1/122. Massive pulmonary haemorrhage caused by leptospirosis successfully treated with nitric oxide inhalation and haemofiltration. A patient with leptospirosis who developed oliguric renal failure, massive pulmonary haemorrhage and respiratory failure is described. The patient's clinical condition and arterial oxygenation failed to improve despite vigorous supportive measures. nitric oxide inhalation and haemofiltration resulted in a marked clinical improvement and subsequent full recovery. We suggest that the addition of haemofiltration and nitric oxide inhalation therapy should be considered in patients with pulmonary haemorrhage and renal failure caused by leptospirosis, in whom conventional therapy fails. ( info) |
2/122. Facial palsy in a patient with leptospirosis: causal or accidental. Facial palsy, one of the most common neurological syndromes, has many causes. This is the first report of a patient with leptospirosis who developed facial palsy. The lesion responded to treatment with doxycycline hyclate. ( info) |
3/122. Identification of leptospira andamana isolated from the spinal fluid of a fatal case of leptospirosis in Sao Paulo, 1963. The IAL-S. P. strain was isolated from the spinal fluid of a patient male, aged 35, black, a sewer worker with fever, myalgia, jaundice, vomiting and meningitis symptoms with a 5-day incubation period after the lower half of the body had been submerged for 2 hours in sewers when unblocking a drain. Leptospires were isolated by direct inoculation of the spinal fluid taken on the 9th day of the illness into the Fletcher's media and into guinea pigs by the intraperitoneal route. The patient gave a positive agglutination test for L. andamana with cross-reaction with L. sejroe. The strain was identified as L. andamana by the cross-agglutination-lysis test and the cross-absorption test. The IAL-S. P. strain is undoubtedly not saprophytic but parasitic and pathogenic for man and animals, however its biological properties resist to the oligodynamic action of Cu and Hg and the 8-azoguanine action as in the case of the Patoc 1 strain. I could be recommended to reconsider whether the strain belongs to L. interrogans, L. biflexa or to another group because the grounds for L. andamana being saprophytic were denied by this report. ( info) |
| The authors present three patients with acalculous cholecystitis seen at a tertiary care center in Bangkok. The first patient was explored surgically because peritonitis was suspected. The two other patients were treated conservatively with antibiotics and supportive care, and they recovered fully. The diagnosis of leptospirosis was confirmed by increasing antibody titers in three patients and by blood culture in one patient. leptospira were not detected in the surgical specimen. leptospirosis is a systemic disease that can present with a multitude of symptoms and signs including right upper quadrant pain mimicking cholecystitis. A high level of awareness and appropriate laboratory studies should allow early diagnosis and may prevent unnecessary surgical intervention. ( info) |
5/122. Tubulointerstitial renal failure in childhood leptospirosis. We report three children with tubulointerstitial renal failure following leptospirosis. All had acute nonoliguric renal failure with mild hypocalemia and mild metabolic acidosis. Maximum blood urea nitrogen (BUN) and creatinine were 217 and 7.1 mg/dl, respectively, on the 6th day of disease, and no patient required dialysis. They presented with acute febrile illness and dehydration, and required intravenous fluid supplements. myalgia, vomiting, and bleeding were found in two children. abdominal pain, arthralgia, diarrhea, and conjunctival suffusion were found in one child. Only one child, who had an underlying disease of beta-thalassemia/Hb E, had jaundice, hepatosplenomegaly, anemia, and thrombocytopenia. Penicillin treatment was given in one case. All recovered, with normal renal function. The leptospirosis complement fixation test was used to confirm diagnosis. L. batavia was considered the etiologic agent in two of the children. ( info) |
6/122. serum procalcitonin and proinflammatory cytokines in a patient with acute severe leptospirosis. leptospirosis is a zoonosis, with clinical manifestations ranging from the imperceptible to severe, potentially fatal renal and liver failure accompanied by haemorrhage and jaundice. In this case report of a patient with severe leptospirosis, serum levels of procalcitonin decreased ahead of any obvious clinical improvement, and thus may be useful as a prognostic marker. Levels of soluble IL-2 receptor were very high and correlated well with the clinical course. ( info) |
