Intensive Care Medicine

, Volume 33, Issue 11, pp 1959–1966 | Cite as

Leptospirosis in Reunion Island (Indian Ocean): analysis of factors associated with severity in 147 confirmed cases

  • Fabrice Paganin
  • Arnaud Bourdin
  • Cécile Dalban
  • Jean-Paul Courtin
  • Patrice Poubeau
  • Gianandrea Borgherini
  • Alain Michault
  • Jean-Claude Sally
  • François Tixier
  • Robert Genin
  • Claude Arvin-Berod



Analysis of risk factors associated with severity in patients with confirmed leptospirosis.

Design and setting

Retrospective study in 147 leptospirosis-confirmed patients at two tertiary nonteaching hospital in Reunion Island.


138 men and 9 women, aged 36 ± 14 years, 80 in the ICU and 67 in medical wards.

Measurements and results

We collected demographic, clinical, biological, and radiographic data and performed univariate and multivariate analysis to examine risk factors associated with admission in ICU and mortality. Pulmonary forms were more frequent (85%) than in previous reports, with 85 cases (65.3%) on abnormal chest radiography. Among the 38 patients who underwent bronchoalveolar lavage at admission 31 (81.5%) had alveolar hemorrhage. Independent factors related to ICU admission were: age over 46 years (OR 3.02), creatinine higher than 200 μmol/l (6.69), shock (13.87), and acute respiratory failure (20.69). Mortality was 12.9%. The only factor independently related to mortality was need for mechanical ventilation (OR 20.94). Icterohemorrhagiae serogroup was found in 62 cases (42.8%) but was not related to death.


Pulmonary involvement is a major feature in leptospirosis disease but is not associated with poor outcome. Identification of clinical and laboratory findings on admission may help to better characterize severe cases.


Leptospirosis Pulmonary manifestations Risk factor Mortality Intensive care Alveolar hemorrhage 


