Title: Clinical Profile of Leptospirosis in Khammam

Authors: Venkatesh Garlapati, Dilip M Rampure, G Rajashekarappa, Goutham Vidyam

 DOI:  http://dx.doi.org/10.18535/jmscr/v3i10.16

Abstract

BACKGROUND: In the last few decades  infectious diseases  like leptospirosis have re-emerged and are on the rise. With other infectious diseases like Malaria, Dengue, Infective hepatitis which simulate leptospirosis   being rampant, there is a  need to know  the  clinical  profile, complications  of leptospirosis particularly from this part of the country.

OBJECTIVES: The present study was undertaken to understand the clinical profile, laboratory findings and complications of leptospirosis.

METHODS: Fifty patients who were positive for IgM anti leptospiral antibodies in Mamata General Hospital were subjected to detailed history, clinical examination, investigations and followed up till discharge or death. They were treated as per protocol, clinical data was tabulated. Statistical analysis was done.

RESULTS: Dark Ground Microscopy of urine was positive for leptospira in 58% patients. The age groupcommonly involved was 20-39 years(58%). Most of the patients were males (76%), with occupation involving outdoor activity(66%). Common symptoms encountered were fever, musculoskeletal, jaundice and oliguria. Less commonly seen were bleeding, gastrointestinal symptoms, respiratory symptoms and altered sensorium. Important signs seen were conjunctival suffusion, hepatomegaly, hypotension, splenomegaly.

Hyperbilurubinemia was predominantly of conjugated type and elevation of transminases was mild to moderate. Mean bilurubin was 4.67mg/dl. Mean SGOT was 99.23U/L and SGPT was 96.97U/L. AKI was seen in 46% and six of them needed Hemodialysis. Thrombocytopenia was seen in 56% patients.40% had multiorgan failure, 4% had aseptic meningitis, 2% had ARDS, 2% had GI hemorrhage.

CONCLUSION; A high degree of clinical suspicion is the key to diagnosis ofleptospirosis. Fever and musculoskeletal features are most common symptoms. Conjunctival suffusion is a common finding. Liver and kidney are common organs involved. Multi Organ Failure was significantly associated with mortality (p<.05). Thrombocytopenia was significantly related to clinical bleeding (p<.001)

References

1.      Aravind G N, Prashanth V N, Clinical Profile Of Leptospirosis ijcci July 2015 Page No 1-23

2.      Herve dupont et al ;Leptospirosis :Prognostic factors associated with mortality.Clinical infectious diseases, 1997;25:720-4.

3.      Sandhya A Kamath et al;Reemerging of Infections in Urban India-Focus Leptospirosis. J.Assoc Physician India ;MARCH 2003;51.

4.      T K Dutta et al; Leptospirosis-An overview; JAPI; JUNE 2005:53.

5.      Paul N. Levett et al; Leptospirosis. Infectious diseases and their etiologic agents.chapter 237;2789-92

6.      Shivakumar S. Leptospirosis—Current Scenario in India. API Medicine Update. 2008;18:799-809.

7.      Report of the Brainstorming meeting on Leptospirosis Prevention and control. Mumbai, 16-17 February 2006. Joint Publication by Office of WHO, Representative to India, New Delhi and Regional Medical Research Centre (ICMR), WHO Collaborating Centre for Diagnosis, Research, Reference and Training in Leptospirosis, Port Blair, Andaman and Nicobar Islands.

8.      A De et al.An Outbreak of Leptospirosis in Mumbai;IJourn Med Microbiol.2002;20:153-155

9.      MA Muthusethupathietal “Leptospirosis in Madras - A clinical and serological study” J.Assoc Physician India ;1995, 43, No: 7; 456-458

10.  Singh SS, Vijayachari P, Sinha, etal “Clinico-epidemiological study of hospitalized cases of severe Leptospirosis”. Indian J Med Res 1999; 109:94-9

11.  Alan R Katz et al.Assessment of the clinical presentation and treatment of 353 cases of laboratory confirmed leptospirosis in Hawaii, 1974-1998;Clin Inf Dis. 2001; 33; 1834-41

12.  Viviani-M, et al “Leptospirosis description of clinical cases and review of the literature” Minerva-Anesterial. 1998 Oct: 64(10):465-9

13.  Chih Wei Yang et al. Leptospirosis;An ignored cause of Acute renal failure inTaiwan;American Journal of kidney diseases;30:1997:840-45

14.  Adrian Covic et al .A retrospective study in Moldova of acute renal failure due to leptospirosis;Nephrol Dial Transplant(2003):18;1128-34

15.  Editorial “Leptospirosis on the Horizon” The National Medical Journal of India 2000, 13, No-5,228-230

16.  Clerke AM et al.Clinical profile of leptospirosis in South Gujarat;J of postgrad med.2002:48;117-8.

Corresponding Author

Venkatesh Garlapati

Post Graduate Trainees, Department of General Medicine,

Mamata Medical College and Hospital, Khammam,Telangana, India