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Zheng X, He P, Zhong R, Chen G, Xia J, Li C. Weil's Disease in an HIV-Infected Patient: A Case Report and Literature Review. Diagnostics (Basel) 2023; 13:3218. [PMID: 37892039 PMCID: PMC10606346 DOI: 10.3390/diagnostics13203218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 09/27/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
Weil's disease, an icterohemorrhagic infection, is the most severe and fatal form of leptospirosis and is characterized by jaundice, renal dysfunction, and hemorrhagic predisposition. Weil's disease with HIV infection has rarely been reported. A 68-year-old male with HIV infection presented to our hospital with fever and dyspnea that progressed to severe hemoptysis and systemic multiple organ failure, necessitating a tracheal intubation ventilator. A diagnosis of Weil's disease was made after Leptospira interrogans was identified via metagenomic next-generation sequencing (mNGS) in bronchoalveolar lavage fluid (BALF). After immediately receiving supportive therapy and targeted antimicrobial agents, the patient achieved complete recovery upon discharge. The co-infection of HIV infection and leptospirosis resulting in systemic multi-organ failure is rare, but awareness should be raised of the differential diagnosis. mNGS can help identify pathogens and facilitate the use of targeted and efficacious antimicrobial therapy in unusual clinical environments.
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Affiliation(s)
| | | | | | | | - Jinyu Xia
- Infectious Disease Prevention and Treatment Center, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, China; (X.Z.); (P.H.); (R.Z.); (G.C.)
| | - Chunna Li
- Infectious Disease Prevention and Treatment Center, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, China; (X.Z.); (P.H.); (R.Z.); (G.C.)
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2
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Barthélemy A, Magnin M, Pouzot-Nevoret C, Bonnet-Garin JM, Hugonnard M, Goy-Thollot I. Hemorrhagic, Hemostatic, and Thromboelastometric Disorders in 35 Dogs with a Clinical Diagnosis of Leptospirosis: A Prospective Study. J Vet Intern Med 2016; 31:69-80. [PMID: 27911985 PMCID: PMC5259627 DOI: 10.1111/jvim.14626] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 10/11/2016] [Accepted: 11/02/2016] [Indexed: 01/23/2023] Open
Abstract
Background Leptospirosis in dogs is occasionally associated with a hemorrhagic syndrome, the pathophysiology of which is not fully understood. Hypothesis/Objectives To characterize hematologic, hemostatic, and thromboelastometric abnormalities in dogs with leptospirosis and to study their association with hemorrhagic diatheses and outcomes. Animals Thirty‐five client‐owned dogs. Methods A prospective observational single cohort study was conducted. Results from the CBC, coagulation tests (prothrombin, activated partial thromboplastin and thrombin times, fibrinogen, fibrin(ogen) degradation products, and D‐dimer concentrations), rotational thromboelastometry (TEM), signalment, hemorrhagic diatheses, occurrence of disseminated intravascular coagulation (DIC) at admission, and survival to discharge were recorded. Results The most common hematologic and hemostatic abnormalities were anemia (30/35), thrombocytopenia (21/35), and hyperfibrinogenemia (15/35). Eight dogs were diagnosed with DIC. A normal TEM profile was found in 14 dogs, a hypercoagulable profile in 14 dogs, and a hypocoagulable profile in 7 dogs. The 8 dogs with hemorrhagic diatheses at admission had significantly decreased platelet counts (P = .037) and increased D‐dimer concentrations (P = .015) compared with other dogs. Dogs with a hypocoagulable profile exhibited more hemorrhagic diatheses compared with the dogs that had normal and hypercoagulable profiles (P = .049). The mortality rate was lower in dogs with a hypercoagulable profile than in those with a hypocoagulable profile (21% vs 57%; P = .043). Disseminated intravascular coagulation was not a significant prognostic factor. Conclusions and Clinical Importance Thromboelastometric parameters were altered in dogs with both hypercoagulable and hypocoagulable profiles. A hypocoagulable profile was significantly correlated with hemorrhagic diathesis and higher mortality rate.
