Lymphopenia is observed regularly in the acute (leptospiraemic) phase but not the immune phase of leptospirosis

Serial Changes in Complete Blood Counts in Patients with Leptospirosis: Our Experience

INTRODUCTION

Leptospirosis is an infectious disease caused by Leptospira interrogans. It is endemic in many parts of the world. The symptoms vary between milder forms to severe type with organ dysfunction. The disease presents with diagnostic challenge as it clinically mimics acute febrile illness due to other causes.

AIM

To study serial changes in complete blood counts in patients with leptospirosis.

MATERIALS AND METHODS

A retrospectively collected data was prospectively studied for clinical and laboratory data of leptospirosis patients proven by raised IgM titres by ELISA on day 2 (counted from day of admission of patient to hospital) of unexplained fever. The changes in complete blood counts from admission upto the discharge of the patient were studied. SPSS version 13 (SPSS Inc. Chicago) was used for data analysis. The collected data was analysed using frequency, percentage, mean, median, standard deviation and Mann-Whitney test. A p-value less than 0.05 were considered significant.

RESULTS

Mean haemoglobin concentration showed a progressive decline (<12.5 gm/dl) from day 1 to day 7 in both mild and severe disease. Platelet counts were significantly low (p=0.002), (<1,50,000 cells/mm³) in severe disease and showed a declining trend as compared to mild disease. Total leukocyte counts were significantly higher (p=0.001), (>11,000 cells/m³) in patients with severe disease from day 4 to day 5 of the illness.

CONCLUSION

Complete blood count is a routine test done in the monitoring of patients with leptospirosis. Declining haemoglobin, marked thrombocytopenia and a normal to high total leukocyte count will help in early detection of severe disease and thus preventing mortality by timely management.

Severe leptospirosis complicated by Epstein-Barr Virus reactivation

INTRODUCTION

Weil's disease is a severe, potentially fatal illness following Leptospira interrogans infection. The reported case of a patient suffering from acute renal failure, jaundice, thrombocytopenia, rhabdomyolysis and encephalitis syndrome highlights the clinical challenge in reference to Weil syndrome complicated by Epstein-Barr Virus (EBV) reactivation.

MATERIALS AND METHODS

The diagnosis of leptospirosis was performed using four different diagnostic methods. Sera were analyzed with an in-house IgM and IgG enzyme-linked immunosorbent assay (ELISA) and indirect haemagglutination assay (IHA). Microscopic agglutination test (MAT) was done using 17 reference strains comprising 14 serogroups and 17 serovars. Polyvalent EBV-IgG analysis, EBV-IgG/IgM/IgA western blot analysis as well as quantitative EBV polymerase chain reaction (PCR) were performed.

RESULTS

Leptospira IHA showed an initial titer of 1:640 (cut-off 1:320), leptospiral IgG was negative, but IgM was positive. MAT was negative at that time for all 17 strains analyzed. One week later, leptospirosis IHA titer increased to 1:20,480. Leptospiral IgG was now positive, -IgM remained positive and urine was tested negative for leptospiral DNA. The MAT showed positive results for L. interrogans serovar Bataviae, serovar Copenhageni, serovar Pyrogenes and L. borgpetersenii serovar Serjoe. During follow-up examinations, both the leptospiral IgM and IgG remained positive and MAT showed positive results for L. interrogans of different serovars. EBV IgA immunoblot taken at admission was positive for VCA-p18, quantitative EBV-PCR showed an EBV viral load of 2.8E3 copies/ml indicating acute EBV-reactivation.

CONCLUSION

Leptospirosis represents a neglected and re-emerging disease which is difficult to diagnose since Leptospira-PCR from whole blood or urine is frequently negative in the case of early empiric antibiotic treatment. EBV-reactivation might represent a severe complication in Weil's disease which potentially aggravates clinical manifestations of leptospirosis including hepatitis, nephritis, and rhabdomyolysis. Thus, there might be a need for peripheral blood EBV-PCR and EBV blotting in patients suffering from complicated Weil syndrome, also in terms of the choice of antibiotic treatment.

Changes in full blood count parameters in leptospirosis: a prospective study

BACKGROUND

Leptospirosis presents diagnostic challenges to clinicians, in settings where other acute febrile illness are prevalent. The patterns of serial changes in haematological parameters in leptospirosis has not been evaluated previously.

METHODS

Clinical and laboratory data were collected prospectively from patients with leptospirosis in two hospitals in Sri Lanka. Leptospirosis was diagnosed based on WHO clinical criteria with confirmation using Microscopic Agglutination Test titre > 400 or 4 fold rise between acute and convalescent samples. Full blood count parameters were analysed up to the 14(th) day of illness.

RESULTS

Data from 201 patients with leptospirosis were available. Leukocyte counts and absolute neutrophil counts showed a decline over the first 5 days of illness, then rose until the end of the second week. On day 3 of fever, the majority (75%) had normal leukocyte counts, and by day 5, leukocytosis was seen only in 38.1%; leucopenia was an uncommon finding. Lymphopenia was seen in over half on day 5, declining to just under a quarter of patients by day 10. Platelets declined over the first 6 days and then gradually rose. Thrombocytopenia was seen in nearly three-fourths of patients by day 5. Haemoglobin and haematocrit levels declined over the course of illness. Total white cell and neutrophil counts were higher, and haemoglobin and haematorcrit were significantly lower, in patients with severe disease.

CONCLUSIONS

Neither leukocytosis nor lymphopenia were prominent features, while thrombocytopenia was seen during the 3(rd) to 5(th) day of illness, with dropping haemoglobin levels. Neutrophilia and low haemoglobin levels appear to predict severe disease. These findings may be of use to clinicians in differentiating leptospirosis from other acute infections like dengue, and could help in predicting severe leptospirosis.