With the intensifying of the rain, the State is witnessing a surge in leptospirosis cases and deaths across various districts, making this one of the most vexing and lethal infectious diseases which claims a significant number of lives every year in Kerala.
What used to be a seasonal illness which spiked around monsoon is now reported throughout the year. But the mortality profile of the disease has shown a significant change, especially in the last three years, with the number of lives lost to leptospirosis climbing steeply.
In 2023, when confirmed and probable cases were put together, the State had reported 5,186 cases and 282 deaths. In 2024, the number of cases jumped to 5,980 and the deaths to 394.This year seems no different and as on November 18, 5,107 cases and 339 deaths have been recorded (including confirmed and probable).
The disease typically affects those in the low socio economic strata, whose livelihood/occupation puts them at continuous risk of exposure to contaminated water and soil, such as livestock farmers, manual labourers or gardeners.
“We find that construction workers — especially the migrant workers who are employed in the road works on the State’s highways — are at heightened risk of contracting leptospirosis as they are constantly in touch with soil. The proliferation of wayside eateries has increased the chances of soil contamination by rodents,” a Health official says.
Late diagnosis and rapid progression of the disease leading to a cascade of lethal complications like pulmonary haemorrhage and multi-organ failure is what makes leptospirosis highly fatal.
“Previously, patients showed signs of complications only by the second week of the illness.This clinical picture has been varying in recent times, with the patient developing complications suddenly and falling to an acute state within the first week itself,” he says.
That said, majority of the cases of leptospirosis is actually mild or sub-clinical and it is only in 5-10 % of the cases that the disease progresses rapidly, making the prognosis quite unpredictable
In the initial days, it is not easy to distinguish the clinical symptoms of leptospirosis from other tropical illnesses like dengue fever. It starts as fever and myalgia (body pain), so often, patients would self treat themselves with over-the-counter analgesics in the initial days and would seek medical care only when things go south.
“As per the State’s treatment protocol, doctors in the periphery are advised to maintain a high index of suspicion, if a patient presents with fever and myalgia and without any respiratory symptoms. If patient history reveals any epidemiological link, antibiotics should be started immediately without waiting for a diagnostic test,” doctors say.
Molecular diagnosis (PCR) has been introduced by the State for the early detection of leptospirosis, however, these tests are not widely available across districts.
When complications set in and the patient’s condition starts to deteriorate, intensive management and multidisciplinary support are crucial. However, secondary care hospitals often lack round-the-clock emergency management facilities which could lead to significant delays in accessing appropriate care, doctors point out.
The health system lays stress on integrated leptospirosis prevention and control with multi-sectoral involvement, environment surveillance and appropriate risk communication to people who are at high risk of contracting the disease, for whom doxycycline (antibiotic) prophylaxis can be protective against leptospirosis.
Published – November 20, 2025 08:42 pm IST
