IS IT LEPTOSPIROSIS?
This year a lot of undue fear was impregnated in the minds of the public due to repeated newspaper reports of patients suffering from leptospirosis in Mumbai.
On pg 518 of this issue, S Kore et al from LTMG Hospital report a case of leptospirosis in a female patient who had just delivered five days back. It is worth noting that the patient was residing at Dharavi in Mumbai, a locality which is known to be most dirty and filthy. The case is made by the newspapers that as if Cholera has broken out in Mumbai. If that happens, certainly it will be big news. However a disease like leptospirosis is off and on seen in our city. The incidence increases in the rainy season. Due to heavy rains in Mumbai, often flooding takes place and one finds knee deep water in areas like Dharavi. Because of poor municipal drainage maintenance, this water is mixed up with sewage and if our poor people with or without shoes pass through this water or in fact, very often young men and children start swimming or playing in this water for fun (due to the scarcity of access to swimming pools to this type of population), this disease which is otherwise seen only in sewage workers shows increased incidence. Yes, the disease must be diagnosed as early as possible because it is curable with ordinary antibiotics which are cheap and easily available. Although the authors in this issue did not mention which blood and urine tests were carried out to confirm the diagnosis, most of the common pathological laboratories in private practice do not carry out any tests to confirm the diagnosis of this illness. Fortunately, the clinical suspicion of this disease can be very strong and often right. These patients who have fever complain of so severe muscle pains (which are passed off as severe body ache as in the above case) that on examination, the muscles are extremely tender (a finding which was present in this case) and in fact if blood test for CPK is done it will be found to be very high. Associated red eyes or subconjunctival haemorrhages as in this case also point to the diagnosis of such a patient who often has clinical jaundice. The routine blood tests once more strongly point towards the diagnosis when the leucocyte count is high. Routine urine test shows the presence of albumin and casts and there is an abnormality of the liver function and the kidney function tests.
Close differential diagnosis of a fever patient having abnormal kidney and liver function tests is falciparum malaria. Such patients will have severe anaemia, severe thrombocytopenia and marked rise in LDH even when very often MPs are not demonstrable in the peripheral smears. Of course, this is also a treatable disease and many lives can be saved with a good diagnosis.
Finally, there is one more fever which can mimic the above fever but for which there is no specific treatment and this is dengue virus fever. Patients having this fever do complain of very severe bodyache and backache (known as break-bone fever). Such patients often complain of pain in the eyes and find difficulty in rolling the eyes which may be congested. They quite often develop a mild rash or itching after 5-6 days, often in the palms and by this time, the fever is coming down. These patients will always have leucopenia. In case the dengue fever is of haemorrhagic type it is often fatal. The patient can develop severe thrombocytopenia and a renal shutdown.