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PubMedDate not supplied

Leptospirosis patient with AIDS: the first case reported.

A case of renal icterohemorrhagic leptospirosis involving a patient with acquired immunodeficiency syndrome (AIDS) is reported. Despite the low levels of CD4+ T lymphocytes, the clinical course of leptospirosis was similar to that observed in non-immunodepressed patients, and no worsening of AIDS occurred due to the infection by the spirochete. Serologic conversion was observed in the microscopic agglutination test, with maximum titer of 1:3,200. The patient had positive urine cultures for Leptospira interrogans for two months, whereas blood cultures were negative.

AIDS-Related Opportunistic Infections↗
PubMed2005

[Leptospirosis: report of a fulminant fatal case and review].

In relation to the explosive increase of new and reemerging infectious diseases that threaten the humanity, and as a result of this clinical case, a literature review is done on Leptospirosis stressing out the necessity of having in mind the leptospirosis in the differential diagnostic for fever and jaundice syndrome.

Adolescent↗
PubMed1985

Rapid serodiagnosis of leptospirosis using the IgM-specific Dot-ELISA: comparison with the microscopic agglutination test.

The dot enzyme-linked immunosorbent assay (Dot-ELISA) was compared to the microscopic agglutination test (MA test) for the diagnosis of human leptospirosis. Of 177 sera from 68 soldiers who trained in the Republic of Panama, 102 sera were positive in the MA test and 93 of these sera were positive in the IgM-specific Dot-ELISA. Incidence of infection was 50 of 68 patients with the MA test and 48 of 68 in the IgM Dot-ELISA. Five MA test-positive sera were reactive only in the IgG-specific Dot-ELISA, suggesting previous exposure. All 21 infecting serovars of Leptospira interrogans, as determined by positive reactions in the MA test or culture of blood and urine specimens, were reactive in the Dot-ELISA. Of 75 sera negative in the MA test, 61 were nonreactive in the Dot-ELISA. However, 9 of these 14 Dot-ELISA-positive/MA test-negative sera were acute samples from patients whose later sera were MA test-positive. Positive reactions in the IgM Dot-ELISA occurred in 2 of 30 control, 4 of 10 Lyme disease, 1 of 11 relapsing fever, and 1 of 8 yaws sera; 10 syphilis patient sera were nonreactive. The IgM-specific Dot-ELISA appears to be sensitive and specific for the serodiagnosis of acute leptospirosis. In addition, this rapid test is inexpensive, simple to perform, utilizes minute volumes of killed leptospiral antigen and is easily adaptable to field use.

Agglutination Tests↗
PubMed1988

Penicillin therapy in icteric leptospirosis.

A prospective, controlled randomized study of penicillin therapy in icteric human leptospirosis was carried out between 1 October 1983 and 31 December 1986. Thirty-eight patients received intravenous crystalline penicillin for 5 days, while 41 assigned to a control group received intravenous fluids only. A comparison of the results of laboratory tests made on the day of admission revealed no significant differences between the 2 groups. There was no significant difference in time for defervescence, return of biochemical parameters to normal, incidence of iritis, or mortality in the 2 groups. Three patients (7.3%) in the control group and 1 patient (2.6%) in the treatment group died. The overall mortality rate was 5.9%. Leptospira were recovered from urine cultures in 6 control patients but from none of the treated patients' post-treatment cultures. We conclude that penicillin has little effect on clinical outcome in icteric leptospirosis.

Adult↗
PubMed1997

Lung lesions in human leptospirosis: microscopic, immunohistochemical, and ultrastructural features related to thrombocytopenia.

