Ioannou Petros, Pendondgis Maria, Kampanieri Eleni, Koukias Stergos, Gorgomyti Maria, Tryfinopoulou Kyriaki, Kofteridis Diamantis
School of Medicine, University of Crete, 71003 Heraklion, Greece.
Internal Medicine Department, University Hospital of Heraklion, 71110 Heraklion, Greece.
Trop Med Infect Dis. 2025 Jul 25;10(8):209. doi: 10.3390/tropicalmed10080209.
Leptospirosis is an under-recognized zoonosis that affects both tropical and temperate regions. While it is often associated with exposure to contaminated water or infected animals, its presentation and epidemiology in Mediterranean countries remain incompletely understood. This retrospective cohort study investigates the clinical and epidemiological profile of leptospirosis in Crete, Greece, a region where data are scarce.
All adult patients with laboratory-confirmed leptospirosis admitted to three major public hospitals in Crete, Greece, between January 2019 and December 2023 were included in the analysis. Diagnosis was made through serologic testing along with compatible clinical symptoms.
A total of 17 patients were included. Their median age was 48 years, with a predominance of males (70.6%). Notably, more than half of the patients had no documented exposure to classic risk factors such as rodents or standing water. Clinical presentations were varied but commonly included fever, fatigue, acute kidney injury, and jaundice. Of the patients who underwent imaging, most showed hepatomegaly. The median delay from symptom onset to diagnosis was 11 days, underscoring the diagnostic challenge in non-endemic areas. Ceftriaxone was the most frequently administered antibiotic (76.5%), often in combination with tetracyclines or quinolones. Despite treatment, three patients (17.6%) died, all presenting with severe manifestations such as ARDS, liver failure, or shock. A concerning increase in cases was noted in 2023.
Leptospirosis can present with severe and potentially fatal outcomes even in previously healthy individuals and in regions not traditionally considered endemic. The relatively high mortality and disease frequency noted emphasize the importance of maintaining a high index of suspicion. Timely diagnosis and appropriate antimicrobial therapy are essential to improving patient outcomes. Additionally, the need for enhanced public health awareness, diagnostic capacity, and possibly environmental surveillance to control this neglected but impactful disease better, should be emphasized.
钩端螺旋体病是一种未得到充分认识的人畜共患病，影响热带和温带地区。虽然它通常与接触受污染的水或受感染的动物有关，但其在地中海国家的表现和流行病学仍未完全了解。这项回顾性队列研究调查了希腊克里特岛钩端螺旋体病的临床和流行病学特征，该地区相关数据匮乏。
纳入2019年1月至2023年12月期间在希腊克里特岛的三家主要公立医院住院的所有实验室确诊钩端螺旋体病成年患者。通过血清学检测及相符的临床症状进行诊断。
共纳入17例患者。他们的中位年龄为48岁，男性占多数（70.6%）。值得注意的是，超过一半的患者没有记录到接触过啮齿动物或积水等典型危险因素。临床表现多样，但常见的有发热、疲劳、急性肾损伤和黄疸。接受影像学检查的患者中，大多数表现为肝肿大。从症状出现到诊断的中位延迟时间为11天，这凸显了非流行地区的诊断挑战。头孢曲松是最常用的抗生素（76.5%），常与四环素或喹诺酮类联合使用。尽管进行了治疗，仍有3例患者（17.6%）死亡，均表现为严重症状，如急性呼吸窘迫综合征、肝衰竭或休克。2023年病例数出现令人担忧的增加。
即使在以前健康的个体以及传统上不被认为是流行地区，钩端螺旋体病也可能导致严重且潜在致命的后果。所观察到的相对较高的死亡率和疾病发生率强调了保持高度怀疑指数的重要性。及时诊断和适当的抗菌治疗对于改善患者预后至关重要。此外，应强调提高公众健康意识、诊断能力以及可能加强环境监测，以更好地控制这种被忽视但影响重大的疾病。
