Leptospirosis in intensive care units: report of 33 cases

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Introduction

Leptospirosis is, in general, a self-limited disease but it can be associated with important complications such as multiple organic dysfunction and high mortality [1].

Objective

The goal of this paper is to evaluate the clinical characteristics and the morbimortality of severe leptospirosis in general Intensive Care Units from two general hospitals.

Methods

All cases with the diagnosis of leptospirosis confirmed by blood macroagglutination test and admitted from 1990 to 1999 were studied. We have analyzed their clinical and laboratory characteristics, the occurrence of multiple organ dysfunction and their mortality rate. We have also compared survivors with non-survivors. The quantitative variables have been compared by unpaired t-tests and the qualitative variables by a Chi squared test.

Results

We described 33 adult patients, aged 40± 16 years, of which 27 were men and 6 women. The most frequent clinical manifestations were fever (n=30), myalgias (n=29), jaundice (n=27) and dyspnea (n=27). All patients showed some level of organic dysfunction such as respiratory (n=29), renal (n=24), hepatic (n=24) and cardiovascular (n=20). The mortality rate was 52% (n=17). The comparison of non-survivors with survivors showed they have higher incidences of respiratory, renal, cardiovascular and neurological failures as well as higher levels of acidosis (P< 0.05).

Conclusions

In endemic regions leptospirosis has to be considered as a cause of multiple organic dysfunction with a high mortality rate mainly when respiratory, renal, cardiovascular or neurological failures are present.