Materiały źródłowe

• #1 Leptospirosis | Nature Reviews Disease Primers

  https://www.nature.com/articles/s41572-025-00614-5

  Leptospirosis is a zoonotic bacterial infection that is prevalent across all continents and is caused by pathogenic spirochaetes of the genus Leptospira. Although infection can be asymptomatic, symptomatic disease can vary in severity from mild to severe illness, the latter characterized by icterus and/or multi-organ dysfunction and potentially death. An estimated one million cases of leptospirosis occur globally each year, resulting in ~60,000 deaths. […] The pathogenesis of severe leptospirosis is poorly understood but is believed to involve an interplay between genetic predisposition, pathogen virulence and dysregulated immune responses that trigger a cytokine storm with associated immunoparesis. […] Future research is needed to accurately estimate leptospirosis disease burden across the globe, to understand the pathophysiology of severe leptospirosis to inform the design of targeted immunotherapies and vaccines, and to develop cost-effective and accurate point-of-care diagnostics.

• #2 Weil’s Disease—Immunopathogenesis, Multiple Organ Failure, and Potential Role of Gut Microbiota

  https://www.mdpi.com/2218-273X/12/12/1830

  Leptospirosis is an important zoonotic disease, causing about 60,000 deaths annually. […] Weil’s syndrome (10% of cases), is a severe form of leptospirosis with a high mortality rate; it is characterized by hepatic dysfunctions associated with renal failure and hemorrhages. […] Severe leptospirosis patients should receive early recognition and intensive medical care. […] The clinical hallmarks of severe leptospirosis can resemble septic shock, with multi-organ failure, hypotension, and death, which suggest that the development of severe leptospirosis could be associated with dysregulated inflammation. […] High levels of chemokines are found in susceptible hamsters, and are associated with organ damage and poor outcome. […] Notably, patients with severe clinical signs had higher levels of CXCL8/IL-8 expression, and these patients had a higher mortality rate.

• #3 Prognosis of Leptospirosis | Hospital Clínic Barcelona

  https://www.clinicbarcelona.org/en/assistance/diseases/leptospirosis/progression-of-the-disease

  The prognosis tends to be good, although some patients may require hospitalisation and may also have autoinflammatory complications in the mid- to long-term. […] In patients with a severe case of the disease (Weils disease) or complications, mortality is around 40%. […] Early treatment of the infection prevents a poor prognosis.

• #4 Leptospirosis (Weil’s Disease) | Doctor

  https://patient.info/doctor/leptospirosis-weils-disease

  Prognosis: The vast majority of leptospiral infections are self-limiting. However, Weil’s disease has a mortality rate of up to 22% in developing countries and around 5% in the UK. Important causes of death include acute kidney injury, cardiopulmonary failure and widespread haemorrhage. One to three people in England and Wales die every year from leptospirosis. […] Leptospirosis is usually self-limiting. Most cases recover fully within two to six weeks but some may take up to three months. […] Death is often caused by gastrointestinal and pulmonary haemorrhage, acute kidney injury and adult respiratory distress syndrome. […] Factors associated with poor prognosis include altered mental status, oliguria, acute kidney injury, respiratory involvement, hypotension and arrhythmia. […] Severe pulmonary haemorrhage syndrome due to extensive alveolar haemorrhage has a fatality rate of over 50%. […] Infection in pregnant women may be grave leading to severe fetal and maternal morbidity and mortality. […] Mortality increases with age. […] After infection, immunity develops against the infecting strain, but this may not fully protect against infection with unrelated strains.

• #5 Leptospirosis – Wikipedia

  https://en.wikipedia.org/wiki/Leptospirosis

  The overall risk of death for leptospirosis is 510%. For those with jaundice, the case fatality can increase up to 15%. For those infected who present with confusion and neurological signs, there is a high risk of death. Other factors that increase the risk of death include reduced urine output, age more than 36 years, and respiratory failure. With proper care, most of those infected will recover completely. Those with acute kidney failure may develop persistent mild kidney impairment after they recover. In those with severe lung involvement, the risk of death is 5070%. […] Thirty percent of people with acute leptospirosis complained of long-lasting symptoms characterised by weakness, muscle pain, and headaches.

