{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T21:13:33Z","timestamp":1769807613336,"version":"3.49.0"},"reference-count":39,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T00:00:00Z","timestamp":1769472000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>Leptospirosis is an important zoonosis that can present as a self-limited influenza-like illness or progress to severe, including life-threatening multiorgan dysfunction. We report the epidemiology, clinical profile, and correlates of severity among adults hospitalized patients with leptospirosis diagnosed in central Romania over a period of 17 years. We conducted a retrospective, single-center cohort study of adults admitted between 1 January 2008 and 1 December 2025 with laboratory-confirmed leptospirosis. Confirmation was based on positive anti-Leptospira IgM serology, with repeat testing when the initial result was equivocal and confirmation with a microscopic agglutination test. We extracted demographic, exposure, clinical, laboratory, treatment, and outcome data from medical records. The modified Faine score was also calculated using admission data. Sixty-four patients were included in this analysis, of which 53 (82.8%) were male patients. Admissions peaked in 2023\u20132025 (34\/64, 53.1%) and in the August\u2013September months. Reported exposures were predominantly peri-domestic (46.9%), followed by rural\/animal-related occupations (20.3%) and freshwater contact (17.2%). Severe disease occurred in 26\/64 (40.6%), was more frequent in men (p = 0.021), and was more common pre-pandemic than during\/after the pandemic (p &lt; 0.001). Severe cases were associated with oliguria\/anuria, hematuria, and jaundice, alongside higher urea\/creatinine and bilirubin, lower hemoglobin and lymphocyte percentages, and a longer hospitalization period. One in-hospital death occurred (1.6%). Serogroup identification was available for 10 patients (15.6%) (pre-pandemic only). The mean modified Faine score was 27.5 \u00b1 6.0. In this temperate-region cohort study, hospitalized leptospirosis showed a marked male predominance, a late-summer peak, and a substantial burden of severe disease. Early renal and hepatobiliary manifestations with concordant laboratory abnormalities may support timely risk stratification and escalation of care, while expanded molecular diagnostics and systematic typing are needed to clarify temporal trends and guide prevention.<\/jats:p>","DOI":"10.3390\/microorganisms14020298","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T15:41:56Z","timestamp":1769528516000},"page":"298","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Leptospirosis in Central Romania: A 17-Year Single-Center Cohort Study of Hospitalized Adults"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7391-3394","authenticated-orcid":false,"given":"Victoria","family":"Birlutiu","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania"},{"name":"County Clinical Emergency Hospital, 550245 Sibiu, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7400-2904","authenticated-orcid":false,"given":"Rares-Mircea","family":"Birlutiu","sequence":"additional","affiliation":[{"name":"Department 14-Orthopedics, Anaesthesia Intensive Care Unit, Faculty of Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Foisor Clinical Hospital of Orthopedics, Traumatology, and Osteoarticular TB, 030167 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Costa, F., Hagan, J.E., Calcagno, J., Kane, M., Torgerson, P., Martinez-Silveira, M.S., Stein, C., Abela-Ridder, B., and Ko, A.I. (2015). Global Morbidity and Mortality of Leptospirosis: A Systematic Review. PLoS Negl. Trop. Dis., 9.","DOI":"10.1371\/journal.pntd.0003898"},{"key":"ref_2","first-page":"CD008264","article-title":"Antibiotics for leptospirosis","volume":"2012","author":"Coldren","year":"2012","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1128\/CMR.14.2.296-326.2001","article-title":"Leptospirosis","volume":"14","author":"Levett","year":"2001","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"5066","DOI":"10.1038\/s41598-022-09079-y","article-title":"Spatial\u2013temporal patterns and risk factors for human leptospirosis in Thailand, 2012\u20132018","volume":"12","author":"Chadsuthi","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_5","first-page":"e99035","article-title":"Leptospirosis Complicated by Haemorrhagic Cardiac Tamponade: A Challenging Case of Weil\u2019s Disease","volume":"17","author":"Walsh","year":"2025","journal-title":"Cureus"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"100741","DOI":"10.1016\/j.cegh.2021.100741","article-title":"A short review on leptospirosis: Clinical manifestations, diagnosis and treatment","volume":"11","author":"Chacko","year":"2021","journal-title":"Clin. Epidemiol. Glob. Health"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"106225","DOI":"10.1016\/j.actatropica.2021.106225","article-title":"Climate change and zoonoses: A review of the current status, knowledge gaps, and future trends","volume":"226","author":"Rupasinghe","year":"2022","journal-title":"Acta Trop."