A Retrospective Study on Clinical and Biochemical Profile of Neuroleptospirosis

Abstract

BACKGROUND Leptospirosis is a zoonotic disease usually reported from South India. The clinical spectrum may range from asymptomatic infection, subclinical to a fatal hepatorenal syndrome. Most physicians are sensitized to diagnose leptospirosis, sometimes the diagnosis is missed, especially when associated with neurological manifestations. About 10-15 percent of cases can have neurological manifestations. These patients are referred to a tertiary care hospital due to poor therapeutic response. Since early management can be lifesaving, this study was carried out to evaluate the laboratory profile and clinical features in patients with neuroleptospirosis in a tertiary care centre in South India. METHODS This retrospective single centre study was conducted at Government Medical College, Thiruvananthapuram, Kerala. Neuroleptospirosis was diagnosed by clinical and laboratory findings of hepatorenal syndrome, and anti leptospira antibody detection by ELISA. RESULTS Total of 160 patients with leptospirosis were admitted during the period of study. 31 patients were diagnosed clinically as neuroleptospirosis. Out of 31 patients 21 (67.7 %) were males and 10(32.3 %) were females. The mean age was 56.9  14.61 years. (M: F 2:1, range 18-68 years,). The chief manifestations were fever in 29 (93.5 %), myalgia in 23(74.2 %), headache in 17 (54 %), jaundice in 14 (45 %), and conjunctival suffusion in 9 patients (29 %). Two patients (6.4 %) had altered sensorium and neck stiffness in 23 patients (74.19 %). Most common neurological manifestation was aseptic meningitis (87) followed by encephalitis (19.4 %), seizures in 9.7 %, mean WBC count was 17297.10  8948.413 cells/microliter. Mean platelet count at admission was 88258.06  108727.478 cell/microliter. Mean serum creatinine was 3.9  2.3 mg/dl. Seven  patients (22.58 %) succumbed to death. Mean age of patients who died were 50.63  11.94 years (p < 0.084), mortality was more common in females (50 %) (p < 0.074). Irrespective of age and sex, WBC count at admission > 18,800 cell/ μL is associated with increased mortality (p+0.032). CONCLUSIONS Early recognition of neuroleptospirosis in patients with hepatorenal dysfunction and altered sensorium is critical in the treatment of patients. Female gender and elevated WBC count at admission indicates poor prognosis. KEY WORDS Neuroleptospirosis, Prognosis, Aseptic Meningitis.