The Clinical and Laboratory Picture of Leptospirosis. Twenty-year experience

Hippokratia 2002, 6(3):129-136

E. Koutlas, L. Nikolaidou-Tokalaki, G. Zacharakis


Leptospirosis (L) is caused by various serovars of L. interrogans. Its clinical appearance varies from a mild anicteric to a severe icterohemorrhagic (Weil’s syndrome). The aim of this retrospective study is to quote our experience as to the clinical appearance of this entity. Eighty eight sporadic L cases served as material (men: 85, women: 3), of mean age 41.7±14.2 yrs, admitted during the last 20-year period (1981-2000). The diagnosis, made mainly on clinical grounds, was confirmed serologically by an ELISA, in 77.4% of the cases. Symptoms, complications, the most characteristic laboratory findings and the course of the illness were analysed. Results. 1. The clinical manifestations, in declining order, were fever: 100%, renal participation: 85% (azotemia: 54.5%), jaundice (bilirubin > 3.0 mg/dl): 80.7%, myalgias: 80%, digestive tract involvement: 48%, hypotension: 38%, headache: 37% (nuchal rigidity: 7%, abnormal CSF: 2.3%), 2nd wave of fever: 24.1%, respiratory system involvement: 23.9%, manifestations from the skin and the eyes, each by: 9.0%. 2. Laboratory findings: Creatine-phosphokinase (CPK) gave characteristically high peak values (717.3±904.5 IU/L), but not alanine-aminotransferase (ALT: 92.8±82.2 IU/L). Blood urea nitrogen (BUN) and creatinine, both gave also abnormal peak values (137.1± 89.3 mg/dl and 3.46±2.7 mg/dl respectively), as did bilirubin (16.9±13.9 mg/dl). There was also a fall in platelet count (100.7±70.6 x 109/L). 3. The course was good in 87.5%. Severe complications appeared in 11 patients (12.5%), of whom 10 (11.4%) died. Mean patient arrival time was 7.2±4.6 days, mean pyrexia duration: 7.8±3.3 days, mean duration of hospitalization: 13.2±7.2 days, and mean duration of illness (in the survivals): 20.4±8.1 days. In conclusion, L lasting approximately 3 weeks, appeared, at least in those who were admitted, as a severe illness, mainly with jaundice, myalgias, and renal involvement, but with lungs, CNS, skin, and eyes being sparsely involved.