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Miida S, Maruyama M, Sato T, Nagoya T, Goto R, Isokawa O, Koizumi N, Terai S. Acute pancreatitis as a rare complication of leptospirosis: A case report and literature review. J Infect Chemother 2024; 30:552-556. [PMID: 38052307 DOI: 10.1016/j.jiac.2023.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/26/2023] [Accepted: 11/28/2023] [Indexed: 12/07/2023]
Abstract
Leptospirosis is a zoonotic disease. We present a case of acute pancreatitis associated with leptospirosis. An 88-year-old woman was admitted to the hospital with high fever and severe myalgia of the lower extremities. Based on the clinical presentation, hepatic dysfunction with a mild increase in bilirubin, renal dysfunction, and life history, the possibility of leptospirosis was considered. Plain computed tomography of the trunk on admission revealed no special findings. Appropriate antimicrobial therapy was administered at an early stage. After treatment initiation, the clinical symptoms and blood test abnormalities began to improve, and the patient appeared to be doing well. Although no abdominal or back pain was consistently noted during hospitalization, the serum amylase level increased over time; therefore, the patient underwent another computed tomography scan on the ninth day. Acute pancreatitis, which was absent upon admission, was noted. Appropriate treatment for pancreatitis was administered, and the patient was discharged. A subsequent serum antibody test confirmed the diagnosis of leptospirosis. Herein, we also summarized previous cases of acute pancreatitis associated with leptospirosis. The time of onset for pancreatitis was inconsistent, and there were a few cases of pancreatitis without abdominal or back pain. In contrast, serum amylase or lipase levels were elevated in all patients, which could be an important trigger for suspected complications of pancreatitis. When leptospirosis is suspected, complications of pancreatitis should always be considered, even in the absence of apparent abdominal pain. Regular monitoring of pancreatic enzymes such as amylase and lipase is recommended.
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Affiliation(s)
- Suguru Miida
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
| | - Masaki Maruyama
- Department of Gastroenterology, Kashiwazaki General Hospital and Medical Center, Kashiwazaki, Japan
| | - Takeki Sato
- Department of Gastroenterology, Kashiwazaki General Hospital and Medical Center, Kashiwazaki, Japan
| | - Takuro Nagoya
- Department of Gastroenterology and Hepatology, Tsubame Rosai Hospital, Tsubame, Niigata, Japan
| | - Ryo Goto
- Department of Gastroenterology, Kashiwazaki General Hospital and Medical Center, Kashiwazaki, Japan
| | - Osamu Isokawa
- Department of Gastroenterology, Kashiwazaki General Hospital and Medical Center, Kashiwazaki, Japan
| | - Nobuo Koizumi
- Department of Bacteriology I, National Institute of Infectious Diseases, Shinjuku, Tokyo, Japan
| | - Shuji Terai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
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Howard M. Acute kidney injury and liver disease in an American bulldog with suspected leptospirosis. Can Vet J 2024; 65:385-388. [PMID: 38562974 PMCID: PMC10945455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
A 6-year-old spayed female American bulldog was brought to a veterinary clinic with a 3-day history of vomiting, lethargy, anorexia, icterus, hemorrhagic diarrhea, and oliguria. The dog's clinical signs, complete blood (cell) count, serum biochemistry, urinalysis, and diagnostic imaging were indicative of acute kidney injury and acute hepatopathy consistent with leptospirosis. Treatment for leptospirosis was initiated but, due to the dog's lack of response and progression of clinical signs, euthanasia was ultimately elected after 3 d of hospitalization. The dog tested negative for Leptospira spp. on ELISA; urine, blood, and tissue PCRs; and immunohistochemistry. This case demonstrates that confirmation of leptospirosis can be challenging, even in an animal with the expected clinical presentation. Therefore, limitations of the diagnostic tests available, as well as the possibility of other, less likely differential diagnoses such as toxicosis, must be considered.
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Affiliation(s)
- Matthew Howard
- Ontario Veterinary College, University of Guelph, 50 Stone Road East, Guelph, Ontario N1G 2W1
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3
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Torres AEP, Bolívar-Lozano SA, Faccini-Martínez ÁA. Diffuse alveolar hemorrhage as a presentation of severe anicteric leptospirosis. Rev Soc Bras Med Trop 2024; 57:e009052024. [PMID: 38324815 PMCID: PMC10852465 DOI: 10.1590/0037-8682-0582-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/12/2023] [Indexed: 02/09/2024] Open
Affiliation(s)
| | | | - Álvaro A. Faccini-Martínez
- Hospital Militar Central, Servicio de Infectología, Bogotá D.C, Colombia
- Universidad Militar Nueva Granada, Facultad de Medicina, Bogotá D.C, Colombia
- Servicios y Asesorías en Infectología - SAI, Bogotá, D.C, Colombia
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Putri A, Charoenwisedsil R, Techavachara N, Imad H, Chinpraditsuk S, Thaipadungpanit J, Matsee W. Severe leptospirosis with rhabdomyolysis in a traveller visiting Thailand. J Travel Med 2024; 31:taad161. [PMID: 38123495 DOI: 10.1093/jtm/taad161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023]
Abstract
We present a case of leptospirosis in a 32-year-old German who exhibited a progressing fever, calf pain complicated with acute kidney injury, and rhabdomyolysis following engagement in freshwater activities at a waterfall in Thailand. Fortunately, the patient made a full recovery without the need for renal replacement therapy.
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Affiliation(s)
- Anastasia Putri
- Thai Travel Clinic, Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Rachata Charoenwisedsil
- Thai Travel Clinic, Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Narissara Techavachara
- Thai Travel Clinic, Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Hisham Imad
- Thai Travel Clinic, Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Travel Medicine Research Unit, Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Sutatip Chinpraditsuk
- Thai Travel Clinic, Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Janjira Thaipadungpanit
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Wasin Matsee
- Thai Travel Clinic, Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Travel Medicine Research Unit, Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Jin Y, Lan W, Chen X, Liu W, Luo W, Chen S. A rare case of anti-DPPX encephalitis combined with neuroleptospirosis. BMC Neurol 2024; 24:34. [PMID: 38243162 PMCID: PMC10797929 DOI: 10.1186/s12883-024-03538-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 01/14/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Neuroleptospirosis and anti-dipeptidyl-peptidase-like protein 6 (DPPX) encephalitis are both very rare and have only been reported in the form of respective case reports. There are no reports of anti-DPPX encephalitis combined with neuroleptospirosis in the literature. We reported the first case of neuroleptospirosis combined with elevated DPPX antibodies in serum and cerebrospinal fluid (CSF). CASE PRESENTATION A previously healthy 53-year-old Chinese male farmer with a history of drinking raw stream water and flood sewage exposure was brought to the hospital due to an acute onset of neuropsychiatric symptoms. No fever or meningeal irritation signs were detected on physical examination. Routine laboratory investigations, including infection indicators, leukocyte and protein in CSF, electroencephalogram and gadolinium-enhanced magnetic resonance imaging of the brain, all revealed normal. While metagenomic next-generation sequencing (mNGS) identified the DNA genome of Leptospira interrogans in the CSF. Anti-DPPX antibody was detected both in blood and in CSF. A diagnosis of neuroleptospirosis combined with autoimmune encephalitis associated with DPPX-Ab was eventually made. He resolved completely after adequate amount of penicillin combined with immunotherapy. CONCLUSION We highlight that in patients with acute or subacute behavioral changes, even in the absence of fever, if the most recent freshwater exposure is clear, physicians should pay attention to leptospirosis. Due to the low sensitivity of routine microscopy, culture, polymerase chain reaction and antibody testing, mNGS may have more advantages in diagnosing neuroleptospirosis. As autoimmune encephalitis can be triggered by various infections, neuroleptospirosis may be one of the causes of autoimmune encephalitis. Since neuronal antibody measurements themselves are not that common in neuroleptospirosis, future studies are needed to determine whether the detection of anti-DPPX antibodies is a rare event in leptospirosis. Early identification of autoimmune encephalitis and timely administration of immunotherapy may lead to a better outcome.
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Affiliation(s)
- Yong Jin
- Department of Neurology, Huizhou Central People's Hospital, No. 41, Eling North Road, Huizhou, Guangdong Province, 516001, China
| | - Wei Lan
- Department of Neurology, Huizhou Central People's Hospital, No. 41, Eling North Road, Huizhou, Guangdong Province, 516001, China
| | - Xiaodong Chen
- Department of Neurology, Huizhou Central People's Hospital, No. 41, Eling North Road, Huizhou, Guangdong Province, 516001, China
| | - Wu Liu
- Department of Neurology, Huizhou Central People's Hospital, No. 41, Eling North Road, Huizhou, Guangdong Province, 516001, China
| | - Weiliang Luo
- Department of Neurology, Huizhou Central People's Hospital, No. 41, Eling North Road, Huizhou, Guangdong Province, 516001, China.
| | - Suqin Chen
- Department of Neurology, Huizhou Central People's Hospital, No. 41, Eling North Road, Huizhou, Guangdong Province, 516001, China.
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Campbell S, Stewart J, Quail G, Withey G, Smith S, Hanson J. Case Report: Leptospirosis Complicated by Persistent, Bilateral Sensorineural Hearing Loss. Am J Trop Med Hyg 2023; 109:1238-1241. [PMID: 37962328 DOI: 10.4269/ajtmh.23-0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 07/16/2023] [Indexed: 11/15/2023] Open
Abstract
The clinical manifestations of leptospirosis range from mild to life-threatening and can impact on multiple organ systems. A wide array of neurological manifestations of leptospirosis have been reported, although the pathophysiology of neuroleptospirosis remains incompletely understood. We present a case of leptospirosis complicated by bilateral sensorineural deafness, with nodular meningitis demonstrated in the internal auditory meatus on magnetic resonance imaging. The patient was treated with doxycycline, ceftriaxone, systemic and topical steroids, and hyperbaric oxygen therapy, with modest, but incomplete, improvement.
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Affiliation(s)
| | - James Stewart
- Division of Medicine, Cairns Hospital, Cairns, Australia
| | - Gavin Quail
- Department of Surgery, Cairns Hospital, Cairns, Australia
| | - Grant Withey
- Department of Radiology, Cairns Hospital, Cairns, Australia
| | - Simon Smith
- Division of Medicine, Cairns Hospital, Cairns, Australia
| | - Josh Hanson
- Division of Medicine, Cairns Hospital, Cairns, Australia
- The Kirby Institute, University of New South Wales, Sydney, Australia
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Conreur C, Coureau M, Grimaldi D, Simonet O, Vallot F, Ndjekembo Shango D. A 16-year-old man with leptospirosis and atypical disseminated intravascular coagulation: a case report. J Med Case Rep 2023; 17:493. [PMID: 38008733 PMCID: PMC10680241 DOI: 10.1186/s13256-023-04239-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 10/31/2023] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND Leptospirosis is known for its pulmonary form characterized by intra-alveolar hemorrhage, exhibiting a high mortality rate. Management by venous-venous extracorporeal membrane oxygenation has been reported in a small number of cases. CASE PRESENTATION We report herein the case of a 16-year-old Caucasian male who was admitted with rapidly deteriorating respiratory and digestive complaints. He developed severe acute respiratory distress syndrome secondary to disseminated intravascular coagulation and intra-alveolar hemorrhage, requiring initiation of venous-venous extracorporeal membrane oxygenation. Initial infectious and immunological assessments were inconclusive, but repeat serology on the tenth day of admission confirmed a diagnosis of leptospirosis. The patient received multiple transfusions, and upon favorable response to treatment with corticosteroids and antibiotics, he was successfully weaned off venous-venous extracorporeal membrane oxygenation, which was discontinued after 12 days. CONCLUSION Leptospirosis is a rare cause of severe acute respiratory failure following pulmonary hemorrhage. It is typically diagnosed by serology, with detectable IgM antibodies 5-7 days after the onset of symptoms. We report that early support with respiratory extracorporeal membrane oxygenation favors timely clearance of endobronchial clotting, parenchymal recovery, and prevention of ventilator-induced lung injury. Major hypofibrinogenemia, which did not seem to worsen during extracorporeal membrane oxygenation application, was managed by repeated transfusions. Further studies investigating the pathogenesis of this coagulopathy are required to further optimize the management of this rare and severe complication.
