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[Multiple organ failure syndrome in infection caused by ictero-hemorragic Leptospira. Description of a clinical case].

A 53 years old fisherman was admitted to General Intensive Care Unit in Arezzo with signs and symptoms of Weil disease. An early acute respiratory failure developed. Radiological and haemodynamic findings confirmed a diagnosis of ARDS. The patient developed a severe jaundice, acute renal failure and ARDS (MOF multiple organs failure). To support different failures of the organs, CMV (continuous mandatory ventilation: CPPV with PEEP max 10 cm H2; IRV max 2:1) and AMV (assisted mandatory ventilation: Pressure Support Ventilation), haemofiltration, haemoperfusion and plasmapheresis were simultaneously used, that got better and better renal and respiratory performances. Haemodynamic worsening by PEEP during extracorporeal treatment was overcome by PSV very useful new ventilatory procedure even during weaning period. The patient treated in such manner survived without important disabilities. This care confirms that ARDS (non cardiogenic edema) and MOF can develop during Icterohaemorrhagic Leptospirosis.

Acute Kidney Injury↗

Investigation on monoclonal antibodies against two serovars of the icterohaemorrhagiae serogroup of Leptospira.

By means of the cell fusion technique, two hybridoma cell lines, V-1 and H2-1 have been obtained. V-1 cells secrete monoclonal antibody against serovars icterohaemorrhagiae and dakota. The H2-1 cell line secretes serovar-specific monoclonal antibody against serovar H2. These monoclonal antibodies have been successfully used in serovar-typing of leptospires isolated in China. The results of identification of leptospires by using monoclonal antibodies showed total coincidence with that by the traditional cross agglutinin absorption test and factor antiserum method. It was confirmed by using monoclonal antibody that the serological agglutination totally paralleled with animal protection. On the basis of the study, a concept was proposed that the agglutination in vitro and the protection in vivo are different manifestations in different reaction systems from the same antibody (antibodies) stimulated by a component(s) of the surface antigen of leptospires.

Agglutination Tests↗

[Interaction of Leptospira with the host's body in the infectious process in guinea pigs].

In experiments on guinea pigs the pathogenicity of leptospires is manifested by their adhesion to liver cells, colonization of the surface of these cells, accumulation of leptospires in the renal interstice and their colonization of the nephrothelial surface of proximal convoluted tubules in the kidneys, by toxic microcirculatory disturbances, dystrophy and necrosis of nephrothelial cells. Then the primary toxic action of circulating leptospires, microcirculatory disturbances and hemorrhagic syndrome augment during the colonization of the surface of liver cells, accompanied by their dystrophy and dissociation, as well as by jaundice. The accumulation of leptospires in the renal interstice and their subsequent multiplication on the nephrothelium of the proximal convoluted tubules are responsible for the development of interstitial nephritis and necrotic nephrosis. The persistence of lesions in the liver and kidneys, occurring in some cases in spite of elimination of the infective agent from these organs due to increasing antibody production suggests the toxic action of immune complexes.

Animals↗