Early identification of leptospirosis as an ignored cause of multiple organ dysfunction syndrome

Huang Yu Yang, Tzung Hai Yen, Chan Yu Lin, Yung Chang Chen, Min Jeng Pan, Chih Hsiung Lee, Chun Chen Yu, Mai Szu Wu, Shin Shu Wu, Cheng Hao Weng, Kwan Hsing Chen, Cheng Chieh Hung, Chih Wei Yang

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Leptospirosis is the most common zoonosis in the world but remains underreported, owing to protean manifestations and ignorance about the disease among health care providers in Taiwan. From September 2000 to March 2006, surveillance of 455 patients with multiple organ dysfunction syndrome with unclear cause or clinical suspicion of leptospirosis was performed. Diagnosis was further confirmed by microscopic agglutination test or isolation of Leptospira. Cases were classified as excluded based on confirmed etiology other than leptospirosis or negative paired serologic test. Forty-two patients were confirmed as having leptospirosis, which accounted for 9.2% of total patients with multiple organ dysfunction syndrome. Forty-nine excluded cases were identified for a case-control analysis for clinical distinction. The most common presentations of leptospirosis were fever (97.6%), acute kidney injury (85.7%), and jaundice (61.9%). The leptospirosis group showed lower urine specific gravity (cutoff value, 1.0145) and enlarged kidney size (cutoff value, 11.05 cm) as compared with the excluded cases by multivariate logistics regression. Delayed antibiotic administration prolongs the duration of hospitalization (R 2 = 0.486, P <0.01). No mortality has been found in the leptospirosis group after initiation in 2003 of rapid immunoglobulin M serology assay that showed considerably high sensitivity and specificity. Leptospirosis accounts for a salient cause of multiple organ dysfunctions in Taiwan. Early awareness of leptospirosis by distinct presentations, followed by prompt antibiotics therapy, can dramatically save the patients. The easily performed rapid immunoglobulin M serology assay is suitable as a rapid screening test for the diagnosis of leptospirosis.

Original languageEnglish
Pages (from-to)24-29
Number of pages6
JournalShock
Volume38
Issue number1
DOIs
Publication statusPublished - Jul 2012
Externally publishedYes

Fingerprint

Leptospirosis
Multiple Organ Failure
Serology
Taiwan
Immunoglobulin M
Anti-Bacterial Agents
Leptospira
Agglutination Tests
Specific Gravity
Zoonoses
Serologic Tests
Jaundice
Acute Kidney Injury
Health Personnel
Hospitalization
Fever
Logistic Models
Urine
Kidney
Sensitivity and Specificity

Keywords

  • acute kidney injury
  • Leptospirosis
  • multiple organ dysfunction syndrome
  • rapid IgM serology assay

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Emergency Medicine

Cite this

Yang, H. Y., Yen, T. H., Lin, C. Y., Chen, Y. C., Pan, M. J., Lee, C. H., ... Yang, C. W. (2012). Early identification of leptospirosis as an ignored cause of multiple organ dysfunction syndrome. Shock, 38(1), 24-29. https://doi.org/10.1097/SHK.0b013e3182594ad7

Early identification of leptospirosis as an ignored cause of multiple organ dysfunction syndrome. / Yang, Huang Yu; Yen, Tzung Hai; Lin, Chan Yu; Chen, Yung Chang; Pan, Min Jeng; Lee, Chih Hsiung; Yu, Chun Chen; Wu, Mai Szu; Wu, Shin Shu; Weng, Cheng Hao; Chen, Kwan Hsing; Hung, Cheng Chieh; Yang, Chih Wei.

In: Shock, Vol. 38, No. 1, 07.2012, p. 24-29.

Research output: Contribution to journalArticle

Yang, HY, Yen, TH, Lin, CY, Chen, YC, Pan, MJ, Lee, CH, Yu, CC, Wu, MS, Wu, SS, Weng, CH, Chen, KH, Hung, CC & Yang, CW 2012, 'Early identification of leptospirosis as an ignored cause of multiple organ dysfunction syndrome', Shock, vol. 38, no. 1, pp. 24-29. https://doi.org/10.1097/SHK.0b013e3182594ad7
Yang, Huang Yu ; Yen, Tzung Hai ; Lin, Chan Yu ; Chen, Yung Chang ; Pan, Min Jeng ; Lee, Chih Hsiung ; Yu, Chun Chen ; Wu, Mai Szu ; Wu, Shin Shu ; Weng, Cheng Hao ; Chen, Kwan Hsing ; Hung, Cheng Chieh ; Yang, Chih Wei. / Early identification of leptospirosis as an ignored cause of multiple organ dysfunction syndrome. In: Shock. 2012 ; Vol. 38, No. 1. pp. 24-29.
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abstract = "Leptospirosis is the most common zoonosis in the world but remains underreported, owing to protean manifestations and ignorance about the disease among health care providers in Taiwan. From September 2000 to March 2006, surveillance of 455 patients with multiple organ dysfunction syndrome with unclear cause or clinical suspicion of leptospirosis was performed. Diagnosis was further confirmed by microscopic agglutination test or isolation of Leptospira. Cases were classified as excluded based on confirmed etiology other than leptospirosis or negative paired serologic test. Forty-two patients were confirmed as having leptospirosis, which accounted for 9.2{\%} of total patients with multiple organ dysfunction syndrome. Forty-nine excluded cases were identified for a case-control analysis for clinical distinction. The most common presentations of leptospirosis were fever (97.6{\%}), acute kidney injury (85.7{\%}), and jaundice (61.9{\%}). The leptospirosis group showed lower urine specific gravity (cutoff value, 1.0145) and enlarged kidney size (cutoff value, 11.05 cm) as compared with the excluded cases by multivariate logistics regression. Delayed antibiotic administration prolongs the duration of hospitalization (R 2 = 0.486, P <0.01). No mortality has been found in the leptospirosis group after initiation in 2003 of rapid immunoglobulin M serology assay that showed considerably high sensitivity and specificity. Leptospirosis accounts for a salient cause of multiple organ dysfunctions in Taiwan. Early awareness of leptospirosis by distinct presentations, followed by prompt antibiotics therapy, can dramatically save the patients. The easily performed rapid immunoglobulin M serology assay is suitable as a rapid screening test for the diagnosis of leptospirosis.",
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