Leptospirosis Patients Research Articles

Predictors of Severity and Management of Severe Leptospirosis Patients in Intensive Care Unit

Background: Severe leptospirosis or Weil's syndrome occurs in 10% of leptospirosis cases, with a mortality rate of 5-40%. Misdiagnosis of leptospirosis often occurs due to nonspecific symptoms. Discussion of risk factors, causative agents, pathogenesis, clinical manifestations, diagnostic techniques, and predictors of disease severity are crucial for successful management.Cases: We report 3 cases of leptospirosis with various clinical manifestations and management. In these 3 cases, older age was associated with severe leptospirosis and poor outcomes. The SPiRO score can identify patients with severe leptospirosis requiring intensive care. All three cases of leptospirosis were severe with complications in the kidneys, lungs, and hematological system requiring intensive care in the intensive care unit (ICU).Discussion: Early and appropriate management can reduce patient mortality rates. ICU management of leptospirosis includes antibiotics, fluid balance, and support for affected organs. Patients with respiratory failure are given oxygenation using high-flow nasal cannula (HFNC), non-invasive ventilation (NIV), or invasive mechanical ventilation with endotracheal intubation (ETT). Acute kidney failure in leptospirosis can be managed with hemodialysis as indicated or may improve with conservative therapy. Corticosteroids may be administered for thrombocytopenia associated with leptospirosis.Conclusion: The three cases of leptospirosis were severe with complications in the kidneys, lungs, and hematological system requiring intensive care in the ICU. Early and appropriate management can reduce patient mortality rates. In these 3 cases, older age, mechanical ventilation, acute kidney failure, septic shock, thrombocytopenia, and elevated transaminase enzymes were associated with severe leptospirosis and poor outcomes.

Incidence of dengue, chikungunya, malaria, typhoid fever, scrub typhus, and leptospirosis in patients presenting with acute febrile illness at a tertiary care hospital, Amritsar.

India is both a tropical and subtropical region, where common causes of acute undifferentiated febrile illness (AUFI) include malaria, dengue fever, chikungunya fever, enteric fever, leptospirosis, scrub typhus, and Japanese encephalitis. These illnesses contribute significantly to patient morbidity and mortality, although the exact burden of each infection varies regionally. Given the high prevalence of these tropical diseases, prioritizing differential diagnoses in cases of AUFI is crucial. In recent years, dengue, chikungunya, malaria, typhoid fever, scrub typhus, and leptospirosis along with coinfections between these diseases have reemerged as major causes of AUFI in many parts of India. These diseases are the most frequent contributors to AUFI and significantly increase patient morbidity and mortality compared to other causes. Although leptospirosis is not endemic in Punjab, cases are still screened as part of the National Centre for Disease Control (NCDC) National One Health Programme for Prevention and Control of Zoonoses (NOHPPCZ). Additionally, as a tertiary care hospital, the facility receives patients from migratory populations and other states beyond Punjab, thereby addressing a broader range of cases. To determine the incidence and clinical profile of dengue, chikungunya, malaria, typhoid fever, scrub typhus, and leptospirosis among patients presenting with acute undifferentiated fever admitted to the Department of Medicine at GNDH Tertiary Complex, Amritsar. The present study was conducted in the Viral Research and Diagnostic Laboratory, Department of Microbiology, Government Medical College, Amritsar, over a 12-month period from January 1, 2023, to December 31, 2023. A total of 276 patients aged over 18 years with acute undifferentiated febrile illness (AUFI) presenting to the inpatient services of the Medicine Department at Government Medical College, Amritsar, during the study period constituted the study population. The demographic and clinical profiles of the cases were recorded using a predesigned pro forma. Rapid immunochromatographic tests and enzyme-linked immunosorbent assays (ELISA) were performed on blood samples to identify active infections of dengue, chikungunya, scrub typhus, leptospirosis, typhoid fever, and malaria. The overall incidences of dengue, chikungunya, malaria, typhoid fever, scrub typhus, and leptospirosis among AUFI cases were 11.6% (32/276), 24.6% (68/276), 0.7% (2/276), 5.4% (15/276), 1.4% (4/276), and 8.7% (24/276), respectively. The incidence of coinfected cases among AUFI cases was 15.6% (43/276). The most common coinfection was dengue + chikungunya, observed in 26 cases, followed by dengue + leptospirosis in 6 cases, leptospirosis + scrub typhus in 4 cases, chikungunya + typhoid fever in 3 cases, chikungunya + malaria in 2 cases, and leptospirosis + typhoid fever in 2 cases. The incidence of dengue, chikungunya, malaria, typhoid fever, scrub typhus, and leptospirosis was slightly higher among females (34.4%) compared to males (33.7%). Fever accompanied by myalgia was the most common presenting complaint in all cases. The most significant etiological agents of AUFI in our investigation were chikungunya, followed by dengue, leptospirosis, typhoid fever, scrub typhus, and malaria. The high incidence of co-infections (15.6%) observed in our study reflects an undefined level of previous infections, cross-reactivity, and subclinical infections within the population. As the majority of tropical infections are location-specific yet clinically indistinguishable, regional knowledge and the use of commonly available serological tests are essential for the timely detection of other etiological agents of AUFI.

