PROGNOSTIC VALUE OF EARLY CLINICAL DIAGNOSIS OF LEPTOSPIROSIS

Abstract

The case-fatality rate of severe leptospirosis is above 50% at delayed intensive treatment. Our purpose was to assess the prognostic value of the early clinical diagnosis of leptospirosis. Material and Methods: One hundred consecutive patients with leptospirosis were treated in the Clinic of Infectious Diseases at University Hospital “Dr Georgi Stranski”-Pleven (1976-2018). They were distributed retrospectively in groups with mild, moderate, and severe course (27, 39, and 34, respectively). The once interesting for prognosis was the risk for severe course. Data were analyzed with statistical software (IВМ SPSS Statistics 19.0). Results: The mild cases were hospitalized meanly three days after clinical onset (range 1-7 days). The early clinical diagnosis was leptospirosis, acute viral hepatitis, and “flu-like” (23/27, 85.19%; 3/27, 11.11%; 1/27, 3.70%, respectively). The moderate cases were hospitalized meanly four days after clinical onset (range 1-10 days). Nineteen moderate cases (48.72%) were misdiagnosed as aseptic meningitis, acute viral hepatitis, viral infection, obstructive jaundice, and nephrolithiasis. Comorbidity was registered in 33.33%. The severe cases were hospitalized meanly five days after clinical onset (range 2-12 days). Misdiagnoses (in 35.29%) were obstructive jaundice, acute pancreatitis, cholecystitis, pneumonia, and sepsis. Comorbidity was registered in 44.12%. The comparative analysis revealed that the patients hospitalized after the fourth day since clinical onset had a significantly more severe course (p<0.05). Conclusion: The time between clinical onset and hospital admission has significant prognostic value and could be assessed with other clinical predictors of leptospirosis. The early clinical diagnosis is of great importance for initiating intensive treatment (including hemodialysis).