Assessment of the Clinical Presentation and Treatment of 353 Cases of Laboratory‐Confirmed Leptospirosis in Hawaii, 1974–1998

TLDR

Leptospirosis is a globally distributed zoonosis that is frequently misdiagnosed because of its nonspecific, protean presentation, and it is most commonly reported in Hawaii. The authors clinically evaluated all 353 laboratory‑confirmed leptospirosis cases in Hawaii from 1974 through 1998. Most patients presented with nonspecific symptoms such as fever, myalgia, and headache; jaundice occurred in 39 % and conjunctival suffusion in 28 %, and initiating antibiotics before day 7 of symptoms significantly shortened the duration of illness, highlighting the importance of early recognition and treatment.

Abstract

Leptospirosis is frequently misdiagnosed as a result of its protean and nonspecific presentation. Leptospirosis, a zoonosis with global distribution, commonly occurs in tropical and subtropical regions; most reported cases in the United States occur in Hawaii. All laboratory-confirmed leptospirosis cases in the State of Hawaii from 1974 through 1998 (n = 353) were clinically evaluated. The most common presentation involved nonspecific signs or symptoms, including fever, myalgia, and headache. Jaundice occurred in 39% of cases; conjunctival suffusion was described in 28% of these cases. Initiation of antibiotics before the seventh day of symptoms was associated with a significantly shortened duration of illness. Because early recognition and initiation of antibiotic therapy are important, clinicians should familiarize themselves with the clinical presentation of leptospirosis, and when evaluating a patient with a febrile illness, they should obtain exposure and travel histories and entertain the possibility of leptospirosis in the differential diagnosis.