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Affiliation(s)
- Charlotte Conreur
- Department of Intensive Care, Centre Hospitalier de Wallonie Picarde, Rue des Sports, 51, 7500, Tournai, Belgium.
| | - Michelle Coureau
- Department of Intensive Care, Erasme Hospital, Route de Lennik, 808, 1700, Brussels, Belgium
| | - David Grimaldi
- Department of Intensive Care, Erasme Hospital, Route de Lennik, 808, 1700, Brussels, Belgium
| | - Olivier Simonet
- Department of Intensive Care, Centre Hospitalier de Wallonie Picarde, Rue des Sports, 51, 7500, Tournai, Belgium
| | - Frédéric Vallot
- Department of Intensive Care, Centre Hospitalier de Wallonie Picarde, Rue des Sports, 51, 7500, Tournai, Belgium
| | - Didier Ndjekembo Shango
- Department of Intensive Care, Centre Hospitalier de Wallonie Picarde, Rue des Sports, 51, 7500, Tournai, Belgium
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8
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Zhang Y, Zheng Y. Leptospirosis-associated meningitis in a patient with sjögren's syndrome: a case report. BMC Infect Dis 2023; 23:778. [PMID: 37946137 PMCID: PMC10636908 DOI: 10.1186/s12879-023-08794-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/06/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Leptospirosis is a zoonotic disease that afflicts both humans and animals. It progresses from flu-like symptoms to more severe hepatic and renal failure, and may also lead to aseptic meningitis. Individuals with autoimmune diseases (ADs) are potentially more susceptible to Leptospirosis. Thus far, limited data has documented the association between Leptospirosis and autoimmune disorders. CASE PRESENTATION The patient had a definitive pathological diagnosis of Sjögren's syndrome (SS). Due to recurrent headaches, the patient sought consultation with a neurologist. Lumbar puncture revealed elevated white blood cells and protein levels in the cerebrospinal fluid, along with decreased glucose. Tuberculous meningitis was suspected. Radiographic imaging exhibited meningeal enhancement, ventricular enlargement, and hydrocephalus. The patient commenced treatment with anti-tuberculosis therapy and corticosteroids. Subsequently, high-throughput sequencing (HTS) of cerebrospinal fluid identified the presence of Leptospira interrogans. The patient was ultimately diagnosed with Leptospiral meningitis, and underwent antimicrobial and immunosuppressive therapy, resulting in stabilization of the condition and gradual symptom recovery. CONCLUSIONS The case highlights the challenges in diagnosing and managing leptospirosis-related meningitis in the presence of ADs and emphasizes the importance of utilizing HTS for accurate pathogen detection. The potential correlation between leptospirosis and SS warrants further investigation, as does the need for multidisciplinary involvement in treatment strategies for such complex cases.
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Affiliation(s)
- Yifan Zhang
- Neurological Center, Shenzhen Baoan People's Hospital, Shenzhen, China
| | - Yong Zheng
- Neurological Center, Shenzhen Baoan People's Hospital, Shenzhen, China.
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9
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Tagoe JNA, Yeboah C, Behene E, Kumordjie S, Nimo-Paintsil S, Attram N, Nyarko EO, Carroll JA, Fox AT, Watters C, Koram K, Anang AK, Sanders T, Letizia AG. Coinfection of Malaria and Bacterial Pathogens among Acute Febrile Patients in Selected Clinics in Ghana. Am J Trop Med Hyg 2023; 109:1036-1046. [PMID: 37748764 PMCID: PMC10622490 DOI: 10.4269/ajtmh.23-0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 07/05/2023] [Indexed: 09/27/2023] Open
Abstract
Malaria remains the leading cause of acute febrile illness (AFI) in Africa despite successful control measures and programs. Acute febrile illnesses can be misdiagnosed as malaria as a result of the overlapping spectrum of nonspecific symptoms or may not be pursued because of limited diagnostic capabilities. This study investigated potential etiologies of AFIs in Ghana and determined the relationship between coinfection between malaria and Q fever, leptospirosis, and culturable bacteria in febrile patients. Participants were enrolled between July 2015 and December 2019 from four Ghanaian military treatment facilities. Of the 399 febrile participants, 222 (55.6%) males and 177 (44.6%) females were enrolled. Malaria was diagnosed in 275 (68.9%) participants. Malaria coinfection occurred with leptospirosis, Q fever, and blood-cultured bacteria in 11/206 (5.3%), 24/206 (11.7%), and 6/164 (3.7%) participants, respectively. Among the 124 malaria-negative samples, the positivity rates were 4.1% (3/74), 8.1% (6/74), and 3.6% (2/56) for leptospirosis, Q fever, and bacterial pathogens isolated from blood culture, respectively. The majority of documented clinical signs and symptoms were not significantly associated with specific diseases. Approximately 10% of malaria-positive participants also had evidence suggesting the presence of a bacterial coinfection. Therefore, even in the case of a positive malaria test, other pathogens contributing to febrile illness should be considered. Understanding the frequency of malaria coinfection and other etiological agents responsible for AFIs will improve diagnosis and treatment and better inform public health knowledge gaps in Ghana.
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Affiliation(s)
- Janice N. A. Tagoe
- Noguchi Memorial Institute for Medical Research, Accra, Ghana
- U.S. Naval Medical Research Unit-No.3, Ghana Detachment, Accra, Ghana
| | - Clara Yeboah
- Noguchi Memorial Institute for Medical Research, Accra, Ghana
- U.S. Naval Medical Research Unit-No.3, Ghana Detachment, Accra, Ghana
| | - Eric Behene
- Noguchi Memorial Institute for Medical Research, Accra, Ghana
- U.S. Naval Medical Research Unit-No.3, Ghana Detachment, Accra, Ghana
| | - Selassie Kumordjie
- Noguchi Memorial Institute for Medical Research, Accra, Ghana
- U.S. Naval Medical Research Unit-No.3, Ghana Detachment, Accra, Ghana
| | | | - Naiki Attram
- U.S. Naval Medical Research Unit-No.3, Ghana Detachment, Accra, Ghana
| | | | | | - Anne T. Fox
- U.S. Naval Medical Research Unit-No.3, Ghana Detachment, Accra, Ghana
| | - Chaselynn Watters
- U.S. Naval Medical Research Unit-No.3, Ghana Detachment, Accra, Ghana
| | - Kwadwo Koram
- Noguchi Memorial Institute for Medical Research, Accra, Ghana
| | | | - Terrel Sanders
- U.S. Naval Medical Research Unit-No.3, Ghana Detachment, Accra, Ghana
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Petakh P, Rostoka L, Isevych V, Kamyshnyi A. Identifying risk factors and disease severity in leptospirosis: A meta-analysis of clinical predictors. Trop Doct 2023; 53:464-469. [PMID: 37501591 DOI: 10.1177/00494755231187673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Leptospirosis is a bacterial zoonosis with a wide spectrum of clinical presentations. In order to identify potential risk factors and predictors of disease severity, a meta-analysis of the clinical features of severe and non-severe leptospirosis patients was conducted. PubMed was searched to collect studies on the difference in clinical characteristics of severe and nonsevere patients, and data were analyzed using Comprehensive Meta-Analysis V3 software. Results showed that patients with severe outcomes were more likely to have dyspnoea, oliguria, and hemorrhagic symptoms than nonsevere patients. Determining these predictors in the early stages of the disease could thus significantly reduce the development of severe cases and related mortality.
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Affiliation(s)
- Pavlo Petakh
- Department of Microbiology, Virology, and Immunology, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
- Department of Biochemistry and Pharmacology, Uzhhorod National University, Uzhhorod, Ukraine
| | - Larysa Rostoka
- Department of Biochemistry and Pharmacology, Uzhhorod National University, Uzhhorod, Ukraine
| | - Vitaliia Isevych
- Department of Biochemistry and Pharmacology, Uzhhorod National University, Uzhhorod, Ukraine
| | - Aleksandr Kamyshnyi
- Department of Microbiology, Virology, and Immunology, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
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Parra Barrera EL, Reales-González J, Salas D, Reyes Santamaría E, Bello S, Rico A, Pardo L, Parra E, Rodriguez K, Alarcon Z, Guerra Vega AP, Porras MA, Gomez-Rangel SY, Duarte C, Moreno J. Fatal acute undifferentiated febrile illness among clinically suspected leptospirosis cases in Colombia, 2016-2019. PLoS Negl Trop Dis 2023; 17:e0011683. [PMID: 37844106 PMCID: PMC10602388 DOI: 10.1371/journal.pntd.0011683] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 10/26/2023] [Accepted: 09/26/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Acute undifferentiated febrile illness is a common challenge for clinicians, especially in tropical and subtropical countries. Incorrect or delayed diagnosis of febrile patients may result in medical complications or preventable deaths. Common causes of acute undifferentiated febrile illness in Colombia include leptospirosis, rickettsioses, dengue fever, malaria, chikungunya, and Zika virus infection. In this study, we described the acute undifferentiated febrile illness in postmortem patients reported as suspected cases of leptospirosis through the national leptospirosis surveillance in Colombia, 2016-2019. METHODOLOGY/PRINCIPAL FINDINGS We retrospectively analyze human fresh and formalin-fixed tissue samples from fatal suspected leptospirosis cases reported by the Public Health Laboratories in Colombia. Leptospirosis confirmation was made by immunohistochemistry, real-time polymerase chain reaction (PCR) in the tissue samples. In some cases, the serum sample was used for confirmation by Microagglutination test (MAT). Simultaneously, tissue samples were tested by PCR for the most common viral (dengue, Zika, and chikungunya), bacterial (Brucella spp., and Rickettsia spp.), and parasitic (malaria). Fresh tissue samples from 92 fatal suspected leptospirosis cases were reported to the National Reference Laboratory from 22/32 departments in Colombia. We confirmed leptospirosis in 27% (25/92) of cases. Other pathogens identified by real-time PCR were Brucella spp. (10.9%), Rickettsia spp. (14.1%), and dengue (2.2%). Dengue (6.9%), hepatitis (3.5%), and Yellow Fever cases (2.2%) were detected by the pathology. All patients were negative for chikungunya and Plasmodium spp. Most cases were classified as undifferentiated febrile illnesses (45.7%; 42/92). CONCLUSIONS/SIGNIFICANCE This study underscores the importance of early and accurate recognition of leptospirosis to prevent mortalities. Moreover, it draws attention to the existence of other febrile syndromes in Colombia, including rickettsiosis and brucellosis, that currently lack sufficient human surveillance and regular reporting. Expanding laboratory surveillance to include viruses such as Hantavirus, Mayaro virus, Oropouche virus, and West Nile virus is crucial.
