1
|
Camous L, Pommier JD, Tressières B, Martino F, Picardeau M, Loraux C, Valette M, Chaumont H, Carles M, Demoule A, Breurec S. Organ Involvement Related to Death in Critically Ill Patients With Leptospirosis: Unsupervised Analysis in a French West Indies ICU. Crit Care Explor 2024; 6:e1126. [PMID: 38980049 PMCID: PMC11233108 DOI: 10.1097/cce.0000000000001126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024] Open
Abstract
OBJECTIVES To identify distinct phenotypes of critically ill leptospirosis patients upon ICU admission and their potential associations with outcome. DESIGN Retrospective observational study including all patients with biologically confirmed leptospirosis admitted to the ICU between January 2014 and December 2022. Subgroups of patients with similar clinical profiles were identified by unsupervised clustering (factor analysis for mixed data and hierarchical clustering on principal components). SETTING All patients admitted to the ICU of the University Hospital of Guadeloupe on the study period. PATIENTS One hundred thirty critically ill patients with confirmed leptospirosis were included. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS At ICU admission, 34% of the patients had acute respiratory failure, and 26% required invasive mechanical ventilation. Shock was observed in 52% of patients, myocarditis in 41%, and neurological involvement in 20%. Unsupervised clustering identified three clusters-"Weil's Disease" (48%), "neurological leptospirosis" (20%), and "multiple organ failure" (32%)-with different ICU courses and outcomes. Myocarditis and neurological involvement were key components for cluster identification and were significantly associated with death in ICU. Other factors associated with mortality included shock, acute respiratory failure, and requiring renal replacement therapy. CONCLUSIONS AND RELEVANCE Unsupervised analysis of critically ill patients with leptospirosis revealed three patient clusters with distinct phenotypic characteristics and clinical outcomes. These patients should be carefully screened for neurological involvement and myocarditis at ICU admission.
Collapse
Affiliation(s)
- Laurent Camous
- Réanimation Médicale et Chirurgicale, CHU de Guadeloupe, Guadeloupe, France
| | - Jean-David Pommier
- Réanimation Médicale et Chirurgicale, CHU de Guadeloupe, Guadeloupe, France
- Institut Pasteur de la Guadeloupe, Morne Jolivière, Guadeloupe, France
| | - Benoît Tressières
- Centre d’Investigation Clinique Antilles-Guyane, Inserm CIC 1424, CHU de Guadeloupe, Guadeloupe, France
| | - Frederic Martino
- Réanimation Médicale et Chirurgicale, CHU de Guadeloupe, Guadeloupe, France
- Université de Paris and Université des Antilles, INSERM, BIGR, Paris, France
| | - Mathieu Picardeau
- Unité de biologie des Spirochètes, French National Reference Centre for Leptospirosis, CNRS UMR 6047, Institut Pasteur, Université Paris Cité, Paris, France
| | - Cecile Loraux
- Laboratoire de Microbiologie, CHU de Guadeloupe, Guadeloupe, France
| | - Marc Valette
- Réanimation Médicale et Chirurgicale, CHU de Guadeloupe, Guadeloupe, France
| | - Hugo Chaumont
- Centre d’Investigation Clinique Antilles-Guyane, Inserm CIC 1424, CHU de Guadeloupe, Guadeloupe, France
- Service de Neurologie, CHU de Guadeloupe, Guadeloupe, France
| | - Michel Carles
- Service de maladies infectieuses et tropicales, CHU de Nice, Nice, France
| | - Alexandre Demoule
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
- Groupe Hospitalier Universitaire, Assistance Publique, Hôpitaux de Paris, Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive et Réanimation (Département R3S), Paris, France
| | - Sebastien Breurec
- Centre d’Investigation Clinique Antilles-Guyane, Inserm CIC 1424, CHU de Guadeloupe, Guadeloupe, France
- Université de Paris and Université des Antilles, INSERM, BIGR, Paris, France
- Laboratoire de Microbiologie, CHU de Guadeloupe, Guadeloupe, France
- Département de Pathogenèse et contrôle des infections chroniques et émergentes, Université de Montpellier, INSERM, Etablissement français du Sang, Montpellier, France
| |
Collapse
|
2
|
Samanta A, Poddar U, Sen Sarma M, Srivastava A, Yachha SK, Mishra P. Persistent fever in acute hepatitis: think beyond acute viral hepatitis. Infect Dis (Lond) 2024; 56:476-483. [PMID: 38465663 DOI: 10.1080/23744235.2024.2325568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 02/26/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Acute hepatitis due to various tropical infections can mimic the clinical picture of acute viral hepatitis(AVH), leading to increased morbidity and mortality. We aimed to identify clinical and laboratory parameters that could help to distinguish acute hepatitis due to tropical infections from AVH. METHODS We retrospectively analyzed our database of 150 children (107 boys) with AVH and 50 children(34 boys)with acute hepatitis due to tropical infections between January 2013 and March 2023. Clinical features, investigations, complications and outcomes were compared. RESULTS Hepatitis A (75%) was the commonest etiology of AVH while enteric fever (34%), dengue (26%), scrub typhus (20%) and leptospirosis (16%) constituted the majority of tropical infections. Persistent fever and skin rashes were found in 88% and 16% of patients respectively in the tropical infection group and none in the AVH group (p < 0.001). On univariate analysis, prodromal symptoms, clinically detectable jaundice, cholestatic pattern, total and direct bilirubin and liver enzymes were significantly higher in AVH while headache, myalgia, leukopoenia, thrombocytopenia, hyponatremia were significantly higher in tropical infections group (all p < 0.05). Multivariate analysis identified thrombocytopenia (Odds ratio [OR] 4.237) as an independent positive predictive factor and markedly elevated total bilirubin (OR 0.575), direct bilirubin (OR 0.498), aspartate aminotransferase (OR 0.841) and alanine aminotransferase (OR 0.863) as independent negative predictive factors for acute hepatitis due to tropical infections. CONCLUSION High index of suspicion for tropical infections is warranted in patients with persistent fever after the onset of jaundice, especially in the presence of skin rash and thrombocytopenia.SUMMARYAcute viral hepatitis and acute hepatitis due to tropical infections can have similar clinical and biochemical parameters. Milder degree of jaundice, lower elevation of serum transaminases and thrombocytopenia can be useful predictors for acute hepatitis due to tropical infections.
Collapse
Affiliation(s)
- Arghya Samanta
- Department of Pediatric Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Ujjal Poddar
- Department of Pediatric Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Moinak Sen Sarma
- Department of Pediatric Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Anshu Srivastava
- Department of Pediatric Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Surender Kumar Yachha
- Department of Pediatric Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Prabhakar Mishra
- Department of Biostatistics and Health Informatics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| |
Collapse
|
3
|
Miida S, Maruyama M, Sato T, Nagoya T, Goto R, Isokawa O, Koizumi N, Terai S. Acute pancreatitis as a rare complication of leptospirosis: A case report and literature review. J Infect Chemother 2024; 30:552-556. [PMID: 38052307 DOI: 10.1016/j.jiac.2023.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/26/2023] [Accepted: 11/28/2023] [Indexed: 12/07/2023]
Abstract
Leptospirosis is a zoonotic disease. We present a case of acute pancreatitis associated with leptospirosis. An 88-year-old woman was admitted to the hospital with high fever and severe myalgia of the lower extremities. Based on the clinical presentation, hepatic dysfunction with a mild increase in bilirubin, renal dysfunction, and life history, the possibility of leptospirosis was considered. Plain computed tomography of the trunk on admission revealed no special findings. Appropriate antimicrobial therapy was administered at an early stage. After treatment initiation, the clinical symptoms and blood test abnormalities began to improve, and the patient appeared to be doing well. Although no abdominal or back pain was consistently noted during hospitalization, the serum amylase level increased over time; therefore, the patient underwent another computed tomography scan on the ninth day. Acute pancreatitis, which was absent upon admission, was noted. Appropriate treatment for pancreatitis was administered, and the patient was discharged. A subsequent serum antibody test confirmed the diagnosis of leptospirosis. Herein, we also summarized previous cases of acute pancreatitis associated with leptospirosis. The time of onset for pancreatitis was inconsistent, and there were a few cases of pancreatitis without abdominal or back pain. In contrast, serum amylase or lipase levels were elevated in all patients, which could be an important trigger for suspected complications of pancreatitis. When leptospirosis is suspected, complications of pancreatitis should always be considered, even in the absence of apparent abdominal pain. Regular monitoring of pancreatic enzymes such as amylase and lipase is recommended.
Collapse
Affiliation(s)
- Suguru Miida
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
| | - Masaki Maruyama
- Department of Gastroenterology, Kashiwazaki General Hospital and Medical Center, Kashiwazaki, Japan
| | - Takeki Sato
- Department of Gastroenterology, Kashiwazaki General Hospital and Medical Center, Kashiwazaki, Japan
| | - Takuro Nagoya
- Department of Gastroenterology and Hepatology, Tsubame Rosai Hospital, Tsubame, Niigata, Japan
| | - Ryo Goto
- Department of Gastroenterology, Kashiwazaki General Hospital and Medical Center, Kashiwazaki, Japan
| | - Osamu Isokawa
- Department of Gastroenterology, Kashiwazaki General Hospital and Medical Center, Kashiwazaki, Japan
| | - Nobuo Koizumi
- Department of Bacteriology I, National Institute of Infectious Diseases, Shinjuku, Tokyo, Japan
| | - Shuji Terai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| |
Collapse
|
4
|
Singh S, Acharya N, Karnik M, Reddy BSK, Waghe T, Beedkar A. Leptospirosis-Associated Acute Respiratory Distress Syndrome (ARDS) in Pregnancy: A Rare Presentation. Cureus 2024; 16:e61809. [PMID: 38975427 PMCID: PMC11227288 DOI: 10.7759/cureus.61809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Accepted: 06/03/2024] [Indexed: 07/09/2024] Open
Abstract
Leptospirosis, a zoonotic disease caused by spirochetes of the genus Leptospira, poses unique challenges in pregnancy due to its varied clinical presentation and potential adverse outcomes for both mother and fetus. We present a case of a 24-year-old primigravida at 35 weeks of gestation who presented with fever, dyspnea, and abdominal pain, and was ultimately diagnosed with leptospirosis complicated by acute respiratory distress syndrome (ARDS). Prompt initiation of antibiotic therapy, supportive care, and timely delivery via emergency cesarean section led to favorable maternal and neonatal outcomes. This case report underscores the importance of considering leptospirosis in pregnant patients presenting with similar symptoms, particularly in endemic regions, and highlights the critical role of multidisciplinary management in optimizing outcomes.