  1. 1.
    Levett PN (2001) Leptospirosis. Clin Microbiol Rev 4:296–326CrossRefGoogle Scholar
  2. 2.
    Bharti AR, Nally JE, Ricaldi JN, Matthias MA, Diaz MM, Lovett MA, Levett PN, Gilman RH, Willig MR, Gotuzzo E, Vinetz JM, Peru-United States Leptospirosis Consortium (2003) Leptospirosis: a zoonotic disease of global importance. Lancet Infect Dis 3:757–771PubMedCrossRefGoogle Scholar
  3. 3.
    Meites E, Jay MT, Deresinski S, Shieh WJ, Zaki SR, Tompkins L, Smith DS (2004) Reemerging leptospirosis, California. Emerg Infect Dis 10:406–412PubMedGoogle Scholar
  4. 4.
    Seijo A, Coto H, San Juan J, Videla J, Deodato B, Cernigoi B, Messina OG, Collia O, de Bassadoni D, Schtirbu R, Olenchuk A, de Mazzonelli GD, Parma A. Lethal (2002) Leptospiral pulmonary hemorrhage: an emerging disease in Buenos Aires, Argentina. Emerg Infect Dis 8:1004–1005PubMedGoogle Scholar
  5. 5.
    Pea L, Roda L, Boussaud V, Lonjon B (2003) Desmopressin therapy for massive hemoptysis associated with severe leptospirosis. Am J Respir Crit Care Med 167:726–728PubMedCrossRefGoogle Scholar
  6. 6.
    Luks AM, Lakshminiarayamana S, Hirshmann JV (2003) Leptospirosis presenting as diffuse alveolar hemorrhage. Chest 123:639–643PubMedCrossRefGoogle Scholar
  7. 7.
    Thammakunpee K, Silpapojakul K, Borrirak B (2005) Leptospirosis and its pulmonary complications. Respirology 10:656–659CrossRefGoogle Scholar
  8. 8.
    Trevejo RT, Rigau-Perez JG, Ashford DA, McClure EM, Jarquin-Gonzalez C, Amador JJ, de los Reyes JO, Gonzalez A, Zaki SR, Shieh WJ, McLean RG, Nasci RS, Weyant RS, Bolin CA, Bragg SL, Perkins BA, Spiegel RA (1998) Epidemic leptospirosis associated with pulmonary hemorrhage-Nicaragua, 1995. J Infect Dis 178:1457–1463PubMedCrossRefGoogle Scholar
  9. 9.
    Viera ML, Gama-Simoes MC, Collares-Pereira M (2006) Human Leptospirosis in Portugal: a retrospective study of eighteen years. Int J Infect Dis 10:378–386CrossRefGoogle Scholar
  10. 10.
    Segura ER, Ganoza CA, Campos K, Ricaldi JN, Torres S, Silva H, Cespedes MJ, Matthias MA, Swancutt MA, Lopez Linan R, Gotuzzo E, Guerra H, Gilman RH, Vinetz JM, Peru-United States Leptospirosis Consortium (2005) Clinical spectrum of pulmonary involvement in leptospirosis in a region of endemicity, with quantification of leptospiral burden. Clin Infect Dis 40:343–351PubMedCrossRefGoogle Scholar
  11. 11.
    Guidelines for the Management of Adults with Community-Acquired Pneumonia (2001) Diagnosis, assessment of severity, antimicrobial therapy, and prevention. Am J Respir Crit Care Med 163:1730–1754Google Scholar
  12. 12.
    O'Neil KM, Rickman LS, Lazarus AA (1991) Pulmonary manifestations of leptospirosis. Rev Infect Dis 13:705–709PubMedGoogle Scholar
  13. 13.
    Feigin RD, Anderson DC (1975) Human leptospirosis. CRC Crit Rev Clin Lab Sci 5:413–465PubMedGoogle Scholar
  14. 14.
    Katz AR, Ansdell VE, Effler PV, Middleton CR, Sasaki DM (2001) Assessment of the clinical presentation and treatment of 353 cases of laboratory-confirmed leptospirosis in Hawaii, 1974–1998. Clin Infect Dis 33:1834–1841PubMedCrossRefGoogle Scholar
  15. 15.
    Tattevin P, Leveiller G, Flicoteaux R, Jaureguiberry S, Tulzo YL, Dupont M, Arvieux C, Michelet C (2005) Respiratory manifestations of leptospirosis: a retrospective study. Lung 183:283–289PubMedCrossRefGoogle Scholar
  16. 16.
    Park SK, Lee SH, Rhee YK, Kang SK, Kim KJ, Kim MC, Kim KW, Ghang WH (1989) Leptospirosis in Chonbuk province of Korea in 1987: a study of 93 patients. Am J Trop Med Hyg 41:345–351PubMedGoogle Scholar
  17. 17.
    Arokianathan D, Trower K, Pooboni S, Sosnowski A, Moss P, Thaker H (2005) Leptospirosis: a case report of a patient with pulmonary haemorrhage successfully managed with extra corporeal membrane oxygenation. J Infect 50:158–162PubMedCrossRefGoogle Scholar
  18. 18.
    Salkade HP, Divate S, Deshpande JR, Kawishwar V, Chaturvedi R, Kandalkar BM, Vaideeswar P (2005) A study of autopsy findings in 62 cases of leptospirosis in a metropolitan city in India. J Postgrad Med 51:169–173PubMedGoogle Scholar
  19. 19.
    Tanomkiat W, Poonsawat P (2005) Pulmonary findings in 118 leptospirosis patients. Southeast Asian J Trop Med Public Health 36:1247–1251PubMedGoogle Scholar
  20. 20.
