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VOLUME 25 , ISSUE S2 ( May, 2021 ) > List of Articles


Leptospirosis in Intensive Care Unit

Niteen D Karnik, Aditi S Patankar

Citation Information :

DOI: 10.5005/jp-journals-10071-23852

License: CC BY-NC 4.0

Published Online: 01-05-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Tropical infections constitute 20 – 30% of intensive care unit (ICU) admissions in developing countries. Leptospirosis is a spectrum with mild form presenting as an acute febrile illness with jaundice, complicating in few as acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC), and multi-organ dysfunction syndrome (MODS). The poor prognostic markers are hemorrhagic ARDS, acute renal failure, DIC, severe metabolic acidosis, older age, chronic alcohol abuse, high SOFA score, and septic shock. The confirmatory diagnosis relies on antibody testing, such as microscopic agglutination test (MAT) and IgM ELISA, while the reverse transcription-polymerase chain reaction test being reserved for clinically suspected antibody negative cases. The spectrum of multi-organ involvement necessitates a complete hematological, biochemical workup, including electrocardiogram (ECG), chest X-ray, and two-dimensional echocardiography. Specific antimicrobial therapy consists of the following—benzylpenicillin, ceftriaxone, cefotaxime, and doxycycline. The reported mortality ranges from 6% to as high as 44%. Various ICU scores like SPiRO, THAI LEPTO score, and Faine's criteria have been useful in risk stratification. Optimizing intensive care treatment with appropriate antibiotics, lung protection ventilation strategies, strict fluid management, and if need be timely initiation of renal replacement therapy (RRT) helps in reducing mortality.