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Affiliation(s)
- Eliana L Parra Barrera
- Grupo de Microbiología, Subdirección Laboratorio Nacional de Referencia. Dirección de Redes en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
- Grupo de Virología, Subdirección Laboratorio Nacional de Referencia. Dirección de Redes en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
| | - Jhonatan Reales-González
- Grupo de Microbiología, Subdirección de Investigación en Salud Pública. Instituto Nacional de Salud, Bogotá, Colombia
| | - Daniela Salas
- Grupo de Enfermedades Transmitidas por Vectores y Zoonosis, Instituto Nacional de Salud, Bogotá, Colombia
| | - Elizabeth Reyes Santamaría
- Departamento de Medicina interna y Departamento de Medicina crítica y cuidados intensivos. Hospital Universitario Fundación Santa Fe de Bogotá, Colombia
| | - Solmara Bello
- Grupo de Microbiología, Subdirección Laboratorio Nacional de Referencia. Dirección de Redes en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
| | - Angélica Rico
- Grupo de Virología, Subdirección Laboratorio Nacional de Referencia. Dirección de Redes en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
- Grupo de Enfermedades Transmisibles Prevenibles por Vacunación en Salud, Dirección de Vigilancia y Análisis del Riesgo en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
| | - Lissethe Pardo
- Grupo de Virología, Subdirección Laboratorio Nacional de Referencia. Dirección de Redes en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
| | - Edgar Parra
- Grupo de Patología, Subdirección Laboratorio Nacional de Referencia. Dirección de Redes en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
| | - Karina Rodriguez
- Grupo de Microbiología, Subdirección Laboratorio Nacional de Referencia. Dirección de Redes en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
| | - Zonía Alarcon
- Grupo de Microbiología, Subdirección de Investigación en Salud Pública. Instituto Nacional de Salud, Bogotá, Colombia
| | - Angela Patricia Guerra Vega
- Grupo de Parasitología, Subdirección Laboratorio Nacional de Referencia. Dirección de Redes en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
| | - Mayra A Porras
- Grupo de Virología, Subdirección Laboratorio Nacional de Referencia. Dirección de Redes en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
| | - Sergio Yebrail Gomez-Rangel
- Grupo de Virología, Subdirección Laboratorio Nacional de Referencia. Dirección de Redes en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
| | - Carolina Duarte
- Grupo de Microbiología, Subdirección Laboratorio Nacional de Referencia. Dirección de Redes en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
| | - Jaime Moreno
- Grupo de Microbiología, Subdirección de Investigación en Salud Pública. Instituto Nacional de Salud, Bogotá, Colombia
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Phannajit J, Lertussavavivat T, Limothai U, Tachaboon S, Avihingsanon Y, Praditpornsilpa K, Eiam-Ong S, Tungsanga K, Sitprija V, Srisawat N. Long-term kidney outcomes after leptospirosis: a prospective multicentre cohort study in Thailand. Nephrol Dial Transplant 2023; 38:2182-2191. [PMID: 36746439 DOI: 10.1093/ndt/gfad030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Leptospirosis is one of the most important public-health zoonotic diseases in the tropics that can cause severe organ dysfunction and death. Currently there are insufficient data on long-term renal dysfunction in patients after leptospirosis infection. METHODS A prospective multicentre cohort study was conducted at 15 hospitals in the Sisaket province of Thailand. Confirmed leptospirosis patients admitted from 1 December 2015 to 30 November 2018 were followed between 1 February 2020 and 31 October 2020 (median 4.1 years after hospital discharge). The primary outcome was a composite of major kidney adverse events (MAKEs) including all-cause mortality, dialysis and new-onset chronic kidney disease (CKD). RESULTS Of the 217 confirmed leptospirosis cases enrolled, 32.7% were classified as having severe leptospirosis. Fifteen cases (6.9%) were deceased at the time of hospital admission. After a median follow-up time of 4.18 years, 30 patients had died and 33 patients developed CKD. Patients with severe leptospirosis had a significantly higher risk of MAKEs {adjusted hazard ratio 2.45 [95% confidence interval (CI) 1.44-4.18]}. Patients with intensive care unit admission, pulmonary haemorrhage and acute kidney injury also had a higher risk of MAKEs and all-cause mortality. Participants with severe leptospirosis in the follow-up cohort showed a higher risk of developing CKD compared with non-severe leptospirosis [adjusted odds ratio 3.22 (95% CI 1.04-9.96)], especially renal magnesium and phosphate wasting. CONCLUSION Leptospirosis patients, especially severe leptospirosis, are associated with long-term kidney sequelae. Our finding reflects the importance of long-term follow-up and the urgent need for specific interventions.
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Affiliation(s)
- Jeerath Phannajit
- Division of Clinical Epidemiology, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok, Thailand
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Tanat Lertussavavivat
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Umaporn Limothai
- Center of Excellence in Critical Care Nephrology, Chulalongkorn University, Bangkok, Thailand
- Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Sasipha Tachaboon
- Center of Excellence in Critical Care Nephrology, Chulalongkorn University, Bangkok, Thailand
- Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Yingyos Avihingsanon
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kearkiat Praditpornsilpa
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Somchai Eiam-Ong
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kriang Tungsanga
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Visith Sitprija
- Queen Saovabha Memorial Institute, Thai Red Cross, Bangkok, Thailand
| | - Nattachai Srisawat
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Critical Care Nephrology, Chulalongkorn University, Bangkok, Thailand
- Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Tropical Medicine Cluster, Chulalongkorn University, Bangkok, Thailand
- Academy of Science, Royal Society of Thailand, Bangkok, Thailand
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Charles JC, Jayarajah U, Subasinghe D. Clinical characteristics and outcomes of patients with leptospirosis complicated with acute pancreatitis: a systematic review. J Int Med Res 2023; 51:3000605231197461. [PMID: 37776529 PMCID: PMC10542321 DOI: 10.1177/03000605231197461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 08/08/2023] [Indexed: 10/02/2023] Open
Abstract
OBJECTIVES Acute pancreatitis (AP) is a severe complication of leptospirosis. This review focuses on the current evidence of AP in patients with leptospirosis. METHODS Data on clinical characteristics, biochemical parameters, diagnosis, complications, critical care, fluid management, operative management, and outcomes were analyzed. This study was registered in PROSPERO (CRD42022360802). RESULTS We included 35 individual case reports and 4 case series involving 79 patients. Sex was reported for 48 (60.7%) patients; 38 (48.1%) were male and 10 (12.6%) were female. The patients' mean age was 45.13 (15-83 years). Acute kidney injury, thrombocytopenia, hypotension, and liver injury were the most common complications reported. Complete recovery was reported for 36 (45.5%) patients. Biochemical and radiological recovery was reported for 10 (12.6%) and 9 (11.3%) patients, respectively. Death was reported in 18 (22.7%) patients. CONCLUSION A high degree of clinical suspicion and different modalities of investigations are essential in the diagnosis of AP in leptospirosis. AP can be easily missed in leptospirosis because both conditions share similar clinical presentations and complications. Because of the high prevalence of acute kidney injury, judicious fluid management and close monitoring are mandatory.
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Affiliation(s)
- James C Charles
- Department of Surgery, Teaching Hospital Jaffna, Jaffna, Sri Lanka
| | - Umesh Jayarajah
- Department of Surgery, Colombo South Teaching Hospital, Dehiwala, Sri Lanka
| | - Duminda Subasinghe
- Department of Surgery, Faculty of Medicine, University of Colombo, Sri Lanka
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14
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Rathinam SR, Kohila GJ, Gowri PC, Balagiri KS. Leptospiral uveitis- "Transition 'from epidemic to endemic form" difficulties in laboratory confirmations. Indian J Ophthalmol 2023; 71:3031-3038. [PMID: 37530277 PMCID: PMC10538821 DOI: 10.4103/ijo.ijo_61_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 05/02/2023] [Accepted: 05/29/2023] [Indexed: 08/03/2023] Open
Abstract
Purpose Leptospirosis is a waterborne zoonotic disease that primarily causes systemic illness, followed by uveitis. After heavy flooding in Madurai district, an epidemic outbreak of systemic and ocular leptospirosis occurred in 1994. Our data shows a transition to endemicity after each epidemic. Aim The aim of this study is to report the clinical signs, epidemic outbreaks, and persistent endemicity of leptospiral uveitis, as well as the diagnostic dilemmas associated with it. Methods A retrospective analysis of clinical signs was conducted using medical records of leptospiral uveitis patients over a period of 27 years (1994-2020) in a tertiary care eye hospital. The clinical workup of uveitis included a detailed clinical history, systemic, and ophthalmic examination. Microagglutination tests (MATs) was done at the Centers for Disease Control and Prevention (CDC) in Atlanta and later in our regional laboratory. Serum samples were collected from human systemic leptospirosis cases and a small group of animals in and around Madurai. Results The first epidemic outbreak resulted in 200 seropositive patients. Subsequent epidemic outbreaks occurred in 1997, 1998, 2001, 2005, and 2012, with Madurai experiencing multiple outbreaks. However, the disease remained endemic, with 25-50 patients being observed per year in between the peaks. Ocular examination revealed acute non-granulomatous uveitis (94.9%), pan uveitis (59.8%), vitreous inflammatory reaction (55.4%), retinal vasculitis (29.5%), disc hyperemia (20.9%), and hypopyon. (16.2%). New serovars emerged every year, resulting in decreased sensitivity of the MAT. Over time, the MAT started to miss diagnoses. Conclusion The persistent endemicity of leptospiral uveitis emphasizes the need for accessible diagnostic tests. The low performance of the MAT can be attributable to the use of an older panel. The incorporation of new isolates in the MAT by a national laboratory will improve the accuracy of diagnosis.
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Affiliation(s)
- SR. Rathinam
- Aravind Eye Hospital and PG. Institute of Ophthalmology, Aravind Medical Research Foundation, Madurai, Tamil Nadu, India
| | - G. Jeya Kohila
- Aravind Eye Hospital and PG. Institute of Ophthalmology, Aravind Medical Research Foundation, Madurai, Tamil Nadu, India
| | | | - KS. Balagiri
- Biostatistics, Aravind Medical Research Foundation, Madurai, Tamil Nadu, India
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15
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Danguilan RA. Hemoperfusion in Leptospirosis. Contrib Nephrol 2023; 200:252-261. [PMID: 37263231 DOI: 10.1159/000527571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/23/2022] [Indexed: 06/03/2023]
Abstract
Leptospirosis is the most common zoonosis frequently seen in the tropics and subtropics especially during the rainy season when humans wade in floods contaminated by the urine of infected rats in urban areas. Aside from direct toxicity of the leptospires, the role of an exuberant immune response to the pathogen leading to secondary organ damage has been recognized. Thus, our treatment protocol for patients with severe leptospirosis characterized by renal failure, acute liver injury, and lung hemorrhage now includes a short course of methylprednisolone and intravenous cyclophosphamide. In some patients, however, hemodynamic collapse and acute respiratory distress syndrome ensue, which may be due to the release of cytokines resulting from the dysregulated immune response. Blood purification in the form of hemoperfusion (HP) with neutral macroporous resin-adsorbing beads adsorbs cytokines and other inflammatory mediators leading to cardiovascular stability and stabilization of endothelial membranes. HP may be considered part of a multiorgan system therapeutic approach in diseases with reversible multiorgan failure that can lead to an improvement in patient survival.
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Affiliation(s)
- Romina A Danguilan
- Department of Adult Nephrology, National Kidney and Transplant Institute, Quezon City, Philippines
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16
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Madrigal TPR, Panlilio MTT, Burog AILD, Danguilan RA, Chavez JR. Incidence of acute pancreatitis among patients with leptospirosis requiring extracorporeal membrane oxygenation (ECMO): a descriptive study. BMJ Open Gastroenterol 2023; 10:bmjgast-2022-001094. [PMID: 36927735 PMCID: PMC10030540 DOI: 10.1136/bmjgast-2022-001094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/05/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Acute pancreatitis (AP) is an infrequently reported manifestation of leptospirosis. It is more commonly seen in patients with acute respiratory distress syndrome. Despite novel modalities such as extracorporeal membrane oxygenation (ECMO), the mortality rate remains high and whether this is associated with the lung injury caused by the inflammation in AP remains unclear. OBJECTIVES AND METHODS A descriptive study was conducted at a tertiary hospital in the Philippines. Primary outcome was defined as the presence or absence of AP. Secondary outcomes were defined as 28-day mortality rate, length of hospital stay, ECMO days, renal replacement therapy (RRT) days, days on mechanical ventilation, presence of local complications of AP and development of nosocomial infections. RESULTS A total of 27 patients were included in the study, and 88.89% (n=24) were men. The mean age for all patients was 33.59±10.22 years. Out of the 27 patients, 19 (70.37%) were diagnosed with AP. Among these 19 patients, one (5.26%) had necrotising pancreatitis and two (10.52%) developed local complications of pancreatitis. Six patients (31.58%) died among those who developed AP, while one (12.50%) died among those who did not. The duration of hospital stay, ECMO, RRT, mechanical ventilation and development of nosocomial infections was also higher in the group who presented with AP. CONCLUSION AP is an under-reported complication of leptospirosis. Our study demonstrated a higher mortality and morbidity in patients with leptospirosis who developed AP.