Investigating animals and environments in contact with leptospirosis patients in Aotearoa New Zealand reveals complex exposure pathways

ABSTRACT Case history: Three human leptospirosis cases from a case-control study were recruited for in-contact animal and environment sampling and Leptospira testing between October 2020 and December 2021. These cases were selected because of regular exposure to livestock, pets, and/or wildlife, and sampling was carried out on their farms or lifestyle blocks (sites A–C), with veterinarians overseeing the process for livestock, and cases collecting environmental and wildlife samples. Laboratory findings: Across the three sites, a total of 137 cattle, > 40 sheep, 28 possums, six dogs, six rats, three pigs and three rabbits were tested. Herd serology results on Site A, a dairy farm, showed infection with Tarassovi and Pomona; urinary shedding showed Leptospira borgpetersenii str. Pacifica. Animals were vaccinated against Hardjo, Pomona and Copenhageni. The farmer was diagnosed with Ballum. On Site B, a beef and sheep farm, serology showed infection with Pomona; animals were not vaccinated, and the farmer was diagnosed with Hardjo. On Site C, cattle were shedding L. borgpetersenii; animals were not vaccinated, and the case’s serovar was indeterminate. Six wild animals associated with Sites A and C and one environmental sample from Site A were positive for pathogenic Leptospira by PCR. Conclusion: These findings highlight the complexity of potential exposures and the difficulty in identifying infection sources for human cases. This reinforces the need for multiple preventive measures such as animal vaccination, the use of personal protective equipment, pest control, and general awareness of leptospirosis to reduce infection risk in agricultural settings. Clinical relevance: Farms with unvaccinated livestock had Leptospira infections, highlighting the importance of animal vaccination. Infections amongst stock that were vaccinated emphasise the importance of best practice vaccination recommendations and pest control.

WCN25-4523 Leptospirosis in patients on chronic haemodialysis – A case series

WCN25-4523 Leptospirosis in patients on chronic haemodialysis – A case series

Uncovering Latent Infections in Kidneys: A Novel Molecular Approach for Differential Leptospira Detection

Uncovering Latent Infections in Kidneys: A Novel Molecular Approach for Differential Leptospira Detection

MicroRNA biomarkers and host response pathways in severe pulmonary hemorrhagic syndrome due to leptospirosis: A multi-omics study.

MicroRNA biomarkers and host response pathways in severe pulmonary hemorrhagic syndrome due to leptospirosis: A multi-omics study.

STUDY OF HUMAN LEPTOSPIROSIS IN A TERTIARY CARE HOSPITAL, VISAKHAPATNAM

Objective: Prevalence of leptospirosis in humans is found in an alarming number in recent times. This endemic zoonotic disease is widespread and potentially fatal. It is usually seen in areas with poor socioeconomic conditions, water stagnation, garbage accumulation, which becomes breeding sites for the rodents. Infection may turn epidemic during monsoon. Reservoir of infection is rat scientifically named as Rattus rattus and infection results from direct or indirect exposure to host animals that carry the pathogen in their renal tubules and shed pathogenic leptospires in their urine. The main objective of this study was to estimate the seropositivity of leptospirosis in patients presenting with undifferentiated acute febrile illness for 5 to 7 days during one year period from February 2023 to February 2024 in a tertiary care hospital, Visakhapatnam, India. Methods: A total of 279 blood samples received from suspected cases of leptospirosis were subjected to IgM ELISA. Results: Out of total 279 cases, 20 were positive for leptospirosis (OD ratio ≥1.00). All the positive cases presented with a fever more than 99.5°F, chills and headache with elevated serum procalcitonin levels. Peak incidence of cases was recorded during July and August 2023. Conclusion: Seroprevalence of human leptospirosis in this study was found to be 7.2%.

