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PubMed2000

Treatment and outcome of dogs with leptospirosis: 36 cases (1990-1998).

OBJECTIVE: To characterize serologic and clinical features and outcome of dogs with leptospirosis that were treated conservatively (i.e., medical management alone) or with hemodialysis. DESIGN: Retrospective study. ANIMALS: 36 dogs with leptospirosis. PROCEDURE: History; results of physical examinations, ultrasonography, and serologic, hematologic, and serum biochemical analyses; time to resolution of azotemia; and outcome were obtained from medical records. Dogs were treated conservatively (n = 22) or with hemodialysis (14). RESULTS: Between 1990 and 1998, amount of rainfall was positively correlated with number of cases of leptospirosis identified per year. Serum antibodies against 6 Leptospira serovars were measured, and titers were highest to Leptospira pomona in 16 (44%) dogs, L bratislava in 9 (25%) dogs, and L hardjo in 1 (3%) dog. Eight (22%) dogs had equally high titers to L pomona and L bratislava, 1 (3%) had equally high titers to L grippotyphosa and L canicola, and 1 (3%) had high titers to L grippotyphosa, L pomona, L canicola, and L bratislava. During initial evaluation, all dogs were azotemic. Thirty (83%) dogs survived, including 12 of 14 (86%) dogs treated with hemodialysis and 18 of 22 (82%) treated conservatively. Serum creatinine concentration was similar in both groups after resolution of clinical signs. CONCLUSIONS AND CLINICAL RELEVANCE: Infection with L pomona and L bratislava was recognized as a cause of leptospirosis in dogs, and resulted in development of acute renal failure with various degrees of azotemia. Prognosis for dogs with mild to moderate azotemia was good with conservative treatment, whereas treatment with hemodialysis appeared to improve prognosis for dogs with severe azotemia.

Animals↗
PubMed1997

Acute renal failure in leptospirosis in Uruguay.

The present study was carried out to describe epidemiology and clinical pattern of acute renal failure caused by leptospirosis in Uruguay. For these purposes, all literature published in Uruguay was reviewed. Three studies were analyzed: 2 series of patients and 1 case report that summarize 26 cases. The incidence of acute renal failure found in the first study was 8% and in the second one, 15%. The first study included only dialyzed patients, which could explain the aforementioned difference. The estimated annual incidence of leptospirosis in Uruguay is about 10 cases/year. Therefore, the expected incidence of acute renal failure due to leptospirosis is of 0.7-1.3 cases/year. All but 1 case were males. Mean age was 35 +/- 14.5. Source of infection was known in 23/26. Typical symptoms were: fever 26/26, myalgias 22/26, dehydration 21/26, jaundice 21/26, conjunctival suffusion 20/26, and digestive disturbance 18/26. Bleeding and meningitis were infrequent (8/26, 5/26, respectively). Acute renal failure was intrinsic in 18/26. Nonoliguric forms were predominant (14/18). Kalemia was low or normal in 22/26 cases. Dialysis was performed in 9/26 cases, but the number of dialyses per patient was high (9.4 +/- 4). The survival rate was 23/26. We concluded that leptospirosis is an infrequent cause of acute renal failure in Uruguay, with an expected frequency of approximately 1 case/year. Clinical picture was typical and contact was frequently known, which made diagnosis easy. Acute renal failure was predominantly polyuric and with low or normal kalemia; survival rate was high.

Acute Kidney Injury↗
PubMed1997

Review of leptospirosis notifications in Queensland 1985 to 1996.

To provide an overview of leptospirosis in Queensland, the World Health Organization/Food and Agriculture Organization Collaborating Centre for Reference and Research on Leptospirosis undertook a study of notifications of the disease from 1985 to 1996. The review encompassed information drawn from notifications to Queensland Health and questionnaires sent to doctors. Notifications were highest between February and July and the highest population rates were identified in the Central West and Peninsula Health Regions. Ninety-one per cent of notifications were for males. At risk population groups included meat workers, those working with farm animals and banana workers. The study found the incidence of leptospirosis was higher in 1996 than in previous years. Improved diagnosis and surveillance will aid our understanding of the preventable risk factors for leptospirosis, especially in geographic areas not considered at high risk and in groups not in occupations traditionally linked to the disease.

