Lessons from Leptospirosis Deaths in Sri Lanka, 2025: Findings from a National Secondary Data Analysis
Background: Leptospirosis is a globally important zoonotic disease and a leading cause of preventable mortality in Sri Lanka, with deaths driven by occupational and environmental exposure, delayed care-seeking, late clinical recognition and severe complications.
Methods: A descriptive secondary data analysis was conducted using the national leptospirosis death review database of the Epidemiology Unit, Ministry of Health, Sri Lanka. The analysis included 206 valid death records reported during 2025 through institutional death review forms.
Results: The median age was 53 years (IQR 41.5–61.5; range 16–84). Males accounted for 168/205 deaths (82.0%). The largest age group was 45–59 years (79/205, 38.5%). The highest numbers of deaths were reported from Kurunegala (34/206, 16.5%), Gampaha (19/206, 9.2%) and Rathnapura (16/206, 7.8%). Fever (155/198, 78.3%), headache (121/198, 61.1%), myalgia (115/198, 58.1%) and anuria/oliguria (93/198, 47.0%) were the most commonly documented features. Paddy field exposure was recorded in 68/206 (33.0%) of deaths. The median time from symptom onset to admission was 3 days, and the median time from symptom onset to death was 7 days. Among death review findings, late presentation or delayed treatment-seeking was the most frequent theme (75/87, 86.2%).
Conclusions: These findings highlight opportunities to reduce leptospirosis deaths in Sri Lanka through earlier detection, prompt evidence-based treatment supported by regular clinician training, targeted risk communication for high-risk populations, improved chemoprophylaxis uptake, timely referral, and strengthened access to critical care and renal support services.