Volume 16, Number 2—February 2010
Dispatch
Severe Leptospirosis in Hospitalized Patients, Guadeloupe
Cécile Herrmann-Storck
, Magalie Saint Louis, Tania Foucand, Isabelle Lamaury, Jacqueline Deloumeaux, Guy Baranton, Maurice Simonetti, Natacha Sertour, Muriel Nicolas, Jacques Salin, and Muriel Cornet
, Magalie Saint Louis, Tania Foucand, Isabelle Lamaury, Jacqueline Deloumeaux, Guy Baranton, Maurice Simonetti, Natacha Sertour, Muriel Nicolas, Jacques Salin, and Muriel Cornet
Table 1
Demographic, epidemiologic, and clinical characteristics as a function of severity among 168 case-patients with confirmed leptospirosis, Hospital of Pointe-à-Pitre, Guadeloupe, French West Indies, 2003–2004*
| Characteristics |
Univariate analysis† |
Multivariate analysis |
|||||
|---|---|---|---|---|---|---|---|
| All case-patients,
N = 168 |
Case-patients with severe disease, n = 24 |
Case-patients
with nonsevere disease, n = 144 |
p value |
||||
| OR (95% CI) |
p value |
||||||
| Male sex | 143/168 (85.1) | 18/24 (75) | 125/144 (86.8) | 0.2 | 2.6 (0.4–17.7) | 0.3 | |
| Age, y, mean ± SD (no. patients) | |||||||
| F | 58.5 ± 17.9 (25) | 55.5 ± 2.4 (6) | 36.7 ± 8 (19) | 0.05 | |||
| M |
47 ± 15.9 (143) |
51.8 ± 6.5 (18) |
49.6 ± 2.9 (125) |
0.5 |
|||
| Exposure to occupational risk‡ | 74/133 (55.6) | 12/20 (60) | 62 /113 (54.8) | 0.6 | |||
| Contact with swine | 41/115 (35.6) | 5/10 (50) | 36/105 (34.2) | 0.5 | |||
| Contact with cattle | 36/113 (31.9) | 1/10 (10) | 35/103 (34) | 0.8 | |||
| Contact with rodents |
56/114 (49.1) |
3/9 (33.3) |
53/105 (50.5) |
0.5 |
|||
| Medical history | |||||||
| Duration of illness before antibacterial therapy§ >10 d | 21/141 (14.9) | 7/22 (31.8) | 14/119 (11.8) | 0.01 | 4.8 (1.1–20.2) | 0.032 | |
| Diabetes mellitus | 13/75 (17.3) | 3/22 (13.6) | 10/53 (18.9) | 0.5 | |||
| Chronic hypertension ¶ | 24/75 (32) | 9/22 (40.9) | 15/53 (28.3) | 0.2 | 30.9 (6.0–157.4) | <0.001 | |
| Chronic alcoholism# |
29/75 (38.7) |
11/22 (50.0) |
18/53 (34) |
0.2 |
16.8 (4.1–57.9) |
<0.001 |
|
| Initial features | |||||||
| Hypothermia (<36.5°C) | 28/144 (19.4) | 7/23 (30.4) | 21/121 (17.3) | 0.1 | 4.6 (0.9–24.6) | 0.07 | |
| Hyperthermia (>37.7°C) | 82/144 (56.9) | 10/23 (43.5) | 72/121 (59.5) | 0.1 | 3.8 (0.7–21.2) | 0.12 | |
| Hypotension, SBP <100 mm Hg | 24/143 (16.8) | 7/20 (35) | 17/123 (13.8) | 0.02 | 0.3 (0.1–1.8) | 0.2 | |
| Myalgia | 73/77 (94.8) | 12/13 (92.3) | 61/64 (95.3) | 0.6 | |||
| Consciousness disorders | 10/119 (8.4) | 4/13 (30.8) | 6/106 (5.7) | 0.01 | 3.8 (1.1–13.2) | 0.035 | |
| Nuchal rigidity | 10/116 (8.6) | 2/12 (16.7) | 8/104 (7.7) | 0.2 | |||
| Headache | 70/91 (76.9) | 5/7 (71.4) | 65/84 (77.4) | 0.7 | |||
| Conjunctival suffusion | 46/116 (39.6) | 4/12 (33.3) | 42/104 (40.4) | 0.4 | |||
| Icterus | 57/117 (48.7) | 9/12 (75) | 48/105 (45.7) | 0.1 | 5.9 (1.1–31.1) | 0.036 | |
| Hemorrhage** | 15/165 (9.1) | 5/24 (20.8) | 10/141 (7.1) | 0.04 | 4.2 (0.3–67.9) | 0.31 | |
| Hepatosplenomegaly | 30/86 (34.9) | 7/11 (63.6) | 23/75 (30.7) | 0.02 | 1.7 (0.2–13.9) | 0.62 | |
| Abdominal pain | 64/124 (51.6) | 14/18 (77.8) | 50/106 (47.2) | 0.009 | 3 (0.7–13.2) | 0.139 | |
| Digestive disorders (diarrhea, vomiting) | 66/105 (62.8) | 12/15 (80) | 54/90 (60) | 0.2 | 3.5 (0.7–18.0) | 0.12 | |
| Abnormalities at chest auscultation†† | 19/135 (14.1) | 8/17 (47) | 11/118 (9.3) | <0.001 | 8.7 (1.8–41.3) | 0.006 | |
| Chest radiologic anomalies‡‡ | 22/112 (19.6) | 6/16 (37.5) | 16/96 (16.7) | 0.05 | 0.8 (0.1–10.4) | 0.85 | |
| Alveolar infiltrate | 9/112 (8.0) | 5/16 (31.2) | 4/96 (4.2) | <0.001 | |||
| Electrocardiographic disorders§§ | 22/73 (30.1) | 5/16 (31.2) | 17/57 (29.8) | 0.9 | |||
| Oliguria¶¶ or anuria | 34/128 (26.6) | 10/23 (43.5) | 24/105 (22.9) | 0.04 | 5.6 (1.5–20.6) | 0.009 | |
*OR, odds ratio; CI, confidence interval; SBP, systolic blood pressure. Boldface indicates significance.
†All values no. case-patients/no. examined (%) except as indicated.
‡Farming, livestock farming, construction, and gardening.
§Ampicillin or cefotaxime.
¶As reported by patients with specific therapy.
#Defined as alcohol dependence.
**Hemoptysis, hematuria, purpura, bleeding of the gums, and hematemesis.
††Crackles or ronchi.
‡‡Only anomalies of the lungs.
§§Excluding patients >60 y of age or with sinus tachycardia.
¶¶Urinary volume <400 mL/d.
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Page updated: December 10, 2010
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