Leptospirosis: An emerging disease in cryptogenic hepatitis patients in north India

We assessed the role of occult HBV, leptospirosis, cytomegalovirus and Epstein-Barr virus in cryptogenic hepatitis cases.246 consecutive cases with symptoms of acute hepatitis were enrolled in the study with 30 healthy controls. ELISA for HAV, HBV, HCV and HEV were performed to rule out common viral etiology of hepatitis. Occult HBV was detected by amplification of HBV pre-core gene. IgM antibodies to leptospira, CMV and EBV were detected by ELISA.142 (57.7%) were HBV positive, 6 (2.43%) were HCV positive, 5 (2.03%) were positive for HAV and 3 (1.21%) were HEV positive. Two had occult HBV infection. 90 cases were labeled as cryptogenic. 46 (51%) of these were positive for leptospirosis, 8 (8.8%) were positive for CMV and 2 (2.2%) were positive for EBV. Mean age of these patients was 29.43years. Majority belonged to rural areas. Deranged liver functional test was observed in most of the cases. Leptospirosis emerged as a major cause of hepatitis apart from HBV in this region. It should be actively looked for during the preliminary work up of hepatitis cases so that it can be treated on time preventing significant morbidity. We recommend detection of leptospira in the preliminary work up itself in cryptogenic hepatitis if the clinical condition so merits.