title: Does leptospirosis behave adversely in cirrhosis of the liver?
abstract: OBJECTIVE
  Leptospirosis, endemic in India, is complicated by jaundice and renal failure. Whether leptospirosis could result in a worsening of preexisting chronic liver disease (CLD) is not known. Aim of the study was to analyze the clinical profile and natural course of leptospirosis in decompensated CLD in comparison to those acquiring the infection in an otherwise healthy individual.
  
  
  METHODS
  Cases were patients with liver cirrhosis who presented with fever and/or jaundice and were screened and found positive for leptospirosis. Controls were patients diagnosed to have leptospirosis during the same period, but in the absence of liver disease. Both cases and controls were followed up until recovery or death.
  
  
  RESULTS
  Thirty-one patients had cirrhosis of the liver, and 91 controls had leptospirosis. Significantly more number of cirrhotics had jaundice (87.1 % vs. 16.5 %; p = 0.001), elevated blood urea (41.9 % vs. 18.7 %; p = 0.01), and serum creatinine (41.9 % vs. 19.8 %; p = 0.03) compared to the controls. There were four deaths due to hepatorenal dysfunction and coagulopathy in cirrhotics and no deaths in the control group (4 vs. 0; p = 0.001).
  
  
  CONCLUSIONS
  Leptospirosis should be considered as yet another important cause of acute-on-chronic liver failure in endemic areas associated with poor outcome. Death is often due to hepatorenal dysfunction.
authors.affiliation: Department of Gastroenterology, Stanley Medical College and Hospital, Chennai, 600 001, India, aravindhsom@gmail.com.
authors.forename: Aravindh
authors.initials: A
authors.lastname: Somasundaram
authors.forename: Nattusamy
authors.initials: N
authors.lastname: Loganathan
authors.forename: Joy
authors.initials: J
authors.lastname: Varghese
authors.forename: Singh
authors.initials: S
authors.lastname: Shivakumar
authors.forename: Venkataraman
authors.initials: V
authors.lastname: Jayanthi
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003404:Creatinine / Q000097:blood; D019353:Endemic Diseases; D005260:Female; D005334:Fever; D006530:Hepatorenal Syndrome / Q000401:mortality; D006801:Humans; D007194:India; D007565:Jaundice / Q000097:blood; D007922:Leptospirosis / Q000150:complications* / Q000473:pathology; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D014508:Urea / Q000097:blood
chemical_list: D014508:Urea; D003404:Creatinine