Increasing Trends of Leptospirosis in Northern India: A Clinico-Epidemiological Study

Leptospirosis is often not suspected by physicians in patients with acute febrile illnesses reporting from supposedly “non-endemic areas,” including north India. Clinical manifestations are protean, and complications can affect most organ systems, including liver, kidneys, lungs, and the central nervous system. Timely diagnosis and specific therapy can reduce severity of illness and, in turn, mortality. In this study conducted at a tertiary care center in north India, we find how a much-neglected disease entity has emerged as a major cause of acute febrile illness in a so called “non-endemic area.” Incidence is increasing yearly. The majority of patients were from a rural background, and were farmers or farm labourers. Poor hygiene, contact with animals, rat infestation of houses, and contact with stagnant dirty water are the major determinants of disease. Apart from the usual symptoms of intermittent fever with chill and rigor, hepatosplenomegaly, renal decompensation, muscle pain and tenderness, and conjunctival suffusion, signs and symptoms indicating involvement of the respiratory and central nervous systems were also commonly observed. Severe complications resulting in mortality do occur and is especially due to late suspicion among primary level physicians, and the resulting inappropriate therapy

Modified Faine's criteria.

<p>A presumptive diagnosis of leptospirosis may be made if: (i) Score of Part A+Part B = 26 or more (Part C laboratory report is usually not available before fifth day of illness; thus it is mainly a clinical and epidemiologic diagnosis during early part of disease) or Part A+Part B+Part C≥25.</p><p>A score between 20 and 25: Suggests a possible but unconfirmed diagnosis of leptospirosis.</p

Laboratory parameters of 86 patients at time of diagnosis and hospital stay.

*<p>In 68 cases ranged from 60 IU to 200 IU, in two cases was >200 IU.</p>**<p>In 64 cases, between 2–8 mg/dl, in 2 cases >8 mg/dl.</p

Time trends in leptospirosis.

<p>(A) Percentage of leptospirosis patients among those with acute febrile illnesses. (B) Month- and year-wise distribution of cases. * Total number of leptospirosis patients was 232 (9 in 2004, 17 in 2005, 25 in 2006, 74 in 2007, and 107 in 2008).</p

Epidemiological pattern and age group of 86 leptospirosis patients.

*<p>Documented history of travel to known endemic areas alongwith history of unprotected bathing in ponds of those areas.</p

Area of residence of 86 patients of leptospirosis in India.

<p>Area of residence of 86 patients of leptospirosis in India.</p

Clinical features of 86 leptospirosis patients.

<p>Clinical features of 86 leptospirosis patients.</p

Complications of leptospirosis cases while in hospital.

*<p>Mild ascitis and mild to moderate pleural effusion mainly detected in chest X-ray and ultrasonographic investigations.</p>**<p>33 cases presented with altered sensorium and 32 with headache. 10 cases of these cases could be definitely categorized as neuroleptospirosis, as evidenced by CT finding of diffuse cerebral edema, generalized seizures, neck rigidity, or neurological deficits.</p

Epidemiological risk factors found in the 86 leptospirosis patients.

<p>Epidemiological risk factors found in the 86 leptospirosis patients.</p