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The authors describe a rare case from the clinical practice. Treatment including hemosorption was employed in a 38-year-old with a severe form of icterohemorrhagic leptospirosis accompanied by acute reno-hepatic failure and pronounced thrombocytopenia--15 x 10(9)l. The relative significance of thrombocytopenia as one of the main contraindication to hemosorption is suggested.
The authors examined 195 domestic animals for leptospirosis serologically in Sudan (170 cattle, 7 sheep and 18 goats) and 771 wild animals (36 species) with 13 serovars from 13 serogroups. 54% of domestic animals namely, 108 cattle and 1 sheep were positive in titer levels of 1:400 and higher. Cattle sera with the serovars of the serogroup Icterohaemorrhagiae were 2.4% positive with Cynopteri 2.4%, Autumnalis 3.5%, Australis 1.2%, Pomona 2.9%, Grippotyphosa 2.9%, Hebdonadis 17.1%, Bataviae 9.4% and Tarassovi 50.6%. Only one Numida meleagris of the 54 wild birds (14 species) was positive in low titer level of 1:100 with L. canicola. Seventy (9.8%) of the 717 wild mammals (22 species) examined were positive namely with the serovars of the serogroups Icterohaemorrhagiae 3.4%, Javanica 3.0%, Pomona 2.0%, Grippotyphosa 0.7%, Hebdomadis 0.4%, Ballum, Australis, Pyrogenes, Bataviae each 0.3% and Cynopteri 0.1%, whereby sera from 7 animals reacted simultaneously with the serovars of two serogroups. With regard to the species, positive reactions were found in Erinaceus albiventris, Eidolon helbum, Cercopithecus aethiops, Genetta spec., Canis adustus et aurus, Felis silvestris, Leptailurus serval, Arvicanthis niloticus, Mastomys spec., Mus spec., Gazella spec., Tragelaphus spec. The positivity in rodents was very low - 1.2%.
The authors examined serologically and bacteriologically 129 wild living small mammals (9 species) in Neumarkt, in Styria. A total of 17 animals were positive (all Microtus agrestis), of these 10 serologically (6 with L. saxkoebing, 3 with L. grippotyphosa and 1 with L. sorexjalna) and 7 bacteriologically. Of the 7 isolated leptospirae-strains one did not survive up to typing, the 6 remaining were identified as L. saxkoebing. It is the first evidence of the existence of leptospirosis natural foci of the serovar saxkoebing in Austria and at the same time the first isolation of L. saxkoebing from Microtus agrestis in Central Europe. The serovar saxkoebing, which BORG-PETERSEN described in the year 1942 (1943) and isolated from the yellow-neck mouse (Apodemus flavicollis) is found in most European countries (KATHE and MOCHMANN, 1967), may, however not be found in some regions although its main reservoir, the yellow-neck mouse dwells, as SEBEK (1965) and SEBEK and ROSICKY (1974) drew attention to in Czechoslovakia. In Austria, in fact L. saxkoebing antibodies have been demonstrated in wild- and also domestic-animals (SEBEK, et. al., 1973b, 1976a, 1976b), however, a reliable proof of these serovars was not found.
At the area of a natural focus of leptospirosis (caused by L. pomona) in the Mozdok region of the North Occetic ASSR leptospires were detected by the method of dark field microscopy in 22% of intact soil samples. The presence of pathogenic leptospires in this soil was not confirmed by the method of the biological assay on Syrian golden hamsters. In controlled tests lasting 1-277 days, in 30.4% of cases L. pomona retained their viability, pathogenic and antigenic properties for as long as 74 days, while staying in the soil at the focus of infection with humidity being 15.2-31.4% and pH = 6.7-7.2. 11 Leptospira cultures isolated after staying in the soil retained their pathogenic properties and the death of the animals used in the bioassay from the acute form of leptospiral infection.
An active natural focus of icterohemorrhagic leptospirosis has been detected in the area of fish-breeding ponds in Rostov Province, where the intensive epizootic among the population of Norway rats is observed the whole year round (574 animals have been examined, 56 cultures have been isolated). The epizootic process reaches its highest intensity in autumn (the proportion of infected animals exceeds 50%). This natural focus in the area of fish-breeding ponds is epidemiologically dangerous. The limitation of its infectious potential is possible by means of poisoned baits.
