The Predictive Factors for Severe Leptospirosis Cases in Kedah

Abstract

Over the past decade, increased awareness about leptospirosis disease in developing and industrialized countries has resulted in increased numbers of leptospirosis cases being reported worldwide. About 5% to 15% of leptospirosis patients end up with severe forms of the disease. Complication due to leptospirosis requires monitoring, specific treatments, and intensive care admission, thus increasing the cost of treating severe leptospirosis cases. Currently, we have data on incident and mortality rates, but we do not have data on the number of patients with severe form of leptospirosis or how many patients have complications, and whether or not these complications were resolved. Therefore, we carried out this study to determine the predictive factors for severe leptospirosis cases in Kedah. We conducted a cross-sectional study. The data of patients diagnosed with leptospirosis were obtained from the surveillance unit, Kedah Health Department, through the e-notification system. These data were then sorted according to the hospitals where the patients were admitted. The patients’ medical records were collected, and their information was obtained using a checklist. A total of 456 confirmed leptospirosis cases were included in the study, with 199 patients classified as severe cases and 257 patients as mild cases, based on the Malaysian leptospirosis guidelines. Most patients were male (71.5%) with a mean SD age of 36.62 ± 20.75 years. The predictive factors for severe leptospirosis include abnormal lung sounds (OR: 3.07 [CI 1.58–6.00]), hepatomegaly (OR: 7.14 [1.10–45.98]), hypotension (OR: 2.16 [1.08–4.34]), leukocytosis (OR: 2.12 [1.37–3.29]), low hematocrit (OR: 2.33 [1.43–3.81]), and increased alanine aminotransferase (SGPT ALT) (OR: 2.12 [1.36–3.30]). In conclusion, knowing these predictive factors will help clinicians identify severe leptospirosis cases earlier and develop their treatment plans accordingly, to reduce the complications and death from severe leptospirosis.

Clinical profile, management and outcome of patients with leptospirosis during the times of COVID-19 pandemic: A prospective study from a tertiary care centre in South India

“…This explains the high baseline severity in most cases. Similar to previous studies, cases were seen more commonly in men than women [10,12,13,[21][22][23][24][28][29][30][31][32][33][34][35]. This might be due to higher chances of exposure during outdoor activities.…”

“…Most patients present with fever, myalgias, and headache. Myalgia and headache have been described in 28-100% and 19-100% cases respectively in published literature [6,7,10,12,13,21,22,24,29,31,32,[34][35][36][37][38]. Conjunctival suffusion is characteristically seen in many patients with leptospirosis and may help to make a diagnosis.…”

Predictors of Severe Leptospirosis: A Multicentre Observational Study From Central Malaysia

“…In another study conducted in the suburban area in Malaysia, factors that were associated with mortality included patients above 70years with symptoms of oliguria and breathlessness, requirement of vasopressor support, invasive ventilation and steroid use [13]. The present study and two other studies in Malaysia [13,24] also showed lung involvement as one of the predictors of severity and mortality in leptospirosis. Leptospirosis patients with pulmonary hemorrhage were also reported in several case reports including travelers who visited Malaysia [25,26,27].…”

“…The independent predictor of severity included AKI, ALT > 50 IU and platelet < 150 × 10 9 /L. A recent study from Malaysia also showed the association of ALT with severe leptospirosis [24]. In another study conducted in the suburban area in Malaysia, factors that were associated with mortality included patients above 70years with symptoms of oliguria and breathlessness, requirement of vasopressor support, invasive ventilation and steroid use [13].…”

The Potential of Rats and Bats as Reservoirs of Leptospirosis and Japanese Encephalitis (JE) in Muna Region, Southeast Sulawesi Province, Indonesia

“…Control measures should be implemented including managing wastes properly, keeping the house clean, and maintaining the hygienic and sanitary of sewage. A study in Kedah proved that the predictive factors will help clinicians to identify severe leptospirosis cases earlier and develop their treatment plans so that the complications and mortality rate from severe leptospirosis can be reduced (Sandhu et al, 2020). Besides rats, in Brazil, Leptospira was found in bovine (65.69%), equine (20.32%), and canine (5.64%) (Polo et al, 2019).…”