Abgueguen Pierre, Delbos Valerie, Blanvillain Jerome, Chennebault Jean Marie, Cottin Jane, Fanello Serge, Pichard Eric
Department of Infectious and Tropical Diseases, CHU Angers, 4 rue Larrey, 49933 Angers Cedex 9, France.
J Infect. 2008 Sep;57(3):171-8. doi: 10.1016/j.jinf.2008.06.010. Epub 2008 Jul 24.
Because early recognition and initiation of antibiotic therapy are important, clinicians should familiarize themselves with the clinical presentation of leptospirosis, and determine prognostic factors.
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.
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.
由于早期识别和启动抗生素治疗很重要，临床医生应熟悉钩端螺旋体病的临床表现，并确定预后因素。
本研究纳入了1995年1月至2005年12月期间在昂热大学医院接受治疗的所有钩端螺旋体病患者——包括疑似病例（流行病学提示特征与相符的临床、实验室及影像学表现相结合，且无其他可设想的诊断）和确诊病例（通过直接检查或血液、尿液或脑脊液培养发现微生物，或通过血清转化或两份样本间抗体滴度显著升高确诊）。严重钩端螺旋体病定义为入住重症监护病房或需要进行肾透析。统计分析使用SPSS 12.0软件。
在审查的97份记录中，我们保留了62例符合上述标准的病例，包括35例确诊病例、27例疑似病例和15例严重病例。男女比例为9∶1。患者的平均年龄为45±18岁[12 - 77岁]。观察到的主要临床体征有：发热（n = 59）伴寒战（n = 42）、弥漫性肌痛（n = 41）、头痛（n = 38）、黄疸（n = 24）、结膜充血（n = 10）、皮疹（n = 11）、疱疹（n = 7）、肾脏损害（n = 33），有时严重（>500微摩尔/升）（n = 7）、脑膜炎（n = 12）、脑膜脑炎（n = 2）、心肌炎或心包炎（n = 6）以及非典型肺部影像学病变（n = 16），有时伴有急性呼吸窘迫综合征（n = 6）。血液检查显示65.5%的患者（n = 40）存在血小板减少（血小板<140 G/L）。逻辑回归模型显示，有两个标准仍然独立预测严重钩端螺旋体病的发展：临床黄疸（p = 0.005）以及临床或心电图显示的心脏损害（p<0.02）。这些因素在首次临床检查及病情发展过程中易于识别，应有助于通过对疑似钩端螺旋体病患者进行早期管理来降低死亡率。
