Leptospirosis Mimicking Sepsis: A Multicenter Study
Leptospirosis is a common zoonotic infection in the world. Whether anicteric form of leptospirosis is a mild clinical course; icteric form of leptospirosis is severe clinical course which may sometimes result in mortality in the presence of the sepsis. The aims of our study were to evaluate clinical and laboratory findings of patients with leptospirosis according to jaundice and sepsis situations, and also to determine risk factors for mortality.
One hundred fifty seven patients were included to the study. The data between the dates of 1991-2013 from three different hospitals were retrospectively obtained from the formal records and laboratory findings. Patients firstly classified according to the presence of sepsis and non-sepsis then, they were divided into subgroups according to the presence of jaundice as icteric/anicteric. Clinical features and laboratory data were compared. Risk factors associated with mortality were determined.
One hundred twenty nine (82%) of the patients were male. One hundred ten of the patients (68%) had signs of sepsis. Vomiting, abdominal pain, the presence of lung pathology also increased blood urea nitrogen and creatinine levels was significantly evident in sepsis group (p=0.046, p=0.025, p=0.003, p=0.002, p<0.001, respectively). 99 of the patients (63%) were icteric and jaundice occurred more frequently in the sepsis group (p=0.115). At the first admission to hospital, serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total/direct bilirubin, potassium were higher in died patients than those of living ones (p=0.001, p=0.003, p=0.034, p=0.036, p=0.006; respectively). Change in mental status (p=0.004, OR:5.3, CI 95%: 1711-17042) and ALT elevation (p= 0.030, OR:1.004, CI 95 %: 1000-1008) were identified as independent risk factors for mortality.
The clinical and laboratory findings of leptospirosis are similar to sepsis. Elevation of serum transaminase and bilirubin levels and also presence of hyperkalemia has been associated with mortality in patients with leptospirosis. In areas where the disease is endemic; liver and kidney dysfunction is accompanied to the sepsis condition. So, leptospirosis should be investigated for the differential diagnosis.
K. Kart Yasar, None
M. Hatipoglu, None
M. Sunbul, None
H. Leblebicioglu, None