DOI: https://doi.org/10.14710/jai.v0i0.62735

Predictors of Severity and Management of Severe Leptospirosis Patients in Intensive Care Unit

1Department of Anesthesiology and Intensive Therapy, Universitas Gadjah Mada Academic Hospital, Yogyakarta, Indonesia

2Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Nursing and Public Health, Gadjah Mada University, Yogyakarta, Indonesia

Received: 20 Mar 2024; Revised: 3 Sep 2024; Accepted: 13 Sep 2024; Available online: 19 Oct 2024.
Open Access Copyright 2021 JAI (Jurnal Anestesiologi Indonesia)
Creative Commons License This work is licensed under a Creative Commons Attribution 4.0 International License.

Citation Format:
Cover Image
Abstract

Background: Severe leptospirosis or Weil's syndrome occurs in 10% of leptospirosis cases, with a mortality rate of 5-40%. Misdiagnosis of leptospirosis often occurs due to nonspecific symptoms. Discussion of risk factors, causative agents, pathogenesis, clinical manifestations, diagnostic techniques, and predictors of disease severity are crucial for successful management.

Cases: We report 3 cases of leptospirosis with various clinical manifestations and management. In these 3 cases, older age was associated with severe leptospirosis and poor outcomes. The SPiRO score can identify patients with severe leptospirosis requiring intensive care. All three cases of leptospirosis were severe with complications in the kidneys, lungs, and hematological system requiring intensive care in the intensive care unit (ICU).

Discussion: Early and appropriate management can reduce patient mortality rates. ICU management of leptospirosis includes antibiotics, fluid balance, and support for affected organs. Patients with respiratory failure are given oxygenation using high-flow nasal cannula (HFNC), non-invasive ventilation (NIV), or invasive mechanical ventilation with endotracheal intubation (ETT). Acute kidney failure in leptospirosis can be managed with hemodialysis as indicated or may improve with conservative therapy. Corticosteroids may be administered for thrombocytopenia associated with leptospirosis.

Conclusion: The three cases of leptospirosis were severe with complications in the kidneys, lungs, and hematological system requiring intensive care in the ICU. Early and appropriate management can reduce patient mortality rates. In these 3 cases, older age, mechanical ventilation, acute kidney failure, septic shock, thrombocytopenia, and elevated transaminase enzymes were associated with severe leptospirosis and poor outcomes.

Note: This article has supplementary file(s).

Fulltext View|Download |  common.other
Letter Application
Subject
Type Other
  Download (270KB)    Indexing metadata
 common.other
Copyright Transfer Agreement
Subject
Type Other
  Download (391KB)    Indexing metadata
Keywords: clinical manifestations; diagnosis; intensive care unit; management; severe leptospirosis

Article Metrics:

