Area of residence of 86 patients of leptospirosis in India.

<p>Area of residence of 86 patients of leptospirosis in India.</p

Epidemiological pattern and age group of 86 leptospirosis patients.

*<p>Documented history of travel to known endemic areas alongwith history of unprotected bathing in ponds of those areas.</p

Time trends in leptospirosis.

<p>(A) Percentage of leptospirosis patients among those with acute febrile illnesses. (B) Month- and year-wise distribution of cases. * Total number of leptospirosis patients was 232 (9 in 2004, 17 in 2005, 25 in 2006, 74 in 2007, and 107 in 2008).</p

Warthin Starry stain showing <i>Leptospira</i> in the tubular cells of the kidney.

<p>Warthin Starry stain showing <i>Leptospira</i> in the tubular cells of the kidney.</p

Complications of leptospirosis cases while in hospital.

*<p>Mild ascitis and mild to moderate pleural effusion mainly detected in chest X-ray and ultrasonographic investigations.</p>**<p>33 cases presented with altered sensorium and 32 with headache. 10 cases of these cases could be definitely categorized as neuroleptospirosis, as evidenced by CT finding of diffuse cerebral edema, generalized seizures, neck rigidity, or neurological deficits.</p

Epidemiological risk factors found in the 86 leptospirosis patients.

<p>Epidemiological risk factors found in the 86 leptospirosis patients.</p

Modified Faine's criteria.

<p>A presumptive diagnosis of leptospirosis may be made if: (i) Score of Part A+Part B = 26 or more (Part C laboratory report is usually not available before fifth day of illness; thus it is mainly a clinical and epidemiologic diagnosis during early part of disease) or Part A+Part B+Part C≥25.</p><p>A score between 20 and 25: Suggests a possible but unconfirmed diagnosis of leptospirosis.</p

Laboratory parameters of 86 patients at time of diagnosis and hospital stay.

*<p>In 68 cases ranged from 60 IU to 200 IU, in two cases was >200 IU.</p>**<p>In 64 cases, between 2–8 mg/dl, in 2 cases >8 mg/dl.</p

Clinical features of 86 leptospirosis patients.

<p>Clinical features of 86 leptospirosis patients.</p

Initial disease severity and quality of care of emergency department sepsis patients who are older or younger than 70 years of age

<div><p>Objective</p><p>Due to atypical symptom presentation older patients are more prone to delayed sepsis recognition. We investigated whether initial disease severity <i>before</i> emergency department (ED) treatment (including treatable acute organ dysfunction), quality of ED sepsis care and the impact on mortality was different between patients older and younger than 70 years. If differences exist, improvements are needed for ED management of older patients at risk for sepsis.</p><p>Methods</p><p>In this observational multicenter study, ED patients who were hospitalized with a suspected infection were stratified by age <70 and ≥70 years. The presence of treatable and potentially reversible acute organ dysfunction was measured by the RO components of the Predisposition, Infection, Response and Organ dysfunction (PIRO) score, reflecting acute sepsis-related organ dysfunction developed <i>before</i> ED presentation. Quality of care, as assessed by the full compliance with nine quality performance measures and the standardized mortality ratio (SMR: observed/expected in-hospital mortality), was compared between older and younger patients.</p><p>Results</p><p>The RO-components of the PIRO score were 8 (interquartile range; 4–9) in the 833 older patients, twice as high as the 4 (2–8; P<0.001) in the 1537 younger patients. However, full compliance with all nine quality performance measures was achieved in 34.2 (31.0–37.4)% of the older patients, not higher than the 33.0 (30.7–35.4)% in younger patients (P = 0.640). In-hospital mortality was 9.2% (95%-CI, 7.3–11.2) in patients ≥70, twice as high as the 4.6% (3.6–5.6) in patients <70 years, resulting in an SMR (in study period) of ~0.7 in both groups (P>0.05).</p><p>Conclusion</p><p>Older sepsis patients are sicker at ED presentation but are not treated more expediently or reliably despite their extra acuity The presence of twice as much treatable acute organ dysfunction <i>before</i> ED treatment suggests that acute organ dysfunction is recognized relatively late by general practitioners or patients in the out of hospital setting.</p></div