Lung fragments from 12 patients were collected immediately after death and studied by light and electron microscopy and by immunohistochemistry to describe the main morphologic and ultrastructural aspects of the lung and platelets in leptospirosis (Weil's syndrome), to search for the possibility of disseminated intravascular coagulation (DIC), and to assess the relationship between endothelial lesions and local platelet aggregation and the leptospiral antigen distribution, as well as its relationship with the intensity of the lesions. The immunohistochemical results for fibrin aggregates were positive in the lumen and/or on the vascular endothelium in nine cases and on the alveolar surface in seven cases, leading to the diagnosis of the adult respiratory distress syndrome in these seven cases. Test results for leptospiral antigen by immunohistochemistry were positive in eight cases with no direct relationship between antigen deposits in the pulmonary vascular endothelium and intensity of the lesions. The ultrastructural findings were uniform and constant. Capillary lesions were characterized by swelling of endothelial cells, an increase in pinocytotic vesicles, and giant dense bodies in the cytoplasm of these cells. No necrosis, rupture, nor exposed subendothelial collagen was observed outside the hemorrhagic areas, and the intercellular junctions were preserved. The lung involvement in severe human leptospirosis presents as hemorrhagic pneumopathy with septal capillary lesions that are the usual cause of death. The thrombocytopenia that was verified in 11 of 12 patients in our study seems to bear no relationship to DIC and seems to be determined by activation, adhesion, and aggregation of platelets to the stimulated vascular endothelium, with an amorphous electron-dense substance between the endothelial cells and the adherent platelets in places where the subendothelial collagen was not exposed.

Adult↗
PubMed1997

Outcome of leptospirosis in children.

We conducted a retrospective analysis of 43 consecutive children (35 boys and 8 girls), 4-14 years of age and living in an urban area, who were hospitalized at the Instituto de Infectologia Emilio Ribas (Sao Paulo, Brazil) from January 1989 to December 1995 with an acute illness subsequently diagnosed as leptospirosis. Epidemiologic data indicated contact with contaminated water in most cases (88%). The patient sera reacted most strongly with Leptospira interrogans serovars copenhageni (45%) and icterohaemorrhagiae (32.7%). Jaundice was present in 70% of the patients, elevated transaminase levels in 56%, renal failure in 79%, meningitis in 23%, thrombocytopenia in 65%, and hemorrhagic manifestations in 11.6%. Three children had pulmonary hemorrhage with respiratory failure and one death occurred as a consequence of respiratory failure. We also observed that antimicrobial therapy reduced the extent of renal failure and thrombocytopenia. These data indicate that antibiotics benefit children with late, severe leptospirosis and that severe disease also occurs in children and should be considered in the differential diagnosis.

Acute Kidney Injury↗
PubMed2003

Leptospirosis--3 cases and a review.

Leptospirosis is an infectious disease of variable severity characterized by sudden onset of headache, myalgia and prostration. Although most common in the tropics, an increasing number of cases is reported in Europe and Northern America. Severe forms referred to as Weil's disease commonly involve kidneys, liver, lungs, CNS and heart and require early recognition and immediate initiation of adequate therapy. We describe 3 patients with Weil's syndrome from an urbanized region in Southern Germany, who developed renal and respiratory failure. PCR facilitated early diagnosis, and therefore, specific treatment before serological tests were positive. Illustrating the case histories, initial presentations and clinical courses, we point out difficulties with early diagnosis and treatment. Furthermore, we offer a comprehensive overview on leptospirosis with emphasis on renal involvement, current diagnostic tools and evidence-based therapy.

Adolescent↗
PubMedDate not supplied

[Aspergillosis of the heart and liver in leptospirosis].

A study made in three autopsies suggested development during the second to third week of leptospirosis icterohaemorrhagica against the background of secondary immunodeficiency (due to severity of the underlying condition or induced by glucocortocoid and antibiotic therapy) Aspergillus affection of the heart that had significantly aggravated the clinical course of leptospirosis and appeared to be the immediate provoking cause of acute cardiovascular insufficiency with a fatal result to follow. Two cases demonstrated an isolated fungal infection of the myocardium. In one of these running a longer (20 days in duration) course there took place a hematogenic dissemination of the aspergilli present in the liver during the development of the metastatic focus in the myocardium. The observations done suggest that each case requires individual consideration as to part the fungus infection plays in the outcome of the pathological process depending upon its type and extension in the organ.

Acute Disease↗
PubMed1997

The ratio of plasma levels of IL-10/TNF-alpha and its relationship to disease severity and survival in patients with leptospirosis.