• #6 Leptospirosis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/220563-overview

  The mild form of leptospirosis rarely is fatal, and an estimated 90% of cases fall into this category. The mortality rate in severe leptospirosis averages approximately 10%, but has been described as ranging from 5-40%. Elderly and immunocompromised people are at the highest risk for mortality overall. Most deaths occur from renal failure, massive hemorrhage, or acute respiratory distress syndrome (ARDS). […] The incidence of pulmonary involvement has increased over the past few years, affecting up to 70% patients. Pulmonary involvement has emerged as a serious cause of mortality, becoming the main cause of leptospirosis-associated death in some countries. […] Leptospirosis occurring during pregnancy is ominous. In a review of 16 cases, spontaneous abortion was likely during the first 2 trimesters. When disease occurred in the third trimester, a third of pregnancies ended in abortion or perinatal death.

• #7 Leptospirosis (Weil’s Disease) | Doctor

  https://patient.info/doctor/leptospirosis-weils-disease

  Prognosis: The vast majority of leptospiral infections are self-limiting. However, Weil’s disease has a mortality rate of up to 22% in developing countries and around 5% in the UK. Important causes of death include acute kidney injury, cardiopulmonary failure and widespread haemorrhage. One to three people in England and Wales die every year from leptospirosis. […] Leptospirosis is usually self-limiting. Most cases recover fully within two to six weeks but some may take up to three months. […] Death is often caused by gastrointestinal and pulmonary haemorrhage, acute kidney injury and adult respiratory distress syndrome. […] Factors associated with poor prognosis include altered mental status, oliguria, acute kidney injury, respiratory involvement, hypotension and arrhythmia. […] Severe pulmonary haemorrhage syndrome due to extensive alveolar haemorrhage has a fatality rate of over 50%. […] Infection in pregnant women may be grave leading to severe fetal and maternal morbidity and mortality. […] Mortality increases with age. […] After infection, immunity develops against the infecting strain, but this may not fully protect against infection with unrelated strains.

• #8 Leptospirosis – Wikipedia

  https://en.wikipedia.org/wiki/Leptospirosis

  The overall risk of death for leptospirosis is 510%. For those with jaundice, the case fatality can increase up to 15%. For those infected who present with confusion and neurological signs, there is a high risk of death. Other factors that increase the risk of death include reduced urine output, age more than 36 years, and respiratory failure. With proper care, most of those infected will recover completely. Those with acute kidney failure may develop persistent mild kidney impairment after they recover. In those with severe lung involvement, the risk of death is 5070%. […] Thirty percent of people with acute leptospirosis complained of long-lasting symptoms characterised by weakness, muscle pain, and headaches.

• #9 A Systematic Review of the Mortality from Untreated Leptospirosis | PLOS Neglected Tropical Diseases

  https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0003866

  Leptospirosis occurs worldwide, but the global incidence of human disease and its mortality are not well understood. […] This systematic review contributes to our understanding of the mortality of untreated leptospirosis and provides data for the estimation of DALYs attributable to this disease. We show that mortality is significantly higher in older patients with icteric disease or renal failure but is lower in younger, anicteric patients. […] Mortality data was available for all (41/41) patient series, for a total of 3,390 patients. Median series mortality was 2.2% (range 0-39.7%) with a total of 314/3,390 deaths, and a wide variation in mortality across series. […] Mortality was associated with host factors; the median series mortality in series including jaundiced patients approached 20% and in those with a high incidence of renal failure was over 12%.

• #10 A Systematic Review of the Mortality from Untreated Leptospirosis | PLOS Neglected Tropical Diseases

  https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0003866

  Mortality increased with age and was highest in those aged over 60 (60.0% (33.3-60)) but was negligible in children under 15 years of age at 0% (0-25%). […] This review clarifies the untreated mortality from leptospirosis and shows that despite wide variation, it is of high significance in elderly, jaundiced patients and/or those with renal failure, but much lower in younger, anicteric patients.

• #11 Leptospirosis (Weil’s Disease) | Doctor

  https://patient.info/doctor/leptospirosis-weils-disease

  Prognosis: The vast majority of leptospiral infections are self-limiting. However, Weil’s disease has a mortality rate of up to 22% in developing countries and around 5% in the UK. Important causes of death include acute kidney injury, cardiopulmonary failure and widespread haemorrhage. One to three people in England and Wales die every year from leptospirosis. […] Leptospirosis is usually self-limiting. Most cases recover fully within two to six weeks but some may take up to three months. […] Death is often caused by gastrointestinal and pulmonary haemorrhage, acute kidney injury and adult respiratory distress syndrome. […] Factors associated with poor prognosis include altered mental status, oliguria, acute kidney injury, respiratory involvement, hypotension and arrhythmia. […] Severe pulmonary haemorrhage syndrome due to extensive alveolar haemorrhage has a fatality rate of over 50%. […] Infection in pregnant women may be grave leading to severe fetal and maternal morbidity and mortality. […] Mortality increases with age. […] After infection, immunity develops against the infecting strain, but this may not fully protect against infection with unrelated strains.

