A Retrospective Study on Clinical and Biochemical Profile of Neuroleptospirosis

BACKGROUND Leptospirosis is a zoonotic disease usually reported from South India. The clinical spectrum may range from asymptomatic infection, subclinical to a fatal hepatorenal syndrome. Most physicians are sensitized to diagnose leptospirosis, sometimes the diagnosis is missed, especially when associated with neurological manifestations. About 10-15 percent of cases can have neurological manifestations. These patients are referred to a tertiary care hospital due to poor therapeutic response. Since early management can be lifesaving, this study was carried out to evaluate the laboratory profile and clinical features in patients with neuroleptospirosis in a tertiary care centre in South India. METHODS This retrospective single centre study was conducted at Government Medical College, Thiruvananthapuram, Kerala. Neuroleptospirosis was diagnosed by clinical and laboratory findings of hepatorenal syndrome, and anti leptospira antibody detection by ELISA. RESULTS Total of 160 patients with leptospirosis were admitted during the period of study. 31 patients were diagnosed clinically as neuroleptospirosis. Out of 31 patients 21 (67.7 %) were males and 10(32.3 %) were females. The mean age was 56.9  14.61 years. (M: F 2:1, range 18-68 years,). The chief manifestations were fever in 29 (93.5 %), myalgia in 23(74.2 %), headache in 17 (54 %), jaundice in 14 (45 %), and conjunctival suffusion in 9 patients (29 %). Two patients (6.4 %) had altered sensorium and neck stiffness in 23 patients (74.19 %). Most common neurological manifestation was aseptic meningitis (87) followed by encephalitis (19.4 %), seizures in 9.7 %, mean WBC count was 17297.10  8948.413 cells/microliter. Mean platelet count at admission was 88258.06  108727.478 cell/microliter. Mean serum creatinine was 3.9  2.3 mg/dl. Seven  patients (22.58 %) succumbed to death. Mean age of patients who died were 50.63  11.94 years (p &lt; 0.084), mortality was more common in females (50 %) (p &lt; 0.074). Irrespective of age and sex, WBC count at admission &gt; 18,800 cell/ μL is associated with increased mortality (p+0.032). CONCLUSIONS Early recognition of neuroleptospirosis in patients with hepatorenal dysfunction and altered sensorium is critical in the treatment of patients. Female gender and elevated WBC count at admission indicates poor prognosis. KEY WORDS Neuroleptospirosis, Prognosis, Aseptic Meningitis.</jats:p

Initial Serum Creatine Phosphokinase Level as an Indicator of Severity and Prognosis of Acute Organophosphorus Poisoning - A Retrospective Clinical Study

BACKGROUND Organophosphorus poisoning is possibly the most common acute poisoning in the developing countries and is a global health problem.1,2 Between 750,000 and 3,000,000 of OP poisoning occur globally every year.3 OP insecticides bind and irreversibly inhibit butyrylcholinesterase. These compounds cause excessive stimulation of muscarinic and nicotinic cholinergic receptors in the central and autonomic nervous systems and at skeletal neuromuscular junctions.4 Butyrylcholinesterase (BChE) is also known as pseudocholinesterase.5 Due to the limitations in accuracy and cost of plasma pseudocholinesterase level estimation, alternate biochemical marker options for OP poisoning have been studied for evaluation of patients with OP poisoning. Increased creatine phosphokinase (CPK) levels are seen in OP poisoning in early phase.6,7 This study was conducted to correlate initial serum CPK levels with the clinical severity at presentation and the final clinical outcome. METHODS This descriptive study was carried out after reviewing case records of patients &gt;/= 18 years with acute organophosphorus (OP) poisoning who were admitted under the Internal medicine department of Government Medical College Thiruvananthapuram between January 2019 and December 2019. The severity of poisoning was categorized based on Peradeniya organophosphorus poisoning (POP) scale. Serum CPK level, serum pseudocholinesterase, and total dose of atropine in milligrams until the outcome in the hospital were recorded. The student's t-test and Pearson's correlation coefficient were used for the assessment of statistical significance. RESULTS Clinical severity as per POP SCALE was mild (score 0–3) in 24 (27 %), moderate (score 4–7) in 50 (55.81 %) and severe (score 8–11) in 16 (18 %) patients. Serum CPK, serum pseudocholinesterase level, and total atropine dose strongly correlated with clinical severity of OP poisoning. Our study strongly recommends serum CPK as an alternative marker. CONCLUSIONS Serum CPK level can be an effective biomarker in acute OP poisoning because its level can predict the prognosis of OP poisoning. KEY WORDS Creatine Phosphokinase, Organophosphorus Poisoning, Severity.</jats:p