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Abstract：
BACKGROUND: Leptospirosis presents with highly variable clinical manifestations affecting different organ systems in different individuals. The presentation ranges from an asymptomatic or mild disease to a severe disease associated with multiorgan failure and higher mortality. Leptospirosis is highly underreported due to a lack of diagnostic modalities and less suspicion among clinicians.
METHODS: We present this single-center retrospective case series of 12 cases, which include various common and uncommon scenarios by which the disease can present and can be missed due to lack of suspicion. The study contains individual patient characteristics including demographic, laboratory, clinical, and treatment data. The association between these variables and mortality was analyzed using p-values and results were described. A p-value of<0.05 was considered statistically significant.
RESULTS: A total of 12 cases were included in the study. The male-to-female ratio was 3:1. The mean age was higher (37.75±9.81 years) in cases who died than those who recovered (34.25±14.09). Factors like history of alcoholism, presence of chronic liver disease (CLD), jaundice, acute renal failure, requirement of dialysis, and requirement of intensive care were significantly associated with increased risk of death (odds ratio >1, p-value <0.05). The most common symptom of presentation was fever in 11 (91.66%) cases. Jaundice and renal failure were significantly associated with death (odds ratio 1.2, p-value 0.04). The requirement of intensive care treatment (odds ratio 2.1, p-value 0.05) and dialysis (odds ratio 39.66, p-value 0.03) were also significantly associated with death. The percentage of death was lower in the group of patients who received combination antibiotic therapy.
CONCLUSIONS: Leptospirosis has varied presentations in different individuals and the diagnosis can be missed due to lack of specific signs and symptoms. Severe diseases involving multiple organs and preexisting comorbidities are associated with higher mortality rates. Timely diagnosis and treatment are necessary to reduce mortality and increase survival.
METHODS: We present this single-center retrospective case series of 12 cases, which include various common and uncommon scenarios by which the disease can present and can be missed due to lack of suspicion. The study contains individual patient characteristics including demographic, laboratory, clinical, and treatment data. The association between these variables and mortality was analyzed using p-values and results were described. A p-value of<0.05 was considered statistically significant.
RESULTS: A total of 12 cases were included in the study. The male-to-female ratio was 3:1. The mean age was higher (37.75±9.81 years) in cases who died than those who recovered (34.25±14.09). Factors like history of alcoholism, presence of chronic liver disease (CLD), jaundice, acute renal failure, requirement of dialysis, and requirement of intensive care were significantly associated with increased risk of death (odds ratio >1, p-value <0.05). The most common symptom of presentation was fever in 11 (91.66%) cases. Jaundice and renal failure were significantly associated with death (odds ratio 1.2, p-value 0.04). The requirement of intensive care treatment (odds ratio 2.1, p-value 0.05) and dialysis (odds ratio 39.66, p-value 0.03) were also significantly associated with death. The percentage of death was lower in the group of patients who received combination antibiotic therapy.
CONCLUSIONS: Leptospirosis has varied presentations in different individuals and the diagnosis can be missed due to lack of specific signs and symptoms. Severe diseases involving multiple organs and preexisting comorbidities are associated with higher mortality rates. Timely diagnosis and treatment are necessary to reduce mortality and increase survival.
摘要：
背景：钩端螺旋体病具有高度可变的临床表现，影响不同个体的不同器官系统。表现范围从无症状或轻度疾病到与多器官衰竭和更高死亡率相关的严重疾病。由于缺乏诊断方式和临床医生的怀疑较少，钩端螺旋体病被高度低估。
方法：我们提出了12例单中心回顾性病例系列，其中包括各种常见和不常见的情况，这种疾病可以出现，并且由于缺乏怀疑而可能被错过。该研究包含个体患者特征，包括人口统计学，实验室,临床,和治疗数据。使用p值分析这些变量与死亡率之间的关联，并描述结果。P值<0.05被认为是统计学上显著的。
结果：共12例纳入研究。男女比例为3:1。死亡病例的平均年龄（37.75±9.81岁）高于康复病例（34.25±14.09）。比如酗酒史，慢性肝病（CLD）的存在，黄疸,急性肾功能衰竭,透析的要求，重症监护和重症监护要求与死亡风险增加显著相关(比值比>1,p值<0.05).最常见的症状是发热11例(91.66%)。黄疸和肾衰竭与死亡显著相关（比值比1.2，p值0.04）。重症监护治疗的需求（比值比2.1，p值0.05）和透析（比值比39.66，p值0.03）也与死亡显着相关。接受联合抗生素治疗的患者组的死亡百分比较低。
结论：钩端螺旋体病在不同个体中有不同的表现，由于缺乏特定的体征和症状，可能会漏诊。涉及多个器官的严重疾病和先前存在的合并症与较高的死亡率相关。及时诊断和治疗对于降低死亡率和增加生存率是必要的。
方法：我们提出了12例单中心回顾性病例系列，其中包括各种常见和不常见的情况，这种疾病可以出现，并且由于缺乏怀疑而可能被错过。该研究包含个体患者特征，包括人口统计学，实验室,临床,和治疗数据。使用p值分析这些变量与死亡率之间的关联，并描述结果。P值<0.05被认为是统计学上显著的。
结果：共12例纳入研究。男女比例为3:1。死亡病例的平均年龄（37.75±9.81岁）高于康复病例（34.25±14.09）。比如酗酒史，慢性肝病（CLD）的存在，黄疸,急性肾功能衰竭,透析的要求，重症监护和重症监护要求与死亡风险增加显著相关(比值比>1,p值<0.05).最常见的症状是发热11例(91.66%)。黄疸和肾衰竭与死亡显著相关（比值比1.2，p值0.04）。重症监护治疗的需求（比值比2.1，p值0.05）和透析（比值比39.66，p值0.03）也与死亡显着相关。接受联合抗生素治疗的患者组的死亡百分比较低。
结论：钩端螺旋体病在不同个体中有不同的表现，由于缺乏特定的体征和症状，可能会漏诊。涉及多个器官的严重疾病和先前存在的合并症与较高的死亡率相关。及时诊断和治疗对于降低死亡率和增加生存率是必要的。
