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BACKGROUND: Leptospirosis is the most widespread zoonosis in the world. It can manifest
inmany ways ranging from a mild febrile illness of short duration to a severe infection with jaundice
and renal failure. It is caused by many strains of leptospira. Rarely other organs such as lungs, gall
bladder, brain and ophthalmic fissures are involved mainly due to vacuitis1.
Cardiac involvement in Leptospirosis: An analysis of data of 50 patients with serologically
provenleptospirosis demonstrated that 70% of the patients had electrocardiographic abnormalities,
with atrial fibrillation being the commonest major arrhythmia noted2.
Thirty-six percent of the patients had conduction system abnormalities and 30% had T wave
changes. Another series has reported AV block in 44% of patients with leptospirosis3. A glycoprotein
fraction of leptospiral cell wall has been incriminated in the pathogenesis of these rhythm
disturbances. This protein is thought to inhibit the Na-K ATPase and may be responsible for the
arrhythmia. Univariate analysis has shown that cardiac arrhythmia is more common in patients
dying of leptospirosis than in the survivors. Other reported cardiac abnormalities include
myocarditis and pericarditis4. In seven cases of fatal leptospirosis, petechial hemorrhages were
found in the heart and the pericardium in all the autopsy specimens and interstitial myocarditis was
found in five specimens. In another study, acute coronary arteritis was found in 70% of patients who
died of leptospirosis and evidence of aortitis was present in more than half5. One case of leptospira
endocarditis, possibly caused by serovarIcterohaemorrhagiae has been reported in literature.
Infective endocarditis can also be caused by rare germs6.
Keywords: Leptospirosis, Infective endocarditis, Negative blood culture.