Clinical presentation of leptospirosis: a retrospective study of 201 patients in a metropolitan city of Brazil

Abstract

INTRODUCTION: leptospirosis is a zoonosis of worldwide importance. The disease is endemic in Brazil. This study was conducted to describe the clinical and laboratory presentation of leptospirosis in a metropolitan city of Brazil. METHODS: this is a retrospective study including 201 consecutive patients with leptospirosis admitted to tertiary hospitals in Fortaleza, Brazil, between 1985 and 2006. All patients had clinical and epidemiological data suggestive of leptospirosis, and positive laboratorial test for leptospirosis (microscopic agglutination test, MAT, higher than 1:800). RESULTS: a total of 201 patients were included, with mean age of 38.9 ± 15.7 years; 79.1% were male. The mean length from onset of symptoms to admission was 7 ± 3 days. The main clinical signs and symptoms at admission were fever (96.5%), jaundice (94.5%), myalgia (92.5%), headache (74.6%), vomiting (71.6%) and dehydration (63.5%). Hemorrhagic manifestations were present in 35.8%. Acute kidney injury was found in 87% of the patients. Platelet count was less than 100,000/mm³ in 74.3%. Hematuria was found in 42.9%. Death occurred in 31 cases (15.4%). CONCLUSIONS: leptospirosis is a globally relevant disease with potential fatal outcome. Signs and symptoms suggestive of leptospirosis must be known by any physician in order to institute early adequate treatment to improve outcome. Early indication and daily hemodialysis seems to be beneficial in this group of patients

La evidencia serológica de leptospirosis en pacientes con sospecha clínica de dengue en el estado de Ceará, Brasil

“…The most frequent laboratory abnormalities in the patients with leptospirosis were thrombocytopenia, leukocytosis and transaminase elevation, as well as low hematocrit and hemoglobin levels (21). These abnormalities were also observed in the present study.…”

“…These authors reported that patients with leptospirosis presented fever (96.5%), headache (74.6%), myalgia (92.5%), jaundice (94.5%), vomiting (71.6%), dehydration (63.5%) and chills (62.2%) (21). It is worth emphasizing that of the five patients who were positive for leptospirosis, three were hospitalized, where they probably developed some of the most severe forms of leptospirosis.…”

Atrial flutter complicating severe leptospirosis: a case report

“…It is caused by species of Leptospira, and transmitted to humans by direct contact with infected tissues or contaminated urine, or indirectly by contact with contaminated water or soil. Mammalian reservoirs are the main distributors, and although rodents are the most important reservoir, other animals, including livestock, wild and domestic animals may excrete leptospires in their urine and, therefore, be a potential source of infection [1][2][3] . Leptospirosis is associated with occupational and recreational exposure, usually occurring as endemic in rural areas with outbreaks associated with floods 1,3 .…”

Sociodemographic and clinical characteristics of patients infected with Leptospira spp. treated at four hospitals in Medellín, Colombia, 2008-2013

“…Este estudio incluyó 119 pacientes hospitalizados con diagnóstico de leptospirosis, en quienes se encontró una mayor frecuencia de complicaciones, especialmente falla hepática y síndrome de Weil, y una mortalidad general similar a la reportada en Colombia, pero inferior a la informada en algunas series de casos en otros países (22)(23)(24)(25)(26)(27)(28)(29). Se encontró, además, que cerca del 10 % de los pacientes no recibió tratamiento antibiótico a pesar de encontrarse hospitalizado.…”

“…Aunque la frecuencia de complicaciones fue superior a la descrita en la mayoría de las series, la mortalidad no excedió la informada en otros estudios colombianos y en el Sistema Nacional de Vigilancia en Salud Pública (1,5 a 5 %) (6,15,18,22,24,31), y fue inferior a la reportada en las series de casos en otros países (7 a 22 %) (23)(24)(25)(26)(27)(28)(29)32,33). Esta disociación entre una mayor frecuencia de complicaciones y una menor mortalidad es difícil de explicar, especialmente si se tiene en cuenta el gran número de pacientes que presentó síndrome de Weil, complicación asociada con una mayor mortalidad (32)(33)(34).…”