Collapse
Affiliation(s)
- Shivani Singh
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Neema Acharya
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Megha Karnik
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Bingu Shiv Kiran Reddy
- Pulmonary and Critical Care Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Tejal Waghe
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Aishwarya Beedkar
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
5
|
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.
Collapse
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.)
| |
Collapse
|
6
|
Phannajit J, Lertussavavivat T, Limothai U, Tachaboon S, Avihingsanon Y, Praditpornsilpa K, Eiam-Ong S, Tungsanga K, Sitprija V, Srisawat N. Long-term kidney outcomes after leptospirosis: a prospective multicentre cohort study in Thailand. Nephrol Dial Transplant 2023; 38:2182-2191. [PMID: 36746439 DOI: 10.1093/ndt/gfad030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Leptospirosis is one of the most important public-health zoonotic diseases in the tropics that can cause severe organ dysfunction and death. Currently there are insufficient data on long-term renal dysfunction in patients after leptospirosis infection. METHODS A prospective multicentre cohort study was conducted at 15 hospitals in the Sisaket province of Thailand. Confirmed leptospirosis patients admitted from 1 December 2015 to 30 November 2018 were followed between 1 February 2020 and 31 October 2020 (median 4.1 years after hospital discharge). The primary outcome was a composite of major kidney adverse events (MAKEs) including all-cause mortality, dialysis and new-onset chronic kidney disease (CKD). RESULTS Of the 217 confirmed leptospirosis cases enrolled, 32.7% were classified as having severe leptospirosis. Fifteen cases (6.9%) were deceased at the time of hospital admission. After a median follow-up time of 4.18 years, 30 patients had died and 33 patients developed CKD. Patients with severe leptospirosis had a significantly higher risk of MAKEs {adjusted hazard ratio 2.45 [95% confidence interval (CI) 1.44-4.18]}. Patients with intensive care unit admission, pulmonary haemorrhage and acute kidney injury also had a higher risk of MAKEs and all-cause mortality. Participants with severe leptospirosis in the follow-up cohort showed a higher risk of developing CKD compared with non-severe leptospirosis [adjusted odds ratio 3.22 (95% CI 1.04-9.96)], especially renal magnesium and phosphate wasting. CONCLUSION Leptospirosis patients, especially severe leptospirosis, are associated with long-term kidney sequelae. Our finding reflects the importance of long-term follow-up and the urgent need for specific interventions.
Collapse
Affiliation(s)
- Jeerath Phannajit
- Division of Clinical Epidemiology, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok, Thailand
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Tanat Lertussavavivat
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Umaporn Limothai
- Center of Excellence in Critical Care Nephrology, Chulalongkorn University, Bangkok, Thailand
- Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Sasipha Tachaboon
- Center of Excellence in Critical Care Nephrology, Chulalongkorn University, Bangkok, Thailand
- Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Yingyos Avihingsanon
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kearkiat Praditpornsilpa
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Somchai Eiam-Ong
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kriang Tungsanga
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Visith Sitprija
- Queen Saovabha Memorial Institute, Thai Red Cross, Bangkok, Thailand
| | - Nattachai Srisawat
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Critical Care Nephrology, Chulalongkorn University, Bangkok, Thailand
- Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Tropical Medicine Cluster, Chulalongkorn University, Bangkok, Thailand
- Academy of Science, Royal Society of Thailand, Bangkok, Thailand
| |
Collapse
|
7
|
Mišić-Majerus L, Kišek TC, Ružić-Sabljić E. Leptospirosis and characterization of Leptospira isolates from patients in Koprivnica-Križevci County, Croatia from 2000-2004. Access Microbiol 2023; 5:acmi000431. [PMID: 37223056 PMCID: PMC10202403 DOI: 10.1099/acmi.0.000431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 02/28/2023] [Indexed: 05/25/2023] Open
Abstract
Introduction Leptospirosis, caused by spirochetes of the genus Leptospira , is present in the Koprivnica-Križevci County area, Croatia. Clinical manifestation can range from asymptomatic, short-term mild, non-specific febrile disease, to severe forms with high mortality rates. Aim The aim of the study was to valuate culture in front of microscopic agglutination test (MAT) for diagnosis of infection, and to evaluate clinical and laboratory features of the disease. Moreover, we want to characterize Leptospira strains involved in infection in Koprivnica-Križevci County, Croatia. Methods We included 68 patients with clinical presentation consistent with leptospirosis collected in a 5-year period (2000-2004). Clinical samples (blood, urine and cerebrospinal fluid, CSF) were inoculated in Kolthoff's medium; species of isolated Leptospira strains was determined with Tm of real-time PCR, serogroup/serovar with MAT and NotI-RFLP analysis. Demonstration of specific antibodies in patients' sera was done using microscopic agglutination test. Results Leptospira was isolated from the blood of 14/51(27.5 %) patients and the most often identified serogroup/serovar was Icterohaemorrhagiae (8/10, 80%) followed by Grippotyphosa (10%). Regarding to species level, 8/10 isolated belonged to L. interrogans sensu stricto and one to L. kirschneri species. MAT was carried out on 51 patients with suspected leptospirosis, and was positive in 11/51(21.5 %) patients. Most of our patients presented with moderate severe symptoms, were hospitalized from August to October, and were infected mainly during the work or recreation in our county. The frequency of particular clinical features and pathological laboratory findings correlated with the severity of the clinical condition. Conclusions Leptospirosis can be confirmed microbiologically, culture and MAT contributed almost equally to the diagnosis of infection. Serovar Icterohaemorrhagiae was found as the dominant one, and L. interrogans sensu stricto as dominant species in our county. Epidemiological data shown that leptospirosis occurs seasonally, affects the rural population, and most commonly is presented with moderate severe clinical course.
Collapse
Affiliation(s)
- Ljiljana Mišić-Majerus
- Department of Infectious Diseases, General Hospital "Dr. Tomislav Bardek", Željka Selingera 1, Koprivnica, Croatia
| | - Tjaša Cerar Kišek
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Ljubljana, Zaloška 4, Ljubljana, Slovenia
| | - Eva Ružić-Sabljić
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Ljubljana, Zaloška 4, Ljubljana, Slovenia
| |
Collapse
|
8
|
Al Hariri YK, Sulaiman SAS, Khan AH, Adnan AS, Al-Ebrahem SQ. Determinants of prolonged hospitalization and mortality among leptospirosis patients attending tertiary care hospitals in northeastern state in peninsular Malaysia: A cross sectional retrospective analysis. Front Med (Lausanne) 2022; 9:887292. [PMID: 36160172 PMCID: PMC9500579 DOI: 10.3389/fmed.2022.887292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundLeptospirosis is the most common anthropozoonosis worldwide and imposes a major public health problem in many tropical countries. It is a leading cause of disease burden in form of mortality, morbidity and hospital admission. Identifying patients at high risk for mortality or for prolonged hospitalization may save lives and preserve economy. The aim of the current study is to identify significant factors associated with disease mortality and prolonged hospitalization.DesignCress-sectional retrospective study.SettingsTertiary care teaching hospitals in Kelantan, Peninsular Malaysia.ParticipantsAdult patients proven to have leptospirosis depending on IgM ELISA were classified into two classes depending on prolonged hospitalization (>7 days or ≤ 7 days) and mortality (fatal cases or non-fatal cases). Patients' clinico-laboratory data were compared according to these two outcomes using the appropriate statistical test.ResultsOf the 525 patients enrolled, 136 (25.9%) had prolonged hospitalization. The mean length of stay was 6.77 ± 5.68 days. Logistic regression analysis identified acute kidney injury (AKI) (OR 2.3), Jaundice (OR 2.7), elevated alanine aminotransferase (ALT) (OR 2), and prolonged prothrombin time (PT) (OR 1.9) independently associated with prolonged hospitalization. Case fatality rate was 6.48% and around one third of fatal cases had prolonged hospitalization of more than seven days. Factors associated with leptospirosis mortality included age >40 years (p < 0.001), patients presented with tachypnea (p = 0.002), pulmonary infiltrate (p < 0.001), T-wave changes (p < 0.001), atrial fibrillation (p = 0.013), conducting abnormality (p < 0.001), chronic kidney diseases (p < 0.001), multiple organ dysfunctions (p < 0.0010), respiratory failure (p < 0.001), pneumonia (p < 0.001), sepsis (p = 0.004), low venous PH (p = 0.042), AKI (P < 0.001), elevated AST (p < 0.001) or ALT (p = 0.004), hypoalbuminemia (p < 0.001), rhabdomyolysis (p < 0.001), severe thrombocytopenia (p = 0.042), prolonged PT (p < 0.001) or prolonged aPTT (p < 0.017).ConclusionsSignificant proportion of leptospirosis patients (25.9%) had prolonged hospital stay and less proportion died (6.48%). Early identifying patients with factors associated with prolonged hospitalization and death will positively impact practitioners' decisions regarding the proper and fast course of management including ICU admission.
Collapse
Affiliation(s)
- Yassin K. Al Hariri
- Department of Clinical Sciences, Ajman University, Ajman, United Arab Emirates
- *Correspondence: Yassin K. Al Hariri
| | - Syed A. S. Sulaiman
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
- Advanced Medical and Dental Institute, Universiti Sains Malaysia (USM), Penang, Malaysia
| | - Amer H. Khan
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
- Amer H. Khan
| | - Azreen S. Adnan
- Management Science University (MSU) Medical Centre, Shah Alam, Selangor, Malaysia
| | | |
Collapse
|
9
|
Chiriboga JD, Garcia J, Garcia D, Mena S, Leon-Rojas JE. The COVID-19 Mirage: A Young Biologist With an Atypical Presentation of a Zoonotic Disease During the COVID-19 Pandemic. Cureus 2022; 14:e26493. [PMID: 35919211 PMCID: PMC9339226 DOI: 10.7759/cureus.26493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
COVID-19 has become one of the main causes of febrile illness among emergency department patients and is always a differential diagnosis to keep in mind. Nonetheless, some patients with a history of exposure, persistent fever, and suspicion of COVID-19 end up having entirely different etiologies. Here, we present the case of a 29-year-old male biologist with an uncommon presentation of a zoonotic disease, characterized by unspecific signs and symptoms, which led to a delayed diagnosis, causing significant emotional distress in the patient. We also coin the term “COVID-19 Mirage," to serve as a constant reminder for clinicians of the effect that COVID-19 has caused on the differential diagnosis of fever of unknown etiology.