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"14","DOI":"10.7861\/clinmed.2021-0784","article-title":"Leptospirosis: Clinical aspects","volume":"22","author":"Rajapakse","year":"2022","journal-title":"Clin. Med."},{"key":"ref_9","first-page":"2300266","article-title":"Epidemiology of reported cases of leptospirosis in the EU\/EEA, 2010 to 2021","volume":"29","author":"Innocenti","year":"2024","journal-title":"Eurosurveillance"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1136\/pgmj.64.748.163","article-title":"Leptospirosis\u2014Can it be a sexually transmitted disease?","volume":"64","author":"Harrison","year":"1988","journal-title":"Postgrad. Med. J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1093\/infdis\/158.1.246","article-title":"Human-to-Human Transmission of Leptospira interrogans by Milk","volume":"158","author":"Bolin","year":"1988","journal-title":"J. Infect. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1136\/bmj.1.5638.228","article-title":"Leptospirosis in Human Pregnancy followed by Death of the Foetus","volume":"1","author":"Coghlan","year":"1969","journal-title":"BMJ"},{"key":"ref_13","first-page":"1253","article-title":"Guidelines for the diagnosis of human leptospirosis","volume":"47","author":"Shivakumar","year":"2025","journal-title":"Indian J. Vet. Anim. Sci. Res."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Bandara, K., Weerasekera, M.M., Gunasekara, C., Ranasinghe, N., Marasinghe, C., and Fernando, N. (2016). Utility of modified Faine\u2019s criteria in diagnosis of leptospirosis. BMC Infect. Dis., 16.","DOI":"10.1186\/s12879-016-1791-9"},{"key":"ref_15","first-page":"65","article-title":"Leptospirosis in Humans","volume":"387","author":"Haake","year":"2015","journal-title":"Curr. Top. Microbiol. Immunol."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Reis, E.A.G., Hagan, J.E., Ribeiro, G.S., Teixeira-Carvalho, A., Martins-Filho, O.A., Montgomery, R.R., Shaw, A.C., Ko, A.I., and Reis, M.G. (2013). Cytokine Response Signatures in Disease Progression and Development of Severe Clinical Outcomes for Leptospirosis. PLoS Negl. Trop. Dis., 7.","DOI":"10.1371\/journal.pntd.0002457"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Goris, M.G.A., Kikken, V., Straetemans, M., Alba, S., Goeijenbier, M., van Gorp, E.C.M., Boer, K.R., Wagenaar, J.F.P., and Hartskeerl, R.A. (2013). Towards the Burden of Human Leptospirosis: Duration of Acute Illness and Occurrence of Post-Leptospirosis Symptoms of Patients in The Netherlands. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0076549"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Herath, N.J., Kularatne, S.A., Weerakoon, K.G., Wazil, A., Subasinghe, N., and Ratnatunga, N.V. (2014). Long term outcome of acute kidney injury due to leptospirosis? A longitudinal study in Sri Lanka. BMC Res. Notes, 7.","DOI":"10.1186\/1756-0500-7-398"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Yang, H.-Y., Hung, C.-C., Liu, S.-H., Guo, Y.-G., Chen, Y.-C., Ko, Y.-C., Huang, C.-T., Chou, L.-F., Tian, Y.-C., and Chang, M.-Y. (2015). Overlooked Risk for Chronic Kidney Disease after Leptospiral Infection: A Population-Based Survey and Epidemiological Cohort Evidence. PLoS Negl. Trop. Dis., 9.","DOI":"10.1371\/journal.pntd.0004105"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1159\/000480691","article-title":"Leptospirosis Renal Disease: Emerging Culprit of Chronic Kidney Disease Unknown Etiology","volume":"138","author":"Yang","year":"2018","journal-title":"Nephron"},{"key":"ref_21","unstructured":"European Centre for Disease Prevention and Control (ECDC) (2024). Leptospirosis\u2014Annual Epidemiological Report for 2022, European Centre for Disease Prevention and Control (ECDC)."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1007\/s10096-019-03797-4","article-title":"Leptospirosis: A neglected tropical zoonotic infection of public health importance\u2014An updated review","volume":"39","author":"Karpagam","year":"2020","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_23","first-page":"62","article-title":"Human leptospirosis in Detroit and the role of rats as chronic carriers","volume":"7","author":"Thiermann","year":"1980","journal-title":"Int. J. Zoonoses"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Costa, F., Ribeiro, G.S., Felzemburgh, R.D.M., Santos, N., Reis, R.B., Santos, A.C., Fraga, D.B.M., Araujo, W.N., Santana, C., and Childs, J.E. (2014). Influence of Household Rat Infestation on Leptospira Transmission in the Urban Slum Environment. PLoS Negl. Trop. Dis., 