Leptospirosis as a cause of acute respiratory failure: clinical features and outcome in 35 critical care patients

Abstract

Leptospirosis may have important complications, such as acute respiratory failure (ARF) associated or not with other organic dysfunction, with a high mortality rate. We report the characteristics and evolution of severe leptospirosis associated with ARF. During 10 years, 35 consecutive adult patients admitted in two general Intensive Care Units with severe leptospirosis and ARF, were followed up. Clinical characteristics, associated organic dysfunction and mortality were analyzed. Survivors were compared with non-survivors. The most frequent clinical manifestations were dyspnea, fever, myalgia, jaundice, hemoptysis and coughing. All patients presented ARF, needing mechanical ventilation, as well as other organic dysfunctions. The mortality rate was 51%. Non-survivors were older and had a higher incidence of organic dysfunction, mainly renal, cardiovascular and neurological failures, as well as a higher level of acidosis. In conclusion, leptospirosis should be considered as a cause of severe ARF and other associated organic dysfunctions.

Determinants of mortality and impact of therapy in patients with leptospirosis admitted for intensive care in a Sri Lankan hospital – a three year retrospective study

“…Yet methyl prednisolone mechanical ventilation, to be unacceptably high as 55%. 28 In a study from Brazil by Vieira et al 29 where all 35 patients presented with ARF required mechanical ventilation and developed multi-organ failure, mortality was 51%. In another study from India, 9 all 60 leptospirosis patients who were admitted to the ICU had evidence of severe sepsis, 46 of 60 had multiple organ dysfunction and reported mortality was 52%.…”

Comparison between early and delayed acute kidney injury secondary to infectious disease in the intensive care unit

“…Leptospirosis is associated with a high mortality when complicated with multiple organ failure ([50%). Male gender, alcohol dependence, age [50 years, acute respiratory Fischer's exact test: * P = 0.08 and ** P = 0.19 distress syndrome, metabolic acidosis and need of mechanical ventilation represent poor prognostic factors [31][32][33]. An early treatment of leptospirosisassociated AKI improves survival [34,35].…”

Leptospirosis

“…Prompt triage of highrisk patients is critical since complications require aggressive treatment and monitoring. Older adults (over 30-40 years of age) have an increased risk for death [10,60,64,66]. Independent prognostic factors for mortality are acute renal failure (oliguria, hyperkalemia, serum creatinine !3.0 or 4.0 mg/dl), respiratory insufficiency (dyspnea, pulmonary rales, radiological evidence for infiltrates), hypotension, arrhythmias and altered mental status [10,[59][60][61]63 ].…”