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Leptospirosis in Barbados. A clinical study.
C N Edwards1, G D Nicholson, T A Hassell
1Department of Medicine, U.W.I., Queen Elizabeth Hospital, Barbados.
The West Indian Medical Journal
|March 1, 1990
Summary
This clinical study investigated leptospirosis in Barbados, identifying common serogroups and symptoms. High-dose penicillin showed no benefit for jaundiced patients, with a 5.7% overall mortality rate.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Tropical Medicine
Background:
- Leptospirosis is a zoonotic disease with significant global health implications.
- Clinical manifestations vary widely, complicating diagnosis and management.
- Understanding local epidemiology and serogroup prevalence is crucial for effective public health strategies.
Purpose of the Study:
- To characterize the clinical presentation and epidemiology of leptospirosis in Barbados.
- To evaluate diagnostic markers for renal involvement in leptospirosis.
- To assess the efficacy of high-dose penicillin in jaundiced leptospirosis patients.
Main Methods:
- A 39-month prospective clinical study involving 88 confirmed leptospirosis cases.
- Clinical data collection including symptoms, laboratory findings (creatinine, urea, amylase, bilirubin), and cardiac assessments.
- Serogroup identification and a randomized trial of high-dose penicillin in jaundiced patients.
Main Results:
- The most common serogroups were autumnalis, icterohaemorrhagiae, ballum, and canicola.
- Jaundice (95%), anorexia (85%), and headache (85%) were predominant symptoms.
- Renal impairment was noted in 49% of admissions, with 16% classified as renal failure. Urine to plasma urea ratio proved sensitive for pre-renal azotemia.
- Cardiac involvement (arrhythmias, myocarditis, pericarditis) occurred in 18% and 6% respectively. Elevated serum amylase was seen in 65% of cases.
- Bilirubin normalized in 5.5 weeks. Thrombocytopenia was not linked to disseminated intravascular coagulation. High-dose penicillin offered no benefit in jaundiced patients.
- Overall mortality was 5.7%.
Conclusions:
- Leptospirosis in Barbados presents with characteristic symptoms, with autumnalis and icterohaemorrhagiae being major serogroups.
- The urine to plasma urea ratio is a valuable tool for diagnosing pre-renal azotemia in leptospirosis.
- High-dose penicillin is not beneficial for jaundiced leptospirosis patients, and early recognition of clinical and laboratory findings is essential for management.