Oliguria as a diagnostic marker of severe leptospirosis: a study from the Transcarpathian region of Ukraine.

Leptospirosis is an emerging illness presenting a broad range of clinical manifestations, ranging from asymptomatic or mild cases to severe and fatal outcomes. Early detection is crucial for effective treatment; however, similar clinical presentations in various febrile illnesses or co-infections, along with challenges in laboratory diagnostics, can lead to misdiagnosis and severe consequences. Identifying clinical predictors for severe forms of the disease is essential in mitigating complications and reducing mortality. Consequently, we conducted a retrospective case-control study to identify clinical markers indicative of severe disease in leptospirosis patients from the Transcarpathian region. The study focused on patients admitted with clinically suspected leptospirosis, involving a total of 51 diagnosed cases, with 13 resulting in severe outcomes and death. Categorical variables were analyzed using χ2, revealing a mean patient age of 50 years, predominantly male (n = 36, 70.5%). Oliguria emerged as a significant independent factor associated with mortality (odds ratio [OR], 13.5; 95% confidence interval [CI], 2.56-71.12; p = 0.001). Additionally, our analysis uncovered a noteworthy increase in leptospirosis notification rates in Transcarpathian compared to Ukraine, with 150 cases out of the total 433 in Ukraine. The highest notification rates were observed in Mukachevo District and Perechyn District. These findings highlight the importance of early recognition of key clinical markers, such as oliguria, which are critical for predicting severe outcomes in leptospirosis patients. The higher notification rates in Transcarpathian regions also underscore the need for enhanced surveillance, targeted public health interventions, and timely treatment to reduce mortality in endemic areas.

Efficacy of Adjunct Hemoperfusion Compared to Standard Medical Therapy on 28-Day Mortality in Leptospirosis Patients with Renal Failure and Shock: A Single-Center Randomized Controlled Trial.

Hemoperfusion is a novel adjunct therapy that targets the dysregulated inflammatory events in severe sepsis. Previous studies have reported conflicting results on its efficacy and safety. This study was designed to assess the efficacy and safety of hemoperfusion among leptospirosis patients in septic shock and renal failure in terms of improvement in 28-day mortality, SOFA score, level of inflammatory markers, hemodynamics, and renal and pulmonary function. A total of 37 severe leptospirosis patients were enrolled and randomized into either standard medical therapy (SMT) alone, n = 20, or with hemoperfusion (HP), n = 17. Vital signs, urine output, vasopressor dose, PaO2/FiO2 (P/F) ratio, and biochemical parameters of patients from each treatment arm were compared. The hemoperfusion group showed a 36.84% (p = 0.017) risk reduction in 28-day mortality. Levels of procalcitonin, IL6, and lactate significantly decreased from baseline to day 7 in both groups. Statistically significant improvements in serum creatinine (p = 0.04) and PF ratio (p = 0.045) were observed in the hemoperfusion cohort. Intention-to-treat and per-protocol approaches showed that hemoperfusion increased the survival rate and decreased the mortality risk. This benefit for survival persisted even when patients were also receiving extracorporeal membrane oxygenation (ECMO), showing that hemoperfusion's benefits are independent of ECMO use. Hemoperfusion is a safe and effective adjunct therapy for managing severe sepsis. It promotes earlier renal and pulmonary function recovery and improves the survival of septic shock patients.

The Potential of Eight Plasma Proteins as Biomarkers in Redefining Leptospirosis Diagnosis.

