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Leptospirosis: Epidemiological and Clinical Characteristics at the National Reference Hospital in Panama

Laia J. Vazquez GuillametWilliam Crawford Gorgas Center for Geographic Medicine, University of Alabama at Birmingham, Birmingham, Alabama;

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Ana Belen ArauzDepartment of Infectious Diseases, Hospital Santo Tomas, Panama City, Panama;
Department of Medicine, University of Panama, Panama City, Panama;
National Research System, National Secretary of Research, Technology and Innovation, Panama City, Panama;

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Jose A. SuárezGorgas Memorial Institute for Health Studies, Panama City, Panama;

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Emma GonzálezHospital Regional Nicolas A. Solano, La Chorrera, Panama;

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Jose Domingo de ObaldíaGorgas Memorial Institute for Health Studies, Panama City, Panama;
Hospital Aquilino Tejeira, Cocle, Panama

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Dianik MorenoGorgas Memorial Institute for Health Studies, Panama City, Panama;

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German HenostrozaWilliam Crawford Gorgas Center for Geographic Medicine, University of Alabama at Birmingham, Birmingham, Alabama;

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Blas ArmiénNational Research System, National Secretary of Research, Technology and Innovation, Panama City, Panama;
Gorgas Memorial Institute for Health Studies, Panama City, Panama;

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ABSTRACT.

Leptospirosis represents a public health problem in Panama, with an incidence rate of 1 in 100,000 inhabitants in 2014. Despite active surveillance and reports of outbreaks in the news, publications about human leptospirosis in Panama are scarce. The objective of this study was to describe the epidemiological and clinical features of leptospirosis in a cohort of patients admitted to the national reference hospital from January 2013 to December 2018. A total of 188 patients with suspected leptospirosis were identified, but only 56.9% (107 of 188) of the medical records could be retrieved. Microagglutination assays were completed in 45% (48 of 107) of the patients, confirming leptospirosis in 29.2% (14 of 48) of the patients. The most prevalent serogroup identified was Leptospira interrogans icterohemorrhagiae (4 of 14, 28.6%). The majority of patients with confirmed disease were middle-aged (36.4 ± 15.7 years), male (11 of 14, 78.6%), and symptomatic for 6.8 ± 0.7 days before admission. The predominant clinical presentation was fever (13 of 14, 92.9%), abdominal pain (7 of 14, 50%), and jaundice (8 of 14, 57.1%). Respiratory failure (8 of 14, 57.1%), elevated creatinine levels on admission (8 of 14, 57.1%), transfusion of blood-derived products (6 of 14, 42.9%), and required use of vasopressors (4 of 14, 28.6%) were common complications. Mortality was 28.6% (4 of 14). Empiric antibiotic therapy was initiated in almost all patients (10 of 12, 83.3%), and was appropriate in 90% (9 of 10) of them. Our study highlights the high prevalence of severe disease and reveals the diagnostic challenges concealing the true burden of leptospirosis in Panama. However, the small number of confirmed patients limits the generalization of these findings.

Author Notes

Address correspondence to Ana Belen Arauz, Infectious Diseases Department, Hospital Santo Tomas, Calle 37 Este, Panama City, Panama. E-mail: aarauz@hst.gob.pa

These authors contributed equally to this work.

Financial support: The work was supported by the Department of Research in Emerging and Zoonotic Diseases, the Ministry of Economy and Finance of Panama (project no. 111130150.501, awarded to B. A.), and a 2018 Gorgas Research Scholarship from the Gorgas Memorial Institute awarded to L. J. V. G.

Disclosure: G. H., coauthor of this study, serves as director of the William Crawford Gorgas Center for Geographic Medicine, and oversees the Gorgas Scholarship Award.

Authors’ addresses: Laia J. Vazquez Guillamet and German Henostroza, William Crawford Gorgas Center for Geographic Medicine, University of Alabama at Birmingham, Birmingham, AL, E-mails: laia.vazquez@isglobal.org and ghenostroza@uabmc.edu. Ana Belen Arauz, Department of Infectious Diseases, Hospital Santo Tomas, Panama City, Panama, Department of Medicine, University of Panama, Panama City, Panama, and National Research System, National Secretary of Research, Technology and Innovation, Panama City, Panama, E-mail: anabelenarauz@gmail.com. Jose A. Suárez and Dianik Moreno, Gorgas Memorial Institute for Health Studies, Panama City, Panama, E-mails: jasuarez05@gmail.com and dmoreno@gorgas.gob.pa. Emma González, Hospital Regional Nicolas A. Solano, La Chorrera, Panama, E-mail: draemmagonzalez@hotmail.com. Jose Domingo de Obaldía, Gorgas Memorial Institute for Health Studies, Panama City, Panama, and Hospital Aquilino Tejeira, Cocle, Panama, E-mail: josedomingo3088@gmail.com. Blas Armién, National Research System, National Secretary of Research, Technology and Innovation, Panama City, Panama, and Gorgas Memorial Institute for Health Studies, Panama City, Panama, E-mail: barmien@gorgas.gob.pa.

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