Clinical profile, management and outcome of patients with leptospirosis during the times of COVID-19 pandemic: A prospective study from a tertiary care centre in South India

Abstract

Leptospirosis is a rodent-borne acute febrile illness, classically seen after heavy rainfall and floods. This study aimed to describe the clinical profile, management strategies and outcome of patients with leptospirosis amidst the Coronavirus disease-2019 outbreak. A prospective study of adult patients with undifferentiated fever (5-15 days) was conducted in South India between October 2020 and February 2021. The demographic, clinical details, laboratory details, treatment and outcome of leptospirosis positive (based on serology) and negative patients were compared. A chisquare test was used for qualitative variables, while an independent t-test or Mann Whitney U test was used for continuous variables. Of the 206 patients with suspected acute febrile illness, a total of 63 patients were diagnosed with leptospirosis based on serology results. The median sequential SUMMARY organ failure assessment score was higher in those with leptospirosis (p<0.001). Myalgia, abdominal pain, jaundice, decreased urine output, myocarditis, and dialysis requirement were more common in patients with leptospirosis. Leucocytosis and raised procalcitonin/ C-reactive protein were more common in patients with leptospirosis. The duration of stay and antibiotic consumption was higher in patients with leptospirosis. Acute febrile illness such as leptospirosis should be suspected in tropical areas with significant risk factors. The presence of conjunctival suffusion, hepatic and renal dysfunction should warrant a serology test for leptospirosis.

Impacto da pandemia da COVID-19 sobre as notificações das Doenças Febris Agudas em um Hospital de Referência em Infectologia em Goiás

“…Os casos foram mais frequentes no sexo masculino, provavelmente devido a maiores chances de exposição dos homens durante suas atividades ocupacionais. A maioria dos pacientes apresentou febre, mialgia e cefaleia, sintomas semelhantes aos observados na COVID-19 (Gupta et al, 2021). O aumento de casos de Leptospirose em 2020, a maior prevalência da doença no sexo masculino e os sintomas descritos pelo estudo realizado na Índia são semelhantes aos resultados encontrados neste estudo.…”

Coinfection of leptospirosis and coronavirus disease 2019: A retrospective case series from a coastal region in South India

“…From July to November 2020, the COVID pandemic coincided with an outbreak of leptospirosis in Udupi, Karnataka, India. 8 Since these diseases have similar manifestations, it is often difficult to differentiate the two entities. 6 It becomes all the more challenging in patients where there is a coinfection of COVID and leptospirosis.…”

“…Similarly, when comparing the patients with coinfection to patients from another published study with leptospirosis alone who were admitted at the same time in our hospital, it was noticed that dyspnea was significantly commoner in patients with coinfection (Table 1 ). 8 Although respiratory involvement is noted in leptospirosis alone due to increased vascular permeability, bacterial invasion, or pulmonary hemorrhage, concurrent COVID‐19 seems to increase the severity. 10 Chest X‐ray abnormalities in moderate to severe COVID‐19 range from consolidation to ground glassing.…”

“…The presence of coinfection was also associated with poor outcomes in coinfected patients compared to either infection in isolation (Table 1 ). 8 , 9…”

“… 7 There is increased exposure to leptospirosis in coastal areas with heavy rainfalls and floods in the monsoons. 8 Therefore, a patient presenting with fever in the monsoon season may have concurrent COVID‐19 and leptospirosis in such an area. This report discusses the clinical features and management of patients who were coinfected with COVID‐19 and leptospirosis.…”