnostics 12, no. 6 (2022): 1455.
Berger A, Treis B, Fingerle V, Sing A. Leptospiren. Medizinische Mikrobiologie und Infektiologie vol. 8, 8th ed. (Springer‐Verlag, 2016), 375–379.
Eule J C, Wagner B, Leibold W, Deegen E. Occurrence of Various Immunoglobulin Isotopes in Horses With Equine Recurrent Uveitis (ERU). Berliner Und Munchener Tierarztliche Wochenschrift 113, no. 6 (2000): 253–257.
Verma A, Artiushin S, Matsunaga J, Haake D A, Timoney J F. LruA and LruB, Novel Lipoproteins of Pathogenic Associated With Equine Recurrent Uveitis. Infection and Immunity 73, no. 11 (2005): 7259–7266.
Loibl J K. Immunologische und mikrobiologische Untersuchungen zur intraokular persistierenden Leptospireninfektion bei Pferden mit Rezidivierender Uveitis. Inaugural‐Dissertation, Ludwig‐Maximilians‐Universität München, 2009.
Roczek A. Entwicklung einer quantitativen PCR zum Nachweis von DNA pathogener Leptospiren in Glaskörper‐und Kammerwasserproben von Pferden. Inaugural‐Dissertation, Ludwig‐Maximilians Universität München, 2008.
Morter R L, Williams R D, Bolte H, Freeman M J. Equine Leptospirosis. Journal of the American Veterinary Medical Association 155, no. 2 (1969): 436–442.
House J A, Gregg D A, Lubroth J, Dubovi E J, Torres A. Experimental Equine Herpesvirus‐1 Infection in Llamas. Journal of Veterinary Diagnostic Investigation 3, no. 2 (1991): 137–143.
Gentil M, Racz K, Eule J C, Müle E. Infektionserreger im Kammerwasser von Pferden mit Uveitis. Paper presented at: 28. Jahrestagung der FG ‘Innere Medizin und klinische Labordiagnostik’ der DVG (InnLab) 2020; Gießen, Germany.