Severe leptospirosis in non-tropical areas: a nationwide, multicentre, retrospective study in French ICUs

Miailhe, Arnaud-Félix; Mercier, Emmanuelle; Maamar, Adel; Lachérade, Jean-Claude; Thuaut, Aurélie Le; Gaultier, Aurélie; Asfar, Pierre; Argaud, Laurent; Ausseur, Antoine; Salah, Adel Ben; Botoc, Vlad; Chaoui, K.; Charpentier, Julien; Cracco, Christophe; Prost, Nicolas de; Eustache, Marie-Line; Ferré, Alexis; Gauvin, Elena; Goursaud, Suzanne; Grall, Maximilien; Guiot, P.; Jonas, Maud; Lambiotte, Fabien; Landais, Mickaël; Lemarié, Jérémie; Lesieur, Olivier; Lhommet, Claire; Michel, P.; Monseau, Yannick; Moschietto, Sébastien; Nseir, Saad; Osman, David; Pillot, J.; Piton, Gaël; Sédillot, Nicholas; Sirodot, Michel; Thévenin, Didier; Zafrani, Lara; Zerbib, Yoann; Bourhy, Pascale; Lascarrou, Jean-Baptiste; Reignier, Jean; Leptorea,

doi:10.1007/s00134-019-05808-6

Cited by 20 publications

(16 citation statements)

References 34 publications

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“…28,29,76 For example, a cohort of patients with severe leptospirosis managed in well-resourced ICUs in France had a median (IQR) SAPS II score of 40 and a case-fatality rate of 8.8%. 56 Meanwhile, a cohort of patients with severe leptospirosis managed in a single ICU on R eunion Island-which also had access to advanced supportive care including extracorporeal membrane oxygenation-had a median (IQR) SAPS II score of 38 and a case-fatality rate of 5.9%. 55 In contrast, in a Moroccan cohort with lower SAPS II scores (24 6 11.5), the case-fatality rate was greater at 23%.…”

Section: Discussionmentioning

confidence: 99%

The Applicability of Commonly Used Severity of Illness Scores to Tropical Infections in Australia

Salaveria

Smith

Liu

et al. 2022

The American Journal of Tropical Medicine and Hygiene

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Many patients with leptospirosis, melioidosis, and rickettsial infection require intensive care unit (ICU) admission in tropical Australia every year. The multi-organ dysfunction associated with these infections results in significantly elevated severity of illness (SOI) scores. However, the accuracy of these SOI scores in predicting death from these tropical infections is incompletely defined. This retrospective study was performed at Cairns Hospital, a tertiary-referral hospital in tropical Australia. All patients admitted to ICU with laboratory-confirmed leptospirosis, melioidosis, and rickettsial disease between January 1, 1999 and June 30, 2020, were eligible for the study. The ability of Acute Physiology and Chronic Health Evaluation (APACHE) II, APACHE III, Simplified Acute Physiology Scores (SAPS) II, and Sequential Organ Failure Assessment (SOFA) scores to predict death before ICU discharge was evaluated. Overall, 18 (12.1%) of the 149 included patients died: 15/74 (20.3%) with melioidosis, 2/54 (3.7%) with leptospirosis and 1/21 (4.8%) with rickettsial disease. However, the APACHE II, APACHE III, SAPS II, and SOFA scores significantly overestimated the case-fatality rate of all the infections; the disparity between the predicted and observed mortality was most marked in the cases of leptospirosis and rickettsial disease. Commonly used SOI scores significantly overestimate the case-fatality rate of melioidosis, leptospirosis, and rickettsial infections in Australian ICU patients. This may be at least partly explained by the unique pathophysiology of these infections, particularly leptospirosis and rickettsial disease. However, SOI scores may still be useful in facilitating the comparison of disease severity in clinical trials that examine patients with these pathogens.

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Section: Discussionmentioning

confidence: 99%

The Applicability of Commonly Used Severity of Illness Scores to Tropical Infections in Australia

Salaveria

Smith

Liu

et al. 2022

The American Journal of Tropical Medicine and Hygiene

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“…However, some recent studies in humans showed only PCR results on blood samples [ 10 , 21 , 25 ] while acknowledging the potential of urine sampling to improve sensibility [ 21 ]. A recent study on leptospirosis cases in 79 French Metropolitan ICUs showed that 53% of patients were diagnosed by PCR on blood while only 11% were diagnosed by PCR on urine samples [ 26 ]. Even though the number of PCR tests performed on the different type of samples was not indicated, this study suggests that urine sampling was not as frequent as blood sampling for PCR testing.…”

Section: Discussionmentioning

confidence: 99%

Seven Years Leptospirosis Follow-Up in a Critical Care Unit of a French Metropolitan Hospital; Role of Real Time PCR for a Quick and Acute Diagnosis

Bahuaud

Pastuszka

Brun

et al. 2020

JCM

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(1) Background: Leptospirosis infection can lead to multiple organ failure, requiring hospitalization in an intensive care unit for supportive care, along with initiation of an adapted antibiotic therapy. Achieving a quick diagnosis is decisive in the management of these patients. (2) Methods: We present here a review of leptospirosis cases diagnosed in the intensive care unit of our hospital over seven years. Clinical and biological data were gathered, and we compared the differences in terms of diagnostic method. (3) Results: Molecular biology method by Polymerase Chain Reaction (PCR) allowed quick and reliable diagnosis when performed in the first days after the symptoms began. Moreover, we identified that sampling blood and urine for PCR was more efficient than performing PCR on only one type of biological sample. (4) Conclusions: Our results confirm the efficiency of PCR for the quick diagnosis of leptospirosis and suggest that testing both blood and urine early in the disease might improve diagnosis.

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“… 23 In a multicenter study conducted in 79 ICUs of France, mortality at 9% was associated with an elderly population, leukocytosis, invasive ventilation, need for dialysis, ethanol addiction, and hepatic encephalopathy. 24 Leptospirosis causing hepatorenal ( n = 101, 63%), neurological ( n = 8, 5%), and respiratory complications ( n = 17, 11%) with pulmonary hemorrhage had highest mortality predictability. In Weeratunga et al's study done in Sri Lanka ( n = 45), high mortality of 44.4% was associated with low pH very high CRP levels, hyperkalemia, metabolic acidosis, and multi-organ system failure.…”

Section: Eptospirosis : O Utcome In Icumentioning

confidence: 99%

Leptospirosis in Intensive Care Unit

Karnik

Patankar

2021

Indian Journal of Critical Care Medicine

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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.

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Severe leptospirosis in non-tropical areas: a nationwide, multicentre, retrospective study in French ICUs

Cited by 20 publications

References 34 publications

The Applicability of Commonly Used Severity of Illness Scores to Tropical Infections in Australia

The Applicability of Commonly Used Severity of Illness Scores to Tropical Infections in Australia

Seven Years Leptospirosis Follow-Up in a Critical Care Unit of a French Metropolitan Hospital; Role of Real Time PCR for a Quick and Acute Diagnosis

Leptospirosis in Intensive Care Unit

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