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PubMed1997

Evaluation of leptospira micro capsule agglutination test (MCAT) for serodiagnosis of leptospirosis.

A micro capsule agglutination test (MCAT) was evaluated for its usefulness in the diagnosis of leptospirosis. The test was performed on 180 serum samples from 120 patients suspected to have leptospirosis and the results were compared with those obtained by microscopic agglutination test (MAT). The overall sensitivity and specificity of the test in comparison with MAT were 84.7 and 87.0 per cent respectively. Further, to study the relative merits of MCAT and MAT in diagnosing leptospirosis early in the course of the disease, its sensitivity and specificity during the early stages of the disease were compared with those of a single MAT done on acute samples in 60 patients from whom paired samples were available. The test appeared to have a higher sensitivity than MAT during the early stages of the disease (75% vs 58.3%) though the specificity was less than that of MAT (83.3% vs 100%). The sensitivity of the test declined to 61 per cent three to four weeks after the onset of illness. MCAT detected antibodies against serogroups Australis (76.9%), Autumnalis (100%) Ballum (100%), Canicola (100%), Cynopteri (100%), Grippotyphosa (71.8%), Icterohaemorrhagiae (93.3%), Javanica (100%), Pomona (75%) and Pyrogenes (100%). MCAT appears to be a useful screening test for early diagnosis of leptospirosis. It is a simple and easy to read test which does not require any special expertise or equipment.

Agglutination Tests↗
PubMed1997

[Leukocyte chromatin anisotropy in patients with leptospirosis].

Chromatin anisotropy is measured and its correlation with the cytochemical activity of leukocytes estimated in 19 patients with icterohemorrhagic leptospirosis. Leukocyte and neutrophil nuclei chromatin anisotropy increases during the acute period of leptospirosis, indicating an increase of cuchromatization and transcription activity. Neutrophil nuclei euchromatization is observed in patients with all forms of leptospirosis irrespective of the disease severity. Lymphocyte nuclei euchromatization is observed only in the patients with a favorable course but not in those with the severe course of the disease. Correlations between neutrophil and lymphocyte nuclei euchromatization and cytochemical activity of lymphocytes and monocytes are detected. The optic anisotropic effect is proposed to be used as an extra diagnostic criterion of leptospirosis severity.

Adult↗
PubMed1998

Ocular manifestations in the acute phase of leptospirosis.

OBJECTIVES: To study the ocular manifestations during the acute phase of leptospirosis and their incidence in hospitalized patients due to systemic complications, and to verify the importance of routine ophthalmologic care in these cases. METHODS: Twenty-one patients, 20 males and 1 female, with clinical and laboratory (ELISA IgM) diagnoses of leptospirosis were subjected to ophthalmologic examination. RESULTS: We observed conjunctival hyperemia in 18 patients (85.7%), increased retinal venous caliber in 12 patients (57.1%), optic disc redness in 12 patients (57.1%), subconjunctival hemorrhage in four patients (19.0%), optic disc edema in one patient (4.8%), retinal vasculitis in one patient (4.8%), retinal hemorrhage in one patient (4.8%), hard exudates in one patient (4.8%), and papillitis in one patient (4.8%). No anterior chamber reaction was found. CONCLUSIONS: We observed a high incidence of several ocular manifestations in the acute phase of leptospirosis. Despite the systemic severity and high incidence of ocular disorders in the acute phase of leptospirosis, the short-term visual outcome of these patients was good.

Acute Disease↗
PubMed1982

Leptospirosis: I. Clinical investigation of the infection in dairy cattle in the Waikato district of New Zealand.