Collapse
|
10
|
Naik BK, Sulakshana S, Gopaldas JA, Devvrat S. Tropical Fever Unveiling an Asymptomatic Case of Polycythemia Vera. Indian J Crit Care Med 2022; 26:387-389. [PMID: 35519928 PMCID: PMC9015943 DOI: 10.5005/jp-journals-10071-24137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We report a case of fulminant hepatic failure due to the Budd–Chiari syndrome following preservation with a tropical fever. A young lady came with fever, altered mental status, jaundice, and renal failure. Following tropical workup, it was diagnosed as a case of leptospirosis (WHO Faine's criteria) with multi-organ dysfunction. Despite adequate antimicrobial cover, she progressed to hepatic coma (hyperammonemia) and was noted to have worsening conjugated hyperbilirubinemia. Following history review and evaluation for other causes of hepatic failure, hepatic vein thrombosis was detected in addition to the presence of antibodies against Leptospira antigen. Further studies into the causes of thrombosis and persistent hemoconcentration despite aggressive fluid resuscitation led to the diagnosis of polycythemia vera (cytometric analysis). During her stay, she further worsened despite aggressive organ support including dialysis but she succumbed to gram-negative sepsis that occurred during her stay in ICU. This is an interesting and rare case of leptospirosis that unveiled a case of previously asymptomatic polycythemia vera.
Collapse
Affiliation(s)
- B Kishansing Naik
- Department of Critical Care, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
| | - Sulakshana Sulakshana
- Department of Anaesthesiology and Critical Care, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
- Sulakshana Sulakshana, Department of Anaesthesiology and Critical Care, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India, e-mail:
| | | | - Sai Devvrat
- Department of General Medicine, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
| |
Collapse
|
11
|
Abdelrahim NA, Fadl-Elmula IM, Hartskeerl RA, Ahmed A, Goris M. Are Pathogenic Leptospira a Possible Cause of Aseptic Meningitis in Suspected Children in Sudan? Res Rep Trop Med 2021; 12:267-274. [PMID: 35002355 PMCID: PMC8725262 DOI: 10.2147/rrtm.s339058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 12/07/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Clinical presentations of leptospirosis are diverse, with meningitis easily confused with other microbial causes. We aimed to investigate the involvement of pathogenic leptospira in the cerebrospinal fluid (CSF) of meningitis-suspected children in Sudan. METHODS A total of 153 CSF specimens were collected over 5 months from patients attending a reference pediatric hospital in Omdurman, Sudan. All patients had provisionally been diagnosed with meningitis on admission. Demographic, clinical, and conventional laboratory findings were obtained. DNA was extracted using a QIAamp mini kit, and the secY gene investigated using real-time PCR. RESULTS Nine of 153 (6%) CSF specimens were positive for pathogenic leptospiral DNA. All these patients were male (seven infants and two toddlers aged ˂4 years). Typical conventional laboratory findings for aseptic meningitis (ie, CSF turbidity/pleocytosis, normal or reduced CSF glucose, normal or elevated proteins) were seen in five (56%). All patients presented with fever and seizures, 56% vomiting and stiff neck, and 29% bulging fontanel. Most (67%) patients presented in summer (March to May). Polymicrobial infections were identified in three patients (33%). CONCLUSION We conclude that pathogenic leptospira are probably a common cause of meningitis in children in Sudan; therefore, we recommend including leptospirosis in the differential diagnosis of CNS infections and other undifferentiated febrile illnesses in this country.
Collapse
Affiliation(s)
- Nada Abdelghani Abdelrahim
- Department of Medical Microbiology, Faculty of Medical Laboratory Sciences, Nile University, Khartoum, Sudan
| | - Imad Mohammed Fadl-Elmula
- Department of Pathology & Clinical Genetics, Al-Neelain University and Assafa Academy, Khartoum, Sudan
| | - Rudy A Hartskeerl
- OIE and National Collaborating Centre for Reference and Research on Leptospirosis, Department of Medical Microbiology, Academic Medical Center, Amsterdam, Netherlands
| | - Ahmed Ahmed
- OIE and National Collaborating Centre for Reference and Research on Leptospirosis, Department of Medical Microbiology, Academic Medical Center, Amsterdam, Netherlands
| | - Marga Goris
- OIE and National Collaborating Centre for Reference and Research on Leptospirosis, Department of Medical Microbiology, Academic Medical Center, Amsterdam, Netherlands
| |
Collapse
|
12
|
Kakita T, Okano S, Kyan H, Miyahira M, Taira K, Kitashoji E, Koizumi N. Laboratory diagnostic, epidemiological, and clinical characteristics of human leptospirosis in Okinawa Prefecture, Japan, 2003-2020. PLoS Negl Trop Dis 2021; 15:e0009993. [PMID: 34905535 PMCID: PMC8670671 DOI: 10.1371/journal.pntd.0009993] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/12/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Leptospirosis is considered an endemic disease among agricultural workers in Okinawa Prefecture, which is the southernmost part of Japan and has a subtropical climate, but data on the current status and trend of this disease are scarce. METHODOLOGY/PRINCIPAL FINDINGS We conducted a retrospective study of clinically suspected leptospirosis patients whose sample and information were sent to the Okinawa Prefectural Institute of Health and Environment from November 2003 to December 2020. Laboratory diagnosis was established using culture, nested polymerase chain reaction (PCR), and/or microscopic agglutination test (MAT) with blood, cerebrospinal fluid, and/or urine samples. Statistical analyses were performed to compare the epidemiological information, clinical features, and sensitivities of diagnostic methods among laboratory-confirmed cases. Serogroups and the species of Leptospira isolates were determined by MAT using 13 antisera and flaB sequencing. A total of 531 clinically suspected patients were recruited, among whom 246 (46.3%) were laboratory confirmed to have leptospirosis. Among the confirmed cases, patients aged 20-29 years (22.4%) and male patients (85.7%) were the most common. The most common estimated sources of infection were recreation (44.5%) and labor (27.8%) in rivers. Approximately half of the isolates were of the L. interrogans serogroup Hebdomadis. The main clinical symptoms were fever (97.1%), myalgia (56.3%), and conjunctival hyperemia (52.2%). Headache occurred significantly more often in patients with Hebdomadis serogroup infections than those with other serogroup infections. The sensitivities of culture and PCR exceeded 65% during the first 6 days, while the sensitivity of MAT surpassed that of culture and PCR in the second week after onset. PCR using blood samples was a preferable method for the early diagnosis of leptospirosis. CONCLUSIONS/SIGNIFICANCE The results of this study will support clinicians in the diagnosis and treatment of undifferentiated febrile patients in Okinawa Prefecture as well as patients returning from Okinawa Prefecture.
Collapse
Affiliation(s)
- Tetsuya Kakita
- Department of Biological Sciences, Okinawa Prefectural Institute of Health and Environment, Uruma, Okinawa, Japan
| | - Sho Okano
- Department of Biological Sciences, Okinawa Prefectural Institute of Health and Environment, Uruma, Okinawa, Japan
| | - Hisako Kyan
- Department of Biological Sciences, Okinawa Prefectural Institute of Health and Environment, Uruma, Okinawa, Japan
| | - Masato Miyahira
- Department of Biological Sciences, Okinawa Prefectural Institute of Health and Environment, Uruma, Okinawa, Japan
| | - Katsuya Taira
- Department of Biological Sciences, Okinawa Prefectural Institute of Health and Environment, Uruma, Okinawa, Japan
| | - Emi Kitashoji
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Nagasaki, Japan
| | - Nobuo Koizumi
- Department of Bacteriology I, National Institute of Infectious Disease, Shinjuku, Tokyo, Japan
| |
Collapse
|
13
|
Fabian E, Wenisch C, Eisner F, Muhr T, Bauer PK, Prein K, Maierhofer U, Lax SF, Krause R, Zollner G, Weihs W, Krejs GJ. Clinical-Pathological Conference Series from the Medical University of Graz : Case No 164: A 46-year-old man with abdominal pain, dyspnea and rapidly progressing multiorgan failure. Wien Klin Wochenschr 2021; 133:731-740. [PMID: 33871688 PMCID: PMC8053743 DOI: 10.1007/s00508-021-01841-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2021] [Indexed: 12/22/2022]
Affiliation(s)
- Elisabeth Fabian
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Christoph Wenisch
- 4th Department of Internal Medicine with Infectious and Tropical Medicine, State Hospital Klinik Favoriten, Vienna, Austria
| | - Florian Eisner
- Division of Emergency Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Tina Muhr
- Division of Cardiology, Department of Internal Medicine, State Hospital (LKH) Graz II, Graz, Austria
| | - Philipp K Bauer
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Kurt Prein
- Department of Pathology, State Hospital (LKH) Graz II, Graz, Austria
| | - Urša Maierhofer
- Department of Pathology, State Hospital (LKH) Graz II, Graz, Austria
| | - Sigurd F Lax
- Department of Pathology, State Hospital (LKH) Graz II, Graz, Austria
| | - Robert Krause
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Gernot Zollner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Wolfgang Weihs
- Division of Cardiology, Department of Internal Medicine, State Hospital (LKH) Graz II, Graz, Austria
| | - Guenter J Krejs
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
| |
Collapse
|
14
|
Baerlocher S, Helfenstein S, Mahr A, Crippa S, Garcia Boy R, Kahlert CR, Yurttas T, Hatz C, Kohler P. Leptospirosis Followed by Kawasaki-Like Disease: Case Report From an Adult Swiss Patient and Review of the Literature. Open Forum Infect Dis 2021; 8:ofab088. [PMID: 33884275 PMCID: PMC8047852 DOI: 10.1093/ofid/ofab088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/18/2021] [Indexed: 12/03/2022] Open
Abstract
Kawasaki disease (KD) is a vasculitis that mostly occurs in children, but rare cases in adults have been reported. We describe the case of a 43-year-old Swiss male who developed symptoms compatible with KD 7 weeks after leptospirosis, which was presumably acquired after swimming in a creek in the Swiss Alps. We performed a literature review and identified 10 other cases (all in children), in which Kawasaki-like disease was diagnosed in the context of leptospirosis. Outcome was favourable in most cases, including our patient. This exceptional case demonstrates both the possibility of autochthonous cases of leptospirosis in Switzerland as well as a possible association of leptospirosis with Kawasaki-like disease.
