Different clinical profile of leptospirosis in a tertiary care Indian hospital: A Himalayan experience.

Background: Leptospirosis is a globally prevalent zoonotic disease with a significant burden in tropical and subtropical regions, including India. Despite its high fatality rate and endemic nature, the disease remains underreported in many areas, particularly in Northern India.

Aim: To analyze the demography, clinical presentation, complications, and mortality risk factors in presumptive leptospirosis patients admitted to a tertiary care hospital over the last 7 years from the Himalayan and Sub-Himalayan regions of Northern India.

Methods: A retrospective analysis was conducted on hospital records of patients admitted with leptospirosis at the All India Institute of Medical Sciences, Rishikesh, between January 2018 and December 2024. Diagnosis was based on the Modified Faine's Criteria and laboratory confirmation via IgM enzyme-linked immunosorbent assay (ELISA) and other diagnostic tests. Statistical analysis, including logistic regression, was performed to determine mortality predictors.

Results: A total of 62 patients were included in the study. The most common symptoms were fever (98.39%), myalgia (41.94%), and jaundice (20.97%). Thrombocytopenia was the most frequent complication, occurring in 72.58% of cases, followed by hepatic involvement (62.9%) and acute kidney injury (40.32%). Multiorgan dysfunction syndrome was present in 66.13% of cases, with 19.35% developing acute respiratory distress syndrome (ARDS). The overall mortality rate was 20.97%, with a higher but non-significant mortality trend in the Himalayan region (35% vs 14.29%, P = 0.094). Logistic regression analysis revealed that no categorical predictor alone was statistically significant. However, ARDS had a high odds ratio (OR = 2.10), suggesting clinical importance despite variability. Jaundice (OR = 2.28, P = 0.383) and creatinine levels (OR = 2.12, P = 0.1029) showed a possible trend toward increased mortality, despite statistical variability. Higher international normalized ratio levels (OR = 0.33, P = 0.0662) were suggestive of a protective effect.

Conclusion: Leptospirosis remains a severe and often fatal disease in Himalayan and sub-Himalayan regions, particularly in hilly areas, where underreporting and delayed diagnosis contribute to poor outcomes. Mortality was highest (33.33%) in cases with multiorgan involvement, particularly affecting the liver, kidneys, and lungs. We did not identify any statistically significant mortality predictors. Although the study did not assess the impact of timely diagnosis, improving healthcare accessibility in hilly regions may facilitate earlier detection and intervention, potentially reducing mortality.