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Urban epidemic of severe leptospirosis in Brazil. Salvador Leptospirosis Study Group.
Lancet. 1999 Sep 04; 354(9181):820-5.Lct

Abstract

BACKGROUND

Leptospirosis has, traditionally, been considered a sporadic rural disease. We describe a large urban outbreak of leptospirosis.

METHODS

Active surveillance for leptospirosis was established in an infectious-disease referral hospital in Salvador, Brazil, between March 10 and Nov 2, 1996. Patients meeting case criteria for severe manifestations of leptospirosis were recruited into the study. The diagnosis was confirmed in the laboratory with the microagglutination test and identification of leptospires in blood or urine. Risk factors for death were examined by multivariate analyses.

FINDINGS

Surveillance identified 326 cases of which 193 (59%) were laboratory-confirmed (133) or probable (60) cases. Leptospira interrogans serovar copenhageni was isolated from 87% of the cases with positive blood cultures. Most of the cases were adult (mean age 35.9 years [SD 15.9]), and 80% were male. Complications included jaundice (91%), oliguria (35%), and severe anaemia (26%). 50 cases died (case-fatality rate 15%) despite aggressive supportive care including dialysis (in 23%). Altered mental status was the strongest independent predictor of death (odds ratio 9.12 [95% CI 4.28-20.3]), age over 37 years, renal insufficiency, and respiratory insufficiency were also significant predictors of death. Before admission to hospital, 42% were misdiagnosed as having dengue fever in the outpatient clinic; an outbreak of dengue fever was taking place concurrently.

INTERPRETATION

An epidemic of leptospirosis has become a major urban health problem, associated with high mortality. Diagnostic confusion with dengue fever, another emerging infectious disease with a similar geographic distribution, prevents timely intervention that could minimise mortality.

Authors+Show Affiliations

Gonçalo Moniz Research Centre, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador. albertko@cpunet.com.brNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

10485724

Citation

Ko, A I., et al. "Urban Epidemic of Severe Leptospirosis in Brazil. Salvador Leptospirosis Study Group." Lancet (London, England), vol. 354, no. 9181, 1999, pp. 820-5.
Ko AI, Galvão Reis M, Ribeiro Dourado CM, et al. Urban epidemic of severe leptospirosis in Brazil. Salvador Leptospirosis Study Group. Lancet. 1999;354(9181):820-5.
Ko, A. I., Galvão Reis, M., Ribeiro Dourado, C. M., Johnson, W. D., & Riley, L. W. (1999). Urban epidemic of severe leptospirosis in Brazil. Salvador Leptospirosis Study Group. Lancet (London, England), 354(9181), 820-5.
Ko AI, et al. Urban Epidemic of Severe Leptospirosis in Brazil. Salvador Leptospirosis Study Group. Lancet. 1999 Sep 4;354(9181):820-5. PubMed PMID: 10485724.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Urban epidemic of severe leptospirosis in Brazil. Salvador Leptospirosis Study Group. AU - Ko,A I, AU - Galvão Reis,M, AU - Ribeiro Dourado,C M, AU - Johnson,W D,Jr AU - Riley,L W, PY - 1999/9/15/pubmed PY - 2000/3/18/medline PY - 1999/9/15/entrez SP - 820 EP - 5 JF - Lancet (London, England) JO - Lancet VL - 354 IS - 9181 N2 - BACKGROUND: Leptospirosis has, traditionally, been considered a sporadic rural disease. We describe a large urban outbreak of leptospirosis. METHODS: Active surveillance for leptospirosis was established in an infectious-disease referral hospital in Salvador, Brazil, between March 10 and Nov 2, 1996. Patients meeting case criteria for severe manifestations of leptospirosis were recruited into the study. The diagnosis was confirmed in the laboratory with the microagglutination test and identification of leptospires in blood or urine. Risk factors for death were examined by multivariate analyses. FINDINGS: Surveillance identified 326 cases of which 193 (59%) were laboratory-confirmed (133) or probable (60) cases. Leptospira interrogans serovar copenhageni was isolated from 87% of the cases with positive blood cultures. Most of the cases were adult (mean age 35.9 years [SD 15.9]), and 80% were male. Complications included jaundice (91%), oliguria (35%), and severe anaemia (26%). 50 cases died (case-fatality rate 15%) despite aggressive supportive care including dialysis (in 23%). Altered mental status was the strongest independent predictor of death (odds ratio 9.12 [95% CI 4.28-20.3]), age over 37 years, renal insufficiency, and respiratory insufficiency were also significant predictors of death. Before admission to hospital, 42% were misdiagnosed as having dengue fever in the outpatient clinic; an outbreak of dengue fever was taking place concurrently. INTERPRETATION: An epidemic of leptospirosis has become a major urban health problem, associated with high mortality. Diagnostic confusion with dengue fever, another emerging infectious disease with a similar geographic distribution, prevents timely intervention that could minimise mortality. SN - 0140-6736 UR - https://www.unboundmedicine.com/medline/citation/10485724/Urban_epidemic_of_severe_leptospirosis_in_Brazil__Salvador_Leptospirosis_Study_Group_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0140-6736(99)80012-9 DB - PRIME DP - Unbound Medicine ER -