Abstract

AN OBSERVATIONAL STUDY ON CHANGE IN PATTERNS OF CLINICAL PRESENTATIONS IN LEPTOSPIROSIS OVER THIRTY YEARS IN SOUTH INDIA

Author(s): Prabhakaran Kuriyandan1, P. K. Mukundan2

BACKGROUND
Leptospirosis is a widespread zoonotic disease prevalent in the tropics and temperate regions of the world. The clinical profile of the disease is highly variable with subclinical presentations as well as classical presentation in the form of fever with disproportionate myalgia; mild hepatocellular jaundice, subconjunctival haemorrhage, with polymorpholeukocytosis (Weil’s syndrome). Rare forms of presentation and complications in the form of myocarditis, acute renal failure, acute liver failure, acute respiratory distress syndrome (ARDS) and pulmonary haemorrhage, aseptic meningitis have also been noted.
MATERIALS AND METHODS
It is a retrospective observational study on 3 sets of 40 patients each, from different periods spread across 1983-84, 1988-89, 2004-05, conducted in a tertiary care centre in south India.
RESULTS
Total 120 cases were studied, mean age was 40.3 yrs. 85 percent of them were males. The mean time between symptom onset and admission was 7.5 days. The incidence of renal failure and acute respiratory distress was higher (49 %) among patients admitted during 2004-2005 compared with the earlier groups. Crystalline penicillin started earlier cured almost all cases.
CONCLUSION
Leptospirosis is an important zoonotic disease in south India, with a wide variety of clinical presentations. The natural history of the disease when detected earlier clinically can improve the treatment outcome dramatically. Newer diagnostic modalities have increased disease detection rate but still clinical diagnosis is the cornerstone of better patient care. The treatment strategies have changed over the years but the therapy with crystalline penicillin is still the gold standard.
KEYWORDS
Leptospirosis, Weil’s Syndrome, Myocarditis, ARDS, Pulmonary Haemorrhage, Penicillin