Leptospirosis, a notifiable endemic disease in Malaysia, has higher mortality rates than regional dengue fever. Diverse clinical symptoms and limited diagnostic methods complicate leptospirosis diagnosis. The demand for accurate biomarker-based diagnostics is increasing. This study investigated the plasma proteome of leptospirosis patients with leptospiraemia and seroconversion compared with dengue patients and healthy subjects using isobaric tags for relative and absolute quantitation (iTRAQ)-mass spectrometry (MS). The iTRAQ analysis identified a total of 450 proteins, which were refined to a list of 290 proteins through a series of exclusion criteria. Differential expression in the plasma proteome of leptospirosis patients compared to the control groups identified 11 proteins, which are apolipoprotein A-II (APOA2), C-reactive protein (CRP), fermitin family homolog 3 (FERMT3), leucine-rich alpha-2-glycoprotein 1 (LRG1), lipopolysaccharide-binding protein (LBP), myosin-9 (MYH9), platelet basic protein (PPBP), platelet factor 4 (PF4), profilin-1 (PFN1), serum amyloid A-1 protein (SAA1), and thrombospondin-1 (THBS1). Following a study on a verification cohort, a panel of eight plasma protein biomarkers was identified for potential leptospirosis diagnosis: CRP, LRG1, LBP, MYH9, PPBP, PF4, SAA1, and THBS1. In conclusion, a panel of eight protein biomarkers offers a promising approach for leptospirosis diagnosis, addressing the limitations of the "one disease, one biomarker" concept.

Impact of Antibiotic and Steroid Therapy on Leptospirosis Outcomes: A Retrospective Cohort Study in Transcarpathia, Ukraine.

Leptospirosis presents a significant health challenge in the Transcarpathian region of Ukraine, with higher incidence rates and mortality compared to national averages. We conducted a retrospective cohort study to investigate the effects of antibiotic and steroid treatments on outcomes in leptospirosis patients. Our analysis of clinical and laboratory data from a single center revealed that dexamethasone showed significant effects on various clinical variables, as did investigated antibiotics. Notable differences in clinical and laboratory outcomes were observed, particularly in direct bilirubin levels, which were significantly higher in non-survivors. ROC analysis demonstrated high sensitivity and specificity of direct bilirubin as a predictor of mortality. These findings highlight the importance of targeted treatment strategies and the potential of specific laboratory markers in improving leptospirosis management.

Organ Involvement Related to Death in Critically Ill Patients With Leptospirosis: Unsupervised Analysis in a French West Indies ICU.

To identify distinct phenotypes of critically ill leptospirosis patients upon ICU admission and their potential associations with outcome. Retrospective observational study including all patients with biologically confirmed leptospirosis admitted to the ICU between January 2014 and December 2022. Subgroups of patients with similar clinical profiles were identified by unsupervised clustering (factor analysis for mixed data and hierarchical clustering on principal components). All patients admitted to the ICU of the University Hospital of Guadeloupe on the study period. One hundred thirty critically ill patients with confirmed leptospirosis were included. None. At ICU admission, 34% of the patients had acute respiratory failure, and 26% required invasive mechanical ventilation. Shock was observed in 52% of patients, myocarditis in 41%, and neurological involvement in 20%. Unsupervised clustering identified three clusters-"Weil's Disease" (48%), "neurological leptospirosis" (20%), and "multiple organ failure" (32%)-with different ICU courses and outcomes. Myocarditis and neurological involvement were key components for cluster identification and were significantly associated with death in ICU. Other factors associated with mortality included shock, acute respiratory failure, and requiring renal replacement therapy. Unsupervised analysis of critically ill patients with leptospirosis revealed three patient clusters with distinct phenotypic characteristics and clinical outcomes. These patients should be carefully screened for neurological involvement and myocarditis at ICU admission.

Drug Prescription Pattern for Leptospirosis and Association with Outcome: Observations from a Tertiary Care Center