An investigation was made into the prevalence of leptospiral infection in cattle. An area 50 km radius was selected in a region where leptospirosis was reputedly common. Farmers volunteered 250 herds with 39 500 cows for testing and 7 500 animals were selected and sampled. Twenty-nine cows (0.4%) on 14 (5.6%) of the farms had leptospiruria at the first examination. Leptospirae were cultured from the urines of nine of these animals and all were Leptospira interrogans serovar hardjo. Serologically 12.5% of cows had titres of 1:200 or greater to hardjo and 3.5% titres of 1:200 or greater to pomona. In the Spring of 1977, there was evidence of clinical leptospirosis in calves associated with only one of the herds and no clinical leptospirosis in the 250 lactating herds, although leptospiral titres were found in 88% of them. This indicated that clinical disease was much less common than infection. We concluded that leptospirosis was of minor economic importance in dairy cattle, although it could be significant in individual herds, and a health hazard to farm workers.

Journal Article↗
PubMed1981

Markedly elevated creatinine phosphokinase, cotton wool spots, and pericarditis in a patient with leptospirosis.

We are reporting a patient with acute leptospirosis whose creatinine phosphokinase was markedly elevated secondary to an associated myositis. In patients presenting with acute hepatitis, an elevated creatinine phosphokinase should suggest the diagnosis of leptospirosis. Our patient's course of illness was made unusual by the appearance of cotton wool spots, previously unreported in leptospirosis as well as by pericarditis in the absence of uremia. This illustrates our ever widening recognition of the clinical manifestations of leptospirosis.

Adult↗
PubMed1997

[The importance of myoglobin in the pathogenesis of leptospirosis].

Measurements were made of serum and urine myoglobin in 48 patients with leptospiral jaundice (LJ) and 56 patients with various acute infections. At the height of LJ blood myoglobin level reached 28.96 +/- 4.3 micrograms/l (normal concentration 0.315 +/- 0.002 microgram/l). Compared to acute pneumonia, acute viral hepatitis, tonsillitis, erysipelas, diphtheria, health values, the ratio of serum myoglobin to urine myoglobin in leptospirosis made up 45.25 against 5.4, 4.8, 6.8, 3.7, 1.8 and 1.3, respectively. A relationship was found between concentrations of myoglobin, bilirubin, creatinine in the blood and leptospirosis severity. Elevation of serum myoglobin as a manifestation of specific myositis is pathognomic for leptospirosis and contributes to the onset of acute renal failure and disturbance of bilirubin metabolism. Quantitation of blood myoglobin may be helpful as an additional test for leptospirosis severity.

Adolescent↗
PubMed1996

Prospective serological study of leptospirosis in southern Spain.

This article reports data concerning a serosurvey carried out in Southern Spain to assess the current epidemiological status of a population exposed to risk of leptospirosis. Microagglutination and IgM-EIA tests were carried out on sera from a sample of workers in agriculture-related occupations, exposed to marsh waters. A cohort of 197 workers were followed for a year in an active surveillance program to evaluate seroconversion (laboratory confirmed leptospirosis). The results have shown for the cohort a density of incidence: 6.4 x 100 persons per year, and for the reference population an accumulated incidence of 41.25/100,000. Prevalence rates (P) were 21.3 x 100 and 144 x 10(5) for the cohort and population respectively. Rates were higher in cray-fishers (P: 62.7%), rice-workers, and butchers. This is the first report identifying cray-fishers as a high risk group for leptospirosis, and the reporting of human contamination by Australis serogroup in Spain.

Adolescent↗
PubMed1995

A twelve-year study of leptospirosis on Barbados.

