Please use this identifier to cite or link to this item: https://www.arca.fiocruz.br/handle/icict/7574
Title: Urban epidemic of severe leptospirosis in Brazil. Salvador Leptospirosis Study Group
Authors: Ko, Albert Icksang
Reis, Mitermayer Galvão dos
Dourado, Cibele M. Ribeiro
Johnson Junior, Warren D
Riley, Lee Woodland
Salvador Leptospirosis Study Group
Affilliation: Fundação Oswaldo Cruz. Centro de Pesquisa Gonçalo Moniz. Salvador, BA, Brasil / Division of International Medicine and Infectious Disease. Cornell University Medical College. New York, USA
Fundação Oswaldo Cruz. Centro de Pesquisa Gonçalo Moniz. Salvador, BA, Brasil
Hospital Couto Maia. Secretary of Health for the State of Bahia. Salvador, BA, Brasil
Division of International Medicine and Infectious Disease. Cornell University Medical College. New York, USA
School of Public Health. University of California. Berkeley, USA
Abstract: BACKGROUND: Leptospirosis has, traditionally, been considered a sporadic rural disease. We describe a large urban outbreak of leptospirosis. METHODS: Active surveillance for leptospirosis was established in an infectious-disease referral hospital in Salvador, Brazil, between March 10 and Nov 2, 1996. Patients meeting case criteria for severe manifestations of leptospirosis were recruited into the study. The diagnosis was confirmed in the laboratory with the microagglutination test and identification of leptospires in blood or urine. Risk factors for death were examined by multivariate analyses. FINDINGS: Surveillance identified 326 cases of which 193 (59%) were laboratory-confirmed (133) or probable (60) cases. Leptospira interrogans serovar copenhageni was isolated from 87% of the cases with positive blood cultures. Most of the cases were adult (mean age 35.9 years [SD 15.9]), and 80% were male. Complications included jaundice (91%), oliguria (35%), and severe anaemia (26%). 50 cases died (case-fatality rate 15%) despite aggressive supportive care including dialysis (in 23%). Altered mental status was the strongest independent predictor of death (odds ratio 9.12 [95% CI 4.28-20.3]), age over 37 years, renal insufficiency, and respiratory insufficiency were also significant predictors of death. Before admission to hospital, 42% were misdiagnosed as having dengue fever in the outpatient clinic; an outbreak of dengue fever was taking place concurrently. INTERPRETATION: An epidemic of leptospirosis has become a major urban health problem, associated with high mortality. Diagnostic confusion with dengue fever, another emerging infectious disease with a similar geographic distribution, prevents timely intervention that could minimise mortality.
DeCS: Surtos de Doenças/estatística & dados numéricos
Saúde da População Urbana/estatística & dados numéricos
Doença de Weil/epidemiologia
Adulto
Brasil/epidemiologia
Dengue/diagnóstico
Diagnóstico Diferencial
Feminino
Humanos
Leptospira interrogans/isolamento & purificação
Masculino
Vigilância da População
Doença de Weil/diagnóstico
Issue Date: 1999
Publisher: Lancet
Citation: KO, A. I. et al. Urban epidemic of severe leptospirosis in Brazil. Lancet, v. 354, n. 9181, p. 820-825, 1999.
ISSN: 0140-6736
Copyright: open access
Appears in Collections:BA - IGM - Artigos de Periódicos

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