Collapse
Affiliation(s)
- Severin Baerlocher
- Department of Internal Medicine, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
| | - Seth Helfenstein
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
| | - Alfred Mahr
- Department of Rheumatology, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
| | - Selina Crippa
- Department of Internal Medicine, Regional Hospital of Grabs, St. Gallen, Switzerland
| | | | - Christian R Kahlert
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
- Children’s Hospital of Eastern Switzerland, Infectious Diseases and Hospital Epidemiology, St. Gallen, Switzerland
| | | | - Christoph Hatz
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
- University of Basel, Basel, Switzerland
- Department of Medicine, Swiss TPH, Basel, Switzerland
| | - Philipp Kohler
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
| |
Collapse
|
15
|
Pérez-Cervera J, Vaello-Paños A, Dávila-Dávila E, Delgado-Expósito G, Morales-Martínez de Tejada Á, Aranda-López CA, Doncel-Vecino LJ, Sánchez-Sánchez M. Cardiac tamponade secondary to leptospirosis. A rare association: A case report. J Cardiol Cases 2021; 23:140-143. [PMID: 33717381 DOI: 10.1016/j.jccase.2020.10.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 09/16/2020] [Accepted: 10/08/2020] [Indexed: 11/25/2022] Open
Abstract
Herein is described the case of a 39-year-old female agronomist who was admitted to hospital after a syncopal episode. She had had fever, abdominal pain, nausea, and vomiting for the previous month. The patient showed signs of hypoperfusion, so a trans-thoracic echocardiography was done, demonstrating the presence of a cardiac tamponade. An emergency pericardiocentesis was performed, draining 500 ml of hematic content. Thoracic-abdominal computed tomography showed bilateral pleural effusion and also peritoneal effusion. Laboratory tests were compatible with an inflammatory situation with neutrophilic leukocytosis, alteration of hepatic function, and a plateau elevation of high-sensitivity troponin T. Colchicine was initiated but the evolution of the patient was torpid, making necessary the performance of a pericardial window due to an abrupt increase of pericardial effusion and echocardiographic signs of impending cardiac tamponade. Two chest tubes were inserted due to an increasing bilateral pleural effusion. Serology was positive for Leptospira spp. so doxycycline was initiated. She reported that she had inspected a rice-field the previous month. The patient presented a good response to the treatment, being discharged from hospital completely asymptomatic, with no pericardial effusion and practically resolved pleural effusions. She was evaluated again one month later, with no trace of effusions or symptoms. <Learning objective: Cardiac tamponade secondary to leptospirosis has never been described before. Leptospirosis is a global zoonosis that usually does not affect the heart or its associated structures. Myocarditis and arrhythmias are the most frequently associated cardiac manifestations. Presence of fever, nausea, abdominal pain, jaundice, or conjunctival suffusion in a patient in contact with an environment possibly contaminated by Leptospira should make this infection be considered as the cause of the clinical picture.>.
Collapse
|
16
|
Abstract
A 21-year-old man presented with the chief complaints of fever and sore throat after visiting Cambodia and Thailand. Computed tomography revealed multiple pulmonary nodules. After performing antibiotic therapy, the pulmonary nodules without bacteremia disappeared completely. Paired microscopic agglutination tests revealed seroconversion against Leptospira serogroup Autumnalis. Thus, he was diagnosed with multiple pulmonary nodules caused by leptospirosis. Leptospirosis is a common zoonosis that occurs in tropical and subtropical areas. Its various clinical features include unspecified fever and Weil's disease. Although diffuse alveolar hemorrhaging is known to occur in severe leptospirosis, multiple pulmonary nodules resembling septic emboli or vasculitis are a rare complication.
Collapse
Affiliation(s)
- Ran Nagai
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
- Department of Cardiology, National Center for Global Health and Medicine, Japan
| | - Kei Yamamoto
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
| | - Daisuke Shiojiri
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
| | - Satoshi Kutsuna
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
| | - Yasuyuki Kato
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
| | - Nobuo Koizumi
- Department of Bacteriology I, National Institute of Infectious Diseases, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
| |
Collapse
|
17
|
Spittler J, Gillum R, DeSanto K. Common Injuries in Whitewater Rafting, Kayaking, Canoeing, and Stand-Up Paddle Boarding. Curr Sports Med Rep 2020; 19:422-429. [PMID: 33031208 DOI: 10.1249/jsr.0000000000000763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Paddle sports continue to be popular forms of outdoor recreation in the United States and around the world. This includes not only the more traditional sports of rafting, kayaking, and canoeing but also the newer and growing sport of stand-up paddle boarding. Because these sports are based in an aquatic environment, and frequently whitewater, there are unique, significant risks of injury. Overall, injuries in paddling sports are mostly musculoskeletal and are both acute and chronic in nature. Some injuries, such as environmental and head injuries, are especially problematic because they can lead to serious morbidity and mortality, most importantly drowning. This review describes the epidemiology, type, and location of injuries across paddle sports. It not only focuses on whitewater injuries but also includes information on injuries sustained in other aquatic paddling environments.
Collapse
Affiliation(s)
- Jack Spittler
- Departments of Family Medicine and Orthopedics, University of Colorado, Aurora, CO
| | - Ryan Gillum
- Department of Family Medicine, St. Mary's Hospital, Grand Junction, CO
| | - Kristen DeSanto
- Strauss Health Sciences Library, University of Colorado Anschutz Medical Campus, Aurora, CO
| |
Collapse
|
18
|
Schattner A, Dubin I, Glick Y, Nissim E. Acute painless pancreatitis as an unusual presentation of leptospirosis in a low-incidence country. BMJ Case Rep 2020; 13:13/8/e234988. [PMID: 32843404 DOI: 10.1136/bcr-2020-234988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
A healthy, urban-dwelling man presented with lassitude, jaundice without increased liver enzymes or obstructive features on imaging, brief acute kidney injury, leucocytosis with near-normal C reactive protein and markedly increased serum amylase and lipase. Leptospirosis was not considered for 10 days because of the low incidence of the disease in the country, absent animal contact and physicians' low index of suspicion. Presentation without fever and without the commonly associated abdominal pain, myalgia, headache, thrombocytopaenia or elevated serum creatine kinase added to the diagnostic challenge. Once an infectious cause of acute pancreatitis was contemplated, leptospirosis was immediately sought and diagnosed by PCR of urine and microscopic agglutination test, and he fully recovered on ceftriaxone. Physicians in countries with a low incidence of leptospirosis should be more aware of the possibility of the disease even when several key features such as fever or pain are missing and the patient has a rare infectious acute pancreatitis.
Collapse
Affiliation(s)
- Ami Schattner
- Faculty of Medicine, Hebrew University Hadassah Medical School, Jerusalem, Israel .,Laniado Hospital, Sanz Medical Centre, Netanya, Israel
| | - Ina Dubin
- Laniado Hospital, Sanz Medical Centre, Netanya, Israel
| | - Yair Glick
- Laniado Hospital, Sanz Medical Centre, Netanya, Israel
| | | |
Collapse
|
19
|
Remya AR, Vishwash B, Lee C, Pai PS, Espinoza Oras AA, Ozevin D, Mathew MT. Hip implant performance prediction by acoustic emission techniques: a review. Med Biol Eng Comput 2020; 58:1637-1650. [PMID: 32533510 DOI: 10.1007/s11517-020-02202-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 05/22/2020] [Indexed: 11/26/2022]
Abstract
Nowadays, acoustic emission (AE) has its applications in various areas, including mechanical, civil, underwater acoustics, and biomedical engineering. It is a non-destructive evaluation (NDE) and a non-intrusive method to detect active damage mechanisms such as crack growth, delamination, and processes such as friction, continuous wear, etc. The application of AE in orthopedics, especially in hip implant monitoring, is an emerging research field. This article presents a thorough literature review associated with the implementation of acoustic emission as a diagnostic tool for total hip replacement (THR) implants. Structural health monitoring of an implant via acoustic emission and vibration analysis is an evolving research area in the field of biomedical engineering. A review of the literature reveals a lack of reliable, non-invasive, and non-traumatic early warning methods to evaluate implant loosening that can help to identify patients at risk for osteolysis prior to implant failure. Developing an intelligent acoustic emission technique with excellent condition monitoring capabilities will be an achievement of great importance that fills the gaps or drawbacks associated with osteolysis/implant failure. Graphical abstract.
Collapse
Affiliation(s)
- Ampadi R Remya
- Department of Biomedical Science, UIC School of Medicine, Rockford, IL, USA
- Department of Material Science and Civil Engineering, University of Illinois, Chicago, IL, USA
| | - B Vishwash
- Department of Material Science and Civil Engineering, University of Illinois, Chicago, IL, USA
- Department of Mechanical Engineering, NMAM Institute of Technology, Nitte, Karnataka, 574110, India
| | - Christine Lee
- Department of Material Science and Civil Engineering, University of Illinois, Chicago, IL, USA
- Department of Bioengineering, University of Illinois, Chicago, IL, USA
| | - P Srinivasa Pai
- Department of Material Science and Civil Engineering, University of Illinois, Chicago, IL, USA
- Department of Mechanical Engineering, NMAM Institute of Technology, Nitte, Karnataka, 574110, India
| | - Alejandro A Espinoza Oras
- Department of Material Science and Civil Engineering, University of Illinois, Chicago, IL, USA
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Didem Ozevin
- Department of Material Science and Civil Engineering, University of Illinois, Chicago, IL, USA
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Mathew T Mathew
- Department of Biomedical Science, UIC School of Medicine, Rockford, IL, USA.
- Department of Material Science and Civil Engineering, University of Illinois, Chicago, IL, USA.
