Septic shock with multiple organ dysfunction as clinical presentation of severe leptospirosis in endemic areas

Abstract

Introduction: Leptospirosis is an anthropozoonosis that can cause a self-limited anicteric febrile illness (85 to 90% of cases) or manifest in its most severe form known as Weil's disease (5 to 10% of cases). The objective of the study was to describe three cases of severe leptospirosis diagnosed and to highlight the importance of septic shock with multi-organ dysfunction as a clinical form of presentation of the disease in endemic areas.

Clinical cases: We present a series of three cases that attended the emergency department with a clinical picture compatible with septic shock without an apparent focus of infection preceded by a febrile syndrome with nonspecific symptoms, all with epidemiology suggestive of leptospirosis, and with syndrome severe hemorrhagic pulmonary disease, liver failure and acute renal failure, finally leading to the diagnosis of Weil's disease. The few reports in the literature of septic shock as a clinical form of presentation of severe leptospirosis are due to an underdiagnosis of this entity, especially in the bacteremia phase where the occurrence of this complication is unusual due to the absence of the immune-mediated phenomena that determine it.

Conclusions: It is essential that medical personnel keep leptospirosis in mind among the etiological diagnoses of an acute febrile condition that progresses to septic shock with multi-organ dysfunction, particularly in endemic areas, since timely diagnosis and effective treatment will have a direct impact on the evolution of leptospirosis disease and will have a direct impact on the patient's prognosis and health.