Prevalence of leptospirosis in Thoothukudi-Southern coastal city, Tamil Nadu

Introduction: Leptospirosis, a Zoonosis with multi-systemic involvement, is caused by the pathogenic strains of Leptospira. Leptospirosis has a very wide range of natural rodent and non-rodent reservoir hosts. Rural farm workers, sewer workers and fishermen are at high risk for Leptospirosis, and it can be a significant public health problem when water and food safety are not ensured. Few reports are available about circulating Leptospiral species and serogroups in Southern Tamilnadu. Our study wants to highlight the threat of Leptospirosis in coastal areas of southern India so that preventive measures should be initiated. Aim: To determine the prevalence of Leptospirosis in PUO (Pyrexia of unknown origin) cases in Tuticorin coastal district of Tamil Nadu by serological test IgM ELISA and to analyse the predisposing factors for Leptospirosis. Materials: A Cross-sectional comparative study stretched over a period of 2 months involving 50 cases with clinical suspicion of Leptospirosis, the other causes of fever being excluded. Detailed history taken with complete clinical examination. The diagnostic modality used in this study is IgM Elisa. Results: Out of the 50 cases investigated for leptospirosis, 5 (10%) came out to be positive. Amongst the positive cases, 4 out of 5 had direct animal contact, 4 out of 5 belonged to the rural area and 2 out of 5 had access to common water bodies. Conclusion: Leptospirosis showed higher prevalence among rural people with animal contact and access to water bodies. Keyword: Leptospirosis, Prevalence, Disease Burden. Introduction Leptospirosis, a Zoonosis with multisystemic involvement, is caused by the pathogenic strains of Leptospira. It is a gram-negative spirochete. Leptospirosis has an extensive range of natural rodent and non-rodent reservoir hosts. Leptospira are excreted in large numbers in the urine of rodents and cattle contaminating soil as well as water bodies. Farm laborers, sewer workers, and fishermen are at high risk of contracting Leptospirosis, and it can be a significant public health problem when water and food safety are not secured. The outbreaks of Leptospirosis have been reported from coastal districts of Gujarat, Maharashtra, Kerala, Tamil Nadu, Andhra Pradesh, Karnataka and Andaman's from time to time. The LeptospiraSerovars predominantly present in India are L. andamana, L. pomana, L. grippotyphosa, L.hebdomadis, L.semoranga, L.javanica, L.autumnalis and L.canicola. Almost 90% of patients present as Anicteric leptospirosis with only 5-10% cases being icteric. If left untreated disease progresses rapidly, mortality rates being high in severe cases. Few reports are available about circulating Leptospiral species and serogroups in Southern Tamilnadu. Case definition criteria are used for detection of cases. According to these criteria, leptospirosis should be suspected in a person presenting with a history of abrupt onset of high fever and myalgia, with any one or more of the following features: jaundice, oliguria, cough and breathlessness, hemorrhagic tendency, and signs of meningeal irritation or altered sensorium or convulsions. In addition to clinical evaluation, Leptospirosis is diagnosed by the serological detection of Leptospira by enzyme-linked immunosorbent assay (ELISA) for Leptospira immunoglobulin (IgM) antibody, Macroscopic slide agglutination test (MSAT) and Microscopic agglutination test (MAT). Our study wants to highlight the threat of Leptospirosis in coastal areas of southern India so that preventive measures should be initiated. We studied the prevalence of Leptospirosis in PUO (Pyrexia of unknown origin) cases in Tuticorin-coastal district of Tamil Nadu by serological test IgM ELISA and to analyse the predisposing factors for Leptospirosis. Materials & Methods This is a Cross-sectional study performed in a tertiary care hospital, Thoothukudi Government Medical College Hospital, Thoothukudi. A total of 50 clinically suspected febrile cases of leptospirosis, both outpatients and inpatients attending Government medical college hospital, Thoothukudi were included in the study. Patients with fever, headache and myalgia jaundice, oliguria, respiratory symptoms, hemorrhagic manifestations and convulsions were included. Patients with fever due to other causes like malignancy and autoimmune diseases were excluded from this study. Detailed history is obtained from all the patients and complete clinical examination is done. Patient’s data like age, sex, symptoms-fever, body ache, headache, vomiting, joint pain & duration of hospital stay collected and documented as per proforma. Clinical assessment for signs of infection like purpuric rashes, reduction in platelet count is made. All cases are Kalaivani. V et al. Prevalence of leptospirosis in Thoothukudi Southern coastal. International Journal of Medical Microbiology and Tropical Diseases, October-December, 2017;3(4):151-154 152 monitored until discharge from the hospital. Informed consent is obtained from all the patients. Results: A total of 50 clinically suspected febrile cases of leptospirosis, both outpatients and inpatients attending Government medical college hospital, Thoothukudi were included in the study. Patients in 0 to 70 years age group with associated symptoms like headache, jaundice, oliguria, respiratory distress, hemorrhagic manifestations included in the study. During the study period, the total number of samples screened was 50, 5(10%) were positive for Leptospirosis and 45 (90 %) were negative. (Fig. 1) Fig.1: Prevalence of Leptospirosis Of the 50 cases screened 28(56%) were males, 22 (44%) were females showing mild difference in the sex distribution. Out of the leptospirosis positive cases 3 (60%) were males and 2 (40%) of the positive were females. Among the age groups, there was no preference for a single age group. Positivity was evenly distributed among all age groups. (Table 1) Table 1: Age and sex distribution of Leptospirosis