Evaluation of cardiovascular status in severe leptospirosis.

OBJECTIVES: To note incidence and profile of cardiac involvement in severe leptospirosis in South Gujarat. METHODS: A study was carried out on twenty-five serologically proved leptospirosis patients referred to Government Medical College, New Civil Hospital, Surat between June 2002 to September 2002. In all the patients detailed history, physical examination and specific investigations were done to find out the incidence and profile of cardiac involvement in severe leptospirosis. RESULTS: Out of twenty-five seropositive patients, 14(56%) had cardiovascular manifestations. Electrocardiography abnormalities were seen in 13(52%) patients. The commonest finding was first-degree AV block seen in II(44%) patients followed by ST-segment depression in four (16%) patients, T-wave inversion in leads II, III and avF in two (8%) patients, corrected QT-interval prolongation in three (12%) patients and ventricular premature beats in two (8%) patients. Atrial fibrillation was seen in only one patient. Left ventricular function as assessed by two-dimensional echocardiography was normal in all patients. CONCLUSION: In cardiovascular involvement of leptospirosis, although electrocardiographic abnormalities were commonly seen, there was no left ventricular dysfunction.

Clinical profile of leptospirosis in South gujarat.

BACKGROUND: South Gujarat has been witnessing increasing incidence of leptospirosis for the last few years. AIM: To study the clinical profile of leptospirosis in South Gujarat. SETTINGS AND DESIGN: Prospective study during July-September 2000 at the New Civil Hospital, Surat, Gujarat. PATIENTS AND METHODS: All the consecutive cases with clinical suspicion of leptospirosis were screened for lgM antileptospira antibody on the first and the fourteenth day. A four fold or greater increase in agglutinin antibody titre on paired samples was considered diagnostic. If the patient died before the fourteenth day then initial titre greater than 1:15 was considered diagnostic. RESULTS: Total number of patients referred to the hospital were fifty, of which thirty-eight [33 males, with age 14-50 (30 +/- 10.51)] were diagnosed as having leptospirosis. Most common organs involved were liver (27, 71.05%) and kidney (24, 63.15%). Cardio-vascular (12, 31.5%), pulmonary (10, 26.35%), neurological (2, 5.26%) and haematological (8, 21%) involvements were less common. Six patients died because of pulmonary involvement in the form of alveolar haemorrhage, while one died because of cardiac involvement. CONCLUSION: Liver and kidney were the most commonly involved organs in severe leptospirosis. Pulmonary involvement, though uncommon, led to high mortality.

The role of glucocorticoid pulse therapy in pulmonary involvement in leptospirosis.

OBJECTIVES: This study discusses incidence and clinical profile of pulmonary involvement in leptospirosis in South Gujarat. It also tries to evaluate the effect of high dose glucocorticoid pulse therapy (GPT) on it. METHOD: A study was carried out on hundred and two patients of suspected leptospirosis, referred to Government Medical College, New Civil Hospital, Surat between June 99 to September 99. The incidence, clinical profile, and specific investigations were studied in patients having pulmonary involvement. Some of the patients were given high dose glucocorticoid pulse therapy. Their outcomes were compared with those who had not been given glucocorticoid pulse therapy. RESULTS: Out of seventy seven seropositive patients 13 (16.8%) developed pulmonary involvement. Mortality was two out of eight patients in the group that received GPT and four out of five patients in the group that did not receive GPT. Two patients who died in the steroid treated group received the drug after 12 hours of onset of dyspnea. CONCLUSIONS: High dose GPT should be given as early as possible after the onset of dyspnea to all the patients with pulmonary involvement in leptospirosis. Further studies are required to establish the GPT as a standard regimen in treatment of pulmonary involvement in leptospirosis.