ArticlePLoS neglected tropical diseases2019
Severe leptospirosis in tropical Australia: Optimising intensive care unit management to reduce mortality.
Article in PLoS neglected tropical diseases, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 1 of them a synthesis that pooled it.
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Who cites it
18 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Pooled it
- Deciphering the "Doxycycline Deficiency Syndrome": Defining the Characteristic Clinical, Laboratory and Imaging Findings in Patients Presenting with Leptospirosis, Q Fever and Rickettsial Diseases in Far North Queensland, Tropical Australia.Tropical medicine and infectious disease · 2026Article
- The Characteristics of Patients That Develop Severe Leptospirosis: A Scoping Review.Pathogens (Basel, Switzerland) · 2025Article
- Lung Involvement in Patients with Leptospirosis in Tropical Australia; Associations, Clinical Course and Implications for Management.Tropical medicine and infectious disease · 2025Article
- Presentation and Clinical Course of Leptospirosis in a Referral Hospital in Far North Queensland, Tropical Australia.Pathogens (Basel, Switzerland) · 2025Article
- Maternal and Foetal Outcomes of Leptospirosis in Pregnancy: An Observational Descriptive Study at a Tertiary Care Centre in Western India.Journal of obstetrics and gynaecology of India · 2025Article
- Leptospirosis.Nature reviews. Disease primers · 2025Review
- Factors associated with the lethality of human leptospirosis in Brazil.Cadernos de saude publica · 2025Article
- Severe leptospirosis in tropical and non-tropical areas: A comparison of two french, multicentre, retrospective cohorts.PLoS neglected tropical diseases · 2024Article
- Case Report: Leptospirosis Complicated by Persistent, Bilateral Sensorineural Hearing Loss.The American journal of tropical medicine and hygiene · 2023Article
- Pulmonary haemorrhage as a frequent cause of death among patients with severe complicated Leptospirosis in Southern Sri Lanka.PLoS neglected tropical diseases · 2023Observational
- Limited Awareness of Melioidosis in High-risk Populations Despite an Increasing Incidence of the Disease in Far North Queensland, Australia.The American journal of tropical medicine and hygiene · 2022Article
- The aetiology and clinical characteristics of cryptococcal infections in Far North Queensland, tropical Australia.PloS one · 2022Article
- The Applicability of Commonly Used Severity of Illness Scores to Tropical Infections in Australia.The American journal of tropical medicine and hygiene · 2021Article
- Leptospirosis in Intensive Care Unit.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2021Article
- Clinical profile, management and outcome of patients with leptospirosis during the times of COVID-19 pandemic: A prospective study from a tertiary care centre in South India.Le infezioni in medicina · 2021Article
- Circulating microtranscriptome profiles reveal distinct expression of microRNAs in severe leptospirosis.PLoS neglected tropical diseases · 2020Observational
- Improving the mortality of severe leptospirosis.Intensive care medicine · 2020Article
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Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSevere leptospirosis can have a case-fatality rate of over 50%, even with intensive care unit (ICU) support. Multiple strategies-including protective ventilation and early renal replacement therapy (RRT)-have been recommended to improve outcomes. However, management guidelines vary widely around the world and there is no consensus on the optimal approach. METHODOLOGY/PRINCIPAL
findingsAll cases of leptospirosis admitted to the ICU of Cairns Hospital in tropical Australia between 1998 and 2018 were retrospectively reviewed. The patients' demographics, presentation, management and clinical course were examined. The 55 patients' median (interquartile range (IQR)) age was 47 (32-62) years and their median (IQR) APACHE III score was 67 (48-105). All 55 received appropriate antibiotic therapy, 45 (82%) within the first 6 hours. Acute kidney injury was present in 48/55 (87%), 18/55 (33%) required RRT, although this was usually not administered until traditional criteria for initiation were met. Moderate to severe acute respiratory distress syndrome developed in 37/55 (67%), 32/55 (58%) had pulmonary haemorrhage, and mechanical ventilation was required in 27/55 (49%). Vasopressor support was necessary in 34/55 (62%). Corticosteroids were prescribed in 20/55 (36%). The median (IQR) fluid balance in the initial three days of ICU care was +1493 (175-3567) ml. Only 2/55 (4%) died, both were elderly men with multiple comorbidities.
conclusionIn patients with severe leptospirosis in tropical Australia, prompt ICU support that includes early antibiotics, protective ventilation strategies, conservative fluid resuscitation, traditional thresholds for RRT initiation and corticosteroid therapy is associated with a very low case-fatality rate. Prospective studies are required to establish the relative contributions of each of these interventions to optimal patient outcomes.
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