1/16. Pulmonary haemorrhage as a predominant cause of death in leptospirosis in seychelles.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.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
2/16. Massive rhabdomyolysis and multiple organ dysfunction syndrome caused by leptospirosis.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.- - - - - - - - - - ranking = 6keywords = organ (Clic here for more details about this article) |
3/16. facial nerve palsy associated with leptospirosis.This case report describes the findings of a 27-year-old black male from Bahia, brazil, who developed facial palsy during the convalescence phase of leptospirosis. The patient recovered without neurological sequel. This work calls attention to a possible association between leptospirosis and facial palsy.- - - - - - - - - - ranking = 1.599536446195keywords = nerve (Clic here for more details about this article) |
4/16. Clinicopathological and immunohistochemical features of the severe pulmonary form of leptospirosis.Four cases of severe pulmonary form of leptospirosis (SPFL) are described. In all four of these blood culture proven cases, there was severe pulmonary injury characterized by alveolar hemorrhage and acute respiratory failure. Three patients died in less than 48 hours after onset of the first respiratory signs. Leptospiral antigen detection in lung tissues was positive by immunoperoxidase in all three of these cases, suggesting that the microorganism exerts a local direct destructive action. patients with SPFL should be carefully monitored, as the abrupt onset of severe alveolar hemorrhage can lead to respiratory insufficiency and death. The authors emphasize the importance of radiological findings and blood gas analysis for prompt clinical diagnosis, and suggest that corticosteroids, associated with antibiotics, early respiratory support, and platelet transfusions are useful as an attempt to prevent further development of SPFL.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
5/16. First evidence of leptospirosis in vanuatu.The clinical picture of leptospirosis is often confusing and biological confirmation with reference tests (microagglutination test or isolation of the organism) is not usually possible in tropical countries where the disease remains undiagnosed. We report here the first human cases of leptospirosis in vanuatu (South Pacific), which occurred during the 1989-1990 epidemic of dengue, and discuss the differential diagnosis of the 2 diseases.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
6/16. 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 = organ (Clic here for more details about this article) |
7/16. Peripheral nerve palsy in a case of leptospirosis.We describe an unusual case of leptospirosis in a 54-year-old man presenting peripheral nerve palsy. The diagnosis of leptospirosis was confirmed by ELISA IgM and the microscopic agglutination test. Electrophysiological studies showed that no response could be obtained from the right fibular nerve. At 7 months after the initiation of treatment, additional electrophysiological studies and a neurological examination showed, respectively, a chronic axonal lesion of right fibular nerve with signs of re-innervation and a nearly complete clinical recovery. We feel that this case may serve to remind clinicians that peripheral nerve palsy is a potential clinical feature of leptospirosis.- - - - - - - - - - ranking = 3.19907289239keywords = nerve (Clic here for more details about this article) |
8/16. leptospirosis presenting to an intensive care unit in provincial new zealand: a case series and review.BACKGROUND: leptospirosis is a disease associated with meat and agricultural workers which is endemic in new zealand and australia. During 2003-2005, it resulted in 207 hospitalisations in new zealand. Hawke's Bay had the highest regional incidence in 2004 and 2005. While admission to intensive care units with leptospirosis is not infrequent, no such cases have been described in the literature from new zealand, and only five from australia. methods: A chart review of all patients admitted to the intensive care/high dependency unit of a regional hospital in new zealand with a diagnosis of leptospirosis from June 1999 to May 2005. Admission features, progress and diagnostic tests were collated, and apache II score on admission and daily Sequential Organ Failure Assessment (SOFA) score were calculated. RESULTS: 15 cases were identified; median age was 44 years (range, 27-62), and 13 were men. myalgia, headache, nausea and vomiting were common; nine had conjunctival suffusion. Ten had hypotension and 14 had renal failure before ICU admission. Eleven received vasoactive support, and three received renal replacement therapy. Median length of ICU stay was 4 days (range, 2- 11; mean, 4 days). Median hospital stay was 6 days (range, 2-13; mean, 7.6 days). All patients survived and were discharged free of dialysis. CONCLUSION: leptospirosis presents to the ICU with a variety of signs and symptoms. Renal failure is the most common organ dysfunction requiring intensive care, and its severity is disproportionate to other signs of severe sepsis. leptospirosis has a good prognosis with early management in an ICU.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
9/16. leptospirosis: a forgotten cause of aseptic meningitis and multisystem febrile illness.leptospirosis is a worldwide spirochetal zoonosis that spans a clinical spectrum from a mild febrile illness to a severe icteric disease with renal failure (Weil's syndrome). The illness is characteristically biphasic with conjunctival suffusion and an "immune" meningitis during the later phase of illness. Most patients, even those with severe disease, recover without residual organ impairment. The diagnosis is confirmed by serology, by culture of blood or spinal fluid during the first phase of illness, or by culture of urine during the second phase. doxycycline is the recommended therapy and is effective if given within the first several days of illness; it may also have a role in prophylaxis.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
10/16. leptospirosis. Epidemiological features of a sporadic case.leptospirosis occurred in a 45-year-old man with presumed infection from an exposure to contaminated water at his source of employment. An intensive epidemiological investigation, including serological examination of all family members and pets and cultures on the patient and his family pets (cats and dogs), proved that the leptospiral organism was acquired by the patient's exposure to his dogs. The risk of acquiring infection from dogs that are asymptomatic and vaccinated is emphasized by this report.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
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