Graduate School, CES University, Medellin, Colombia.
Faculty of Veterinary Medicine and Animal Sciences, CES University, Medellin, Colombia.
PLoS Negl Trop Dis. 2024 Sep 19;18(9):e0012449. doi: 10.1371/journal.pntd.0012449. eCollection 2024 Sep.
Leptospirosis is responsible for various clinical syndromes, classically linked with fever and acute kidney injury.
METHODOLOGY/PRINCIPAL FINDINGS: A prospective multicenter observational study was conducted in six health institutions in the region of Urabá, Colombia. Enrollment was based on leptospirosis-compatible clinical syndrome and a positive preliminary serological test, with PCR used to confirm the disease. Clinical data were collected using a standard questionnaire at enrollment, complemented with a review of clinical records. A total of 100 patients were enrolled, 37% (95% CI 27.0-46.9%) had a positive PCR result confirming acute leptospirosis. The most frequent symptoms in patients with a positive PCR test were headache (91.9%; 34/37), chills and sweating (80.6%; 29/37), nausea (75%; 27/37), dizziness (74.3%; 26/37), vomiting (61.1%; 22/37), congestion (56.8%; 21/37), and conjunctival suffusion (51.4%; 19/37). The frequency of clinical signs classically described in leptospirosis was low: jaundice (8.3%; 3/36) and anuria/oliguria (21.6%; 8/37). An increased neutrophile percentage was reported in 60.6% (20/33) of patients. The presence of complications was 21.6% (8/37), with pulmonary complications being the most frequent (75.0% 6/8). One confirmed case died resulting in a fatality of 2.7% (95% CI 0.5-13.8).
CONCLUSIONS/SIGNIFICANCE: Leptospirosis should be considered within the differential diagnoses of an undifferentiated acute febrile syndrome. Leptospirosis presents diagnostic challenges due to limitations in both clinical and laboratory diagnosis thus it is important to improve understanding of disease presentation and identify signs and symptoms that might help differentiate it from other causes of febrile illness.
钩端螺旋体病可引起多种临床综合征，常伴有发热和急性肾损伤。
方法/主要发现：在哥伦比亚乌拉瓦地区的 6 家医疗机构进行了一项前瞻性多中心观察性研究。纳入标准为符合钩端螺旋体病的临床综合征和初步血清学检测阳性，采用 PCR 检测来确诊该病。在入组时使用标准问卷收集临床数据，并结合临床记录进行回顾。共纳入 100 例患者，37%（95%CI 27.0-46.9%）PCR 检测结果阳性，证实为急性钩端螺旋体病。PCR 检测阳性患者最常见的症状为头痛（91.9%；34/37）、寒战和出汗（80.6%；29/37）、恶心（75%；27/37）、头晕（74.3%；26/37）、呕吐（61.1%；22/37）、充血（56.8%；21/37）和结膜充血（51.4%；19/37）。钩端螺旋体病经典描述的临床体征频率较低：黄疸（8.3%；3/36）和无尿/少尿（21.6%；8/37）。60.6%（20/33）的患者中性粒细胞百分比升高。并发症发生率为 21.6%（8/37），其中肺部并发症最常见（75.0%；6/8）。1 例确诊患者死亡，病死率为 2.7%（95%CI 0.5-13.8）。
结论/意义：在鉴别诊断未明确的急性发热综合征时，应考虑钩端螺旋体病。由于临床和实验室诊断均存在局限性，钩端螺旋体病的诊断具有挑战性，因此，提高对该病临床表现的认识并识别有助于将其与其他发热性疾病区分开来的体征和症状非常重要。
