Factors Associated with Severe Leptospirosis, Martinique, 2010-2013

Abstract

To identify factors associated with disease severity, we examined 102 patients with quantitative PCR-confirmed leptospirosis in Martinique during 2010-2013. Associated factors were hypotension, chest auscultation abnormalities, icterus, oligo/anuria, thrombocytopenia, prothrombin time <68%, high levels of leptospiremia, and infection with L. interrogans serovar Icterohaemorrhagiae/Copenhageni.

Keywords: Leptospira interrogans; Martinique; bacteria; leptospiremia; qPCR; quantitative PCR; serogroup Icterohaemorrhagiae; severe leptospirosis.

Figure 1

Leptospiremia in 102 patients with quantitative PCR–confirmed leptospirosis and day of sample collection since symptom onset, Martinique, 2010–2013. Each symbol (triangle, circle, or square) represents the leptospiremia of 1 leptospirosis patient on the day when the sample was collected. D indicates day since symptom onset. Open symbols indicate severe cases; closed symbols indicate nonsevere cases. Triangles correspond to Leptospira interrogans species, circles to other identified species, and squares to cases without genomic identification. Dotted line indicates the threshold for severe diseases determined by receiver operating characteristic curve analysis.

Figure 2

Distribution of leptospiremia among 102 patients with quantitative PCR–confirmed leptospirosis, grouped by severity criteria, Martinique, 2010–2013. Criteria that met our clinical definition for severe leptospirosis were shock treated with vasoactive drugs, acute renal failure requiring dialysis, internal bleeding requiring blood transfusion (e.g., alveolar hemorrhage), and respiratory insufficiency requiring mechanical ventilation or death during hospitalization. Horizontal lines in box-and-whisker plots indicate (top to bottom) maximum value, third quartile, median (second quartile), first quartile, minimum value. Dotted line indicates the threshold for severe diseases determined by receiver operating characteristic curve analysis.