Leptospirosis: need for diagnostic criteria.

S ir, I read the article “Mildly Elevated Transaminases: Excellent diagnostic c l u e f o r A n i c t e r i c L e p t o s p i r o s i s ” with interest.1 Leptospirosis can be diagnosed only by laboratory tests as clinical features are non specific. But the laboratory tests are complex and hence definite guidelines for diagnosis of human leptospirosis is necessary. I fully agree that microscopic agglutination test (MAT) and PCR can be done only in specialised laboratories. IgM Elisa / macroscopic slide agglutination test (MSAT) are simple and sensitive tests which are adequate for diagnosis of leptospirosis and can be done in small inst i tut ions . The modif ied Faine’s criteria utilising IgM Elisa / MSAT can be used as the guidelines for diagnosis of leptospirosis in Indian institutions, as MAT is not easily available.2 Raised liver enzyme (SGOT and SGPT) can occur in anicteric leptospirosis. But, it also can occur in many febrile diseases such as malaria, typhoid, scrub typhus, dengue and viral hepatitis. It is essential that kits to diagnose these febri le diseases are also avai lable , as co-infections can also occur (for example malaria + leptospirosis) with similar clinical features. In fact, mild elevation of SGOT and SGPT with disproportionate elevation of serum bilirubin due to cholestasis is considered the hallmark of leptospiral hepatitis. It is essential that data on elevated SGOT and SGPT from other infectious diseases are analysed before this can be considered specific for leptospirosis. I fully agree that empiric therapy for leptospirosis can be started early, as the Leptospirosis : Need for diagnostic criteria