Department of Public Health and Research, CHU Réunion, Saint-Pierre, Reunion, France.
Clinical Investigation Center, INSERM CIC 1410, CHU Réunion, Saint-Pierre, Reunion, France.
PLoS One. 2023 May 17;18(5):e0285900. doi: 10.1371/journal.pone.0285900. eCollection 2023.
In tropical regions, leptospirosis and dengue fever (DF) are infectious diseases of epidemiological importance and have overlapping symptomatic features. The objective of this study was to identify the factors associated to diagnosing leptospirosis that differentiate it to DF at the initial hospital evaluation. A multicenter retrospective study was conducted comparing confirmed leptospirosis to DF cases. Clinical/laboratory findings were compiled at hospital admission on Reunion Island between 2018 and 2019. Multivariable logistic regression was used to identify the predictors of leptospirosis. In total, 98 leptospirosis and 673 DF patients were included with a mean age of 47.8 (±17.1) and 48.9 (±23.3) years, respectively. In the multivariate analyses, the main parameters associated with leptospirosis were: i) increased neutrophil counts, ii) C-reactive protein values, iii) the absence of prolonged partial thromboplastin time, and iv) a decrease of platelets. The most discriminating parameter was C-reactive protein (CRP). With a threshold of 50mg/L, CRP taken alone had a sensitivity of 94% and a specificity of 93.5%. The positive and negative likelihood ratios were 14.5 and 0.06, respectively. In the setting of an early presumptive diagnosis, we found that an increased CRP value (>50 mg/L) could help diagnose leptospirosis and aid the decision process for hospital surveillance and/or a potential antibiotic treatment regimen.
在热带地区，钩端螺旋体病和登革热（DF）是具有流行病学重要性的传染病，具有重叠的症状特征。本研究的目的是确定与诊断钩端螺旋体病相关的因素，以将其与初始医院评估时的 DF 区分开来。进行了一项多中心回顾性研究，比较了确认的钩端螺旋体病和 DF 病例。2018 年至 2019 年在留尼汪岛的医院入院时收集了临床/实验室发现。使用多变量逻辑回归来确定钩端螺旋体病的预测因素。共纳入 98 例钩端螺旋体病和 673 例 DF 患者，平均年龄分别为 47.8（±17.1）和 48.9（±23.3）岁。在多变量分析中，与钩端螺旋体病相关的主要参数是：i）中性粒细胞计数增加，ii）C 反应蛋白值，iii）部分凝血活酶时间延长，iv）血小板减少。最具鉴别力的参数是 C 反应蛋白（CRP）。CRP 阈值为 50mg/L 时，CRP 单独检测的灵敏度为 94%，特异性为 93.5%。阳性和阴性似然比分别为 14.5 和 0.06。在早期推定诊断的情况下，我们发现 CRP 值升高（>50mg/L）可有助于诊断钩端螺旋体病，并有助于医院监测和/或潜在抗生素治疗方案的决策过程。