8.","DOI":"10.1371\/journal.pntd.0003338"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e00132115","DOI":"10.1590\/0102-311x00132115","article-title":"Rat infestation associated with environmental deficiencies in an urban slum community with high risk of leptospirosis transmission","volume":"33","author":"Santos","year":"2017","journal-title":"Cad. Saude Publica"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Hagan, J.E., Moraga, P., Costa, F., Capian, N., Ribeiro, G.S., Wunder, E.A., Felzemburgh, R.D.M., Reis, R.B., Nery, N., and Santana, F.S. (2016). Spatiotemporal Determinants of Urban Leptospirosis Transmission: Four-Year Prospective Cohort Study of Slum Residents in Brazil. PLoS Negl. Trop. Dis., 10.","DOI":"10.1371\/journal.pntd.0004275"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"794","DOI":"10.7326\/0003-4819-125-10-199611150-00002","article-title":"Sporadic Urban Leptospirosis","volume":"125","author":"Vinetz","year":"1996","journal-title":"Ann. Intern. Med."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Galan, D.I., Roess, A.A., Pereira, S.V.C., and Schneider, M.C. (2021). Epidemiology of human leptospirosis in urban and rural areas of Brazil, 2000\u20132015. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0247763"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Bradley, E.A., and Lockaby, G. (2023). Leptospirosis and the Environment: A Review and Future Directions. Pathogens, 12.","DOI":"10.3390\/pathogens12091167"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"133","DOI":"10.30638\/eemj.2007.018","article-title":"Leptospirosis: Clinical and environmental aspects of the Iasi country","volume":"6","author":"Manciuc","year":"2007","journal-title":"Environ. Eng. Manag. J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"749","DOI":"10.30638\/eemj.2018.075","article-title":"Risks of leptospirosis linked to living and working environments","volume":"17","author":"Manciuc","year":"2018","journal-title":"Environ. Eng. Manag. J."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Jipa, R.E., Andreescu, N., Manea, E., Diaconu, S., Niculescu, D., Antonic\u0103, D., Irimescu, N., Moroti, R., and Hristea, A. (2014). Clinical and laboratory characteristics in leptospirosis. BMC Infect. Dis., 14.","DOI":"10.1186\/1471-2334-14-S7-P29"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/j.semnephrol.2008.04.008","article-title":"Leptospiral Nephropathy","volume":"28","author":"Andrade","year":"2008","journal-title":"Semin. Nephrol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"ofaf035","DOI":"10.1093\/ofid\/ofaf035","article-title":"Leptospirosis\u2014Improving Healthcare Outcomes for a Neglected Tropical Disease","volume":"12","author":"Dreyfus","year":"2025","journal-title":"Open Forum Infect Dis."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"638","DOI":"10.3390\/idr16040049","article-title":"Epidemiological Features of Leptospirosis and Identification of Leptospira wolffii as a Persistently Prevailing Species in North\u2013Central Bangladesh","volume":"16","author":"Sultana","year":"2024","journal-title":"Infect. Dis. Rep."},{"key":"ref_36","first-page":"785","article-title":"Serological & molecular approaches for diagnosis of leptospirosis in a tertiary care hospital in north India: A 10-year study","volume":"137","author":"Chaudhry","year":"2013","journal-title":"Indian J. Med. Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"118","DOI":"10.4997\/jrcpe.2020.208","article-title":"Epidemiological, Clinical and Laboratory Features of Leptospirosis Compared to Other Acute Febrile Illnesses","volume":"50","author":"Balasundaram","year":"2020","journal-title":"J. R. Coll. Physicians Edinb."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Wangrangsimakul, T., Althaus, T., Mukaka, M., Kantipong, P., Wuthiekanun, V., Chierakul, W., Blacksell, S.D., Day, N.P., Laongnualpanich, A., and Paris, D.H. (2018). Causes of acute undifferentiated fever and the utility of biomarkers in Chiangrai, northern Thailand. PLoS Negl. Trop. Dis., 12.","DOI":"10.1371\/journal.pntd.0006477"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1038\/s41572-025-00614-5","article-title":"Leptospirosis","volume":"11","author":"Rajapakse","year":"2025","journal-title":"Nat. Rev. Dis. Primers"}],"container-title":["Microorganisms"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-2607\/14\/2\/298\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T08:30:47Z","timestamp":1769761847000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-2607\/14\/2\/298"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,27]]},"references-count":39,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["microorganisms14020298"],"URL":"https:\/\/doi.org\/10.3390\/microorganisms14020298","relation":{},"ISSN":["2076-2607"],"issn-type":[{"value":"2076-2607","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,27]]}}}