Article
Differences in clinical manifestations of imported versus autochthonous leptospirosis in Austria and Germany
Unterschiede in den klinischen Manifestationen von importierter und autochthon erworbener Leptospirose in Österreich und Deutschland
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Published: | June 2, 2010 |
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Objectives: Leptospirosis, probably the most common zoonosis worldwide, is a rare disease in Austria and Germany. Increasing international travel activity has led to a growing number of imported cases in our countries in addition to a low but persisting rate of autochthonous illnesses, leading to a slight increase of the overall incidence in recent years. Not least because of its protean clinical manifestations leptospirosis can be difficult to diagnose. Jaundice as a cardinal symptom is not only helpful for diagnosis but is also traditionally considered as an indicator of severe courses. Recently, however, various countries observed an increasing number of severe anicteric cases. The mortality rate of these cases, predominantly presenting with the severe pulmonary hemorrhage syndrome and the acute respiratory distress syndrome, was much higher than the case fatality rate of patients with Weil's disease.
Methods: In the present study we retrospectively analyzed the clinical spectrum of 24 imported and 35 autochthonous cases with acute leptospirosis treated between 1998 and 2008 in six infectious disease units in Austria and Germany. Aim of the study was to assess whether imported and autochthonous cases differ in clinical manifestations and outcome. As there is currently no consistent definition of what characterizes „severe“ or „life-threatening“ forms of leptospirosis, we classified the cases according to previously established independent risk factors for fatal outcome in order to assess risk factors other than jaundice in anicteric cases.
Results: Our data indicate that although severe leptospirosis (i.e. presence of one or more independent risk factors for death) occurred in similar proportions of imported (67%) and autochthonous (86%) infections (p=0.1), the imported cases were significantly fewer icteric (13% versus 69%; p<0.0001).
Conclusions: In conclusion, the clinical spectrum of imported leptospirosis differs from that of autochthonous cases in Austria and Germany. An increasing incidence of severe anicteric imported cases should be anticipated with rising global travel activities. The risk factors for fatal outcome and general management strategy of severe leptospirosis resemble those of sepsis and the multi-organ dysfunction syndrome, possibly providing a basis for an effective therapy even when leptospirosis is initially not suspected.