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Affiliation(s)
- A Barthélemy
- Intensive Care Unit (SIAMU), VetAgro Sup campus vétérinaire de Lyon, Université de Lyon, Marcy l'Etoile, France.,Univ Lyon, VetAgro Sup, APCSe, Marcy l'Etoile, France
| | - M Magnin
- Intensive Care Unit (SIAMU), VetAgro Sup campus vétérinaire de Lyon, Université de Lyon, Marcy l'Etoile, France.,Univ Lyon, VetAgro Sup, APCSe, Marcy l'Etoile, France
| | - C Pouzot-Nevoret
- Intensive Care Unit (SIAMU), VetAgro Sup campus vétérinaire de Lyon, Université de Lyon, Marcy l'Etoile, France.,Univ Lyon, VetAgro Sup, APCSe, Marcy l'Etoile, France
| | | | - M Hugonnard
- Clinic for Small Animal Internal Medicine, USC 1233 Emerging Pathogens and Wild Rodents, VetAgro Sup Campus Vétérinaire de Lyon, Université de Lyon, Marcy l'Etoile, France
| | - I Goy-Thollot
- Intensive Care Unit (SIAMU), VetAgro Sup campus vétérinaire de Lyon, Université de Lyon, Marcy l'Etoile, France.,Univ Lyon, VetAgro Sup, APCSe, Marcy l'Etoile, France
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3
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Rajapakse S, Weeratunga P, Niloofa MJR, Fernando N, Rodrigo C, Maduranga S, de Silva NL, Fernando NL, de Silva HJ, Karunanayake L, Handunnetti S. Clinical and laboratory associations of severity in a Sri Lankan cohort of patients with serologically confirmed leptospirosis: a prospective study. Trans R Soc Trop Med Hyg 2016; 109:710-6. [PMID: 26464233 DOI: 10.1093/trstmh/trv079] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Leptospirosis results in significant morbidity and mortality. This study elucidates markers of severity in a cohort of Sri Lankan patients. METHODS Patients presenting to three healthcare institutions in the Western province of Sri Lanka with leptospirosis serological confirmed by the microscopic agglutination test (MAT) were included. Prospective data regarding demographic, clinical and laboratory parameters was extracted. Univariate associations and subsequent multivariate logistic regression models were constructed. RESULTS The study included 232 patients, with 68.5% (159) demonstrating severe disease. Significant associations of severe disease at a significance level of p<0.05 were fever >38.8°C on presentation, age >40 years, muscle tenderness, tachycardia on admission, highest white cell count >12 350/mm(3) and <7900/mm(3), highest neutrophil percentage >84%, haemoglobin >11.2 g/dL and <10.2 g/dL, packed cell volume (PCV) >33.8% and <29.8%, lowest platelet count <63 500/mm(3), highest alanine transaminase (ALT) >70 IU/L and hyponatremia with sodium <131 mEq/L. On multivariate analysis, PCV <29.8% (p=0.011; OR 3.750; CI: 1.394-10.423), ALT >70 IU/L (p=0.044; OR 2.639; CI: 1.028-6.774) and hyponatremia <131 mEq/L (p=0.019; OR 6.413; CI: 1.353-30.388) were independent associations of severe disease. CONCLUSIONS Severity associations were demonstrated with both clinical and laboratory parameters. There is a need for novel biomarkers for prediction of severity in leptospirosis.
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Affiliation(s)
- Senaka Rajapakse
- Tropical Medicine Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo 08, Sri Lanka
| | - Praveen Weeratunga
- Tropical Medicine Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo 08, Sri Lanka
| | - M J Roshan Niloofa
- Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo, Colombo 03, Sri Lanka
| | - Narmada Fernando
- Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo, Colombo 03, Sri Lanka
| | - Chathuraka Rodrigo
- Tropical Medicine Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo 08, Sri Lanka
| | - Sachith Maduranga
- Tropical Medicine Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo 08, Sri Lanka
| | - Nipun Lakshitha de Silva
- Tropical Medicine Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo 08, Sri Lanka
| | - Nipun Lakshitha Fernando
- Tropical Medicine Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo 08, Sri Lanka
| | - H Janaka de Silva
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Lilani Karunanayake
- Department of Bacteriology, Medical Research Institute, Colombo 08, Sri Lanka
| | - Shiroma Handunnetti
- Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo, Colombo 03, Sri Lanka
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4
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Rajapakse S, Rodrigo C, Balaji K, Fernando SD. Atypical manifestations of leptospirosis. Trans R Soc Trop Med Hyg 2015; 109:294-302. [PMID: 25813883 DOI: 10.1093/trstmh/trv026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 02/11/2015] [Indexed: 12/23/2022] Open
Abstract
Leptospirosis is an illness with a wide spectrum of clinical manifestations and severe illness affects nearly all organ systems. Serious and potentially life-threatening clinical manifestations of acute leptospirosis are caused by both direct tissue invasion by spirochaetes and by the host immune responses. In its severe form, leptospirosis can cause multi-organ dysfunction and death in a matter of days. Therefore it is critical to suspect and recognize the disease early, in order to initiate timely treatment. While the classical presentation of the disease is easily recognized by experienced clinicians practising in endemic regions, rarer manifestations can be easily missed. In this systematic review, we summarize the atypical manifestations reported in literature in patients with confirmed leptospirosis. Awareness of these unusual manifestations would hopefully guide clinicians towards early diagnosis.
