title: Assessment of the clinical presentation and treatment of 353 cases of laboratory-confirmed leptospirosis in Hawaii, 1974-1998.
abstract: Leptospirosis is frequently misdiagnosed as a result of its protean and nonspecific presentation. Leptospirosis, a zoonosis with global distribution, commonly occurs in tropical and subtropical regions; most reported cases in the United States occur in Hawaii. All laboratory-confirmed leptospirosis cases in the State of Hawaii from 1974 through 1998 (n=353) were clinically evaluated. The most common presentation involved nonspecific signs or symptoms, including fever, myalgia, and headache. Jaundice occurred in 39% of cases; conjunctival suffusion was described in 28% of these cases. Initiation of antibiotics before the seventh day of symptoms was associated with a significantly shortened duration of illness. Because early recognition and initiation of antibiotic therapy are important, clinicians should familiarize themselves with the clinical presentation of leptospirosis, and when evaluating a patient with a febrile illness, they should obtain exposure and travel histories and entertain the possibility of leptospirosis in the differential diagnosis.
authors.affiliation: Department of Public Health Sciences and Epidemiology, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI 96822, USA. katz@hawaii.edu
authors.forename: A R
authors.initials: AR
authors.lastname: Katz
authors.forename: V E
authors.initials: VE
authors.lastname: Ansdell
authors.forename: P V
authors.initials: PV
authors.lastname: Effler
authors.forename: C R
authors.initials: CR
authors.lastname: Middleton
authors.forename: D M
authors.initials: DM
authors.lastname: Sasaki
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006254:Hawaii; D006801:Humans; D007223:Infant; D007919:Leptospira / Q000302:isolation & purification; D007922:Leptospirosis / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents