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Hypotension, renal failure, and pulmonary complications in leptospirosis
Kannika Niwattayakul1, Janthira Homvijitkul, Surachai Niwattayakul
1Department of Medicine, Loei Hospital, Thailand.
Abstract:
During a recent outbreak of leptospirosis in northeastern Thailand, 148 patients with serologically diagnosed leptospirosis were seen in Loei hospital. The common serotypes were L. pyrogenes, and L. sejroe. Hypotension with a mean arterial pressure less than 70 mmHg upon admission or within 24 h after admission was observed in 94 patients or 64%. 30 patients had normal renal function; 30 patients had prerenal azotemia with mild pulmonary complication in 2; and 34 patients had acute renal failure. 29 patients with acute renal failure had pulmonary complications including pulmonary hemorrhage in 8, pulmonary edema in 3, acute respiratory distress syndrome (ARDS) in 14 and interstitial pneumonitis in 4. 54 patients had normal blood pressure. In this group 5 patients had acute renal failure; 16 had prerenal azotemia and 33 had normal renal function. Interstitial pneumonitis was noted in one patient with prerenal azotemia. Less renal complication and minimal pulmonary complication were seen in leptospirosis patients with normal blood pressure. The patients with normal renal function had no pulmonary complication. Good association existed between hypotension, renal failure and pulmonary complications.
Insights
Hypotension and acute renal failure are common in leptospirosis patients, often accompanied by pulmonary complications. Early blood pressure monitoring is crucial for predicting severe outcomes in leptospirosis.
Area of Science:
- Infectious Diseases
- Nephrology
- Pulmonology
Background:
- Leptospirosis is a zoonotic disease with a wide spectrum of clinical manifestations.
- Outbreaks necessitate understanding disease patterns and complications in affected populations.
- Specific serotypes like L. pyrogenes and L. sejroe were prevalent during this outbreak.
Purpose of the Study:
- To investigate the clinical characteristics and complications of leptospirosis during an outbreak in northeastern Thailand.
- To determine the association between hypotension, renal function, and pulmonary complications in leptospirosis patients.
Main Methods:
- Retrospective analysis of 148 serologically diagnosed leptospirosis patients at Loei hospital.
- Assessment of blood pressure, renal function (normal, prerenal azotemia, acute renal failure), and pulmonary complications upon admission and within 24 hours.
- Correlation of clinical parameters to identify associations between hypotension, renal failure, and pulmonary issues.
Main Results:
- 64% of patients (94/148) presented with hypotension (mean arterial pressure < 70 mmHg).
- Acute renal failure (ARF) was observed in 34 patients, with 29 experiencing pulmonary complications, including ARDS and pulmonary hemorrhage.
- Patients with normal blood pressure exhibited significantly fewer renal and pulmonary complications.
Conclusions:
- Hypotension is a significant indicator associated with increased risk of acute renal failure and pulmonary complications in leptospirosis.
- Normal renal function correlated with the absence of pulmonary complications, suggesting a milder disease course.
- Close monitoring of blood pressure is vital for early detection and management of severe leptospirosis.