head JofIMAB
Journal of IMAB - Annual Proceeding (Scientific Papers)
Publisher: Peytchinski Publishing Ltd.
ISSN: 1312-773X (Online)
Issue: 2022, vol. 28, issue3
Subject Area: Medicine
DOI: 10.5272/jimab.2022283.4450
Published online: 14 July 2022

Original article
J of IMAB. 2022 Jul-Sep;28(3):4450-4455
Galya GanchevaORCID logo Corresponding Autoremail,
Department of Infectious Diseases, Epidemiology, Parasitology and Tropical Medicine, Faculty of Public Health, Medical University - Pleven, Bulgaria.

The case-fatality rate of severe leptospirosis is above 50% at delayed intensive treatment. Our purpose was to assess the prognostic value of the early clinical diagnosis of leptospirosis.
Material and Methods: One hundred consecutive patients with leptospirosis were treated in the Clinic of Infectious Diseases at University Hospital “Dr Georgi Stranski”-Pleven (1976-2018). They were distributed retrospectively in groups with mild, moderate, and severe course (27, 39, and 34, respectively). The once interesting for prognosis was the risk for severe course. Data were analyzed with statistical software (IВМ SPSS Statistics 19.0).   
Results: The mild cases were hospitalized meanly three days after clinical onset (range 1-7 days). The early clinical diagnosis was leptospirosis, acute viral hepatitis, and “flu-like” (23/27, 85.19%; 3/27, 11.11%; 1/27, 3.70%, respectively).
The moderate cases were hospitalized meanly four days after clinical onset (range 1-10 days). Nineteen moderate cases (48.72%) were misdiagnosed as aseptic meningitis, acute viral hepatitis, viral infection, obstructive jaundice, and nephrolithiasis. Comorbidity was registered in 33.33%.
The severe cases were hospitalized meanly five days after clinical onset (range 2-12 days). Misdiagnoses (in 35.29%) were obstructive jaundice, acute pancreatitis, cholecystitis, pneumonia, and sepsis. Comorbidity was registered in 44.12%. 
The comparative analysis revealed that the patients hospitalized after the fourth day since clinical onset had a significantly more severe course (p<0.05).
Conclusion: The time between clinical onset and hospital admission has significant prognostic value and could be assessed with other clinical predictors of leptospirosis. The early clinical diagnosis is of great importance for initiating intensive treatment (including hemodialysis).

Keywords: leptospirosis, diagnosis, prognosis,

pdf - Download FULL TEXT /PDF 1410 KB/
Please cite this article as: Gancheva G. Prognostic Value of Early Clinical Diagnosis of Leptospirosis. J of IMAB. 2022 Jul-Sep;28(3):4450-4455. DOI: 10.5272/jimab.2022283.4450

Corresponding AutorCorrespondence to: Galya Ivanova Gancheva, Clinic of Infectious Diseases, University Hospital, Pleven; 8A, Georgi Kochev Str., Pleven 5800, Bulgaria; E-mail: galya_gancheva@abv.bg

