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

Abstract：

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.

journal_name

PLoS Negl Trop Dis

journal_title

PLoS neglected tropical diseases

authors

Sharp TM,Rivera García B,Pérez-Padilla J,Galloway RL,Guerra M,Ryff KR,Haberling D,Ramakrishnan S,Shadomy S,Blau D,Tomashek KM,Bower WA

doi

10.1371/journal.pntd.0004482

subject

Has Abstract

pub_date

2016-02-25 00:00:00

pages

e0004482

issue

eissn

1935-2727

issn

1935-2735

pii

PNTD-D-15-02087

journal_volume

pub_type

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