• #12 Predictors of severe leptospirosis: a multicentre observational study from Central Malaysia | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-021-06766-5

  Leptospirosis is a re-emerging disease with vast clinical presentations, that ranges from subclinical or mild to severe and fatal outcomes. […] Identification of clinical predictors for the severe form of the disease plays a crucial role in reducing disease complication and mortality. […] Among the 83 patients, 50 showed mild disease and 33 developed severe illness. […] We identified mechanical ventilation, acute kidney injury, septic shock, creatinine level of 1.13 mg/dL, urea 7 mmol/L, alanine aminotransferase 50 IU, aspartate aminotransferase 50 IU, and platelet 150109/L as factors associated with severe illness. […] Acute kidney injury, high level of alanine aminotransferase and low level of platelets were found to be independent predictors of severity. […] Lungs, liver and kidney involvement and septic shock were found as the prognostic factors for severe leptospirosis.

• #13 Predictors of severe leptospirosis: a multicentre observational study from Central Malaysia | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-021-06766-5

  The two extreme manifestations of leptospirosis which are mild/subclinical and severe illness with mortality caution that the disease should not be taken lightly, and constant monitoring of patients is essential. […] Several independent prognostic factors for fatal leptospirosis have been reported across the globe and these include older age, oliguria, hyperkalaemia, abnormal serum creatinine level, ARDS, pulmonary haemorrhage, elevated bilirubin level, hypotension, arrhythmia and altered mental status. […] We identified mechanical ventilation, AKI, septic shock, creatinine level of 1.13 mg/dL, urea 7 mmol/L, ALT 50 IU, AST 50 IU, and platelet 150109/L are associated with severe illness. […] AKI, high level of ALT and low level of platelet were defined as the independent factors for severity.

• #14 Prognostic Factors for Leptospirosis Infection Severity

  https://www.mdpi.com/2414-6366/8/2/112

  Prognostic Factors for Leptospirosis Infection Severity […] Background: Leptospirosis is an important health problem in Thailand. People infected with leptospirosis may not have any mild symptoms, whereas some people have acute and severe illnesses. It is crucial to strengthen critical patients’ diagnosis and treatment to prevent severe complications and reduce mortality. This study was performed to explore a set of parameters for the prediction of severe leptospirosis illness under routine clinical practice. […] The prognosis of leptospirosis depends on the severity, early diagnosis, and prompt intensive treatment. If not treated, the patient could develop kidney failure, meningitis, liver damage, and respiratory distress. In some cases, death occurs. […] The results of this study showed that severe leptospirosis infections have identifiable predictors. The predictors may be used to develop a scoring system for predicting the level of severity. […] The six significant predictors identified in the study were hemoptysis (OR = 25.80, 95% CI 5.69, 116.92), hypotension (blood pressure < 90/60 mmHg) (OR = 17.33, 95% CI 6.89, 43.58), platelet count < 100,000/μL (OR = 8.37, 95% CI 4.65, 15.09), white blood cell count (WBC) > 14,000/μL (OR = 5.12, 95% CI 2.75, 9.51), hematocrit ≤ 30% (OR = 3.49, 95% CI 1.61, 7.57), and jaundice (OR = 3.11, 95% CI 1.71, 5.65). These predictors could correctly predict the severity of leptospirosis infection in 91.31% of the area under the receiver operation curve (AuROC). […] The severity of leptospirosis infection is significantly associated with some routine clinical parameters. Hemoptysis, jaundice, hypotension (blood pressure < 90/60 mmHg), platelet count < 100,000/μL, white blood cell (WBC) count > 14,000/μL, and hematocrit ≤ 30% are the predictors that increase severe dengue infection. They may guide clinicians to pay some attention to leptospirosis patients with these risks. In the future implications, these predictors may be used to develop a scoring system for predicting the level of severity and managing leptospirosis infection severity early in the course of the illness.