1. Costa F, Hagan JE, Calcagno J, Kane M, Torgerson P, Martinez-Silveira MS, et al. Global Morbidity and Mortality of Leptospirosis: A Systematic Review. PLoS Negl Trop Dis. 2015 Sep 17;9(9):e0003898. [PubMed]
2. Rajapakse S, Rodrigo C, Haniffa R. Developing a clinically relevant classification to predict mortality in severe leptospirosis. J Emerg Trauma Shock. 2010 Jul;3(3):213-9. [PubMed]
3. Tubiana S, Mikulski M, Becam J, Lacassin F, Lefevre P, Gourinat AC, et al. Risk factors and predictors of severe leptospirosis in New Caledonia. PLoS Negl Trop Dis. 2013; 7(1):e1991. [PubMed]
4. Lee N, Kitashoji E, Koizumi N, Lacuesta TLV, Ribo MR, Dimaano EM, et al. Building prognostic models for adverse outcomes in a prospective cohort of hospitalized patients with acute leptospirosis infection in the Philippines. Trans R Soc Trop Med Hyg. 2017 Dec 1;111(12):531-9. [PubMed]
5. Hochedez P, Theodose R, Olive C, Bourhy P, Hurtrel G, Vignier N, et al. Factors Associated with Severe Leptospirosis, Martinique, 2010-2013. Emerg Infect Dis. 2015 Dec;21(12):2221-4. [PubMed]
6. Spichler AS, Vilaca PJ, Athanazio DA, Albuquerque JO, Buzzar M, Castro B, et al. Predictors of lethality in severe leptospirosis in urban Brazil. Am J Trop Med Hyg. 2008 Dec;79(6):911-4. [PubMed]
7. Panaphut T, Domrongkitchaiporn S, Thinkamrop B. Prognostic factors of death in leptospirosis: a prospective cohort study in Khon Kaen, Thailand. Int J Infect Dis. 2002 Mar; 6(1):52-9. [PubMed]
8. Al Hariri YK, Sulaiman SAS, Khan AH, Adnan AS, Al Ebrahem SQ. Mortality of leptospirosis associated acute kidney injury (LAKI) & predictors for its development in adults: A systematic review. J Infect Public Health. 2019 Nov-Dec;2(6):751-759. [PubMed]
9. Daher EF, Soares DS, Galdino GS, Macedo ES, Gomes PEAC, Pires Neto RDJ, et al. Leptospirosis in the elderly: the role of age as a predictor of poor outcomes in hospitalized patients. Pathog Glob Health. 2019 May:113(3):117-123. [PubMed]
10. Doudier B, Garcia S, Quennee V, Jarno P, Brouqui P. Prognostic factors associated with severe leptospirosis. Clin Microbiol Infect. 2006 Apr; 12(4):299-300. [PubMed]
11. Visith S. Renal dysfunction in leptospirosis: a view from the tropics. Nat Clin Pract Nephrol. 2006 Dec; 2(12):658-9. [PubMed]
12. Visith S, Kearkiat P. Nephropathy in Leptospirosis. J Postgrad Med. 2005 Jul-Sep;51(3):184-8. [PubMed]
13. Haake D, Levett P. Leptospira Species (Leptospirosis). In: Bennet JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennet,s Principles and Practice of Infectious Diseases, 8th ed. Philadelphia: “Churchill Livingstone”, 2015; Vol. 1, Part III, Chapter 241; 2714-2720.
14. Gancheva G. [Complex studies on leptospirosis]. [PhD dissertation] Medical University - Pleven, Bulgaria. 2006:72-73. [in Bulgarian]
15. Rista E, Puca E, Cadri V, Saliaj K, Akshija I, Duraku A, et al. Acute kidney injury in leptospirosis: A country-level report. Travel Med Infect Dis. 2022 Jun 2;49:102359. Online ahead of print. [PubMed]
16. Daher EF, Silva GB Jr., Karbage NN, Carvalho PC Jr., Kataoka RS, Silva EC, et al. Predictors of oliguric acute kidney injury in leptospirosis. A retrospective study on 196 consecutive patients. Nephron Clin Pract. 2009; 112(1):c25-30. [PubMed]
17. Prisacariu A, Fastenaekels M, Jobe J. Leptospirose sévère compliquée d’un choc septique: à propos d’un cas. Journal Européen des Urgences et de Réanimation. 2021 Oct; 33(3):173-7. [Crossref]
18. De Brito T, Aiello VD, da Silva LF, Goncalves da Silva AM, Ferreira da Silva WL, Castelli JB, et al. Human hemorrhagic pulmonary leptospirosis: pathological findings and pathophysiological correlations. PloS One. 2013 Aug 12;8(8):e71743. [PubMed]
19. Delmas B, Jabot J, Chanareille P, Ferdynus C, Allyn J, Allou N, et al. Leptospirosis in ICU: A Retrospective Study of 134 Consecutive Admissions. Crit Care Med. 2018 Jan;46(1):93-99. [PubMed]
20. Yamaguchi T, Higa N, Okura N, Matsumoto A, Hermawan I, Yamashiro T, et al. Characterizing interactions of Leptospira interrogans with proximal renal tubule epithelial cells. BMC Microbiol. 2018 Jul;18(1):64. [PubMed]

Received: 18 December 2021
Published online: 14 July 2022

back to Online Journal