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PubMedDate not supplied

[Pulmonary compromise in leptospirosis].

To study the pulmonary complications in leptospirosis case records of 23 such patients admitted at the Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, Brasil, were reviewed. Hemoptysis were seen in 21.7% and sputal blood in 30.4% of patients. Arterial gasometry detected hypoxemia and hypocapnia in most cases. Thoracic radiology showed an alveolar pattern in 60% of the patients, alveolo-interstitial in 20%, interstitial in 6%, and in 14% the lungs were considered to be normal. Necropsy of 13 cases showed edema, congestion and hemorrhage in the lungs in all cases. Hyaline membrane was found in 30% and fibrin thrombi in 46% of these cases, resulting in a diagnosis of adult respiratory distress syndrome and acute disseminated intravascular coagulation (consumption coagulopathy) in leptospirosis.

Adult↗
PubMedDate not supplied

[Hemoptysis and the adult respiratory distress syndrome as the causes of death in leptospirosis. Changes in the clinical and anatomicopathological patterns].

Human leptospirosis, one of the main urban endemics/epidemics in Brazil, has dramatically grown in the last three decades, especially after floods caused by summer rains. This presentation describes recent changes in the clinical patterns of this pathology in our region, expressed by the emergence of massive haemoptysis and acute respiratory distress syndrome, or both conditions associated. The evident changes in the respiratory structures emerged as a serious life threat and death mechanisms, becoming the main cause of death in leptospirosis among us because of their high incidence. This new face of the disease demands a revision of current concepts about its seriousness and raises speculations about the pathogenesis of such alterations.

Adult↗
PubMedDate not supplied

[Leptospirosis in children in Ciego de Avila Province, Cuba].

The morbidity of leptospirosis among children from Ciego de Avila Province was investigated from 1982 to 1995, and 253 cases were diagnosed. Isolated cases prevailed over those occurring in outbreaks. The 10-14 age group was predominant, followed by the 5-9 age group. According to sex, it was more frequently found in males than in females. One death occurred during this period. There was an increase of cases from July to August and October, and November showed a higher incidence of cases. Fever, headache and myalgia were the symptoms and signs more frequently reported, and 92% of cases showed no icterus. Acute fever, leptospirosis and viral meningoencephalitis were the presumptive diagnoses most frequently made. Possible sources of infection involving a larger number of cases were contact with low terrains and bathing in rivers, ponds and lakes. Regarding diagnosis, 162 cases were diagnosed by the microagglutination test and 91 by the hemolytic test. Canicola, australis and pomona were the serogroups more frequently detected by the microagglutination test.

Adolescent↗
PubMedDate not supplied

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.

Adult↗
PubMedDate not supplied

[Severe forms of leptospirosis: clinical, demographic and environmental aspects].

Characteristics of 1,016 patients hospitalized with leptospirosis in the Hospital Couto Maia, Salvador, BA, Brazil, between 1993 and 1997 are described. Higher pluviometric precipitation was related to an increase in the number of hospitalizations during the following month. Males corresponded to 81.1% (824/1,016) of these; mean age was 35.7+/-15.4 years. Almost 94% (778/829) of the 829 patients with information about race were black or mulatto (mixed race). For ages 18 years or above, almost 93% had not completed high school level. The mean incubation period was estimated as 6.3+/-3.9 days. Average duration of symptoms was 6.1+/-2.4 days. Hemorrhagic events corresponded to 14.3% (145/1,016). The case-fatality rate among 1,009 patients that were not transferred was 14.2% (143/1,009). Renal failure was the attributable cause of death in 76.2% (109/143). The data indicate that leptospirosis is closely related to lower socioeconomic levels, and that higher pluviometric precipitation antecedes the outbreaks.

Adult↗
PubMedDate not supplied

[Human leptospirosis in Belo Horizonte City, Minas Gerais, Brazil: a geographic approach].

