Leptospirosis In Himachal
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Febrile Jaundice: Leptospirosis CPC by Unit III Medicine IGMC
• Leptospirosis is an emerging zoonosis world wide • Being reported in many areas of SouthEast Asia now. • Till now not reported from Sub-Himalayan region of North India. • We present the profile of 13 Leptospira Positive patients (IgM Elisa or PCR).
• All patients presenting in Indira Gandhi Medical College during three months from 1st August to 31st October,2008 who positive for leptospirosis were included. • Their presenting complaints, examination findings, and lab findings were recorded and analyzed based on the Faine’s criteria and modified Faine’s criteria.
Following were noted • • • • • • • • • • • • •
Presenting complaints, Age, Sex, Address, Duration of pyrexia, Degree of temperature rise, Conjunctival suffusion, Headache, Meningisms, Myalgias, Jaundice, Contact with animals or flood water, Titre of IgM for leptospira.
No
Name
Duration Of pyrexia Days (2)
Temp >39* (2)
Conj Suffusion (4)
Meningism (4)
Muscle Pain (4)
Head ache (2)
Urea proteinuria mg% (2)
Jaundice (1)
Contact With animals (10)
IgM Titre (15)
Faine’s Criteria Score WHO
Faine’s Criteria Score Modified
1
Meera 42/F
4
+
+
+
+
+
140
+
+
27
41
56
2
Rajni 32/F
7
-
+
-
+
-
99
+
+
32
23
38
3
Parwati 35/F
6
+
-
+
-
+
60
-
+
24
22
37
4
SainKali 56/F
10
-
+
+
+
+
205
-
+
26
38
53
5
Babli 35/F
10
+
+
+
+
+
175
+
+
80
41
56
6
Leela Devi 52/F
10
+
-
+
+
+
80
+
+
45
27
42
7
Jodhi Ram 78/M
7
-
-
+
-
+
144
-
+
56
20
35
8
Keshav 24/M
9
+
+
-
-
+
134
+
+
23
23
38
9
Ramesh 35/M
6
-
-
-
+
+
86
-
+
22
20
35
10
Savitri 42/F
8
-
+
-
+
+
241
+
+
16
25
25
11
Anupama 40/F
5
+
-
-
+
+
28
+
+
18
21
35
12
Sundla 69/F
8
+
-
+
+
+
57
-
+
80
26
41
13
Savitri 40/F
10
+
+
-
+
+
294
+
+
25
29
44
• • • • • • • • • • • • •
Total number of patients 13. 3 males &10 females. The age range 24 to 78 yrs Mean age 44 yrs. All had history of contact with animals (cattle or rodents) 12 had deranged renal functions, 12 had headache, 10 had muscle pain, 9 were in second week of pyrexia Mean duration of pyrexia 7.5 days 7 had jaundice, 7 had pyrexia >39 degrees, 7 had conjunctival suffusion, 6 had meningism,
• Only 2 patients had borderline IgM ELISA – i.e. 15-20 u/ml,
• 11 had positive results – >20 u/ml and
• Mean levels of IgM was 34u/ml. • Two tested positive by PCR done at RMRC Port Blair. • All were treated with injection ceftriaxone for 714 days, • All recovered fully • Discharged with normal hepato renal functions.
• Total 7/13 patients had leptospirosis according to WHO’s Faine’s criteria, with a score of >25 • Using modified Faine’s criteria all 13 were positive with a score of >25. • Modified Faine’s criteria have been recently suggested especially in Indian context to diagnose the leptospira infection.
• Leptospirosis is an emerging zoonosis world wide • Being reported in many areas of SouthEast Asia now. • Till now not reported from Sub-Himalayan region of North India. • We present the profile of 13 Leptospira Positive patients (IgM Elisa or PCR).
• All patients presenting in Indira Gandhi Medical College during three months from 1st August to 31st October,2008 who positive for leptospirosis were included. • Their presenting complaints, examination findings, and lab findings were recorded and analyzed based on the Faine’s criteria and modified Faine’s criteria.
Following were noted • • • • • • • • • • • • •
Presenting complaints, Age, Sex, Address, Duration of pyrexia, Degree of temperature rise, Conjunctival suffusion, Headache, Meningisms, Myalgias, Jaundice, Contact with animals or flood water, Titre of IgM for leptospira.
No
Name
Duration Of pyrexia Days (2)
Temp >39* (2)
Conj Suffusion (4)
Meningism (4)
Muscle Pain (4)
Head ache (2)
Urea proteinuria mg% (2)
Jaundice (1)
Contact With animals (10)
IgM Titre (15)
Faine’s Criteria Score WHO
Faine’s Criteria Score Modified
1
Meera 42/F
4
+
+
+
+
+
140
+
+
27
41
56
2
Rajni 32/F
7
-
+
-
+
-
99
+
+
32
23
38
3
Parwati 35/F
6
+
-
+
-
+
60
-
+
24
22
37
4
SainKali 56/F
10
-
+
+
+
+
205
-
+
26
38
53
5
Babli 35/F
10
+
+
+
+
+
175
+
+
80
41
56
6
Leela Devi 52/F
10
+
-
+
+
+
80
+
+
45
27
42
7
Jodhi Ram 78/M
7
-
-
+
-
+
144
-
+
56
20
35
8
Keshav 24/M
9
+
+
-
-
+
134
+
+
23
23
38
9
Ramesh 35/M
6
-
-
-
+
+
86
-
+
22
20
35
10
Savitri 42/F
8
-
+
-
+
+
241
+
+
16
25
25
11
Anupama 40/F
5
+
-
-
+
+
28
+
+
18
21
35
12
Sundla 69/F
8
+
-
+
+
+
57
-
+
80
26
41
13
Savitri 40/F
10
+
+
-
+
+
294
+
+
25
29
44
• • • • • • • • • • • • •
Total number of patients 13. 3 males &10 females. The age range 24 to 78 yrs Mean age 44 yrs. All had history of contact with animals (cattle or rodents) 12 had deranged renal functions, 12 had headache, 10 had muscle pain, 9 were in second week of pyrexia Mean duration of pyrexia 7.5 days 7 had jaundice, 7 had pyrexia >39 degrees, 7 had conjunctival suffusion, 6 had meningism,
• Only 2 patients had borderline IgM ELISA – i.e. 15-20 u/ml,
• 11 had positive results – >20 u/ml and
• Mean levels of IgM was 34u/ml. • Two tested positive by PCR done at RMRC Port Blair. • All were treated with injection ceftriaxone for 714 days, • All recovered fully • Discharged with normal hepato renal functions.
• Total 7/13 patients had leptospirosis according to WHO’s Faine’s criteria, with a score of >25 • Using modified Faine’s criteria all 13 were positive with a score of >25. • Modified Faine’s criteria have been recently suggested especially in Indian context to diagnose the leptospira infection.
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