Early Identification of Leptospirosis as an Ignored Cause of Multiple Organ Dysfunction Syndrome

Abstract

Leptospirosis is the most common zoonosis in the world but remains underreported, owing to protean manifestations and ignorance about the disease among health care providers in Taiwan. From September 2000 to March 2006, surveillance of 455 patients with multiple organ dysfunction syndrome with unclear cause or clinical suspicion of leptospirosis was performed. Diagnosis was further confirmed by microscopic agglutination test or isolation of Leptospira. Cases were classified as excluded based on confirmed etiology other than leptospirosis or negative paired serologic test. Forty-two patients were confirmed as having leptospirosis, which accounted for 9.2% of total patients with multiple organ dysfunction syndrome. Forty-nine excluded cases were identified for a case-control analysis for clinical distinction. The most common presentations of leptospirosis were fever (97.6%), acute kidney injury (85.7%), and jaundice (61.9%). The leptospirosis group showed lower urine specific gravity (cutoff value, 1.0145) and enlarged kidney size (cutoff value, 11.05 cm) as compared with the excluded cases by multivariate logistics regression. Delayed antibiotic administration prolongs the duration of hospitalization (R2 = 0.486, P < 0.01). No mortality has been found in the leptospirosis group after initiation in 2003 of rapid immunoglobulin M serology assay that showed considerably high sensitivity and specificity. Leptospirosis accounts for a salient cause of multiple organ dysfunctions in Taiwan. Early awareness of leptospirosis by distinct presentations, followed by prompt antibiotics therapy, can dramatically save the patients. The easily performed rapid immunoglobulin M serology assay is suitable as a rapid screening test for the diagnosis of leptospirosis.

Live Imaging of Bioluminescent Leptospira interrogans in Mice Reveals Renal Colonization as a Stealth Escape from the Blood Defenses and Antibiotics

“…Here, C57BL/6 mice infected with high doses of the bioluminescent L. interrogans serovar Manilae, suffered from major septicemia and died within a few days. This model of septicemia induced by a highly virulent L. interrogans is novel and may be very useful to understand the pathophysiological consequences of acute leptospirosis, which in humans has a high case/fatality rate [4] , [34] . Moreover, we showed the feasibility of this model to test therapeutic strategies interfering with the growth of bacteria in blood, such as penicillin G treatment administered early after infection, which efficiently cleared the infection in mice.…”

Overlooked Risk for Chronic Kidney Disease after Leptospiral Infection: A Population-Based Survey and Epidemiological Cohort Evidence

“…The pathogen is transmitted to humans through contaminated soil, water, or infected animal urine. Multiple organ involvement [ 7 ] may be encountered in acute severe leptospirosis, and renal involvement is commonly characterized by tubulo-interstitial nephritis and tubular dysfunction [ 8 – 10 ]. Besides protean acute presentations of leptospirosis, the possibility of chronic human infection was suggested with only sporadic cases [ 11 ], such as late onset uveitis with leptospiral DNA amplified from aqueous humor [ 12 ], central sleep apnea due to chronic neuroleptospirosis [ 13 ] and a recent report of neuroleptospirosis diagnosed by next-generation sequencing [ 14 ].…”

Urine Levels of Defensin α1 Reflect Kidney Injury in Leptospirosis Patients

“…Weil’s syndrome, the most severe form of leptospirosis, accounts for 5%–10% of all cases and is characterized by hemorrhagic tendencies and hepatic dysfunction as well as acute renal failure [5], which develops in 16%–40% of cases and has a fatality rate of 22%–33% [5,6,7]. Additionally, delays in diagnosis and therapy are correlated with prolonged hospitalization [8]; therefore, early and accurate diagnosis of leptospirosis is essential for timely and appropriate treatment. Azithromycin and doxycycline have been reported to be effective in the treatment of this disease [9].…”