The management and clinical course of patients admitted to the intensive care unit with leptospirosis in a referral hospital in Far North Queensland, Tropical Australia

BACKGROUND: The case-fatality rate of patients with leptospirosis requiring intensive care unit (ICU) admission in resource-limited settings can exceed 50%. However, the optimal care of critically ill patients with this life-threatening infection is incompletely defined. METHODS: This retrospective study examined the demographic, clinical, laboratory and imaging findings in consecutive individuals with a laboratory-confirmed diagnosis of leptospirosis admitted to the ICU of an Australian referral hospital between May 2015 and April 2025. The care provided to the patients was correlated with their clinical course. RESULTS: The median (interquartile range, IQR) of the 60 individuals was 43 (26-65) years; 49/60 (82%) had no pre-existing comorbidity. The patients' median (IQR) APACHE-III score was 63 (46-89). Multi-organ dysfunction was common: 48/60 (80%) needed vasopressor support, a lung protective ventilation strategy was employed in the 16/60 (27%) requiring mechanical ventilation and renal replacement therapy was initiated in 12/60 (20%) using standard indications. Two patients received extracorporeal membrane oxygenation. While awaiting a diagnosis of leptospirosis, patients were managed using contemporary principles of sepsis care: all 60 patients received antibiotics, fluid resuscitation was conservative and transfusion of blood products was restrictive. Corticosteroids were provided to 23/60 (38%), but this was usually short course hydrocortisone therapy for blood pressure support. All 60 patients survived to discharge and were alive 90 days later. CONCLUSIONS: Leptospirosis can cause life-threatening multi-organ failure in young people without comorbidity. However, in Australia's well-resourced health system, excellent outcomes can be achieved using standard principles of sepsis management before the diagnosis is confirmed.