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Differences in Clinical Manifestations of Imported versus Autochthonous Leptospirosis in Austria and Germany
Bodo Hoffmeister
Bodo Hoffmeister
Department of Infectious Diseases and Pulmonology, Charité University Medicine Berlin, Berlin, Germany; Center for Infectious Diseases and Travel Medicine, Department of Medicine, University Hospital Freiburg, Freiburg, Germany; Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; Section of Infectious Diseases, Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria; Department of Infectious Diseases and Tropical Medicine, Ludwig-Maximilians University of Munich, Munich, Germany; Department of Infectious Diseases, Medizinische Poliklinik, Ludwig-Maximilians University of Munich, Munich, Germany; Department of Anaesthesiology and Intensive Care Medicine, Charité University Medicine Berlin, Berlin, Germany; Department of Intensive Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Section Tropical Medicine, Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Section Tropical Medicine/Clinical Research, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany
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Gabriele Peyerl-Hoffmann
Gabriele Peyerl-Hoffmann
Department of Infectious Diseases and Pulmonology, Charité University Medicine Berlin, Berlin, Germany; Center for Infectious Diseases and Travel Medicine, Department of Medicine, University Hospital Freiburg, Freiburg, Germany; Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; Section of Infectious Diseases, Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria; Department of Infectious Diseases and Tropical Medicine, Ludwig-Maximilians University of Munich, Munich, Germany; Department of Infectious Diseases, Medizinische Poliklinik, Ludwig-Maximilians University of Munich, Munich, Germany; Department of Anaesthesiology and Intensive Care Medicine, Charité University Medicine Berlin, Berlin, Germany; Department of Intensive Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Section Tropical Medicine, Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Section Tropical Medicine/Clinical Research, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany
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Sven Pischke
Sven Pischke
Department of Infectious Diseases and Pulmonology, Charité University Medicine Berlin, Berlin, Germany; Center for Infectious Diseases and Travel Medicine, Department of Medicine, University Hospital Freiburg, Freiburg, Germany; Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; Section of Infectious Diseases, Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria; Department of Infectious Diseases and Tropical Medicine, Ludwig-Maximilians University of Munich, Munich, Germany; Department of Infectious Diseases, Medizinische Poliklinik, Ludwig-Maximilians University of Munich, Munich, Germany; Department of Anaesthesiology and Intensive Care Medicine, Charité University Medicine Berlin, Berlin, Germany; Department of Intensive Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Section Tropical Medicine, Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Section Tropical Medicine/Clinical Research, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany
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Ines Zollner-Schwetz
Ines Zollner-Schwetz
Department of Infectious Diseases and Pulmonology, Charité University Medicine Berlin, Berlin, Germany; Center for Infectious Diseases and Travel Medicine, Department of Medicine, University Hospital Freiburg, Freiburg, Germany; Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; Section of Infectious Diseases, Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria; Department of Infectious Diseases and Tropical Medicine, Ludwig-Maximilians University of Munich, Munich, Germany; Department of Infectious Diseases, Medizinische Poliklinik, Ludwig-Maximilians University of Munich, Munich, Germany; Department of Anaesthesiology and Intensive Care Medicine, Charité University Medicine Berlin, Berlin, Germany; Department of Intensive Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Section Tropical Medicine, Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Section Tropical Medicine/Clinical Research, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany
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Robert Krause
Robert Krause
Department of Infectious Diseases and Pulmonology, Charité University Medicine Berlin, Berlin, Germany; Center for Infectious Diseases and Travel Medicine, Department of Medicine, University Hospital Freiburg, Freiburg, Germany; Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; Section of Infectious Diseases, Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria; Department of Infectious Diseases and Tropical Medicine, Ludwig-Maximilians University of Munich, Munich, Germany; Department of Infectious Diseases, Medizinische Poliklinik, Ludwig-Maximilians University of Munich, Munich, Germany; Department of Anaesthesiology and Intensive Care Medicine, Charité University Medicine Berlin, Berlin, Germany; Department of Intensive Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Section Tropical Medicine, Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Section Tropical Medicine/Clinical Research, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany
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Matthias C. Müller
Matthias C. Müller
Department of Infectious Diseases and Pulmonology, Charité University Medicine Berlin, Berlin, Germany; Center for Infectious Diseases and Travel Medicine, Department of Medicine, University Hospital Freiburg, Freiburg, Germany; Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; Section of Infectious Diseases, Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria; Department of Infectious Diseases and Tropical Medicine, Ludwig-Maximilians University of Munich, Munich, Germany; Department of Infectious Diseases, Medizinische Poliklinik, Ludwig-Maximilians University of Munich, Munich, Germany; Department of Anaesthesiology and Intensive Care Medicine, Charité University Medicine Berlin, Berlin, Germany; Department of Intensive Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Section Tropical Medicine, Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Section Tropical Medicine/Clinical Research, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany
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Angelika Graf
Angelika Graf