| We examined the cause of death during a 12-month period (1995/96) in all consecutive patients admitted to hospital with leptospiral infection in seychelles (indian ocean), where the disease is endemic. leptospirosis was diagnosed by use of the microscopic agglutination test and a specific polymerase chain reaction assay on serum samples. Seventy-five cases were diagnosed and 6 patients died, a case fatality of 8%. All 6 patients died within 9 days of onset of symptoms and within 2 days of admission for 5 of them (5 days for the 6th). On autopsy, diffuse bilateral pulmonary haemorrhage (PH) was found in all fatalities. Renal, cardiac, digestive and cerebral haemorrhages were also found in 5, 3, 3 and 1 case(s), respectively. Incidentally, haemoptysis and lung infiltrate on chest radiographs, which suggest PH, were found in 8 of the 69 non-fatal cases. dengue and hantavirus infections were ruled out. In conclusion, PH appeared to be a main cause of death in leptospirosis in this population, although haemorrhage in other organs may also have contributed to fatal outcomes. This cause of death contrasts with the findings generally reported in endemic settings. ( info) |
| We report a case of leptospiral infection in a 63-year-old man who acquired the infection while swimming in canals and streams in hawaii. The patient's course was atypical in that he was anicteric and had no evidence of meningitis when he presented with fever, rapidly progressive and severe rhabdomyolysis, thrombocytopenia, acute renal failure, and respiratory distress syndrome. Although he recovered after a protracted illness, he required major life support, including mechanical ventilation and hemodialysis. Initial antimicrobial therapy was designed to cover major bacterial and atypical pathogens, including leptospires. An in-depth work-up for causes of this catastrophic illness confirmed acute leptospirosis. Although rare, leptospirosis is a potentially lethal infection classically associated with hepatitis, azotemia, and meningitis. Most patients experience self-limited illness, with fever, myalgias, and malaise followed by an immune-mediated aseptic meningitis. A small proportion develop shock and multiple organ dysfunction. Whereas myalgias are ubiquitous in leptospiral infection, and most patients show mildly elevated muscle enzymes, life-threatening rhabdomyolysis is rare. This atypical case is reported to urge clinicians to consider leptospirosis in the evaluation of a patient with cryptogenic sepsis who develops multiple organ dysfunction associated with rhabdomyolysis. Appropriate antimicrobial therapy, with penicillin or doxycycline, can be life-saving. ( info) |
9/122. leptospirosis complicated by severe aortic stenosis. A previously well 62-year-old male from North queensland presented with leptospirosis featuring fever, renal failure, hepatitis and pulmonary haemorrhage. Management was greatly complicated by severe and previously unrecognized aortic stenosis with a peak valve gradient of 125 mmHg. A successful outcome followed careful haemodynamic management and treatment of the infective illness with subsequent valve replacement. ( info) |
| AIMS: To describe the occurrence of spontaneous cataract absorption in patients with leptospiral uveitis. methods: The records of patients with seropositive leptospiral uveitis seen in the uveitis clinic at Aravind eye Hospital between January 1994 and December 1997 were reviewed retrospectively. RESULTS: During the 4 years of the study, 394 eyes of 276 patients with seropositive leptospiral uveitis were identified. Of these, 54 eyes (13.7%) of 41 patients (14.9%) had a final visual acuity of 20/40 or worse attributable to cataract formation. Of these 54 eyes, 41 eyes (75.9%) had visually significant cataract on their first visit to the uveitis clinic, and 13 eyes (24.1%) were noted to have cataract 1-6 months after presentation. Spontaneous absorption was observed in 10 eyes (18.5%) of eight patients (19.5%), and occurred from 6 weeks to 18 months, with a median of 5 months, after the onset of cataract. Of 12 035 consecutive, non-leptospiral, non-traumatic, uveitic, control patients seen during the same 4 years of the study, none showed spontaneous cataract absorption. CONCLUSION: Spontaneous cataract absorption occurs in a significant number of patients with leptospiral uveitis, and appears to be unique to this form of non-traumatic uveitis. ( info) |