Schouten, N. (Nina) (2016) Severe leptospirosis in Suriname. thesis, Medicine.
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Abstract
Objective Leptospirosis, a neglected zoonosis of worldwide importance, is considered endemic in Suriname, but epidemiological and clinical data is scarce and dated. This study’s objectives were to describe the incidence of severe leptospirosis in Suriname and investigate clinical characteristics and outcome of patients. Predictors of a severe outcome for which intensive care unit (ICU) admission is required were determined. Methods All clinical suspected and laboratory confirmed cases (Leptocheck) of severe leptospirosis patients (between 1 January 2013 and 30 June 2015) were retrospectively included in this study. Medical files were collected from different hospitals in Suriname and presented symptoms, (vital) signs, laboratory tests, severe manifestations, treatment and clinical outcome were extracted for both children and adults. Results From a total of 1122 Leptocheck requests, 75 cases were confirmed. This resulted in an incidence rate of 5.5 (95%CI 4.4-6.9) per 100 thousand population. Eight deceased severe leptospirosis patients gave a mortality rate of 0.59 (95%CI 0.30-l.18) per 100 thousand population. The case fatality ratio was 10.7% (95%CI 4.7-19.9). Relative risks for acquiring severe leptospirosis were increased for men (RR 5.1 95%CI 2.6-10.0), residence of Paramaribo (3.5 95%CI 2.0-6.2) and Creoles (3.1 95%CI 1.3-7.1). Subjective fever (98%) and generalized body pain (87%) were the most prevalent symptoms. Jaundice (57%) was the most frequent sign, followed by conjunctival suffusion (28%). Severe manifestations (such as sepsis 75%; acute kidney failure 34%; respiratory insufficiency 25% and septic shock 25%) were seen in most patients (84%). Weil’s syndrome was present in 50% of patients admitted to the ICU compared to 3% at the medical ward (p<.001). Pulmonary bleeding occurred in 21% of ICU patients. Conclusion The incidence of severe leptospirosis in Suriname found in our retrospective study is lower than suspected but remains significant. Moreover persons acquiring the disease have a high chance of dying. Almost one-fourth of patients had to be admitted to the ICU because of serious manifestations like Weil’s syndrome and pulmonary haemorrhage. The presence of hypotension, increased creatinine, haemorrhages, conjunctival suffusion and decreased thrombocytes on admission were independent predictors of ICU admission and could be helpful in allowing early treatment at the ICU and reduce the mortality.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Nijholt, I. |
| Supervisor name: | Second supervisor: and Wagenaar, Dr. J.F.P. and Daily supervisor: and Hermelijn Drs. S. and and Harkisoen, Dr. S. and Department: Department of Medical Microbiology and Departmen and Medicine, Academic Hospital Paramaribo |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:06 |
| Last Modified: | 25 Jun 2020 11:06 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2592 |
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