Clinical and laboratory characteristics in leptospirosis

Leptospirosis is one of the most common zoonoses in the world, with a wide range of manifestations that can vary from mild to severe with acute hepatic and renal failure, pneumonia or meningitis. Between 2005-2011 in Romania, according to ECDC, 1740 cases have been reported. Objective: To describe clinical and laboratory characteristics of confirmed cases of leptospirosis.

Retrospective study, between January 2004-June 2014, in one infectious diseases hospital in Bucharest. We included patients with leptospirosis diagnosis at discharge and/or positive serology for leptospirosis. Serological diagnosis of acute leptospirosis was made by microscopic agglutination test using a battery of 17 antigens from international reference strains in one national reference laboratory and/or positive IgM-enzyme-linked immunosorbent assay (ELISA). Statistical analysis was performed with SPSS v19.0; continuous variables were described with medians and ranges; categorical variables were described with numbers and percentages.

Of 132 patients with leptospirosis diagnosis at discharge, 105 (80%) had positive serology for leptospirosis. The median age was 37 (IQR 29-53) and 94 (90%) were male. 71 (68%) patients were diagnosed between May and September, 54 (51%) lived in urban areas and 8 (8%) patients had professional exposure. Leptospirosis serotype has been identified in 75 (71%) patients. 9 (9%) patients had meningeal involvement, 12 (12%) patients respiratory manifestations, 66 (63%) patients renal impairment and 38 (36%) patients coagulation impairment. The median level of alanin aminotransferase, gamma-glutamyl transpeptidase and total bilirubin were 88 IU/mL (IQR 50-158), 162 IU/mL (IQR 86-279) and 4.7 mg/dL (IQR 1.2-14.7), respectively. Leukocytosis (WBC >10.000/µL) was present in 55 (52%) patients, severe thrombocytopenia (PLT <50.000/µL) in 25 (24%) patients and 87 (83%) patients had inflammatory syndrome. In-hospital mortality was 4% (4/105).

Liver and renal failure were the most common manifestations in leptospirosis. Increased awareness should be maintained in order to diagnose and initiate early adequate treatment to reduce mortality and morbidity.