Varma Muralidhar D, Vengalil Seena, Vallabhajosyula Saraschandra, Krishnakumar Prashant C, Vidyasagar Sudha
Associate Professor, Department of Medicine, Kasturba Medical College, Manipal University, India.
Trop Doct. 2014 Apr;44(2):100-2. doi: 10.1177/0049475513515212. Epub 2013 Dec 5.
Leptospirosis and dengue fever are increasingly seen as causes of tropical febrile illness and often are clinically indistinguishable. This two-year prospective study from a tertiary care centre comprised 200 patients including 68 men (mean 34.8 years) with dengue and 73 (mean 46.19 years) with leptospirosis. Oliguria, icterus, muscle tenderness, anaemia, leukocytopenia, thrombocytopenia, elevated erythrocyte sedimentation rate (ESR), acute renal failure (ARF) and hypoalbuminaemia appeared more commonly in leptospirosis in comparison to dengue. Eighteen per cent mortality was observed in leptospirosis compared to one per cent in dengue. ARF, hyperbilirubinaemia, acute respiratory distress syndrome (ARDS), creatine kinase (CK) elevation and thrombocytopenia were predictors of death in leptospirosis and thrombocytopenia, ARDS and ARF predictors of death in dengue. On receiver operating characteristics (ROC) analysis, leucocytosis >11000/mm(3), ESR >40 mm, serum creatinine >2 mg/dL, total serum bilirubin >2 mg/dL, CK >500 U/L and serum albumin <3 mg/dL were more likely to be an indication of leptospirosis at presentation compared to dengue.
钩端螺旋体病和登革热越来越被视为热带发热性疾病的病因，且在临床上往往难以区分。这项来自三级医疗中心的为期两年的前瞻性研究纳入了200例患者，其中包括68名男性（平均34.8岁）患有登革热，73名（平均46.19岁）患有钩端螺旋体病。与登革热相比，少尿、黄疸、肌肉压痛、贫血、白细胞减少、血小板减少、红细胞沉降率（ESR）升高、急性肾衰竭（ARF）和低白蛋白血症在钩端螺旋体病中更为常见。钩端螺旋体病的死亡率为18%，而登革热为1%。ARF、高胆红素血症、急性呼吸窘迫综合征（ARDS）、肌酸激酶（CK）升高和血小板减少是钩端螺旋体病死亡的预测因素，而血小板减少、ARDS和ARF是登革热死亡的预测因素。在受试者工作特征（ROC）分析中，与登革热相比，白细胞增多>11000/mm³、ESR>40mm、血清肌酐>2mg/dL、总血清胆红素>2mg/dL、CK>500U/L和血清白蛋白<3mg/dL在就诊时更有可能提示钩端螺旋体病。
