William Crawford Gorgas Center for Geographic Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Department of Infectious Diseases, Hospital Santo Tomas, Panama City, Panama.
Am J Trop Med Hyg. 2022 Nov 14;107(6):1261-1266. doi: 10.4269/ajtmh.21-0851. Print 2022 Dec 14.
Leptospirosis represents a public health problem in Panama, with an incidence rate of 1 in 100,000 inhabitants in 2014. Despite active surveillance and reports of outbreaks in the news, publications about human leptospirosis in Panama are scarce. The objective of this study was to describe the epidemiological and clinical features of leptospirosis in a cohort of patients admitted to the national reference hospital from January 2013 to December 2018. A total of 188 patients with suspected leptospirosis were identified, but only 56.9% (107 of 188) of the medical records could be retrieved. Microagglutination assays were completed in 45% (48 of 107) of the patients, confirming leptospirosis in 29.2% (14 of 48) of the patients. The most prevalent serogroup identified was Leptospira interrogans icterohemorrhagiae (4 of 14, 28.6%). The majority of patients with confirmed disease were middle-aged (36.4 ± 15.7 years), male (11 of 14, 78.6%), and symptomatic for 6.8 ± 0.7 days before admission. The predominant clinical presentation was fever (13 of 14, 92.9%), abdominal pain (7 of 14, 50%), and jaundice (8 of 14, 57.1%). Respiratory failure (8 of 14, 57.1%), elevated creatinine levels on admission (8 of 14, 57.1%), transfusion of blood-derived products (6 of 14, 42.9%), and required use of vasopressors (4 of 14, 28.6%) were common complications. Mortality was 28.6% (4 of 14). Empiric antibiotic therapy was initiated in almost all patients (10 of 12, 83.3%), and was appropriate in 90% (9 of 10) of them. Our study highlights the high prevalence of severe disease and reveals the diagnostic challenges concealing the true burden of leptospirosis in Panama. However, the small number of confirmed patients limits the generalization of these findings.
钩端螺旋体病在巴拿马是一个公共卫生问题，2014 年发病率为每 10 万人中有 1 例。尽管进行了主动监测，并在新闻中报告了疫情爆发，但关于巴拿马人类钩端螺旋体病的出版物却很少。本研究的目的是描述 2013 年 1 月至 2018 年 12 月期间，国家参考医院收治的一组疑似钩端螺旋体病患者的流行病学和临床特征。共确定了 188 例疑似钩端螺旋体病患者，但仅检索到 56.9%（188 例中的 107 例）的病历。对 45%（48 例中的 48 例）的患者进行了微量凝集检测，确认了 29.2%（48 例中的 14 例）的患者患有钩端螺旋体病。最常见的血清群是问号钩端螺旋体黄疸出血群（4 例中的 14 例，28.6%）。确诊疾病的大多数患者为中年（36.4±15.7 岁），男性（14 例中的 11 例，78.6%），在入院前 6.8±0.7 天出现症状。主要临床表现为发热（14 例中的 13 例，92.9%）、腹痛（14 例中的 7 例，50%）和黄疸（14 例中的 8 例，57.1%）。呼吸衰竭（14 例中的 8 例，57.1%）、入院时肌酐水平升高（14 例中的 8 例，57.1%）、输注血液制品（14 例中的 6 例，42.9%）和需要使用血管加压药（14 例中的 4 例，28.6%）是常见的并发症。死亡率为 28.6%（14 例中的 4 例）。几乎所有患者（12 例中的 10 例，83.3%）均开始经验性抗生素治疗，其中 90%（10 例中的 9 例）的治疗是恰当的。我们的研究强调了严重疾病的高患病率，并揭示了掩盖巴拿马钩端螺旋体病真实负担的诊断挑战。然而，确诊患者的数量较少限制了这些发现的推广。
