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Table 2 Characteristics of cases clinically misdiagnosed as leptospirosis

From: Leptospirosis in Indonesia: diagnostic challenges associated with atypical clinical manifestations and limited laboratory capacity

No

Leptospira symptoms

Other symptomsa

Leptospira Standard of Care Results at sites

Leptospira Reference Lab

Final pathogen identified & Lab results

1

Icterus

2,5,6,9,13,14,17,18, 19,20,21, 22

Rapid IgM (neg)

PCR negative

IgM ELISA negative

UNK

 

2

Icterus, suffusion, brown-colored urine

2,4,5,6,7,10,13,14,16,17,18,19,20

IgM ELISA, low titer (Conv)

PCR negative

IgM ELISA negative

R. typhi

PCR Positive

IgM (0.9–4.7)

IgG (2.8–15.2)

IFA Pos

3

 

1,5,10,12

Not done

PCR negative

IgM ELISA negative

UNK

 

4

Gastrocnemius pain, Icterus

2,5,10,13,16,19,20, 22

Rapid IgM negative

PCR negative

IgM ELISA negative

UNK

 

5

Flank pain

2,13,14

Rapid IgM positive, MAT negative

PCR negative

IgM ELISA negative

R. typhi

PCR Negative

IgM (1.3–12.8)

IgG (0.4–3.2)

IFA Pos

6

 

2,5,6,9,13,19

Rapid IgM positive

PCR negative

IgM ELISA negative

UNK

 

7

 

3,4,6,12,13,14,17,18,20

Rapid IgM positive

PCR negative

IgM ELISA negative

R. typhi

PCR Positive

IgM (2.3–8.9)

IgG (1.5–10.1)

IFA Pos

8

Icteric, suffusion

1,4,11,13,19

Rapid IgM positive, MAT negative

PCR negative

IgM ELISA negative

S. aureus

Blood culture

9

 

2,3,4,13,16,17,19,20,22

Rapid IgM negative

PCR negative

IgM ELISA titer 1:100

convalescent sera

Chikungunya

PCR Negative

IgM (6.4–3.3)

IgG (0.2–3.0)

10

Suffusion

3,5,8,10,13.14.20

Rapid IgM positive

PCR negative

IgM ELISA negative

UNK

 

11

Gastrocnemius pain, brown-colored urine, suffusion

2,5,9, 16,17,18,19

Rapid IgM positive, MAT negative

PCR negative

IgM ELISA borderline

UNK

 

12

Brown-colored urine, suffusion

2,3,4,5,10,13,14,18,20

Rapid IgM positive, MAT negative

PCR negative

IgM ELISA negative

R. typhi

PCR Negative

IgM (0.4–1)

IgG (2.7–13.4)

IFA Pos

13

 

6,13,20

Rapid IgM positive

PCR negative

IgM ELISA borderline

Dengue

PCR Positive DENV-3

NS1 positive

IgM (6.335–3.819)

IgG (12.371–12.931)

14

Suffusion

3,16,23,19,20

Rapid IgM positive, MAT inconclusive

PCR negative

IgM ELISA negative

UNK

 

15

Gastrocnemius pain

13,14,15

Rapid IgM positive

PCR negative

IgM ELISA titer 1:100 in acute and convalescent sera

UNK

 
  1. a1: decrease of consciousness; 2: chills; 3: lethargy; 4: anorexia; 5: headache; 6: dizziness; 7: epistaxis; 8: runny nose; 9: sore throat; 10: cough; 11: rhonchi; 12: shortness of breath; 13: nausea; 14: vomiting; 15: diarrhea; 16: constipation; 17: abdominal pain; 18: epigastric pain; 19: arthralgia; 20: myalgia; 21: itchy; 22: ecchymosis; 23: hematemesis