Leptospirosis: Report from the task force on tropical diseases by the World Federation of Societies of Intensive and Critical Care Medicine

Jiménez, Juan Ignacio Silesky; Marroquin, Jorge Luis Hidalgo; Richards, Guy A.; Amin, Pravin

doi:10.1016/j.jcrc.2017.11.005

Cited by 37 publications

(23 citation statements)

References 38 publications

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“…Outbreaks were classified by criteria evaluating certainty of a leptospirosis outbreak ( Table 1 ), based on description of laboratory-confirmed cases, that cases occurred within a defined time period, and that a reliable number of cases were obtained from active case ascertainment. These quality criteria were selected because leptospirosis can be misdiagnosed as other diseases (e.g., dengue, chikungunya, influenza, other acute viral or bacterial illnesses) ( 18 , 21 ) and due to the need to recognize outbreaks as an increase in cases from baseline within a particular timeframe. In most outbreak reports, laboratory diagnosis for leptospirosis was attempted; however, only 40% clearly described identification of laboratory-confirmed cases ( Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

A systematic literature review of leptospirosis outbreaks worldwide, 1970–2012

Muñoz-Zanzi

Groene

Morawski

et al. 2020

Revista Panamericana De Salud Pública

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Objective. This review describes the geographic and temporal distribution of, detection methods for, and other epidemiological features of published leptospirosis outbreaks, with the aim of informing efforts to standardize outbreak-reporting practices. Methods. We conducted a systematic review of leptospirosis outbreaks reported in the scientific literature and ProMED during 1970–2012. Predefined criteria were used to identify and classify outbreaks and a standard form was used to extract information. Results. During 1970–2012, we identified 318 outbreaks (average: 7 outbreaks/year; range: 1–19). Most outbreaks were reported in the Latin America and the Caribbean region (36%), followed by Southern Asia (13%), and North America (11%). Most outbreaks were located in tropical and subtropical ecoregions (55%). Quality classification showed that there was clear description of laboratory-confirmed cases in 40% of outbreaks. Among those, the average outbreak size was 82 cases overall (range: 2–2 259) but reached 253 cases in tropical/subtropical ecoregions. Common risk factors included outdoor work activities (25%), exposure to floodwaters (23%), and recreational exposure to water (22%). Epidemiologic investigation was conducted in 80% of outbreaks, mainly as case interviews. Case fatality was 5% overall (range: 0%–60%). Conclusions. Outbreak reporting increased over the study period with outbreaks covering tropical and non-tropical regions. Outbreaks varied by size, setting, and risk factors; however, data reviewed often had limited information regarding diagnosis and epidemiology. Guidelines are recommended to develop standardized procedures for diagnostic and epidemiological investigations during an outbreak and for reporting.

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Section: Resultsmentioning

confidence: 99%

A systematic literature review of leptospirosis outbreaks worldwide, 1970–2012

Muñoz-Zanzi

Groene

Morawski

et al. 2020

Revista Panamericana De Salud Pública

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“…Its presentation may range from asymptomatic to vital organs involvement. It can lead to acute renal failure, multiple organ disfunction, acute respiratory distress syndrome, and Weil's disease [5]. Its significant morbidity and mortality highlights the importance of recognizing and identifying how leptospirosis can be acquired [6].…”

Section: Case Discussionmentioning

confidence: 99%

“…In the case at hand, we suggest an unusual mode of leptospirosis transmission-direct infection from a rat bite. In tropical countries, individuals exposed to unsanitary conditions typical of urban slums are at greater risk of contracting leptospirosis [1,5,7]. The subject in this case lives in an urban city where leptospirosis outbreaks annually, affecting the population living in areas of poor sanitation infrastructure during the rainy season [8].…”

Section: The Presenting Casementioning

confidence: 99%

“…However, if physicians are not associating rat bites with leptospirosis, especially in areas where cases are uncommon, accurate diagnosis will be delayed and the disease will advance. It's been shown that patients with severe pulmonary hemorrhagic syndrome have a 74% case-fatality ratio [17] and, when admitted to the ICU in the setting of leptospirosis, have a 52% mortality risk [5]. This study aims to raise awareness of leptospirosis in the setting of rat bite in order to avoid inaccurate diagnosis and delay of treatment.…”

