CLINICO-EPIDEMIOLOGICAL PROFILE, COMORBIDITIES AND CO-INFECTIONS AS DETERMINANTS OF OUTCOME IN LEPTOSPIROSIS: A PROSPECTIVE OBSERVATIONAL STUDY

Authors

1. Mithun N. Kagalkar
   Consultant Interventional Cardiologist, Metro United Healthcare, Shivamogga, India
2. Arvind M N
   Professor, Shri Atal Bihari Vajpayee Medical College and Research Institute, Bangalore, India
3. Harika K
   Assistant Professor, Shri Atal Bihari Vajpayee Medical College and Research Institute, Bangalore, India

Abstract

Background: Leptospirosis is an underreported zoonosis with a broad clinical spectrum. Indian data on how comorbidity and co-infection relate to outcome remain limited. Methods: In this prospective, single-centre observational study conducted over 24 months (2018–2020), 85 patients aged 18–70 years with leptospirosis diagnosed by modified Faine's criteria were enrolled. Demographic characteristics, presenting symptoms, comorbidities and laboratory-confirmed co-infections were recorded and related to in-hospital outcome. Proportions were compared using Fisher's exact test. Results: Mean age was 38.49 ± 16.60 years and 42.4% of patients were aged 21–35 years; 58 (68.2%) were male (M:F 2.15:1). Fever (85.9%), myalgia (80.0%), chills or rigors (78.8%) and headache (52.9%) predominated, and mean duration of fever before admission was 6.38 ± 7.00 days. Overall in-hospital mortality was 27.1% (23/85; 95% confidence interval [CI] 18.8–37.3). Diabetes mellitus (n=17, 20.0%) carried the highest case fatality of any comorbidity at 47.1%, versus 22.1% in non-diabetic patients (odds ratio [OR] 3.09, 95% CI 0.88–10.92; p=0.064), whereas hypertension (n=14) conferred no excess risk (28.6% vs 26.8%; OR 1.09; p=1.00). Dengue was the co-infection with the highest case fatality (4/8, 50.0%; OR 3.01, 95% CI 0.51–17.85; p=0.204); no deaths occurred among patients co-infected with malaria, HIV or typhoid. No comorbidity or co-infection was significantly associated with mortality. Conclusion: Leptospirosis affected predominantly young working-age males presenting with non-specific febrile illness and carried substantial mortality. Diabetes mellitus and dengue co-infection each showed an approximately threefold but statistically non-significant increase in case fatality. These subgroups were small, and the associations require confirmation in adequately powered multicentre studies.

Keywords

Leptospirosis; Epidemiology; comorbidity; co-infection; dengue; diabetes; hypertension; mortality

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