Between November 1979 and December 1991, 398 cases of severe leptospirosis were confirmed on Barbados (range for 1980-1991 23-56; mean 32.7; incidence 13.3/100,000/year). For the six-year periods 1980-1985 and 1986-1991 there was no significant change in incidence with time. Incidence is unlikely to change significantly in the next decade. Monthly average case numbers ranged from 1.4 (July) to 4.3 (November). The average (2.8) for June to December (the 7 wetter months) was not significantly higher than that (2.5) for January to May (the 5 drier months). The age range was 7-86. There were three times as many male cases (302) as female (96), and nearly 10 times as many in those < 35. Although the highest number of cases (69) was in males aged 15-24, the highest incidence was in the older age groups, particularly the male 65-74 year-olds, and the female 55-64 year-olds. Leptospirosis was the proven cause of death in 55 (13.8%) hospital patients (annual range 0-13, mean 4.5). Some of a further 39 fatalities might have been cases. Death from leptospirosis was nearly twice as common among the women as among the men. Only one patient under 20 years of age died. Leptospira were isolated and identified from 117 (29.4%) of the 398 sick patients. The infecting organisms were bim (serogroup Autumnalis--75), copenhageni (Icterohaemorrhagiae-26), arborea (Ballum-14) and bajan (Australis-2). These infecting serovars could not be distinguished clinically, but infection was milder in children than in adults. Despite its predominance in surveyed children, serogroup Panama was virtually absent in this study. Rainfall is the major factor affecting the distribution of cases; not surprisingly, sanitation workers and agricultural workers appear to be the groups at highest risk. The general lack of clear-cut risk factors reflects the ubiquity of leptospires in the environment and the fact that the disease is not entirely occupational.

Adolescent↗
PubMed2000

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.

Hawaii↗
PubMed2006

Immunohistochemical and in situ hybridization studies of the liver and kidney in human leptospirosis.

An in situ hybridization (ISH) assay for the detection of leptospiral DNA in tissues was described and its diagnostic and pathogenetic usefulness in combination with immunohistochemistry (IHC) was evaluated in formalin-fixed, paraffin-embedded liver and kidney samples from human fatal cases of leptospirosis. IHC assays with anti-E-cadherin antibodies assessed the liver-plate disarray frequently observed in leptospirosis. Immunohistochemistry detected leptospiral antigen (LAg) in macrophages, both in human liver and kidney. In guinea pigs, in addition to these findings, staining on cell membranes of hepatocytes and, occasionally, in apical membrane of kidney tubular cells was demonstrated. Positive ISH signal was observed chiefly in the nuclei of human hepatocytes and in the cytoplasm and nuclei of liver cells of experimentally infected guinea pigs. Loss of E-cadherin membrane expression is associated with liver-plate disarray. These findings were discussed in the contention that, in leptospirosis, cell membrane damage might be important for the pathogenesis of the disease. Finally, it was suggested that both IHC and/or ISH might be used for both diagnostic and research purposes.

Adult↗
PubMed2000

Pulmonary involvement in leptospirosis.

The objective of this study was to assess the incidence of pulmonary involvement in a cohort of 26 patients in whom a diagnosis of leptospirosis had been made. Seventeen of the 26 patients had respiratory symptoms. Of these 17 patients, 13 had radiographs showing pulmonary abnormality. The most frequent finding was a bilateral patchy alveolar-acinar pattern in six patients. Three patients developed acute respiratory distress syndrome and died due to multiorgan failure. Only cigarette smoking was significantly associated with respiratory involvement (odds ratio, 19.2; 95% CI, 1.7-250; P < 0.001). The results indicate that pulmonary manifestations are observed in a high percentage of patients with leptospirosis. Cigarette smoking is a risk factor for the development of pulmonary involvement in human leptospirosis.

Adolescent↗
PubMed2007

Acute liver failure due to leptospirosis successfully treated with MARS (molecular adsorbent recirculating system) dialysis.

BACKGROUND: Leptospirosis is a re-emerging infectious disease, which may lead to multiple organ failure (MOF)and death. CASE PRESENTATION: We report the first case of severe leptospirosis complicated with acute renal and liver failure, successfully treated with albumin dialysis--molecular adsorbent recirculating system (MARS). Despite antibiotic therapy, optimum medical supportive treatment and timely initiated haemodialysis, the outcome was complicated by severe liver failure: hepatic encephalopathy grade III, hypoglycemia, prominent hyperbilirubinemia (TBIL 31.3 mg/dl, DBIL 28.6 mg/dl)and hepatic cytolysis (ALT 535 IU/l, AST 179 IU/l) and prolongation of the prothrombine time (68.4 sec). The patient underwent two sesions of albumin dialysis with the MARS procedure with complete recovery of hepatic and renal function. CONCLUSION: Albumin dialysis may confer a significant survival benefit on patients with leptospirosis-induced acute liver failure (ALF).