Abattoirs↗
PubMed2005

Disproportional exaggerated aspartate transaminase is a useful prognostic parameter in late leptospirosis.

AIM: To evaluate the hepatic dysfunction in leptospirosis is usually mild and resolved eventually. However, sequential follow-up of liver biochemical data remained lacking.. METHODS: The biochemistry data and clinical symptoms of 11 sporadic patients were collected and analyzed, focusing on the impacts of leptospirosis upon liver biochemistry tests. RESULTS: The results disclosed that of the 11 cases, 5 or 45% died. The liver biochemistry data in the beginning of the disease course were only mildly elevated. Nevertheless, late exaggerated aspartate transaminase (AST) elevations were noted in three cases who finally died when compared with the typical course. Besides, significant higher AST/alanine transaminase (ALT) ratios (AARs) of the peak levels for transaminase were also noted in the cases who eventually succumbed. The mean+/-SD of AARs for the survival group and dead group were 5.65+/-2.27 (n = 5) and 1.86+/-0.64 (n = 6) respectively (P = 0.006). The ratios of the cases who finally died were all more than 3.0. Conversely, the survival group's ratios were less than 3.0. CONCLUSION: Serial follow-up of transaminase might provide evidence to predict some rare evolutions in leptospirosis. If AST elevated progressively without a concomitant change of ALT, it might indicate an acute disease course with ensuing death. Additionally, AAR is another prognostic parameter for leptospirosis. Once the value was higher than 3.0, a grave prognosis is inevitable.

Adult↗
PubMed2005

[Risk factors and frequency of positive antibodies for leptospirosis in a sub urban population near Santiago].

BACKGROUND: Leptospirosis is a zoonotic disease and its incidence is known in Chile since 2002, when it was incorporated as a disease that must be reported to health authorities. A serologic survey for leptospirosis was performed in humans and animals from a farm in a semi urban area in Santiago Chile, after the death of a farmer due to Weil disease in that place. AIM: To report the prevalence of antibodies against leptospirosis and to determine exposure to infection risk factors in the humans and domestic animals studied in this survey. MATERIAL AND METHODS: Antibodies were detected by IgM immunodot and indirect haemagglutination test in 61 humans (43 male, aged 5 to 70 years) and by microscopic agglutination test (MAT) in 44 animals. A questionnaire was applied to determine their exposure to risk factors for infection with Leptospira. RESULTS: Seventy two percent of the studied population were farm workers and 70% had activities that required contact with water from canals, 41% cleaned closed places where rodents were present. Other risk factors detected were lack of sewage and waste disposal, high level of rodent infestation and disposal of faeces into canals used for watering. Two humans (3.3%) and six animals (1 bovine and 5 rodents) had positive antibodies. Among animals, antibodies against Leptospira serovar pomona and icterohaemorragiae were detected. CONCLUSIONS: In Chile, leptospirosis exists not only in rural areas but semi urban ones close to Santiago, although the prevalence is low. Education is necessary among semi urban population to avoid infection.

Adolescent↗
PubMed1995

Evaluation of the immunofluorescent antibody test for the diagnosis of human leptospirosis.

Sera from 175 patients with clinically suspected leptospirosis were tested with the immunofluorescent antibody (IFA) assay and compared with the microscopic agglutination (MA) method. Overall, the IFA test recognized all 58 MA-positive patients with leptospirosis. On acute sera testing, the IFA titer > or = 1:100 was 0.97 specific and more sensitive than the conventional MA method (sensitivities = 0.48 versus 0.17, respectively). None of the 117 MA-negative patients, 101 healthy blood donors, and 93 patients with five diseases commonly confused with leptospirosis had IFA titers > or = 1:400. However, cross-reactivity was seen with sera from patients with syphilis. On serial testing, the IFA antibody first appeared during the first week of illness, peaked by the fourth week, and generally decreased below 1:400 after the fourth month. The IFA test appears to be moderately sensitive and specific for the initial diagnosis of leptospirosis. It could replace the more complicated and less sensitive MA assay.

Adult↗
PubMed1970

Detection and ecology of leptospirosis in Iowa wildlife.

