The role of leptospiremia and specific immune response in severe leptospirosis

• Published in: Scientific reports Vol. 11; no. 1; p. 14630
• Main Authors: Limothai, Umaporn, Lumlertgul, Nuttha, Sirivongrangson, Phatadon, Kulvichit, Win, Tachaboon, Sasipha, Dinhuzen, Janejira, Chaisuriyong, Watchadaporn, Peerapornratana, Sadudee, Chirathaworn, Chintana, Praditpornsilpa, Kearkiat, Eiam-Ong, Somchai, Tungsanga, Kriang, Srisawat, Nattachai
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 16-07-2021; Nature Publishing Group; Nature Portfolio
• Subjects: 631/250; 631/326; 631/337; 692/308; 692/4017; 692/420; 692/499; 692/53; 692/699; Agglutination; Fever; Gelatinase; Hemorrhage; Humanities and Social Sciences; Immune response; Interleukin 6; Leptospirosis; Leukocytes (neutrophilic); Lipocalin; Mechanical ventilation; multidisciplinary; Science; Science (multidisciplinary); Statistical analysis
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-021-94073-z

Leptospirosis can cause a high mortality rate, especially in severe cases. This multicenter cross-sectional study aimed to examine both host and pathogen factors that might contribute to the disease severity. A total of 217 leptospirosis patients were recruited and divided into two groups of non-severe and severe. Severe leptospirosis was defined by a modified sequential organ failure assessment (mSOFA) score of more than two or needed for mechanical ventilation support or had pulmonary hemorrhage or death. We found that leptospiremia, plasma neutrophil gelatinase-associated lipocalin (pNGAL), and interleukin 6 (IL-6) at the first day of enrollment (day 1) and microscopic agglutination test (MAT) titer at 7 days after enrollment (days 7) were significantly higher in the severe group than in the non-severe group. After adjustment for age, gender, and the days of fever, there were statistically significant associations of baseline leptospiremia level (OR 1.70, 95% CI 1.23–2.34, p = 0.001), pNGAL (OR 9.46, 95% CI 4.20–21.33, p < 0.001), and IL-6 (OR 2.82, 95% CI 1.96–4.07, p < 0.001) with the severity. In conclusion, a high leptospiremia, pNGAL, and IL-6 level at baseline were associated with severe leptospirosis.