Background Leptospirosis, a zoonosis associated with potentially fatal consequences, has long been a grossly underreported disease in India. There is no accurate estimate of the problem of leptospirosis in non-endemic areas such as north India. Methods/Principal Findings In order to understand the clinical spectrum and risk factors associated with leptospirosis, we carried out a retrospective study in patients with acute febrile illness in north India over the last 5 years (January 2004 to December 2008). There was increased incidence of leptospirosis (11.7% in 2004 to 20.5% in 2008) as diagnosed by IgM ELISA and microscopic agglutination titer in paired acute and convalescent sera. The disease showed a peak during the rainy season (August and September). We followed up 86 cases of leptospirosis regarding their epidemiological pattern, clinical features, laboratory parameters, complications, therapy, and outcome. Mean age of patients was 32.6 years (2.5 years to 78 years) and males (57%) outnumbered females (43%). Infestation of dwellings with rats (53.7%), working in farm lands (44.2%), and contact with animals (62.1%) were commonly observed epidemiological risk factors. Outdoor workers including farmers (32.6%), labourers (11.6%), para-military personnel (2.3%), and sweepers (1.2%) were commonly affected. Modified Faine's criteria could diagnose 76 cases (88.3%). Renal failure (60.5%), respiratory failure (20.9%), the neuroleptospirosis (11.6%), and disseminated intravascular coagulation (DIC) (11.6%) were the commonest complications. Five patients died, giving a case fatality rate of 5.9%. Conclusions/Significance There has been a rapid rise in the incidence of leptospirosis in north India. Severe complications such as renal failure, respiratory failure, neuroleptospirosis, and DIC are being seen with increasing frequency. Increased awareness among physicians, and early diagnosis and treatment, may reduce mortality due to leptospirosis.
References
[1]
Sambasiva RR, Naveen G, Bhalla P, Agarwal SK (2003) Leptospirosis in India and the Rest of the World. Braz J Infect Dis 7: 178–193. doi: 10.1590/s1413-86702003000300003
[2]
Sehgal SC (2006) Epidemiological patterns in leptospirosis. Indian J Med Microbiol 24: 310–311. doi: 10.4103/0255-0857.29405
[3]
Anagnani R, Pathak AA, Mishra M (2003) Prevalence of leptospirosis in various risk groups. Indian J Med Microbiol 21: 271–273.
[4]
Swapna RN, Tuteja U, Nair L, Sudarshana J (2006) Seroprevalence of leptospirosis of high risk groups in Calicut, North Kerala, India. Indian J Med Microbiol 24: 349–352. doi: 10.4103/0255-0857.29418
[5]
Sumathi G, Narayanan R, Shivakumar S (2008) Leptospirosis Laboratory, Madras Medical College: Review of our experience (2004–2006). Indian J Med Microbiol 26: 206–207. doi: 10.4103/0255-0857.40553
[6]
Basu D, Sarkar P, Chakraborty N, Chanda PR, Biswas S, et al. (2003) Leptospirosis and Weil's disease in eastern India. J Indian Med Assoc 101: 532, 534, 536.
[7]
Clerke AM, Leuva AC, Joshi C, Trivedi SV (2002) Clinical profile of leptospirosis in south Gujrat. J Postgrad Med 48: 117–118.
[8]
Sethi S, Sood A, Pooja , Sharma S, Sengupta C, et al. (2003) Leptospirosis in northern India: a clinical and serological study. Southeast Asian J Trop Med Public Health 34: 822–825.
[9]
Rao P, Sethi S, Sud A, Banga SS, Sharma M (2005) Screening of patients with acute febrile illness for leptospirosis using clinical criteria and serology. Natl Med J India 18: 244–246.
[10]
Sagar V, Berry V (2008) Increasing seropositivity of leptospirosis in a medical college in Ludhiana. Indian J Public Health 52: 50.
[11]
Manocha H, Ghoshal U, Singh SK, Kishore J, Ayyagari A (2004) Frequency of leptospirosis in patients of acute febrile illness in Uttar Pradesh. J Assoc Physicians India 52: 623–5.
[12]
Gupta N, Rao RS, Bhalla P, Agarwal SK (2004) Seroprevalence of leptospirosis in Delhi using indirect haemagglutination assay. Indian J Med Microbiol 22: 134–135.
[13]
Shivakumar S, Shareek PS (2004) Diagnosis of leptospirosis using modified Faine's Criteria. J Assoc Physicians India 52: 678–679.
[14]
Wolff JW (1954) The laboratory diagnosis of leptospirosis. Illinois, USA: Charles C. Thomas Publishers. pp. 31–51.
[15]
Prabhakar MR, Jayakumar M (2006) Reply from authors. To, Shivakumar S. Leptospirosis in Chennai – Changing clinical profile. J Assoc Physicians India 54: 964–965.
[16]
Blacksell SD, Smythe L, Phetsouvanh R, Dohnt M, Hartskeerl R, et al. (2006) Limited diagnostic capacities of two commercial assays for the detection of Leptospira immunoglobulin M antibodies in Laos. Clin Vaccine Immunol 13: 1166–1169. doi: 10.1128/CVI.00219-06
[17]
Bajani MD, Ashford DA, Bragg SL, Woods CW, Aye T, et al. (2003) Evaluation of four commercially available rapid serologic tests for diagnosis of leptospirosis. J Clin Microbiol 41: 803–809. doi: 10.1128/JCM.41.2.803-809.2003
[18]
Dutta TK, Christopher M (2005) Leptospirosis – An overview. J Assoc Physicians India 53: 545–551.
[19]
Ittyachen AM, Krishnapillai TV, Nair MC, Rajan AR (2007) Retrospective study of severe cases of leptospirosis admitted to the intensive care unit. J Postgrad Med 53: 232–235. doi: 10.4103/0022-3859.37510
[20]
Terpstra WJ (2003) International leptospirosis society. Human leptospirosis: Guidance for diagnosis. Surveillance and control. Malta: World Health Organization and the International Leptospirosis Society.
[21]
Vijayachari P, Sehgal SC, Goris MG, Terpstra WJ, Hartskeerl RA (2003) Leptospira interrogans serovar Valbuzzi: a cause of severe pulmonary haemorrhages in the Andaman Islands. J Med Microbiol 52: 913–918. doi: 10.1099/jmm.0.05094-0
[22]
Mathew T, Satishchandra P, Mahadevan A, Nagarathna S, Yasha TC, et al. (2006) Neuroleptospirosis-revisited: experience from a tertiary care neurological centre from south India. Indian J Med Res 124: 155–162.
[23]
Chierakul W, Tientadakul P, Suputtamongkol Y, Wuthiekanun V, Phimda K, et al. (2008) Activation of the coagulation cascade in patients with leptospirosis. Clin Infect Dis 46: 254–260. doi: 10.1086/524664
[24]
Vijayachari P, Sugunan AP, Shriram AN (2008) Leptospirosis: an emerging global public health problem. J Biosci 33: 557–69. doi: 10.1007/s12038-008-0074-z
Jayakumar M, Prabhakar MR, Fernando EM, Manorajan R, Venkatraman R, et al. (2006) Epidemiologic trend changes in acute renal failure –A tertiary centre experience from south India. Renal Failure 28: 405–410. doi: 10.1080/08860220600689034