A retrospective study on human leptospirosis, was done in Belo Horizonte in 1995, using geographic processing resources. Thirty suspected and 19 confirmed cases of leptospirosis were mapped in the area. The majority of confirmed cases (68.4 +/- 13%) were located in North, Northeast and West of the city. The main foci of disease were found in slums and other poor areas: 73.7 +/- 12% of the confirmed cases and 26.7 +/- 12% of suspected cases. Ninety-five percent +/- 6% of the confirmed cases were found in the outskirts of the city where there was a population increase and inadequate infrastructure. It was observed that 50 +/- 14% of the suspected cases and 42 +/- 14% of the confirmed cases were found in areas of high concentration of water resources. Suspected (83.3 +/- 10%) and confirmed cases (79 +/- 11%) occurred in lower altitude areas of the city (750 to 1,000m) and 78 +/- 12% of the individuals had been in contact with contaminated water and/or animals.

Adolescent↗
PubMed2005

Retrospective review of leptospirosis in Guadeloupe, French West Indies 1994-2001.

Demographic, clinical, biological and personal data were obtained from patients hospitalized with symptoms of leptospirosis in the Hospital of Pointe a Pitre, Guadeloupe, French West Indies from 1994 to 2001. Of the 897 screened patients, 212 were acute cases, 607 were non-infected and 78 were undetermined cases. There was no predominant age group. Leptospirosis transmission followed the rainfall cycle and was greater in rural areas. Jaundice and conjunctival suffusion were significantly more frequent in cases than non-cases. Males, professions considered to be at risk and contact with swine or bovine were associated with infection. Serogroups Icterohaemorrhagiae, Cynopteri, Australis, Sejroe, Pomona and Ballum were serovars presumed responsible for acute cases.

Adult↗
PubMed2002

Electrocardiographic alterations in patients hospitalized with leptospirosis in the Brazilian city of Salvador.

OBJECTIVE: To report the frequency and types of electrocardiographic alterations in patients with leptospirosis in the first 24 hours of hospitalization. METHODS: We analyzed the electrocardiograms of 157 patients admitted to the Hospital Couto Maia in the city of Salvador, in the State of Bahia, Brazil, from March 1998 to June 1999. The electrocardiograms were performed in the first 24 hours after hospital admission, independent of the clinical manifestations of the patients. RESULTS: The mean +/- SD for patients' age was 35.5+/- 13.7 (median = 32) years, and jaundice was present in 95.5% of them. Alterations in the electrocardiogram were detected in 68.2% (107/157) of the patients (95% confidence interval = 60.6% - 75.1%). Atrial fibrillation was the most frequent arrhythmia, occurring in 10.8% (17/157) of the patients. Other frequent findings were alterations in ventricular repolarization detected in 38.9% (61/157) of patients and first-degree atrioventricular block in 10.2% (16/157). The patients with atrial fibrillation were older and had higher levels of creatinine and aminotransferases. CONCLUSION: In this sample, approximately 2/3 of the patients had electrocardiographic alterations after hospital admission. Of the major arrhythmias, atrial fibrillation was the most frequent, and the patients with this arrhythmia had evidence of more severe disease. The relation between the presence and type of electrocardiographic alteration and the prognosis of leptospirosis is yet to be assessed.

Adult↗
PubMedDate not supplied

[Epidemiology of human leptospirosis, with special reference to greater Rio de Janeiro, Brazil, from 1970 to 1982].

From 1970 to 1982, 884 cases of human leptospirosis were serologically diagnosed at the Leptospirosis Laboratory, Fundação Oswaldo Cruz - FIOCRUZ, by means of the microscopic agglutination test. Of these patients, 775 were hospitalized in the city of Rio de Janeiro, and 109 were reported by other Brazilian cities. Icterohaemorrhagiae was the presumptive infecting serogroup most commonly encountered in greater Rio patients (76.4%) and in the others (41.3%). During this 13-year period, two Icterohaemorrhagiae strains were isolated. In greater Rio the illness predominated between January and April (53.7%), the male sex accounted for 89.9% of the cases, and patients ranging from 16 to 45 year-olds were the most affected (74.9%).

Adolescent↗
PubMed2000

[Report on a leptospirosis outbreak in the city of Santa Fe, Argentina, March-April 1998].