• #15 Prognostic Factors for Leptospirosis Infection Severity

  https://www.mdpi.com/2414-6366/8/2/112

  Prognostic Factors for Leptospirosis Infection Severity […] Background: Leptospirosis is an important health problem in Thailand. People infected with leptospirosis may not have any mild symptoms, whereas some people have acute and severe illnesses. It is crucial to strengthen critical patients’ diagnosis and treatment to prevent severe complications and reduce mortality. This study was performed to explore a set of parameters for the prediction of severe leptospirosis illness under routine clinical practice. […] The prognosis of leptospirosis depends on the severity, early diagnosis, and prompt intensive treatment. If not treated, the patient could develop kidney failure, meningitis, liver damage, and respiratory distress. In some cases, death occurs. […] The results of this study showed that severe leptospirosis infections have identifiable predictors. The predictors may be used to develop a scoring system for predicting the level of severity. […] The six significant predictors identified in the study were hemoptysis (OR = 25.80, 95% CI 5.69, 116.92), hypotension (blood pressure < 90/60 mmHg) (OR = 17.33, 95% CI 6.89, 43.58), platelet count < 100,000/μL (OR = 8.37, 95% CI 4.65, 15.09), white blood cell count (WBC) > 14,000/μL (OR = 5.12, 95% CI 2.75, 9.51), hematocrit ≤ 30% (OR = 3.49, 95% CI 1.61, 7.57), and jaundice (OR = 3.11, 95% CI 1.71, 5.65). These predictors could correctly predict the severity of leptospirosis infection in 91.31% of the area under the receiver operation curve (AuROC). […] The severity of leptospirosis infection is significantly associated with some routine clinical parameters. Hemoptysis, jaundice, hypotension (blood pressure < 90/60 mmHg), platelet count < 100,000/μL, white blood cell (WBC) count > 14,000/μL, and hematocrit ≤ 30% are the predictors that increase severe dengue infection. They may guide clinicians to pay some attention to leptospirosis patients with these risks. In the future implications, these predictors may be used to develop a scoring system for predicting the level of severity and managing leptospirosis infection severity early in the course of the illness.

• #16 Predictors of severe leptospirosis: a multicentre observational study from Central Malaysia | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-021-06766-5

  The two extreme manifestations of leptospirosis which are mild/subclinical and severe illness with mortality caution that the disease should not be taken lightly, and constant monitoring of patients is essential. […] Several independent prognostic factors for fatal leptospirosis have been reported across the globe and these include older age, oliguria, hyperkalaemia, abnormal serum creatinine level, ARDS, pulmonary haemorrhage, elevated bilirubin level, hypotension, arrhythmia and altered mental status. […] We identified mechanical ventilation, AKI, septic shock, creatinine level of 1.13 mg/dL, urea 7 mmol/L, ALT 50 IU, AST 50 IU, and platelet 150109/L are associated with severe illness. […] AKI, high level of ALT and low level of platelet were defined as the independent factors for severity.

• #17 A simple score to predict severe leptospirosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6391019/

  The case-fatality rate of severe leptospirosis can exceed 50%. While prompt supportive care can improve survival, predicting those at risk of developing severe disease is challenging, particularly in settings with limited diagnostic support. […] A simple, three-point clinical score can help clinicians rapidly identify patients at risk of developing severe leptospirosis, prompting early transfer to referral centres for advanced supportive care. […] In adults with leptospirosis, a simple three-point clinical score—the SPiRO score—appears to reliably identify patients at risk of severe disease. […] The likelihood of severe disease rose incrementally as the score increased, facilitating recognition of the high-risk patient, expediting the initiation of supportive treatment and prompting consideration of transfer to referral centres. […] The SPiRO score therefore has potential global utility.

• #18 Prognosis of Leptospirosis | Hospital Clínic Barcelona

  https://www.clinicbarcelona.org/en/assistance/diseases/leptospirosis/progression-of-the-disease

  The prognosis tends to be good, although some patients may require hospitalisation and may also have autoinflammatory complications in the mid- to long-term. […] In patients with a severe case of the disease (Weils disease) or complications, mortality is around 40%. […] Early treatment of the infection prevents a poor prognosis.

• #19 Leptospirosis | Nature Reviews Disease Primers

  https://www.nature.com/articles/s41572-025-00614-5

  Developing a clinically relevant classification to predict mortality in severe leptospirosis. […] A scoring tool to predict pulmonary complications in severe leptospirosis with kidney failure. […] Prognostic factors for leptospirosis infection severity. […] Clinical characteristics, outcomes, and predictors of leptospirosis in patients admitted to the medical intensive care unit: a retrospective analysis. […] Long-term outcome of leptospirosis infection with acute kidney injury. […] Long-term kidney outcomes after leptospirosis: a prospective multicentre cohort study in Thailand. […] Leptospirosis: a potential culprit for chronic kidney disease of uncertain etiology. […] Leptospirosis as a risk factor for chronic kidney disease: a systematic review of observational studies. […] Understanding the renal fibrotic process in leptospirosis.

