Abstract
Leptospirosis, a disease transmitted from animals to
humans, carries the risk of deadly outcomes, but it is significantly
underreported in Uttar Pradesh because of scarce resources for diagnosis. It
usually impacts people living in developing nations where housing and
sanitation are substandard, with rodents being the primary source of the
disease. The ways it shows up in patients vary significantly, spanning from a
minor fever to Weil’s disease, which causes multiple organs to malfunction.
We are sharing details of the first verified instance of
Weil’s disease tied to leptospirosis, accompanied by AKI needing dialysis,
found in Gorakhpur, Eastern Uttar Pradesh(UP) India, involving a 60-year-old man also from
Gorakhpur, Eastern Uttar Pradesh, who had a severe case of leptospirosis made
worse by acute kidney injury (AKI) that required dialysis. This instance
emphasizes how vital it is to quickly suspect the illness, promptly commence
antibiotic treatment, and provide supportive kidney treatments to achieve better
results where resources are constrained.
Keywords: Acute kidney injury (AKI), Eastern Uttar Pradesh (U.P.)
Introduction
Leptospirosis, a sickness caused by the Leptospira
spirochete germ, typically needs 7–13 days to start growing, although this time
frame can range from 2–20 days[i].
It spreads either by directly touching the pee of sick animals or via dirty
water or ground, with rats being the main cause of the illness [[ii] [iii]]. Even though Eastern Uttar Pradesh (UP) has the correct
setting for this sickness to live, there is not enough information shared about
it [[iv] [v] [vi]].
The reason for the lack of reporting could be because of not knowing enough
about it, not thinking about it enough when looking at patients, and not having
enough ways to test for it. The sickness can show itself in different ways,
from a slight temperature to serious problems that impact the liver, kidneys,
lungs, and brain [[vii]].
It is still difficult to know if someone has leptospirosis and not the other
sicknesses in India like malaria, dengue, viral hepatitis, and typhoid [viii]. Even though Eastern Uttar Pradesh (UP) has the correct
setting for this sickness to live, there is not enough information shared about
it [[iv] [v] [vi]].
The reason for the lack of reporting could be because of not knowing enough
about it, not thinking about it enough when looking at patients, and not having
enough ways to test for it. The sickness can show itself in different ways,
from a slight temperature to serious problems that impact the liver, kidneys,
lungs, and brain [[vii]].
It is still difficult to know if someone has leptospirosis and not the other
sicknesses in India like malaria, dengue, viral hepatitis, and typhoid [[viii]]
Even though Eastern Uttar Pradesh (UP) has the correct
setting for this sickness to live, there is not enough information shared about
it [[iv] [v] [vi]].
The reason for the lack of reporting could be because of not knowing enough
about it, not thinking about it enough when looking at patients, and not having
enough ways to test for it. The sickness can show itself in different ways,
from a slight temperature to serious problems that impact the liver, kidneys,
lungs, and brain [[vii]].
It is still difficult to know if someone has leptospirosis and not the other
sicknesses in India like malaria, dengue, viral hepatitis, and typhoid [[viii]]
Case Report
A 60-year-old man, whose prior health history was
unremarkable, came to the hospital suffering from two weeks of fevers
that came and went, as well as changes in his level of consciousness over the
course of three days. Upon his arrival at the hospital on October 9, 2025, it
was clear that he had jaundice throughout his body, seemed confused, and
appeared to be neglecting his personal hygiene. His vital signs revealed a
blood pressure reading of 122/84 mmHg, and his heart rate was measured at 108
beats per minute, with a regular rhythm. Initial testing of his blood showed a
hemoglobin level of 12.5 g/dL, a total white blood cell count of 7,000/μL, a
platelet count of 1.25 × 10⁵/μL, a blood urea nitrogen level of
158 mg/dL, a creatinine level of 3.5 mg/dL, an ALT level of 68 IU/L, an AST
level of 103 IU/L, an albumin level of 3.1 g/dL, and a total bilirubin level of
7.3 mg/dL (with direct bilirubin at 5.6 mg/dL). Tests for viral infections
(HIV, HBV, HCV), dengue fever (NS1/IgM), malaria, and typhoid fever all came
back negative. Without waiting for specific test results, the patient was
given intravenous ceftriaxone at a dose of 1 gram twice a day, in addition to
general supportive care, which included intravenous fluids and pantoprazole.
Over the subsequent three days, his kidney and liver function got worse, with
his BUN increasing to 210 mg/dL, creatinine rising to 5.91 mg/dL, total
bilirubin climbing to 8.5 mg/dL (direct bilirubin exceeding 7.1 mg/dL), and
platelets decreasing to 100 × 10³/μL. Given the doctors' suspicion based on the patient's symptoms,
a test for IgM Leptospira antibodies was ordered, which came back positive;
however, MAT/PCR testing was not an option at that hospital. Based on this
finding, intravenous doxycycline was started at a dose of 100 mg twice a day. As the patient started to show signs of uremia, he
underwent one session of hemodialysis. In the days that followed, there was a
steady improvement in both his liver and kidney functions. By the ninth day of
his hospital stay (September 19, 2025), his lab results showed a BUN of 68
mg/dL, creatinine of 0.8 mg/dL, total bilirubin of 3.6 mg/dL (direct bilirubin
of 2.8 mg/dL), and platelets of 3.8 × 10⁵/μl, with AST and ALT decreasing to 42
IU/L and 48 IU/L, respectively. When he was discharged, the patient's condition
was stable. In conclusion, this patient was admitted with a sudden
onset of fever, complicated by jaundice, acute kidney injury, and changes in
his mental state. The presence of IgM Leptospira antibodies confirmed the
diagnosis, and the timely administration of doxycycline, along with supportive
treatment and hemodialysis, resulted in a quick improvement in his clinical
condition and lab values.
Laboratory Trends
|
Parameter
|
Day 1
|
Day 4
|
Day 7
|
Discharge
(Day 9)
|
|
Hb / TLC / PLT (g/dL
/ µL / ×10⁵)
|
12.5 / 7000
/ 1.25
|
12.0 / 6800
/ 1.40
|
11.9 / 7400
/ 3.5
|
12.1 / 7600 /
3.8
|
|
AST / ALT (IU/L)
|
103 / 68
|
88 / 60
|
44 / 50
|
42 / 48
|
|
Na / K (mmol/L)
|
138 / 4.0
|
136 / 4.5
|
137 / 4.2
|
138 / 4.3
|
|
Bilirubin Total /
Direct (mg/dL)
|
7.3 / 5.6
|
8.5 / 7.1
|
5.8 / 4.4
|
3.6 / 2.8
|
|
BUN / Creatinine
(mg/dL)
|
158 / 3.5
|
210 / 5.91
|
98 / 2.4
|
68 / 0.8
|
Discussion
This case underscores the importance of maintaining a high
index of suspicion for leptospirosis in patients presenting with fever,
jaundice, and acute kidney injury, as early recognition is critical for timely
intervention. Although the patient developed severe renal dysfunction requiring
dialysis, the condition was reversible with prompt initiation of appropriate
antimicrobial therapy and supportive care. Differentiating leptospirosis from
other common tropical infections such as dengue, malaria, and viral hepatitis
is essential to guide targeted management and prevent treatment delays.
Furthermore, limited diagnostic facilities and low disease awareness in Eastern
Uttar Pradesh continue to hinder early detection, leading to under-recognition
of cases. Strengthening diagnostic access and clinician awareness can play a
pivotal role in improving patient outcomes in this region
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