Leptospirosis in Intensive Care Unit

Abstract

A bstract Tropical infections constitute 20 – 30% of intensive care unit (ICU) admissions in developing countries. Leptospirosis is a spectrum with mild form presenting as an acute febrile illness with jaundice, complicating in few as acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC), and multi-organ dysfunction syndrome (MODS). The poor prognostic markers are hemorrhagic ARDS, acute renal failure, DIC, severe metabolic acidosis, older age, chronic alcohol abuse, high SOFA score, and septic shock. The confirmatory diagnosis relies on antibody testing, such as microscopic agglutination test (MAT) and IgM ELISA, while the reverse transcription-polymerase chain reaction test being reserved for clinically suspected antibody negative cases. The spectrum of multi-organ involvement necessitates a complete hematological, biochemical workup, including electrocardiogram (ECG), chest X-ray, and two-dimensional echocardiography. Specific antimicrobial therapy consists of the following—benzylpenicillin, ceftriaxone, cefotaxime, and doxycycline. The reported mortality ranges from 6% to as high as 44%. Various ICU scores like SPiRO, THAI LEPTO score, and Faine's criteria have been useful in risk stratification. Optimizing intensive care treatment with appropriate antibiotics, lung protection ventilation strategies, strict fluid management, and if need be timely initiation of renal replacement therapy (RRT) helps in reducing mortality. How to cite this article: Karnik ND, Patankar AS. Leptospirosis in Intensive Care Unit. Indian J Crit Care Med 2021;25(Suppl 2): S134–S137.

Relevance of Polymerase Chain Reaction in Early Diagnosis of Leptospirosis

“… 16 , 17 Polymerase chain reaction positivity peaks soon after symptom onset and hence PCR assay can be extremely useful as a method of diagnosis early on. 11 , 18 , 19 In leptospirosis, IgM antibodies begin to appear only by the end of the first week and therefore the sensitivity of these tests in early stages of illness is very low. 11 , 18 , 19 Therefore, in the first week of illness, a significant number of cases will be missed with IgM ELISA whereas a majority can be picked up with PCR.…”

“… 11 , 18 , 19 In leptospirosis, IgM antibodies begin to appear only by the end of the first week and therefore the sensitivity of these tests in early stages of illness is very low. 11 , 18 , 19 Therefore, in the first week of illness, a significant number of cases will be missed with IgM ELISA whereas a majority can be picked up with PCR. Hence, testing protocols using both PCR and IgM ELISA will improve diagnostic yield significantly.…”

Leptospirosis in Pregnancy: Prevalence, Risk Factors, Clinical Characteristics, and Outcomes in a North Indian Population

“…IgG antibodies remain in the blood for years specifying history of past exposure to the disease. MAT (microscopic agglutination test) is considered as the gold standard diagnostic method for leptospirosis by the WHO (World Health Organization) but ELISA is commonly used as the test is more readily available in low resource settings, is user-friendly and has advantage of sensitivity and specificity over MAT [1,6,9,12,13].…”

Acute Kidney Injury Associated with Severe Leptospirosis: Fatal Re-Emerging Disease in Latin America

“…Renal manifestations are variable and range from mild changes in urinary sediment to changes in tubular function, such as low urinary protein excretion to irreversible damage [14]. In severe cases, there may be a drop in glomerular filtration rate, severe electrolyte imbalance [15], and the need for renal replacement therapy (RRT) in up to 31.6% of cases [16,17]. The recovery of kidney function may take several months; however, AKI exposure from severe leptospirosis can lead to long-term end-stage chronic kidney disease (CKD) [18][19][20].…”