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- Title
Early Indicators of Fatal Leptospirosis during the 2010 Epidemic in Puerto Rico.
- Authors
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.
- 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.
- Subjects
LEPTOSPIROSIS; DENGUE; DIAGNOSIS of fever; LEPTOSPIRA; LEUCOCYTES; HEMOPTYSIS; PATIENTS
- Publication
PLoS Neglected Tropical Diseases, 2016, Vol 10, Issue 2, p1
- ISSN
1935-2727
- Publication type
Article
- DOI
10.1371/journal.pntd.0004482