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Affiliation(s)
- Senaka Rajapakse
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Chaturaka Rodrigo
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Krishan Balaji
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Sri Lanka
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Issa N, Guisset O, Mourissoux G, Gabinski C, Camou F. [Leptospirosis and thrombocytopenia]. Rev Med Interne 2014; 36:558-60. [PMID: 25467300 DOI: 10.1016/j.revmed.2014.10.358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 08/01/2014] [Accepted: 10/20/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Leptospirosis is a worldwide zoonosis caused by the spirochete Leptospira interrogans. The spectrum of symptoms reported in leptospirosis is extremely broad. Thrombocytopenia is common during the acute phase of leptospirosis but its pathophysiological mechanism remains not well defined. CASE REPORT We report a 56-year-old man hospitalized for severe sepsis with acute kidney injury and liver failure. Because of the recent flood of his house, we suspected leptospirosis. The diagnosis was rapidly confirmed. Blood tests revealed thrombocytopenia at 9 G/L associated with hyperferritinemia and hypertriglyceridemia. Cytological examination of bone marrow showed abundance of megakaryocytes and hemophagocytosis which confirmed the diagnosis of hemophagocytic syndrome. Clinical symptoms resolved and blood tests returned to normal values in the same time. CONCLUSION We suggest that hemophogocytosis is a possible mechanism of thrombocytopenia in leptospirosis and that examination of bone marrow should be performed to confirm the diagnosis.
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Affiliation(s)
- N Issa
- Service de réanimation médicale, hôpital Saint-André, CHU de Bordeaux, 1, rue Jean-Burguet, 33000 Bordeaux, France.
| | - O Guisset
- Service de réanimation médicale, hôpital Saint-André, CHU de Bordeaux, 1, rue Jean-Burguet, 33000 Bordeaux, France
| | - G Mourissoux
- Service de réanimation médicale, hôpital Saint-André, CHU de Bordeaux, 1, rue Jean-Burguet, 33000 Bordeaux, France
| | - C Gabinski
- Service de réanimation médicale, hôpital Saint-André, CHU de Bordeaux, 1, rue Jean-Burguet, 33000 Bordeaux, France
| | - F Camou
- Service de réanimation médicale, hôpital Saint-André, CHU de Bordeaux, 1, rue Jean-Burguet, 33000 Bordeaux, France
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Craig SB, Smythe LD, Graham GC, Burns MA, McMahon JL, Dohnt MF, Tulsiani SM, McKay DB. Haemoglobin and red cell counts in leptospirosis patients infected with different serovars. Rev Soc Bras Med Trop 2013; 46:237-40. [DOI: 10.1590/0037-8682-1013-2013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Accepted: 05/18/2011] [Indexed: 11/22/2022] Open
Affiliation(s)
- Scott Benjamin Craig
- WHO/OIE/FAO Collaborating Centre for Reference and Research on Leptospirosis, Australia; University of the Sunshine Coast, Australia
| | - Lee Douglas Smythe
- WHO/OIE/FAO Collaborating Centre for Reference and Research on Leptospirosis, Australia; University of the Sunshine Coast, Australia
| | - Glenn Charles Graham
- University of the Sunshine Coast, Australia; Queensland Health Forensic and Scientific Service, Australia
| | - Mary-Anne Burns
- WHO/OIE/FAO Collaborating Centre for Reference and Research on Leptospirosis, Australia
| | - Jamie Lee McMahon
- WHO/OIE/FAO Collaborating Centre for Reference and Research on Leptospirosis, Australia
| | - Michael Francis Dohnt
- WHO/OIE/FAO Collaborating Centre for Reference and Research on Leptospirosis, Australia
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Srivastava R, Ray S, Vaibhav V, Gollapalli K, Jhaveri T, Taur S, Dhali S, Gogtay N, Thatte U, Srikanth R, Srivastava S. Serum profiling of leptospirosis patients to investigate proteomic alterations. J Proteomics 2012; 76 Spec No.:56-68. [PMID: 22554907 PMCID: PMC7185557 DOI: 10.1016/j.jprot.2012.04.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 03/20/2012] [Accepted: 04/07/2012] [Indexed: 11/05/2022]
