EPIDEMIOLOGIC, CLINICAL, BIOLOGICAL AND E VOLUTIVE FEATURES OF LEPTOSPIROSIS - A 30 CASES STUDY IN AQUITAINE

We have studied restrospectively 30 cases of leptospirosis oberved in Aquitaine (South West France) from 1980 till 1992. This review was mad e in three internal and a nephrology department in Bordeaux hospital. Most cases occured by indirect contact with infected animals or by occ upational exposures. Onset was brutal with fever often associated with painful syndrome and sometimes conjunctival suffusion. Jaundice (70%) , acute renal failure (67%), meningitis (50%) and hemorrhagic signs (5 0%) were among the major visceral manifestations. Diagnosis was always confirmed by micro-agglutination test. Leptospira ictero-hemorrhagiae was the predominant serogroup found. The outcome was favorable in 22 patients; reversible complications were seen in six cases (five acute renal failure with hemodialysis myocarditis and pulmonary edema in two hemodialysed patients, polyradiculonevritis). Two patients died (acut e respiratory failure and meningo-encephalitis with diffuse hemorrhagi c syndrome). The characteristic of our series is the high-frequency of hepatorenal syndrome due to the importance of our nephrologist recrui tment. Furthermore our study confirm the vital prognostic characters o f the pulmonary, renal, hemorrhagic and neurologic complications. No a bsolute relationship was found between the clinical and laboratory fin dings and the serotype of leptospira. Penicillin remains the treatment of choice and should be started as soon as possible the avoid the lif e threatening visceral complications.