Leptospirosis is an important zoonotic disease with worldwide distribution and nonspecific clinical manifestation. We report a case of fatal leptospirosis in a previously healthy woman with a causative agent. A young adult Indian woman was brought in dead to the forensic department. Ten days before, she developed fever, dizziness with headache, myalgia, diarrhea, and vomiting. Routine inquest and autopsy were performed on the deceased, revealing hemorrhagic lungs with extensive intra-alveolar hemorrhages, pale liver with dissociation and separation of hepatocyte plates, and edematous brain with histiocyte and lymphocyte infiltration in the parenchyma and meninges. Heart tissue depicts myocarditis and pericarditis inflammatory changes. Cerebrospinal fluid (CSF) was turbid in appearance with mildly elevated leukocytes, predominantly lymphocytes. Real-time PCR targeting lipL32 gene of pathogenic Leptospira was detected in the blood, CSF, brain, kidney, heart, and liver. The genetic profile of the causative agent was ST149 (multi-locus sequence typing Scheme 3). This study illustrates the usefulness of Leptospira PCR assay in postmortem diagnosis and addresses the need for further surveillance to identify the epidemiological link of the disease.

Leptospirosis is an infectious zoonotic disease caused by corkscrew shaped of pathogenic Leptospira spp. Early diagnosis is important as the disease can be treated with antibiotic to prevent complications. The gold standard of leptospirosis diagnosis is microscopic agglutination test (MAT). However, the test is laborious and time consuming. This study aimed to evaluate whether a commercial ELISA (enzyme-linked immunosorbent assay) kit by Virion-Serion can demonstrate antibody against leptospires for accurate and rapid screening for leptospirosis. A total of 212 serum samples were tested with Virion-Serion Classic ELISA IgM, which was earlier collected from patient with clinical manifestation suggestive of leptospirosis in Malaysia and confirmed with MAT. The results were analyzed into two categories. In the first category all samples that were positive with MAT but detected as intermediate by the ELISA were not included. In the second category, all sample that positive with MAT but detected as intermediate were included. When the intermediate results were excluded, the clinical sensitivity was 73% and clinical specificity was 94%. When the intermediate results were included, the clinical sensitivity and specificity were 75% and 85% respectively. From this finding we can conclude that Virion-Serion ELISA IgM Classic kit have a reasonably appropriate performance and can be used for screening and diagnosis for leptospirosis in acute febrile illness however it should be confirmed later with the gold standard serological test which is MAT.

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