• #20 Leptospirosis | Nature Reviews Disease Primers

  https://www.nature.com/articles/s41572-025-00614-5

  The long term efficacy of a hardjo-pomona vaccine in preventing leptospiruria in cattle exposed to natural challenge with Leptospira interrogans serovar hardjo. […] Evaluation of penicillin therapy in patients with leptospirosis and acute renal failure. […] Penicillin therapy in icteric leptospirosis. […] Doxycycline therapy for leptospirosis. […] A simple score to predict severe leptospirosis. […] Development and validation of a simple machine learning tool to predict mortality in leptospirosis. […] Early identification of leptospirosis-associated pulmonary hemorrhage syndrome by use of a validated prediction model.

• #21 Leptospirosis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/220563-overview

  The mild form of leptospirosis rarely is fatal, and an estimated 90% of cases fall into this category. The mortality rate in severe leptospirosis averages approximately 10%, but has been described as ranging from 5-40%. Elderly and immunocompromised people are at the highest risk for mortality overall. Most deaths occur from renal failure, massive hemorrhage, or acute respiratory distress syndrome (ARDS). […] The incidence of pulmonary involvement has increased over the past few years, affecting up to 70% patients. Pulmonary involvement has emerged as a serious cause of mortality, becoming the main cause of leptospirosis-associated death in some countries. […] Leptospirosis occurring during pregnancy is ominous. In a review of 16 cases, spontaneous abortion was likely during the first 2 trimesters. When disease occurred in the third trimester, a third of pregnancies ended in abortion or perinatal death.

• #22 Weil’s Disease—Immunopathogenesis, Multiple Organ Failure, and Potential Role of Gut Microbiota

  https://www.mdpi.com/2218-273X/12/12/1830

  In leptospirosis patients, increasing serum levels of PTX-3 were associated with mortality and disease severity. […] The presence of jaundice implies a poor prognosis with a mortality rate of 19.1%. […] Acute kidney injury (AKI) following leptospirosis can arise due to acute tubular necrosis (ATN) from ischemia and poor perfusion of renal tissue as the result of sepsis and septic shock. […] The main cause of death in patients with leptospirosis is LPHS. The LPHS-related fatality rates are greater than 50%. […] The pathogenic leptospires invade the intercellular junctions of host hepatocytes, and this invasion contributes to the disruption of the junction. […] The mechanism of jaundice proposed by Miyhara et al. is supported by the electron microscopy finding for leptospires and/or their remnants in the intercellular spaces of hepatocytes in humans, particularly in guinea pigs experimental disease.

• #23 Leptospirosis – Wikipedia

  https://en.wikipedia.org/wiki/Leptospirosis

  The overall risk of death for leptospirosis is 510%. For those with jaundice, the case fatality can increase up to 15%. For those infected who present with confusion and neurological signs, there is a high risk of death. Other factors that increase the risk of death include reduced urine output, age more than 36 years, and respiratory failure. With proper care, most of those infected will recover completely. Those with acute kidney failure may develop persistent mild kidney impairment after they recover. In those with severe lung involvement, the risk of death is 5070%. […] Thirty percent of people with acute leptospirosis complained of long-lasting symptoms characterised by weakness, muscle pain, and headaches.

• #24 Leptospirosis manifested with severe pulmonary haemorrhagic syndrome successfully treated with venovenous extracorporeal membrane oxygenation | BMJ Case Reports

  https://casereports.bmj.com/content/13/1/e230075

  Leptospirosis-associated pulmonary haemorrhage syndrome is a severe condition with high mortality. Early and intensive management plays a significant role in treatment outcome. […] Finally, ECMO therapy should be considered early as an adjunctive therapy in patients with severe respiratory failure that is difficult in maintaining adequate oxygenation by conventional mechanical ventilation; because respiratory distress is the most common cause of death in these severe cases of leptospirosis. VV-ECMO was used as adjunct therapy for severe ARDS in leptospirosis. […] In conclusion, we successfully treated a patient with leptospirosis-associated SPHS by using VV-ECMO. Our case emphasises that the survival of leptospiral patients with SPHS could be improved by optimal support, including VV-ECMO. A high index of suspicion is required for an early and accurate diagnosis of leptospirosis to guide appropriate treatment, especially in severe respiratory failure.

• #25 Predictors of severe leptospirosis: a multicentre observational study from Central Malaysia | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-021-06766-5

  Leptospirosis is a re-emerging disease with vast clinical presentations, that ranges from subclinical or mild to severe and fatal outcomes. […] Identification of clinical predictors for the severe form of the disease plays a crucial role in reducing disease complication and mortality. […] Among the 83 patients, 50 showed mild disease and 33 developed severe illness. […] We identified mechanical ventilation, acute kidney injury, septic shock, creatinine level of 1.13 mg/dL, urea 7 mmol/L, alanine aminotransferase 50 IU, aspartate aminotransferase 50 IU, and platelet 150109/L as factors associated with severe illness. […] Acute kidney injury, high level of alanine aminotransferase and low level of platelets were found to be independent predictors of severity. […] Lungs, liver and kidney involvement and septic shock were found as the prognostic factors for severe leptospirosis.

