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Renal involvement Reduced urine output
Haematuria, granular casts or red cell casts in the urine
Acute kidney injury (any degree)
Liver involvement Jaundice
Tender hepatomegaly
Rise in serum aspartate transaminase or alanine transaminase three times above the upper limit of normal
Raised serum bilirubin, alkaline phosphatase or gamma glutamyl transpeptidase
Prolonged prothrombin time
Pulmonary involvement Cough, breathlessness, haemoptysis
Hypoxia-oxygen saturation <94%
Respiratory rate >30/min
Crackles and wheezes on auscultation
Evidence of lung parenchymal involvement on chest radiography or CT scan
Acute respiratory distress syndrome
Cardiac involvement Shortness of breath, chest pain, palpitations, tachycardia, basal crackles
Hypotension
ECG abnormalities: arrhythmias, ST/T changes, conduction abnormalities
Wall motion abnormalities on echocardiography
Haematological involvement Bleeding manifestations
Thrombocytopaenia <130 × 109/L
Deranged coagulation
Disseminated intravascular coagulopathy
Neurological involvement Reduced level of consciousness
Meningism
Focal neurological signs
Isolation of leptospires Blood culture for leptospirosis: gold standard test, requires samples during the first week of illness. Labour intensive and time consuming, requires high levels of biosafety levels, low diagnostic yield. Used for identification of serovar, and for determining antibiotic sensitivity.
Polymerase-chain reaction (PCR): useful for early diagnosis (first week of acute illness). High sensitivity and specificity. Useful for genomic classification.
Dark-ground microscopy of body fluids: low sensitivity, obsolete now.
Serological methods
Antibodies are usually detectable by day 6-10 of illness and peak within 3-4 weeks. Comparison of acute and convalescent have high sensitivity and specificity. Can be used for genus or serogroup identification.Microscopic agglutination test: serological reference standard. However, requires experienced observers to reduce inter-observer variation. Time consuming and hazardous as live cultures are required to provide antigen. Available only in reference laboratories.
IgM enzyme-linked immunosorbent assay (ELISA): easily available. Sensitivity and specificity depend on regional patterns of seropositivity.
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