Twelve patients with leptospirosis were enrolled in a study to evaluate whether a correlation exists between disease severity and plasma levels of TNF-alpha and IL-10 as determined by enzyme-linked immunoassay. Six patients had less severe disease by analysis of liver, kidney and lung involvement, and 6 patients had severe disease, 2 of whom died. The results of the study confirm an association between high levels of TNF-alpha and poor outcome in leptospirosis. Levels of IL-10 were in a similar range in the 10 surviving and the 2 non-surviving patients. The ratio of IL-10/TNF-a correlated with disease severity in that a high ratio was associated with less severe disease and survival. The possibility is raised that treatment approaches to change this cytokine profile may be more effective in this type of inflammatory condition than it has been in bacterial sepsis.

Journal Article↗
PubMed2000

[Renal involvement in convalescents after icterohemorrhagic leptospirosis].

Icterohemorrhagic spirochetosis convalescents develop slowly regressing renal dysfunctions most frequent of which are chronic renal failure, pyelonephritis and tubulointersticial nephritis, arterial hypertension. Renal disorders may be due to immunopathological reactions followed by activation of bacterial microflora. Damage from commissures at the sites of prior hemorrhage is also possible. In bovine leptospirosis renal damage is not so severe but it tends to progression. So, renal affection in leptospirosis is a specific pathology observed in any clinical form of the disease and demands surveillance in the regions of local focuses.

Adolescent↗
PubMed2000

Leptospirosis in Kuala Lumpur and the comparative evaluation of two rapid commercial diagnostic kits against the MAT test for the detection of antibodies to leptospira interrogans.

The aim of the study was to look into the epidemiology of serodiagnosed cases of leptospirosis at the University Hospital and compare two commercial ELISA Assays to the Microscopic Agglutination Test (MAT). Demographic data for all serodiagnosed cases for the years 1991-1997 were collected. From this data, 104 sera (n = 104) were selected as samples for comparative evaluation of the commercial ELISAs (INDX Dip-S-Ticks and PanBio ELISA) to the MAT test. Thirty two (n = 32) negative control sera were selected from serodiagnosed cases of other differential diagnosis of leptospira infection. The MAT test is a standard test that detects agglutination antibodies to leptospira biflexa, while the INDX Dip-S-Ticks is an ELISA dot test assaying for total anti-leptospira antibodies. The PanBio ELISA is a colorometric assay in test well strips to detect anti-leptospira IgM. The sensitivity, specificity, and efficiency of tests were calculated at a MAT cut-off value of 1:320. Demographic data showed that leptospirosis peaks during March-May and Aug-Nov coinciding with the inter-monsoon period with more men being infected than women and more adults than children. The sensitivity, specificity, and efficiency of test for the INDX Dip-S-Ticks were 83.3%, 93.8% and 87.5% while the values for the PanBio ELISA were 54.2%, 96.9% and 71.3%. The suboptimal PanBio result could be related to the blocking effect of high IgG titres or could be related to the diagnostic MAT cut-off values used in this study. The data hence reflects a pattern of transmission that is related to "wet" occupational risk factors. The commercial assays evaluated, are easier to perform but interpretation of results should be based on level of endemicity. The INDX Dip-S-Ticks allows this flexibility and is a practical alternative to the MAT test.

Adult↗
PubMed2001

[Comparative clinical and immunological parameters in convalescence of patients with icterohemorrhagic leptospirosis].

AIM: To investigate clinico-immunological parallels of convalescent period in leptospiral jaundice (LJ). MATERIAL AND METHODS: Clinical and immunological indices were studied in 121 LJ convalescents (97.6% males, age 17-45 years). RESULTS: Acute leptospirosis period was characterized with polymorphic clinical picture impeding precise diagnosis and threatening with such complications as bacterial shock, acute renal failure, acute renal-hepatic failure, DIC-syndrome, respiratory distress. Convalescents for a long time exhibited polyorganic pathology, developed sepsis. In late convalescence one could observe affections of the heart, liver, kidneys, bones, nervous system, eyes. This can be explained by disorders in immunity, especially structural immunodeficiency, and commissures at the sites of hemorrhages. CONCLUSION: Polyorganic pathology in leptospirosis convalescents arises because of immunity disorders which are not associated with the disease form. In late convalescence severe complications may accompany leptospiral jaundice.