• #26 Weil’s Disease—Immunopathogenesis, Multiple Organ Failure, and Potential Role of Gut Microbiota

  https://www.mdpi.com/2218-273X/12/12/1830

  In leptospirosis patients, increasing serum levels of PTX-3 were associated with mortality and disease severity. […] The presence of jaundice implies a poor prognosis with a mortality rate of 19.1%. […] Acute kidney injury (AKI) following leptospirosis can arise due to acute tubular necrosis (ATN) from ischemia and poor perfusion of renal tissue as the result of sepsis and septic shock. […] The main cause of death in patients with leptospirosis is LPHS. The LPHS-related fatality rates are greater than 50%. […] The pathogenic leptospires invade the intercellular junctions of host hepatocytes, and this invasion contributes to the disruption of the junction. […] The mechanism of jaundice proposed by Miyhara et al. is supported by the electron microscopy finding for leptospires and/or their remnants in the intercellular spaces of hepatocytes in humans, particularly in guinea pigs experimental disease.

• #27 Weil’s Disease—Immunopathogenesis, Multiple Organ Failure, and Potential Role of Gut Microbiota

  https://www.mdpi.com/2218-273X/12/12/1830

  In leptospirosis patients, increasing serum levels of PTX-3 were associated with mortality and disease severity. […] The presence of jaundice implies a poor prognosis with a mortality rate of 19.1%. […] Acute kidney injury (AKI) following leptospirosis can arise due to acute tubular necrosis (ATN) from ischemia and poor perfusion of renal tissue as the result of sepsis and septic shock. […] The main cause of death in patients with leptospirosis is LPHS. The LPHS-related fatality rates are greater than 50%. […] The pathogenic leptospires invade the intercellular junctions of host hepatocytes, and this invasion contributes to the disruption of the junction. […] The mechanism of jaundice proposed by Miyhara et al. is supported by the electron microscopy finding for leptospires and/or their remnants in the intercellular spaces of hepatocytes in humans, particularly in guinea pigs experimental disease.

• #28 Leptospirosis (Weil’s Disease) | Doctor

  https://patient.info/doctor/leptospirosis-weils-disease

  Prognosis: The vast majority of leptospiral infections are self-limiting. However, Weil’s disease has a mortality rate of up to 22% in developing countries and around 5% in the UK. Important causes of death include acute kidney injury, cardiopulmonary failure and widespread haemorrhage. One to three people in England and Wales die every year from leptospirosis. […] Leptospirosis is usually self-limiting. Most cases recover fully within two to six weeks but some may take up to three months. […] Death is often caused by gastrointestinal and pulmonary haemorrhage, acute kidney injury and adult respiratory distress syndrome. […] Factors associated with poor prognosis include altered mental status, oliguria, acute kidney injury, respiratory involvement, hypotension and arrhythmia. […] Severe pulmonary haemorrhage syndrome due to extensive alveolar haemorrhage has a fatality rate of over 50%. […] Infection in pregnant women may be grave leading to severe fetal and maternal morbidity and mortality. […] Mortality increases with age. […] After infection, immunity develops against the infecting strain, but this may not fully protect against infection with unrelated strains.

• #29 Leptospirosis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/220563-overview

  The mild form of leptospirosis rarely is fatal, and an estimated 90% of cases fall into this category. The mortality rate in severe leptospirosis averages approximately 10%, but has been described as ranging from 5-40%. Elderly and immunocompromised people are at the highest risk for mortality overall. Most deaths occur from renal failure, massive hemorrhage, or acute respiratory distress syndrome (ARDS). […] The incidence of pulmonary involvement has increased over the past few years, affecting up to 70% patients. Pulmonary involvement has emerged as a serious cause of mortality, becoming the main cause of leptospirosis-associated death in some countries. […] Leptospirosis occurring during pregnancy is ominous. In a review of 16 cases, spontaneous abortion was likely during the first 2 trimesters. When disease occurred in the third trimester, a third of pregnancies ended in abortion or perinatal death.