In March-April 1998 in a neighborhood in the city of Santa Fe, Argentina, there was an outbreak of an acute disease characterized by fever, headaches, and intense myalgias. This article presents the studies surrounding this outbreak and the attempts to identify the source and the mode of transmission. The epidemiological, serological, and clinical findings indicated that the causative agent was Leptospira interrogans. As a screening test, macroscopic agglutination with heat-resistant antigen was applied, followed by the ELISA test, and, as a confirmatory test, microscopic agglutination for 10 serotypes of L. interrogans. The study covered 32 persons, 8 dogs, and 8 water samples. Among the 32 persons, 12 cases were confirmed, 2 were suspicious, and 18 were negative. Six dogs were found to be infected, and motile spirochetes were found in the water samples. The human sera reacted with the ballum, canicola, icterohaemorrhagiae, and pyrogenes serotypes; the canine sera reacted with the ballum, canicola, and pomona serotypes. The coagglutination found in all the confirmed cases indicates that they were acute cases of leptospirosis, but it was impossible to identify the causal serotype. Except for the index case, the disease was not recognized clinically. Several facts suggest that the outbreak was caused by rain that had flooded the study area. The results of this study emphasize the need for active surveillance of leptospirosis when there are floods and other natural disasters.

Animals↗
PubMed2000

[Evaluation of the effectiveness of a new vaccine against human leptospirosis in groups at risk].

In order to evaluate the effectiveness of a new vaccine against human leptospirosis, a prospective cohort study was done with persons in the Cuban province of Holguín who were at risk of becoming ill with leptospirosis. The study included 118,018 persons from 15 to 65 years old who were considered to face either permanent or temporary risk. The vaccinated cohort consisted of 101,137 persons. They received two vaccine doses, 6 weeks apart, of 0.50 mL via deep intramuscular injection into the deltoid muscle of the nondominant arm. The unvaccinated cohort consisted of 16,881 persons. Epidemiological surveillance began 21 days after the application of the second vaccine dose and continued for 1 year. The same criteria for suspected and confirmed cases were maintained throughout the study period. At the end of the surveillance period effectiveness was calculated as being higher than 97%. It is estimated that the vaccination program prevented eight out of ten cases that would have otherwise occurred. Vaccine reactogenicity was also measured in a subsample of 1,500 persons between 15 and 65 years old. The observed symptomatology was low. Slight pain at the injection site was the most frequent symptom (25%). The results of the study indicate the usefulness of the vaccine for disease prevention among people at risk, and its use is thus recommended.

Adolescent↗
PubMed2006

Record linkage and capture-recapture estimates for underreporting of human leptospirosis in a Brazilian health district.

Record linkage and capture-recapture models were used to estimate the number of cases of human leptospirosis in the health district of Santa Maria, RS in southern Brazil. Twelve months of laboratory, hospital and epidemiological surveillance data were matched by name, age, residence and the month of diagnosis. Only laboratory-confirmed cases were considered. The record linkage revealed more than 20 times more cases than the official estimate for the health district, indicating a leptospirosis epidemic, with an annual incidence of more than 3 per 1,000 inhabitants and a case fatality of 0.37%. Severe cases were predominantly found through hospital records, overlapping to some extent with the epidemiological surveillance data, whereas less severe cases were found almost exclusively through laboratory logs. Different combinations of data sources influenced the detection rate for low versus high severity cases. Based on log-linear capture-recapture models, stratified by case severity and taking into account possible dependencies between the data sources, an insignificant number of cases were missed by all sources.

Brazil↗
PubMedDate not supplied

Influence of infecting serogroup on clinical features of leptospirosis in dogs.

