Leptospirosis - Clinical and Echocardiographic Study

BACKGROUND Leptospirosis is a worldwide zoonosis. It has a wide range of clinical symptoms ranging from asymptomatic subclinical infection to life-threatening multi-organ dysfunction. Among cardiac manifestations, myocarditis carries utmost importance as it is associated with poor outcomes in terms of morbidity and mortality. Definitive diagnosis of myocarditis by endomyocardial biopsy is difficult to popularize taking economic cost and operational complexity. We chose echocardiography as the imaging diagnosis method of myocarditis rather than cardiovascular magnetic resonance. Diagnosis of myocarditis arrived by using ECG, Echo and Cardiac enzymes. We wanted to estimate the proportion of cardiac involvement by clinical, electrocardiographical, serological and echocardiographical evaluation of patients with leptospirosis admitted in the Medicine department of Govt. Medical College, Thiruvananthapuram and the association of thrombocytopenia among patients with cardiac involvement. METHODS After obtaining institutional approval, 138 leptospirosis patients were enrolled for this study. Patients were interviewed and blood samples were taken for estimation of platelet count and cardiac enzymes. Electrocardiogram and echocardiogram were done, data entered in to excel sheet and analyzed using SPSS. RESULTS In this study out of 138 patients, 11.6 % were having myocarditis as tested by using a combination of cardiac enzymes, ECG, Echo. Twelve percent of patients had echo findings suggestive of myocarditis. Mean platelet counts in patients with myocarditis were below 50000. CONCLUSIONS Cardiac involvement is a serious manifestation occurring in leptospirosis. Besides cardiac MRI, echocardiogram serves as a useful imaging modality in the diagnosis of myocarditis. An electrocardiogram is the most sensitive investigation for the identification of myocarditis. KEY WORDS Leptospirosis, Myocarditis, Echo, ECG, Cardiac Enzymes, Cardiac Involvement.