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Affiliation(s)
- Tristan Paulo R Madrigal
- Division of Internal Medicine, National Kidney and Transplant Institute, Quezon City, Philippines
| | - Mara Teresa T Panlilio
- Division of Internal Medicine, National Kidney and Transplant Institute, Quezon City, Philippines
| | | | - Romina A Danguilan
- Division of Adult Nephrology, National Kidney and Transplant Institute, Quezon City, Philippines
| | - Joselito R Chavez
- Division of Internal Medicine, National Kidney and Transplant Institute, Quezon City, Philippines
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Goto T, Oda R, Norisue Y, Koizumi N. Case Report: An Imported Case of Severe Leptospirosis with Septic Cardiomyopathy Requiring Venoarterial Extracorporeal Membrane Oxygenation in Japan. Am J Trop Med Hyg 2023; 108:507-509. [PMID: 36623480 PMCID: PMC9978549 DOI: 10.4269/ajtmh.22-0359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 11/15/2022] [Indexed: 01/11/2023] Open
Abstract
A 29-year-old Japanese man presenting with fever, joint pain, and diarrhea was admitted to the intensive care unit for cardiogenic and distributive shock. We suspected leptospirosis based on conjunctival hyperemia, skin rash, elevated bilirubin, and renal involvement; a travel history to Laos was also suggestive. We confirmed the diagnosis with blood and urine polymerase chain reaction and microscopic agglutination tests using paired serum samples. His hemodynamics were unstable, and his echocardiogram showed diffuse and severe left ventricular systolic dysfunction on day 2. He initially required venoarterial extracorporeal membrane oxygenation (V-A ECMO) support but responded and recovered on antimicrobial therapy. His cardiac function and hemodynamics improved on day 5. Severe leptospirosis may cause jaundice, renal failure, pulmonary hemorrhage, acute respiratory distress syndrome, and central nervous system involvement; however, few studies have reported severe cardiac manifestations. Herein, we report the first case of septic cardiomyopathy secondary to leptospirosis that was successfully managed with V-A ECMO. Leptospirosis should be included in the differential diagnosis when a patient returning from an endemic area presents with cardiogenic shock. Furthermore, intensive care management with prompt initiation of V-A ECMO should be considered to reverse septic cardiomyopathy.
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Affiliation(s)
- Takao Goto
- Department of Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Rentaro Oda
- Department of Infectious Diseases, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Yasuhiro Norisue
- Department of Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Nobuo Koizumi
- Department of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan
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18
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Premarathne SS, Gamage C, Chandrajith R, Ratnatunge NV, Wijetunge S, Wazil A, Chou LF, Ko YC, Huang CT, Yang HY, Fonseka A, Sonnadara T, Herath D, Hewavitharane P, Yang CW, Nanayakkara N. Leptospirosis: A Potential Culprit for Chronic Kidney Disease of Uncertain Etiology. Nephron Clin Pract 2023; 147:510-520. [PMID: 36809758 PMCID: PMC10568603 DOI: 10.1159/000528703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 10/23/2022] [Indexed: 02/23/2023] Open
Abstract
PURPOSE Chronic kidney disease of uncertain etiology (CKDu) is an environmental nephropathy in which the etiological factors are yet uncertain. Leptospirosis, a spirochetal infection that is common among agricultural communities, has been identified as a potential etiology for CKDu beyond environmental nephropathy. Although CKDu is a chronic kidney disease, in endemic regions, an increasing number of cases are reported with features suggestive of acute interstitial nephritis without any known reason (AINu), with or without background CKD. The study hypothesizes that exposure to pathogenic leptospires is one of the causative factors for the occurrence of AINu. METHOD This study was carried out using 59 clinically diagnosed AINu patients, 72 healthy controls from CKDu endemic region (endemic controls [ECs]), and 71 healthy controls from CKDu non-endemic region (non-endemic controls [NECs]). RESULTS The seroprevalence of 18.6, 6.9, and 7.0% was observed in the AIN (or AINu), EC, and NEC groups, respectively, from the rapid IgM test. Among 19 serovars tested, the highest seroprevalence was observed at 72.9, 38.9, and 21.1% in the AIN (AINu), EC, and NEC groups, respectively, by microscopic agglutination test (MAT), particularly for serovar Leptospira santarosai serovar Shermani. This emphasizes the presence of infection in AINu patients, and this also suggests that Leptospira exposure might play an important role in AINu. CONCLUSION These data suggest that exposure to Leptospira infection could be one of the possible causative factors for the occurrence of AINu, which may lead to CKDu in Sri Lanka.
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Affiliation(s)
- Shakila Sudarshani Premarathne
- Centre for Research, National Hospital, Kandy, Sri Lanka
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - Chandika Gamage
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - Rohana Chandrajith
- Depatment of Geology, Faculty of Science, University of Peradeniya, Kandy, Sri Lanka
| | | | - Sulochana Wijetunge
- Department of Pathology, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - Abdul Wazil
- Nephrology and Kidney Transplant Unit, National Hospital, Kandy, Sri Lanka
| | - Li-Fang Chou
- Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yi-Ching Ko
- Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | | | - Huang-Yu Yang
- Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Amanda Fonseka
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | | | | | | | - Chih-Wei Yang
- Kidney Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Rijnink EC, Chandie Shaw PK. Subconjunctival Hemorrhage in Leptospirosis. N Engl J Med 2022; 387:e71. [PMID: 36577101 DOI: 10.1056/nejmicm2202675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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20
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Shi J, Wu W, Wu K, Ni C, He G, Zheng S, Cheng F, Yi Y, Ren R, Jiang X. The diagnosis of leptospirosis complicated by pulmonary tuberculosis complemented by metagenomic next-generation sequencing: A case report. Front Cell Infect Microbiol 2022; 12:922996. [PMID: 36268227 PMCID: PMC9577070 DOI: 10.3389/fcimb.2022.922996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 09/15/2022] [Indexed: 11/20/2022] Open
Abstract
Leptospirosis is a zoonotic infection caused by the pathogenic Leptospira. Leptospirosis is transmitted mainly through contact with contaminated rivers, lakes, or animals carrying Leptospira. Human leptospirosis has a wide range of non-specific clinical manifestations ranging from fever, hypotension, and myalgia to multi-organ dysfunction, which severely hampers the timely clinical diagnosis and treatment of leptospirosis. Therefore, there is an urgent clinical need for an efficient strategy/method that can be used for the accurate diagnosis of leptospirosis, especially in critically ill patients. Here, we report a case of a 75-year-old male patient with clinical presentation of fever, cough, and diarrhea. Initial laboratory tests and a computed tomography (CT) scan of the chest suggested only tuberculosis. The patient was finally diagnosed with pulmonary tuberculosis (PTB) combined with leptospirosis by sputum Xpert MTB RIF, epidemiological investigations, and delayed serological testing. Furthermore, through metagenomic next-generation sequencing (mNGS) of clinical samples of cerebrospinal fluid (CSF), urine, plasma and sputum, the causative pathogens were identified as Mycobacterium tuberculosis complex and Leptospira spp. With specific treatment for both leptospirosis and tuberculosis, and associated supportive care (e.g., hemodialysis), the patient showed a good prognosis. This case report suggests that mNGS can generate a useful complement to conventional pathogenic diagnostic methods through more detailed etiological screening (i.e., at the level of species or species complex).
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Affiliation(s)
- Jichan Shi
- Department of Infectious Disease, Wenzhou Central Hospital, The Dingli Clinical College of Wenzhou Medical University, Wenzhou, China
| | - Wenjie Wu
- Institute of Innovative Applications, MatriDx Biotechnology Co., Ltd, Hangzhou, China
| | - Kang Wu
- Institute of Innovative Applications, MatriDx Biotechnology Co., Ltd, Hangzhou, China
| | - Chaorong Ni
- Institute of Infectious Diseases, Center for Disease Control and Prevention, Wenzhou, China
| | - Guiqing He
- Department of Infectious Disease, Wenzhou Central Hospital, The Dingli Clinical College of Wenzhou Medical University, Wenzhou, China
| | - Shilin Zheng
- Department of Infectious Disease, Wenzhou Central Hospital, The Dingli Clinical College of Wenzhou Medical University, Wenzhou, China
| | - Fang Cheng
- Department of Infectious Disease, Wenzhou Central Hospital, The Dingli Clinical College of Wenzhou Medical University, Wenzhou, China
| | - Yaxing Yi
- Institute of Innovative Applications, MatriDx Biotechnology Co., Ltd, Hangzhou, China
| | - Ruotong Ren
- Institute of Innovative Applications, MatriDx Biotechnology Co., Ltd, Hangzhou, China
- Foshan Branch, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
- *Correspondence: Ruotong Ren, ; Xiangao Jiang,
| | - Xiangao Jiang
- Department of Infectious Disease, Wenzhou Central Hospital, The Dingli Clinical College of Wenzhou Medical University, Wenzhou, China
- *Correspondence: Ruotong Ren, ; Xiangao Jiang,
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Gowda VK, Gupta P, Shivappa SK, Bhat M. Basal Ganglia Autoimmune Encephalitis Following Leptospirosis. Neurol India 2022; 70:2121-2124. [PMID: 36352619 DOI: 10.4103/0028-3886.359156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Basal ganglia encephalitis is a part of the spectrum of autoimmune basal ganglia disorders. We are reporting a child who had a fever with focal seizures followed by behavioral problems, rigidity, bradykinesia, and dystonia. His parkinsonism-like features were increasing day by day up to the level that the child was non-ambulatory. His initial Magnetic Resonance Imaging (MRI) of the brain showed asymmetrical T2 hyperintensities involving both the caudate nuclei and putamina. Later, with progressive symptoms, repeat MRI revealed a swelling and symmetrical signal change in both the caudate nuclei and putamina in the form of T2 and Fluid-attenuated inversion recovery (FLAIR) hyperintensities. In addition, there was T2 hyperintensity involving bilateral substantia nigra. Serum basal ganglia antibody, Leptospira Immunoglobulin M (IgM) antibody was positive, and Cerebrospinal Fluid (CSF) oligoclonal band was positive. So, the child was diagnosed with post-leptospirosis autoimmune basal ganglia encephalitis. He was managed with immunomodulatory agents and significant improvement in the symptoms with mild residual extrapyramidal symptoms were noted.
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Affiliation(s)
- Vykuntaraju K Gowda
- Department of Pediatric Neurology, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India
| | - Priya Gupta
- Department of Pediatric Neurology, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India
| | - Sanjay K Shivappa
- Department of Pediatrics, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India
| | - Maya Bhat
- Department of Neuroradiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
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22
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Kularathna MDSV, Kularatne SAM, Pathirage M, Nanayakkara PTMA. Severe leptospirosis complicated with multiorgan dysfunction successfully managed with plasma exchange: a case report. J Med Case Rep 2021; 15:584. [PMID: 34903283 PMCID: PMC8667368 DOI: 10.1186/s13256-021-03135-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/30/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Leptospirosis is a common zoonotic infection caused by the spirochete Leptospira. The disease is more prevalent in the tropics, causing subclinical to severe illness leading to high morbidity and mortality. CASE PRESENTATION A 77-year-old healthy Sri Lankan man presented to the Teaching Hospital Peradeniya with severe leptospirosis complicated with acute kidney injury, pulmonary hemorrhages, myocarditis, and severe thrombocytopenia. He was deteriorating despite treatment with intravenous antibiotics and methylprednisolone boluses. He made a dramatic improvement with two cycles of plasma exchange. CONCLUSION Therapeutic plasma exchange is a life-saving treatment modality in severe leptospirosis with multiorgan failure.
