Assessment of the Clinical Presentation and Treatment of 353 Cases of Laboratory‐Confirmed Leptospirosis in Hawaii, 1974–1998

Abstract

Leptospirosis is frequently misdiagnosed as a result of its protean and nonspecific presentation. Leptospirosis, a zoonosis with global distribution, commonly occurs in tropical and subtropical regions; most reported cases in the United States occur in Hawaii. All laboratory-confirmed leptospirosis cases in the State of Hawaii from 1974 through 1998 (n=353) were clinically evaluated. The most common presentation involved nonspecific signs or symptoms, including fever, myalgia, and headache. Jaundice occurred in 39% of cases; conjunctival suffusion was described in 28% of these cases. Initiation of antibiotics before the seventh day of symptoms was associated with a significantly shortened duration of illness. Because early recognition and initiation of antibiotic therapy are important, clinicians should familiarize themselves with the clinical presentation of leptospirosis, and when evaluating a patient with a febrile illness, they should obtain exposure and travel histories and entertain the possibility of leptospirosis in the differential diagnosis.

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

“…Most of the cases occur in men. 9,11,15,17 The disease is more common among young people, as confirmed in the present study. 9,11,16,19 The cases described here represent the severe end of the spectrum of leptospirosis.…”

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.…”

“…La gravedad de la enfermedad se ha relacionado con la infección por la serovariedad icterohaemorrhagiae, la cual se ha asociado con mayor frecuencia al compromiso hepático y renal (5,23,25,30), principales complicaciones observadas en la población de estudio. Sin embargo, esta no ha sido la serovariedad más frecuente en el departamento de Antioquia.…”

“…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).…”

Approach to Clinical Syndrome of Jaundice and Encephalopathy in Tropics

“…Common initial presentation is with a nonspecific febrile illness, but in some it takes a serious turn in second phase with development of hepatorenal dysfunction often with pulmonary hemorrhage, (also known as Weil's syndrome). 98 These severe manifestations usually develops 4-9 days into the illness. The organisms can damage blood vessels, either directly or through immune mediated injury and lead to centrilobular necrosis of the liver and renal tubular dysfunction (interstitial nephritis and acute tubular necrosis).…”