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Am. J. Trop. Med. Hyg., 79(6), 2008, pp. 911-914
Copyright © 2008 by The American Society of Tropical Medicine and Hygiene

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Predictors of Lethality in Severe Leptospirosis in Urban Brazil

Anne S. Spichler, Pedro J. Vilaça, Daniel A. Athanazio, Jose O. M. Albuquerque, Marcia Buzzar, Bronislawa Castro, Antonio Seguro, AND Joseph M. Vinetz*
Health Municipality Secretariat of São Paulo, São Paulo, Brazil; Department of Nephrology–LIM 12, University of São Paulo School of Medicine, Brazil; Federal University of Bahia, Brazil; Division of Infectious Diseases, Department of Medicine, University of California San Diego School of Medicine, La Jolla, California

To ascertain prognostic factors associated with fatal outcomes in severe leptospirosis, a retrospective case-control study was done using population-based surveillance data. Centralized death certificate reporting of leptospirosis mortality was combined with details of patients’ hospitalizations, which were obtained from hospitals representing all sectors of São Paulo city. Among identified leptospirosis cases, 89 lethal cases and 281 survivor cases were analyzed. Predictors of death included age > 40 years, development of oliguria, platelet count < 70,000/µL, creatinine > 3 mg/dL, and pulmonary involvement. The latter was the strongest risk factor with an estimated odds ratio of 6.0 (95% confidence interval: 3.0–12.0). Serologic findings with highest titer against Leptospira interrogans serovar Copenhageni did not show significant differences between survivors and non-survivors. Lung involvement was an important predictor of death in leptospirosis in São Paulo, of relevance in leptospirosis-endemic regions where this complication is common.

Received March 11, 2008. Accepted for publication August 13, 2008.

Financial support: This work was supported by the Health Municipality Secretariat of São Paulo, São Paulo, and U.S. Public Health Service grants RO1TW05860, D43TW007120, 1R21AI067745, and K24AI068903 to JMV.

* Address correspondence to Joseph M. Vinetz, University of California San Diego School of Medicine, 9500 Gilman Drive, 0741 Palade Labs, Rm. 125, La Jolla, CA 92093-0741. E-mail: jvinetz{at}ucsd.edu

Authors’ addresses: Anne S. Spichler, Pedro J. Vilaça, Jose O. M. Albuquerque, Bronislawa Castro, and Antonio Seguro, Department of Nephrology, Laboratory of Basic Research, LIM-12, Faculty of Medicine, University of São Paulo, Av. Dr. Arnaldo 455, Sala 3310, CEP 01246-903, São Paulo, SP, Brazil. Daniel A. Athanazio, Department of Biointeraction, ICS-UFBA, Av. Reitor Miguel Calmon s/no, Campos de Canela, 40. 110-100 Salvador, Bahia, Brazil, E-mail: daa{at}ufba.br. Marcia Buzzar, Division of Zoonoses, Center for Epidemiological Surveillance, Av. Dr. Arnaldo, 351, 6° Andar, CEP 01246-000 São Paulo, SP, Brazil. Joseph M. Vinetz, University of California San Diego School of Medicine, 9500 Gilman Drive, 0741 Palade Labs, Rm. 125, La Jolla, CA 92093-0741, Tel: +1-858-822-4469, Fax: +1-858-822-5322, E-mail: jvinetz{at}ucsd.edu.






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Copyright © 2008 by the American Society of Tropical Medicine and Hygiene.