Mildly elevated transaminases: excellent diagnostic clue for anicteric leptospirosis.

were anicteric leptospirosis.1 Main presentation in our cases was Weil’s disease, so, it is difficult to draw conclusions from only two patients of anicteric leptospirosis. As far as the study of Elizabeth F Daher et al is concerned this study also had Jaundice in 94.5% patients out of total 201 patients.2 MAT is a highly specific test, though sensitivity is poor, whereas mildly raised transaminases in anicteic leptospirosis can be highly sensitive but have poor specificity for leptospirosis, thus these two tests are not comparable. In my view it will not be prudent to call it “Poor man’s MAT” due to poor specificity, but it can definitely be used as a whistle blower for leptospirosis in the first week of illness. However, on the contrary, we need to be more vigilant in those patients who have disproportionately raised bilirubin levels( >3.5 mg%)2 compared to only mildly raised transaminases and suspect leptospirosis in such patients as quoted by Elizabeth F Daher et al.