title: Clinical aspects and prognostic factors of leptospirosis in adults. Retrospective study in France.
abstract: BACKGROUND
  Because early recognition and initiation of antibiotic therapy are important, clinicians should familiarize themselves with the clinical presentation of leptospirosis, and determine prognostic factors.
  
  
  METHODS
  This study included all patients treated at Angers University Hospital between January 1995 and December 2005 for leptospirosis - both probable (cases combining epidemiologically suggestive features with compatible clinical, laboratory, and radiographic findings, with no other diagnosis envisioned) and confirmed (by finding microorganism on direct examination or culture of blood, urine or CSF, or by seroconversion or by a significant increase in the antibody titer between two samples). Severe leptospirosis was defined by hospitalization in the critical care department or need for renal dialysis. The statistical analysis used SPSS software version 12.
  
  
  RESULTS
  Of 97 records reviewed, we retained 62 cases that met the criteria above, including 35 confirmed cases, 27 probable and 15 severe. The sex ratio was nine men for every woman. The patients' mean age was 45+/-18 years [12-77]. The principal clinical signs observed were: fever (n=59) with shivering (n=42), diffuse myalgia (n=41), headaches (n=38), jaundice (n=24), conjunctival suffusion (n=10), rash (n=11), herpes eruption (n=7), renal damage (n=33) that was sometimes severe (>500 micromol/L) (n=7), meningitis (n=12), meningoencephalitis (n=2), myocarditis or pericarditis (n=6), and atypical radiographic lung disease (n=16), sometimes with ARDS (n=6). Blood tests showed thrombocytopenia (platelets<140 G/L) in 65.5% of patients (n=40). Logistic regression modeling showed that two criteria remained independently predictive of development toward severe leptospirosis: clinical jaundice (p=0.005) and cardiac damage seen either clinically or on ECG (p<0.02). These factors can be identified easily at the first clinical examination and during evolution, and should help to reduce mortality by allowing earlier management of patients with suspected leptospirosis.
authors.affiliation: Department of Infectious and Tropical Diseases, CHU Angers, 4 rue Larrey, 49933 Angers Cedex 9, France. piabgueguen@chu-angers.fr
authors.forename: Pierre
authors.initials: P
authors.lastname: Abgueguen
authors.forename: Valerie
authors.initials: V
authors.lastname: Delbos
authors.forename: Jerome
authors.initials: J
authors.lastname: Blanvillain
authors.forename: Jean Marie
authors.initials: JM
authors.lastname: Chennebault
authors.forename: Jane
authors.initials: J
authors.lastname: Cottin
authors.forename: Serge
authors.initials: S
authors.lastname: Fanello
authors.forename: Eric
authors.initials: E
authors.lastname: Pichard
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D015331:Cohort Studies; D005260:Female; D005602:France / Q000453:epidemiology; D006331:Heart Diseases / Q000209:etiology; D006801:Humans; D007565:Jaundice / Q000209:etiology; D007919:Leptospira / Q000302:isolation & purification; D007922:Leptospirosis / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012737:Sex Factors