Retrospective study of severe cases of leptospirosis admitted in the intensive care unit

Objectives: Evaluate patient demographics, risk factors, complications, seropositivity, treatment and outcome among leptospirosis patients. Design: Retrospective analysis of 104 patients admitted in the intensive care unit (ICU) with a clinical suspicion of leptopirosis. Setting: Ten-bedded medical ICU in a medical school situated in a rural area endemic for leptospirosis. Main Outcome Measures: Seropositivity for leptospirosis, patient demographics, risk factors, complications, treatment and survival. Results: One hundred and four patients were admitted with a clinical suspicion of leptospirosis. Fifty-three (50.7%) were serologically confirmed cases. Males dominated both groups. Most of the admissions were in the monsoon season. Exposure to moist soil was the main risk factor. The mortality in the seronegative group was 26.8% while it was only 3.8% in the seropositive group. Multi-organ dysfunction syndrome, primarily acute respiratory distress syndrome with thromboctyopenia and renal failure were the causes for mortality. All the patients who died presented late into the illness. Conclusions: The initial diagnosis of leptospirosis depends on a high index of clinical suspicion, routinely available diagnostic tests being unreliable in the initial period. A reliable, unsophisticated test should be developed for early detection of this disease. As leptospirosis in its early stage mimics other tropical infections, both medical professionals and the general public (especially with risk of occupational exposure) should be educated about the disease and the need to seek early medical intervention.