A rare case of severe leptospirosis infection presenting as septic shock in a non-endemic area: a case report and literature review.

BACKGROUND: Leptospirosis is a zoonosis caused by spirochete "genus" leptospira. The clinical presentations of leptospirosis range from an influenza-like presentation of fever and myalgia, to severe forms. Leptospirosis can potentially lead to a misdiagnosis or delay in diagnosis when clinical similarities exist. CASE PRESENTATION: A 63-year-old man presented with fever, shock and thrombocytopenia followed by diffuse pulmonary hemorrhage. Peripheral blood Metagenomic Next-generation Sequencing (mNGS) reported Leptospira interrogans. The patient was treated with piperacillin-tazobactam (TZP) plus doxycycline and improved dramatically after 7 days. CONCLUSION: We conclude that leptospirosis can potentially lead to a misdiagnosis or delay in diagnosis. Correctly evaluation of thrombocytopenia in acute febrile illnesses facilitates the differential diagnosis of leptospirosis. mNGS can accurately detect Leptospira DNA during the early stage of the infection.

Evaluation of qSOFA combined with inflammatory mediators for diagnosing sepsis and predicting mortality among emergency department.

BACKGROUND: There are no guidelines in China or worldwide that clearly recommend indicators for the early diagnosis of sepsis in the emergency department. Simple and unified joint diagnostic criteria are also scarce. We compare the Quick Sequential Organ Failure Assessment (qSOFA) score and inflammatory mediator concentrations in patients with normal infection, sepsis, and sepsis death. METHODS: This study used a prospective and consecutive manner, including 79 patients with sepsis in the Emergency Department of Shenzhen People's Hospital from December 2020 to June 2021, and 79 patients with common infections (non-sepsis) matched by age and sex during the same period. The sepsis patients were then divided into a sepsis survival group (n = 67) and a sepsis death group (n = 12) based on whether they survived within 28 days. The baseline characteristics, qSOFA scores, the concentrations of tumor necrosis factor-α(TNF-α), interleukin (IL)-6, IL-1b, IL-8, IL-10, procalcitonin (PCT), high-sensitivity C-reactive protein (HSCRP) and other indicators were collected in all subjects. RESULTS: PCT and qSOFA were independent risk factors for predicting sepsis in the emergency department. The AUC value of PCT was the largest (0.819) among all diagnostic indicators of sepsis, with a cut-off value of 0.775 ng/ml and sensitivity and specificity of 0.785 and 0.709, respectively. The AUC of qSOFA combined PCT was the largest (0.842) in the combination of the 2 indicators, and the sensitivity and specificity were 0.722 and 0.848, respectively. IL-6 was an independent risk factor for predicting death within 28 days. IL-8 had the largest AUC value (0.826) among all indicators predicting sepsis death, with a cut-off value of 215 pg/ml and sensitivity and specificity of 0.667 and 0.895, respectively. Among the combination of two indicators, qSOFA combined with IL-8 had the largest AUC value (0.782) and sensitivity and specificity of 0.833 and 0.612, respectively. CONCLUSIONS: QSOFA and PCT are independent risk factors for sepsis, and qSOFA combined with PCT may be an ideal combination for early diagnosis of sepsis in the emergency department. IL-6 is an independent risk factor for death within 28 days of sepsis, and qSOFA combined with IL-8 may be an ideal combination for early prediction of death within 28 days in sepsis patients in the emergency department.