Background: Leptospirosis, an infection of the tropics, caused by helical spirochetes, Genus Leptospira. For the first time, this study examines the pattern of antibiotic prescription for leptospirosis and its association with outcome. Materials and Methods: This was a hospital-based retrospective study. A total of 227 adults diagnosed and treated for leptospirosis during the study period of January 2013 to December 2018 were included in the study. Information on gender, age, admission details, outcome, inpatient days, and antibiotics used was collected from the patients’ records and analyzed. Results: Around 75% of the leptospirosis patients were male and majority (70.4%) of the patients were from the age group of 31–60 years. Most of the patients (43.6%) were admitted for 6–10 days; 27.3% of the patients were admitted in the intensive care unit (ICU) and the mortality rate was 7.49%. Ceftriaxone was the most (53.3%) prescribed intravenous antimicrobial, followed by piperacillin–tazobactum (32.6%), and among oral antimicrobials, doxycycline was prescribed in 37.4% of the patients. Penicillin was administered to 44 patients with mild disease and all survived. Among the Ceftriaxone and piperacillin–tazobactum prescribed, 26.5% (32/121) and 35% (26/74) were admitted in ICU, respectively. Among the patients with severe disease, who succumbed to leptospirosis, ceftriaxone, and piperacillin–tazobactam were prescribed in 8.28% and 4.05%, respectively. Conclusion: The pattern of antibiotics prescribed in the study center was in accordance with the standard guidelines. The prescriptions were predominantly penicillin and doxycycline in early conditions while ceftriaxone and piperacillin–tazobactum were administered in advance/severe conditions. Patients with mild disease recovered with penicillin, while in advanced disease, even administration of third cephalosporins and doxycycline had a poor prognosis leading to death of the patients, indicating the need for early diagnosis and treatment to be important to prevent mortality.

Study of machine learning techniques for outcome assessment of leptospirosis patients

Leptospirosis is a global disease that impacts people worldwide, particularly in humid and tropical regions, and is associated with significant socio-economic deficiencies. Its symptoms are often confused with other syndromes, which can compromise clinical diagnosis and the failure to carry out specific laboratory tests. In this respect, this paper presents a study of three algorithms (Decision Tree, Random Forest and Adaboost) for predicting the outcome (cure or death) of individuals with leptospirosis. Using the records contained in the government National System of Aggressions and Notification (SINAN, in portuguese) from 2007 to 2017, for the state of Pará, Brazil, where the temporal attributes of health care, symptoms (headache, vomiting, jaundice, calf pain) and clinical evolution (renal failure and respiratory changes) were used. In the performance evaluation of the selected models, it was observed that the Random Forest exhibited an accuracy of 90.81% for the training dataset, considering the attributes of experiment 8, and the Decision Tree presented an accuracy of 74.29 for the validation database. So, this result considers the best attributes pointed out by experiment 10: time first symptoms medical attention, time first symptoms ELISA sample collection, medical attention hospital admission time, headache, calf pain, vomiting, jaundice, renal insufficiency, and respiratory alterations. The contribution of this article is the confirmation that artificial intelligence, using the Decision Tree model algorithm, depicting the best choice as the final model to be used in future data for the prediction of human leptospirosis cases, helping in the diagnosis and course of the disease, aiming to avoid the evolution to death.

Identification of Dominant Leptospira Serogroups among Leptospirosis Cases and Their Clinical Outcomes: A Prospective Hospital-Based Study in Mangaluru, India.

Leptospirosis is a reemerging zoonotic disease of worldwide significance, endemic to the southern region of India, with clinical manifestations similar to other febrile illnesses; hence, it is often misdiagnosed and underreported. Inadequate information about the disease burden and the regional circulating serogroups contributes to its neglected disease status. This study aimed to identify the infecting Leptospira serogroup in the coastal region of Mangaluru and study the clinical symptoms and outcome among leptospirosis patients. Serum samples were collected from 30 patients with confirmed leptospirosis admitted to a tertiary care center in Mangaluru and screened by microscopic agglutination test (MAT) for the infecting serogroup. The clinical profile of these cases was reviewed, and data regarding epidemiological factors such as age, sex, complications, and mortality were recorded. The MAT identified a higher occurrence of serogroup Bataviae (n = 7, 43.75%) and serogroup Australis (n = 5, 31.25%) compared with other serogroups screened in this study population. Patients were aged 16 to 65 years, with a predominance of males. The clinical presentation of leptospirosis ranged from a mild febrile illness to multiorgan failure. Fever (n = 29, 96%) was the common clinical presentation, followed by myalgia, nausea, and abdominal pain. Acute kidney injury, acute respiratory distress syndrome, and multiple organ dysfunction syndrome were the common complications observed. Determining the circulating serogroup is necessary to understand the epidemiology and diversity of Leptospira serogroups among animals and humans to strategize appropriate preventive measures.

