title: Leptospirosis in Barbados. A clinical study.
abstract: A 39-month clinical study of leptospirosis was undertaken at the Queen Elizabeth Hospital, Barbados. Eighty-eight patients had a confirmed diagnosis of the disease during the period. The major serogroups identified were autumnalis (including a new serovar bim), icterohaemorrhagiae, ballum and canicola. The majority of patients presented with jaundice (95%,) anorexia and headaches (85%), fever (76%) and conjunctival suffusion (54%). While abnormal creatinine levels were seen in 49% of patients on admission, only 16% were judged to have had renal failure. The urine to plasma urea ratio showed high sensitivity and specificity in the diagnosis of pre-renal azotemia. Cardiac arrhythmias and myocarditis occurred in 18% of patients and pericarditis in 6%. An elevated serum amylase was found in 65% of cases. The bilirubin level took 5.5 weeks to return to normal. Thrombocytopenia was shown not to be due to a disseminated intravascular coagulation, and a randomised trial of high dose penicillin did not reveal any benefit to jaundiced patients. The overall mortality during the study was 5.7%.
authors.affiliation: Department of Medicine, U.W.I., Queen Elizabeth Hospital, Barbados.
authors.forename: C N
authors.initials: CN
authors.lastname: Edwards
authors.forename: G D
authors.initials: GD
authors.lastname: Nicholson
authors.forename: T A
authors.initials: TA
authors.lastname: Hassell
authors.forename: C O
authors.initials: CO
authors.lastname: Everard
authors.forename: J
authors.initials: J
authors.lastname: Callender
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001460:Barbados / Q000453:epidemiology; D005260:Female; D006801:Humans; D007921:Leptospira interrogans / Q000145:classification*; D041341:Leptospira interrogans serovar canicola / Q000145:classification*; D007922:Leptospirosis / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012703:Serotyping