The purpose of this study was to review recent cases of leptospirosis seen at referral centers in New York State and to identify differences in clinical or clinicopathologic aspects of the disease among different suspected infecting serogroups. Medical records at the Cornell University Hospital for Animals and the Animal Medical Center in New York City were reviewed to identify dogs diagnosed with leptospirosis from September 1996 to August 2002. Records of 55 dogs met the inclusion criteria for the study. The suspected infecting serogroups included 21 occurrences of Grippotyphosa, 12 of Pomona, 6 of Autumnalis, 5 of Bratislava, 2 of Hardjo, and 1 of Canicola. Five dogs had equal titers to serogroups Grippotyphosa and Pomona, and 3 had equal titers to 2 other serogroups. Common clinical signs included lethargy, anorexia, and vomiting. Common clinicopathologic findings included anemia, thrombocytopenia, azotemia, hyperphosphatemia, high liver enzyme activity, and hyperbilirubinemia. Forty-three of 55 dogs were discharged from the hospital. Serogroup-specific analysis indicated that dogs with suspected serogroup Pomona infection were more likely to suffer from vomiting (P = .01), thrombocytopenia (P = .009), severe azotemia (P = .04), and hyperphosphatemia (P = .006) than dogs with other serogroups and were less likely to be discharged alive from the hospital (P = .03). This study suggests that only minor clinically relevant differences exist among serogroups. Leptospira serogroup Pomona caused more severe renal disease and was associated with a worse outcome compared with disease caused by other serogroups.

Animals↗
PubMed1991

Leptospirosis on Kauai: investigation of a common source waterborne outbreak.

During the summer of 1987, a common source waterborne outbreak of leptospirosis occurred on the island of Kauai in the state of Hawaii. Eight leptospirosis cases were identified using the microscopic agglutination test. Methodologic weaknesses in this technique were responsible for the initial missed diagnosis on six of the eight cases. All cases had repeated exposure to the Waimea River. A wide array of animal reservoirs and optimal water conditions may have been factors in this outbreak.

Abortion, Veterinary↗
PubMed1975

Human leptospirosis.

Human leptospirosis is a subject of increasing interest. Although this disease was frequently associated with individuals whose occupation or geographic location placed them in close proximity to wild animals or farm animals, recent cases have been particularly prevalent in young children and adolescents in urban and suburban America. Many of the recent cases have been acquired from household pets, particularly from dogs or hamsters. In particular, healthy dogs who have been immunized with leptospiral organisms, thereby creating a significant risk for their owners. This article will review the pathophysiology, clincal manifestations, laboratory diagnosis, treatment, and prevention of leptospirosis in the modern era, with particular emphasis on a more complete understanding of the epidemiology of this disorder.

Adolescent↗
PubMed2005

Leptospirosis during dengue outbreak, Bangladesh.

We collected acute-phase serum samples from febrile patients at 2 major hospitals in Dhaka, Bangladesh, during an outbreak of dengue fever in 2001. A total of 18% of dengue-negative patients tested positive for leptospirosis. The case-fatality rate among leptospirosis patients (5%) was higher than among dengue fever patients (1.2%).

Adolescent↗
PubMed1990

Leptospirosis in Chonbuk Province of Korea in 1987.

Leptospirosis is a zoonosis with protean clinical manifestations. Its diagnosis requires a high index of suspicion and is confirmed by isolation of the organism or, more commonly, by serologic tests. In the fall of 1987, after severe flooding, we saw 93 patients with leptospirosis, confirmed by a microagglutination test. Thirteen percent of the patients had no clinical or laboratory findings except fever and headache, but the rest had mild to severe manifestations. Jaundice, renal failure, and aseptic meningitis were not common, but pulmonary symptoms, when present, were striking. The mortality rate was 5%. The main cause of death was asphyxiation due to massive hemoptysis from pulmonary hemorrhage and acute respiratory failure.

Adolescent↗
PubMed1982

Thrombocytopenia in leptospirosis.

In a retrospective study undertaken to document the frequency of thrombocytopenia in cases of leptospirosis, 18 of 32 patients (56.3%) had a platelet count of 100 x 10(3)/mm3 or less. Renal failure occurred in 72.2% of thrombocytopenic patients and in 21.4% of patients with normal platelet counts. The association of thrombocytopenia and renal failure was significant (P less than 0.02). The common occurrence of thrombocytopenia and its association with acute renal failure in patients with leptospirosis has not previously been reported.

Acute Kidney Injury↗