1/6. Potential benefit of plasma exchange in treatment of severe icteric leptospirosis complicated by acute renal failure.leptospirosis is a common zoonosis seen worldwide, but it is rare in our locality (hong kong). Clinical manifestations of leptospirosis are variable and may range from subclinical infection to fever, jaundice, hemorrhagic tendency, and fulminant hepato-renal failure. Severe hyperbilirubinemia and acute renal failure have been associated with high mortality. We report our experience with a patient who developed severe Weil's syndrome with marked conjugated hyperbilirubinemia and oliguric acute renal failure. These complications persisted despite treatment with penicillin and hemodiafiltration. plasma exchange was instituted in view of the severe hyperbilirubinemia (970 micromol/liter). This was followed by prompt clinical improvement, with recovery of liver and renal function. The beneficial effects of plasma exchange could be attributed to amelioration of the toxic effects of hyperbilirubinemia on hepatocyte and renal tubular cell function. We conclude that plasma exchange should be considered as an adjunctive therapy for patients with severe icteric leptospirosis complicated by acute renal failure who have not shown rapid clinical response to conventional treatment.- - - - - - - - - - ranking = 1keywords = fever (Clic here for more details about this article) |
2/6. Kawasaki disease before kawasaki at tokyo university hospital.OBJECTIVE: Kawasaki disease (KD) was first reported by Tomisaku Kawasaki in 1967 in japan. Large-scale nationwide epidemiologic surveys have been conducted continuously by the japan Kawasaki disease research Committee; however, there were very few reports of KD before 1967. This study was performed to clarify when KD appeared in japan. DESIGN: We investigated the medical charts of patients who had been hospitalized at tokyo University Hospital between 1940 and 1965. RESULTS: We identified 10 patients whose clinical signs fulfilled the criteria for KD. The ages of the patients ranged from 8 months to 5 years, and their final diagnoses were stevens-johnson syndrome, allergic toxic erythema, Izumi fever, scarlet fever, and cervical lymphadenitis. These 10 patients presented between 1950 and 1964, and no confirmed cases were seen between 1940 and 1949. CONCLUSIONS: Our findings suggested that KD patients were rare before 1950 in japan.- - - - - - - - - - ranking = 2keywords = fever (Clic here for more details about this article) |
3/6. Fever, pulmonary haemorrhage, and acute renal failure in a young girl.leptospirosis is rarely reported in children. It is easily treated with antibiotics but can be fatal if treatment is delayed. A 12-year-old girl was diagnosed with Weil syndrome, a severe form of leptospirosis, 10 days after returning from Mainland china. She presented with fever, hypotension, jaundice, and acute renal failure. She had used well water for bathing and swum in freshwater.- - - - - - - - - - ranking = 1keywords = fever (Clic here for more details about this article) |
4/6. Rat-bite acquired leptospirosis.We report a case of leptospirosis in a boy following a rat-bite, an unusual mode of transmission for this infection. The use of antibiotics for fever following a rat-bite is discussed.- - - - - - - - - - ranking = 1keywords = fever (Clic here for more details about this article) |
5/6. Cotton-wool spots as a sign in leptospirosis (Weil's disease).A 44-year-old black male presented with fever, myalgia and weakness. He had elevated blood urea nitrogen, creatine phosphokinase and serum glutamic-oxaloacetic transaminase. During the first 6 days of this undiagnosed illness azotemia increased, a pericardial friction rub occurred, and hematuria was present. On the 7th day bilateral subconjunctival hemorrhages, anterior uveitis, and peripapillary cotton-wool spots were noted. This combination of findings suggested leptospirosis, which was subsequently confirmed by specific antibody titers. Therapeutic response was achieved with high-dose systemic steroids.- - - - - - - - - - ranking = 1keywords = fever (Clic here for more details about this article) |
6/6. leptospirosis: twelve Turkish patients with the Weil syndrome.Twelve cases of leptospirosis followed by the Infectious Diseases Clinic of the Cukurova University Medical School, Adana, turkey, between January 1994 and November 1995 are reported. Included are their clinical manifestation, laboratory findings and serotype. Nine men and three women with an average age of 40.4 years were studied. Symptoms, clinical manifestations, laboratory findings and treatment of the disease are evaluated. All of the patients had fever and chills and the following symptoms: nausea and vomiting (91.6%), lower back pain and myalgia (58.3%), headache (50%), epistaxis (16.6%) and confusion (25%). The predominant clinical findings were jaundice (91.6%), hepatomegaly (41.6%), dyspnea (25%), conjunctival suffusion (33%), and nuchal rigidity (33%). diagnosis was based on dark-field examination of the blood, cerebrospinal fluid and urine specimens. Also, microscopic agglutination tests (MAT) were carried out for serodiagnosis. MAT showed L. interrogans serovar icterohaemorrhagiae in 11 cases and L. interrogans serovar grippomosocova in one case. There was cross reaction with L. biflexa patoc in all cases. Agglutinations were tested in the same specimens twice and confirmed in the microbiology Laboratory of the Etlik Veterinary research Institute in Ankara. All cases were treated with penicillin and doxycycline. In the end; 83.3% of the patients were cured and 16.6% died due to hepatorenal failure.- - - - - - - - - - ranking = 1keywords = fever (Clic here for more details about this article) |