The authors report the cardiovascular manifestations observed in 15 cases of severe leptospirosis in New Caledonia. Cardiovascular collapse is frequent. Electrocardiographic alterations consist mainly of arrhythmia secondary to atrial fibrillation and repolarisation disorders. A picture of pseudo-pericarditis has also been observed. These cardiac manifestations represent a factor of gravity when associated with multi-visceral manifestations which control the prognosis.
A study of human and animal leptospirosis was carried out in new Caledonia's two most important focuses. This survey showed an annual incidence in the human population of 8.8 p. thousand in the Nera basin and 0.88 p. thousand in the Coulée basin. Male adults with agricultural and livestock occupations are the most exposed, especially from March to May, the end of the hot season. Frequent contacts with fresh water and animals, and the failure to use of gloves and boots, significantly increase the risk of contamination. Two factors of severity are important: serotype and age. Leptospira icterohaemorrhagiae is responsible for serious and fatal clinical forms and patients over 50 years of age have a maximum vital risk. In order to reduce the incidence and the severity of this disease, it appears desirable to vaccinate the farmers and the cattle breeders against L. icterohaemorrhagiae and to institute mass media information campaigns to warn against the risks of contamination.
The results of a serosurvey for leptospiral antibodies in a random sample of healthy subjects are reported. The study was carried out in an area where a waterborne outbreak of leptospirosis, due to leptospires of serogroup Australis, had occurred a month before. Sera were tested with the microagglutination technique. Leptospiral agglutinins were found in 13.8% of tested subjects, mostly in adult females. The highest prevalence rate was observed for serovar lora belonging to serogroup Australis. The leptospires of this group have a relevant spread in the study area in keeping with other surveys carried out in Italy.
In France, between 1974 and 1983, 1 194 diagnoses of L. icterohaemorrhagiae leptospirosis were confirmed serologically at Pasteur Institute (Paris), WHO Reference Center. The number of cases diagnosed each year rose from 74 in 1974 to 277 in 1983. The annual incidence in 1983 was 0.55 per 100 000. The temporal distribution shows that 25% of cases were in August and 63% between July and October. Two areas have a greater incidence: the South West and the East. The departments near the sea of the South East, the North and the West have the lowest incidence.
The authors examined serologically 329 specimens of domestic animals from 8 provinces of Afghanistan for the incidence of leptospirosis. They detected in 15.8% of the animals examined antibodies against Leptospira in titres of 1 : 800 and higher: in 6.4% with serotypes of the serogroup Hebdomadis, 5.5%--Tarassovi, 2.7%--Grippotyphosa, 2.4%--Pomona, 2.1% Javanica, 1.5%--Icterohaemorrhagiae, 0.6% each--Canicola, Ballum, Bataviae, 0.3%--Pyrogenes. Positivity was highest in the buffalo--55.0%, camel--10 of the 18 animals examined, and cattle--25.5%. It was considerably lower in sheep--2.3% and goat--3.2%; also positive was one of the 6 zebus examined.
Fourteen cases of leptospirosis due to the Leptospira interrogans serogroup Icterohaemorrhagiae (Weil's disease) were serologically confirmed in the last 15 years. In two cases, Icterohaemorrhagiae was also isolated from the patients' blood. Both positive cultures were obtained in Korthof's medium by indirect passage through brain-heart infusion medium. One of the isolates was identified as serovar budapest, which has never been reported in Israel. In most of the cases, paradoxical cross-reactions with serovars of the Autumnalis, Hebdomadis and Canicola serogroups were observed in the early stages of the illness. In all cases, we suspected that the source of the infection was serovars of the Icterohaemorrhagiae serogroup shed in the urine of Rattus norvegicus rats. Thirteen of the affected persons were working and living in the Tel Aviv area, all in places not known to be Icterohaemorrhagiae endemic before 1968. One patient was working and living in the Hadera region. All patients were jaundiced, and one died. The illness was usually accompanied by pronounced and long-lasting elevation of blood bilirubin and urea levels.
