Prevalence of leptospira in acute hepatitis syndrome and assessment of IL-8 and TNF-alpha level in leptospiral hepatitis

Abstract

To study the prevalence of leptospira in acute hepatitis syndrome and to assess interleukin (IL)-8 and tumour necrosis factor (TNF)-alpha levels in the pathogenesis of hepatitis due to leptospiral infection.

Two hundred and forty-seven consecutive cases with symptoms of acute hepatitis and 30 healthy controls were enrolled in the study and detailed clinical history was elicited from them. Enzyme-linked immunosorbent assays (ELISAs) for HAV, HBV, HCV and HEV were performed to rule out common viral aetiology of hepatitis. IgM antibodies to leptospira were detected by ELISA. IL-8 and TNF-alpha levels were estimated in leptospira-positive cases and healthy controls by ELISA.

Out of 247 cases of acute hepatitis, 46 (18·62%) were observed to be positive for IgM antibodies for leptospira. The mean age of these patients was 31·99±0·28 years (25 males and 21 females; M/F ratio: 1·19∶1). The mean ALT, AST and ASP were raised in the majority of patients. IL-8 was found to be elevated (130·81 pg/ml) in a large majority of cases 41/46, 89·1% (P<0·001). Patients with more severe symptoms were associated with higher levels of IL-8. One mortality was observed due to leptospira. Unpredictably, TNF-alpha level was largely suppressed (45·63 pg/ml) in most of the leptospira-positive patients in comparison with healthy controls.

Leptospira-induced hepatitis should be actively looked for in patients negative for A–E viral hepatitis. IL-8 appears to play an important role in the pathogenesis of leptospiral hepatitis. High TNF-alpha should alert clinicians for aggressive in hospital management of patients.

This work was supported by grants from Department of Science and Technology (DST), Ministry of Science and Technology, INDIA.