Munoz-Zanzi Claudia, Mueller Melissa, Coriano-Díaz Natalia, Rivera-Gutierrez Ralph, Rivera-Cátala Christian, Millán-Rodríguez Rachel, Cantres Rosa, Piñeiro-Falcón Natalie M, Ríos-Núñez Daiana M, Maldonado-Alfonzo Josean G, Galloway Renee, Santiago-Ramos Luis J, Kircher Amy, Hallman Deana, Martinez Lemuel, Russel-Orama Robin, Nally Jarlath E, Schafer Ilana J
Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA.
Strategic Partnerships and Research Collaborative, University of Minnesota, Minneapolis, Minnesota, USA.
J Trop Med. 2025 Aug 19;2025:9731885. doi: 10.1155/jotm/9731885. eCollection 2025.
Leptospirosis is endemic to Puerto Rico, affecting people through seasonal increases and outbreaks. This report describes the diagnostic approach and clinical characteristics of leptospirosis cases identified through active undifferentiated acute febrile illness (UAFI) surveillance in Puerto Rico. From 2019 to 2021, active surveillance was conducted in four emergency departments (EDs), with standardized recruitment of patients aged ≥ 5 years, presenting with fever or a history of fever of unknown origin within the past two weeks. Additional cases were recruited from referrals of patients with positive leptospirosis diagnostic tests routinely ordered by clinicians. All enrolled patients were subject to a standardized diagnostic algorithm using PCR and serology to identify probable and confirmed leptospirosis cases. Patient data were collected from electronic medical records and interviews. Leptospirosis was diagnosed in 4% of 406 ED-enrolled UAFI patients, eight confirmed and eight probable cases. Referrals resulted in the identification of 12 routinely detected cases (five confirmed and seven probable). Of the 28 cases, 71% were ≤ 7 days post onset, 71% were male, average age was 43 years old, and the most common presentations included lower back pain (82%), headache (75%), fatigue (71%), vomiting (71%), myalgia (71%), and calf pain (64%). Common clinical laboratory findings were elevated AST (78%), hyperglycemia (74%), thrombocytopenia (48%), proteinuria (62%), and hematuria (62%). Classification of four isolates identified serovar Icterohaemorrhagiae/Copenhageni ( = 2), serovar Ballum/Guangdong, and (no serovar match). All but one of the leptospirosis cases met the current Council of State and Territorial Epidemiologists' definition for clinical compatibility with leptospirosis. Hemorrhagic symptoms and acute kidney injury with jaundice were associated with being a leptospirosis case. These findings underscore the role of leptospirosis among febrile illnesses in Puerto Rico, the need for increased awareness to optimize diagnosis and treatment, and further research to improve prevention and intervention strategies.
钩端螺旋体病在波多黎各呈地方性流行，通过季节性增加和暴发影响人群。本报告描述了通过波多黎各活动性未分化急性发热性疾病（UAFI）监测确定的钩端螺旋体病病例的诊断方法和临床特征。2019年至2021年，在四个急诊科开展了主动监测，对年龄≥5岁、在过去两周内出现发热或不明原因发热病史的患者进行标准化招募。其他病例来自临床医生常规开具的钩端螺旋体病诊断检测呈阳性患者的转诊。所有入组患者均接受使用PCR和血清学的标准化诊断算法，以识别可能和确诊的钩端螺旋体病病例。患者数据从电子病历和访谈中收集。在406名入组急诊科的UAFI患者中，4%被诊断为钩端螺旋体病，8例确诊，8例可能病例。转诊导致识别出12例常规检测病例（5例确诊，7例可能）。在这28例病例中，71%在发病后≤7天，71%为男性，平均年龄为43岁，最常见的表现包括下背痛（82%）、头痛（75%）、疲劳（71%）、呕吐（71%）、肌痛（71%）和小腿疼痛（64%）。常见的临床实验室检查结果为AST升高（78%）、高血糖（74%）、血小板减少（48%）、蛋白尿（62%）和血尿（62%）。对四个分离株的分类确定了血清型出血性黄疸型/哥本哈根型（=2）、血清型拜伦型/广东型，以及（无血清型匹配）。除1例钩端螺旋体病病例外，所有病例均符合当前州和地区流行病学家委员会关于与钩端螺旋体病临床相容性的定义。出血症状以及伴有黄疸的急性肾损伤与钩端螺旋体病病例有关。这些发现强调了钩端螺旋体病在波多黎各发热性疾病中的作用，需要提高认识以优化诊断和治疗，并进行进一步研究以改进预防和干预策略。
