Following acute phase of leptospirosis, which tests are performed to determine the extent and severity of organ involvement?

Updated: Jul 08, 2021
  • Author: Sandra G Gompf, MD, FACP, FIDSA; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

In suspected leptospirosis, further laboratory studies should be routinely performed to determine the extent and severity of organ involvement after the acute phase of illness. A complete blood cell count (CBC) is necessary. Findings on general laboratory studies are as follows:

  • In patients with mild disease, elevated erythrocyte sedimentation rates and peripheral leukocytosis (3,000-26,000 x 109/L) with a left shift are noted
  • Significant anemia due to pulmonary and gastrointestinal hemorrhage can occur
  • The platelet count may be diminished as a component of disseminated intravascular coagulation (DIC)
  • Levels of blood urea nitrogen and serum creatinine may be profoundly elevated in the anuric or oliguric phase
  • Serum creatine kinase levels (MM fraction) are often elevated in patients with muscular involvement.
  • Coagulation times may be prolonged in patients with hepatic dysfunction and/or DIC On liver function testing, serum bilirubin levels elevate as part of the obstructive disease due to capillaritis in the liver. Levels of hepatocellular transaminases are elevated less often and less significantly (usually < 200 U/L). Jaundice and bilirubinemia disproportional to hepatocellular damage is common in leptospirosis; alkaline phosphatase levels may be elevated 10-fold.

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