|Year : 2016 | Volume
| Issue : 3 | Page : 390-391
Leptospirosis in sub-Himalayan region: A neglected entity
V Chauhan1, S Thakur2
1 Department of Medicine, Dr. RPGMC, Tanda, Kangra, Himachal Pradesh, India
2 Department of Microbiology, Dr. RPGMC, Tanda, Kangra, Himachal Pradesh, India
|Date of Submission||28-May-2015|
|Date of Acceptance||18-Jan-2016|
|Date of Web Publication||12-Aug-2016|
Department of Medicine, Dr. RPGMC, Tanda, Kangra, Himachal Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Chauhan V, Thakur S. Leptospirosis in sub-Himalayan region: A neglected entity. Indian J Med Microbiol 2016;34:390-1
Leptospirosis is an emerging, but still neglected infection in North India. Healthcare Institutions lack diagnostic facilities and not even a single culture proven case has been reported from this region despite numerous reports of immunoglobulin M (IgM) ELISA and microscopic agglutination test (MAT) positive leptospirosis. Sethi et al. have reported 232 IgM ELISA positive cases of leptospirosis, diagnosed over 5 years, out of which 86 were positive by MAT.  These cases belonged to Haryana (44%), Punjab (30%), Himachal (22%), Uttar Pradesh and Bihar. Cases have also been reported from Delhi, mostly slums during the months of August and September. ,
Most cases of leptospirosis are subclinical or have a mild clinical illness. The clinical picture of leptospirosis completely overlaps scrub typhus; fever, headache, conjunctival suffusion, myalgia, meningism, meningo-encephalitis, acute respiratory distress syndrome, hepatorenal dysfunction, rash and multi-organ dysfunction syndrome. In Himachal, scrub typhus has gained a limelight over the years, pushing leptospirosis into the background. In 2013, total 3050 samples were tested in Himachal for scrub typhus, free of cost, using IgM ELISA and Weil-Felix with a positivity rate of 18%.  Sadly, leptospirosis has remained a neglected entity and claims many lives without ever being diagnosed or wrongly diagnosed as scrub typhus. Lack of physician awareness, absence of MAT and IgM ELISA testing in government setup is responsible for this neglect.
We report five cases of leptospirosis diagnosed by IgM ELISA in the month of September 2014, in a rural medical college in Himachal. These cases were from a geographically distinct area than the 13 cases, reported earlier, from Himachal.  All of these patients belonged to rural farming background with occupational exposures such as rice plantation and cattle rearing, as the sources of exposure for leptospirosis during monsoons. We always keep a possibility of leptospirosis in the absence of an eschar on clinical examination. We tested 30 patients for leptospirosis in 2014 out of which, 16 (53%) were tested in September. The positive cut-off of ELISA was taken as >20.0 U/ml, borderline as 15.0-20.0 U/ml and negative as <15.0 U/ml. Except for September, sera from all other months were negative for leptospirosis. In September, out of 16, we had 5 (31%) cases (3 positive and 2 borderline) positive by IgM, ELISA for leptospirosis [Table 1]. The scrub typhus also showed a peak in September (50% cases). This is the month when after the monsoons are over, people go out for cutting grass and for rice plantation, which predisposes them to scrub typhus and leptospirosis.
High bilirubin with mild transaminitis favours a diagnosis of leptospirosis whereas an eschar points towards scrub typhus. In the absence of an eschar at admission, We have to cover both illnesses by giving injectable ceftriaxone and doxycycline.
To conclude, positivity rate of 31% in the month of September points towards a possible endemicity of leptospirosis. Only routine testing with IgM ELISA and MAT similar to scrub typhus will give us the true picture of leptospirosis in this region. Physicians and Microbiologists need to test more to diagnose more of leptospirosis just like scrub typhus.
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Conflicts of interest
There are no conflicts of interest.
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