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АНЕСТЕЗІОЛОГИ, ХІРУРГИ

"Actual Infectology" Том 7, №2, 2019

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Evaluation of the dynamics of morbidity in leptospirosis during the last 5 years

Authors: М.О. Аndrushchak, V.D. Moskaliuk, M.O. Sokolenko
Bukovinian State medical University, Chernivtci, Ukraine

Categories: Infectious diseases

Sections: Medical forums

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Background. Leptospirosis — acute infectious disease, zoonotic, caused by different types of leptospira. Among the most dangerous natural-focal diseases, leptospirosis remains the only infection that is registered and has a tendency to increase in all administrative territories of Ukraine annually. In the main cases, leptospirosis is rare. The total number of patients in some years varied from 15 to 58 people. Leptospirosis was first discovered in 1967. In the early years, only severe jaundicats were found, but with improvement, by the use of indirect hemagglutination in laboratory diagnostics, it became possible to diagnose cases of non-jaundiced forms of the disease. The epidemic situation with leptospirosis in the region remains unstable. In 2016, four cases of leptospirosis were registered in the region in 2016, three of which resulted in death of the patients. Moreover, in a laboratory study of leptospirosis in the fatal cases of 2014 and 2015. In the year of mouse rodents in 4.4 %, the result was positive. The lesions affected by leptospirosis of rodents fork in all regions of the region and in Chernivtsi. The purpose was to study the dynamics of the disease in leptospirosis in the population of Chernivtsi region, features of clinical symptoms and consequences of the disease.
Materials and methods. 47 medical cards of inpatient patients treated at the Chernivtsi infectious diseases department during the period of 2014–2018 were processed. The analysis of medical cards of patients included clinical and laboratory research, and for accounting purposes, stastical documentation of the State Sanitary and Epidemiological Service of Chernivtsi region for 2014–2018.
Results and discussion. For the studied period in Chernivtsi region. Ill with leptospirosis 41 people. The gender distribution comprised: women — 31 %, men — 69 %. Patients’ age ranged from 28 to 64 years. The largest number of patients was hospitalized from August to October 2014 — 17 cases, 41.46 % (which corresponds to seasonality for leptospirosis), the mortality of this pathology — 5 %, in 2015 — 9 cases, which was 21.95 %, in 2016 4 cases, 9.7 % 2 of which ended lethally, in 2017 — 6 cases, 14.63 %, in 2018 — 5 cases, 12.19 %. At the place of residence, the countryside prevailed over urban 68.5 % by 32.5 %, respectively. Most of the patients, namely 81 %, noticed that they were fishing on the eve, drank water from uncleaned reservoirs, 24 % noticed that rodents lived next to them, and 15 % did not bind disease to leptospirosis with the above-mentioned reasons. An increase in temperature to 38.5–39.0 °C, headache was observed in 91 % of patients. Myalgia is frequent complaint of patients with leptospirosis in almost all cases. The onset of the disease is acute. The first symptoms are: chills, headache, body pain, pain in the right hypochondrium, in the muscles, especially in the liver, dry mouth, thirst. In 8 (19.51 %) patients there was multiple vomiting. Two patients (4.87 %) had manifestations of infectious-toxic shock with a decrease in blood pressure to 90/50–60/40 mm Hg. The phenomenum of scleritis was detected in 6 (14.63 %) patients, bronchitis — in 16 (39 %). All patients noted the tightness of the tongue with thick layers, its dryness, but the characteristic hyperemia of the mucous membrane of the oral cavity was found in only 15 (36.58 %) persons. One of the leading symptoms of leptospirosis is damage to the liver with a moderate increase in its size (up to 2–3 cm below the costal arch, dense consistency, somewhat painful). These changes are observed in both icteric and non-icteric forms of the disease. In the biochemical analysis, there was an increase in creatinine and urea, a decrease in the level of red blood cells and hemoglobin. Bilirubin remained within normal limits. The average number of bed days spent is 21 days. Analysis of laboratory parameters: increase of bilirubin level in 50%, decrease of hemoglobin level — in 44 %. Isolation of culture of leptospiros was carried out using the reaction of microagglutination, diagnostic titer 1 : 200. The most commonly encountered serogroups, such as Pomona, Canicola, Habdomadis. The clinic was characterized by the following symptoms: body temperature increase — 91.3 %, myalgia — 87.36 %, yellowness of sclera — 64.28 %, headache — 59.74 %, inflammation disorder, as a complication — 62.28 %. Diagnosis was complicated due to the presence of a concomitant disease — viral hepatitis — in 39.71 %. The disease started acutely, the incubation period fluctuated within 7–14 days. Diagnosis on the basis of complaints, anamnesis of the disease. In 64 % of the diagnosis was “Leptospirosis with jaundice form moderate-severe course”. In 23 %, “Leptospirosis is jaundiced, moderately severe” with concomitant pathology, chronic hepatitis B. In 21 % of patients, leptospirosis was complicated by acute renal insufficiency. They were transferred to resuscitation and treatment.
Conclusions. Epidemiological situation of dissemination of leptospirosis among the population of Chernivtsi region, considered unstable, endemic. Compared to other years, the level of morbidity has decreased, but the risk of the disease remains. 


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