Comparative study of the in-hospital case-fatality rate of leptospirosis between pediatric and adult patients of different age groups

O objetivo principal foi comparar a letalidade hospitalar da leptospirose entre pacientes pediátricos (< 19 anos) e adultos (> 19 anos), levando em consideração gênero, função renal, duração dos sintomas e icterícia. Prontuários de 1016 pacientes foram revistos. Análise comparativa foi restrita a 840 pacientes (100 pediátricos, 740 adultos) com informações sobre as variáveis incluídas na análise. Entre estes pacientes 81,4 por cento eram do sexo masculino e 91,5 por cento apresentavam icterícia à admissão. A letalidade da leptospirose foi 14,4 por cento. A razão entre número de pacientes que morreram e número de pacientes que sobreviveram, ajustada para gênero, icterícia, duração de sintomas, uréia sérica e creatinina sérica foi quase quatro vezes maior no grupo adulto do que no pediátrico (odds ratio (OR) = 3,94; intervalo de confiança de 95 por cento = 1,19-13,03, p = 0,029). Em adultos, idade mais avançada foi também significantemente e independentemente associada com maior risco de morte (p < 0,01). Pacientes mais velhos foram também mais freqüentemente dialisados. Em conclusão, os dados mostram que a letalidade da leptospirose é mais alta em adultos do que em crianças e adolescentes, mesmo após o ajuste para os efeitos de potenciais fatores de risco de morte. Entre adultos, idade avançada mostrou-se também associada fortemente e independentemente com risco mais alto de morte.

Penicillin at the late stage of leptospirosis: a randomized controlled trial

There is evidence that an early start of penicillin reduces the case-fatality rate of leptospirosis and that chemoprophylaxis is efficacious in persons exposed to the sources of leptospira. The existent data, however, are inconsistent regarding the benefit of introducing penicillin at a late stage of leptospirosis. The present study was developed to assess whether the introduction of penicillin after more than four days of symptoms reduces the in-hospital case-fatality rate of leptospirosis. A total of 253 patients aged 15 to 76 years with advanced leptospirosis, i.e., more than four days of symptoms, admitted to an infectious disease hospital located in Salvador, Brazil, were selected for the study. The patients were randomized to one of two treatment groups: with intravenous penicillin, 6 million units day (one million unit every four hours) for seven days (n = 125) and without (n = 128) penicillin. The main outcome was death during hospitalization. The case-fatality rate was approximately twice as high in the group treated with penicillin (12 percent; 15/125) than in the comparison group (6.3 percent; 8/128). This difference pointed in the opposite direction of the study hypothesis, but was not statistically significant (p = 0.112). Length of hospital stay was similar between the treatment groups. According to the results of the present randomized clinical trial initiation of penicillin in patients with severe forms of leptospirosis after at least four days of symptomatic leptospirosis is not beneficial. Therefore, more attention should be directed to prevention and earlier initiation of the treatment of leptospirosis

Electrocardiographic alterations in patients hospitalized with leptospirosis in the Brazilian City of Salvador

OBJECTIVE: To report the frequency and types of electrocardiographic alterations in patients with leptospirosis in the first 24 hours of hospitalization. METHODS: We analyzed the electrocardiograms of 157 patients admitted to the Hospital Couto Maia in the city of Salvador, in the State of Bahia, Brazil, from March 1998 to June 1999. The electrocardiograms were performed in the first 24 hours after hospital admission, independent of the clinical manifestations of the patients. RESULTS: The mean ± SD for patients' age was 35.5± 13.7 (median = 32) years, and jaundice was present in 95.5 percent of them. Alterations in the electrocardiogram were detected in 68.2 percent (107/157) of the patients (95 percent confidence interval = 60.6 percent - 75.1 percent). Atrial fibrillation was the most frequent arrhythmia, occurring in 10.8 percent (17/157) of the patients. Other frequent findings were alterations in ventricular repolarization detected in 38.9 percent (61/157) of patients and first-degree atrioventricular block in 10.2 percent (16/157). The patients with atrial fibrillation were older and had higher levels of creatinine and aminotransferases. CONCLUSION: In this sample, approximately 2/3 of the patients had electrocardiographic alterations after hospital admission. Of the major arrhythmias, atrial fibrillation was the most frequent, and the patients with this arrhythmia had evidence of more severe disease. The relation between the presence and type of electrocardiographic alteration and the prognosis of leptospirosis is yet to be assessed

The association between serum potassium at hospital admission and the case-fatality rate of leptospirosis in men

Severe leptospirosis affects predominantly males and presents a high susceptibility to hypokalemic acute renal failure. As hypokalemia and hyperkalemia induce severe complications, it is important to evaluate if the initial serum potassium is an independent risk factor for death in leptospirosis. The medical records of 1016 patients hospitalized with the diagnosis of leptospirosis were reviewed. The analysis was restricted to 442, according to the following criteria: male, 18 years or older, information about death or hospital discharge and recorded values of serum potassium, serum creatinine and duration of symptoms at admission. Potassium values lower than 3.5 mEq/L (hypoK), 3.5-5 mEq/L (normoK) and above 5 mEq/L (hyperK) were detected in 180, 245 and 17 patients, respectively. The death rate increased with serum potassium: 11.1 percent in the hypoK, 14.7 percent in the normoK and 47.1 percent in the hyperK group (p = 0.002). In a logistic regression model (normoK as referent), including age, creatinine and duration of symptoms, hypoK was not associated with increased death rate (odds ratio (OR) = 0.80; p > 0.1). On the other hand, hyperK showed a significant association with increased risk of death (OR = 3.95, p = 0.021). In conclusion, in this sample of men with leptospirosis initial serum potassium was positively and independently correlated with the risk of in-hospital death