Prognostic Factors for Leptospirosis Infection Severity

Abstract

Background: Leptospirosis is an important health problem in Thailand. People infected with leptospirosis may not have any mild symptoms, whereas some people have acute and severe illnesses. It is crucial to strengthen critical patients’ diagnosis and treatment to prevent severe complications and reduce mortality. This study was performed to explore a set of parameters for the prediction of severe leptospirosis illness under routine clinical practice. Methods: A case-control study was conducted in eight general hospitals in Thailand. Retrospective collection data were used, and key information was retrieved from inpatient medical files. Patients were grouped into two severity categories, severe and non-severe infection. Backward elimination was used to reach the final multivariate model. Results: The six significant predictors identified in the study were hemoptysis (OR = 25.80, 95% CI 5.69, 116.92), hypotension (blood pressure < 90/60 mmHg) (OR = 17.33, 95% CI 6.89, 43.58), platelet count < 100,000/µL (OR = 8.37, 95% CI 4.65, 15.09), white blood cell count (WBC) > 14,000/µL (OR = 5.12, 95% CI 2.75, 9.51), hematocrit ≤ 30% (OR = 3.49, 95% CI 1.61, 7.57), and jaundice (OR = 3.11, 95% CI 1.71, 5.65). These predictors could correctly predict the severity of leptospirosis infection in 91.31% of the area under the receiver operation curve (AuROC). Conclusions: The results of this study showed that severe leptospirosis infections have identifiable predictors. The predictors may be used to develop a scoring system for predicting the level of severity.

Epidemiological and Genomic analysis of Vibrio parahaemolyticus isolated from imported travelers at the port of Shanghai, China (2017-2019)

“…Climate is known to have influence on the distribution of human pathogens [28]. Thailand is predominantly an agricultural country, locates in a tropical zone, which has a hot and humid climate with different epidemiology from other countries [29]. Meanwhile, it is one of the most visited countries globally, improving opportunities for pathogens transmission all around the world.…”

Demographic and clinical risk factors associated with severity of lab-confirmed human leptospirosis in Colombia, 2015–2020

“…Previous studies about the clinical factors associated with severe leptospirosis have shown signs and symptoms like hemorrhage [ 33 ], pulmonary signs and symptoms (abnormal lung sounds, dyspnea) [ 33 ], hypotension, oliguria, jaundice [ 52 , 53 ], and hyperkalemia [ 33 ]. Laboratory testing as packed cell volume (PCV: 29.8%), hyponatremia (<131 mEq/L), and highest alanine transaminase (ALT: 70 IU/L) were found to be independently associated with severe disease [ 52 , 54 ]. We found rash, dyspnea, tachycardia, and jaundice associated with severe leptospirosis.…”

“…For example, a review estimated that 11–53% of dengue virus infections present rash compared to 5% of leptospirosis cases [ 58 ]. Studies in Puerto Rico [ 59 ], Thailand [ 52 ], and Nicaragua [ 38 ] did not find evidence that rash was an indicator of severe or fatal leptospirosis. In India, one study found that skin rash was significantly associated with leptospirosis in children [ 60 ], and another study found only suggestive evidence of such an association among urban leptospirosis cases [ 61 ], but not a sign of severity.…”

Acute Kidney Injury Associated with Severe Leptospirosis: Fatal Re-Emerging Disease in Latin America

“…In addition, there may be pulmonary involvement, and this is described as severe pulmonary hemorrhage syndrome, which reaches a fatality rate greater than 50% [7]. The prognosis depends on early diagnosis, severity, and timely intensive treatment [8]. However, the presentation is usually different in different geographical areas of the world and is explained by variations in intrinsic virulence between serovars and existing species [4].…”