Leptospirosis in Reunion Island (Indian Ocean): analysis of factors associated with severity in 147 confirmed cases

Abstract

Pulmonary involvement is a major feature in leptospirosis disease but is not associated with poor outcome. Identification of clinical and laboratory findings on admission may help to better characterize severe cases.

Leptospirosis-Associated Hospitalizations, United States, 1998–2009

“…In the presence of renal dysfunction and failure, which have been reported in 26%–47% of leptospirosis patients ( 25 , 31 – 34 ), fluid replacement therapy and dialysis are indicated to improve clinical outcome ( 2 , 3 ). The presence of hemorrhagic conditions, including hematuria, hematemesis, and hemoptysis, ranges from 9.1% to 81.5% in patients hospitalized for leptospirosis ( 30 , 31 , 35 ), and these conditions often require blood transfusions ( 2 ). These therapies and procedures increase the cost of patient care ( 3 6), and such increases may be reflected in our study findings.…”

Differences in Clinical Manifestations of Imported versus Autochthonous Leptospirosis in Austria and Germany

“…3 An association of infecting serovar and disease severity has long been assumed, but could not be proven yet. 8,18,35 In addition, host factors such as higher age 17,23 and male sex 36 predispose for more severe disease. In vitro , two more factors have been identified: serum levels of mannose-binding lectin, 37 and toll-like receptor 4 (TLR4) linked activation of macrophages by whole heat-killed Leptospira as part of the innate immune system.…”

“…Jaundice has traditionally been considered as an indicator of complicated forms, the most severe being Weil's disease with the triad of jaundice, acute renal failure (ARF), and hemorrhages and a mortality rate of 5% to 15%. 2,8 In recent years, however, an increasing number of severe anicteric forms has been observed in various countries like China, Korea, Nicaragua, Peru, and India. [9][10][11][12][13][14] In these cases, serious pulmonary manifestations with severe pulmonary hemorrhage syndrome (SPHS) and acute respiratory distress syndrome (ARDS) predominated.…”

“…15 There is, however, currently no consistent definition of what characterizes "severe forms" of leptospirosis, although several factors associated with an increased risk of fatal outcome (therefore being prognostically relevant) have been identified over the past decade ( Table 1 ). 8,[16][17][18][19][20][21][22][23][24][25][26] In Austria and Germany, leptospirosis is a rare disease overall. Usually less than 60 cases are notified in Germany annually with the actual incidence being 0.06/100,000 per year.…”

Serial CT features of pulmonary leptospirosis in 10 dogs

“…Although symptoms are mild in most of these, intra-alveolar haemorrhage as diagnosed on bronchoalveolar lavage (BAL) has been reported to occur in 25.4 per cent of patients with pulmonary involvement and bears no relationship with the severity of leptospirosis (Paganin and others 2009). Pulmonary haemorrhage can also be occult on conventional radiography: thoracic radiographs were read as normal in 38.7 per cent of 31 patients with alveolar haemorrhage confirmed by BAL (Paganin and others 2007). In people, leptospirosis is characterised on thoracic radiographs by small nodular opacities (1–7 mm diameter), with or without areas of consolidation, with a predominantly peripheral distribution (Im and others 1989).…”