Leptospirosis in the Seychelles.
OBJECTIVE: To ascertain the incidence of leptospirosis in the Seychelles, identify its sources, review diagnostic features and assess complications. DESIGN: A prospective survey over a two-year period 1988-1990 of all cases diagnosed as having leptospirosis at Victoria Hospital, the main referral hospital for the Islands. RESULTS: Eighty cases were diagnosed on clinical grounds with serological confirmation in 58 (73%). Leptospira interrogans serovar icterohaemorrhagiae was identified in 27 (33%) and serovar autumnalis in 2 (3%), there was broad cross-reactivity in the other specimens. In a further 7 (9%), the diagnosis was confirmed at autopsy. Useful diagnostic aids were the finding of myalgia in 68 (85%) and a raised creatine phosphokinase (CPK) level in 61 (76%). CPK elevation was found to be a more reliable indicator of disease the earlier in the illness it was measured. Other important clinical signs are reviewed. Sixty (76%) were regular drinkers suggesting a relationship with home-brewed alcohol, 48 (60%) were in at-risk occupations; 13 (16%) deaths resulted. CONCLUSIONS: Leptospirosis in the Seychelles is likely to be rat borne. An annual incidence of 60 per 100,000 was found with significant mortality. Muscle tenderness and raised CPK levels were the most reliable early diagnostic aids.