- Department of Bioengineering, University of Illinois, Chicago, IL, USA.
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.
| |
Collapse
|
20
|
Philip N, Bahtiar Affendy N, Ramli SNA, Arif M, Raja P, Nagandran E, Renganathan P, Taib NM, Masri SN, Yuhana MY, Than LTL, Seganathirajah M, Goarant C, Goris MGA, Sekawi Z, Neela VK. Leptospira interrogans and Leptospira kirschneri are the dominant Leptospira species causing human leptospirosis in Central Malaysia. PLoS Negl Trop Dis 2020; 14:e0008197. [PMID: 32203511 PMCID: PMC7117766 DOI: 10.1371/journal.pntd.0008197] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 04/02/2020] [Accepted: 03/03/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Leptospirosis, commonly known as rat-urine disease, is a global but endemic zoonotic disease in the tropics. Despite the historical report of leptospirosis in Malaysia, the information on human-infecting species is limited. Determining the circulating species is important to understand its epidemiology, thereby to strategize appropriate control measures through public health interventions, diagnostics, therapeutics and vaccine development. METHODOLOGY/PRINCIPLE FINDINGS We investigated the human-infecting Leptospira species in blood and serum samples collected from clinically suspected leptospirosis patients admitted to three tertiary care hospitals in Malaysia. From a total of 165 patients, 92 (56%) were confirmed cases of leptospirosis through Microscopic Agglutination Test (MAT) (n = 43; 47%), Polymerase Chain Reaction (PCR) (n = 63; 68%) or both MAT and PCR (n = 14; 15%). The infecting Leptospira spp., determined by partial 16S rDNA (rrs) gene sequencing revealed two pathogenic species namely Leptospira interrogans (n = 44, 70%) and Leptospira kirschneri (n = 17, 27%) and one intermediate species Leptospira wolffii (n = 2, 3%). Multilocus sequence typing (MLST) identified an isolate of L. interrogans as a novel sequence type (ST 265), suggesting that this human-infecting strain has a unique genetic profile different from similar species isolated from rodents so far. CONCLUSIONS/SIGNIFICANCE Leptospira interrogans and Leptospira kirschneri were identified as the dominant Leptospira species causing human leptospirosis in Central Malaysia. The existence of novel clinically important ST 265 (infecting human), that is different from rodent L. interrogans strains cautions reservoir(s) of these Leptospira lineages are yet to be identified.
Collapse
Affiliation(s)
- Noraini Philip
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Norliza Bahtiar Affendy
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Siti Nur Alia Ramli
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Muhamad Arif
- Center of Excellence in Life Sciences, Bharathidasan University, Tiruchirappalli, India
| | - Pappitha Raja
- School of Medicine, Dentistry and Biomedical Sciences, Queens University, Belfast, Northern Ireland, United Kingdom
| | - Elanngovan Nagandran
- Clinical Research Centre Unit, Tengku Ampuan Rahimah Hospital, Ministry of Health Malaysia, Klang, Selangor, Malaysia
| | - Pukunan Renganathan
- Clinical Research Centre Unit, Tengku Ampuan Rahimah Hospital, Ministry of Health Malaysia, Klang, Selangor, Malaysia
| | - Niazlin Mohd Taib
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Siti Norbaya Masri
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Muhamad Yazli Yuhana
- Infectious Diseases Unit, Internal Medicine Department, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Leslie Thian Lung Than
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Mithra Seganathirajah
- General Medicine, Hospital Serdang, Ministry of Health Malaysia, Jalan Puchong, Kajang, Selangor, Malaysia
| | - Cyrille Goarant
- Institut Pasteur de Noume´a, Leptospirosis Research and Expertise Unit, Noume´a, New Caledonia
| | - Marga G. A. Goris
- OIE and National Collaborating Centre for Reference and Research on Leptospirosis Academic Medical Center, Department of Medical Microbiology, University of Amsterdam, Amsterdam, the Netherlands
| | - Zamberi Sekawi
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Vasantha Kumari Neela
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| |
Collapse
|
21
|
Zhang AZ, Negoescu D, Munoz-Zanzi C. When and what to test for: A cost-effectiveness analysis of febrile illness test-and-treat strategies in the era of responsible antibiotic use. PLoS One 2020; 15:e0227409. [PMID: 31914143 PMCID: PMC6948826 DOI: 10.1371/journal.pone.0227409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 12/18/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Febrile illness caused by viral and bacterial diseases (e.g., dengue and leptospirosis) often have similar symptoms and are difficult to differentiate without diagnostic tests. If not treated appropriately, patients may experience serious complications. The question of what diagnostic tests to make available to providers in order to inform antibiotic therapy remains an open problem for health services facing limited resources. METHODS AND FINDINGS We formulated the problem of minimizing the weighted average of antibiotic underuse and overuse to inform the optimal diagnostic test and antibiotic treatment options for given occurrence probabilities of several bacterial and viral infections. We modeled the weight of antibiotic overuse as a monetary penalty per unnecessarily administered course, which we varied in both the base case and sensitivity analysis. Detailed Markov cohort models of febrile illness progression were used to estimate the weight of antibiotic underuse. The model accounted for multiple infections simultaneously and incorporated test, treatment, and other direct and indirect costs, as well as the effect of delays in seeking care and test turnaround times. We used the Markov models to numerically estimate disability-adjusted life years (DALYs), pre-penalty costs, and likelihood of antibiotics overuse per patient for fifteen different strategies in two example settings in Thailand, one with a higher probability of bacterial infections (Northern Thailand, Scenario A) and one with a higher probability of viral infections (Bangkok, Scenario B). We found that empirical antibiotic treatment to all patients always incurs the lowest pre-penalty cost (Scenario A: $47.5/patient, $100.6/patient, $149.5/patient for patients seeking care on day one, day four, and day ten respectively; Scenario B: $94.1/patient, $108.7/patient, $122.1/patient on day one, day four, and day ten respectively), and the lowest DALYs, (Scenario A: 0.2 DALYs/patient, 0.9 DALYs/patient, 1.7 DALYs/patient on day one, day four, and day ten, respectively; Scenario B: 0.5 DALYs/patient, 0.7 DALYs/patient, 0.9 DALYs/patient on day one, day four, and day ten, respectively). However, such strategy resulted in the highest proportion of antibiotic overuse per patient (Scenario A: 38.1%, 19.3%, 7.5% on day one, day four, and day ten, respectively; Scenario B: 82.9%, 42.1%, 16.3% on day one, day four, and day ten, respectively). Consequently, empirical antibiotic treatment became suboptimal with antibiotic overuse penalties above $12,800/course, $18,400/course, $23,900/course for patients presenting on day one, day four, and day ten in Scenario A and above $1,100/course, $1,500/course, $1,600/course for patients presenting on day one, day four, and day ten in Scenario B. CONCLUSIONS Empirical antibiotic treatment to all patients provided the best outcomes if antibiotic overuse was not the primary concern or if presenting with viral disease (such as dengue) was unlikely. Empirical antibiotic treatment to severe patients only was in most cases not beneficial. Otherwise, strategies involving diagnostic tests became optimal. In particular, our results indicated that single test strategies (bacterial RDT or viral PCR) were optimal in regions with a greater probability of presenting with viral infection. PCR-led strategies (e.g., parallel bacterial PCR, or multiplex PCR) are robust under parameter uncertainty (e.g., with uncertain disease occurrence probabilities).
Collapse
Affiliation(s)
- Anthony Zhenhuan Zhang
- College of Science and Engineering, Industrial and System Engineering, University of Minnesota, Minneapolis, Minnesota, United States of America
- * E-mail: (AZZ); (CMZ)
| | - Diana Negoescu
- College of Science and Engineering, Industrial and System Engineering, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Claudia Munoz-Zanzi
- School of Public Health, Division of Environmental Health Sciences, University of Minnesota, Minneapolis, Minnesota, United States of America
- * E-mail: (AZZ); (CMZ)
| |
Collapse
|
22
|
Fever in the Returned Traveler. HUNTER'S TROPICAL MEDICINE AND EMERGING INFECTIOUS DISEASES 2020. [PMCID: PMC7152027 DOI: 10.1016/b978-0-323-55512-8.00150-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
International travel is associated with a risk of infections not typically seen in high-income settings. Malaria is the most important tropical infection in travelers, but epidemics of dengue, chikungunya, and Zika emphasize that clinicians need to be aware of the rapidly changing distribution of many arboviruses. A detailed travel history and a syndromic approach to the investigation and management of patients is key. Consultation with a specialist is often recommended to ensure that appropriate management and investigations are undertaken in febrile returned travelers. Travel, especially to low-income regions, is associated with an increased risk of infections not typically seen in high-income countries (e.g., malaria, enteric fever, dengue, chikungunya, Zika, and schistosomiasis). Although gastroenteritis, respiratory tract infections, and self-limiting viral infections are common, a minority of patients will have a potentially life-threatening tropical infection. The evaluation of an ill returned traveler requires a detailed travel history with an understanding of the geographic distribution of infections, risk factors for acquisition, incubation periods, clinical presentations, and appropriate laboratory investigations. A syndromic approach to specific investigations, and to presumptive therapy pending laboratory confirmation of the diagnosis, is appropriate. Travel is also a risk factor for acquisition of antimicrobial-resistant bacteria, such as those containing extended spectrum β-lactamases, that become part of the traveler's colonizing flora. As a rule, malaria should be excluded in all travelers presenting with a fever who have visited the tropics.
Collapse
|
23
|
Effler P. Leptospirosis: key things to know about this quintessential zoonotic pathogen. MICROBIOLOGY AUSTRALIA 2020. [DOI: 10.1071/ma20006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Leptospirosis is a human and veterinary illness caused by spirochete bacteria in the genus Leptospira. In symptomatic infection the clinical presentation ranges from non-specific febrile illness to fulminant organ system failure with a high case fatality rate. Leptospires are excreted in the urine of infected mammals with rodents being the main source for human exposures. Leptospires can survive for months in urine-contaminated water and moist soil and humans can acquire infection via direct exposure to urine from infected animals or indirectly though contact with urine-contaminated water and wet soil. While leptospirosis occurs worldwide, it is more common in tropical and sub-tropical climates where it is estimated to cause more than a million illnesses and result in almost 60000 deaths annually. Flood-related leptospirosis outbreaks have been documented in many settings, including Australia, and are expected to increase with climate change. The largest outbreak of human leptospirosis in Australia occurred in 2018 when 84 cases where identified among workers on a berry farm in New South Wales. In 2019 unprecedented clusters of fatal canine leptospirosis occurred in urban areas of Sydney and Melbourne. It is not yet known whether the recent leptospirosis outbreaks among dogs and humans are an aberration or herald a growing threat to public and veterinary health in Australia. A One Health approach is critical to understanding the emergence of leptospirosis in an era of climate change, population growth, changes to agricultural practices, increased travel and urbanisation, both in Australia and abroad.
