11/33. Unusual causes of reactive arthritis: Leptospira and coxiella burnetii.Reactive arthritis is a well-defined clinical syndrome occurring after various infections, although most cases are usually associated with Chlamydiae and gastrointestinal pathogens. Its immunologic background has been extensively studied, as has its relationship with HLA-B27. We describe two cases of reactive arthritis arising after infections with two pathogens not so far related to the occurrence of reactive arthritis: one patient exhibited migratory oligoarthritis shortly after the course of acute q fever, and another patient developed monoarthritis during recovery from leptospirosis. arthritis was transient and did not exhibit a chronic course in either patient. We further discuss the context of pathophysiology of the arthritis in these patients, with an emphasis on the immunomodulatory properties of these two pathogens.- - - - - - - - - - ranking = 1keywords = fever (Clic here for more details about this article) |
12/33. Report of three children with leptospirosis in rural area of the east of turkey.leptospirosis is a systemic infection usually producing fever with hepatorenal involvement, meningoencephalitis, and hemorrhage. In this article, we present three children between 10 and 13 years of age with leptospirosis. The purpose of this paper is to emphasize that leptospirosis is a problem in our country with farmers/cattle and that leptospirosis should be considered in certain ill children. The main symptoms were headache, fever, fatigue, abdominal pain and unconsciousness. Two patients had hepatic and renal involvement. The other had hepatic, pulmonary and probably pericardial involvement. In all children spirochetes were demonstrated in blood and urine smears by dark-field microscopy and they were also isolated from urine and blood cultures by using Flecher medium. All patients were treated with penicillin; however, one subsequently required additional antibiotics due to klebsiella pneumoniae septicemia. While one patient was discharged in a good health, the others were taken to their home by parents without completing treatment. In conclusion, we would like to emphasize that leptospirosis is still a public health problem in our region (Eastern turkey) in where the majority of population are farmers and raise domestic animals such as cattle in rural areas. Additionally, leptospirosis should be considered in children admitted with headache, unconsciousness, fever and abdominal pain.- - - - - - - - - - ranking = 3keywords = fever (Clic here for more details about this article) |
13/33. Reemerging leptospirosis, california.leptospirosis is a reemerging infectious disease in california. leptospirosis is the most widespread zoonosis throughout the world, though it is infrequently diagnosed in the continental united states. From 1982 to 2001, most reported california cases occurred in previously healthy young adult white men after recreational exposures to contaminated freshwater. We report five recent cases of human leptospirosis acquired in california, including the first documented common-source outbreak of human leptospirosis acquired in this state, and describe the subsequent environmental investigation. Salient features in the california cases include high fever with uniform renal impairment and mild hepatitis. Because leptospirosis can progress rapidly if untreated, this reemerging infection deserves consideration in febrile patients with a history of recreational freshwater exposure, even in states with a low reported incidence of infection.- - - - - - - - - - ranking = 1keywords = fever (Clic here for more details about this article) |
14/33. leptospirosis presenting with fever and pulmonary hemorrhage.Reports of leptospirosis have recently been increasing in taiwan. We report a case of leptospirosis with the unusual initial manifestation of pulmonary hemorrhage. The patient presented with cough for 1 week and was admitted. After admission, fever, hemoptysis and severe dyspnea developed suddenly. Chest radiograph showed bilateral diffuse pulmonary infiltrates and he was transferred to the emergency room of our hospital. oxygen saturation was 86% under room air and respiratory rate was 30 per minute. After admission to the thoracic ward on the third morning, parenteral penicillin and trimethoprim-sulfamethoxazole were given empirically, and a dramatic recovery ensued. Microscopic agglutination test showed an increased titer of 1:6400 against Leptospira interrogans serogroup shermani on the fourth day of hospitalization. Neither jaundice nor renal insufficiency occurred during treatment. Pulmonary hemorrhage may be an under-recognized manifestation of leptospirosis in Taiwanese patients. leptospirosis should be taken into consideration in the differential diagnosis of pulmonary hemorrhage. Early treatment can lead to cure with reduced morbidity.- - - - - - - - - - ranking = 5keywords = fever (Clic here for more details about this article) |
15/33. Leptospiral pneumonia.Severe leptospirosis rarely presents with primary pulmonary manifestations, without any associated jaundice or renal dysfunction. The authors report a nine-year-old boy who presented with complaints of abrupt onset of high fever; with myalgia, headache, and pain in right chest region, productive cough with hemoptysis and vomiting developing over the past 72 hours. Chest radiograph showed consolidation in the right upper lobe with air bronchogram. A history of contact with sewage water and presence of conjunctival suffusion in a child with pneumonia made us suspect leptospirosis. Following prompt initiation of parenteral penicillin therapy the child's complaints resolved over the next five days. Dri-Dot test to detect anti-Leptospira antibodies was positive. The diagnosis of leptospirosis was confirmed by a positive microagglutination test to leptospira interrogans serovar australis by a fourfold rise in antibody titer in paired sera collected during convalescence. leptospirosis presenting with pulmonary hemorrhage has been associated with significant mortality but it can be successfully treated with early clinical suspicion of alveolar hemorrhage and prompt therapy.- - - - - - - - - - ranking = 1keywords = fever (Clic here for more details about this article) |