Abstract
Leptospirosis is a zoonotic infectious disease of tropical, subtropical and temperate zones, which is caused by the pathogenic spirochetes of genus Leptospira. Although this zoonosis is generally not considered as fatal, the pathogen can eventually cause severe infection with septic shock, multi-organ failure and lethal pulmonary hemorrhages leading to mortality. In this study, we have performed a proteomic analysis of serum samples from leptospirosis patients (n = 6), febrile controls (falciparum malaria) (n = 8) and healthy subjects (n = 18) to obtain an insight about disease pathogenesis and host immune responses in leptospiral infections. 2DE and 2D-DIGE analysis in combination with MALDI-TOF/TOF MS revealed differential expression of 22 serum proteins in leptospirosis patients compared to the healthy controls. Among the identified differentially expressed proteins, 8 candidates exhibited different trends compared to the febrile controls. Functional analysis suggested the involvement of differentially expressed proteins in vital physiological pathways, including acute phase response, complement and coagulation cascades and hemostasis. This is the first report of analysis of human serum proteome alterations in leptospirosis patients, which revealed several differentially expressed proteins, including α-1-antitrypsin, vitronectin, ceruloplasmin, G-protein signaling regulator, apolipoprotein A-IV, which have not been reported in context of leptospirosis previously. This study will enhance our understanding about leptospirosis pathogenesis and provide a glimpse of host immunological responses. Additionally, a few differentially expressed proteins identified in this study may further be investigated as diagnostic or prognostic serum biomarkers for leptospirosis. This article is part of a Special Issue entitled: Integrated omics.
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Affiliation(s)
- Rajneesh Srivastava
- Wadhwani Research Center for Biosciences and Bioengineering, Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, Powai, Mumbai 400076, India
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8
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Craig SB, Graham GC, Burns MA, Dohnt MF, Smythe LD, McKay DB. Haematological and clinical-chemistry markers in patients presenting with leptospirosis: a comparison of the findings from uncomplicated cases with those seen in the severe disease. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2010; 103:333-41. [PMID: 19508751 DOI: 10.1179/136485909x435058] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In a retrospective study, the laboratory findings from the first blood samples taken following hospital presentation in patients with uncomplicated leptospirosis have been compared with the corresponding data for patients admitted, to a high-dependency medical ward or intensive-care unit, with severe leptospirosis. The aim was to identify those laboratory markers that differentiate the two clinical groups upon initial presentation. Marked differences were observed, in some of the haematological and clinical-chemistry markers, between the patients with severe leptospirosis and those with the uncomplicated disease. Statistically significant differences were found in haemoglobin concentrations, haematocrits, counts of erythrocytes, leucocytes, neutrophils and platelets, and serum concentrations of creatinine, urea, protein and albumin. These markers may therefore be useful in the assessment and early detection of disease severity in patients with suspected leptospirosis. Investigations into the use of albumin treatments, which might significantly improve the clinical care of patients with acute leptospirosis, appear to be justified.
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Affiliation(s)
- S B Craig
- WHO/FAO/OIE Collaborating Centre for Reference and Research on Leptospirosis, Communicable Diseases Unit, Queensland Health Forensic and Scientific Services, P.O. Box 594, Archerfield, Queensland, 4108, Australia.
