Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Wallner, C.
Evaluation of risk factors for autochthonous Leptosirosis in Austria
[ Diplomarbeit ] Medical University of Graz; 2013. pp. 79
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Hönigl Martin
- Krause Robert
- Altmetrics:
- Abstract:
- Background: In contrast to Germany and other European countries autochthonous leptospirosis occurs frequently in Austria. In particular high rates are found in south-east Austria, the reasons for that as well as associated risk factors, however, have not been identified yet. The present clinical study analysed patients with leptospirosis regarding origin of infection (autochthonous versus imported) common risk factors for acquiring the infection, clinical symptoms and Leptospira spp.. Methods: We retrospectively analysed risk factors for leptospirosis in South-East Austria. Adult patients (age ¿18 years) that had been tested positive for leptospirosis (serology: IgM) within a 9-years period (2004-2012) were included. Data concerning clinical course of disease as well as recreational or residential risk factors (up to 3 weeks before onset of infection) were collected via telephone questionnaires and/or electronic patient databases. Results: 128 patients (79 male, 49 female, median age 42.7 years) were included. 120/128 (93.75%) of patients had acquired leptospirosis within Austria and 8 (6.25%) had possible imported infections (5 Asia, 1 South America, 2 Africa). Symptoms reported most frequently included fever 83/128 (64.8%), myalgia/arthralgia (35.2%), abdominal pain/diarrhoea (32%), general weakness (28.1%), jaundice (24.2%), headache (21.7%), nausea/ vomiting (20.3%) and acute kidney injury (11.7%). Lab results at admission showed thrombocytopenia in 20.3% of cases, 13.3% had leukopenia and 21.9% leucocytosis. Elevated serum creatinine (39.1% of cases) and liver transaminases (>2 times normal value; 42.2%) were frequent. L. Bratislava (30.5%), L. Sejroe (23.7%), L. Ballum (22%) L. Australis (16.9%) and L. Grippotyphosa (13.6%) were the most frequently identified serotypes. Risk factors were evaluated in cases that completed the telephone questionnaire (n=82, 4 possibly imported cases). Concerning recreational risk factors activities in woods/wet areas were reported by 58.5%, followed by gardening/ hunting (46.3%), tidying up basement/ attic/ hut (28%), and swim/snorkel/dive (17.1%). Rodents in surroundings (73.2%) was the most important residential risk factor, followed by contact to pets (61%), farm/farm animals (28%) and eating fruit/vegetable grown in own garden (24.4%). Because of the relatively high number of infections in females we tried to figure out differences in risk factors and clinical presentation. Infected females were more likely to have eaten food from own garden/farmer/farmers market or have worked in a garden. On the contrary activities in woods/wet area and farm/contact to farm animals were risk factors more often present in males. With regard to lab results we detected differences in elevation of alanine transaminase (female 46.9%; male 39.2%) and serum creatinine (male 45.6%, female 28.6%). Male patients were more likely to present with gastrointestinal symptoms, while a higher percentage of females complained about prostration. Conclusion: Autochthonous infections represent the vast majority of leptospirosis cases in South-East Austria. Because of its rarity and broad clinical spectrum the burden of leptospirosis is certainly an underestimated disease in Austria. The main risk factors for acquiring leptospirosis were activities in woods and wet areas as well as contacts to pets and rodents living in the surroundings.