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

Abstract

BackgroundLeptospirosis, 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 FindingsIn 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/SignificanceThere 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.

Clinical and Laboratory Presentations of Leptospirosis Patients in North of Iran

“…Manifestations of icterus, myalgia and fatigue in ages over 50 were higher (80% comparing to 50% in the ages under 40) and by increasing the age, the emergence of icterus was increased. The most common laboratorial finding of the present study, like other studies, was the increasing of transaminases, but in different studies and also in text books it is mentioned that this disease creates a slight increase in transaminases( maximum 200 U/L) (Kasper et al, 2016;Sethi et al, 2010). But in our study, in three cases and in a study from India in two cases out of 86, there were abnormal increase in transaminases (over 200U/L), that regarding to the rejection of the other causes of increase in transaminases and the diseases along with, such as viral hepatitis, it can be attributable to the leptospirosis, it means that the 200U/L cut point is not absolute for this disease ( Sethi et al, 2010).…”

“…The most common laboratorial finding of the present study, like other studies, was the increasing of transaminases, but in different studies and also in text books it is mentioned that this disease creates a slight increase in transaminases( maximum 200 U/L) (Kasper et al, 2016;Sethi et al, 2010). But in our study, in three cases and in a study from India in two cases out of 86, there were abnormal increase in transaminases (over 200U/L), that regarding to the rejection of the other causes of increase in transaminases and the diseases along with, such as viral hepatitis, it can be attributable to the leptospirosis, it means that the 200U/L cut point is not absolute for this disease ( Sethi et al, 2010). In next stage of the outbreak of laboratorial symptoms there was thrombocytopenia with 80.5% frequency that was similar to the studies in Guilan; in contrast, in the studies of other areas of the world, appearing this disease with para clinical sign has been less than our study (Daher et al, 2010;Katz et al, 2011;MansourGhanaei et al, 2005).…”

“…This can be due to the sociological condition of our area that the elderly are more engaged in the agriculture, and the lower tendency of youths to this occupation caused the increase in the age average of the farmers. In addition, our study was performed on the hospitalized patients, and regarding to the weaker immune system of elderlies, the probability of hospitalization is higher among them, although some studies have shown lower average age of infection (Sethi et al, 2010).…”

Insights into Leptospirosis, a Neglected Disease

“…Also, in general, there were few cases of the disease in North India due to the relatively dry weather. But now, a detailed study [Sethi et al, 2010] project the alarming increase in the incidence of the disease. The study aims to correlate predisposing factors like living conditions, human habits, exposure to animals, occupation etc to the observed disease prevalence as well as the severity of symptoms in these patients.…”

Leptospirosis in children: A review for family physicians

“…[1,2] Common Indian serovars include autumnalis, australis, batavia, canicola, copenhagni, cynopteri, grippotyphosa, hardjo, icterohaemorrhagiae, javanica, patoc, pomona, pyrogenes, ratnapura, and valbuzzi. [5,[22][23][24][25][26][27][28][29][30][31][32][33] Leptospires enter the human body through abrasions and cuts in the skin or through intact mucous membrane (conjunctiva, nasopharynx, and vagina); occasionally, the entry may be via intact soggy skin that has been exposed to water for prolonged period. [1][2][3][4] Post penetration, they circulate in the bloodstream and spread to other organs.…”