Severe leptospirosis in tropical and non-tropical areas: A comparison of two french, multicentre, retrospective cohorts.

BACKGROUND: Leptospirosis is an anthropozoonosis that occurs worldwide but is more common in tropical regions. Severe forms may require intensive care unit (ICU) admission. Whether the clinical patterns and outcomes differ between tropical and non-tropical regions with similar healthcare systems is unclear. Our objective here was to address this issue by comparing two cohorts of ICU patients with leptospirosis managed in mainland France and in the overseas French department of Réunion, respectively. METHODOLOGY/PRINCIPAL FINDINGS: We compared two retrospective cohorts of patients admitted to intensive care for severe leptospirosis, one from Reunion Island in the Indian Ocean (tropical climate) and the other from metropolitan France (temperate climate). Chi-square and Student's t tests were used for comparisons. After grouping the two cohorts, we also performed multiple correspondence analysis and hierarchical clustering to search for distinct clinical phenotypes. The Réunion and Metropolitan France cohorts comprised 128 and 160 patients respectively. Compared with the Réunion cohort, the metropolitan cohort had a higher mean age (42.5±14.1 vs. 51.4±16.5 years, p<0.001). Severity scores, length of stay and mortality did not differ between the two cohorts. Three phenotypes were identified: hepato-renal leptospirosis (54.5%) characterized by significant hepatic, renal and coagulation failure, with a mortality of 8.3%; moderately severe leptospirosis (38.5%) with less severe organ failure and the lowest mortality rate (1.8%); and very severe leptospirosis (7%) manifested by neurological, respiratory and cardiovascular failure, with a mortality of 30%. CONCLUSIONS/SIGNIFICANCE: The outcomes of severe leptospirosis requiring ICU admission did not differ between tropical and temperate regions with similar healthcare access, practices, and resources, despite some differences in patient characteristics. The identification of three different clinical phenotypes may assist in the early diagnosis and management of severe leptospirosis.

Intraspecific Variation in Mercury, δ15 N, and δ13 C Among 3 Adélie Penguin (Pygoscelis adeliae) Populations in the Northern Antarctic Peninsula Region.

Mercury (Hg) is a pervasive environmental contaminant that accumulates in the organs and tissues of seabirds at concentrations capable of causing acute or long-term adverse health effects. In the present study, Hg concentrations in Adélie penguin (Pygoscelis adeliae) egg membranes and chick feathers served as a proxy for Hg bioavailability in the marine environment surrounding the northern Antarctic Peninsula. Stable isotopes were measured in conjunction with Hg to infer information regarding feeding habits (δ15 N, diet/trophic level; δ13 C, foraging habitat). The Hg concentrations were low relative to toxicity benchmark values associated with adverse health effects in birds and ranged between 0.006 and 0.080 µg g-1 dry weight (n = 65) in egg membranes and 0.140 to 1.05 µg g-1 fresh weight (n = 38) in feathers. Egg membrane δ15 N signatures suggested that females from different breeding colonies had similar diets consisting of lower and higher trophic prey prior to arrival to breeding grounds. In contrast, δ15 N signatures in feathers indicated that chick diet varied by colony. The Hg concentrations demonstrated significant positive relationships with δ15 N, providing support for the hypothesis of Hg biomagnification up the food chain. The δ13 C signatures in both tissue types provided evidence of foraging habitat segregation among populations. The differences in Hg exposure and foraging ecology suggest that each colony has localized foraging behaviors by breeding adults that warrant additional investigation. Environ Toxicol Chem 2021;40:2791-2801. © 2021 SETAC.