Verbal autopsy of probable leptospirosis deaths in a tertiary care centre in North Kerala

Abstract

Leptospirosis is a significant zoonosis in India, especially in southern regions, where it causes substantial morbidity and mortality. Verbal autopsy is a structured interview used to determine probable cause of death from caregivers or next of kin. Objectives were to identify factors associated with fatality among probable leptospirosis patients admitted to a tertiary centre in North Kerala. A hospital-based descriptive study was conducted at Government Medical College Kannur. Twelve probable leptospirosis deaths reported between January and December 2024 were included. Case records and telephonic interviews with relatives were used to collect data on disease course. Mean age of the deceased was 49.88±11.6 years, with male predominance (75%) and most being agricultural workers (58.3%). Chronic alcoholism was present in 50%, while 91.7% had no prior comorbidities. Common features were fever (100%), myalgia (58.3%), and reduced urine output (41.7%). Liver derangement occurred in all cases and renal impairment in 66.7%. Mean patient delay was 2.1 days; diagnostic and treatment delays were 0.9 days each. Although doxycycline prophylaxis was issued to 50%, none had taken it. Sepsis/ multiorgan dysfunction syndrome (MODS) (58.3%) and cardiac complications (41.7%) were leading causes of death. Most fatalities occurred in the economically productive age group (40-60 years). Deaths happened despite early diagnosis, treatment, and few pre-existing comorbidities, suggesting rapid progression to multi-organ failure. High occupational exposure among agricultural workers, chronic alcoholism, and poor prophylaxis adherence were present. These findings suggest the need for improved public health awareness and preventive strategies for high-risk populations.