Leptospirosis - an under-diagnosed clinical condition.
I Shah, S Warke, CT Deshmukh, JR Kamat
Department of Paediatrics, Seth G. S. Medical College and K. E. M. Hospital, Parel, Mumbai, India., India
Department of Paediatrics, Seth G. S. Medical College and K. E. M. Hospital, Parel, Mumbai, India.
Leptospirosis is a zoonotic disease caused by leptospiral spirochaete. Two cases in children are described presenting with hepatorenal dysfunction.
|How to cite this article:|
Shah I, Warke S, Deshmukh C T, Kamat J R. Leptospirosis - an under-diagnosed clinical condition. J Postgrad Med 1999;45:93-4
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Shah I, Warke S, Deshmukh C T, Kamat J R. Leptospirosis - an under-diagnosed clinical condition. J Postgrad Med [serial online] 1999 [cited 2023 Sep 27 ];45:93-4
Available from: https://www.jpgmonline.com/text.asp?1999/45/3/93/339
Leptospirosis is a zoonotic disease caused by leptospiral spirochaete. It is characterised by an icteric course or an anicteric course. Anicteric leptospirosis usually presents as aseptic meningitis. Icteric leptospirosis also commonly called as Weil's syndrome is characterised by jaundice and renal dysfunction. We present here two patients of Weil's syndrome and who recovered with treatment.
A 7-year-old male child came with fever and haematemesis since five days. The patient was icteric, but liver was not palpable. Rest of the examination was normal. There was no oliguria. Patient had a platelet count of 15,000/cmm, though there was no purpura. Coagulation profile was normal. Biochemical investigations revealed BUN of 96 mg/dl, creatinine of 5.3 mg/dl, total bilirubin of 2.9 mg/dl (direct 1.5 mg/dl) and normal liver enzymes. Patient was suspected to have either viral hepatitis or leptospirosis. Patient's serum antileptospiral IgM antibody by ELISA was positive. Patient was treated with ciprofloxacin and showed complete recovery.
A 7-year-old male child came with history of jaundice since four days and petechial rash since two days. There was a prior history of fever a week back, which lasted for five day. Other than petechial rash and mild hepatomegaly, the rest of the examination was normal. Patient had thrombocytopenia (count 25,000/cu.mm), normal coagulation profile, bilirubin 19 mg/dl (direct bilirubin of 9 mg/dl), BUN 9 mg/dl, creatinine 3 mg/dl and mildly elevated liver enzymes. In this patient also, the same differential diagnosis were considered. Patient's antileptospiral IgM was positive. He was treated with crystalline penicillin.
Weil's syndrome is a hepatorenal disease characterised by a septicaemic phase (fever, myalgia) and an immune phase (hepatic and renal function impairment). Jaundice remains the hallmark. The main animal reservoir for this zoonotic disease is the rat. In children and housewives, the main reservoir is the pet dog. After penetration of skin and mucous membranes, the organisms invade the blood stream and spread throughout the body to produce protean manifestations of the disease. IgM Elisa test is very sensitive (100%) for detection of Acute leptospirosis. However, it is not very specific, at the most indicating a presumptive diagnosis. For confirmation, either culture positivity or recent seroconversion or a four fold rise in microagglutinin titres should be demonstrated. However, urine for leptospires may remain positive even after acute infection subsides in a chronic carrier.
A large epidemiological study in Kerala (Kolenchery) was carried out for leptospirosis post irrigation of dry lands. Cases of leptospirosis were rarely diagnosed in Kolenchery before irrigation. The study involved 976 cases of leptospirosis. The increase in incidence was probably due to geographical characteristics, continuous moisture of the soil due to irrigation in summer and year round cultivation making food and cover available to host rodents.
Thus, leptospirosis should be considered in every case with acute hepatorenal dysfunction as it can be treated with penicillin/tetracycline or ciprofloxacin.
The authors thank Dr. R G Shirhatti, Dean of Seth GS Medical College and King Edward Memorial Hospital, for giving permission to publish this article.
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