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

Abstract

Background Leptospirosis is a common zoonoses and is a major global public health threat. Most cases are mild, typically presenting as a non-specific acute febrile illness. However, leptospirosis can have life-threatening manifestations, including pulmonary hemorrhage syndrome, and acute kidney injury. In Colombia, notification and lab-confirmation of suspected human cases are mandatory. However, little is known about the demographic and clinical factors associated with severe leptospirosis, which could help to reduce clinical complications and mortality. Our aim was to identify risk factors associated with severe leptospirosis, intensive care unit (ICU) admission, and mortality in lab-confirmed cases in Colombia, 2015–2020. Methods and findings We analyzed 201 lab-confirmed human leptospirosis cases by microagglutination test. We used a logistic regression to identify the demographic and clinical risk factors associated with severe leptospirosis, admission to ICU, and death. Most leptospirosis confirmed cases occurred in men (85.6%); the mean age was 36.7 years. We classified severe cases (43.3%) by clinical manifestations as renal (29.9%) and liver (27.4%) failure, multiple-organ failure (24.4%), septic shock (24.4%), Weil syndrome (18.4%), pulmonary hemorrhage (18.4%), and meningitis (2.5%), admitted to the ICU (30.3%), and fatal (8.5%). Clinical conditions associated with severe leptospirosis were dyspnea (OR: 5.54; 95% CI: 1.46 to 20.98), tachycardia (OR:9.69; 95% CI: 15.96 to 58.8), and rash (OR: 10.25; 95% CI: 25.01 to 42.08). Conclusions We identified demographic characteristics and clinical symptoms associated with severe leptospirosis in Colombia. We hope these results can support clinicians in providing timely treatment to leptospirosis patients to avoid preventable medical complications or deaths.

Current treatment options for leptospirosis: a mini-review

“…The prevalence of leptospirosis in tropical regions, particularly East-Sub-Saharan Africa, Oceania, Southeast Asia and the Caribbean, is 73% ( Costa et al, 2015 ; Rajapakse, 2022 ). Leptospirosis infection can occur and spread among people who have special jobs and occupations, e.g., military personnel, water sports participants and athletes, fishermen, rural farmers, slaughterhouse workers, veterinarians, and sewage workers, or among urban slum residents and vulnerable populations with low-level sanitation and poor housing ( Parra Barrera et al, 2023 ; Philip and Ahmed, 2023 ). This situation increases human contact with leptospirosis in infected rats.…”

“…This situation increases human contact with leptospirosis in infected rats. As previous reports have shown, leptospirosis is the main bacterial agent of pulmonary hemorrhage syndrome (PHS) and is known as a global life-threatening infectious disease ( Costa et al, 2015 ; Haake and Levett, 2015 ; Rajapakse, 2022 ; Parra Barrera et al, 2023 ). It may also lead to life-threatening acute kidney injury (AKI; Parra Barrera et al, 2023 ).…”

“…As previous reports have shown, leptospirosis is the main bacterial agent of pulmonary hemorrhage syndrome (PHS) and is known as a global life-threatening infectious disease ( Costa et al, 2015 ; Haake and Levett, 2015 ; Rajapakse, 2022 ; Parra Barrera et al, 2023 ). It may also lead to life-threatening acute kidney injury (AKI; Parra Barrera et al, 2023 ). Despite the presence of a wide range of reservoir hosts, including domestic and wild animals, Rattus norvegicus (or the brown rat) is the main source of leptospirosis in human hosts.…”

“…A survey performed by Parra Barrera et al (2023) revealed that 85.6% of the patients with leptospirosis in Colombia between 2015 and 2020 were men, with a mean age of 36.7 years.…”

“…Ceftriaxone, doxycycline, ampicillin, and penicillin (50.0%, 14.9%, 7.4%, and 5.2%, respectively) were administered to most patients. Furthermore, patients who received antibiotic therapy for severe leptospirosis were not included ( Parra Barrera et al, 2023 ). Antibiotic therapy for inpatients with leptospirosis may include intravenous ampicillin, cefotaxime, ceftriaxone and penicillin ( Panaphut et al, 2003 ; Haake and Levett, 2015 ).…”