1. Diagnostic

2. Laboratory studies are used for two purposes: 1.to confirm the diagnosis 2.to determine the extent of organ involvement and severity of complications.

3. Patient Laboratory Worksheet Blood Chemistry -Na, K, BUN, Creatinine, Alkaline phosphatase, iPO4, iCa, SGOT, SGPT CBC (complete blood count) MAT Ultrasound (whole abdomen) Chest X-ray Anti-HAV IgM, HBsAg, AntiHBs, AntiHBc IgG

4. Laboratory Findings In Leptospirosis ESR – Increased Leukocyte Count – ranges from 3,000-26,000/microliter Mild Thrombocytopenia Elevated levels of Bilirubin & ALP Mild increase in serum levels of aminotransferases PT may be prolonged Elevated Creatine Phosphokinase Harrison’s, Internal Medicine, 17 th Ed.

5. Radiologic Findings Patchy alveolar pattern, corresponds to scattered alveolar hemorrhage, affect lower lobes in the periphery of the lung fields. Harrison’s, Internal Medicine, 17 th Ed.

6. BLOOD CHEMISTRY09/1609/1809/1909/21 Normal Values BUN41.629.421.3 7–20 mg/dL Creatinine3.31.81.61.3 0.6–1.2 ng/mL Alkaline phosphatase166 33–96 U/L Total bilirubin5.3 0.3–1.3 mg/dL Direct bilirubin4.2 0.1–0.4 mg/dL Indirect bilirubin1.1 0.2–0.9 mg/dL Na130134142 136–146 meq/L K3.73.34.7 3.5–5.0 meq/L iPO42.8 2.5–4.3 mg/dL iCa1.06 4.5–5.3 mg/dL

7. URINALYSIS09/16/0909/17/09Normal Values ColorYellow TransparencySlightly turbid pH5.0 5.0–9.0 Specific Gravity1.0101.0151.001–1.035 Albumin-- Sugar-- RBCs5-7/hpf0-1/hpf0–2/high power field Pus cells3-6/hpf 0–2/high power field Squamous cellsFew None Bacteria++None Amorphous urate++

8. CBC09/16/09Normal Values Hgb118133–162 g/L RBC5.634.30–5.60 x 10 12 /L Hct0.350.388–0.464 MCV61.6079–93.3 fL MCH20.4026.7–31.9 pg/cell MCHC33.4032.3–35.9 g/dL RDW15.20< 14.5% MPV7.09.00–12.95 fL Plt234165–415 x 10 9 /L WBC11.405-10 x 10 9 /L Neutro0.89 Bands0.020.0-0.05 Seg0.870.40–0.70 Lympho0.100.20–0.50 Eosino0.010.0–0.6

9. 09/18 Prothrombin time12.7 Normal control12.5 PT ratio1.0 INR1.0 aPTT45.6 Normal control36.3 CHEMILUMINESCENT IMMUNOASSAY 09/16 Anti HAV IgM0.254 nonreactive

10. Ultrasound of the LGBPS (09/15/09): Normal sized liver with fatty changes, slightly contracted gallbladder, ultrasonologically normal pancreas, spleen, kidneys and urinary bladder, prostatic hypertrophy with concretions MAT (done last 09/18/09 in UP-PGH): Positive (indicative of Leptospirosis) Chest Xray (09/18/09): Subsegmental atelectasis, left lobe ECG (09/18/09): Sinus rhythm, left axis deviation, nonspecific ST-T wave changes

11. Microscopic Agglutination Test (MAT) Principle: Antibodies in the test serum react with antigens on the surface of the bacteria and agglutinate them. A single MAT titer of or 1:400 on any sera or identification of spirochetes on dark-field microscopy, when accompanied by the appropriate clinical scenario, is strongly suggestive.

12. o A positive MAT was defined as a single titer of >1:400 or a 4-fold rise in titer between acute and convalescent sera samples, confirms the diagnosis of leptospirosis. » CDC (Centers for Disease Control)