To gain additional information on the extent of leptospirosis in wildlife following a human outbreak in Iowa, wild mammals and lower forms of life were collected. Isolation, darkfield microscopic, serologic and pathologic procedures were used to identify past or present evidence of leptospiral infection. Leptospires were isolated from 7 of 75 (9%) mammals. Serotype grippotyphosa was isolated from three raccoons (procyon lotor) and one Western Harvest Mouse (Reithrodontomys megalotis). Serotype ballum was isolated from three opossums (Didelphis marsupialis). Leptospires, unidentified to date, were isolated from frog (Rana pipiens) kidneys. Other positive serologic and pathologic tests gave evidence of infection or previous infection. Utilization of Darkfield microscopic and silver staining techniques did not detect all cases of leptospiral infection. Macroscopic and microscopic serologic methods failed to identify evidence of leptospirosis in all mammals from which leptospires were isolated. Pathologic lesions could only be considered presumptive evidence for leptospirosis. These findings indicate that detection of leptospirosis in wildlife cannot be limited to a single diagnostic test. A combination of diagnostic procedures and clinical evaluation is necessary. Although serotype pomona was implicated as the predominant infecting leptospire in the human cases and domestic animals and was isolated from water at a swimming site, only serotypes grippotyphosa, ballum and ICF (frog isolate) were isolated from wild mammals and lower forms of life in the same vicinity.

Animals↗
PubMed1998

[Respiratory manifestations of leptospirosis. A retrospective study of 91 cases (1978-1984)].

Leptospirosis, an ubiquitous zoonotic disease, is a systemic infection usually producing fever with hepatorenal involvement, meningoenephalitis, and hemorrhage. Respiratory manifestations are less well known but have been described in certain regions such as Southeast Asia or the Reunion Island. From January 1978 through December 1994, 154 cases of documented leptospirosis were admitted to the South Reunion Hospital Center. Pulmonary involvement was observed in 91 of these cases (59.1%) with hemoptysis (37.4%) and radiological evidence of bilateral reticulonodular infiltration (40%). Extra-pulmonary manifestations in most cases suggested leptospirosis at admission. Thirteen consecutive patients underwent endoscopy explorations with bronchoalveolar lavage: intra-alveolar hemorrhage was evidenced in all cases. This highly typical pattern of cytolysis would emphasize (20.8%) when the classical extra-pulmonary signs are too discrete to suggest the diagnosis. In this series, 10 patients required ventilatory assistance and 2 were given corticosteroid boluses for massive hemoptysis. Mortality due to leptospirosis is two-fold higher in cases with pulmonary involvement.

Adolescent↗
PubMed1976

Co-antibodies in human leptospirosis.

Investigations concerning the co-antibodies formed in the course of human leptospirosis and the extractive antigens of leptospiras were reviewed. As a whole, the results concerning leptospira antigens point, next to antigens of serotype, to genus-specific and intertype antigens deeply seated in the cells. These cannot be identified by the MAL test, and therefore are not related to the co-agglutinins in human leptospirosis. The associations of co-antibodies in human leptospirotic sera were analyzed, using the MAL and CF tests performed with 20 pathogenic and water serotypes of leptospira. The results showed that in the course of human leptospirosis high titer co-antibodies are formed, both agglutinating and complement fixing, variably associated for one or more serotype antigens not belonging to the infecting strain. The various biological interpretations of the phenomenon were discussed and the hypothesis of antigenic changes of leptospira strains in vivo as well as in vitro was discussed, as a determining factor in the formation co-antibodies in leptospirosis.

Agglutinins↗
PubMed2000

[Hepatobiliary alternations in leptospirosis convalescents].

AIM: To study hepatic function in leptospirosis convalescents. MATERIALS AND METHODS: Clinical laboratory and device examinations were performed in 121 leptospirosis convalescents. RESULTS: The majority of the examinees retained biochemical signs of cholestatic, mesenchymal-inflammatory and moderate cytolytic syndromes secondary to hepatic impairment. Ultrasound and radionuclide investigations detected biliary disorders and secondary chronic hepatitis in many of leptospirosis convalescents. CONCLUSION: It is shown that leptospirosis rehabilitation must be targeted. Reasons of development of chronic hepatic and biliary lesions in population of the north Caucus and Kuban in the absence of viral hepatitis markers are suggested.

