PCR on Formalin-Fixed Necropsy Tissues to Diagnose Leptospirosis (Correspondence) (Polymerase Chain Reaction) (Clinical Report)
Sir, A 44 yr old male soldier who was serving somewhere in the forests of north-east India during 2004-2005 was admitted to a military unit hospital in the region with complaints of low-grade intermittent fever, arthralgia, lethargy and nausea of one-week duration. Although blood smears for malarial parasite was negative, based on clinical diagnosis and endemicity of malaria in the region, he was initially administered treatment for malaria. Ultrasonography of abdomen showed mild hepatomegaly and acalculus cholecystitis. During the next 3 days he developed icterus, oliguria and malena. Investigations at the hospital showed derangement of liver and renal functions in the form of elevated levels of serum bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), urea and creatinine (1). Blood and urine cultures, Widal test and Weil-Felix test were negative (1). Tests for human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) were non reactive. In view of his uremic status, peritoneal dialysis was started. He was then managed as a case of septicaemia with acute renal failure with a differential diagnosis of malignant tertian (MT) malaria, viral haemorrhagic fever or a rickettsial disease. He was treated with a combination of broad-spectrum antibiotics and antimalarials in addition to other supportive measures.