LEPTOSPIROSIS

DIAGNOSTIC WORKUP

DIRECT MICROSCOPIC EXAMINATION OF BLOOD,

URINE, OR CEREBROSPINAL FLUID

CULTURE OF LEPTOSPIRES FROM CLINICAL SPECIMENS

SEROLOGICAL TESTS AND ANTIBODY DETECTION

COMPLETE BLOOD COUNT

URINALYSIS

HISTOLOGY

RATIONALE
- If suspected within the first week up to 10 days of
exposure, leptospires may be seen on microscopic
examination of bodily fluids.
- Results of direct examination must be supported by
other laboratory tests and observations as it is not
considered conclusive.
- Serves as the definitive diagnosis for leptospirosis.
- Includes blood cultures, urine and CSF cultures, and if
needed, even tissue cultures.
- Used for faster results and confirmation of
leptospirosis since direct microscopic results may be
not be conclusive and culture of samples may take
some time.
- Main methods used are microscopic agglutination test
(MAT), and enzyme-linked immunosorbent assay
(ELISA).
- For assessment of the severity and extent of organ
involvement after the acute phase of illness.
- Leptospirosis patients may reveal particular CBC
results based on the phase and severity of illness:
- Elevated erythrocyte sedimentation rates
- Peripheral leukocytosis with left shift
- Significant anemia may also be noted if with
hemorrhage
- BUN and serum creatinine may be profoundly
eleveated in anuric or oliguric phase
- Serum creatine kinase may also be elevated if
patient has muscular involvement
- If with hepatic dysfunction already, coagulation
may be prolonged
- Jaundice and bilirubinemia that is
disproportional to hepatocellular damage is
common in leptospirosis
- ALP levels may be elevated 10-fold
- For assessment of the severity of illness after the
acute phase of illness.
- May reveal proteinuria.
- Leukocytes, erythrocytes, hyaline casts, and granular
casts may also be present in urinary sedimentation.
- Histological findings from different tissues obtained
from the patient may also aid in the confirmation and
diagnosis of leptospirosis.
- After inoculation and during the incubation period, the
leptospires may already be found in the liver since it is
the site for its active replication.

References:
Levett PN. Leptospirosis. Clin Microbiol Rev. Apr 2001;14(2):296-326.
Monash University. Clinical Laboratory Diagnosis of Leptospirosis. Retrieved from
http://www.med.monash.edu.au/microbiology/staff/adler/clinical-laboratory-diagnosis-ofleptospirosis.pdf
World Health Organization. (2003). Human Leptospirosis: Guidance for Diagnosis, Surveillance, and Control.
Retrieved from http://www.who.int/csr/don/en/WHO_CDS_CSR_EPH_2002.23.pdf