Section: The Presenting Casementioning

confidence: 99%

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Severe leptospirosis after rat bite: A case report

et al. 2020

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A 43-year-old woman presented to an emergency department in Salvador, Brazil, with a twoday history of fever (39.5 o to 40.0˚C), chills, headache, arthralgia, myalgia, and loss of appetite in the setting of a recent rat bite. She had no previous relevant medical history but reported a street-rat bite on her right ankle 13 days prior to presentation (Fig 1). The rat bite occurred while she was walking to a drugstore in the early evening in December 2014 in a mediumincome neighborhood of Salvador, a coastal city in the northeast of Brazil. Shortly after the incident, she went to an urgent care unit where she received tetanus and rabies vaccines and wound care. She denied exposure to other potentially leptospires-contaminated environments, such as water or mud. When the symptoms began, she was seen at the hospital where she received medical examination and laboratory evaluation. Her complete blood count (Day 1) showed discrete anemia, leukocytosis with neutrophilia, and thrombocytopenia (Table 1). Her urinalysis showed hematuria. The erythrocyte sedimentation rate was 24 mm 3 /hr, creatine phosphokinase was 1,182 U/L, and no other pertinent findings were reported. Blood culture showed no growth, and a rapid dengue test was nonreactive. She received intravenous fluids, muscle relaxants, and analgesics and was discharged without a clear diagnosis. Persistent symptoms brought the patient back to the hospital the next day (Day 2) complaining of shortness of breath, diffused myalgia, arthralgia, odynophagia, dry mouth, and hemoptysis as well as cutaneous rashes. Clinical examination recorded a temperature of 38.0˚C, blood pressure of 117/72 mmHg, heart rate of 100 beats per minute, respiratory rate of 16 breaths per minute, and oxygen saturation of 99% breathing room air, in addition to dehydration. She was admitted to the hospital that same day-antibiotics (ceftriaxone) and supportive measures were initiated. On Day-3, she developed shortness of breath and crepitus on thorax auscultation at the base of her right lung and had 82% of oxygen saturation at room air. The patient was admitted to the intensive care unit (ICU) for noninvasive respiratory support. Thorax computed tomography and X-ray revealed bilateral diffused consolidation with air bronchogram and a posterior basal laminar stroke of her left lung (Fig 2). The antibiotics were changed to moxifloxacin and cefepime. Oseltamivir and corticosteroids were introduced. Additionally, during Day 3 in the ICU, the patient presented with hemoptysis and pulmonary congestion, likely associated to hypervolemia, which were resolved by the Day 4. The patient was discharged on Day 6 with complete resolution of fever and respiratory symptoms. A definitive diagnosis of leptospirosis was made based on the epidemiological history of rat bite, compatible clinical symptoms, and laboratory tests. A positive immunoglobulin M (IgM) ELISA (Bio-Manguinhos, Rio de

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“…There are various diagnostic methods: those based on microbiology (darkfield microscopy), serology (microscopic agglutination test [MAT], enzyme-linked immunosorbent assay [ELISA], immunofluorescence, hemagglutination, and lateral flow assay), and those based on molecular biology. MAT is the gold standard for serodiagnosis of leptospirosis because of its unsurpassed diagnostic specificity (63,64). A combination of C-reactive protein (CRP) and ELISA has been proposed to achieve a rapid diagnosis with little margin for error; however, MAT should subsequently be used to identify the serotype for epidemiological purposes (63).…”

Section: Diagnostic Testsmentioning

confidence: 99%

Acute Kidney Injury and Acute Liver Failure in Leptospira Infection and Weil’s Syndrome

Chávez-Íñiguez

Cabrera-Aguilar

García-García

et al. 2020

jrenhep

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Leptospirosis is considered a zoonosis acquired predominantly from contaminated surfaces and water, more commonly in emerging countries with limited sanitary conditions. Leptospira in the host unleashes an immune response that explains the symptoms and clinical signs; once it reaches the kidney and liver tissue, it can manifest with alterations that lead to acute and chronic diseases in both organs. Weil’s syndrome is the best known clinical manifestation with jaundice and acute kidney injury that could lead to multiple organ failure and death. For its diagnosis, there are simplified scores such as the SPiRO score, the microbiological criteria by microscopy or serological tests; the treatment focuses on antibiotics and, if necessary, provides organic support until the infection is curtailed. The purpose of this review was to address the impact of Lep-tospira infection on the kidney and liver, the mechanisms of organ damage, the clinical presentation, and diagnosis and management of this disease.

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Leptospirosis: Report from the task force on tropical diseases by the World Federation of Societies of Intensive and Critical Care Medicine

Cited by 37 publications

References 38 publications

A systematic literature review of leptospirosis outbreaks worldwide, 1970–2012

A systematic literature review of leptospirosis outbreaks worldwide, 1970–2012

Severe leptospirosis after rat bite: A case report

Acute Kidney Injury and Acute Liver Failure in Leptospira Infection and Weil’s Syndrome

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