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Gohil J, Gowda A, George T, Easwer HV, George A, Nair P. Pituitary apoplexy and panhypopituitarism following acute leptospirosis. Pituitary 2021; 24:854-858. [PMID: 34021443 PMCID: PMC8139373 DOI: 10.1007/s11102-021-01156-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/12/2021] [Indexed: 10/27/2022]
Abstract
Leptospirosis is a common tropical febrile illness which may manifest with the hepatorenal syndrome and systemic hemorrhagic manifestations. Pituitary apoplexy is a rare but life-threatening condition characterized by a hemorrhage within the pituitary gland or a pituitary adenoma. Apoplexy is very rarely associated with some inducing events such as infectious diseases such as dengue hemorrhagic fever, Hantaan virus, Puumala virus have also been reported to cause pituitary apoplexy. We present the first case of pituitary apoplexy in a patient who was being treated for leptospirosis and discuss the possible mechanisms of apoplexy in the scenario presented. We also review other reports of infectious causes that may result in pituitary apoplexy.
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Affiliation(s)
- Jaypalsinh Gohil
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthpuram, Kerala, India
| | - Arun Gowda
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthpuram, Kerala, India
| | - Tobin George
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthpuram, Kerala, India
| | - H V Easwer
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthpuram, Kerala, India
| | | | - Prakash Nair
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthpuram, Kerala, India.
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24
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Abstract
Leptospirosis is a neglected infectious disease caused by pathogenic species of the genus Leptospira. The acute disease is well-described, and, although it resembles other tropical diseases, it can be diagnosed through the use of serological and molecular methods. While the chronic renal disease, carrier state, and kidney fibrosis due to Leptospira infection in humans have been the subject of discussion by researchers, the mechanisms involved in these processes are still overlooked, and relatively little is known about the establishment and maintenance of the chronic status underlying this infectious disease. In this review, we highlight recent findings regarding the cellular communication pathways involved in the renal fibrotic process, as well as the relationship between renal fibrosis due to leptospirosis and CKD/CKDu.
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Affiliation(s)
- Luan Gavião Prado
- Laboratório de Bacteriologia, Instituto Butantan, Avenida Vital Brasil, 1500, São Paulo 05503-900, Brazil;
- Departamento de Microbiologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, Avenida Lineu Prestes 1374, São Paulo 05508-000, Brazil
| | - Angela Silva Barbosa
- Laboratório de Bacteriologia, Instituto Butantan, Avenida Vital Brasil, 1500, São Paulo 05503-900, Brazil;
- Correspondence:
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25
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Chuaypen N, Limothai U, Kunadirek P, Kaewsapsak P, Kueanjinda P, Srisawat N, Tangkijvanich P. Identification and validation of circulating miRNAs as potential new biomarkers for severe liver disease in patients with leptospirosis. PLoS One 2021; 16:e0257805. [PMID: 34570814 PMCID: PMC8476044 DOI: 10.1371/journal.pone.0257805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 09/10/2021] [Indexed: 11/23/2022] Open
Abstract
Background Leptospirosis, a global zoonotic infectious disease, has various clinical manifestations ranging from mild self-limiting illness to life-threatening with multi-organ damage, including liver involvement. This study was aimed at identifying circulating microRNAs (miRNAs) as novel biomarkers for predicting severe liver involvement in patients with leptospirosis. Methods In a discovery set, 12 serum samples of patients with anicteric and icteric leptospirosis at initial clinical presentation were used for miRNA profiling by a NanoString nCounter miRNA assay. In a validated cohort, top candidate miRNAs were selected and further tested by qRT-PCR in serum samples of 81 and 16 individuals with anicteric and icteric leptospirosis, respectively. Results The discovery set identified 38 significantly differential expression miRNAs between the two groups. Among these, miR-601 and miR-630 were selected as the top two candidates significantly up-regulated expressed in the icteric group. The enriched KEGG pathway showed that these miRNAs were mainly involved in immune responses and inflammation. In the validated cohort, miR-601 and miR-630 levels were significantly higher in the icteric group compared with the anicteric group. Additionally, these two miRNAs displayed good predictors of subsequent acute liver failure with a high sensitivity of 100%. On regression analysis, elevated miR-601 and miR-630 expression were also predictive of multi-organ failures and poor overall survival. Conclusion Our data indicated that miRNA expression profiles were significantly differentiated between the icteric and anicteric groups. Serum miR-601 and miR-630 at presentation could potentially serve as promising biomarkers for predicting subsequent acute liver failure and overall survival in patients with leptospirosis.
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Affiliation(s)
- Natthaya Chuaypen
- Center of Excellence in Hepatitis and Liver Cancer, Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Umaporn Limothai
- Excellence Center for Critical Care Nephrology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Pattapon Kunadirek
- Center of Excellence in Hepatitis and Liver Cancer, Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Pornchai Kaewsapsak
- Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Patipark Kueanjinda
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nattachai Srisawat
- Excellence Center for Critical Care Nephrology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Pisit Tangkijvanich
- Center of Excellence in Hepatitis and Liver Cancer, Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- * E-mail:
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26
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Selvarajah S, Ran S, Roberts NW, Nair M. Leptospirosis in pregnancy: A systematic review. PLoS Negl Trop Dis 2021; 15:e0009747. [PMID: 34520461 PMCID: PMC8462732 DOI: 10.1371/journal.pntd.0009747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 09/24/2021] [Accepted: 08/20/2021] [Indexed: 12/29/2022] Open
Abstract
Introduction Leptospirosis is a leading zoonotic disease worldwide with more than 1 million cases in the general population per year. With leptospirosis being an emerging infectious disease and as the world’s environment changes with more floods and environmental disasters, the burden of leptospirosis is expected to increase. The objectives of the systematic review were to explore how leptospirosis affects pregnancy, its burden in this population, its effects on maternal and fetal outcomes and the evidence base surrounding treatment options. Methods We performed a systematic review of published and unpublished literature using automated and manual methods to screen nine electronic databases since inception, with no language restriction. Two reviewers independently screened articles, completed the data extraction and assessment of risk of bias. Due to significant heterogeneity and paucity of data, we were unable to carry out a meta-analysis, but we conducted a pooled analysis of individual patient data from the case reports and case series to examine the patient and disease characteristics, diagnostic methods, differential diagnoses, antibiotic treatments, and outcomes of leptospirosis in pregnancy. The protocol for this review was registered on the International Prospective Register of Systematic Reviews, PROSPERO: CRD42020151501. Results We identified 419 records, of which we included eight observational studies, 21 case reports, three case series and identified four relevant ongoing studies. Overall the studies were with moderate bias and of ‘fair’ quality. We estimated the incidence of leptospirosis in pregnancy to be 1.3 per 10,000 in women presenting with fever or with jaundice, but this is likely to be higher in endemic areas. Adverse fetal outcomes were found to be more common in pregnant patients who presented in the second trimester compared with patients who presented in the third trimester. There is overlap between how leptospirosis presents in pregnancy and in the general population. There is also overlap between the signs, symptoms and biochemical disturbances associated with leptospirosis in pregnancy and the presentation of pregnancy associated conditions, such as Pre-Eclampsia (PET), Acute Fatty Liver of Pregnancy (AFLP) and HELLP Syndrome (Haemolysis Elevated Liver enzymes Low Platelets). In 94% of identified cases with available data, there was an indicator in the patient history regarding exposure that could have helped include leptospirosis in the clinician’s differential diagnosis. We also identified a range of suitable antibiotic therapies for treating leptospirosis in pregnancy, most commonly used were penicillins. Conclusion This is the first systematic review of leptospirosis in pregnancy and it clearly shows the need to improve early diagnosis and treatment by asking early, treating early, and reporting well. Ask early—broaden differential diagnoses and ask early for potential leptospirosis exposures and risk factors. Treat early—increase index of suspicion in pregnant patients with fever in endemic areas and combine with rapid field diagnosis and early treatment. Report well—need for more good quality epidemiological studies on leptospirosis in pregnancy and better quality reporting of cases in literature. There are more than 1 million cases of leptospirosis in the general population each year. Leptospirosis is an emerging infectious disease and as the world’s environment changes with more floods and environmental disasters, the impact of leptospirosis on the world is expected to increase. Leptospirosis is a zoonotic disease passed onto humans and can cause a range of illness from mild symptoms to severe organ failure and death. It is typically underreported and understudied, hence its classification as a ‘Neglected Tropical Disease’. This is the first systematic review on Leptospirosis in Pregnancy looking at how common it is in pregnancy, how it affects maternal and fetal outcomes, and options for management. We found there to be overlap between how leptospirosis presents in the general population and in pregnancy, and that it can mimic non-infectious conditions that only present in pregnancy such as Pre-Eclampsia, Acute Fatty Liver of Pregnancy and other syndromes where liver and platelet function is affected. Adverse fetal outcomes were found to be more common in pregnant patients who presented in the second trimester compared with patients who presented in the third trimester. In 94% of identified cases with available data, there was a clue in the patient’s history that could have indicated possible exposure to leptospirosis, which is very important in raising suspicion of a diagnosis of leptospirosis in pregnancy. We also identified a range of suitable antibiotic therapies for treating leptospirosis in pregnancy, most commonly used were penicillins. Our recommendations are: Ask early—broaden differential diagnoses and ask early for potential leptospirosis exposures and risk factors. Treat early—combine considering leptospirosis as a cause of fever in pregnant patients in endemic areas with prompt diagnosis and treatment. Report well—there is a need for more good quality epidemiological studies on leptospirosis in pregnancy and better quality reporting of cases in literature.
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Affiliation(s)
- Sujitha Selvarajah
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom
- * E-mail:
| | - Shaolu Ran
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Nia Wyn Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, United Kingdom
| | - Manisha Nair
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom
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27
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Nisansala T, Weerasekera M, Ranasinghe N, Marasinghe C, Gamage C, Fernando N, Gunasekara C. Importance of KIM-1 and MCP-1 in Determining the Leptospirosis-Associated AKI: A Sri Lankan Study. Biomed Res Int 2021; 2021:1752904. [PMID: 34124239 PMCID: PMC8192184 DOI: 10.1155/2021/1752904] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 05/05/2021] [Accepted: 05/22/2021] [Indexed: 12/03/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is one of most prevalent and serious complications of leptospirosis, a prevalent zoonotic disease in tropical countries. Prompt diagnosis of the leptospirosis-associated AKI is a challenge as there are no proper diagnostic tools that can identify patients in the early stage. Kidney injury molecule-1 (KIM-1) and monocyte chemoattractant protein-1 (MCP-1) are widely used novel AKI biomarkers that are studied in various disease conditions with AKI, but not in leptospirosis. Thus, this study is aimed at seeking the importance of KIM-1 and MCP-1 in determining the leptospirosis-associated AKI. METHODS Leptospirosis-suspected patients who were admitted to medical wards of two selected hospitals in the Western province of Sri Lanka were recruited. Leptospirosis was confirmed by three diagnostic tests: PCR, MAT, and culture, and the status of AKI was determined by Kidney Disease Improving Global Outcomes (KDIGO) criteria. RESULTS Of 170 leptospirosis-suspected patients, 79 were leptospirosis confirmed, and among them, 24.05% of patients were diagnosed to have AKI according to KDIGO criteria. Median serum KIM-1 (p < 0.0001), urine KIM-1 (0.0053), serum MCP-1 (0.0080), and urine MCP-1 (0.0019) levels in those developing AKI were significantly higher than in patients not developing AKI. The biomarker levels associated with leptospirosis AKI had AUC-ROC of 0.8565, 0.7292, 0.7024, and 0.7282 for serum KIM-1, urine KIM-1, serum MCP-1, and urine MCP-1, respectively. CONCLUSION This study revealed serum KIM-1 as a promising marker for leptospirosis-associated AKI among the tested biomarkers. Thus, further validation is recommended with a larger study group.