Alanine Transaminase↗
PubMed1990

New topics on leptospirosis.

In the United States, leptospirosis takes the second place in human diseases transmitted by animals. The clinical features of leptospirosis are very various in man and domestic animals by the nature of the serovar involved and the animal species infected. There are many epidemiological cycles of leptospirosis but environmental conditions are always important.

Acute Disease↗
PubMed2006

A model of Leptospirosis infection in an African rodent to determine risk to humans: seasonal fluctuations and the impact of rodent control.

Human leptospirosis (Leptospira spp. infection) is a worldwide public health problem that is of greatest concern for humid tropical and subtropical regions. The magnitude of the problem in these areas is larger because of the climatic and environmental conditions the bacterium face outside their hosts but also because of the frequency of contacts between people and sources of infection. Rodents are thought to play the most important role in the transmission of human leptospirosis. We here model the dynamics of infection in an African rodent (Mastomys natalensis) that is thought to be the principal source of infection in parts of Tanzania. Our model, representing the climatic conditions in central Tanzania, suggests a strong seasonality in the force of infection on humans with a peak in the abundance of infectious mice between January and April in agricultural environments. In urban areas the dynamics are predicted to be more stable and the period of high numbers of infectious animals runs from February to July. Our results indicate that removal of animals by trapping rather than reducing the suitability of the environment for rodents will have the greater impact on reducing human cases of leptospirosis.

Animals↗
PubMed2006

Evaluation of a recombinant LipL41 antigen of Leptospira interrogans serovar canicola in ELISA for serodiagnosis of bovine leptospirosis.

The efficacy of a recombinant leptospiral lipoprotein LipL41 as an antigen for conducting enzyme-linked immunosorbent assay (ELISA) for diagnosis of bovine leptospirosis was evaluated. Using known positive and known negative cattle sera the recombinant antigen was found to be highly reactive in the concentration of 100 ng/well. Using a total of 321 field cattle sera the sensitivity of ELISA as compared to microscopic agglutination test (MAT) was calculated to be 100% whereas the specificity was 85.3%. The seropositivity of leptospirosis among bovine population was found to be 21.18% having the predominance of serovars Sejroe and Pomona. It was concluded that rLipL41 protein could be a putative diagnostic candidate for serodiagnosis of bovine leptospirosis.

Agglutination Tests↗
PubMed2005

Leptospirosis: a case report of a patient with pulmonary haemorrhage successfully managed with extra corporeal membrane oxygenation.

Leptospirosis is a zoonosis of worldwide significance. Pulmonary involvement is common but often mild and of little clinical significance. However, over the last two decades an increasing number of cases have been reported with pulmonary haemorrhage as a prominent feature [Carvalho CR, Bethlem EP. Pulmonary complications of leptospirosis. Clin Chest Med, 2002;23(2):469-78]. These cases are particularly challenging to treat as they often have resistant hypoxaemia despite maximal invasive mechanical ventilation. Consequently, there is a high mortality rate. Here, we present a case of severe leptospirosis complicated by massive pulmonary haemorrhage which was successfully managed by extra corporeal membrane oxygenation (ECMO).

Adult↗
PubMed2005

Leptospirosis and pancytopenia: two case reports and review of the literature.

Besides the classical manifestations, leptospirosis may rarely occur with erythroid hypoplasia and/or pancytopenia. In this study, we reported two cases of leptospirosis presented with pancytopenia as the prevailing manifestation. In addition, the presence of pancytopenia in leptospirosis is reviewed. In both patients, the outcome was favourable as the bone marrow aplasia reversed completely after treatment with intravenous penicillin. In conclusion, this case study suggests that Leptospira infection should be included in the differential diagnosis of febrile pancytopenia, even in the absence of classical signs of severe disease as jaundice, meningitis, renal failure and pulmonary infiltrates.

Aged↗
PubMed2006

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.

Electromyography↗