Leptospirosis in India: a systematic review and meta-analysis of clinical profile, treatment and outcomes

Introduction: Leptospirosis is a zoonotic bacterial infection with significant mortality and morbidity, especially in resource-limited settings. This systematic review aimed to study the clinical profile and outcome of patients with leptospirosis in India. Methodology: All articles up to 02.08.2022 were searched using the two databases, PubMed and Scopus. A total of 542 articles were found using the search terms related to ‘leptospirosis’ and ‘India’. After two rounds of screening, 55 articles were included. The data were collected on epidemiology, clinical features, laboratory features and treatment of patients with leptospirosis. Results: Most cases of leptospirosis were reported from the coastal belt. A large percentage of patients were identified as farmers, and exposure to rainfall was identified as an important risk factor. Fever was present in 97%, and conjunctival suffusion was present in 35% of cases. Haemoptysis, gastrointestinal bleeding, and haematuria were present in 5%, 5% and 12% of patients, respectively. Liver and kidney were involved in 34% and 35% of the patients, respectively. The aver-age haemoglobin, leucocyte count and platelet count across various studies ranged from 9.6-12.5 grams/ dl, 8.8-11.3 thousand/µl and 20-130 thousand/µl, re-spectively. Treatment details were sparsely available in some studies, with penicillin, ceftriaxone, and dox-ycycline used commonly. The pooled mortality across various studies was calculated as 11% [95% CI-8-15%, I²=93%, P<0.001]. Conclusions: Leptospirosis is associated with significant mortality in Indian settings. There is a need for studies focussing on treatment modalities.