A Prospective Study of Leptospirosis as a Differential Diagnosis of Dengue like Illness

Background: Leptospirosis is both a zoonotic and environmental disease. The bacteria are hosted in animal kidneys for months and even years, and the bacteria are released in the environment by the urine of these animals. The transmission to humans occurs by contact with infected animals or contaminated water. There are different entry points for this contamination, it could be a skin abrasion, it could be through the mucous membranes, it can also occur through inhalation of droplets of urines for instance during farming activities and sometimes, it occurs by drinking water. Clinical presentation of leptospirosis mimics dengue as pyrexia with thrombocytopenia is common in both.

Methods: We have included all patients between age group of 0-18 years with complaints of fever. Laboratory investigation showed thrombocytopenia but negative dengue serology and raised Serum glutamic oxaloacetic transaminase/ Serum glutamic pyruvic transaminase (SGOT/SGPT) and no other obvious cause of illness. Hence leptospira serology was done.

Results: Total of 15 patients were cases of dengue like illness, out of which Leptospira serology samples came positive in 60% (9). Total number of cases of dengue like illness are 15 out of which 66.6%patients belonged to >10 years (11-18) & 33.33 % patients were <10 years and gender ratio was 66.6% (10) male & 33.33% (5) females. The patients who were diagnosed as dengue like illness were given antibiotic- 46.6% (7) were given Doxycycline & 53.3% (8) cases were given Azithromycin. Clinical improvement with increase in their platelet count was seen within 48 hrs. of starting the antibiotic in all of them.

Conclusion: Leptospirosis should be considered as an important differential diagnosis while treating patient of dengue like illness. Consider treating such patient with doxycycline/azithromycin as this result in clinical improvement & may prevent any complications.