Cardiovascular lesions in leptospirosis: an autopsy study.

OBJECTIVES: Leptospiral involvement of the cardiovascular system often remains an under-estimated critical clinical factor. This report studied the cardiovascular changes in fatal cases of leptospirosis in Mumbai city, India in the year 2005.

METHODS: This is a year's retrospective study of autopsied cases of leptospirosis, selected on the basis of clinical criteria. The demographic details, clinical presentation, and investigations were noted. Detailed gross examination of the cardiovascular system was carried out and multiple sections were taken.

RESULTS: Forty-four cases of leptospirosis in the year 2005 formed 3.52% of the autopsies performed. The highest number of cases (25 patients) was seen in the month of August that corresponded to the deluge on the 26th of July. The majority (86%) were adults; all presented as acute febrile illness that terminated with severe respiratory insufficiency. Involvement of the cardiovascular system was found in 41 cases, an incidence of 93.2%. Clinical evidence of cardiac affection was not noted in most. Gross cardiac features noted were cardiomegaly and petechiae in one or more layers. The predominant feature on histopathological examination was the presence of interstitial myocarditis (100% of cases), with involvement of the epicardium/endocardium (39%), valves (36%), coronary arteries (51%) and aorta (56%).

CONCLUSIONS: Correlating the autopsy, leptospirosis can be visualized as an infective systemic vasculitis. The unusual manifestation of pulmonary hemorrhagic syndrome in these cases camouflaged the cardiovascular involvement.