Abstract

--- - Author summaryLeptospirosis is a neglected tropical disease and a public health concern worldwide. Infection in humans usually occurs through direct or indirect contact with the urine of infected animals. Most leptospirosis cases are mild, but between 5-15% of cases can be severe and even fatal, primarily due to delays in diagnosis, misrecognition, inadequate treatment, or pathogenicity of some strains. The factors associated with severity could be used to support triaging and avoid preventable medical complications or death. Colombia is an endemic country for leptospirosis, with mandatory laboratory surveillance. Our objective was to determine the demographic and clinical risk factors associated with severe leptospirosis. We used a unique dataset of 201 lab-confirmed leptospirosis cases notified to the National Reference Laboratory with a reported clinical history from several regions in Colombia. The cases presented severe illness (43.3%), ICU admission (30.3%), and fatal (8.5%). Severe leptospirosis was associated with dyspnea, tachycardia, and rash; fatal cases were associated with jaundice. We hope these results raise awareness among healthcare workers and support clinicians in avoiding preventable medical complications or death in human leptospirosis in Colombia and elsewhere. - "BackgroundLeptospirosis is a common zoonoses and is a major global public health threat. Most cases are mild, typically presenting as a non-specific acute febrile illness. However, leptospirosis can have life-threatening manifestations, including pulmonary hemorrhage syndrome, and acute kidney injury. In Colombia, notification and lab-confirmation of suspected human cases are mandatory. However, little is known about the demographic and clinical factors associated with severe leptospirosis, which could help to reduce clinical complications and mortality. Our aim was to identify risk factors associated with severe leptospirosis, intensive care unit (ICU) admission, and mortality in lab-confirmed cases in Colombia, 2015-2020. Methods and findingsWe analyzed 201 lab-confirmed human leptospirosis cases by microagglutination test. We used a logistic regression to identify the demographic and clinical risk factors associated with severe leptospirosis, admission to ICU, and death. Most leptospirosis confirmed cases occurred in men (85.6%); the mean age was 36.7 years. We classified severe cases (43.3%) by clinical manifestations as renal (29.9%) and liver (27.4%) failure, multiple-organ failure (24.4%), septic shock (24.4%), Weil syndrome (18.4%), pulmonary hemorrhage (18.4%), and meningitis (2.5%), admitted to the ICU (30.3%), and fatal (8.5%). Clinical conditions associated with severe leptospirosis were dyspnea (OR: 5.54; 95% CI: 1.46 to 20.98), tachycardia (OR:9.69; 95% CI: 15.96 to 58.8), and rash (OR: 10.25; 95% CI: 25.01 to 42.08). ConclusionsWe identified demographic characteristics and clinical symptoms associated with severe leptospirosis in Colombia. We hope these results can support clinicians in providing timely treatment to leptospirosis patients to avoid preventable medical complications or deaths."