Severe acute respiratory distress syndrome, leptospirosis, and lung protective strategies.
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A screw-capped glass tube containing a Leptospira culture accidentally broke and the laboratory worker who was handling the tube sustained a cut on his hand. The wound was flooded with the culture. The culture was that of strain MG 347 belonging to serovar Australis recovered from a patient, and it had undergone 52 passages in Ellinghausen McCullough Johnson Harris medium. The laboratory worker developed a headache 21 days after the accident and became febrile the next day. He was hospitalized for 5 days and was treated initially with doxycycline and later with ciprofloxacin. A blood sample collected on the second day of illness, after starting doxycycline therapy, yielded leptospires and the isolate, HZ 651, was identified as serovar Australis. Monoclonal antibody patterns and randomly amplified polymorphic DNA fingerprinting patterns of the isolate and strain MG 347 were identical, thus indicating that HZ 651 and MG 347 were clonal.
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Renal function studies and kidney biopsies were performed in four patients presenting with renal insufficiency and acute Leptospira pomona infection. The renal lesion in all patients revealed acute interstitial nephritis. There was no evidence of immunologically mediated disease in three patients who were biopsied seven, eight and eight days respectively following the onset of symptoms. The fourth, in whom there was no evidence of prior renal disease, and whose biopsy was performed 16 days after symptoms began, showed glomerular Clq, and C3 immunofluorescence and mesangial, subepithelial and intramembranous dense deposits by electron microscopy. In addition, circulating immune complexes were demonstrated in this patient. These findings suggest that in this instance at least, the renal lesions of Leptospira pomona infections can be immunologically mediated. Because this may well be a transient phase, the timing of investigations could be crucial to its detection.
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