Publication:

Clinical profile of leptospirosis with focus on inflammatory biomarkers

Background In the last few decades leptospirosis has re-emerged and is on the rise. Infectious diseases like malaria, dengue, infective hepatitis which simulate leptospirosis being rampant, so there is a need to know the clinical profile and biomarkers of leptospirosis. Study aimed to understand the clinical profile, laboratory findings and complications of leptospirosis with focus on inflammatory biomarkers.

Methods All consecutive inpatients of J.S.S medical college hospital with clinical suspicion of leptospirosis were screened for IgM anti-leptospiral antibody. Twenty-five patients who were positive for IgM antileptospiral antibodies were considered as cases and twenty-five patients who were admitted for fever other than leptospirosis were taken as controls and subjected to detailed history, clinical examination, investigations and followed up till discharge or death.

Results The age group commonly involved was 18-55 years (84%). Most of the patients were males (76%), with occupation involving outdoor activity (66%). Common symptoms were fever (100%), musculoskeletal pain (92%), headache (80%) and jaundice (64%). Less commonly seen were respiratory symptoms (36%), bleeding (24%), and gastrointestinal symptoms (16%). Important signs seen were conjunctival suffusion, hepatomegaly, splenomegaly and hypotension. Hyperbilirubinemia was predominantly of conjugated type and elevation of transaminases and alkaline phosphatase were mild to moderate. Mean bilirubin was 4.67mg/dl, Mean SGOT and SGPT were 99.23U/L and 96.97U/L respectively. ARF was seen in 48% and six of them needed haemodialysis. Thrombocytopenia was seen in 76% patients. 28% had multi-organ failure (MOF), 8% had aseptic meningitis, 8% had ARDS and 4% had GI haemorrhage.

Conclusions Musculoskeletal symptoms are most common next to fever. Conjunctival suffusion is a common finding. Liver and kidney are more commonly involved organs. MOF was significantly associated with mortality (p<.05). Thrombocytopenia was significantly related to clinical bleeding (p<.001). TNF-alpha and Interleukin-12 were significantly elevated in leptospirosis and may correlate with severity.