Spectrum of Radiological Findings in Leptospirosis on Chest Radiograph and Ultrasonography-Study during Epidemics in South Gujarat Region of India

Abstract

Introduction: Leptospirosis is an acute generalised infectious disease caused by any of the group of spirochetes of the genus Leptospira. The disease can involve many organs mainly liver, central nervous system, kidneys, skeletal muscle, and lungs. Diagnosis can be done on the basis of epidemiological, clinical and laboratory features. As the disease has varied manifestations, it is frequently misdiagnosed even in areas of high prevalence. A delay in diagnosis can leads to severe form of disease and development of its complications. Aim: To find out involvement of thoracic and abdominal organs in each and every patient with the help of chest radiographs and Ultrasonography (USG) of abdomen and thorax. Also, to put together the radiological spectrum of pulmonary manifestations, and other system involvement in leptospirosis during epidemics in south Gujarat region and their role in early diagnosis and follow up of patients. Materials and Methods: Study was carried out for 3 years. Total 380 patients of suspected leptospirosis were referred during epidemic during months of July to October in year 2008, 2009 and 2010 for confirmation of diagnosis and management. Total 275 patients were confirmed for leptospirosis by serological test (ELISA) during first and second week of illness which was included in our study. All 275 patients were evaluated with chest radiographs and ultrasound of chest and abdomen. Those patients which are clinically suspected for leptospirosis but were serologically negative were excluded. Results: Out of 275 confirmed patients of leptospirosis, 54 patients had signs of pulmonary haemorrhage on chest radiograph (19.65%). Out of these 54 patients 50 (which accounts 92% of pulmonary hemorrhage patients and 18% of total 275 patients) died due to severe pulmonary haemorrhage and respiratory distress. Pleural effusion was diagnosed on X-ray chest in 10 patients but it was found in 68 patients on USG. Signs of acute renal disease were found on USG of abdomen in 124 patients (45%). Hepatic involvement was found in 192 patients while 68 patients had multi organ involvement (24.7%). Changes of acute pancreatitis were noted in 11 patients while 16 patients had pericardial effusion and 198 patients had ascites. Conclusion: Chest radiograph and USG study of each and every patient suspected of leptospirosis has got definite role in confirming different organ involvement and thus helps us in early diagnosis, planning treatment and for judgement of prognosis. As it is non-invasive and easily available procedure, it is also helpful for follow-up after treatment.

Keywords

• Acute pancreatitis
• Pericardial effusion
• Pulmonary haemorrhage
• Respiratory distress