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Affiliation(s)
- Thilini Nisansala
- Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka
| | - Manjula Weerasekera
- Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka
| | | | - Chamil Marasinghe
- Department of Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka
| | - Chandika Gamage
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Sri Lanka
| | - Neluka Fernando
- Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka
| | - Chinthika Gunasekara
- Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka
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28
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Jilg N, Lau ES, Baker MA, Levy BD, Loscalzo J. A Treacherous Course. N Engl J Med 2021; 384:860-865. [PMID: 33657298 DOI: 10.1056/nejmcps2020668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Nikolaus Jilg
- From the Department of Medicine, Brigham and Women's Hospital (N.J., E.S.L., M.A.B., B.D.L., J.L.), the Department of Medicine, Massachusetts General Hospital (N.J.), and the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute (M.A.B.) - all in Boston
| | - Emily S Lau
- From the Department of Medicine, Brigham and Women's Hospital (N.J., E.S.L., M.A.B., B.D.L., J.L.), the Department of Medicine, Massachusetts General Hospital (N.J.), and the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute (M.A.B.) - all in Boston
| | - Meghan A Baker
- From the Department of Medicine, Brigham and Women's Hospital (N.J., E.S.L., M.A.B., B.D.L., J.L.), the Department of Medicine, Massachusetts General Hospital (N.J.), and the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute (M.A.B.) - all in Boston
| | - Bruce D Levy
- From the Department of Medicine, Brigham and Women's Hospital (N.J., E.S.L., M.A.B., B.D.L., J.L.), the Department of Medicine, Massachusetts General Hospital (N.J.), and the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute (M.A.B.) - all in Boston
| | - Joseph Loscalzo
- From the Department of Medicine, Brigham and Women's Hospital (N.J., E.S.L., M.A.B., B.D.L., J.L.), the Department of Medicine, Massachusetts General Hospital (N.J.), and the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute (M.A.B.) - all in Boston
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29
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Little J, Vaidya A, Jilg N, Lau E, Baker M. A Treacherous Course. N Engl J Med 2021; 384:e10. [PMID: 33534978 DOI: 10.1056/nejmimc2026145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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30
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Soler MC, Mogliani S, Benítez ST, Cabillón LN, Rollié RD, Martins GM. [Glucocorticoids in leptospira alveolar hemorrhage]. Medicina (B Aires) 2021; 81:107-110. [PMID: 33611253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
We present the clinical cases of two patients who were admitted to the HIGA San Martín de La Plata emergency ward with a clinical picture compatible with leptospirosis, who evolved with respiratory failure and alveolar hemorrhage. In both, glucocorticoids were administered with good evolution. A bibliographic search of articles published since 2005 in Spanish and English and a review of the topic was carried out. Based on the current evidence, no clear recommendation can be made for the use of corticosteroids in severe leptospirosis. The published bibliography is scarce and of low quality. There would appear to be a benefit in the use of corticosteroids in cases of pulmonary involvement due to severe leptospirosis. High-quality studies are needed to make recommendations with scientific evidence, to verify the adequate dose of corticosteroids, time of initiation, duration of treatment and the cases in which this therapy should be administered.
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Affiliation(s)
- Mercedes C Soler
- Servicio de Emergentología, Hospital Interzonal General de Agudos San Martín, La Plata, Buenos Aires, Argentina. E-mail:
| | - Sabrina Mogliani
- Servicio de Emergentología, Hospital Interzonal General de Agudos San Martín, La Plata, Buenos Aires, Argentina
| | - Santiago T Benítez
- Servicio de Emergentología, Hospital Interzonal General de Agudos San Martín, La Plata, Buenos Aires, Argentina
| | - Lorena N Cabillón
- Servicio de Emergentología, Hospital Interzonal General de Agudos San Martín, La Plata, Buenos Aires, Argentina
| | - Ricardo D Rollié
- Servicio de Emergentología, Hospital Interzonal General de Agudos San Martín, La Plata, Buenos Aires, Argentina
| | - Gustavo M Martins
- Servicio de Emergentología, Hospital Interzonal General de Agudos San Martín, La Plata, Buenos Aires, Argentina
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31
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Abstract
A 21-year-old man presented with the chief complaints of fever and sore throat after visiting Cambodia and Thailand. Computed tomography revealed multiple pulmonary nodules. After performing antibiotic therapy, the pulmonary nodules without bacteremia disappeared completely. Paired microscopic agglutination tests revealed seroconversion against Leptospira serogroup Autumnalis. Thus, he was diagnosed with multiple pulmonary nodules caused by leptospirosis. Leptospirosis is a common zoonosis that occurs in tropical and subtropical areas. Its various clinical features include unspecified fever and Weil's disease. Although diffuse alveolar hemorrhaging is known to occur in severe leptospirosis, multiple pulmonary nodules resembling septic emboli or vasculitis are a rare complication.
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Affiliation(s)
- Ran Nagai
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
- Department of Cardiology, National Center for Global Health and Medicine, Japan
| | - Kei Yamamoto
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
| | - Daisuke Shiojiri
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
| | - Satoshi Kutsuna
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
| | - Yasuyuki Kato
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
| | - Nobuo Koizumi
- Department of Bacteriology I, National Institute of Infectious Diseases, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
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Chiu HH, Juan HL, Lu PL, Chang K. A graveyard keeper with severe hyperbilirubinemia caused by leptospirosis. J Microbiol Immunol Infect 2020; 54:536-537. [PMID: 32518036 DOI: 10.1016/j.jmii.2020.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Huei-Hsuan Chiu
- Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC.
| | - Huai-Lei Juan
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC.
| | - Po-Liang Lu
- Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC.
| | - Ko Chang
- Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC; Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC.
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Ladak M. Unusual case of pyogranulomatous hepatitis of suspected infectious etiology in a 3-year-old Labrador retriever dog. Can Vet J 2020; 61:534-536. [PMID: 32355355 PMCID: PMC7155889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A 3-year-old spayed female Labrador retriever dog was presented with clinical signs of lethargy, vomiting, hyporexia, and increased respiratory effort. An exploratory laparotomy was conducted and a liver biopsy submitted for histopathologic evaluation revealed moderate multifocal coalescing pyogranulomatous hepatitis. Clinical signs, hematological parameters, and liver histopathology suggested an infectious etiology, such as leptospirosis, mycobacteriosis, or fungal infection. Polymerase chain reaction (PCR) and immunohistochemistry (IHC) for leptospirosis were negative. The infectious etiology was not identified, but leptospirosis may have played a role in the disease.
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Affiliation(s)
- Malika Ladak
- Ontario Veterinary College, University of Guelph, Guelph, Ontario N1G 2W1
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34
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Ince N, Kilinçel Ö, Demirel-Gügül T, Tanişman I, Altun G. Leptospirosis: a six-case report from west black sea, Turkey. Infez Med 2020; 28:91-97. [PMID: 32172267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Leptospirosis is a ubiquitous acute bacterial zoonosis. This report describes six cases presenting to our hospital with symptoms such as fever and muscle pain and diagnosed as leptospirosis. All cases presented with fever, muscle pain, and lethargy and were engaged in activities such as farming, hunting, and fishing. Thrombocytopenia and impaired liver function tests were found in all patients, increased creatine-kinase in five, and increased creatinine in four. Leptospirosis was diagnosed using polymerase chain reaction (PCR). The course of the disease resulted in cure in three cases, chronic kidney disease sequelae in one, and death in two. In conclusion, the possibility of leptospirosis should be considered in patients presenting with non-specific symptoms such as fever and muscle pain and developing thrombocytopenia, and liver and kidney function disorder. Risk factors should also be investigated when taking histories. Early diagnosis and antibiotic therapy being started as quickly as possible are important in terms of the course of the disease.
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Affiliation(s)
- Nevin Ince
- Düzce University Faculty of Medicine, Department of Infectious Diseases, Düzce, Turkey
| | - Özge Kilinçel
- Düzce Atatürk State Hospital, Microbiology Laboratory, Düzce, Turkey
| | | | - Işilay Tanişman
- Düzce University Faculty of Medicine, Department of Infectious Diseases, Düzce, Turkey
| | - Gülşah Altun
- Düzce University Faculty of Medicine, Department of Internal Diseases, Düzce, Turkey
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35
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Gupta N, Nischal N. Management of acute febrile diseases in limited resource settings: a case-based approach. Infez Med 2020; 28:11-16. [PMID: 32172256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
There is a massive burden of acute febrile diseases during the post-monsoon season in tropical countries. Despite this, there is a lack of clarity amongst the primary care physicians and travel medicine experts on how to approach such patients in a syndromic fashion. In this review, the authors summarize a case-based approach in the management of acute febrile diseases.
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Affiliation(s)
- Nitin Gupta
- Department of Infectious Diseases, Kasturba Medical College, Manipal, India
| | - Neeraj Nischal
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
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36
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Meneses GC, da Silva GB, Tôrres PPBF, de Castro VQ, Lopes RL, Martins AMC, Daher EDF. Novel kidney injury biomarkers in tropical infections: a review of the literature. Rev Inst Med Trop Sao Paulo 2020; 62:e14. [PMID: 32074217 PMCID: PMC7032010 DOI: 10.1590/s1678-9946202062014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/21/2020] [Indexed: 12/29/2022] Open
Abstract
Tropical diseases are mainly found in the tropical regions of Asia, Africa and Latin America. They are a major Public Health problem in these regions, most of them are considered neglected diseases and remain as important contributors to the development of AKI (Acute Kidney Injury), which is associated with increased patients' morbidity and mortality. In most countries, kidney disease associated to tropical diseases is attended at health services with poor infrastructure and inadequate preventive measures. The long-term impacts of these infections on kidney tissue may be a main cause of future kidney disease in these patients. Therefore, the investigation of novel kidney injury biomarkers in these tropical diseases is of utmost importance to explain the mechanisms of kidney injury, to improve their diagnosis and prognosis, as well as the assessment to health systems by these patients. Since 2011, our group has been studying renal biomarkers in visceral and cutaneous leishmaniasis, schistosomiasis, leptospirosis and leprosy. This study has increased the knowledge on the pathophysiology of kidney disease in the presence of these infections and has contributed to the early diagnosis of kidney injury, pointing to glomerular, endothelial and inflammatory involvement as the main causes of the mechanisms leading to nephropathy and clinical complications. Future perspectives comprise establishing long-term cohort groups to assess the development of kidney disease and the patients' survival, as well as the use of new biomarkers such as urinary exosomes to detect risk groups and to understand the progression of kidney injuries.
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Affiliation(s)
- Gdayllon Cavalcante Meneses
- Universidade Federal do Ceará, Faculdade de Medicina, Departamento
de Medicina Clínica, Programa de Pós-Graduação em Ciências Médicas, Fortaleza,
Ceará, Brazil
- Universidade Federal do Ceará, Faculdade de Farmácia, Odontologia e
Enfermagem, Laboratório de Nefrologia e Doenças Tropicais, Fortaleza, Ceará,
Brazil
| | - Geraldo Bezerra da Silva
- Universidade de Fortaleza, Centro de Ciências da Saúde, Curso de
Medicina, Programa de Pós-Graduação em Saúde Coletiva e Ciências Médicas, Fortaleza,
Ceará, Brazil
- Universidade Federal do Ceará,Faculdade de Farmácia, Odontologia e
Enfermagem, Programa de Pós-Graduação em Ciências Farmacêuticas, Fortaleza, Ceará,
Brazil
| | - Paulo Pacelli Bezerra Filizola Tôrres
- Universidade Federal do Ceará,Faculdade de Farmácia, Odontologia e
Enfermagem, Programa de Pós-Graduação em Ciências Farmacêuticas, Fortaleza, Ceará,
Brazil
| | - Valeska Queiroz de Castro
- Universidade Federal do Ceará,Faculdade de Farmácia, Odontologia e
Enfermagem, Programa de Pós-Graduação em Ciências Farmacêuticas, Fortaleza, Ceará,
Brazil
| | - Renata Lima Lopes
- Universidade de Fortaleza, Centro de Ciências da Saúde, Curso de
Medicina, Programa de Pós-Graduação em Saúde Coletiva e Ciências Médicas, Fortaleza,
Ceará, Brazil
| | - Alice Maria Costa Martins
- Universidade Federal do Ceará, Faculdade de Farmácia, Odontologia e
Enfermagem, Laboratório de Nefrologia e Doenças Tropicais, Fortaleza, Ceará,
Brazil
- Universidade Federal do Ceará,Faculdade de Farmácia, Odontologia e
Enfermagem, Programa de Pós-Graduação em Ciências Farmacêuticas, Fortaleza, Ceará,
Brazil
| | - Elizabeth De Francesco Daher
- Universidade Federal do Ceará, Faculdade de Medicina, Departamento
de Medicina Clínica, Programa de Pós-Graduação em Ciências Médicas, Fortaleza,
Ceará, Brazil
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37
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Tomschik M, Koneczny I, Schötta AM, Scharer S, Smajlhodzic M, Rosenegger PF, Blüthner M, Höftberger R, Zimprich F, Stanek G, Markowicz M. Severe Myasthenic Manifestation of Leptospirosis Associated with New Sequence Type of Leptospira interrogans. Emerg Infect Dis 2019; 25:968-971. [PMID: 31002066 PMCID: PMC6478190 DOI: 10.3201/eid2505.181591] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We report the rapid development of a myasthenic crisis as the first-time manifestation of myasthenia gravis. The symptoms developed in the course of acute leptospirosis associated with a new sequence type of Leptospira interrogans. Antibiotic treatment led to rapid amelioration of myasthenia.
