Leptospirosis in Intensive Care Unit

Area of Science:

• Tropical Medicine
• Infectious Diseases
• Critical Care Medicine

Background:

• Tropical infections are a significant cause of ICU admissions in developing nations.
• Leptospirosis presents as a spectrum, ranging from mild febrile illness to severe multi-organ dysfunction syndrome (MODS).
• Severe manifestations include acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), and disseminated intravascular coagulation (DIC).

Purpose of the Study:

• To review the clinical spectrum, diagnosis, and management of leptospirosis in the intensive care unit (ICU).
• To identify prognostic markers and risk stratification tools for severe leptospirosis.
• To outline optimal intensive care strategies for reducing mortality.

Main Methods:

• Review of clinical presentation, diagnostic methods (antibody testing, PCR), and prognostic indicators.
• Discussion of multi-organ involvement requiring comprehensive hematological, biochemical, and imaging workup.
• Summary of antimicrobial therapies and intensive care interventions.

Main Results:

• Poor prognostic markers include hemorrhagic ARDS, acute renal failure, DIC, metabolic acidosis, older age, alcohol abuse, high SOFA score, and septic shock.
• Confirmatory diagnosis relies on antibody tests (MAT, IgM ELISA) or PCR for antibody-negative cases.
• Reported mortality rates for leptospirosis in ICUs range from 6% to 44%.

Conclusions:

• Effective management involves prompt diagnosis, appropriate antimicrobial therapy (benzylpenicillin, ceftriaxone, cefotaxime, doxycycline), and supportive ICU care.
• Lung protection ventilation, fluid management, and timely renal replacement therapy (RRT) are vital.
• Utilizing ICU scores (SPiRO, THAI LEPTO, Faine's criteria) aids in risk stratification and optimizing patient outcomes.