Clinical characteristics and prognosis of patient with leptospirosis: A multicenter retrospective analysis in south of China

Abstract

PurposeLeptospirosis is a zoonotic disease caused by pathogenic spirochetes of the genus Leptospira. However, there is currently no consensual definition or diagnostic criteria for severe and different forms of leptospirosis. Therefore, more insight on clinical manifestations, risk factors, and outcomes of leptospirosis is warranted. The identification of leptospirosis with distinct clinical manifestations and prognosis in our population.MethodsMultiple correspondence analysis and hierarchical classification on principal components were presented to identify different clinical types of leptospirosis. The outcomes were clinical phenotypes, laboratory and imaging findings, and prognosis.ResultsThe 95 enrolled patients had median values of 54.0 years (39.0-65.0) for age, 9.0 (7.0-14.0) for total hospital stay lengths, of whom 86.3% was male and 40.0% was transferred to ICU. Three clinical types were distinguished: mild leptospirosis (n=43, 45.3%) with less organ dysfunction and shorter hospital stays; respiratory leptospirosis (n=28, 29.5%) with hemoptysis, and respiratory and circulatory failure; and hepato-renal leptospirosis (n=24, 25.3%) with worst liver and kidney dysfunction. Total hospital mortality was 15.8% and was associated with dyspnea and high levels of neutrophil counts.ConclusionsThe identification of leptospirosis with distinct clinical manifestations and prognosis in our population may assist clinicians to distinguish leptospirosis-like disease. Moreover, dyspnea and neutrophil count were found to be independent risk factors for severe leptospirosis progression.

Organ Involvement Related to Death in Critically Ill Patients With Leptospirosis: Unsupervised Analysis in a French West Indies ICU

“…In contrast with previous clustering studies ( 5 , 15 ), our main finding was the identification of only three clinical clusters that we named: “the Weil’s disease” group (cluster 1), the “neurologic leptospirosis” group (cluster 2), and the “multiple organ failure” group (cluster 3). These clinical phenotypes are associated with different ICU outcomes.…”

“…The clinical pattern is pleomorphic, and the only specific entity described is an association between ARF and hemoptysis due to alveolar hemorrhage, defined as “severe pulmonary hemorrhagic leptospirosis” and characterized by a grim outcome ( 16 ), which seems to be rare. In our analysis, despite the frequency of ARF, we did not identify a specific respiratory cluster, in contrast with previous studies ( 5 , 15 ). Notably, the presence of interstitial lesions on pulmonary CT was associated with 30-day mortality in our study (Table 1 ), as previously described ( 4 , 5 , 15 ).…”

Diagnosis of pulmonary hemorrhagic leptospirosis complicated by invasive pulmonary aspergillosis complemented by metagenomic next-generation sequencing: a case report

“…Imaging of pulmonary diffuse hemorrhagic leptospirosis typically reveals bilateral patchy peripheral infiltrates, often with a “snowflake” appearance, that can progress to confluent consolidation or a ground-glass appearance ( 11 ). The lesions are obvious in the middle and lower lobes of bilateral lungs, and the imaging manifestations are consistent with the clinical symptoms.…”

Demographic and clinical risk factors associated with severity of lab-confirmed human leptospirosis in Colombia, 2015–2020

“…About one-third of reported lab-confirmed human leptospirosis cases in Colombia required admission to the ICU (30.3%) in 2015–2020. ICU admission in this study is reported in countries where leptospirosis is a health concern, such as China, were an estimated 40% of cases are admitted to the ICU [ 70 ]. Unfortunately, despite being an endemic country, human leptospirosis in Colombia is not widely known.…”