Adult↗
PubMed2000

The relationship between rainfall and human leptospirosis in Florianópolis, Brazil, 1991-1996.

The relationship between serologically confirmed cases of leptospirosis and the amount of rainfall in greater Florianôpolis, in southern Brazil, was studied retrospectively for the period 1991 to 1996. Maximum daily and total monthly rainfall for present and previous months were statistically significant predictors of the number of cases of leptospirosis in Poisson regression models. However, daily maximum rainfall data showed a much better model fit than total monthly rainfall. For each millimeter increase in maximum daily rainfall for the month above the average for the period studied, there was an increase of 0.55% in the number of leptospirosis cases relative to the period average. For the past month's daily maximum, this increase was 0.21%. Maximum daily rainfall during the month is a sensitive indicator of large amounts of rain falling in a brief period of time. This may cause flash floods and, thus, disseminate pathogenic Leptospira among the human population, particularly in densely populated areas with large rodent populations and without adequate drainage. This situation is typical for the association of tropical rainstorms and the spread of leptospirosis among slum dwellers.

Antibodies, Bacterial↗
PubMed2001

The role of glucocorticoid pulse therapy in pulmonary involvement in leptospirosis.

OBJECTIVES: This study discusses incidence and clinical profile of pulmonary involvement in leptospirosis in South Gujarat. It also tries to evaluate the effect of high dose glucocorticoid pulse therapy (GPT) on it. METHOD: A study was carried out on hundred and two patients of suspected leptospirosis, referred to Government Medical College, New Civil Hospital, Surat between June 99 to September 99. The incidence, clinical profile, and specific investigations were studied in patients having pulmonary involvement. Some of the patients were given high dose glucocorticoid pulse therapy. Their outcomes were compared with those who had not been given glucocorticoid pulse therapy. RESULTS: Out of seventy seven seropositive patients 13 (16.8%) developed pulmonary involvement. Mortality was two out of eight patients in the group that received GPT and four out of five patients in the group that did not receive GPT. Two patients who died in the steroid treated group received the drug after 12 hours of onset of dyspnea. CONCLUSIONS: High dose GPT should be given as early as possible after the onset of dyspnea to all the patients with pulmonary involvement in leptospirosis. Further studies are required to establish the GPT as a standard regimen in treatment of pulmonary involvement in leptospirosis.

Adult↗
PubMed2001

[Leptospirosis in children of Libreville: difficult diagnosis, apropos of 1 case].

Leptospirosis is a widespread zoonosis, which is diagnosed less frequently in children than might be expected from the level of exposure to hazards, especially in tropical areas. A 15 1/2-year-old Gabonese boy was admitted following five days of fever, headache, myalgia, abdominal pain, diarrhea, intestinal bleeding, jaundice and conjunctival suffusion. Laboratory data showed abnormal liver and renal function tests, and diagnosis of Plasmodium falciparum malaria was confirmed by thin blood smear. The patient did not clinically improve despite antimalarial treatment and then leptospirosis was suspected. Serologic tests were performed and leptospirosis was later confirmed. Antibiotic treatment (cefuroxim) was given. The outcome was good, liver and renal tests returned to normal in a few days. In tropical area, leptospirosis should be considered in children who are diagnosed with either an unexplained fever, a pseudo-influenza syndrome, or jaundice with hepatorenal involvement and gastrointestinal bleeding.

Abdominal Pain↗
PubMed2001

Environmental and travel factors related to leptospirosis in Thailand.

To identify potential environmental and travel factors related to leptospirosis, we conducted an unmatched case controlled study and household assessment of cases and controls in Nakhon Ratchasima province (north-eastern, Thailand) from August to December, 1998. Fifty-six cases and 145 controls were included in the study. Cases were hospitalized patients who had been diagnosed with leptospirosis and tested positive for anti-leptospiral IgM antibody using the Panbio ELISA (Panbio Inc, Brisbane, Australia). Controls were the neighbors of cases who had tested negative. Standardized questionnaires and household assessments were used to collect information on demographics, number of animals kept, evidence of rats in the home, presence of rat food inside the home, road characteristics, awareness of leptospirosis disease, environment, and travel history. Multivariant, unconditional logistic regression demonstrated that travel on potholed roads was independently associated with leptospirosis infection (OR 5.0; 95%CI 1.2-20.2) and traveling by car was a protective factor (OR 0.2; 95%CI 0.06-0.9).

