PURPOSE: Leptospirosis is a zoonosis with worldwide disribution, known for variable clinical spectrum. The course of the disease is related tothe antigenicity, host immunity, and the stage of antimicrobial exposure inititation. Adecline in pernicious features has been observed in the recent past. We studied the pulmonary involvement in hospitalised cases, admitted in our hospital in South India and our observations form the basis for presentation.
METHODS: Patients clinically suspected having leptospirosis, referred to our centre formed the material. Diagnosis was based on Faine's criteria (WHO, Offset Publications, 1982). They were evaluated for organsystem involvement. Pulmonary Involvement (PI) was graded on the basis of tachypnea (excluding other causes), tachycardia, lung signs, oxygen saturation and radiology chest. Invasive or noninvasive ventilation was considered whenever relevant. PI was correlated with other organ dysfunction and outcome.
RESULTS: Of 140 patients referred, 54 satisfied the diagnosis. Males (35) and females (19) were in the age group 13-64 years; majority were in the group 31-50 years (59.3%). Males (64.6%) outnumbered females. Organ involvement by clinicolaboratory criteria was; hepatic (80.7%), renal (61%), pulmonary (27.7%), hematological (14%) and neurological (1.8%). While the majority had hepatorenal involvement, associated PI contributed prolonged and significant morbidity. Acute lung injury was evident radiologically in 10 of 15 patients with PI. PI was present in the two males who died, despite assisted ventilation and antibiotic and supportive therapy. Outcome was directly related to multiorgan involvement. Details will be presented.
CONCLUSION: There is a decrease in morbidity pattern in leptospirosis evaluated, as was observed elsewhere in India. Morbidity was related to delayed institution of therapy and multiorgan involvement. Considering the small nuber of deaths, PI cannot be assumed to be the risk factor.
CLINICAL IMPLICATIONS: Leptospirosis is a potentially fatal disease globally, with seasonal variations. Patients presenting with stormy onset and having multiorgan failure need early intensive care. Hemorragic tendencies and PI are unfavorable factors. Assisted ventilation should be considerd at the earliest clinical sign. Specific therapy should not be delayed for want of definite diagnosis.
DISCLOSURE: Gopinathan Pisharath, No Financial Disclosure Information; No Product/Research Disclosure Information