Collapse
|
24
|
Bini Viotti J, Chan JC, Rivera C, Tuda C. Sporadic leptospirosis case in Florida presenting as Weil`s disease. IDCases 2019; 19:e00686. [PMID: 32226765 PMCID: PMC7093744 DOI: 10.1016/j.idcr.2019.e00686] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 12/04/2019] [Accepted: 12/04/2019] [Indexed: 11/27/2022] Open
Abstract
Leptospirosis has been rarely reported in the United States and has been historically related to occupational exposure to infected animals, and contaminated environments. Over the past decade, there are indications that at-risk populations may be changing in the United States, to also include participants in freshwater sports and occasionally individuals living in economically disadvantaged urban inner- city environments. We present a case of Weil`s disease in a 39-year-old homeless man who had been released from prison two weeks prior and denied direct contact with infected animals or contaminated fresh water. Prison inmates and homeless patients are potentially at high risk of rat exposure and infection with Leptospira. A high index of suspicion is needed for diagnosis of leptospirosis in the absence of traditional risk factors. To our knowledge, this is the first case of leptospirosis associated with homelessness and incarceration in the United States. A literature review on leptospirosis cases in Florida over the past 60 years was performed.
Collapse
Affiliation(s)
- Julia Bini Viotti
- Department of Medicine, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Joseph C. Chan
- Department of Infectious Diseases, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Cynthia Rivera
- Department of Infectious Diseases, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Claudio Tuda
- Department of Infectious Diseases, Mount Sinai Medical Center, Miami Beach, FL, USA
| |
Collapse
|
25
|
Miailhe AF, Mercier E, Maamar A, Lacherade JC, Le Thuaut A, Gaultier A, Asfar P, Argaud L, Ausseur A, Ben Salah A, Botoc V, Chaoui K, Charpentier J, Cracco C, De Prost N, Eustache ML, Ferré A, Gauvin E, Goursaud S, Grall M, Guiot P, Jonas M, Lambiotte F, Landais M, Lemarié J, Lesieur O, Lhommet C, Michel P, Monseau Y, Moschietto S, Nseir S, Osman D, Pillot J, Piton G, Sedillot N, Sirodot M, Thevenin D, Zafrani L, Zerbib Y, Bourhy P, Lascarrou JB, Reignier J. Severe leptospirosis in non-tropical areas: a nationwide, multicentre, retrospective study in French ICUs. Intensive Care Med 2019; 45:1763-1773. [PMID: 31654079 DOI: 10.1007/s00134-019-05808-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 09/26/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE To report the incidence, risk factors, clinical presentation, and outcome predictors of severe leptospirosis requiring intensive care unit (ICU) admission in a temperate zone. METHODS LEPTOREA was a retrospective multicentre study conducted in 79 ICUs in metropolitan France. Consecutive adults admitted to the ICU for proven severe leptospirosis from January 2012 to September 2016 were included. Multiple correspondence analysis (MCA) and hierarchical classification on principal components (HCPC) were performed to distinguish different clinical phenotypes. RESULTS The 160 included patients (0.04% of all ICU admissions) had median values of 54 years [38-65] for age, 40 [28-58] for the SAPSII, and 11 [8-14] for the SOFA score. Hospital mortality was 9% and was associated with older age; worse SOFA score and early need for endotracheal ventilation and/or renal replacement therapy; chronic alcohol abuse and worse hepatic dysfunction; confusion; and higher leucocyte count. Four phenotypes were identified: moderately severe leptospirosis (n = 34, 21%) with less organ failure and better outcomes; hepato-renal leptospirosis (n = 101, 63%) with prominent liver and kidney dysfunction; neurological leptospirosis (n = 8, 5%) with the most severe organ failures and highest mortality; and respiratory leptospirosis (n = 17, 11%) with pulmonary haemorrhage. The main risk factors for leptospirosis contamination were contact with animals, contact with river or lake water, and specific occupations. CONCLUSIONS Severe leptospirosis was an uncommon reason for ICU admission in metropolitan France and carried a lower mortality rate than expected based on the high severity and organ-failure scores. The identification in our population of several clinical presentations may help clinicians establish an appropriate index of suspicion for severe leptospirosis.
Collapse
Affiliation(s)
- Arnaud-Félix Miailhe
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Emmanuelle Mercier
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Bretonneau, CRICS-TRIGGERSEP network, Tours, France
| | - Adel Maamar
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Jean-Claude Lacherade
- Service de Médecine Intensive Réanimation, Centre Hospitalier Départemental de la Vendée, La Roche sur Yon, France
| | - Aurélie Le Thuaut
- Direction de la recherche, Plateforme de Méthodologie et Biostatistique, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Aurélie Gaultier
- Direction de la recherche, Plateforme de Méthodologie et Biostatistique, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Pierre Asfar
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Angers, Angers, France
| | - Laurent Argaud
- Service de Réanimation médicale, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Antoine Ausseur
- Service de Réanimation polyvalente, Centre Hospitalier de Cholet, Cholet, France
| | - Adel Ben Salah
- Service de Réanimation polyvalente, Centre Hospitalier de Chartres, Chartres, France
| | - Vlad Botoc
- Service de Réanimation et surveillance continue, Centre Hospitalier de Saint Malo, Saint-Malo, France
| | - Karim Chaoui
- Service de Réanimation polyvalente, Centre Hospitalier de Cahors, Cahors, France
| | - Julien Charpentier
- Service de Médecine Intensive Réanimation, Hôpital Cochin, Groupe Hospitalier Centre-Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Christophe Cracco
- Service de réanimation polyvalente et surveillance continue, Centre Hospitalier d'Angoulême, Angoulême, France
| | - Nicolas De Prost
- Service de Réanimation Médicale, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Marie-Line Eustache
- Service de Réanimation polyvalente, Centre Hospitalier Bretagne-Atlantique, Vannes, France
| | - Alexis Ferré
- Service de Réanimation médico-chirurgicale, Centre hospitalier de Versailles, site André Mignot, Le Chesnay, France
| | - Elena Gauvin
- Service de Réanimation polyvalente, Centre Hospitalier de Niort, Niort, France
| | - Suzanne Goursaud
- Service de Réanimation médicale, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Maximilien Grall
- Service de Réanimation médicale, Hôpital Charles Nicolle, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | - Philippe Guiot
- Service de réanimation médicale, GHRMSA, Mulhouse, France
| | - Maud Jonas
- Service de Réanimation polyvalente et USC, Centre Hospitalier de Saint Nazaire, Saint Nazaire, France
| | - Fabien Lambiotte
- Service de Réanimation polyvalente, Centre Hospitalier de Valenciennes, Valenciennes, France
| | - Mickael Landais
- Service de Réanimation polyvalente, Centre Hospitalier du Mans, Le Mans, France
| | - Jérémie Lemarié
- MD, INSERM, U1116, 54500, Vandoeuvre-lès-Nancy, France.,Université de Lorraine, Nancy, France.,Service de Réanimation Médicale, Centre Hospitalier Universitaire de Nancy, Hôpital Central, Nancy, France
| | - Olivier Lesieur
- Service de Réanimation et surveillance continue, Hôpital Saint-Louis, La Rochelle, France
| | - Claire Lhommet
- Service de Réanimation polyvalente, Centre Hospitalier de Saint Brieuc, Saint Brieuc, France
| | - Philippe Michel
- Service de réanimation médico-chirurgicale, Centre Hospitalier René-Dubos, Pontoise, France
| | - Yannick Monseau
- Service de Réanimation polyvalente, Centre Hospitalier de Périgueux, Périgueux, France
| | - Sébastien Moschietto
- Service de Médecine Intensive Réanimation, Centre Hospitalier Henri Duffaut, Avignon, France
| | - Saad Nseir
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Lille, Lille, France.,Faculté de Médecine, Université de Lille, Lille, France
| | - David Osman
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jérome Pillot
- Service de réanimation polyvalente, Hôpital Saint-Léon, Centre hospitalier de la Côte Basque, Bayonne, France
| | - Gaël Piton
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Nicholas Sedillot
- Service de réanimation polyvalente, Centre Hospitalier Fleyriat, Bourg-en-Bresse, France
| | - Michel Sirodot
- Service de Médecine Intensive Réanimation, Centre Hospitalier Annecy, Annecy, France
| | - Didier Thevenin
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Lens, Lens, France
| | - Lara Zafrani
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Yoann Zerbib
- Service de Réanimation médicale, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
| | - Pascale Bourhy
- Unité de Biologie des Spirochètes, Institut Pasteur, Paris, France
| | - Jean-Baptiste Lascarrou
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Jean Reignier
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France. .,Université de Nantes, Nantes, France. .,Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Hotel-Dieu, 30 Bd. Jean Monnet, 44093, Nantes Cedex 1, France.
| | | |
Collapse
|
26
|
A Case of Fusobacterium necrophorum without Lemierre’s Syndrome Mimicking Acute Leptospirosis. Case Rep Infect Dis 2019; 2019:4380429. [PMID: 31662923 PMCID: PMC6778927 DOI: 10.1155/2019/4380429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 09/05/2019] [Indexed: 11/30/2022] Open
Abstract
Jaundice, conjunctival hyperemia, and acute kidney injury (AKI) are the characteristics of leptospirosis. However, it is not well known that Fusobacterium necrophorum infection can have a clinical picture similar to that of leptospirosis. A 38-year-old man was admitted with jaundice, conjunctival hyperemia, and AKI for 7 days. Chest CT scan showed multiple pulmonary nodules, atypical for leptospirosis. We started treatment with IV piperacillin-tazobactam and minocycline. He became anuric and was urgently started on hemodialysis on the second hospital day. Later on, blood cultures grew Fusobacterium necrophorum and other anaerobic bacteria. Antibody and PCR assays for Leptospira were negative. We narrowed the antibiotics to IV ceftriaxone and metronidazole. He responded well to the treatment and was discharged on the 18th hospital day. F. necrophorum infection is known to cause mixed infection with other anaerobic bacteria. The resistance of many anaerobic bacteria continues to progress, and F. necrophorum itself sometimes produces β-lactamase. This case highlights the potential risks of using penicillin before diagnosis of leptospirosis.