Four patients with leptospirosis icterohaemorrhagica (LH) were admitted to an intensive care unit in a state of shock. Haemodynamic studies showed that the shock was due to three different mechanisms which were often associated or successive in the same patient: (1) septic shock with fall of systemic vascular resistance (SVR) and no widening of arteriovenous oxygen difference (AVDO2); (2) cardiogenic shock, probably due in part to specific myocarditis, with reduced left ventricular work and normal or high pulmonary wedge pressure; and (3) hypovolaemic shock with the increased SVR and widened AVDO2. These data suggest that haemodynamic studies are required in patients with LIH associated with shock in order to determine its mechanism and provide guidelines for its treatment.
An outbreak of acute febrile illness with haemorrhagic manifestations and pulmonary involvement occurred in Diglipur of North Andaman during October-November 1993. Investigations were carried out to see whether leptospires were responsible for this outbreak. Serum samples were collected from suspected cases and tested for presence of antibodies to leptospires by microscopic agglutination test (MAT) using a battery of 19 antigens representing 16 serogroups. 66.7 per cent of the specimens showed significant titres of antibodies against leptospires, 18 of 23 paired sera (78.3%) showed sero-conversion or four-fold rise in antibody titres. The commonest serovar involved was Leptospira grippotyphosa followed by L. canicola and L. JEZ bratislava. In 7 patients L. grippotyphosa was the sole serovar against which antibodies were detected. Clinical and epidemiological observations of this outbreak were similar with that of earlier seasonal outbreaks of acute febrile illness with haemorrhagic manifestations occurring in the same area, indicating that the past outbreaks may also have been due to leptospires. This is the first report of pulmonary leptospirosis from India.
Time course of cellular immunity parameters was followed up in 56 patients with different forms of icterohemorrhagic leptospirosis of various severity. A grave course of the disease was associated with development of secondary structural immunodeficiency manifesting by reduction of E = RFC count, of immunoregulatory index, and of the count of T lymphocytes. The course of convalescence was found related to the immune response: if immunodeficiency persisted during the early convalescence period, the patients developed late complications.
Canine serum samples (n = 400) from the Pretoria area were tested for Leptospira antibodies, using the microscopic agglutination test. The prevalence of antibodies (inconclusive and positive titres) was 1.5%. Reactions were only against Leptospira interrogans serovars tarassovi and pyrogens. Leptospirosis does not appear to be an important canine disease in the Pretoria area.
In severe course of icterohemorrhagic form leptospirosis presenting with an acute renal-hepatic insufficiency and manifest hypocoagulation (BC II-III), plasmasorption on the sorbent SKN [correction of CKH] IK with carboperfusion of 0.8-1.2 1 plasma appears to be warranted. Being endowed with an apparent detoxicating effect at the expense of absorbtion of creatinin, urea bilirubin, this manipulation, with small doses of heparin, promotes also stabilization of hemostasis and arresting of hypocoagulation, which fact enhances appreciably the compensatory power of the organism improving the prognosis of the condition.
A total of 120 patients were examined presenting with a grave course of icterohemorrhagic leptospirosis; a pathomorphologic investigation of the brain from 75 deceased was done. Practically in all cases, the affection was accompanied by neurotoxicosis, with microcirculatory disturbances being its morphological substrate. The leading clinical syndromes of the affection of the central nervous system appeared to be general cerebral, meningeal, and encephalitic syndromes. Meningitis was diagnosed in 29.2%, meningoencephalitis in 5% of patients. Morphologic studies showed that predominantly focal serous meningitides and meningoencephalitides are significantly more common that they are diagnosed in clinical settings. They tend to develop during the second and third weeks of the course of the illness. Lumbal puncture is to be carried out on a differentiated basis only, since it may cause dysbalance in metabolic processes of the organism together with progression of those events being related to brain swelling.
The clinical course of grave forms of leptospirosis presents with disorders in the fluid and electrolyte balance and acid-base condition (ABC) which fact necessitates taking prompt action for the condition to be corrected. Correction of disorders in the fluid and electrolyte balance involves employment of glucose and salt solutions, dextrans, and in most severe cases albumin drugs under control of hematocrit values, plasma osmolarity, and 24-h diuresis monitoring. Correction of disorders in the ABC is primarily aimed at alleviating the metabolic acidosis through detoxication by applying specific therapy together with oral and parenteral administration of sodium hydrogen carbonate.