ArticlePLoS neglected tropical diseases2016
Early Indicators of Fatal Leptospirosis during the 2010 Epidemic in Puerto Rico.
Article in PLoS neglected tropical diseases, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 1 of them a synthesis that pooled it.
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Who cites it
22 citing papers in PubMed, 1 synthesis or guideline pooled it, 48 citations in OpenAlex.
- Cytokine response in human leptospirosis with different clinical outcomes: a systematic review.BMC infectious diseases · 2020Pooled it
- Estimating the burden of leptospirosis in the Caribbean: Insights from environmental and sociodemographic factors.PLoS neglected tropical diseases · 2026Article
- Molecular detection and genetic characterisation of a large flood-borne outbreak of human leptospirosis in Jakarta, Indonesia: A retrospective analysis of surveillance data.PLoS neglected tropical diseases · 2026Article
- Leptospirosis in the Caribbean Region between 2000 and 2022: A scoping review of morbidity and mortality.PLoS neglected tropical diseases · 2026Article
- The Characteristics of Patients That Develop Severe Leptospirosis: A Scoping Review.Pathogens (Basel, Switzerland) · 2025Article
- Diagnosis and Clinical Description of Leptospirosis Cases Identified Through Hospital-Based Active Surveillance in Puerto Rico, 2019-2021.Journal of tropical medicine · 2025Article
- Leptospirosis Outbreak in Aftermath of Hurricane Fiona - Puerto Rico, 2022.MMWR. Morbidity and mortality weekly report · 2024Article
- Acute Calculous Cholecystitis Associated with Leptospirosis: Which is the Emergency? A Case Report and Literature Review.Journal of critical care medicine (Universitatea de Medicina si Farmacie din Targu-Mures) · 2024Article
- Fatal acute undifferentiated febrile illness among clinically suspected leptospirosis cases in Colombia, 2016-2019.PLoS neglected tropical diseases · 2023Article
- Demographic and clinical risk factors associated with severity of lab-confirmed human leptospirosis in Colombia, 2015-2020.PLoS neglected tropical diseases · 2023Article
- Culture-Independent Detection and Identification ofMicrobiology spectrum · 2022Article
- Article
- Insight into the Structure, Functions, and Dynamics of theMembranes · 2022Review
- Determinants of prolonged hospitalization and mortality among leptospirosis patients attending tertiary care hospitals in northeastern state in peninsular Malaysia: A cross sectional retrospective analysis.Frontiers in medicine · 2022Article
- Seroprevalence, Risk Factors, and Rodent Reservoirs of Leptospirosis in an Urban Community of Puerto Rico, 2015.The Journal of infectious diseases · 2019Article
- The prevalence of Leptospira among invasive small mammals on Puerto Rican cattle farms.PLoS neglected tropical diseases · 2019Article
- Leptospirosis among Returned Travelers: A GeoSentinel Site Survey and Multicenter Analysis-1997-2016.The American journal of tropical medicine and hygiene · 2018Article
- Leptospirosis Cases Infected with Uncommon Serogroups, Puerto Rico, 2013-2015.The American journal of tropical medicine and hygiene · 2018Article
- Leptospirosis presenting as acute acalculous cholecystitis.Clinical case reports · 2017Article
- FatalThe American journal of tropical medicine and hygiene · 2017Article
Corrections and comments
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Authors and funding
12 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundLeptospirosis is a potentially fatal bacterial zoonosis that is endemic throughout the tropics and may be misdiagnosed as dengue. Delayed hospital admission of leptospirosis patients is associated with increased mortality. METHODOLOGY/PRINCIPAL
findingsDuring a concurrent dengue/leptospirosis epidemic in Puerto Rico in 2010, suspected dengue patients that tested dengue-negative were tested for leptospirosis. Fatal and non-fatal hospitalized leptospirosis patients were matched 1:1-3 by age. Records from all medical visits were evaluated for factors associated with fatal outcome. Among 175 leptospirosis patients identified (4.7 per 100,000 residents), 26 (15%) were fatal. Most patients were older males and had illness onset during the rainy season. Fatal case patients first sought medical care earlier than non-fatal control patients (2.5 vs. 5 days post-illness onset [DPO], p < 0.01), but less frequently first sought care at a hospital (52.4% vs. 92.2%, p < 0.01). Although fatal cases were more often diagnosed with leptospirosis at first medical visit (43.9% vs. 9.6%, p = 0.01), they were admitted to the hospital no earlier than non-fatal controls (4.5 vs. 6 DPO, p = 0.31). Cases less often developed fever (p = 0.03), but more often developed jaundice, edema, leg pain, hemoptysis, and had a seizure (p ≤ 0.03). Multivariable analysis of laboratory values from first medical visit associated with fatal outcome included increased white blood cell (WBC) count with increased creatinine (p = 0.001), and decreased bicarbonate with either increased WBC count, increased creatinine, or decreased platelet count (p < 0.001). CONCLUSIONS/SIGNIFICANCE: Patients with fatal leptospirosis sought care earlier, but were not admitted for care any earlier than non-fatal patients. Combinations of routine laboratory values predictive of fatal outcome should be considered in admission decision-making for patients with suspected leptospirosis.
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