Collapse
|
27
|
Chiu CH, Chen PC, Wang YC, Lin CL, Lee FY, Wu CC, Chang KH. Risk of Dementia in Patients with Leptospirosis: A Nationwide Cohort Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16173168. [PMID: 31480270 PMCID: PMC6747145 DOI: 10.3390/ijerph16173168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 08/24/2019] [Accepted: 08/27/2019] [Indexed: 12/13/2022]
Abstract
Background: Studies have linked some bacterial infections with an increased likelihood for development of dementia. However, there is a paucity of data on the relationship between dementia and leptospirosis. In view of this, we conducted a retrospective cohort study to determine whether leptospirosis is a risk factor for dementia. Methods: Data were collected from the Taiwan National Health Insurance Research Databases (2000–2010) to investigate the incidence of and risk factors for dementia in patients with leptospirosis. Patients with leptospirosis who did not have a history of dementia were enrolled in the study. For each leptospirosis patient, four controls were randomly selected after frequency matching of age, sex, and index date. Cox proportional hazard regression models were used for the analyses of dementia risk. Results: A greater risk of dementia was observed in the leptospirosis cohort than in the non-leptospirosis cohort both in patients without any comorbidity (adjusted HR (aHR) = 1.23, 95% CI = 1.06–1.43) and with a comorbidity (aHR = 2.06, 95% CI = 1.7–2.5). Compared with the non-leptospirosis cohort without these comorbidities, the leptospirosis cohort with ≥2 comorbidities exhibited a significantly increased risk of dementia (aHR = 6.11, 95% CI = 3.15–11.9), followed by those with any one comorbidity (adjusted HR = 3.62, 95% CI = 1.76–7.46). Conclusions: Patients with leptospirosis were at a 1.89-fold greater risk of subsequent dementia, but potential genetic susceptibility bias in the study group is a major confound.
Collapse
Affiliation(s)
- Chun-Hsiang Chiu
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center Taipei, Taipei 11490, Taiwan
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan
| | - Po-Chung Chen
- Division of Family Medicine, Department of Community Medicine, Taoyuan Armed Forces General Hospital, Taoyuan 32549, Taiwan
| | - Ying-Chuan Wang
- Department of Family Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung 40402, Taiwan
- College of Medicine, China Medical University, Taichung 40402, Taiwan
| | - Feng-You Lee
- Department of Emergency Medicine, Taichung Tzu Chi Hospital, Taichung 42743, Taiwan
| | - Chia-Chang Wu
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11042, Taiwan
| | - Kuang-Hsi Chang
- Department of Medical Research, Tungs' Taichung Metroharbor Hospital, Taichung 43503, Taiwan.
- Institute of Biomedical Sciences, China Medical University, Taichung 40402, Taiwan.
- General Education Center, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli 35664, Taiwan.
| |
Collapse
|
28
|
Roumpou A, Papaioannou I, Lampropoulos C. Weil's disease with haemoptysis and acute respiratory distress syndrome. BMJ Case Rep 2019; 12:12/5/e229350. [PMID: 31151976 DOI: 10.1136/bcr-2019-229350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 35-year-old male patient reached the emergency department after an episode of massive haemoptysis a few hours ago. Fever and dyspnea were mentioned to be present the last 5 days. His medical history included only malaria, successfully treated 2 years ago. Clinical examination revealed high fever, jaundice, cyanosis, tachypnea and bilateral rales on pulmonary auscultation. Laboratory investigation showed high erythrocyte sedimentation rate and C reactive protein, leucocytosis, anaemia, mild thrombocytopaenia, renal impairment, hyperbilirubinaemia and abnormal liver function tests; arterial blood gas analysis showed respiratory alkalosis with severe hypoxia. Thoracic X-ray revealed bilateral pulmonary infiltrates, whereas abdominal and heart ultrasound detected hepatomegaly and small pericardial infusion, respectively. The diagnosis of leptospirosis along with acute respiratory distress syndrome was confirmed by positive IgM Leptospira antibodies. Empirical treatment with triple antibiotic therapy and corticosteroids was applied. The patient was discharged after 1 week, without any symptoms and with almost normal laboratory tests.
Collapse
|
29
|
Schmalzle SA, Tabatabai A, Mazzeffi M, Matta A, Hollis A, Zubrow M, Rajagopal K, Thom K, Scalea T. Recreational 'mud fever': Leptospira interrogans induced diffuse alveolar hemorrhage and severe acute respiratory distress syndrome in a U.S. Navy seaman following 'mud-run' in Hawaii. IDCases 2019; 15:e00529. [PMID: 30976519 PMCID: PMC6441746 DOI: 10.1016/j.idcr.2019.e00529] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 03/20/2019] [Accepted: 03/20/2019] [Indexed: 01/23/2023] Open
Abstract
A 23-year-old man with a viral-like prodrome developed sudden severe dyspnea and was found to have renal failure, anemia, shock, and diffuse alveolar hemorrhage with acute respiratory distress syndrome, requiring emergent endotracheal intubation and extracorporeal membrane oxygenation (ECMO). Travel and exposure history from peripheral sources revealed that the patient had participated in a 'mud-run' in Hawaii two weeks prior to symptom onset. The patient was subsequently diagnosed with leptospirosis and treated with ceftriaxone and doxycycline. He was discharged on hospital day 13 with full recovery. Leptospirosis is associated with exposure to water, soil, or other matter contaminated with urine of carrier animals. It has been associated with a multitude of activities over time; most recently recreational water-based activities including 'mud-runs' in endemic areas have been added to the list of routes of exposure. This case underscores the importance of obtaining a thorough epidemiological exposure and travel history and being aware of areas of endemicity for life-threatening infections. Additionally, to our knowledge this is the second case of a patient in the United States treated with ECMO for leptospirosis induced pulmonary hemorrhage.
Collapse
Affiliation(s)
- Sarah A Schmalzle
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
- Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, MD, United States
- University of Maryland School of Medicine, Baltimore, MD, United States
- Corresponding author at: Institute of Human Virology, 725 West Lombard St, N147, Baltimore, MD, 21201, United States.
| | - Ali Tabatabai
- University of Maryland School of Medicine, Baltimore, MD, United States
| | - Michael Mazzeffi
- University of Maryland School of Medicine, Baltimore, MD, United States
| | - Ann Matta
- University of Maryland School of Medicine, Baltimore, MD, United States
| | - Allison Hollis
- University of Maryland School of Medicine, Baltimore, MD, United States
| | - Marc Zubrow
- University of Maryland School of Medicine, Baltimore, MD, United States
| | - Keshava Rajagopal
- University of Texas, Houston and Memorial Hermann,Texas Medical Center, Houston, TX, United States
| | - Kerri Thom
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Thomas Scalea
- University of Maryland School of Medicine, Baltimore, MD, United States
| |
Collapse
|
30
|
Ghafouri RR, Araj-Khodaei M, Targhi ST, Varshochi M, Parsian Z, Yarani R, Golzari SEJ. First Report of a Disease by Rhazes 10 Centuries Ago. Int J Prev Med 2019; 10:6. [PMID: 30774840 PMCID: PMC6360843 DOI: 10.4103/ijpvm.ijpvm_216_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 06/18/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Abu Bakr Mohammad Ibn Zakariya Al-Razi (865-925 CE), who was known as "Rhazes" in the west, was a famous scientist of medieval ages. He has more than 200 books and treatises. His masterpiece on medicine "Kitab Al-Hawi Fi Al-Tibb" contains around 900 case reports. Some of the diseases which seem to be recently reported have been stated previously, but not well described. Considering symptoms of the patient described at that time, differential diagnosis will be discussed. CASE PRESENTATION Rhazes described a patient with bilious fever. He had developed bloody urine and stool on the fourth day and fatigue. Subsequently, the patient's urine and stool color turned into dark and black, respectively, and died the following day. According to Rhazes attitude, it was malignant measles. Meyerhof in his book has referred to post-measles acute glomerulonephritis, but more appropriate differential diagnoses are compatible with this patient. DISCUSSION One of the best diagnoses for this case can be Weil's syndrome. Presence of fever, icterus, hemorrhage and renal injury, all suggest Weil's syndrome without pulmonary involvement. The other probable diagnosis is thrombotic thrombocytopenic purpura (TTP). Meningococcal sepsis is the other possible diagnosis. CONCLUSION To sum up, as three compatible diseases with the case; have been described more than a thousand years after Rhazes (Weil's syndrome 1886, TTP 1925 and meningococcemia 1805); if the case is either Weil's or TTP or meningococcal sepsis, it is the first report of the disease in the world by Rhazes.