Article Info
Section: Case Reports
Language : EN
Recent articles
Comparison of The Effectiveness Between Fentanyl and Ketamine as Adjuvant Epidural Analgesia with Ropivacaine In Post Operation of The Lower Extremity Effectiveness and Efficiency of Peripheral Nerve Blocks as Adjunct to General Anaesthesia for Open Reduction and Internal Fixation Surgery at Primary Hospital in Tangerang Comparison of The Effectiveness of Use Antiseptic Povidone Iodine 10% And Octenidine Hydrochloride 0.1% in The Action of Neuroaxial Blocks in Patients Who Will Surgery in Haji Adam Malik General Hospital Medan Low Dosage Regional Anesthesia for Bladder Tumors in Aortic Stenosis Patient Sepsis-Induced Coagulopathy as a Risk for Postoperative Arterial Thrombosis: A Case Report Management of Adult-Onset Still's Disease Patients in Intensive Care Unit: a Case Report More recent articles
Most cited articles
Patofisiologi Penyakit Jantung Koroner Midazolam Intravena Dosis Rendah Tidak Mempengaruhi Nitric Oxide Intraperitoneal Mencit Balb/C Yang Terpapar Lipopolisakarida More cited articles
  1. Samrot, A. V., Sean, T. C., Bhavya, K. S., Sahithya, C. S., Chandrasekaran, S. P., Palanisamy, P., Robinson, E. R., Subbiah, S. K., & Mok, P. L. (2021). Leptospiral infection, pathogenesis and its diagnosis. Pathogens, 10(2), 145. https://doi.org/10.3390/pathogens10020145
  2. Johnson RC. Leptospira. In: Baron S, editor. Medical Microbiology. 4th edition. Galveston (TX): University of Texas Medical Branch at Galveston; 1996. Chapter 35. Available from: https://www.ncbi.nlm.nih.gov/books/NBK8451/
  3. Rajapakse, S. (2022). Leptospirosis: Clinical aspects. Clinical Medicine, 22(1), 14-17. https://doi.org/10.7861/clinmed.2022-0073
  4. Levett, P. N. (2001). Leptospirosis. Clinical Microbiology Reviews, 14(2), 296-326. https://doi.org/10.1128/CMR.14.2.296-326.2001
  5. Alian, S., Asghari, H., Najafi, N., Davoudi, A., & Yazdani, J. (2014). Corticosteroid in the treatment of moderate to severe thrombocytopenia due to leptospirosis. Iranian Red Crescent Medical Journal, 16(10), e16030. https://doi.org/10.5812/ircmj.16030
  6. Evangelista, K.V. and Coburn, J. (2010) ‘leptospira as an emerging pathogen: A review of its biology, pathogenesis and host immune responses’, Future Microbiology, 5(9), pp. 1413–1425. doi: 10.2217/fmb.10.102
  7. Haake, D. A. (2015). Leptospirosis in humans. Current Topics in Microbiology and Immunology, 387, 65-97. https://doi.org/10.1007/978-3-662-45059-8_7
  8. WHO Informal Expert Consultation on Surveillance, Diagnosis and Risk Reduction of Leptospirosis. Chennai, India, 17–18 September 2009; SEA-CD-217; World Health Organization—Regional Office for South-East Asia: New Delhi, India. [(accessed on 31st August 2024)]. Available online: https://tinyurl.com/4kdnnsz7
  9. World Health Organization. Human leptospirosis: guidance for diagnosis, surveillance, and control [internet]. 2003. Available from: https://iris.who.int/handle/10665/42667 [Accessed 31 August 2024]
  10. Karnik, N. D., & Patankar, A. S. (2021). Leptospirosis in intensive care unit. Indian Journal of Critical Care Medicine. https://doi.org/10.5005/jp-journals-10071-23852
  11. Miklaušić Pavić, B. (2020) ‘Adjunctive treatment of leptospirosis with corticosteroids’, Infektološki glasnik, 39(2), pp. 50–53. doi: 10.37797/ig.39.2.4
  12. Simbolon, O. M. (n.d.). Dexamethasone vs methylprednisolone [Video]. YouTube. https://youtu.be/eg7wzdehQzc
  13. Rodrigo C, Lakshitha De Silva N, Goonaratne R, et al. High dose corticosteroids in severe leptospirosis: a systematic review. Trans R Soc Trop Med Hyg, 2014 ; 108: 743-750
  14. Fatoni, A. Z., & Kestriani, N. D. (2018). Acute kidney injury pada pasien kritis. Anesth Crit Care, 36, 64-76
  15. Gonçalves-de-Albuquerque, C.F. et al. (2023) ‘Cellular pathophysiology of leptospirosis: Role of Na/K-ATPase’, Microorganisms, 11(7), p. 1695. doi: 10.3390/microorganisms11071695
  16. Miyahara, S., Saito, M., Kanemaru, T., Villanueva, S. Y., Gloriani, N. G., & Yoshida, S. (2014). Destruction of the hepatocyte junction by intercellular invasion of Leptospira causes jaundice in a hamster model of Weil's disease. International journal of experimental pathology, 95(4), 271–281. https://doi.org/10.1111/iep.12085
  17. Smith, S., Kennedy, B. J., Dermedgoglou, A., Poulgrain, S. S., Paavola, M. P., Minto, T. L., Luc, M., Liu, Y. S., & Hanson, J. (2019). Simple score to predict severe leptospirosis. PLoS Neglected Tropical Diseases, 13(2), e0007163. https://doi.org/10.1371/journal.pntd.0007163
  18. Philip, N., Lung Than, L. T., Shah, A., Yuhana, M. Y., Sekawi, Z., & Neela, V. K. (2021). Predictor of severe leptospirosis: Multicentre observational study from central Malaysia. BMC Infectious Diseases, 21(1), 1081. https://doi.org/10.1186/s12879-021-06800-0
  19. Chang, M. L., Yang, C. W., Chen, J. C., Ho, Y. P., Pan, M. J., & Lin, C. H. (2005). Disproportional exaggerated aspartate transaminase is a useful prognostic parameter in late leptospirosis. World Journal of Gastroenterology, 11(35), 5553-5556. https://doi.org/10.3748/wjg.v11.i35.5553
  20. Wang, H. K., Lee, M. H., Chen, Y. C., Hsueh, P. R., & Chang, S. C. Factors associated with severity and mortality in patients with confirmed leptospirosis at a regional hospital in northern
  21. Gvajaia, N., Tkeshelashvili, M., Ratiani, L., Pachkoria, E., & Mikadze, I. (2023). Leptospirosis-induced septic shock and multi-organ dysfunction syndrome: A complex case of zoonotic infection in a young female patient. Cureus, 15(12), e51243. https://doi.org/10.7759/cureus.51243
  22. Dai, J., Yao, C., Ling, H., Li, B., Chen, R., & Shi, F. (2023). A rare case of severe leptospirosis infection presenting as septic shock in a non-endemic area: A case report and literature review. BMC Infectious Diseases, 23, 503. https://doi.org/10.1186/s12879-023-08515-6

Last update:

No citation recorded.

Last update: 2025-02-20 18:57:33

No citation recorded.