Clinico-epidemiological study of hospitalized cases of severe leptospirosis

In an attempt to understand the clinical spectrum and pathological and bioc hemical abnormalities and their prognostic importance in leptospirosis, a p rospective study was carried out in Port Blair during September 1996 to Aug ust 1997, Out of 80 patients suspected to have leptospirosis, 58 were prove d to have current leptospiral infection using serological tests and among t hese, 14 died giving a case fatality rate of 24.1 per cent. The incidence o f the disease showed two separate peaks roughly coinciding with the paddy s olving and harvesting season and the majority of the patients had history o f exposure to wet and water logged environment prior to the attack of the d isease. The disease presented as two separate clinical syndromes - the hepa to-renal form and the pulmonary form though some degree of overlap was pres ent. Hepatic and renal complications occurred in 30 patients each with 26 o f them having both. These generally occurred late in the course of the dise ase and the mortality rate was relatively low, In contrast pulmonary compli cation occurred quite early and the case fatality rate in those patients wa s very high (6.7% vs 42.9%), The other complications encountered in the cur rent series of cases were refractory hypotension probably due to myocarditi s in 40 per cent and neck stiffness and altered sensorium due to central ne rvous involvement in 12.1 per cent of the patients. The chances of the pati ents developing complications were considerably low if treated early and ve ry few of them developed any complications after 2 days of hospitalized tre atment. The early occurrence of pulmonary complications indicates a pathoge nesis totally different from that responsible for the other complications.