Dr Maongwati
Jaundice is a presenting symptom of many diseases. It is only a symptom and not a disease. Jaundice could be due to viral hepatitis, obstruction of the bile duct, malaria, alcoholic liver disease, destruction of RBCs (haemolytic anemia), and various liver infections and injuries. We have already highlighted earlier in an article of how jaundice could be a very common presentation of malaria. Viral hepatitis is a common cause of jaundice especially during summer months. Recently we have seen many cases of jaundice associated with high fever, severe myalgia (muscle pain), headache and kidney involvement in the form of decreased urine output and renal dysfunction. Some were associated with skin rashes, lymph node enlargement, redness of eyes. Since malaria is endemic in Dimapur, we started treating such patients with antimalarials. This is because in the recent past we came across lots of cases of malarial fever presenting with jaundice, severe headache, myalgia and renal involvement. But all these patients were tested negative for malarial parasite as well as viral markers for hepatitis. Instead, many patients deteriorated on antimalarial treatment. Keeping in mind “Leptospirosis” as one of the differential diagnosis, we started treating such patients with antibiotics like Ampicillin, Penicillin and Doxycycline. To our pleasant surprise patients started responding and two patients who became unconscious could be saved with the use of these antibiotics. It was an eye opener and we looked for a test to confirm the diagnosis. Our effort was rewarded when we sent our first blood sample to Mumbai which confirmed the disease – “Leptospirosis”. Subsequently four more samples were tested positive for leptospirosis.
We, at Zion Hospital have seen altogether about 15 such clinically suspicious cases of leptospirosis. Almost all the cases had jaundice with Bilirubin ranging from 2.8mg% -39mg%. Many had renal failure with blood urea as high as 181mg%. Three patients had loss of consciousness. Two patients had altered sensorium. Liver function was deranged in 80-90% of patients. The peculiar finding was the liver enzymes SGOT /SGPT were raised modestly, but serum Alkaline phosphatase was raised 3-5 times the normal value in many cases. Only after the blood tests confirmed our suspicion, did we realise that we are indeed dealing with this not very uncommon disease – “Leptospirosis”. We are sharing our experience only to make our patients more aware of other causes of jaundice. Otherwise some may be still seeking a cure for jaundice with the “Kobiras” trying to wash their jaundice, in the process delaying the treatment which may cost them their lives. Secondly, we also want to share with our esteemed colleagues this experience of ours so that we can put our heads together to keep our options open when dealing with a case of jaundice not responding to antimalarials/when MP is negative and viral markers are negative.
About Leptospirosis :-
Leptospirosis is a bacterial disease that affects humans and animals alike. It is caused by the bacteria – “leptospira interrogans”. It infects the humans on exposure to water contaminated with the urine of infected animals. Leptospira can be carried by cattle, pigs, dogs, rodents (rats) and wild animals. Humans get infected through water, food or soil contaminated by animal urine. It may happen by swallowing contaminated water, food or through skin and mucous membrane. Once infected, patients develop symptoms of high fever, severe headache, chills, muscle-ache, vomiting, jaundice, red eyes, abdominal pain and skin rashes. Patients may develop even kidney failure, meningitis and liver failure if left untreated. After exposure, humans can become sick from 2 days upto 4 weeks. Illness may last upto 3–4 weeks. Generally it is treated with antibiotics like Ampicillin, Penicillin and doxycycline. To prevent Leptospirosis one has to avoid swimming or wading in water that may be infected with animal urine, minimize contact with muddy/marshy water. Drink only boiled water. If any symptoms of leptospirosis is suspected, report to your local doctor for confirmation and treatment.
Zion Hospital Research Wing
Dimapur