• #30 Leptospirosis (Weil’s Disease) | Doctor

  https://patient.info/doctor/leptospirosis-weils-disease

  Prognosis: The vast majority of leptospiral infections are self-limiting. However, Weil’s disease has a mortality rate of up to 22% in developing countries and around 5% in the UK. Important causes of death include acute kidney injury, cardiopulmonary failure and widespread haemorrhage. One to three people in England and Wales die every year from leptospirosis. […] Leptospirosis is usually self-limiting. Most cases recover fully within two to six weeks but some may take up to three months. […] Death is often caused by gastrointestinal and pulmonary haemorrhage, acute kidney injury and adult respiratory distress syndrome. […] Factors associated with poor prognosis include altered mental status, oliguria, acute kidney injury, respiratory involvement, hypotension and arrhythmia. […] Severe pulmonary haemorrhage syndrome due to extensive alveolar haemorrhage has a fatality rate of over 50%. […] Infection in pregnant women may be grave leading to severe fetal and maternal morbidity and mortality. […] Mortality increases with age. […] After infection, immunity develops against the infecting strain, but this may not fully protect against infection with unrelated strains.

• #31 Leptospirosis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/220563-overview

  In general, survivors of leptospirosis experience little long-term morbidity, regardless of disease severity. Hepatic and renal functions return to normal, despite severe dysfunction during acute illness, even among patients who required dialysis. […] Approximately a third of patients with documented aseptic meningitis may continue to complain of periodic headaches of varying severities. Patients who have had leptospiral uveitis may experience persistent visual acuity loss (caused by lens pigmentation following anterior uveitis) and blurry vision (associated with keratic precipitates in the anterior chamber).

• #32 Leptospirosis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/220563-overview

  In general, survivors of leptospirosis experience little long-term morbidity, regardless of disease severity. Hepatic and renal functions return to normal, despite severe dysfunction during acute illness, even among patients who required dialysis. […] Approximately a third of patients with documented aseptic meningitis may continue to complain of periodic headaches of varying severities. Patients who have had leptospiral uveitis may experience persistent visual acuity loss (caused by lens pigmentation following anterior uveitis) and blurry vision (associated with keratic precipitates in the anterior chamber).

• #33 Leptospirosis – Wikipedia

  https://en.wikipedia.org/wiki/Leptospirosis

  The overall risk of death for leptospirosis is 510%. For those with jaundice, the case fatality can increase up to 15%. For those infected who present with confusion and neurological signs, there is a high risk of death. Other factors that increase the risk of death include reduced urine output, age more than 36 years, and respiratory failure. With proper care, most of those infected will recover completely. Those with acute kidney failure may develop persistent mild kidney impairment after they recover. In those with severe lung involvement, the risk of death is 5070%. […] Thirty percent of people with acute leptospirosis complained of long-lasting symptoms characterised by weakness, muscle pain, and headaches.

• #34 Leptospirosis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/220563-overview

  The mild form of leptospirosis rarely is fatal, and an estimated 90% of cases fall into this category. The mortality rate in severe leptospirosis averages approximately 10%, but has been described as ranging from 5-40%. Elderly and immunocompromised people are at the highest risk for mortality overall. Most deaths occur from renal failure, massive hemorrhage, or acute respiratory distress syndrome (ARDS). […] The incidence of pulmonary involvement has increased over the past few years, affecting up to 70% patients. Pulmonary involvement has emerged as a serious cause of mortality, becoming the main cause of leptospirosis-associated death in some countries. […] Leptospirosis occurring during pregnancy is ominous. In a review of 16 cases, spontaneous abortion was likely during the first 2 trimesters. When disease occurred in the third trimester, a third of pregnancies ended in abortion or perinatal death.

• #35 Leptospirosis: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/24021-leptospirosis

  Most cases of leptospirosis are mild and don’t need treatment. Your healthcare provider will still keep a close eye on your symptoms. […] If your symptoms worsen or you have new symptoms, don’t hesitate to contact your provider. Go to the ER if you have any symptoms of Weils syndrome. […] Only about 1% of people with leptospirosis get severely ill with Weils syndrome. Weils syndrome is often deadly if not treated or if you delay treatment. But if treated promptly, it’s very likely you’ll recover.

• #36 Weil’s Disease—Immunopathogenesis, Multiple Organ Failure, and Potential Role of Gut Microbiota

  https://www.mdpi.com/2218-273X/12/12/1830

  Leptospirosis is an important zoonotic disease, causing about 60,000 deaths annually. […] Weil’s syndrome (10% of cases), is a severe form of leptospirosis with a high mortality rate; it is characterized by hepatic dysfunctions associated with renal failure and hemorrhages. […] Severe leptospirosis patients should receive early recognition and intensive medical care. […] The clinical hallmarks of severe leptospirosis can resemble septic shock, with multi-organ failure, hypotension, and death, which suggest that the development of severe leptospirosis could be associated with dysregulated inflammation. […] High levels of chemokines are found in susceptible hamsters, and are associated with organ damage and poor outcome. […] Notably, patients with severe clinical signs had higher levels of CXCL8/IL-8 expression, and these patients had a higher mortality rate.

