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Leptospirosis and its co-infections in India: prevalence, geographic distribution, and clinical implications

Gloris Joseph1, Shrivathsa Kulavalli1, Sabine Bélard2,3

  • 1Department of Infectious Diseases, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.

BMC Infectious Diseases
|June 26, 2026
PubMed
Abstract

Insights

Coinfections with leptospirosis, such as dengue and hepatitis E, are common in India and lead to worse outcomes. Early diagnosis and treatment of febrile patients are crucial for improving survival rates.

Area of Science:

  • Infectious Diseases
  • Public Health
  • Epidemiology

Background:

  • Leptospirosis is a significant zoonotic disease in tropical regions, often co-occurring with other endemic infections.
  • Limited data exists on the frequency, symptoms, and mortality associated with leptospirosis coinfections in India.
  • This study addresses the knowledge gap regarding coinfections in Indian leptospirosis patients.

Purpose of the Study:

  • To determine the frequency and geographical distribution of coinfections in patients diagnosed with leptospirosis in India.
  • To identify common coinfecting pathogens and their clinical presentations.
  • To assess the impact of coinfections on patient outcomes and mortality.

Main Methods:

  • A systematic literature search was conducted across major databases (Scopus, PubMed, Embase, Web of Science) for studies published between January 2010 and August 2024.
  • Eligible studies reporting on coinfections in leptospirosis patients in India were selected for full-text data extraction.
  • A standardized methodology was employed for data evaluation and synthesis.

Main Results:

  • Out of 804 screened articles, 39 studies were included, analyzing 1565 leptospirosis cases, with 236 (15.1%) having coinfections.
  • Observational studies identified 113 coinfections (8.6%) among 1318 leptospirosis cases, most frequently dengue (69.9%), hepatitis E (13.2%), typhoid (7.9%), and malaria (7.9%).
  • New Delhi, Kerala, and Karnataka reported the highest coinfection rates. Common symptoms included fever, vomiting, icterus, and thrombocytopenia. Coinfections were linked to poorer outcomes and increased mortality.

Conclusions:

  • Leptospirosis coinfections with dengue, hepatitis E, malaria, typhoid, and scrub typhus are prevalent in India, complicating diagnosis due to overlapping symptoms.
  • These coinfections are associated with severe outcomes, including multi-organ dysfunction and higher mortality rates.
  • Prompt diagnostic testing for febrile illnesses and timely, appropriate treatment are vital for improving patient prognoses.
Keywords:
Acute febrile illness (AFI)Co-infectionsLeptospirosisPrevalence

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