Efficacy and safety of antibiotics for treatment of leptospirosis: a systematic review and network meta-analysis

BackgroundLeptospirosis, an important zoonotic bacterial disease, commonly affects resource-poor populations and results in significant morbidity and mortality worldwide. The value of antibiotics in leptospirosis remains unclear, as evidenced by the conflicting opinions published.MethodsWe conducted a search in the PubMed, Web of Science, and Cochrane Library databases for studies. These studies included clinical trials and retrospective studies that evaluated the efficacy or safety of antibiotics for leptospirosis treatment. The primary outcomes assessed were defervescence time, mortality rate, and hospital stays. Subgroup analyses were performed based on whether there were cases involving children and whether there were cases of severe jaundice. Safety was defined as the prevalence of adverse events associated with the use of antibiotics. p scores were utilized to rank the efficacy of the antibiotics.ResultsThere are included 9 randomized controlled trials (RCTs), 1 control trial (CT), and 3 retrospective studies (RS) involving 920 patients and 8 antibiotics. Six antibiotics resulted in significantly shorter defervescence times compared to the control, namely cefotaxime (MD, − 1.88; 95% CI = − 2.60 to − 1.15), azithromycin (MD, − 1.74; 95% CI = − 2.52 to − 0.95), doxycycline (MD, − 1.53; 95% CI = − 2.05 to − 1.00), ceftriaxone (MD, − 1.22; 95% CI = − 1.89 to − 0.55), penicillin (MD, − 1.22; 95% CI = − 1.80 to − 0.64), and penicillin or ampicillin (MD, − 0.08; 95% CI = − 1.01 to − 0.59). The antibiotics were not effective in reducing the mortality and hospital stays. Common adverse reactions to antibiotics included Jarisch–Herxheimer reaction, rash, headache, and digestive reactions (nausea, vomiting, diarrhea, abdominal pain, and others).ConclusionsFindings recommend that leptospirosis patients be treated with antibiotics, which significantly reduced the leptospirosis defervescence time. Cephalosporins, doxycycline, and penicillin are suggested, and azithromycin may be a suitable alternative for drug-resistant cases.Systematic review registrationPROSPERO CRD42022354938.

Levels of Cytokines in Leptospirosis Patients with Different Serovars and rfb Locus.

Leptospirosis has a wide spectrum of clinical manifestations ranging from mild to severe disease. The cytokine response is considered one of the key drivers for this varying manifestation. The different cytokine response observed in patients with leptospirosis could be due to the variation of infecting serovars. Since the rfb locus codes for the lipopolysaccharide synthesis of the bacterial cell wall, which also determines the serovar, this locus may play a role in driving a specific cytokine response in the host. We investigated 12 commonly used cytokine profiles in serum samples of culture, microscopic agglutination test (MAT), or polymerase chain reaction (PCR)-positive patients with leptospirosis. The sequences of the rfb locus in culture-positive samples were generated from whole genome sequencing and serovar status was drawn from original data published. Isolated cultures were subjected to whole genome sequencing using the PacBio RS II system, and the resulting data were used to determine the species. The recovered genomic data were annotated with the Rapid Annotation using Subsystem Technology (RAST) subsystem, and the rfb locus was extracted. The cytokine analysis was carried out using the Qiagen human ELISA kit. Eighteen samples were found to be positive by culture, while the other 7 samples were positive by PCR or MAT. Infections from Leptospira interrogans serovar Autumnalis (5), Pyrogens (3), Icterohaemorrhagiae (1) Leptospira borgpetersenii (all 7 samples clustered in same clonal group with serovar status not determined), Leptospira weilii (1 with serovar status not determined), and Leptospira kirschneri serovar Grippotyphosa (1) were included in the analysis. Three patients [infected with Leptospira interrogansserovar Autumnalis (2) and Pyrogens (1)] and 2 MAT-positive patients (highest titer against serovar Bratislava of L.interrognas) were reported to have severe clinical manifestations, while the rest had mild to moderate symptoms. Although the serum cytokine concentration of patients with severe clinical manifestation was comparatively higher, a statistically significant difference was observed only for interleukin (IL)-1β (P < 0.05). IL-10/tumor necrosis factor-alpha (TNF-α) ratio was high in patients with severe complications. In general, patients infected with L. interrogans showed higher concentration of cytokines compared to L. borgpetersenii.

