Introduction:
Leptospirosis is a zoonosis, with the spirochaete Leptospira being transmitted to humans from rodents. While it was a common tropical infection seen during the monsoons in India, these days, we are seeing sporadic cases of leptospirosis in other periods of the year too. However, it is uncommon to see leptospirosis in the chronic dialysis population, owing to their passive lifestyle. We report a series of five cases of leptospirosis in the chronic dialysis patients in a single dialysis center in southern India.
Methods:
Between November 2023 and August 2024, we diagnosed five cases of leptospirosis in patients undergoing chronic hemodialysis in the dialysis unit of our institution in Southern part of India. The clinical profile of these cases are described.
Results:
There were four males and one female with age ranging between 37-74 years. Two belonged to urban areas and three from rural areas. Only one among these was an agriculturist. All patients presented with fever and gastrointestinal symptoms. Myalgia was seen in 80%. Laboratory evaluation uniformly revealed varying grades of hepatic dysfunction. Ig M antibodies for leptospira were detected in all. Two patients had significant hypotension and one developed atrial fibrillation. All were continued on regular haemodialysis and none required invasive ventilation. All patients responded to treatment with antibiotics, Amoxycillin/Clavulanic acid or Doxycycline.
Discussion: Contamination of water with rodent urine allows for the entry of leptospira into human hosts through ingestion or directly through skin via cuts and abrasions. Leptospirosis has not been reported in chronic dialysis patients in the literature so far, to the best of our knowledge. The source of leptospiral infection is obscure as these patients did not work in the fields and did not report the presence of rodents in their homes. Only one patient had farmlands, but he too was not active in the fields owing to his frailty. The disparity in size between the dialyzer pore size and the leptospiral dimensions precluded transmission through dialysis water. The cases occurred sporadically and thus transmission in the dialysis unit was not plausible.
Conclusions:
Conclusions: In tropical countries, leptospirosis should be considered as a differential diagnosis in febrile patients on chronic dialysis, even though they are generally not active in agricultural practices. Urban leptospirosis is also on the rise. During evaluation of fever in dialysis patients, subtle clues like myalgia disproportionate to fever should alert the clinicians to evaluate for this condition.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.