Leptospirosis among patients presenting with dengue-like illness in Puerto Rico
Michael G. Brucea b✉, Eduard Joachim Sandersc, John A. D. Leaked, Oren Zaidele, Sandra L. Braggf, T. Ayef, Kathleen A. Shuttg, Carmen C. Desedah, José G. Rigau-Pérezc, Jordan W. Tapperoi, Bradley A. Perkinsj, Richard A. Spiegelf, David A. Ashfordk
- aArctic Investigations Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention (CDC), Anchorage, Alaska 99508, USA. zwa8@cdc.gov
- bArctic Investigations Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention (CDC), 4055 Tudor Centre Drive, Anchorage, Alaska 99508, USA
- cDengue Branch, Division of Vector-Borne Infectious Diseases, CDC, 1324 Calle Canada, San Juan 00920, Puerto Rico
- dDivision of Infectious Diseases, Children's Hospital and Health Center, 3020 Children's Way, MC 5041, San Diego, CA 92123, USA
- eCedars-Sinai Medical Center, Division of Gastroenterology, 8700 Beverly Blvd., Los Angeles, CA 90048, USA
- fMeningitis and Special Pathogens Branch, Division of Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd. Atlanta, GA 30333, USA
- gInfectious Diseases Epidemiology Research Unit, Division of Infectious Diseases, University of Pittsburgh Graduate School of Public Health and School of Medicine, Pittsburgh, Pennsylvania, USA
- h
Papers open inside SciRah from the original publisher or repository; SciRah never hosts them.
Abstract
Leptospirosis is difficult to distinguish from dengue fever without laboratory confirmation. Sporadic cases/clusters of leptospirosis occur in Puerto Rico, but surveillance is passive and laboratory confirmation is rare. We tested for leptospirosis using an IgM ELISA on sera testing negative for dengue virus IgM antibody and conducted a case-control study assessing risk factors for leptospirosis, comparing clinical/laboratory findings between leptospirosis (case-patients) and dengue patients (controls). Among 730 dengue-negative sera, 36 (5%) were positive for leptospirosis. We performed post mortem testing for leptospirosis on 12 available specimens from suspected dengue-related fatalities; 10 (83%) tested positive. Among these 10 fatal cases, pulmonary hemorrhage and renal failure were the most common causes of death. We enrolled 42 case-patients and 84 controls. Jaundice, elevated BUN, hyperbilirubinemia, anemia, and leukocytosis were associated with leptospirosis (p < .01 for all). Male sex, walking in puddles, rural habitation, and owning horses were independently associated with leptospirosis. Epidemiological, clinical, and laboratory criteria may help distinguish leptospirosis from dengue and identify patients who would benefit from early antibiotic treatment.
TL;DRE Epidemiological, clinical, and laboratory criteria may help distinguish leptospirosis from dengue and identify patients who would benefit from early antibiotic treatment. (Semantic Scholar)