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

Details

• Alternative Title:
  PLoS Negl Trop Dis
• Personal Author:
  Sharp, Tyler M. ; Rivera García, Brenda ; Pérez-Padilla, Janice ; Galloway, Renee L. ; Guerra, Marta ; Ryff, Kyle R. ; Haberling, Dana ; Ramakrishnan, Sharada ; Shadomy, Sean ; Blau, Dianna ; Tomashek, Kay M. ; Bower, William A.
• Description:
  Background
  
  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.
  
  Methodology/Principal Findings
  
  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).
  
  Conclusions/Significance
  
  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.
  
  
• Subjects:
  Adolescent Adult Aged Aged, 80 And Over Case-Control Studies Child Child, Preschool Early Diagnosis Epidemics Female Humans Infant Leptospira Leptospirosis Male Middle Aged Young Adult

  More +
• Source:
  PLoS Negl Trop Dis. 10(2).
• Pubmed ID:
  26914210
• Pubmed Central ID:
  PMC4767218
• Document Type:
  Journal Article
• Place as Subject:
  Puerto Rico
• Volume:
  10
• Issue:
  2
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:1021c0aa2c1f70b3857a731a4bf4ff03301d8eed59e96d75570af0b898fd1bbe
• Download URL:
  https://stacks.cdc.gov/view/cdc/38571/cdc_38571_DS1.pdf
• File Type:
  [PDF - 1.42 MB ]