Epidemiology and Characteristics of Leptospirosis Inpatients in Demak Regency in 2018-2023

Demak Regency is an endemic area of leptospirosis. Cases of death due to leptospirosis in humans in Demak Regency in 2018-2023 with a CFR of &gt;11%. Many deaths are found in leptospirosis patients who are hospitalized due to their poor prognosis. This study aimed to describe the characteristics of leptospirosis patients who are hospitalized in Demak Regency. This study used a quantitative descriptive design. Patients’ data were taken from medical records at Sunan Kalijaga, Sultan Fatah, and NU Islamic Hospital in Demak Regency. The results of the study showed that of the 73 confirmed cases, 58.9% were male patients, and 69.9% were &gt;40 years old. Of the 22 deaths, women exceeded men with 54.5%, and &gt;40 years old at 81.8%. Based on laboratory examinations, the average platelet level was 110.18 cells/mm, creatinine level was 3.66 mg/dL, and urea level was 131.54 mg/dL. In the case of death, the patients’ platelet level &lt;100.000 cells/mm was 86.3%, creatinine level &gt;3 mg/dL was 77.2%, and urea level &gt;90 mg/dL was 86.3%. Symptoms that often appeared were myalgia. In this study, icteric and oliguria were not always symptoms in leptospirosis patients who died. Yet dyspnea and icteric symptoms have the potential to be predictors of death in leptospirosis patients. As many as 64.38% of patients did not have comorbidities. As many as 69.86% of leptospirosis patients were given a single type of antibiotic and 30.14% with a combination of antibiotics. Overall, 100% of the patients received antibiotics based on the severity of the disease. Detailed case description reports and patient prognosis need to be carried out to improve the handling of patients with leptospirosis.

Why do Doctors Miss the Diagnosis of Leptospiral Uveitis? Emergence of New Serovars and Challenges in Diagnosis

ABSTRACT Purpose Leptospirosis is an endemic disease in India and uveitis is its late complication. Several Indian reports showed diversity of serovars, changing patterns and existence of new serovars. Failure to add new serovars in testing panel result in increased false-negativity in serology. Aim To analyse seroprevalence, changing patterns and to discuss the resulting challenges in diagnosis. Methods In this retrospective study covering the period from 1994 to 2020, we analysed data from laboratory records of patients diagnosed with leptospiral uveitis in South India. Microscopic agglutination Test (MAT) and/or Enzyme-Linked Immunosorbent Assay (ELISA) were performed on clinically diagnosed leptospiral uveitis cases from our hospital, as well as on systemic leptospirosis patients from government and private hospitals. Results Out of a total of 87 216 new uveitis cases with varying causes over 27 years, 3,658 (4.1%) were clinically diagnosed as leptospiral uveitis. Among them, 1,268 (34.7%) patients were seropositive. In 1994, 92% of clinically diagnosed leptospirosis patients were seropositive in the MAT performed at the Centers for Disease Control and Prevention in Atlanta. However, the positivity rate gradually declined to 35% over the years. The predominant serovars identified were L. autumnalis, L. icterohaemorrhagiae, and L. australis. There were notable variations in the distribution of serovars over the years. Conclusions The data suggest a declining sensitivity of MAT and ELISA, possibly due to the emergence of new serovars. Customizing the panel based on local isolates could enhance the performance of MAT. Critical need is the addition of advanced molecular techniques to improve the diagnosis.

Disability-adjusted life years due to leptospirosis in Monaragala District of Sri Lanka.

Leptospirosis is a zoonotic infection with significant morbidity and mortality. As an occupational disease, it has become a global concern due to its disease burden in endemic countries and rural areas. The aim of this study was to assess disease burden in terms of Disability-adjusted life years (DALYs) of leptospirosis.A hospital-based descriptive cross-sectional study was conducted using 450 clinically diagnosed leptospirosis patients admitted to base and above hospitals in Monaragala District, Sri Lanka, using a pre-tested interviewer-administered questionnaire. The patients were followed up until normal day-to-day life after discharge. Estimation of DALYs was done using laboratory-confirmed leptospirosis patients. Leptospirosis disease burden in Monaragala District was 44.9 DALYs per 100,000 population, which includes 33.18 Years of life losts and 10.9 YLDs. The incidence of leptospirosis in Monaragala District during the study period was 59.8 per 100,000 population, and the case fatality rate (CFR) was 1.5% and 75% of deaths were among males.The disease burden of leptospirosis in Monaragala District was significantly high and urgent efforts to control and prevent leptospirosis should be a priority.