Towards the Burden of Human Leptospirosis: Duration of Acute Illness and Occurrence of Post-Leptospirosis Symptoms of Patients in The Netherlands (original) (raw)
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Leptospirosis in the intensive care unit: a cohort of 57 patients
Critical Care - CRIT CARE, 2005
Introduction Community-acquired pneumonia remains a common condition worldwide. It is associated with significant morbidity and mortality. The aim of this study was to evaluate conditions that could predict a poor outcome. Design Retrospective analyse of 69 patients admitted to the ICU from 1996 to 2003. Demographic data included age, sex and medical history. Etiologic agents, multiorgan dysfunction, nosocomial infections, SAPS II and PORT scores were recorded for each patient. For statistical analysis we used a t test, chi-square test and Mann-Whitney U test on SPSS ® . A value of P less than 0.05 was considered significant. Results Forty-seven patients were male and 22 patients were female. Mean age was 52 years. Sixty-seven percent had serious pre-morbid conditions including pulmonary disease (34.8%), cardiac problems (36.2%), diabetes (13%) and chronic liver disease (5.8%); 40.6% were smokers, drug abusers or alcohol dependents. Sixtyeight patients required invasive mechanical ventilation. The average length of ventilation was 13.5 days, median 8 days. The mean SAPS II score was 40.14 and the mean PORT score was 141. The mortality rate was 27.5% (SAPS II estimated mortality, 35%). Complications reported were ARDS (40.6%), septic shock (34.8%), acute renal failure (2.9%), cardiac arrest (8.7%) and nosocomial infeccions (46.4%). Mortality rates were higher for previous hepatic (75%) and metabolic (33%) diseases. We found a close association between crude mortality and SAPS II score (P = 0.003) and development of complications (P = 0.0028). Respiratory dysfunction (P = 0.006) and septic shock (P = 0.022) were most significantly related to mortality. No significant differences were founded regarding age, comorbidities, PORT score, etiologic agents, nosocomial infections and length of invasive mechanical ventilation. Conclusions Previous hepatic chronic disease was strictly related to higher mortality as well as isolation of MRSA. ARDS and septic shock predicted a poor outcome. SAPS II score was the best severity indicator of mortality.
Journal of critical care, 2017
Leptospirosis is a zoonosis caused by a gram negative aerobic spirochete of the genus Leptospira. It is acquired by contact with urine or reproductive fluids from infected animals, or by inoculation from contaminated water or soil. The disease has a global distribution, mainly in tropical and subtropical regions that have a humid, rainy climate and is also common in travelers returning from these regions. Clinical suspicion is critical for the diagnosis and it should be included in the differential diagnosis of any patient with a febrile hepatorenal syndrome in, or returning from endemic regions. The leptospiremic phase occurs early and thereafter there is an immunologic phase in which the most severe form, Weil's disease, occurs. In the latter, multiple organ dysfunction predominates. The appropriate diagnostic test depends on the stage of the disease and consists of direct and indirect detection methods and cultures. Severely ill patients need to be monitored in an ICU with ap...
Transactions of the Royal Society of Tropical Medicine and Hygiene, 2014
Leptospirosis has a mortality rate of 5-20%. Poor prognostic factors are older age; oliguria; elevated potassium, creatinine and/or bilirubin levels; and altered mental status. We conducted this retrospective study to analyse the predictors of mortality among Indian patients with leptospirosis. Clinical, biochemical, demographic and treatment related data (time between onset of symptoms and commencement of leptospira specific antibiotics) of 101 leptospirosis patients were reviewed. Predictors identified by univariate analysis were analysed by multivariable Cox regression for survival analysis. Prominent clinical features were: fever (101/101, 100%), jaundice (62, 62.4%), vomiting (42, 41.6%), oliguria (35, 34.7%), cough (18, 17.8%) and dyspnoea (10, 10.0%). Common complications were acute kidney injury (22, 21.8%), cardiovascular collapse (13, 12.9%), haemorrhages (10, 10.0%), meningitis (7, 6.9%), acute respiratory distress syndrome and pancreatitis (5, 5.0% each). Seventeen patie...
2017
Background: Leptospirosis has a wide range of clinical presentation from mild to severe disease with organ dysfunctions and death. There are risk and prognostic factors for severity and mortality including demographic, epidemiological, clinical presentations and laboratory results. Early recognition of risk factors enables early ICU care and organ supports. Purpose: The study was conducted to identify the risk and prognostic factors for severe leptospirosis and its mortality. Methods: This was a retrospective case-control study carried out in the general ICU in Hospital Raja Perempuan Zainab II from 1st January 2013 to 31st December 2016. Patients who presented with severe organ involvement which required dialysis, tracheal intubation and mechanical ventilation, vasopressors or inotropes, transfusion or death were grouped as cases. Controls were defined as patient with mild organ involvement without requirement or with minimal organ supports. Chi-Square test, Fisher‘s exact test, St...
Impact of clinical and laboratory findings on prognosis in leptospirosis
Swiss medical weekly, 2004
OBJECTIVE The aim of this study was to evaluate epidemiological, clinical and laboratory features, and risk factors for mortality in leptospirosis. METHODS Seventy-two adult leptospirosis cases were reviewed. Categorical clinical and laboratory findings of survivors and non-survivors were assessed by Chi square analysis. Non-categorical findings were assessed by the student t test. Clinical findings and laboratory data with p <0.05 were assessed by stepwise logistic regression analysis for mortality. RESULTS Of all patients, mean age was 47.3 +/- 15.7 years, 82% were men and, 51% were farmers. Icterus occurred in 75%, and high fever was seen in 61 of the patients. The most frequently detected serotype was Leptospira icterohaemorrhagiae (30%). Overall mortality rate was 17%. In those non-survivors, altered mental status (p = 0.002), hepatomegaly (p = 0.037), haemorrhage (p = 0.019), ALT level (p = 0.008), AST level (p = 0.02), prolonged prothrombin time (p = 0.02) and increased se...
Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine, 2006
BACKGROUND Leptospirosis is a disease associated with meat and agricultural workers which is endemic in New Zealand and Australia. During 2003-2005, it resulted in 207 hospitalisations in New Zealand. Hawke's Bay had the highest regional incidence in 2004 and 2005. While admission to intensive care units with leptospirosis is not infrequent, no such cases have been described in the literature from New Zealand, and only five from Australia. METHODS A chart review of all patients admitted to the intensive care/high dependency unit of a regional hospital in New Zealand with a diagnosis of leptospirosis from June 1999 to May 2005. Admission features, progress and diagnostic tests were collated, and APACHE II score on admission and daily Sequential Organ Failure Assessment (SOFA) score were calculated. RESULTS 15 cases were identified; median age was 44 years (range, 27-62), and 13 were men. Myalgia, headache, nausea and vomiting were common; nine had conjunctival suffusion. Ten had ...
Journal of Travel Medicine, 1996
Leptospirosis is a zoonosis caused by a spirochete, Leptospiru infcrro,quns.The disease has a wide range of clinical manifestations, ranging from a mild febrile illness to classic Weils disease, which presents with jaundice, myalgia, acute renal failure, and tissue hemorrhage.Transmission usually occurs from contact with infected water surfaces. Recently, recreational activities such as hiking, swimming in lakes, biking through infected water, and hunting have been associated with the acquisition of this disease.This review describes the epidemiology, clinical manifestations, diagnostic methods, management, and prevention of this disease. Historic Background Leptospirosis was defined as a clinical disease in 1886 by Weil, who described a severe syndrome ofjaundice, myalgia, acute renal failure, and tissue hemorrhage.' In 1914, the spirochete was identified and the mode of transmission by the rat was elucidated by Inada and Ino.' In the past, leptospirosis has had several synonyms such as fish handler's disease, swamp fever, mouse fever, rice field fever, and Japanese autumnal fever.' Epidemiology Leptospirosis is a zoonotic disease that occurs with a worldwide distribution.4 The annual frequency in the United States in the mid-1980s was around 40 to 120 cases per year. Four hundred and ninety-eight cases were reported to the Centers for Disease Control and Prevention between 1974 and 1978, nearly 100 cases above the previous 5 years.'The number of cases up to the year 1991 in the United States appears to have remained
Prognostic Factors of Leptospirosis Patients in Dr. Sardjito General Hospital, Yogyakarta, Indonesia
Acta Interna: The Journal of Internal Medicine, 2011
Background:. Severe disease can be fatal, although majority of cases are mild and self-limited. Objective: To determine the prognostic factors for leptospirosis that associated with mortality in patients with leptospirosis in Dr. Sardjito General Hospital, Yogyakarta. e conducted a retrospective study of data collected in our hospital between Jan 2010 until May 2011, from whom the diagnosis of leptospirosis was confirmed based on pertinent clinical and epidemiological data and positive serology. Result: Thirty two patients were included in this study, including 29 survivors (90.62%) and 3 non-survivors (9.38%). Of these 32 patients, 26 patients (81.25%) were admitted to the medical ward and 6 patients (18.75 %) were admitted to the ICU. Multivariate logistic regression demonstrated that three factors were independently associated with mortality: higher level of potassium (OR 10.8; CI 1.194-97.728; p<0.01) on admission and neurological dysfunction (altered mentation or seizure) (OR 30; CI 4.367-206.07; p<0.01) Conclusion: The mortality of leptospirosis remains high despite improvements in patients care. In order to improve the early treatment of high-risk patients, these higher levels of potassium on admission and neurological dysfunction, which are associated with mortality, can be used at the time of admission as prognostic factors.
Clinical Profile of Patients of Leptospirosis and Its Outcome
Journal of Advanced Research in Medicine, 2020
Background: Leptospirosis is an emerging spirochetal zoonosis worldwide. It is underreported and under diagnosed in India. The clinical manifestations of Leptospirosis range from an asymptomatic illness, self-limiting systemic infection to severe and potentially fatal disease. Approximately 1 million severe cases occur per year. Aims and Objectives: To study the clinical profile of acute onset fever (less than 7 days) that are IgM positive for leptospira and to study their in hospital outcome. Methods: This observational study was conducted in Dr. Hedgewar Hospital, Aurangabad, Maharashtra. The IgM positive leptospirosis patients admitted during January 2014 to December 2018 were included in the study. The information on demographic and clinical profile of these patients was recorded and analyzed based on modified Faine's criteria. Their in hospital outcome was assessed. Result: The study included 62 leptospirosis IgM positive patients. The mean age was 38.14±15.84 years. All patients presented with fever. Acute Respiratory Distress Syndrome (ARDS) was the most common complication seen in 48.38%. Case Fatality Rate (CFR) was found to be 16.12% (10 out of 62) patients. Conclusion • High proportion of cases indirectly reflects the endemic nature of the disease. • The clinical presentation of leptospirosis is highly protean and may vary from sub-clinical to mild illness to life-threatening complications and death.