Department of Infectious Diseases and Pulmonology, Charité University Medicine Berlin, Berlin, Germany; Center for Infectious Diseases and Travel Medicine, Department of Medicine, University Hospital Freiburg, Freiburg, Germany; Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; Section of Infectious Diseases, Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria; Department of Infectious Diseases and Tropical Medicine, Ludwig-Maximilians University of Munich, Munich, Germany; Department of Infectious Diseases, Medizinische Poliklinik, Ludwig-Maximilians University of Munich, Munich, Germany; Department of Anaesthesiology and Intensive Care Medicine, Charité University Medicine Berlin, Berlin, Germany; Department of Intensive Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Section Tropical Medicine, Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Section Tropical Medicine/Clinical Research, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany
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Stefan Kluge
Stefan Kluge
Department of Infectious Diseases and Pulmonology, Charité University Medicine Berlin, Berlin, Germany; Center for Infectious Diseases and Travel Medicine, Department of Medicine, University Hospital Freiburg, Freiburg, Germany; Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; Section of Infectious Diseases, Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria; Department of Infectious Diseases and Tropical Medicine, Ludwig-Maximilians University of Munich, Munich, Germany; Department of Infectious Diseases, Medizinische Poliklinik, Ludwig-Maximilians University of Munich, Munich, Germany; Department of Anaesthesiology and Intensive Care Medicine, Charité University Medicine Berlin, Berlin, Germany; Department of Intensive Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Section Tropical Medicine, Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Section Tropical Medicine/Clinical Research, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany
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Gerd D. Burchard
Gerd D. Burchard
Department of Infectious Diseases and Pulmonology, Charité University Medicine Berlin, Berlin, Germany; Center for Infectious Diseases and Travel Medicine, Department of Medicine, University Hospital Freiburg, Freiburg, Germany; Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; Section of Infectious Diseases, Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria; Department of Infectious Diseases and Tropical Medicine, Ludwig-Maximilians University of Munich, Munich, Germany; Department of Infectious Diseases, Medizinische Poliklinik, Ludwig-Maximilians University of Munich, Munich, Germany; Department of Anaesthesiology and Intensive Care Medicine, Charité University Medicine Berlin, Berlin, Germany; Department of Intensive Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Section Tropical Medicine, Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Section Tropical Medicine/Clinical Research, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany
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Winfried V. Kern
Winfried V. Kern
Department of Infectious Diseases and Pulmonology, Charité University Medicine Berlin, Berlin, Germany; Center for Infectious Diseases and Travel Medicine, Department of Medicine, University Hospital Freiburg, Freiburg, Germany; Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; Section of Infectious Diseases, Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria; Department of Infectious Diseases and Tropical Medicine, Ludwig-Maximilians University of Munich, Munich, Germany; Department of Infectious Diseases, Medizinische Poliklinik, Ludwig-Maximilians University of Munich, Munich, Germany; Department of Anaesthesiology and Intensive Care Medicine, Charité University Medicine Berlin, Berlin, Germany; Department of Intensive Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Section Tropical Medicine, Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Section Tropical Medicine/Clinical Research, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany
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Norbert Suttorp
Norbert Suttorp
Department of Infectious Diseases and Pulmonology, Charité University Medicine Berlin, Berlin, Germany; Center for Infectious Diseases and Travel Medicine, Department of Medicine, University Hospital Freiburg, Freiburg, Germany; Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; Section of Infectious Diseases, Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria; Department of Infectious Diseases and Tropical Medicine, Ludwig-Maximilians University of Munich, Munich, Germany; Department of Infectious Diseases, Medizinische Poliklinik, Ludwig-Maximilians University of Munich, Munich, Germany; Department of Anaesthesiology and Intensive Care Medicine, Charité University Medicine Berlin, Berlin, Germany; Department of Intensive Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Section Tropical Medicine, Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Section Tropical Medicine/Clinical Research, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany
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Jakob P. Cramer
Jakob P. Cramer
Department of Infectious Diseases and Pulmonology, Charité University Medicine Berlin, Berlin, Germany; Center for Infectious Diseases and Travel Medicine, Department of Medicine, University Hospital Freiburg, Freiburg, Germany; Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; Section of Infectious Diseases, Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria; Department of Infectious Diseases and Tropical Medicine, Ludwig-Maximilians University of Munich, Munich, Germany; Department of Infectious Diseases, Medizinische Poliklinik, Ludwig-Maximilians University of Munich, Munich, Germany; Department of Anaesthesiology and Intensive Care Medicine, Charité University Medicine Berlin, Berlin, Germany; Department of Intensive Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Section Tropical Medicine, Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Section Tropical Medicine/Clinical Research, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany
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Leptospirosis, a zoonosis occurring worldwide, has a broad spectrum of clinical manifestations. Recently, various countries observed an increase of severe anicteric cases. In Austria and Germany, growing numbers of imported cases are notified in addition to autochthonous infections. The aim of this study was to assess whether imported and autochthonous cases differ in clinical manifestations and outcome. We retrospectively analyzed 24 imported and 35 autochthonous cases treated in six infectious disease units between 1998 and 2008. To compare disease severity, patients were classified according to established independent risk factors for fatal outcome. Although severe leptospirosis (i.e., presence of ≥ 1 independent risk factors for death) occurred in similar proportions of imported (67%) and autochthonous (86%) infections (P = 0.1), imported cases were significantly fewer icteric (13% versus 69%; P < 0.0001). In conclusion, an increasing incidence of severe anicteric imported cases of leptospirosis should be anticipated with rising global travel activities.
