Plasma exchange in severe leptospirosis.
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Morphofunctional and immunofluorescent studies were done in guinea pigs experimentally infected with Leptospira interrogans serovar icterohaemorrhagiae to determine the role of leptospiral antigen, gamma-globulin, and complement C3 deposits in the pathogenesis of the renal lesions. A sharp increase in leptospiral antigen deposits was observed in the late phase of the experimental infection. Immunoglobulin and complement C3 were small compared with the heavy leptospiral antigen deposits. Moreover, leptospiral antigen was observed mainly in the interstitium whereas immunoglobulin and complement C3 deposits were seen in glomeruli and small blood vessel walls. In our experimental model bacterial migration and local liberation of factors causing virulence seems more likely to determine the renal damage.
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A total of 270 serum samples collected in Chiang Mai province were examined for antibodies against leptospira using the microscopic agglutination test (MAT). Four of 40 serum specimens from patients who visited the hospital with the common cold, were positive with a titre of 20. Twelve (10.4%) of the 115 samples in the Doi Saket district showed a positive reaction. Only 2 of 115 sera of school children in Chiang Mai city had antibodies. Specific serovars detected were Leptospira hebdomadis (5), L. australis (3), L. icterohaemorrhagiae (2), L. bataviae (2), and one each of L. canicola, L. javanica and L. pyrogenes. One case of mixed infection with L. hebdomadis and L. javanica, and L. autumnalis and L. australis were observed.
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