Hypocalcemia, hypochloremia, and eosinopenia as clinical predictors of leptospirosis: A retrospective study

Predictors of severe leptospirosis: a multicentre observational study from Central Malaysia

Background

Leptospirosis is a re-emerging disease with vast clinical presentations, that ranges from subclinical or mild to severe and fatal outcomes. Leptospirosis can be managed well if diagnosed earlier, however, similar clinical presentations by several other febrile illnesses or co-infections, and laboratory diagnostic challenges due to the biphasic nature of the illness, often result in mis- or underdiagnosis, thereby lead to severe illness. Identification of clinical predictors for the severe form of the disease plays a crucial role in reducing disease complication and mortality. Therefore, we aimed to determine the clinical predictors associated with severe illness among leptospirosis patients from Central Malaysia through a prospective multicenter observational study.

Methods

A prospective multicenter observational study was performed on patients admitted for clinically suspected leptospirosis. Three hospitals namely Hospital Serdang, Hospital Tengku Ampuan Rahimah and Hospital Teluk Intan were included in the study. Among a total of 165 clinically suspected leptospirosis patients, 83 confirmed cases were investigated for clinical predictors for severe illness. Qualitative variables were performed using χ2 and the relationship between mild and severe cases was evaluated using logistic regression. Multivariable logistic regression was used to predict the independent variable for severity.

Results

Among the 83 patients, 50 showed mild disease and 33 developed severe illness. The mean age of the patients was 41.92 ± 17.99 and most were males (n = 54, 65.06%). We identified mechanical ventilation, acute kidney injury, septic shock, creatinine level of > 1.13 mg/dL, urea > 7 mmol/L, alanine aminotransferase > 50 IU, aspartate aminotransferase > 50 IU, and platelet < 150 × 10⁹/L as factors associated with severe illness. Acute kidney injury, alanine aminotransferase > 50 IU and platelet < 150 × 10⁹/L were defined as the independent factors for severity.

Conclusions

Lungs, liver and kidney involvement and septic shock were found as the prognostic factors for severe leptospirosis. Acute kidney injury, high level of alanine aminotransferase and low level of platelets were found to be independent predictors of severity.

High exposure to pathogenic leptospires by the population residing in dairy farms in Hidalgo, Mexico

Leptospirosis is a neglected zoonotic disease of unknown magnitude that has been overlooked and underreported, influenced by complex interactions established among humans, animals, and the environment; certain occupations, such as working with livestock, have an increased risk of exposure. We conducted a cross trans-sectional study in 374 serum samples obtained from workers and residents of dairy farms in the Tizayuca Basin, Hidalgo, Mexico, to determine the prevalence of anti-Leptospira antibody and the risk factors associated to this type of environment. The determination of anti-Leptospira antibodies was obtained by microscopic agglutination test. Seropositivity was defined from titles > 1:100. Seropositivity of anti-Leptospira antibodies among the population was 46.8% (176/374) (95% Cl 41.9-52.1). Thirty-nine percent (146/74) of the analyzed serum reacted to the Hardjo serovar (Sejröe serogroup). Eighty-eight percent (8/9) slaughterhouse workers tested were seropositive. Those who belonged to an ethnic group had OR 1.78 (IC 1.02-3.11, P = 0.041). Seropositivity was associated with having a secondary school level or lower, with OR 1.79 (IC 0.97-3.29, P = 0.058). Exposure to Leptospira in a dairy production farm is a risk factor for humans. Our findings can contribute to strengthening the intervention of the Public Health System to prevent this zoonosis that prevails in dairy farm environments.