Adolescent↗
PubMed2003

An outbreak of leptospirosis among Peruvian military recruits.

Acute undifferentiated febrile illnesses are common in tropical developing countries but are difficult to diagnose on clinical grounds alone. Leptospirosis is rarely diagnosed, despite evidence that sporadic cases and epidemics continue to occur worldwide. The purpose of this study was to diagnose an outbreak of acute undifferentiated febrile illness among Peruvian military recruits that developed after a training exercise in the high jungle rainforest of Peru. Of 193 military recruits, 78 developed an acute febrile illness with varied manifestations. Of these, 72 were found to have acute leptospirosis by a microscopic agglutination test (MAT). An enzyme-linked immunosorbent assay using Leptospira biflexa antigen was insensitive for the detection of anti-leptospiral IgM antibodies compared with the MAT (20 of 72, 28%). This outbreak of acute undifferentiated febrile illness among Peruvian military recruits was due to leptospirosis. High clinical suspicion, initiation of preventative measures, and performance of appropriate diagnostic testing is warranted in similar settings to identify, treat, and prevent leptospirosis.

Adult↗
PubMed2003

Evaluation of cardiovascular status in severe leptospirosis.

OBJECTIVES: To note incidence and profile of cardiac involvement in severe leptospirosis in South Gujarat. METHODS: A study was carried out on twenty-five serologically proved leptospirosis patients referred to Government Medical College, New Civil Hospital, Surat between June 2002 to September 2002. In all the patients detailed history, physical examination and specific investigations were done to find out the incidence and profile of cardiac involvement in severe leptospirosis. RESULTS: Out of twenty-five seropositive patients, 14(56%) had cardiovascular manifestations. Electrocardiography abnormalities were seen in 13(52%) patients. The commonest finding was first-degree AV block seen in II(44%) patients followed by ST-segment depression in four (16%) patients, T-wave inversion in leads II, III and avF in two (8%) patients, corrected QT-interval prolongation in three (12%) patients and ventricular premature beats in two (8%) patients. Atrial fibrillation was seen in only one patient. Left ventricular function as assessed by two-dimensional echocardiography was normal in all patients. CONCLUSION: In cardiovascular involvement of leptospirosis, although electrocardiographic abnormalities were commonly seen, there was no left ventricular dysfunction.

Adult↗
PubMed2003

Acute acalculous cholecystitis and pancreatitis in a patient with concomitant leptospirosis and scrub typhus.

Concomitant leptospirosis and scrub typhus is rare. The spectrum of clinical severity for both scrub typhus and leptospirosis ranges from mild to fatal. Acute pancreatitis and cholecystitis are infrequent complications in adult patients with either leptospirosis or scrub typhus. We report a case of leptospirosis and scrub typhus coinfection in a 41-year-old man presenting with acute acalculous cholecystitis, pancreatitis and acute renal failure. Abdominal computed tomography revealed edematous change of the gallbladder without intrahepatic or pancreatic lesions. The patient was successfully treated with doxycycline and ceftriaxone, and supportive management.

Acalculous Cholecystitis↗
PubMedDate not supplied

[Pathomorphogenesis of the liver, kidneys, and lungs in patients with icteric leptospirosis].

Postmortem and biopsies pathomorphological studies of the liver, kidneys and lungs of patients with leptospirosis were carried out. The content of myoglobin in these organs, blood and urine was investigated. Dystrophy and infiltration of the liver in leptospirosis are moderate and do not correlate with the intensity of icterus. In pathogenesis of hepatorenal and respiratory disturbances in leptospirosis the important role in leptospirosis belongs to rhabdomyolysis resulting in accumulation of blood myoglobin. Its elimination occurs through the liver, kidneys and lungs and this promotes development of such complications as shock, acute renal failure, respiratory distress syndrome. The inclusion in pathogenetic therapy of efferent methods of detoxication effectively eliminates endotoxicosis and hypermyoglobinemia and solves the problem of complications.

Adult↗