Different clinical profile of leptospirosis in a tertiary care Indian hospital: A Himalayan experience

Table 1 Modified Faine’s criteria scoring system to diagnose leptospirosis

Part A: Clinical features	Score	Part B: Epidemiological factors	Score
Headache	2	Contact with contaminated environment	4
Fever ≥ 39°C	2	Occupation involving animals or contaminated water	4
Conjunctival suffusion	4	Rainfall	5
Muscle pain	4	Part C: Laboratory findings	Score
Meningism	4	Positive IgM ELISA	15
Jaundice	1	Positive PCR	15
Albuminuria or nitrogen retention	2	Culture positive	10
Hemorrhages	2	MAT titer ≥ 1:400	15
Cough, hemoptysis, or breathlessness	2	MAT titer ≥ 1:800	20
Interpretation of scores
Presumptive diagnosis of leptospirosis: Total score (Parts A + B + C) ≥ 25; Total score (Parts A + B) ≥ 26		Possible diagnosis of leptospirosis: Total score between 20 and 25

ELISA: Enzyme-linked immunosorbent assay; PCR: Polymerase chain reaction; MAT: Microscopic agglutination test.

Table 2 Frequency of different symptoms, signs, and laboratory findings of the cohort, n (%)

Clinical variable	Frequency, n = 62	No. of patients from Himalayan region, n = 20	No. of patients from Sub-Himalayan region, n = 42	P value
Fever (> 39 °C)	61 (98.39)	20 (100.00)	41 (97.62)	1
Headache	20 (32.26)	7 (35.00)	13 (30.95)	0.977565281
Conjunctival suffusion	9 (14.52)	4 (20.00)	5 (11.90)	0.452540931
Neck rigidity	4 (6.45)	0 (0.00)	4 (9.52)	0.295162635
Myalgia	26 (41.94)	9 (45.00)	17 (40.48)	0.950434811
Jaundice	13 (20.97)	6 (30.00)	7 (16.67)	0.383257647
Dyspnea	15 (24.19)	7 (35.00)	8 (19.05)	0.291929299
Increased liver enzyme (> 3 × upper limit)	39 (62.90)	14 (70.00)	25 (59.52)	0.60511935
Thrombocytopenia	45 (72.58)	14 (70.00)	31 (73.81)	0.992162843
Edema	7 (11.29)	4 (20.00)	3 (7.14)	0.198564612
Abdominal pain	27 (43.55)	11 (55.00)	16 (38.10)	0.326599126
AKI	25 (40.32)	10 (50.00)	15 (35.71)	0.426604756
Hemodialysis Required	14 (22.58)	8 (40.00)	6 (14.29)	0.052520105
Altered sensorium	16 (25.81)	6 (30.00)	10 (23.81)	0.833434549
ARDS	12 (19.35)	7 (35.00)	5 (11.90)	0.070626099
CKD	4 (6.45)	2 (10.00)	2 (4.76)	0.588416137
DIC	8 (12.90)	2 (10.00)	5 (11.90)	1
MODS	41 (66.13)	13 (65.00)	28 (66.67)	1
HDU or ICU requirement	37 (59.67)	13 (65.00)	24 (57.14)	0.754549351

DIC: Disseminated intravascular coagulation; AKI: Acute kidney injury; MODS: Multiorgan dysfunction syndrome; ICU: Intensive care unit; HDU: High dependency Unit; ARDS: Acute respiratory distress syndrome; CKD: Chronic kidney injury.

Table 3 Mortality rate amongst different subgroup of the cohort, n (%)

Clinical variable	Frequency, n = 62	No. of patients from Himalayan region, n = 20	No. of patients from sub-Himalayan region, n = 42	P value
Mortality	13 (20.97)	7 (35.00)	6 (14.29)	0.094

Table 4 Mortality rate as per system involvement in the cohort

System involvement	Discharged	Expired	Total	Mortality (%)
Hematological + renal	20	7	27	25.93
Hematological + renal + hepatic	16	7	23	30.43
Hematological + renal + hepatic + respiratory	6	3	9	33.33