16/33. Fatal septicemic melioidosis in a young military person possibly co-infected with Leptospira interrogans and orientia tsutsugamushi.Concurrent melioidosis, leptospirosis, and scrub typhus after rural activities is rarely reported. A 19-year-old previously healthy man had fever onset after 2 weeks of military training. Pneumonia became evident on the fifth day of fever under intravenous penicillin and oral minocycline therapy. Acute respiratory failure developed the next day with shock and acute renal and liver function deterioration, which resulted in death. blood cultures on the third and fifth days grew burkholderia pseudomallei. serology revealed leptospirosis and scrub typhus. The emergence of melioidosis in taiwan and this death without antibiotic treatment for melioidosis alert us that B. pseudomallei should be included as a possible pathogen of pneumonia and sepsis, especially after rural activities.- - - - - - - - - - ranking = 2keywords = fever (Clic here for more details about this article) |
17/33. Acute pancreatitis caused by leptospirosis: report of two cases.Two cases of acute pancreatitis with leptospirosis are reported in this article. CASE 1: A 68-year-old woman, presented initially with abdominal pain, nausea, vomiting, and jaundice. She was in poor general condition, and had acute abdominal signs and symptoms on physical examination. Emergency laparotomy was performed, acute pancreatitis and leptospirosis were diagnosed on the basis of surgical findings and serological tests. The patient died on postoperative d 6. CASE 2: A 62-year-old man, presented with fever, jaundice, nausea, vomiting, and malaise. Acute pancreatitis associated with leptospirosis was diagnosed, according to abdominal CT scanning and serological tests. The patient recovered fully with antibiotic treatment and nutritional support within 19 d.- - - - - - - - - - ranking = 1keywords = fever (Clic here for more details about this article) |
18/33. leptospirosis in a caver returned from Sarawak, malaysia.This article describes a case of leptospirosis in a man who returned from caving in Sarawak, malaysia, and includes a discussion of epidemiology, pathophysiology, diagnosis, prevention, and treatment. The patient presented with symptoms of leptospirosis, which was confirmed by microhemagglutination titers. He became infected despite taking doxycycline daily for malaria prophylaxis. leptospirosis is an important consideration in any returned traveler with fever. The spirochete spreads from animals to humans via water. Caving in tropical endemic zones may increase exposure risk due to the combination of multiple skin abrasions with immersions. water in caves may increase infection risk because of increased water pH. Standard prophylaxis may be inadequate in cases of high-risk exposures.- - - - - - - - - - ranking = 1keywords = fever (Clic here for more details about this article) |
19/33. Nitric oxide production and immunoglobulin deposition in leptospiral hemorrhagic respiratory failure.Diffuse pulmonary hemorrhage leading to death is a syndrome which may develop in leptospirosis, but its pathophysiology is not well documented. We report an autopsy case of leptospirosis. A healthy 41-year-old man presented with low back myalgia, dry cough and fever for 4 days and a normal chest X-ray on admission. Acute respiratory failure developed hours later. Profuse bloody fluid appeared in the endotracheal tube immediately after intubation. Chest X-ray showed whiteness across all lung fields. He died of persistent shock 16 h after the onset of acute respiratory failure. autopsy revealed diffuse pulmonary hemorrhage with hyaline-membrane formation, myocarditis, interstitial nephritis and hepatitis. silver stain of lung and kidney tissue demonstrated leptospires. Immunohistochemical staining showed inducible nitric oxide synthase in alveolar macrophages. Immunofluorescein staining showed immunoglobulin in alveolar septum and alveolar space. This case suggests that hemorrhagic diffuse alveolar damage with persistent shock is related to over-production of nitric oxide and immunoglobulin deposition in fatal leptospirosis.- - - - - - - - - - ranking = 1keywords = fever (Clic here for more details about this article) |
20/33. leptospirosis presenting with mania and psychosis: four consecutive cases seen in a military hospital in turkey.OBJECTIVE: To present the clinical features and the treatment alternatives of manic and psychotic symptoms in patients with leptospirosis. methods: Clinical observation and diagnosis of four cases with leptospirosis presenting with psychiatric symptoms. RESULTS: leptospirosis diagnoses were established by recovery of the organism from culture, macroagglutination tests, and dark field microscopy in all cases. Leptospira ELISA-Ig M was also positive in all cases. Microagglutination tests were positive in case 1 and case 2. All of the cases were also screened for other possible medical, infectious, and neurological disorders that could account for their clinical symptoms. patients were treated with a combination of antibiotics, antipsychotics and mood stabilizers. CONCLUSIONS: The presence of manic and psychotic symptoms with fever and high transaminase and/or CPK levels in high risk occupational groups during rainy periods should alert the physician to the possibility of leptospirosis. The psychiatric symptoms are sensitive to anti-psychotics and mood stabilizers but not to antimicrobial treatment, suggesting that the psychiatric picture may not be related to direct invasion of the central nervous system by the infectious agent.- - - - - - - - - - ranking = 1keywords = fever (Clic here for more details about this article) |
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