Leptospirosis in intensive care unit

Abstract

Leptospirosis is a ubiquitous disease, with higher incidences in tropical and sub-tropical areas. The occurrence of organ failures in young, healthy adults can lead to the patient being admitted to the intensive care unit, in particular: acute renal failure with hypokalaemia, jaundice with conjugated bilirubin, pulmonary involvement with intra-alveolar haemorrhage, deep thrombocytopenia and/or shock. In temperate zones, the challenge remains to evoke the diagnosis, whereas in endemic zones (such as the French Overseas Territories), it is necessary to rule out all differential diagnosis. Biological diagnosis is based on a specific PCR in blood or urine. Management consists of antibiotic therapy with amoxicillin or third generation cephalosporins and symptomatic management. The prognosis is good and should lead to discussion of exceptional therapies (extracorporeal membrane oxygenation, Desmopressin) in case of refractory organ failure.