Leptospirosis outbreak after a heavy rainfall typhoon in the Philippines: Clinical features, outcome and prognostic factors for mortality
Acta Medica Philippina
;
: 121-128, 2016.
Article
in English
| WPRIM
| ID: wpr-632742
ABSTRACT
@#<p style="text-align justify;"><strong>BACKGROUND AND OBJECTIVES:
</strong> In September 2009, Metro Manila was hit by a heavy rainfall typhoon Ketsana inundating several cities of Metro Manila causing an outbreak of leptospirosis. We analyzed the prognostic factors associated with mortality among leptospirosis patients admitted after the typhoon at nine tertiary hospitals from September to November 2009.<br /><strong>METHODS:
</strong> We reviewed the charts of patients with probable and confirmed leptospirosis. Confirmed leptospirosis was based on any of the following positive leptospiral culture of blood or urine, single high leptospira microagglutination titer (MAT) of 11600 or a fourfold rise in MAT antibody titers or seroconversion. Patients with negative serology or cultures but with history of wading in floodwaters plus any of the following signs and symptons fever, headache, myalgia, conjunctival suffusion, diarrhea and abdominal pain, jaundice, oliguria and changes in sensorium were considered probable cases. <br /><strong>RESULTS:
</strong> We analyzed 332 probable and 259 confirmed leptospirosis patients. Mean age was 37.95± 14.09, mostly males (80.2%). Almost all patients (98%) waded in floodwaters. Majority had moderate to severe form of leptospirosis (83%). Acute renal failure was the most common complication (87.1%). Mortality was 11.3% mostly due to pulmonary hemorrhage. On multivariate analysis of confirmed and probable cases, the factors independently associated with mortality were pulmonary hemorrhage (OR 2.75, 95% CI 1.46 to 5.20), severity of the disease (OR 3.85, 95% CI 1.60 to 9.26), thrombocytopenia (OR 3.16, 95% CI 1.22-8.16), duration of illness before admission (OR 0.88, 95% CI 0.78-0.99) and age (OR 1.03, 95% CI 1.00-1.06).<br /><strong>CONCLUSION:
</strong> Pulmonary hemorrhage remains a poor prognostic factor and strong predictor of mortality among patients with severe leptospirosis. Early consult through heightened awareness of the public and prompt recognition of leptospirosis among clinicians can decrease the risk for progression to complications of leptospirosis and mortality. <br /><br /> </p>
Full text:
Available
Index:
WPRIM (Western Pacific)
Main subject:
Oliguria
/
Philippines
/
Prognosis
/
Serology
/
Thrombocytopenia
/
Abdominal Pain
/
Disease Outbreaks
/
Multivariate Analysis
/
Mortality
/
Diarrhea
Type of study:
Prognostic study
Limits:
Adolescent
/
Adult
/
Female
/
Humans
/
Male
Country/Region as subject:
Asia
Language:
English
Journal:
Acta Medica Philippina
Year:
2016
Type:
Article
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