• #37 Leptospirosis | Nature Reviews Disease Primers

  https://www.nature.com/articles/s41572-025-00614-5

  Leptospirosis is a zoonotic bacterial infection that is prevalent across all continents and is caused by pathogenic spirochaetes of the genus Leptospira. Although infection can be asymptomatic, symptomatic disease can vary in severity from mild to severe illness, the latter characterized by icterus and/or multi-organ dysfunction and potentially death. An estimated one million cases of leptospirosis occur globally each year, resulting in ~60,000 deaths. […] The pathogenesis of severe leptospirosis is poorly understood but is believed to involve an interplay between genetic predisposition, pathogen virulence and dysregulated immune responses that trigger a cytokine storm with associated immunoparesis. […] Future research is needed to accurately estimate leptospirosis disease burden across the globe, to understand the pathophysiology of severe leptospirosis to inform the design of targeted immunotherapies and vaccines, and to develop cost-effective and accurate point-of-care diagnostics.

• #38 Weil’s Disease—Immunopathogenesis, Multiple Organ Failure, and Potential Role of Gut Microbiota

  https://www.mdpi.com/2218-273X/12/12/1830

  Leptospirosis is an important zoonotic disease, causing about 60,000 deaths annually. […] Weil’s syndrome (10% of cases), is a severe form of leptospirosis with a high mortality rate; it is characterized by hepatic dysfunctions associated with renal failure and hemorrhages. […] Severe leptospirosis patients should receive early recognition and intensive medical care. […] The clinical hallmarks of severe leptospirosis can resemble septic shock, with multi-organ failure, hypotension, and death, which suggest that the development of severe leptospirosis could be associated with dysregulated inflammation. […] High levels of chemokines are found in susceptible hamsters, and are associated with organ damage and poor outcome. […] Notably, patients with severe clinical signs had higher levels of CXCL8/IL-8 expression, and these patients had a higher mortality rate.

• #39 Weil’s Disease—Immunopathogenesis, Multiple Organ Failure, and Potential Role of Gut Microbiota

  https://www.mdpi.com/2218-273X/12/12/1830

  In leptospirosis patients, increasing serum levels of PTX-3 were associated with mortality and disease severity. […] The presence of jaundice implies a poor prognosis with a mortality rate of 19.1%. […] Acute kidney injury (AKI) following leptospirosis can arise due to acute tubular necrosis (ATN) from ischemia and poor perfusion of renal tissue as the result of sepsis and septic shock. […] The main cause of death in patients with leptospirosis is LPHS. The LPHS-related fatality rates are greater than 50%. […] The pathogenic leptospires invade the intercellular junctions of host hepatocytes, and this invasion contributes to the disruption of the junction. […] The mechanism of jaundice proposed by Miyhara et al. is supported by the electron microscopy finding for leptospires and/or their remnants in the intercellular spaces of hepatocytes in humans, particularly in guinea pigs experimental disease.

• #40 Weil’s Disease—Immunopathogenesis, Multiple Organ Failure, and Potential Role of Gut Microbiota

  https://www.mdpi.com/2218-273X/12/12/1830

  The gut microbiota can play a crucial role in directing immune responses outside the local environment, including the lungs, kidneys, and liver. […] Therefore, the cross-connection of the gut microbiota with many internal organs of the body plays an important role in the clinical course of many diseases, including leptospirosis.

• #41 Leptospirosis | Nature Reviews Disease Primers

  https://www.nature.com/articles/s41572-025-00614-5

  Leptospirosis is a zoonotic bacterial infection that is prevalent across all continents and is caused by pathogenic spirochaetes of the genus Leptospira. Although infection can be asymptomatic, symptomatic disease can vary in severity from mild to severe illness, the latter characterized by icterus and/or multi-organ dysfunction and potentially death. An estimated one million cases of leptospirosis occur globally each year, resulting in ~60,000 deaths. […] The pathogenesis of severe leptospirosis is poorly understood but is believed to involve an interplay between genetic predisposition, pathogen virulence and dysregulated immune responses that trigger a cytokine storm with associated immunoparesis. […] Future research is needed to accurately estimate leptospirosis disease burden across the globe, to understand the pathophysiology of severe leptospirosis to inform the design of targeted immunotherapies and vaccines, and to develop cost-effective and accurate point-of-care diagnostics.

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