Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2025; 13(25): 106335
Published online Sep 6, 2025. doi: 10.12998/wjcc.v13.i25.106335
Different clinical profile of leptospirosis in a tertiary care Indian hospital: A Himalayan experience
Drupad Das, Sindura Ponnampurathu, Prasan Kumar Panda, Yogendra Pratap Mathuria
Drupad Das, Prasan Kumar Panda, Department of Internal Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh 249203, India
Sindura Ponnampurathu, Yogendra Pratap Mathuria, Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Rishikesh 249203, India
Co-first authors: Drupad Das and Sindura Ponnampurathu.
Author contributions: Das D and Ponnampurathu S contributed to data collection, data analysis and manuscript writing; Panda PK and Mathuria YP provided the concept, interpreted the analysis, critically reviewed the draft, and approved it for publication along with first two authors.
Institutional review board statement: The study was reviewed and approved by the Institutional Ethics Committee, AIIMS Rishikesh to ensure patient confidentiality, data protection, and adherence to ethical standards in research involving human participants.
Informed consent statement: Requirement of informed written consent was waived prior to study enrollment considering the retrospective nature of data collection.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: sharing statement: Data will be made available to others upon request to the corresponding author.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Prasan Kumar Panda, MD, Professor, Department of Internal Medicine, All India Institute of Medical Sciences, Room No. 409, College Block, Rishikesh 249203, India. motherprasanna@rediffmail.com
Received: February 24, 2025
Revised: April 15, 2025
Accepted: May 13, 2025
Published online: September 6, 2025
Processing time: 134 Days and 21.5 Hours
Abstract
BACKGROUND

Leptospirosis is a globally prevalent zoonotic disease with a significant burden in tropical and subtropical regions, including India. Despite its high fatality rate and endemic nature, the disease remains underreported in many areas, particularly in Northern India.

AIM

To analyze the demography, clinical presentation, complications, and mortality risk factors in presumptive leptospirosis patients admitted to a tertiary care hospital over the last 7 years from the Himalayan and Sub-Himalayan regions of Northern India.

METHODS

A retrospective analysis was conducted on hospital records of patients admitted with leptospirosis at the All India Institute of Medical Sciences, Rishikesh, between January 2018 and December 2024. Diagnosis was based on the Modified Faine’s Criteria and laboratory confirmation via IgM enzyme-linked immunosorbent assay (ELISA) and other diagnostic tests. Statistical analysis, including logistic regression, was performed to determine mortality predictors.

RESULTS

A total of 62 patients were included in the study. The most common symptoms were fever (98.39%), myalgia (41.94%), and jaundice (20.97%). Thrombocytopenia was the most frequent complication, occurring in 72.58% of cases, followed by hepatic involvement (62.9%) and acute kidney injury (40.32%). Multiorgan dysfunction syndrome was present in 66.13% of cases, with 19.35% developing acute respiratory distress syndrome (ARDS). The overall mortality rate was 20.97%, with a higher but non-significant mortality trend in the Himalayan region (35% vs 14.29%, P = 0.094). Logistic regression analysis revealed that no categorical predictor alone was statistically significant. However, ARDS had a high odds ratio (OR = 2.10), suggesting clinical importance despite variability. Jaundice (OR = 2.28, P = 0.383) and creatinine levels (OR = 2.12, P = 0.1029) showed a possible trend toward increased mortality, despite statistical variability. Higher international normalized ratio levels (OR = 0.33, P = 0.0662) were suggestive of a protective effect.

CONCLUSION

Leptospirosis remains a severe and often fatal disease in Himalayan and sub-Himalayan regions, particularly in hilly areas, where underreporting and delayed diagnosis contribute to poor outcomes. Mortality was highest (33.33%) in cases with multiorgan involvement, particularly affecting the liver, kidneys, and lungs. We did not identify any statistically significant mortality predictors. Although the study did not assess the impact of timely diagnosis, improving healthcare accessibility in hilly regions may facilitate earlier detection and intervention, potentially reducing mortality.

Keywords: Acute febrile illness; Hilly areas; Leptospira; North India; Weil’s disease; Zoonosis

Core Tip: This study highlights the high burden of severe leptospirosis, with significant multiorgan dysfunction, intensive care unit needs, and a 20.97% overall mortality rate. Patients from the Himalayan region had more severe renal impairment, higher hemodialysis requirements, and nearly double the mortality of the Sub-Himalayan group. Jaundice and acute respiratory distress syndrome were potential contributors to mortality, while international normalized ratio showed a possible protective association. These findings emphasize regional variability in disease severity and the need for targeted risk stratification and resource allocation.