Chronic post-leptospirosis manifestations in Reunion Island.
The objective of this project is to study the outcome of patients with leptospirosis beyond 1 year of infection in terms of clinical and serological aspects, as well as quality of life, use of alternative and complementary medicines, and health literacy profiles.
Leptospirosis is a zoonotic disease caused by spirochetes, pathogenic bacteria of the genus Leptospira. It is transmitted to humans through cutaneomucous lesions by contact with water or soil contaminated by the urine of reservoir animals (rats, dogs, pigs, cattle, etc.). Exposure to fresh water, contact with water or soil contaminated by animal excrement are the main risk factors.
This disease represents a significant public health problem in humans and animals. The annual global incidence is estimated at nearly one million cases with a mortality rate of 5 to 10% overall and up to 50% in cases of multi-visceral failure. The number of cases is growing steadily, and the disease is likely more widespread than diagnosed. The incidence could further increase in the coming decades due to climate change and rapid urbanization
In the Overseas Departments and Regions (DROM), it is an endemic condition, and its incidence is 10 to 100 times higher than that in mainland France, mainly due to climatic reasons. In Réunion, the disease is notifiable with a reported number of cases ranging from 70 to over 100 cases per year in recent years. Nearly 90% of confirmed cases have been hospitalized, and more than a third of patients have been admitted to intensive care.
Recently, a multicentric cohort of hospitalized subjects with leptospirosis in Réunion (COLEPT) was funded by Inserm to identify severity factors of the disease among patients hospitalized in one of the island's 4 hospitals. A community of active hospital practitioners in this field has been identified and forms the core of this project. The study, which began enrollment in January 2020, aims primarily to identify severity factors of leptospirosis in Réunion. Follow-up of patients is planned for up to 1 year with 2 medical visits at 1 month and 1 year, and 2 telephone interviews on quality of life.
The disease is generally perceived as an acute condition with rapid complete recovery. However, the long-term course has been poorly evaluated. Some publications report complications and elements of chronicity in the medium/long term (>1 year) that would require following these patients over a longer period. Regarding these potential chronic manifestations, they may include chronic fatigue, uveitis, renal insufficiency, chronic renal carriage with urinary excretion of leptospires, myalgia and muscle weakness, headaches, malaise, as well as cardiac or neurological manifestations. A Dutch study conducted on subjects with confirmed diagnosis reported 30% of patients with post-leptospirosis chronic symptoms persisting in 21% of subjects more than 24 months after infection, but very little data is available on chronic forms.
