COMPARATIVE STUDY IN LEPTOSPIROSIS AND ACUTE VIRAL HEPATITIS

Retrospectively have been studied clinical signs and routine laboratory investigations of patients with leptospirosis (n1=94) and acute viral hepatitis (AVH) (n2=1705). The comparison of results in two groups have revealed significant differences in the frequency of acute onset in leptospirosis and AVH with fever (respectively in 100% and 58,01%; p<0,005); pains in calf muscles (in leptospirosis in 85,11%, in AVH have not been observed); headache (resp. in 68,08 and 18,96%; p<0,005); anorexia (resp. in 64,89 and 87,36%; p<0,005); lumbar pains (in leptospirosis in 40,43%, in AVH have not been observed); clay colored stool (resp. in 6,38 and 93,60%; p<0,005); heaviness in abdomen (resp. in 3,19 and 84,38%; p<0,005); hepatic tenderness (resp. in 41,49 and 76,63%; p<0,005); conjunctival injection only in leptospirosis (86,17%). Routine laboratory investigations have been demonstrated anemia, leucocytosis, granulocytosis, increased erythrocytes sedimentation rate (ESR) and thrombocytopenia significantly often in leptospirosis than in AVH (p<0,005). The comparison of results of liver biochemical investigations have been established increased serum bilirubin in leptospirosis and AVH (resp. in 75,00 and 93,60%; p<0,05); mildly increased aminotransferases activities in leptospirosis and extremely increased in AVH (p<0,005); increased creatinkynase in leptospirosis; increased fibrinogen level in leptospirosis (av. 6,74 g/L), normal to decreased in AVH (av. 3,01 g/L) (p<0,005). Nitrogen parameters have been increased in leptospirosis with ARF.

Leptospirosis at present is grossly underreported and a diagnostic dilemma because of its protean clinical manifestations.The spectrum of disease ranges from a mild inconsequential febrile illness to a severe fatal form presenting with multi organ failure conventionally called "Weil`s disease (1,3,6,14).The variability in the course of leptospirosis causes diagnostic problems with broad spectrum of diseases such as acute viral hepatitis (AVH), hemorrhagic fevers, dengue fever, typhoid fever, malaria, sepsis, etc (1,3,4,6,14,15).In our practice most often is needed to distinguish leptospirosis and AVH (2).AVH and leptospirosis have certain similarity in clinical symptoms and syndromes.Disorders in liver functions have been observed in both diseases; diagnostic problems are not rare (14,15).
The aim of this research is a comparison of leptospirosis and AVH purposed to establishment of significant differences which could play role as diagnostic criteria in clinical practice.

MATERIALS AND METHODS:
Retrospectively have been studied clinical signs and routine laboratory investigations of patients with leptospirosis (n1 = 94) and AVH (n2 = 1705) treated in Clinic of Infectious Diseases at University Hospital -Pleven, Bulgaria.

DISCUSSION:
Different etiology and pathogenesis of both diseases are in the ground of clinical differences.In leptospirosis generalized vasculitis is the major pathomorphological substrate which initiates multi organ disorders such as ARF, hemorrhagic syndrome, cardiovascular and pulmonary alterations (13).ARF is syndrome with greatest significance for severity of leptospirosis.In our research ARF has been presented in 38,30% of cases with leptospirosis.In AVH we have not observed severe ARF which is controversial with research of Montoliu et al. (1985) (9).Rhabdomyolysis causes muscular pains and contributes acute renal failure (7).Power marker for myocytic damage is creatinkynase which is elevated in leptospirosis (5,11,12).Liver disorders have been observed in both diseases but pathogenic mechanisms are different.In leptospirosis jaundice has complex genesiscentrilobular necrosis, microvascular liver disorders and cholestatic compound in absence of severe parenchymal injury which is frequently observed in AVH.ALF is rare complication in leptospirosis ( 4).These differences correlate with markedly different elevations of aminotransferases and characteristic for each disease changes in fibrinogen and prothrombin index (8,10,11,12).The host immune response involves specific for each disease mechanisms which could explain different changes in routine hemogram in leptospirosis and AVH.

CONCLUSION:
Same clinical signs with different frequency and severity in both diseases have been presented.Investigations of leucocytes, ESR and liver biochemical parameters have been revealed significant differences.Nitrogen parameters have been increased often in leptospirosis; in AVH only in severe cases with acute liver failure.

10.5272/jimab.2007131.25
. Routine laboratory investigations have been demonstrated: leucocytosis (61,29%) with neutrophilia and left shift have been found in leptospirosis and ESR is increased in 95,12% (average 57 mm per hour; up to 140).Leucocytes have been established in normal range with prevalence of mononuclear cells, normal erythrocytes sedimentation rate (ESR) in 31,30%, moderately increased in 35,08% and extremely increased ESR only in 9,27% of cases with AVH.Total bilirubin levels have been correlated with severity of both diseases with prevalence of direct bilirubin fraction.Average total bilirubin level in leptospirosis is 152,8 (in severe cases 281 ìmol/L); in severe AVH 340 ìmol/L.In leptospirosis the elevation of aminotransferases is mild to moderate and ASAT level is higher than ALAT (av.respectively 103 U/L and 94 U/L); increased aminotransferases activity have been correlate with severity of AVH (av. of ALAT ranges from 1730 to 3059 U/L) (p<0,005). DOI:

Table 1 .
Clinical syndromes in leptospirosis and acute viral hepatitis

Table 2 .
Clinical syndromes in leptospirosis and acute viral hepatitis

Table 3 .
Routine hemogram in leptospirosis and acute viral hepatitis