Author Notes
Authors' addresses: Bodo Hoffmeister and Norbert Suttorp, Department of Infectious Diseases and Pulmonology, Charité University Medicine Berlin, Berlin, Germany, E-mails: b.hoffmeister-infekt@charite.de and norbert.suttorp@charite.de. Gabriele Peyerl-Hoffmann and Winfried V. Kern, Center for Infectious Diseases and Travel Medicine, Department of Medicine, University Hospital Freiburg, Freiburg, Germany, E-mails: gabriele.peyerl-hoffmann@uniklinik-freiburg.de and kern@if-freiburg.de. Sven Pischke, Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany, E-mail: pischke.sven@mh-hannover.de. Ines Zollner-Schwetz and Robert Krause, Section of Infectious Diseases, Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria, E-mails: ines.schwetz@meduni-graz.at and robert.krause@medunigraz.at. Matthias C. Müller, Department of Infectious Diseases and Tropical Medicine, Ludwig-Maximilians University of Munich, Munich and Department of Infectious Diseases, Medizinische Poliklinik, Ludwig-Maximilians University of Munich, Munich, Germany, E-mail: matthias.mueller@med.uni-muenchen.de. Angelika Graf, Department of Anaesthesiology and Intensive Care Medicine, Charité University Medicine Berlin, Berlin, Germany, E-mail: angelika.graf@charite.de. Stefan Kluge, Department of Intensive Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany, E-mail: s.kluge@uke.de. Gerd D. Burchard and Jakob P. Cramer, Section Tropical Medicine, Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany and Section Tropical Medicine/Clinical Research, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany, E-mails: gerd.burchard@bni-hamburg.de and cramer@bni-hamburg.de.
Reprint requests: Bodo Hoffmeister, Department of Infectious Diseases and Pulmonology, Charité University Medicine Berlin, Augustenburger Platz 1, 13353 Berlin, Germany, Tel: +49-30-450653389, Fax: +49-30-450553958, E-mail: b.hoffmeister-infekt@charite.de.
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EndNote
-
1.
1999. Leptospirosis worldwide, 1999. Wkly Epidemiol Rec 74: 237–242.
-
2.
Levett PN, 2001. Leptospirosis. Clin Microbiol Rev 14: 296–326.
-
3.
Bharti AR, Nally JE, Ricaldi JN, Matthias MA, Diaz MM, Lovett MA, Levett PN, Gilman RH, Willig MR, Gotuzzo E, Vinetz JM, 2003. Leptospirosis: a zoonotic disease of global importance. Lancet Infect Dis 3: 757–771.
-
4.
Peter G, 1982. Leptospirosis: a zoonosis of protean manifestations. Pediatr Infect Dis 1: 282–288.
-
5.
Turner LH, 1967. Leptospirosis. I. Trans R Soc Trop Med Hyg 61: 842–855.
-
6.
Bovet P, Yersin C, Merien F, Davis CE, Perolat P, 1999. Factors associated with clinical leptospirosis: a population-based case-control study in the Seychelles (Indian Ocean). Int J Epidemiol 28: 583–590.
-
7.
Ashford DA, Kaiser RM, Spiegel RA, Perkins BA, Weyant RS, Bragg SL, Plikaytis B, Jarquin C, De Lose Reyes JO, Amador JJ, 2000. Asymptomatic infection and risk factors for leptospirosis in Nicaragua. Am J Trop Med Hyg 63: 249–254.
-
8.
Paganin F, Bourdin A, Dalban C, Courtin JP, Poubeau P, Borgherini G, Michault A, Sally JC, Tixier F, Genin R, Arvin-Berod C, 2007. Leptospirosis in Reunion Island (Indian Ocean): analysis of factors associated with severity in 147 confirmed cases. Intensive Care Med 33: 1959–1966.
-
9.
Wang CN, John L, Chang TF, Cheng WJ, Lou MY, Hung AT, 1965. Studies on anicteric leptospirosis. I. Clinical manifestations and antibiotic therapy. Chin Med J (Engl) 84: 283–291.
-
10.
Park SK, Lee SH, Rhee YK, Kang SK, Kim KJ, Kim MC, Kim KW, Chang WH, 1989. Leptospirosis in Chonbuk Province of Korea in 1987: a study of 93 patients. Am J Trop Med Hyg 41: 345–351.
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