Does leptospirosis behave adversely in cirrhosis of the liver?

Background and Aim Leptospirosis, endemic in India, is complicated by jaundice and renal failure. Whether leptospirosis could result in a worsening of preexisting chronic liver disease (CLD) is not known. Aim of the study was to analyze the clinical profile and natural course of leptospirosis in dec...

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Bibliographic Details
Published in:Indian journal of gastroenterology 2014-11, Vol.33 (6), p.512-516
Main Authors: Somasundaram, Aravindh, Loganathan, Nattusamy, Varghese, Joy, Shivakumar, Singh, Jayanthi, Venkataraman
Format: Article
Language:English
Subjects:
Adult
Case-Control Studies
Creatinine - blood
Endemic Diseases
Female
Fever
Gastroenterology
Hepatology
Hepatorenal Syndrome - mortality
Humans
India
Jaundice - blood
Leptospirosis - complications
Leptospirosis - pathology
Liver Cirrhosis - complications
Male
Medicine
Medicine & Public Health
Middle Aged
Original Article
Urea - blood
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Summary:Background and Aim Leptospirosis, endemic in India, is complicated by jaundice and renal failure. Whether leptospirosis could result in a worsening of preexisting chronic liver disease (CLD) is not known. Aim of the study was to analyze the clinical profile and natural course of leptospirosis in decompensated CLD in comparison to those acquiring the infection in an otherwise healthy individual. Methods Cases were patients with liver cirrhosis who presented with fever and/or jaundice and were screened and found positive for leptospirosis. Controls were patients diagnosed to have leptospirosis during the same period, but in the absence of liver disease. Both cases and controls were followed up until recovery or death. Results Thirty-one patients had cirrhosis of the liver, and 91 controls had leptospirosis. Significantly more number of cirrhotics had jaundice (87.1 % vs. 16.5 %; p  = 0.001), elevated blood urea (41.9 % vs. 18.7 %; p  = 0.01), and serum creatinine (41.9 % vs. 19.8 %; p  = 0.03) compared to the controls. There were four deaths due to hepatorenal dysfunction and coagulopathy in cirrhotics and no deaths in the control group (4 vs. 0; p  = 0.001). Conclusion Leptospirosis should be considered as yet another important cause of acute-on-chronic liver failure in endemic areas associated with poor outcome. Death is often due to hepatorenal dysfunction.
ISSN:0254-8860
0975-0711
DOI:10.1007/s12664-014-0500-0