  1. Karnad DR, Richards GA, Silva GS, Amin P. Tropical diseases in the ICU: a syndromic approach to diagnosis and treatment. J Crit Care 2018;46:119–126. DOI: 10.1016/j.jcrc.2018.03.025.
  2. WHO|Leptospirosis Burden Epidemiology Reference Group (LERG). WHO 2013.
  3. Chawla V, Trivedi TH, Yeolekar ME. Epidemic of leptospirosis : an ICU experience (multiple letters). J Assoc Physicians India 2004;52:1010–1011. PMID: 15847354
  4. Ittyachen A, Krishnapillai T, Nair MC, Rajan AR. Retrospective study of severe cases of leptospirosis admitted in the intensive care unit. J Postgrad Med 2007;53(4):232. DOI: 10.4103/0022-3859.37510. Available from:
  5. Deodhar D, John M. Leptospirosis: experience at a tertiary care hospital in northern India. Natl Med J India 2011;24(2):78–80. PMID: 21668048
  6. Smith S, Liu YH, Carter A, Kennedy BJ, Dermedgoglou A, Poulgrain SS, et al. Severe leptospirosis in tropical Australia: Optimising intensive care unit management to reduce mortality. PLoS Negl Trop Dis 2019;13(12):e0007929. DOI: 10.1371/journal.pntd.0007929.
  7. Simi S, Jacob C, John TM, George K, Jayaprakash R. 1745 cardiac abnormalities in leptospirosis and prognostic significance of electro-cardiographic manifestations – a cross-sectional study from South-India. Open Forum Infect Dis 2014;1(suppl_1):S469–S470. DOI: 10.1093/ofid/ofu052.1291. Available from:
  8. Mathew T, Satishchandra P, Mahadevan A, Nagarathna S, Yasha TC, Chandramukhi A, et al. Neuroleptospirosis – revisited: experience from a tertiary care neurological centre from south India. Indian J Med Res 2006;124(2):155–162. Available from: PMID: 17015929
  9. Herath NJ, Kamburapola CJ, Agampodi SB. Severe leptospirosis and pancreatitis: a case series from a leptospirosis outbreak in Anuradhapura district, Sri Lanka. BMC Infect Dis 2016;16(1):644. DOI: 10.1186/s12879-016-2010-4. Available from:
  10. Shastri M, Diwanji N, Desai E, Chitara M, Bhatt A. Spectrum of radiological findings in leptospirosis on chest radiograph and ultrasonography-study during epidemics in south Gujarat region of India. Int J Anatomy 2017;6(4):2–7. DOI: 10.7860/IJARS/2017/26056:2306.
  11. Sethi S, Sharma N, Kakkar N, Taneja J, Chatterjee SS, Banga SS, et al. Increasing trends of leptospirosis in Northern India: a clinico-epidemiological study. PLoS Negl Trop Dis 2010;4(1):e579. DOI: 10.1371/journal.pntd.0000579.
  12. Ajjimarungsi A, Bhurayanontachai R, Chusri S. Clinical characteristics, outcomes and predictors of patients with leptospirosis admitted to medical intensive care unit: a retrospective review. medRxiv. DOI: 10.1101/2020.05.18.20105601.
  13. Smith S, Kennedy BJ, Dermedgoglou A, Poulgrain SS, Paavola MP, Minto TL, et al. A simple score to predict severe leptospirosis. Caimano MJ, editor. PLoS Negl Trop Dis 2019;13(2):e0007205. DOI: 10.1371/journal.pntd.0007205.
  14. Andrade L, Cleto S, Seguro AC. Door-to-dialysis time and daily hemodialysis in patients with leptospirosis: impact on mortality. Clin J Am Soc Nephrol 2007;2(4):739–744. DOI: 10.2215/CJN.00680207.
  15. Wiwanitkit V. Peritoneal dialysis in leptospirosis-induced acute renal failure: an appraisal on Thai patients. Ren Fail 2006;28(2):201. DOI: 10.1080/08860220500531302. Available from:
  16. De Francesco Daher E, Soares DS, de Menezes Fernandes ATB, Girão MMV, Sidrim PR, Pereira EDB, et al. Risk factors for intensive care unit admission in patients with severe leptospirosis: a comparative study according to patients’ severity. BMC Infect Dis 2016;16(1):40. DOI: 10.1186/s12879-016-1349-x.
  17. Alian S, Asghari H, Najafi N, Davoudi A, Yazdani J. Corticosteroid in the treatment of moderate to severe thrombocytopenia due to leptospirosis. Iran Red Crescent Med J 2014;16(10):16030. DOI: 10.5812/ircmj.16030. Available from:
  18. Trivedi SV, Chavda RK, Wadia PZ, Sheth V, Bhagade PN, Trivedi SP. The role of glucocorticoid pulse therapy in pulmonary involvement in leptospirosis. J Assoc Physicians India 2001;49:901–903. Available from: PMID: 11837758
  19. Shenoy V V., Nagar VS, Chowdhury AA, Bhalgat PS, Juvale NI. Pulmonary leptospirosis: an excellent response to bolus methylprednisolone. Postgrad Med J 2006;82(971):602–606. DOI: 10.1136/pgmj.2005.044255. Available from:
  20. Mittermaier M, Pickerodt P, Kurth F, de Jarcy LB, Uhrig A, Garcia C, et al. Evaluation of PEEP and prone positioning in early COVID-19 ARDS. EClinicalMedicine 2020;28:100579. DOI: 10.1016/j.eclinm.2020.100579. Available from:
  21. Meaudre E, Asencio Y, Montcriol A, Martinaud C, Graffin B, Palmier B, et al. Immunomodulation in severe leptospirosis with multiple organ failure: plasma exchange, intravenous immunoglobulin or corticosteroids? Ann Fr Anesth Reanim 2008;27(2):172–176 [French]. DOI: 10.1016/j.annfar.2007.10.034. PMID: 18155391.
  22. Delmas B, Jabot J, Chanareille P, Ferdynus C, Allyn J, Allou N, et al. Leptospirosis in ICU: a retrospective study of 134 consecutive admissions. Crit Care Med 2018;46(1):93–99. DOI: 10.1097/CCM.0000000000002825. Available from:
  23. Costa F, Hagan JE, Calcagno J, Kane M, Torgerson P, Martinez-Silveira MS, et al. Global morbidity and mortality of leptospirosis: a systematic review. PLoS Negl Trop Dis 2015;9(9):e0003898. DOI: 10.1371/journal.pntd.0003898. Available from:
  24. Miailhe AF, Mercier E, Maamar A, Lacherade JC, Le Thuaut A, Gaultier A, et al. Severe leptospirosis in non-tropical areas: a nationwide, multicentre, retrospective study in French ICUs. Intensive Care Med 2019;45(12):1763–1773. DOI: 10.1007/s00134-019-05808-6. Available from:
  25. Weeratunga PN, Fernando S, Sriharan S, Gunawardena M, Wijenayake S. Determinants of mortality and impact of therapy in patients with leptospirosis admitted for intensive care in a Sri Lankan hospital – a three year retrospective study. Pathog Glob Health 2015;109(8):387–394. DOI: 10.1080/20477724.2015.1126032. Available from:
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