Clinical spectrum of severe leptospirosis in the UK

Abstract

Introduction:Human leptospirosis is a global zoonotic infection with a characteristic biphasic illness and protean clinical manifestations. The majority are mild flu-like infections. The severe forms cause multiorgan damage with a greater predilection to hepatorenal failure.Case presentation:We attempted to analyse the clinical presentation of severe leptospirosis and decipher the clinical spectrum within this group by reviewing a series of 15 patients with leptospirosis requiring intensive care support for their management. We noticed complications becoming apparent before antibodies became detectable in the blood in a significant number of patients. This appears to belie the biphasic nature of leptospirosis and raises the question of whether the complications occur during the leptospiraemic phase or the immune phase of the infection. The presence of leptospiral DNA in the blood at this time as detected by a molecular assay strengthened this suspicion. Among the 15 patients with severe leptospirosis, only 3 (20 %) had an overseas travel history and the remaining 12 patients acquired their infection within the UK. Fourteen of the 15 patients had hepatorenal dysfunction, with seven requiring dialysis. Eight of the 15 patients received intravenous ceftriaxone with very good outcomes. Three showed significant clinical improvement after the administration of steroids.Conclusion:Many patients with severe leptospirosis will have complications on presentation. Molecular testing is now available for early diagnosis, facilitating early interventions. Ceftriaxone has been effective in treating severe leptospirosis. This study reminds clinicians to consider leptospirosis in the differential diagnosis of similar clinical spectra and offers tools for appropriate management.

Determinants of prolonged hospitalization and mortality among leptospirosis patients attending tertiary care hospitals in northeastern state in Peninsular Malaysia: A cross sectional retrospective analysis

“…The shorter LOS of the fatal cases in these studies may be attributed to the severity of the cases or to the late in the admission after the onset of the symptoms [54] which make the patients at higher risk for the worse outcomes (death). Our results which showed no association of the late admission with mortality may indicate the less severity of the disease in our patients and this is supported by the less prevalence of the severe pulmonary involvement in our sample similarly to another study showed low mortality rate [84] and the less frequent severe pulmonary involvement as well. Moreover, studies showed the shorter LOS in fatal cases also showed higher fatality rate than ours indicating the higher severity of the cases in these studies which may justify the faster and higher mortality rate in those studies.…”

Weil’s disease with haemoptysis and acute respiratory distress syndrome

“…There is no gold standard antibiotic therapy for severe leptospirosis. Therefore, third-generation cephalosporins (ceftriaxone, cefotaxime), piperacillin-tazobactam, meropenem and doxycycline have been used with good outcome as alternatives to penicillin G 50 51. In our case, the patient responded well to triple antibiotic therapy.…”

“…In our case, the patient responded well to triple antibiotic therapy. In addition, several reports indicate that steroid therapy, specifically methylprednisolone first administered bolus intravenously and then orally, is linked to a better outcome of the patient with severe leptospirosis 6 50. Supportive therapy is important to treat any possible complications in Weil’s disease, such as fluids and electrolytes restoration, haemodialysis in severe renal impairment, supportive ventilation or even mechanical ventilation if necessary.…”

Tick-Borne Encephalitis (TBE): From Tick to Pathology

“…The biphasic pattern of disease in European TBE is observed in only two thirds of symptomatic individuals [57]. Moreover, this pattern may occur in other viral and bacterial conditions, including Dengue, Zika [59], severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) [60], leptospirosis [61], and pulmonary anthrax [62]. evidence for preferred neuronal tropism, with neuronal cells exhibiting 10,000-fold higher TBEV replication rates than epithelial cells [52].…”