Table 3 Characteristics of the two fatal leptospirosis cases that were misdiagnosed
| Â | Patient 1 (Surabaya) | Patient 2 (Makassar) |
|---|---|---|
Gender, age range (years) | Male, 45–50 | Female, 60–65 |
Comorbidities | No comorbidities | Diabetes mellitus |
Signs/Symptoms | Fever (3 days), nausea, vomiting, diarrhea | Fever (3 days), chills, headache, dizzy, nausea, vomiting |
Hematology profiles | ||
 Hb (mg/dL) | 11.5 | 13 |
 Hematocrit (%) | 32.9 | 38.7 |
 Leukocyte count (/mm3) | 9600 | 9500 |
 Granulocytes (%) | 92% | Not available |
 Lymphocytes (%) | 3.8% | 6.9% |
 Platelet (/mm3) | 45,000 | 118,000 |
Chemistries | ||
 Bilirubin total, direct, indirect (mg/dL) | 0.9; 0.6; 0.3 |  |
 ASTa (IU/mL) | 139 | 93 |
 ALTb (IU/mL) | 33 | 64 |
 Creatinine (mg/dL) | 4.1 | 1.1 |
Diagnostic tests at the hospital | ||
 Dengue test | Not tested | Negative IgM/IgG |
 Salmonella typhi | Not tested | Tubex TF® test positive [6] |
 Diagnosis at the hospital | Dengue hemorrhagic fever grade I | Typhoid fever |
 Antibiotics | Ceftriaxone | Cefotaxime, intra-venous |
 Cause of death, hospitalization day | Respiratory failure, 2 days | Respiratory failure, 2 days |
Diagnostic test at the reference laboratory (only acute specimen available) | ||
 Dengue virus | RT-PCR, NS1, IgM negative, IgG positive | RT-PCR, NS1, IgM negative, IgG positive |
 Salmonella typhi | Blood culture, PCR, ELISA IgM, IgG negative | Blood culture, PCR, ELISA IgM and IgG negative |
 Leptospira spp | PCR positive (ct value = 30) | PCR positive (ct value = 19) |
ELISA IgM, IgG negative | ELISA IgM, IgG negative | |