Discussion
Similarities in clinical presentation of pulmonary leptospirosis and
covid-19 such as flu-like symptoms, acute respiratory distress, and
CT-identified peripheral ground-glass opacities may cause misdiagnosis
while the ongoing covid-19 pandemic going on all around the world (5).
In order to confirm leptospirosis two tests’ results are needed; IgM-
positive ELISA serology and a positive PCR (7). About 17.5% of the
participants in a report who were positive in MAT were negative in
IgM-ELISA and calculated the specificity and sensitivity of IgM-ELISA as
78.8% (8). That can be the reason why the IgM and IgM ELISA were
negative in this patient.
There are criteria for establishing the severity of leptospirosis
including: severe respiratory failure, initial renal injury with
hypokalemia and elevation of transaminases (5). In this case potassium
was always in a normal range but during the hospitalization it raised
from 3.5 to 4.3; but in a Urine Analysis that was done fourth day of
hospitalization showed proteinuria and 7-8 Red Blood Cells; the
transaminases AST and ALT were always high during this time. So, because
of these evidences severe leptospirosis infection can be considered for
this patient. COVID-19 can rise the amount of D-dimer, LDH, AST and ALT
(9), just like what was seen in this case.
A rise in the amount Procalcitonin (PCT) levels can happen in COVID-19.
In a study PCT level was over eight times higher in patients who had
more crucial appearance than in moderate patients (10) just like that,
in this case PCT level was almost eighty times higher than the upper
limit of the normal range.
Both COVID-19 and leptospirosis can cause Cytokine storms during the
infection (11).
Leptospira is reported to be highly susceptible to a lot of antibiotics.
Although Penicillin is the first choice for this infection, there are
other antibiotics such as doxycycline, cefotaxime and ceftriaxone that
are useful in treatment (12, 13). However, the treatments may be
affective in early onset of the infection. Leptospirosis have some
immune-mediated complications which can be controlled by adjuvant
steroids (13).