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9
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Chierakul W, Tientadakul P, Suputtamongkol Y, Wuthiekanun V, Phimda K, Limpaiboon R, Opartkiattikul N, White NJ, Peacock SJ, Day NP. Activation of the coagulation cascade in patients with leptospirosis. Clin Infect Dis 2008; 46:254-60. [PMID: 18171258 DOI: 10.1086/524664] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Disseminated intravascular coagulation (DIC) is common among patients with sepsis. Leptospirosis is an important cause of sepsis in tropical areas, and pulmonary hemorrhage associated with thrombocytopenia is the major cause of death, but the coagulopathy in severe leptospirosis has not been further characterized. The aim of this study was to evaluate coagulation factors and the presence of DIC in patients with leptospirosis in northeast Thailand. METHODS We measured plasma concentrations of fibrinogen, D-dimer, thrombin-antithrombin III complexes, and prothrombin fragment 1,2 and evaluated the DIC score in 79 patients with culture-confirmed and/or serologically confirmed leptospirosis and in 33 healthy Thai control subjects. RESULTS The median concentrations of fibrinogen, D-dimer, thrombin-antithrombin III complexes, and prothrombin fragment 1,2 were significantly elevated in a cohort of 79 patients with leptospirosis, compared with healthy control subjects (P<or=.001 for all tests). Patients with leptospirosis had significantly longer prothrombin times, longer activated partial thromboplastin times, and lower platelet counts. Thrombocytopenia was present in 38% of case patients and occurred more frequently among patients with culture-negative leptospirosis; in multivariate analysis, it was the only hemostasis factor independently associated with clinical bleeding. Patients who were culture-negative for Leptospira species had higher Acute Physiology and Chronic Health Evaluation II and Sepsis-Related Organ Failure Assessment scores and more bleeding complications. Nearly one-half of patients with leptospirosis had overt DIC as defined by an International Society on Thrombosis and Hemostasis DIC score. CONCLUSIONS Activation of the coagulation system is an important feature of leptospirosis. Thrombocytopenia is an indicator of severe disease and risk of bleeding.
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Affiliation(s)
- Wirongrong Chierakul
- Department of Clinical Tropical Medicine, Mahidol University, Bangkok, Thailand.
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Wagenaar JFP, Goris MGA, Sakundarno MS, Gasem MH, Mairuhu ATA, de Kruif MD, Ten Cate H, Hartskeerl R, Brandjes DPM, van Gorp ECM. What role do coagulation disorders play in the pathogenesis of leptospirosis? Trop Med Int Health 2006; 12:111-22. [PMID: 17207155 DOI: 10.1111/j.1365-3156.2006.01792.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Leptospirosis is a zoonosis of worldwide distribution, spread by the urine of infected animals. It is a major public health problem, especially in developing countries, where circumstances for transmission are most favourable. The clinical picture varies from mild disease to a severe illness with haemostatic derangements and multiorgan failure eventually leading to death. Although the haemorrhagic complications of severe disease are serious, the pathophysiology is scarcely elucidated. The complex mechanisms involved in inflammation-induced coagulation activation are extensively studied in various infectious diseases, i.e. Gram-negative sepsis. Tissue factor-mediated coagulation activation, impairment of anticoagulant and fibrinolytic pathways in close concert with the cytokine network are thought to be important. But for human leptospirosis, data are limited. Because of the growing interest in this field, the impact of leptospirosis, and the availability of new therapeutic strategies, we reviewed the evidence regarding the role of coagulation in leptospirosis and provide suggestions for future research.
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Affiliation(s)
- J F P Wagenaar
- Department of Internal Medicine, Slotervaart Hospital, Amsterdam, the Netherlands.
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Stefos A, Georgiadou SP, Gioti C, Loukopoulos A, Ioannou M, Pournaras S, Dalekos GN. Leptospirosis and pancytopenia: two case reports and review of the literature. J Infect 2005; 51:e277-80. [PMID: 15896845 DOI: 10.1016/j.jinf.2005.03.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2005] [Accepted: 03/22/2005] [Indexed: 11/28/2022]
Abstract
Besides the classical manifestations, leptospirosis may rarely occur with erythroid hypoplasia and/or pancytopenia. In this study, we reported two cases of leptospirosis presented with pancytopenia as the prevailing manifestation. In addition, the presence of pancytopenia in leptospirosis is reviewed. In both patients, the outcome was favourable as the bone marrow aplasia reversed completely after treatment with intravenous penicillin. In conclusion, this case study suggests that Leptospira infection should be included in the differential diagnosis of febrile pancytopenia, even in the absence of classical signs of severe disease as jaundice, meningitis, renal failure and pulmonary infiltrates.
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Affiliation(s)
- Aggelos Stefos
- Department of Medicine, Medical School, University of Thessaly, Papakiriazi 22 Street, 41222 Larissa, Thessaly, Greece
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