Box 1.

Features of organ involvement in leptospirosis

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