Leptospirosis: prognostic factors associated with mortality
Abstract number: P1838
Rodríguez-Guardado A., Rodríguez Pérez M., Asensi V., Alonso P., Fernández J., Sampere A., Cartón J.A.
Background: Leptospirosis is a zoonosis that occurs worldwide. It is characterised by great clinical variability ranging from a mild flu-like illness to acute life-threatening condition. We conducted a retrospective study to identify the factors associated with the prognosis and mortality of this infection.
Methods: All the episodes of leptospirosis diagnosed in the Hospital Central de Asturias, a universitary hospital in the Northern of Spain, between 19972007 were retrospectively reviewed. The diagnosis was based on a positive serology using an indirect agglutination test or IgM specific ELISA and a clinical setting consistent with leptospirosis. Continuous valous were compared using Student t test or U of Man-Whitney. Categorical values were compared using Fisher's exact test or chi2-test. A p value less than to 0.05 was considered statistically significant
Results: Twenty-three episodes were reviewed. Seventy-three (70%) patients were male, (mean age 51 years, limits 1779). All patients have pertinent epidemiological context, including occupational exposure (19 cases) or swimming in a river (4 cases). All patients have positive agglutination from 1/32 to 1/10565 and fourteen patients have IgM positive. The mean delay between onset the first symptoms and hospital admission was 6±4 days (limits 218 days). In the blood test all the patients showed impaired liver function: AST (mean 465 IU/L; limits 1004.300), ALT (mean 678 IU/L; limits 1118.862) and bilirrubine (mean 11.68; limits 440). Nineteen patients showed impaired renal function: creatinine (mean: 3.6; (limits 1.27.6) and urea nitrogen (mean 128, limits 33267). All patients received antibiotic treatment except one patient that dead before the treatment. The treatments were: intravenous penicillin (8 cases), ampicillin (6 cases), third-generation cefhalosporines (6 cases) and doxicycline (one case). 30% of the patients were admitted to the ICU. The most frequents complications were: distress respiratory (9 cases), haemorrhages (4 cases) and renal insufficiency (5 cases). Seven patients (30.6%) dead due to infection. The mortality was associated with: impaired renal function (P = 0.20) and presence of distress respiratory (6 vs 9, p = 0.007, OR = 0.04) in univariable and multivariable analysis.
Conclusion: The mortality of leptospirosis remains high despite the treatments and admission in intensive care unit. The mortality is associated a severe renal disease, and lung complications.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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