    Yiu MW, Ooi GC, Yuen KY, Tsang KW, Lam WK, Chan FL (2003) High resolution CT of Weil's disease. Lancet 362:117PubMedCrossRefGoogle Scholar
  21. 21.
    Nally JE, Chantranuwat C, Wu XY, Fishbein MC, Pereira MM, Da Silva JJ, Blanco DR, Lovett MA (2004) Alveolar septal deposition of immunoglobulin and complement parallels pulmonary hemorrhage in a guinea pig model of severe pulmonary leptospirosis. Am J Pathol 164:1115–1127PubMedGoogle Scholar
  22. 22.
    Zaki SR, Shieh WJ (1996) Leptospirosis associated with outbreak of acute febrile illness and pulmonary haemorrhage, Nicaragua, 1995. The Epidemic Working Group at Ministry of Health in Nicaragua. Lancet 347:535–536PubMedCrossRefGoogle Scholar
  23. 23.
    Courtin JP, Di Francia M, Du Couedic I, Poubeau P, Mahe C, Bapteste J, Arvin-Berod C (1998) Manifestations pulmonaires de la leptospirose: analyse retrospective sur 91 cas. Rev Pneumol Clin 54:382–392PubMedGoogle Scholar
  24. 24.
    Shenoy VV, Nagar VS, Chowdhury AA, Bhalgat PS, Juvale NI (2006) Pulmonary leptospirosis: an excellent response to bolus methylprednisolone. Postgrad Med J 82:602–606PubMedCrossRefGoogle Scholar
  25. 25.
    Doudier B, Garcia S, Quennee V, Jarno P, Brouqui P (2006) Prognostic factors associated with severe leptospirosis. Clin Microbiol Infect 12:299–300PubMedCrossRefGoogle Scholar
  26. 26.
    Dupont H, Dupont-Perdrizet D, Perie JL, Zehner-Hansen S, Jarrige B, Daijardin JB (1997) Leptospirosis: prognostic factors associated with mortality. Clin Infect Dis 25:720–724PubMedGoogle Scholar
  27. 27.
    Daher Ede F, Zanetta DM, Abdulkader RC (2004) Pattern of renal function recovery after leptospirosis acute renal failure. Nephron Clin Pract 98:c8–c14PubMedCrossRefGoogle Scholar
  28. 28.
    Vickery B, Flynn SA, Calder L, Freebairn RC (2006) Leptospirosis presenting to an intensive care unit in provincial New Zealand: a case series and review. Crit Care Resusc 8:192–199PubMedGoogle Scholar
  29. 29.
    Daher E, Zanetta DM, Cavalcante MB, Abdulkader RC (1999) Risk factors for death and changing patterns in leptospirosis acute renal failure. Am J Trop Med Hyg 61:630–634PubMedGoogle Scholar
  30. 30.
    LaRocque RC, Breiman RF, Ari MD, Morey RE, Janan FA, Hayes JM, Hossain MA, Brooks WA, Levett PN (2005) Leptospirosis during dengue outbreak, Bangladesh. Emerg Infect Dis 11:766–769PubMedGoogle Scholar
  31. 31.
    Suputtamongkol Y, Niwattayakul K, Suttinont C, Losuwanaluk K, Limpaiboon R, Chierakul W, Wuthiekanun V, Triengrim S, Chenchittikul M, White NJ (2004) An open, randomized, controlled trial of penicillin, doxycycline, and cefotaxime for patients with severe leptospirosis. Clin Infect Dis 39:1417–1424PubMedCrossRefGoogle Scholar
  32. 32.
    Marotto PC, Nascimento CM, Eluf-Neto J, Marotto MS, Andrade L, Sztajnbok J, Seguro AC (1999) Acute lung injury in leptospirosis: clinical and laboratory features, outcome, and factors associated with mortality. Clin Infect Dis 29:1561–1563PubMedCrossRefGoogle Scholar
  33. 33.
    Panaphut T, Domringkitchaiporn S, Thinkamrop B (2002) Prognostic factors of death in leptospirosis: a prospective cohort study in Khon Kaen, Thailand. Int J Infect Dis 6:52–59PubMedCrossRefGoogle Scholar
  34. 34.
    Ko AI, Galvao Reis M, Ribero Dourado CM, Johnson WD Jr, Riley LW (1999) Urban epidemic of severe leptospirosis in Brazil. Salvador leptospirosis study group. Lancet 354:2003–2004CrossRefGoogle Scholar
  35. 35.
    Vinetz JM (2003) A mountain out of a molehill: do we treat acute leptospirosis, and if so, with what? Clin Infect Dis 36:1514–1516PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Fabrice Paganin
    • 1
  • Arnaud Bourdin
    • 1
  • Cécile Dalban
    • 2
  • Jean-Paul Courtin
    • 1
  • Patrice Poubeau
    • 1
  • Gianandrea Borgherini
    • 1
  • Alain Michault
    • 3
  • Jean-Claude Sally
    • 4
  • François Tixier
    • 5
  • Robert Genin
    • 6
  • Claude Arvin-Berod
    • 1
  1. 1.Service de Pneumologie et Maladies InfectieusesGHSRSt. Pierre, RéunionFrance
  2. 2.Centre d’Investigation CliniqueGHSRSt. Pierre, RéunionFrance
  3. 3.Service de BiologieGHSRSt. Pierre, RéunionFrance
  4. 4.Service de BiologieCHD Félix GuyonSt. Denis, RéunionFrance
  5. 5.Service de RéanimationGHSRSt. Pierre, RéunionFrance
  6. 6.Service de NéphrologieCHD Félix GuyonSt. Denis, RéunionFrance

Personalised recommendations