Clinical analysis and literature review of 2 cases of leptospirosis in Wenchang area following super typhoon 'Yagi'

OBJECTIVE To summarize the clinical data of 2 cases of multiple organ dysfunction syndrome (MODS) induced by infection with renal leptospira so as to provide bases for prevention and control of severe diseases.

METHODS The clinical data of the 2 patients with leptospirosis were retrospectively analyzed after the super typhoon 'Yagi' on Sep. 6, 2024. The cases of leptospirosis that were reported at home and abroad in recent 5 years were retrieved. The epidemiological characteristics, clinical manifestations and treatment outcomes of the cases were observed.

RESULTS The 2 patients began to have symptoms on the nineth day after the typhoon, both cases presented with the manifestation such as fever, pain and fatigue, shortness of breach and cough, jaundice and anuria, with the blood culture negative; the definite diagnosis was mased by blood metagenomic capture method(MetaCAP). The poultry was considered as the infection source, and the illness condition progressed to sepsis and MODS. Case 1 was complicated with empsyxis, jaundice hemorrhage and renal failure and finally died. Case 2 was also detected with leptospira from cerebrospinal fluid and was complicated with renal failure and meningoencephalitis but was cured. Among 17 cases of leptospirosis from the literatures, the male and peasants were dominant, the infected water was the major infection factor (at least 7 cases); fever, pain and fatigue, shortness of breath and cough as well as hemoptysis were the major symptoms. There were at least 12 cases with the decline of platelets counts, 10 cases complicated with empsyxis, 11 cases complicated with shock and MODS and 10 cases treated with invasive mechanical ventilation. The misdiagnosis rate was up to 76.47%, and the mortality rate was 29.41%.

CONCLUSIONS The leptospirosis is a severe disease, early precise antimicrobial treatment and timely organ function support are the crucial to the improvement of prognosis. The health care workers should attach great importance to inquiry for diagnosis, maintain vigilant to the disease for the people with fever of unknown origin, shortness of breath, pain and fatigue by combining the epidemiological history, and make an early definite diagnosis based on novel molecular diagnosis technique so as to avoid the progression to sepsis and MODS.