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D'Elia L, Consiglio Barozzino M, Liberatori M, Panocchia N. [Leptospirosis and kidneys: a clinical case]. G Ital Nefrol 2019; 36:36-5-2019-7. [PMID: 31580545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
We describe here the case of a young patient, employed in agriculture, who entered the emergency room with fever, headache, hematuria and a worsening of renal function; we diagnosed leptospirosis with renal involvement. As the patient lamented very generic symptoms, the anamnesis was fundamental in leading us to suspect an infection, execute the right laboratory analysis, and correctly diagnose a pathology which is currently very rare in Italy.
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Affiliation(s)
- Lorenzo D'Elia
- U.O.C. Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia; Università Cattolica del Sacro Cuore, Roma, Italia
| | - Maria Consiglio Barozzino
- Università Cattolica del Sacro Cuore, Roma, Italia; U.O.C. Medicina Interna, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Massimo Liberatori
- U.O.C. Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia; Università Cattolica del Sacro Cuore, Roma, Italia
| | - Nicola Panocchia
- U.O.C. Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia; Università Cattolica del Sacro Cuore, Roma, Italia
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Abstract
CME: Zoonosis in Switzerland: Leptospirosis Abstract. Leptospirosis is worldwide a common zoonosis that also occurs in Switzerland. Frequently it presents as a self-limited, mild illness. The more severe presentation with jaundice and sever acute kidney injury (Weil's disease) is, however, associated with a high morbidity and mortality. In order to make the diagnosis, it is important to recognize the typical findings and perform the appropriate diagnostic workup. In this article, we discuss the clinical signs, diagnostic workup, therapy and prevention of leptospirosis and present the case of a 54-year-old patient with severe leptospirosis.
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Affiliation(s)
- Isabelle Vock
- 1 Medizinische Klinik, Spital Rheinfelden, Gesundheitszentrum Fricktal
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40
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Carrillo-Larco RM, Altez-Fernandez C, Acevedo-Rodriguez JG, Ortiz-Acha K, Ugarte-Gil C. Leptospirosis as a risk factor for chronic kidney disease: A systematic review of observational studies. PLoS Negl Trop Dis 2019; 13:e0007458. [PMID: 31120876 PMCID: PMC6550415 DOI: 10.1371/journal.pntd.0007458] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/05/2019] [Accepted: 05/11/2019] [Indexed: 01/09/2023] Open
Abstract
Background Leptospirosis is a worldwide prevalent zoonosis and chronic kidney disease (CKD) is a leading global disease burden. Because of pathophysiological changes in the kidney, it has been suggested that these conditions may be associated. However, the extent of this interaction has not been synthetized. We aimed to systematically review and critically appraise the evidence on the association between leptospirosis and CKD. Methodology/Principal findings Observational studies with a control group were selected. Leptospirosis, confirmed with laboratory methods, and CKD also based on a laboratory assessment, were the exposures and outcomes of interest. The search was conducted in EMBASE, MEDLINE, Global Health, Scopus and Web of Science. Studies selected for qualitative synthesis were assessed for risk of bias following the Newcastle-Ottawa Scale. 5,981 reports were screened, and 2 (n = 3,534) were included for qualitative synthesis. The studies were conducted in Taiwan and Nicaragua; these reported cross-sectional and longitudinal estimates. In the general population, the mean estimated glomerular filtration rate (eGFR) was lower (p<0.001) in people testing positive for antileptospira antibodies (eGFR = 98.3) than in negative controls (eGFR = 100.8). Among sugarcane applicants with high creatinine, those who were seropositive had lower eGFR (mean difference: -10.08). In a prospective analysis, people with high antileptospira antibodies titer at baseline and follow-up, had worse eGFR (p<0.05). Conclusion Although the available evidence suggests there may be a positive association between leptospirosis and CKD, whereby leptospirosis could be a risk factor for CKD, it is still premature to draw conclusions. There is an urgent need for research on this association. Leptospirosis is an infection that can affect the kidneys acutely, though it seems that even after the acute infection there could be risk of a long-term impaired kidney function. The evidence on this matter is sparse and limited, thus the need to comprehensively seek, synthetize and appraise the available scientific literature. In so doing, this work has found preliminary evidence that leptospirosis may be associated with impaired kidney function as per eGFR. This work and findings strongly reveal that more research is needed to quantify and characterize the long-term risk of CKD among those who had had leptospirosis infection. The raising burden of non-communicable diseases paired with a still non-negligible burden of communicable and neglected tropical diseases in low- and middle-income countries, deserve the synergism of these two broad fields for the benefit of patients and population health.
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Affiliation(s)
- Rodrigo M. Carrillo-Larco
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Centro de Estudios de Población, Universidad Católica los Ángeles de Chimbote (ULADECH-Católica), Chimbote, Perú
- * E-mail:
| | | | | | - Karol Ortiz-Acha
- Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Cesar Ugarte-Gil
- Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Jayathilaka PGNS, Mendis ASV, Perera MHMTS, Damsiri HMT, Gunaratne AVC, Agampodi SB. An outbreak of leptospirosis with predominant cardiac involvement: a case series. BMC Infect Dis 2019; 19:265. [PMID: 30885170 PMCID: PMC6423826 DOI: 10.1186/s12879-019-3905-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 03/14/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Severe leptospirosis is known to cause multi organ dysfunction including cardiac involvement. In the clinical setting with limited resources, high degree of suspicion is needed to diagnose cardiac involvement including myocarditis. Although myocarditis is not reported as a common complication due to lack of diagnostic facilities, there are evidence to support myocarditis is more prevalent in post mortem studies of patients died due to leptospirosis. We present a case series of severe leptospirosis with cardiac involvement observed during a period of one month at Colombo-North Teaching Hospital, Sri Lanka. CASE PRESENTATION We report here five patients with severe leptospirosis complicated with cardiac involvement, admitted to a single medical ward, Colombo-North Teaching Hospital, Sri Lanka during a one-month period. Out of six suspected leptospirosis patients admitted during that period, five in a raw developed severe leptospirosis with cardiac involvement. In this case series, four patients were confirmed serologically or quantitative PCR and one patient had possible leptospirosis. All patients developed shock during their course of illness. Two patients developed rapid atrial fibrillation. One patient had dynamic T wave changes in ECG and the other two had sinus tachycardia. Two patients had evidence of myocarditis in 2D echocardiogram, whereas other two patients had nonspecific findings and one patient had normal 2D echocardiogram. All five patients had elevated cardiac troponin I titre and it was normalized with the recovery. All five patients developed acute kidney injury. Four patients needed inotropic/vasopressor support to maintain mean arterial pressure and one patient recovered from shock with fluid resuscitation. All patients were recovered from their illness and repeat 2D echocardiograms after recovery did not show residual complications. One patient had serologically proven dengue co-infection with leptospirosis. CONCLUSIONS Myocarditis and cardiac involvement in leptospirosis may be overlooked due to non-specific clinical findings and co-existing multi-organ dysfunction. Atypical presentation of this case series may be due to micro-geographic variation and unusual outbreak of leptospirosis. Co-infection of dengue with leptospirosis should be considered in managing patients especially in endemic areas.
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Affiliation(s)
| | | | | | | | | | - Suneth Buddhika Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
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Ho CW, Tan NW, Thoon KC, Chong CY. A Review of Four Cases of Leptospirosis Presenting for Acute Care to a Tertiary Paediatric Hospital in Singapore. Ann Acad Med Singap 2019; 48:104-108. [PMID: 30997480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Christopher Ww Ho
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore
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43
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Tan TL, Lee LY, Lim WC. Fatal Leptospirosis and Escherichia coli co-infection in a post-partum woman. Med J Malaysia 2018; 73:427-429. [PMID: 30647223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The occurrence of Leptospirosis and Escherichia coli coinfection in the post-partum period is a novel case. This report illustrated a previously well woman from a suburban area presented with acute neurological deterioration following a two days history of fever during her puerperal period. Early interventions with fluids, broad spectrum antibiotics and intensive supportive care were given. Despite that, she deteriorated rapidly and developed pulmonary hemorrhage, disseminated intravascular coagulopathy, and multi-organ failure. She succumbed within 12 hours of admission. The knowledge about such fatal co-infections should be disseminated to medical practitioners encountering Leptospirosis infection and general public.
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Affiliation(s)
- T L Tan
- Hospital Seri Manjung, Department of Internal Medicine, Manjung, Perak Malaysia.
| | - L Y Lee
- Hospital Seri Manjung, Department of Internal Medicine, Manjung, Perak Malaysia
| | - W C Lim
- Hospital Seri Manjung, Department of Internal Medicine, Manjung, Perak Malaysia
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Rahimi R, Omar E, Tuan Soh TS, Mohd Nawi SFA, Md Noor S. Leptospirosis in pregnancy: A lesson in subtlety. Malays J Pathol 2018; 40:169-173. [PMID: 30173235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Leptospirosis is a zoonotic disease caused by spirochaete of the genus Leptospira. Human infection occurs after exposure to water or soil contaminated by urine from an infected animal. Most patients manifest as self-limited systemic illness. However 10% of patients manifest as severe disease associated with high fatality. The disease affects mostly men, cases involving pregnant women are uncommon. We presented a case of leptospirosis in a pregnant woman leading to mortality of both mother and foetus. CASE REPORT A 28-year-old woman at 18 weeks of gestation, had shortness of breath and collapsed. She was brought unconscious to the emergency department and died shortly after arrival. A week prior to this, she had presented to the same hospital with pain on both thighs. Examination of the patient and ultrasound of the foetus revealed normal findings. Post mortem examination revealed hepatosplenomegaly and congested lungs; no jaundice, meningeal inflammation or cardiac abnormalities was evident. Histopathology examination of the lungs revealed pulmonary haemorrhages and oedema. Multiple infarcts were seen in the spleen and the kidneys showed foci of acute tubular necrosis. Laboratory investigations revealed Leptospira IgM antibody and PCR for leptospira were positive. This case illustrates the subtleness of clinical presentation of leptospirosis. The diagnosis was obscure even at post-mortem and was only suspected following histopathological examination, leading to further investigations. CONCLUSION Leptospirosis may have a subtle presentation and a high index of suspicion for this infection is required for early identification of the disease.
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Affiliation(s)
- R Rahimi
- University Teknologi MARA, Faculty of Medicine, Centre for Diagnostic & Research Laboratories, Selangor, Malaysia.
