Indian Journal of Medical Microbiology IAMM  | About us |  Subscription |  e-Alerts  | Feedback |  Login   
  Print this page Email this page   Small font sizeDefault font sizeIncrease font size
 Home | Ahead of Print | Current Issue | Archives | Search | Instructions  
Users Online: 986 Official Publication of Indian Association of Medical Microbiologists 
  Search
 
  
 ~  Similar in PUBMED
 ~  Search Pubmed for
 ~  Search in Google Scholar for
 ~  Article in PDF (345 KB)
 ~  Citation Manager
 ~  Access Statistics
 ~  Reader Comments
 ~  Email Alert *
 ~  Add to My List *
* Registration required (free)  

 
 ~  References
 ~  Article Tables

 Article Access Statistics
    Viewed806    
    Printed6    
    Emailed0    
    PDF Downloaded65    
    Comments [Add]    

Recommend this journal

 


 
  Table of Contents  
CORRESPONDENCE
Year : 2016  |  Volume : 34  |  Issue : 3  |  Page : 390-391
 

Leptospirosis in sub-Himalayan region: A neglected entity


1 Department of Medicine, Dr. RPGMC, Tanda, Kangra, Himachal Pradesh, India
2 Department of Microbiology, Dr. RPGMC, Tanda, Kangra, Himachal Pradesh, India

Date of Submission28-May-2015
Date of Acceptance18-Jan-2016
Date of Web Publication12-Aug-2016

Correspondence Address:
V Chauhan
Department of Medicine, Dr. RPGMC, Tanda, Kangra, Himachal Pradesh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0255-0857.188370

Rights and Permissions



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

How to cite this URL:
Chauhan V, Thakur S. Leptospirosis in sub-Himalayan region: A neglected entity. Indian J Med Microbiol [serial online] 2016 [cited 2017 Apr 23];34:390-1. Available from: http://www.ijmm.org/text.asp?2016/34/3/390/188370


Dear Editor,

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. [1] 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. [2],[3]

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%. [4] 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. [5] 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.


Click here to view


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.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
 ~ References Top

1.
Sethi S, Sharma N, Kakkar N, Taneja J, Chatterjee SS, Banga SS, et al. Increasing trends of leptospirosis in Northern India: A clinico-epidemiological study. PLoS Negl Trop Dis 2010;4:e579.  Back to cited text no. 1
    
2.
Mohanty S, Premlatha MM, Chaudhry R, Dey AB. Time to take leptospirosis seriously in India! J Assoc Physicians India 2003;51:929-30.  Back to cited text no. 2
    
3.
Kaur IR, Sachdeva R, Arora V, Talwar V. Preliminary survey of leptospirosis amongst febrile patients from urban slums of East Delhi. J Assoc Physicians India 2003;51:249-51.  Back to cited text no. 3
    
4.
Lax Awareness Leads to Rise in Scrub Typhus Deaths in Himachal Pradesh. The Times of India. 3 September, 2013, 03:52 am IST. Available from: http://www.timesofindia.indiatimes.com/india/Lax-awareness-leads-to-rise-in-scrub-typhus-deaths-in-Himachal-Pradesh/articleshow/22241461.cms. [Last cited on 2015 Sep 20].  Back to cited text no. 4
    
5.
Chauhan V, Mahesh DM, Panda P, Mokta J, Thakur S. Profile of patients of leptospirosis in sub-Himalayan region of North India. J Assoc Physicians India 2010;58:354-6.  Back to cited text no. 5
    



 
 
    Tables

  [Table 1]



 

Top
Print this article  Email this article
 

    

2004 - Indian Journal of Medical Microbiology
Published by Wolters Kluwer - Medknow

Online since April 2001, new site since 1st August '04