Clinico-epidemiological study of hospitalized cases of severe leptospirosis.

In an attempt to understand the clinical spectrum and pathological and biochemical abnormalities and their prognostic importance in leptospirosis, a prospective study was carried out in Port Blair during September 1996 to August 1997. Out of 80 patients suspected to have leptospirosis, 58 were proved to have current leptospiral infection using serological tests and among these, 14 died giving a case fatality rate of 24.1 per cent. The incidence of the disease showed two separate peaks roughly coinciding with the paddy sowing and harvesting season and the majority of the patients had history of exposure to wet and water logged environment prior to the attack of the disease. The disease presented as two separate clinical syndromes--the hepato-renal form and the pulmonary form though some degree of overlap was present. Hepatic and renal complications occurred in 30 patients each with 26 of them having both. These generally occurred late in the course of the disease and the mortality rate was relatively low. In contrast pulmonary complication occurred quite early and the case fatality rate in those patients was very high (6.7% vs 42.9%). The other complications encountered in the current series of cases were refractory hypotension probably due to myocarditis in 40 per cent and neck stiffness and altered sensorium due to central nervous involvement in 12.1 per cent of the patients. The chances of the patients developing complications were considerably low if treated early and very few of them developed any complications after 2 days of hospitalized treatment. The early occurrence of pulmonary complications indicates a pathogenesis totally different from that responsible for the other complications.