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Asensio-Sánchez VM, Haro-Álvarez B, Herreras J, Martín-Prieto A. Unusual ocular clinical manifestation of leptospirosis. ACTA ACUST UNITED AC 2018; 93:342-346. [PMID: 29398239 DOI: 10.1016/j.oftal.2017.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 12/09/2017] [Accepted: 12/15/2017] [Indexed: 11/19/2022]
Abstract
CLINICAL CASE An uncommon case is presented of a 15 year-old girl with bilateral, multiple serous detachments of retina and retinal pigment epithelium. With clinical and laboratory (IgG 1/160 and IgM 1/160, using an indirect immunofluorescence assay) diagnoses of leptospirosis, a complete ophthalmic examination, fluorescein angiography, autofluorescence and optical coherence tomography were performed, and the patient was followed for two years. DISCUSSION Bilateral, multiple serous detachments of retina and retinal pigment epithelium can be a complication of systemic leptospirosis, a zoonotic disease caused by Leptospira. Without a detailed medical history it may be underdiagnosed, mainly because it can mimic other more common diseases. It may be prudent to ask patients regarding contact with pets.
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Affiliation(s)
- V M Asensio-Sánchez
- Servicio de Oftalmología, Hospital Clínico Universitario, Valladolid, España.
| | - B Haro-Álvarez
- Servicio de Oftalmología, Hospital Clínico Universitario, Valladolid, España
| | - J Herreras
- Servicio de Oftalmología, Hospital Clínico Universitario, Valladolid, España
| | - A Martín-Prieto
- Servicio de Oftalmología, Hospital Clínico Universitario, Valladolid, España
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Cantwell T, Ferre A, Van Sint Jan N, Blamey R, Dreyse J, Baeza C, Diaz R, Regueira T. Leptospirosis-associated catastrophic respiratory failure supported by extracorporeal membrane oxygenation. J Artif Organs 2017; 20:371-376. [PMID: 29019017 PMCID: PMC7102126 DOI: 10.1007/s10047-017-0998-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 09/21/2017] [Indexed: 01/19/2023]
Abstract
A previously healthy, 39-year-old obese farmer, arrived hypotensive and tachycardic, with fever, myalgia, headache, abdominal pain, diarrhea, and progressive dyspnea. Ten days before symptoms onset, he was in direct contact with mice and working in a contaminated drain. Patient laboratory showed acute kidney injury and thrombocytopenia. Chest X-ray exhibited bilateral diffuse interstitial infiltrates. First-line empirical antibiotics were started and influenza discarded. Patient evolved with severe respiratory failure, associated with hemoptysis, and rapidly severe hemodynamic compromise. Despite neuromuscular blockade and prone positioning, respiratory failure increased. Accordingly, veno-venous ECMO was initiated, with bilateral femoral extraction and jugular return. After ECMO connection, there was no significant improvement in oxygenation, and low pre-membrane saturations and low arterial PaO2 of the membrane showed that we were out of the limits of the rated flow. Thus, a second membrane oxygenator was installed in parallel. Afterward, oxygenation improved, with subsequent perfusion enhancement. Regarding etiology, due to high suspicion index, Leptospira serology was performed, coming back positive and meropenem was maintained. The patient ultimately recovered and experience excellent outcome. The clinical relevance of the case is the scared evidence of leptospirosis-associated severe respiratory failure treated with ECMO. This experience emphasizes the importance of an optimal support, which requires enough membrane surface and flow for an obese, highly hyperdynamic patient, during this reversible disease. A high index of suspicion is needed for an adequate diagnosis of leptospirosis to implement the correct treatment, particularly in the association of respiratory failure, pulmonary hemorrhage, and an epidemiological-related context.
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Affiliation(s)
- Tamara Cantwell
- Centro de Pacientes Críticos, Clínica las Condes, Estoril 450, Las Condes, Santiago, Chile
| | - Andrés Ferre
- Centro de Pacientes Críticos, Clínica las Condes, Estoril 450, Las Condes, Santiago, Chile
| | - Nicolette Van Sint Jan
- Centro de Pacientes Críticos, Clínica las Condes, Estoril 450, Las Condes, Santiago, Chile
- Unidad de ECMO, Clínica las Condes, Santiago, Chile
| | - Rodrigo Blamey
- Departamento de Infectología, Clínica las Condes, Santiago, Chile
| | - Jorge Dreyse
- Centro de Pacientes Críticos, Clínica las Condes, Estoril 450, Las Condes, Santiago, Chile
| | - Cristian Baeza
- Departamento de Cardiocirugía, Clínica las Condes, Santiago, Chile
| | - Rodrigo Diaz
- Unidad de ECMO, Clínica las Condes, Santiago, Chile
| | - Tomás Regueira
- Centro de Pacientes Críticos, Clínica las Condes, Estoril 450, Las Condes, Santiago, Chile.
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Zakrajsek E. Unusual presentation of cyathostomiasis in an adult Thoroughbred mare. Can Vet J 2017; 58:1221-1223. [PMID: 29089663 PMCID: PMC5640273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A recently purchased 16-year-old Thoroughbred mare with a history of recurrent colic and low body weight, also had lameness in 3 limbs, pain at the sacro-iliac joint, and increased corneal opacity of the right eye. Response to supportive therapy was poor and euthanasia was elected. A postmortem examination and histopathology confirmed cyathostomiasis within the large colon and cecum and chronic anterior uveitis of the right eye.
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48
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Malalana F, Blundell RJ, Pinchbeck GL, Mcgowan CM. The role of Leptospira spp. in horses affected with recurrent uveitis in the UK. Equine Vet J 2017; 49:706-709. [PMID: 28321895 PMCID: PMC5655720 DOI: 10.1111/evj.12683] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 03/14/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Equine recurrent uveitis (ERU) is a common cause of ocular pain and blindness in horses. Leptospira spp. have been commonly implicated in the pathophysiology of ERU in mainland Europe and the USA. No recent studies have been carried out in the UK, but Leptospira is reported not to be a major factor in the aetiology of ERU in the UK. OBJECTIVES To establish the prevalence of Leptospira-associated ERU in the UK and to identify the serovars involved in these cases; to compare serum vs. aqueous humour antibody levels in cases and controls in order to confirm the diagnosis of Leptospira-associated ERU, and to assess the usefulness of serology alone as a confirmatory test for Leptospira-associated ERU in the UK. STUDY DESIGN Case-control study. METHODS Eyes enucleated for clinical reasons in ERU-affected horses were collected. Blood and aqueous humour were obtained to determine antibody levels against a variety of Leptospira serovars and C-values (aqueous humour value/serum value) were calculated. In addition, eyes, blood and aqueous humour were obtained from control cases for comparison. Histopathology was performed in all eyes to confirm uveitis in each case. Differences in seroprevalences between ERU and control cases and between Leptospira- and non-Leptospira-associated ERU cases were calculated. RESULTS A total of 30 ERU and 43 control eyes were analysed. Of the ERU eyes, only two had a C-value of >4 (prevalence of Leptospira-associated uveitis: 6.7%). Serovars hardjo and javanica were detected. There was no difference in seroprevalence between horses with uveitis and control cases (65.5% and 41.9%, respectively; P = 0.11) or between Leptospira- and non-Leptospira-associated uveitis cases (100% and 63.0%, respectively; P = 0.52). MAIN LIMITATIONS The study was limited by low case numbers. Eyes were presented at different stages of disease. The only test used to detect Leptospira was the microscopic agglutination test. CONCLUSIONS Leptospira-associated ERU is uncommon in the UK. Serology alone may not help to definitively diagnose Leptospira-associated uveitis in this country.
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Affiliation(s)
- F. Malalana
- School of Veterinary Science, University of LiverpoolNestonUK
| | - R. J. Blundell
- School of Veterinary Science, University of LiverpoolNestonUK
| | - G. L. Pinchbeck
- Institute of Infection and Global HealthSchool of Veterinary Science, University of LiverpoolNestonUK
| | - C. M. Mcgowan
- Institute of Ageing and Chronic DiseaseSchool of Veterinary Science, University of LiverpoolNestonUK
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Chu JT, Hossain R, Silverblatt FJ, Hyle EP, Turbett SE. Case 22-2017. A 21-Year-Old Woman with Fever, Headache, and Myalgias. N Engl J Med 2017; 377:268-278. [PMID: 28723324 DOI: 10.1056/nejmcpc1616399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Jacqueline T Chu
- From the Departments of Medicine (J.T.C., E.P.H.), Radiology (R.H.), and Pathology (S.E.T.), Massachusetts General Hospital, and the Departments of Medicine (J.T.C., E.P.H.), Radiology (R.H.), and Pathology (S.E.T.), Harvard Medical School - both in Boston; and the Department of Medicine, Alpert School of Medicine, Brown University, Providence, RI (F.J.S.)
| | - Rydhwana Hossain
- From the Departments of Medicine (J.T.C., E.P.H.), Radiology (R.H.), and Pathology (S.E.T.), Massachusetts General Hospital, and the Departments of Medicine (J.T.C., E.P.H.), Radiology (R.H.), and Pathology (S.E.T.), Harvard Medical School - both in Boston; and the Department of Medicine, Alpert School of Medicine, Brown University, Providence, RI (F.J.S.)
| | - Frederic J Silverblatt
- From the Departments of Medicine (J.T.C., E.P.H.), Radiology (R.H.), and Pathology (S.E.T.), Massachusetts General Hospital, and the Departments of Medicine (J.T.C., E.P.H.), Radiology (R.H.), and Pathology (S.E.T.), Harvard Medical School - both in Boston; and the Department of Medicine, Alpert School of Medicine, Brown University, Providence, RI (F.J.S.)
| | - Emily P Hyle
- From the Departments of Medicine (J.T.C., E.P.H.), Radiology (R.H.), and Pathology (S.E.T.), Massachusetts General Hospital, and the Departments of Medicine (J.T.C., E.P.H.), Radiology (R.H.), and Pathology (S.E.T.), Harvard Medical School - both in Boston; and the Department of Medicine, Alpert School of Medicine, Brown University, Providence, RI (F.J.S.)
| | - Sarah E Turbett
- From the Departments of Medicine (J.T.C., E.P.H.), Radiology (R.H.), and Pathology (S.E.T.), Massachusetts General Hospital, and the Departments of Medicine (J.T.C., E.P.H.), Radiology (R.H.), and Pathology (S.E.T.), Harvard Medical School - both in Boston; and the Department of Medicine, Alpert School of Medicine, Brown University, Providence, RI (F.J.S.)
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Abstract
A 22-year-old man presented to the emergency department on Christmas Day with a 5-day history of myalgias, cough, dyspnea, nonbilious emesis, and nonbloody diarrhea. Although he had been ill for several days, he ultimately sought treatment because of intractable vomiting. He reported feeling feverish, although he had not measured his temperature, and noted one episode of hemoptysis.
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Affiliation(s)
- Sara Mixter
- From the Divisions of General Internal Medicine (S.M., R.S.M., L.P.) and Infectious Disease (S.C.K.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore; and the Department of Medicine and the Division of Infectious Disease, University of California, San Francisco, San Francisco (H.H.)
| | - Reza Sedighi Manesh
- From the Divisions of General Internal Medicine (S.M., R.S.M., L.P.) and Infectious Disease (S.C.K.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore; and the Department of Medicine and the Division of Infectious Disease, University of California, San Francisco, San Francisco (H.H.)
| | - Sara C Keller
- From the Divisions of General Internal Medicine (S.M., R.S.M., L.P.) and Infectious Disease (S.C.K.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore; and the Department of Medicine and the Division of Infectious Disease, University of California, San Francisco, San Francisco (H.H.)
| | - Laura Platt
- From the Divisions of General Internal Medicine (S.M., R.S.M., L.P.) and Infectious Disease (S.C.K.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore; and the Department of Medicine and the Division of Infectious Disease, University of California, San Francisco, San Francisco (H.H.)
| | - Harry Hollander
- From the Divisions of General Internal Medicine (S.M., R.S.M., L.P.) and Infectious Disease (S.C.K.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore; and the Department of Medicine and the Division of Infectious Disease, University of California, San Francisco, San Francisco (H.H.)
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