Ocular Leptospirosis

Lack of Awareness Among Ophthalmologists and Challenges in Diagnosis

Rathinam R. Sivakumar


Curr Opin Ophthalmol. 2022;33(6):532-542. 

In This Article

Abstract and Introduction


Purpose of Review: Systemic leptospirosis exists worldwide. But leptospiral uveitis, an important late complication is not identified by ophthalmologists in several countries.

Recent Findings: In the last 18 months numerous publications, especially on epidemiology, surveillances, and novel rapid diagnostic kits to test at the point of care site on leptospirosis have been published from all over the world. However, publications from ophthalmologists are very scarce. Remarkably ophthalmologists should know the global burden of leptospirosis, prevalence of the disease in their country, demographic factors associated, risk factors, and systemic signs to elicit relevant history and travel history. They should be aware of recent advances in investigations to confirm their clinical diagnosis.

Summary: It is quite evident from this work that leptospirosis is prevalent worldwide. Ophthalmologists' awareness has to improve to identify the etiological diagnosis. They should have access to simple, less expensive, and less cumbersome laboratory tests.


Leptospirosis is a neglected, water borne, zoonotic, spirochetal disease. It has globally significant human morbidity and mortality.[1] The annual global burden is estimated to be 1.03 million cases and 59 800 fatalities[2] The estimated 1.03 million cases annually mark approximately 2.90 million disability-adjusted life years.[3] Although it is a potentially lethal disease involving animals and humans, it has no national surveillance systems and it is not even a notifiable disease in many countries.[1] On the contrary, it has numerous as well as varying clinical manifestations, clinician may easily miss the diagnosis.[4,5] A significant limiting factor is the lack of optimized laboratory investigations which show high sensitivity or specificity. In addition, they are unavailable in primary centers.[6] It can cause epidemic outbreaks after a rainy season.[5,7–9] It also remains endemic in economically challenged sectors like farmers, who cannot access tertiary care for etiological diagnosis. Hence, such endemic but life-threatening cases are often labeled as 'Idiopathic' in farmers.[10] It is a significant public health challenge affecting populations across the world and needs global attention. Ophthalmologists are not exempted; they too miss the ocular manifestations quite often. Leptospiral uveitis is a common late complication. Ophthalmologists need to know the global prevalence of the disease, pathogenesis, systemic manifestations, and available lab tests. Leptospiral uveitis is still named idiopathic, because of low awareness and lack of point-of-care diagnostic kits.