Stratton Hayley, Rosengren Patrick, Kinneally Toni, Prideaux Laura, Smith Simon, Hanson Josh
Department of Medicine, Cairns Hospital, Cairns, QLD 4870, Australia.
School of Medicine and Dentistry, James Cook University, Cairns, QLD 4870, Australia.
Pathogens. 2025 Jun 28;14(7):643. doi: 10.3390/pathogens14070643.
The case-fatality rate of severe leptospirosis can exceed 50%. This retrospective cohort study examined 111 individuals with laboratory-confirmed leptospirosis admitted to Cairns Hospital, a referral hospital in tropical Australia, between January 2015 and June 2024. We examined the patients' demographic, clinical, laboratory and imaging findings at presentation and then correlated them with the patients' subsequent clinical course. Severe disease was defined as the presence of pulmonary haemorrhage or a requirement for intensive care unit (ICU) admission. The patients' median (interquartile range) age was 38 (24-55) years; 85/111 (77%) were transferred from another health facility. Only 13/111 (12%) had any comorbidities. There were 63/111 (57%) with severe disease, including 56/111 (50%) requiring ICU admission. Overall, 56/111 (50%) required vasopressor support, 18/111 (16%) needed renal replacement therapy, 14/111 (13%) required mechanical ventilation and 2/111 (2%) needed extracorporeal membrane oxygenation. Older age-but not comorbidity-was associated with the presence of severe disease. Hypotension, respiratory involvement, renal involvement and myocardial injury-but not liver involvement-frequently heralded a requirement for ICU care. Every patient in the cohort survived to hospital discharge. Leptospirosis can cause multi-organ failure in otherwise well young people in tropical Australia; however, patient outcomes are usually excellent in the country's well-resourced health system.
重症钩端螺旋体病的病死率可能超过50%。这项回顾性队列研究调查了2015年1月至2024年6月期间入住澳大利亚热带地区转诊医院凯恩斯医院的111例实验室确诊的钩端螺旋体病患者。我们检查了患者就诊时的人口统计学、临床、实验室和影像学检查结果，然后将其与患者随后的临床病程进行关联。重症疾病定义为存在肺出血或需要入住重症监护病房（ICU）。患者的年龄中位数（四分位间距）为38（24 - 55）岁；111例中有85例（77%）是从其他医疗机构转诊而来。只有111例中的13例（12%）有任何合并症。111例中有63例（57%）患有重症疾病，其中111例中有56例（50%）需要入住ICU。总体而言，111例中有56例（50%）需要血管活性药物支持，111例中有18例（16%）需要肾脏替代治疗，111例中有14例（13%）需要机械通气，111例中有2例（2%）需要体外膜肺氧合。年龄较大而非合并症与重症疾病的存在相关。低血压、呼吸系统受累、肾脏受累和心肌损伤（而非肝脏受累）常常预示着需要ICU护理。该队列中的每位患者均存活至出院。在澳大利亚热带地区，钩端螺旋体病可导致原本健康的年轻人发生多器官功能衰竭；然而，在该国资源丰富的医疗系统中，患者的预后通常很好。
