Abstract
Abstract Background Leptospirosis (Lepto) remains underreported due to diagnostic limitations. Military personnel are considered high risk due to deployments in endemic locations and exposure in contaminated training sites. We analyzed the frequency, epidemiology, and clinical characteristics of lepto diagnoses in the Military Health System (MHS).Figure 1Leptospirosis Lab and Clinical Case Definitions and Criteria Methods Potential MHS lepto diagnoses were identified by lepto-specific ICD-9/10 codes or positive lepto laboratory tests between 1/1/2013-1/1/2022. Potential cases underwent chart review, were classified per CDC case definitions (Figure 1), and compared for clinical and lab findings.Figure 2Flowchart for Identification of Leptospirosis Cases Results Of 297 identified potential lepto cases, there were 11 confirmed, 134 probable, and 53 possible cases on chart review (Figure 2) of whom 77% (153/198) were hospitalized and one died (Table 1). Cases were confirmed via microscopic agglutination test (MAT, 6/11), blood culture (3/11), MAT and blood culture (1/11), and urine PCR (1/11) (Table 2). Of cases with demographic data, 89% were male (176/197) and 82% (162/197) were service members, with 16% (31/197) retired, dependents, or civilians. Of those with documented exposures, 52% (88/169) were recreational, and an additional 5 cases non-occupational (cumulatively 55%, 93/169). Fresh water exposures were common and more likely in confirmed/probable cases, with 67 associated with jungle warfare training in Okinawa. Of note, 44% of all cases (87/198) were diagnosed in those living in endemic areas without occupational exposure or deployment/travel. Japan (86/198), Guam (55/198), and Hawaii (22/198) were the most common areas of exposure. Confirmed cases were most likely to be exposed and diagnosed in Hawaii.Table 1Clinical Characteristics of Confirmed, Probable, and Possible Leptospirosis Cases Conclusion Lepto remains a common diagnosis within the MHS, especially among service members and in endemic areas. Despite classic teaching, a significant proportion of MHS cases occur in patients living in endemic areas without occupational or deployment exposures. This highlights lepto as a continual threat and burden on systems in endemic areas in addition to the classically recognized military exposures. Furthermore, despite a substantial amount of possible and probable cases, there remain few confirmed cases.Table 2Laboratory Testing of Confirmed, Probable, and Possible Leptospirosis Disclosures All Authors: No reported disclosures
Published Version
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call