Vickery Bevan, Flynn Sharyn A, Calder Lester, Freebairn Ross C
Hawke's Bay Hospital, Hastings, New Zealand.
Crit Care Resusc. 2006 Sep;8(3):192-9.
Leptospirosis is a disease associated with meat and agricultural workers which is endemic in New Zealand and Australia. During 2003-2005, it resulted in 207 hospitalisations in New Zealand. Hawke's Bay had the highest regional incidence in 2004 and 2005. While admission to intensive care units with leptospirosis is not infrequent, no such cases have been described in the literature from New Zealand, and only five from Australia.
A chart review of all patients admitted to the intensive care/high dependency unit of a regional hospital in New Zealand with a diagnosis of leptospirosis from June 1999 to May 2005. Admission features, progress and diagnostic tests were collated, and APACHE II score on admission and daily Sequential Organ Failure Assessment (SOFA) score were calculated.
15 cases were identified; median age was 44 years (range, 27-62), and 13 were men. Myalgia, headache, nausea and vomiting were common; nine had conjunctival suffusion. Ten had hypotension and 14 had renal failure before ICU admission. Eleven received vasoactive support, and three received renal replacement therapy. Median length of ICU stay was 4 days (range, 2- 11; mean, 4 days). Median hospital stay was 6 days (range, 2-13; mean, 7.6 days). All patients survived and were discharged free of dialysis.
Leptospirosis presents to the ICU with a variety of signs and symptoms. Renal failure is the most common organ dysfunction requiring intensive care, and its severity is disproportionate to other signs of severe sepsis. Leptospirosis has a good prognosis with early management in an ICU.
钩端螺旋体病是一种与肉类加工和农业工人相关的疾病，在新西兰和澳大利亚呈地方性流行。在2003年至2005年期间，该病在新西兰导致207人住院治疗。2004年和2005年，霍克湾地区发病率最高。虽然因钩端螺旋体病入住重症监护病房的情况并不罕见，但新西兰的文献中尚未描述过此类病例，澳大利亚仅有5例。
对1999年6月至2005年5月期间在新西兰一家地区医院的重症监护/高依赖病房住院且诊断为钩端螺旋体病的所有患者进行病历回顾。整理入院特征、病情进展和诊断检查结果，并计算入院时的急性生理与慢性健康状况评分系统（APACHE II）得分以及每日序贯器官衰竭评估（SOFA）得分。
共确定15例患者；中位年龄为44岁（范围27 - 62岁），其中13例为男性。肌痛、头痛、恶心和呕吐较为常见；9例有结膜充血。10例在入住重症监护病房前出现低血压，14例出现肾衰竭。11例接受了血管活性药物支持，3例接受了肾脏替代治疗。重症监护病房中位住院时间为4天（范围2 - 11天；平均4天）。中位住院时间为6天（范围2 - 13天；平均7.6天）。所有患者均存活且出院时无需透析。
钩端螺旋体病在重症监护病房表现出多种体征和症状。肾衰竭是最常见的需要重症监护的器官功能障碍，其严重程度与严重脓毒症的其他体征不相称。钩端螺旋体病在重症监护病房进行早期治疗预后良好。
