Journal Article

Early Indicators of Fatal Leptospirosis during the 2010 Epidemic in Puerto Rico

Pérez-Padilla, Janice, Ryff, Kyle R., Guerra, Marta, Sharp, Tyler M., Galloway, Renee L., Bower, William A., Rivera García, Brenda, Blau, Dianna, Ramakrishnan, Sharada, Shadomy, Sean, Haberling, Dana, Tomashek, Kay M.

2016

Overview

Leptospirosis is a potentially fatal bacterial zoonosis that is endemic throughout the tropics and may be misdiagnosed as dengue. Delayed hospital admission of leptospirosis patients is associated with increased mortality. During a concurrent dengue/leptospirosis epidemic in Puerto Rico in 2010, suspected dengue patients that tested dengue-negative were tested for leptospirosis. Fatal and non-fatal hospitalized leptospirosis patients were matched 1:1-3 by age. Records from all medical visits were evaluated for factors associated with fatal outcome. Among 175 leptospirosis patients identified (4.7 per 100,000 residents), 26 (15%) were fatal. Most patients were older males and had illness onset during the rainy season. Fatal case patients first sought medical care earlier than non-fatal control patients (2.5 vs. 5 days post-illness onset [DPO], p < 0.01), but less frequently first sought care at a hospital (52.4% vs. 92.2%, p < 0.01). Although fatal cases were more often diagnosed with leptospirosis at first medical visit (43.9% vs. 9.6%, p = 0.01), they were admitted to the hospital no earlier than non-fatal controls (4.5 vs. 6 DPO, p = 0.31). Cases less often developed fever (p = 0.03), but more often developed jaundice, edema, leg pain, hemoptysis, and had a seizure (p ≤ 0.03). Multivariable analysis of laboratory values from first medical visit associated with fatal outcome included increased white blood cell (WBC) count with increased creatinine (p = 0.001), and decreased bicarbonate with either increased WBC count, increased creatinine, or decreased platelet count (p < 0.001). Patients with fatal leptospirosis sought care earlier, but were not admitted for care any earlier than non-fatal patients. Combinations of routine laboratory values predictive of fatal outcome should be considered in admission decision-making for patients with suspected leptospirosis.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Admission and discharge / Adolescent / Adult / Aged / Aged, 80 and over / Biology and Life Sciences / Case-Control Studies / Child / Child, Preschool / Demographics / Dengue fever / Disease / Early Diagnosis / Epidemics / Family medical history / Fatalities / Female / Hospitalization / Hospitals / Humans / Illnesses / Infant / Infections / Laboratories / Leptospira - genetics / Leptospira - isolation & purification / Leptospira - physiology / Leptospirosis / Leptospirosis - diagnosis / Leptospirosis - epidemiology / Leptospirosis - mortality / Male / Medicine and Health Sciences / Middle Aged / Mortality / Patient outcomes / Patients / People and places / Puerto Rico / Puerto Rico - epidemiology / Surveillance / Urine / Young Adult / Zoonoses