Acute Kidney Injury↗
PubMed2002

[Weil's disease: a case report of acquired leptospirosis in Switzerland].

Leptospirosis is a rare disease in Switzerland. However its incidence is probably underestimated, due to its broad spectrum of presentations, including subclinical benign forms and the ictero-hemorragic form of the Weil's syndrome, whose mortality is high. We describe here a case of Weil's syndrome acquired in Switzerland with a favourable outcome under antibiotherapy. Even in the absence of any travel, the association of an acute renal insufficiency and jaundice with only moderate hepatic cytolysis should lead to the suspicion of leptospirosis. Clinical and epidemiological aspects of the disease are discussed in the article.

Aged↗
PubMedDate not supplied

[An evaluation of the ELISA-IgM test in the early diagnosis of human leptospirosis].

Thirty-seven sera samples from patients with leptospirosis icterohaemorrhagic form were studied with a time interval of 2 to 12 days between the beginning of the symptoms and the collection blood samples. It was isolated leptospira of 5 patients' hemocultures (13.5%) and from 4 of these the etiological agent pertained to the serogroup Icterohaemorrhagiae serovar copenhageni. Thirty-five of them (94.6%), including the four patients whose the etiological agent was isolated, showed reactivity in the enzyme linked immunosorbent (ELISA) IgM test. By this way, it was demonstrated that this test is important for a rapid diagnosis of human leptospirosis, even in the beginning of the disease, when there is still leptospiraemic phase.

Adolescent↗
PubMed1992

[A quick method for the diagnosis of leptospirosis].

Seventy-nine sero-samples from patients with leptospirosis were tested by dot-ELISA and microscopical agglutination test (MAT). Results showed that the accordance rate was 96.19%. 20 sero-samples obtained from healthy people, 4 from hepatitis B(HBV) and 4 from epidemic hemorrhage fever (EHF) were negative by dot-ELISA. We believe dot-ELISA is a simple, rapid method which can be used to diagnose those patients with leptospirosis.

Antigens, Bacterial↗
PubMed1990

[Clinico-morphologic characteristics of leptospirosis with hemorrhagic syndrome].

Infectious toxic shock, acute renal and acute hepatorenal insufficiency are the principal morphoclinical syndromes in malignant forms of icterohemorrhagic leptospirosis. The major complications of acute renal and hepatorenal failure are pyoseptic involvements of the lungs, heart, and pancreas. Direct or indirect signs of the DIC syndrome and intravascular platelet aggregation are characteristic of all the principal clinical syndromes of malignant forms of leptospirosis.

Acute Kidney Injury↗
PubMedDate not supplied

[Treatment of terminal forms of icterohemorrhagic leptospirosis].

Complex therapy, using hemosorption in combination with hemodialysis and hyperbaric oxygenation, was suggested for the treatment of patients with terminal stages of icterohemorrhagic leptospirosis. Such complex therapy decreased the mortality rate of patients with terminal stages of icterohemorrhagic leptospirosis from 76-96% to 18-22% and reduced the in-hospital stay from 60-80 to 35-40 days.

Hemoperfusion↗
PubMed1988

A serologic survey of rice-field leptospirosis in Central Luzon, Philippines.

Although human cases of leptospirosis have been reported from the Philippines, there is a lack of data on its prevalence. We therefore surveyed three rice-farming villages for the presence of leptospiral antibody. Out of 155 sera tested, 63 (43.6%) tested positive using the standard microagglutination test. Antibodies were more frequent in men than women (48 vs. 31%, respectively, p less than 0.01), and less common in the elderly. Exposure to leptospires occurs frequently in rice farmers, and leptospirosis is likely to be an underdiagnosed cause of both mild and severe febrile illness in the Philippines.

Adolescent↗