Collapse
Affiliation(s)
- Rouzbeh R Ghafouri
- Emergency Medicine Research Team, Tabriz University of Medical Science, Tabriz, Iran
| | | | - Somaiyeh T Targhi
- Aging Research Institute, Tabriz University of Medical Science, Tabriz, Iran
| | - Mojtaba Varshochi
- Department of Infectious Diseases, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zahra Parsian
- Emergency Medicine Research Team, Tabriz University of Medical Science, Tabriz, Iran
| | - Reza Yarani
- Department of Pediatrics E, Copenhagen Diabetes Research Center (CPH-DIRECT), Herlev University Hospital, Herlev, Denmark
| | - Samad E J Golzari
- Department of Anesthesiology and Intensive Care Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
31
|
|
32
|
Fatal Dengue, Chikungunya and Leptospirosis: The Importance of Assessing Co-infections in Febrile Patients in Tropical Areas. Trop Med Infect Dis 2018; 3:tropicalmed3040123. [PMID: 30486238 PMCID: PMC6306852 DOI: 10.3390/tropicalmed3040123] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 11/19/2018] [Accepted: 11/20/2018] [Indexed: 12/24/2022] Open
Abstract
The febrile patient from tropical areas, in which emerging arboviruses are endemic, represents a diagnostic challenge, and potential co-infections with other pathogens (i.e., bacteria or parasites) are usually overlooked. We present a case of an elderly woman diagnosed with dengue, chikungunya and Leptospira interrogans co-infection. Study Design: Case report. An 87-year old woman from Colombia complained of upper abdominal pain, arthralgia, myalgia, hyporexia, malaise and intermittent fever accompanied with progressive jaundice. She had a medical history of chronic heart failure (Stage C, New York Heart Association, NYHA III), without documented cardiac murmurs, right bundle branch block, non-valvular atrial fibrillation, hypertension, and chronic venous disease. Her cardiac and pulmonary status quickly deteriorated after 24 h of her admission without electrocardiographic changes and she required ventilatory and vasopressor support. In the next hours the patient evolved to pulseless electrical activity and then she died. Dengue immunoglobulin M (IgM), non-structural protein 1 (NS1) enzyme-linked immunosorbent assay (ELISA), microagglutination test (MAT) for Leptospira interrogans and reverse transcription polymerase chain reaction (RT-PCR) for chikungunya, were positive. This case illustrates a multiple co-infection in a febrile patient from a tropical area of Latin America that evolved to death.
Collapse
|
33
|
Validi M, Karkhah A, Prajapati VK, Nouri HR. Immuno-informatics based approaches to design a novel multi epitope-based vaccine for immune response reinforcement against Leptospirosis. Mol Immunol 2018; 104:128-138. [PMID: 30448609 DOI: 10.1016/j.molimm.2018.11.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 09/04/2018] [Accepted: 11/08/2018] [Indexed: 01/03/2023]
Abstract
Leptospirosis is known as a zoonotic disease of global importance originated from infection with the spirochete bacterium Leptospira. Although several leptospirosis vaccines have been tested, the vaccination is relatively unsuccessful in clinical application despite decades of research. Therefore, this study was conducted to construct a novel multi-epitope based vaccine against leptospirosis by using Hap1, LigA, LAg42, SphH and HSP58 antigens. T cell and IFN gamma epitopes were predicted from these antigens. In addition, to induce strong CD4+ helper T lymphocytes (HTLs) responses, Pan HLA DR-binding epitope (PADRE) and helper epitopes selected from Tetanus toxin fragment C (TTFrC) were applied. Moreover, for boosting immune response, Heparin-Binding Hemagglutinin (HBHA), a novel TLR4 agonist was added to the construct as an adjuvant. Finally, selected epitopes were linked together using EAAAK, GPGPG, AAY and HEYGAEALERAG linkers. Based on the predicted epitopes, a multi-epitope vaccine was construct with 490 amino acids. Physico-chemical properties, secondary and tertiary structures, stability, intrinsic protein disorder, solubility, and allergenicity of this vaccine construct were assessed by applying immunoinformatics analyses. A soluble, and non-allergic protein with a molecular weight of 53.476 kDa was obtained. Further analyses validated the stability of the chimeric protein and the predicted epitopes in the chimeric vaccine indicated strong potential to induce B-cell and T-cell mediated immune response. Therefore, immunoinformatics analysis showed that the modeled multi-epitope vaccine can properly stimulate the both T and B cells immune responses and could potentially be used for prophylactic or therapeutic usages.
Collapse
Affiliation(s)
- Majid Validi
- Clinical Biochemistry Research Center, Basic Health Sciences Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Ahmad Karkhah
- Student Research Committee, School of Medicine, Babol University of Medical Sciences, Babol, Iran; Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Vijay Kumar Prajapati
- Department of Biochemistry, School of Life Sciences, Central University of Rajasthan, Bandarsindri, Kishangarh, Ajmer, Rajasthan, India
| | - Hamid Reza Nouri
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
| |
Collapse
|
34
|
Zubach O, Telegina T, Semenyshyn O, Vasiunets L, Zinchuk A. Leptospirosis in Ukraine (Lviv Oblast): Clinical and Epidemiological Features. Vector Borne Zoonotic Dis 2018; 19:341-346. [PMID: 30335592 PMCID: PMC6486673 DOI: 10.1089/vbz.2018.2375] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The article describes the results of a retrospective analysis of medical records of 395 patients with a clinical diagnosis of leptospirosis treated at the Lviv Oblast Infectious Disease Clinical Hospital (Ukraine) between 2002 and 2016. The main risk factors for leptospirosis were contact with rodents or their excrements (26.84%) and bathing in ponds, small lakes, and reservoirs (10.63%). Among 276 patients in whom the anti-leptospira antibodies were detected by the microscopic agglutination test (MAT), the most common serotypes were Leptospira icterohaemorrhagiae (33.33%) and Leptospira grippotyphosa (25.0%). The mortality rate was significantly higher in patients where leptospirosis diagnosis was established based on clinical symptoms without confirmation by MAT (15.13% vs. 5.43%, p < 0.01).
Collapse
Affiliation(s)
- Olena Zubach
- 1 Department of Infectious Diseases, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Tetiana Telegina
- 1 Department of Infectious Diseases, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Oksana Semenyshyn
- 2 State Institution Lviv Oblast Laboratory Center of the Ministry of Health of Ukraine, Lviv, Ukraine
| | - Lilya Vasiunets
- 2 State Institution Lviv Oblast Laboratory Center of the Ministry of Health of Ukraine, Lviv, Ukraine
| | - Aleksander Zinchuk
- 1 Department of Infectious Diseases, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| |
Collapse
|
35
|
Aksoy GK, Gemici A, Koyun M, Çomak E, Akman S. Rhabdomyolysis-associated acute kidney injury: Answers. Pediatr Nephrol 2018; 33:1503-1504. [PMID: 29124428 DOI: 10.1007/s00467-017-3837-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 10/12/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Gulsah Kaya Aksoy
- Department of Pediatric Nephrology, School of Medicine, Akdeniz University, 07070, Antalya, Turkey.
| | - Atilla Gemici
- Department of Pediatric Nephrology, School of Medicine, Akdeniz University, 07070, Antalya, Turkey
| | - Mustafa Koyun
- Department of Pediatric Nephrology, School of Medicine, Akdeniz University, 07070, Antalya, Turkey
| | - Elif Çomak
- Department of Pediatric Nephrology, School of Medicine, Akdeniz University, 07070, Antalya, Turkey
| | - Sema Akman
- Department of Pediatric Nephrology, School of Medicine, Akdeniz University, 07070, Antalya, Turkey
| |
Collapse
|
36
|
The Spiraling Case of a Yellow Chef: Isolated Hyperbilirubinemia. Case Reports Hepatol 2018; 2018:5876718. [PMID: 30210882 PMCID: PMC6126086 DOI: 10.1155/2018/5876718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 08/07/2018] [Indexed: 11/18/2022] Open
Abstract
Leptospirosis is a common bacterial disease in tropical regions of the world due to greater exposure to rodents and domestic animals; however, this condition can also occur in US urban areas, though it often goes unrecognized. Gastrointestinal symptoms are very commonly seen, and icteric leptospirosis is often confused for other conditions resulting in delayed diagnosis and worse outcomes. As mortality increases with more extensive hepatic involvement, gastroenterologists should be aware of the constellation of gastrointestinal symptoms related to leptospirosis, as it can occur in the absence of classic exposure history.
Collapse
|
37
|
Epidemiology, clinical and laboratory features of 24 consecutive cases of leptospirosis at a German infectious disease center. Infection 2018; 46:847-853. [PMID: 30019313 DOI: 10.1007/s15010-018-1181-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 07/12/2018] [Indexed: 12/15/2022]
Abstract
To determine epidemiological, clinical and laboratory characteristics of leptospirosis, 24 consecutive patients diagnosed with the infection between 2011 and 2017 at the University Medical Center Hamburg-Eppendorf were retrospectively analyzed. The majority of patients were male travelers who returned from Southeast Asia and had a history of freshwater-associated activities. Considering the lack of discriminatory clinical or clinical chemistry parameters, leptospirosis should be regarded as differential diagnosis in any patient with acute febrile illness, especially with a history of travel to tropical and subtropical regions or freshwater exposure.
Collapse
|
38
|
Guernier V, Goarant C, Benschop J, Lau CL. A systematic review of human and animal leptospirosis in the Pacific Islands reveals pathogen and reservoir diversity. PLoS Negl Trop Dis 2018; 12:e0006503. [PMID: 29758037 PMCID: PMC5967813 DOI: 10.1371/journal.pntd.0006503] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/24/2018] [Accepted: 05/07/2018] [Indexed: 12/26/2022] Open
Abstract
Background The Pacific Islands have environmental conditions highly favourable for transmission of leptospirosis, a neglected zoonosis with highest incidence in the tropics, and Oceania in particular. Recent reports confirm the emergence and outbreaks of leptospirosis in the Pacific Islands, but the epidemiology and drivers of transmission of human and animal leptospirosis are poorly documented, especially in the more isolated and less developed islands. Methodology/Principal findings We conducted a systematic review of human and animal leptospirosis within 25 Pacific Islands (PIs) in Polynesia, Melanesia, Micronesia, as well as Easter Island and Hawaii. We performed a literature search using four international databases for articles published between January 1947 and June 2017. We further included grey literature available on the internet. We identified 148 studies describing leptospirosis epidemiology, but the number of studies varied significantly between PIs. No data were available from four PIs. Human leptospirosis has been reported from 13 PIs, with 63% of all studies conducted in Hawaii, French Polynesia and New Caledonia. Animal leptospirosis has been investigated in 19 PIs and from 14 host species, mainly pigs (18% of studies), cattle (16%) and dogs (11%). Only 13 studies provided information on both human and animal leptospirosis from the same location. Serology results were highly diverse in the region, both in humans and animals. Conclusions/Significance Our study suggests that, as in other tropical regions, leptospirosis is widespread in the PIs while showing some epidemiological heterogeneity. Data are scarce or absent from many PIs. Rodents, cattle, pigs and dogs are all likely to be important carriers, but the relative importance of each animal species in human infection needs to be clarified. Epidemiological surveys with appropriate sampling design, pathogen typing and data analysis are needed to improve our understanding of transmission patterns and to develop effective intervention strategies. Leptospirosis is an important bacterial zoonosis that affects people and animals worldwide. It is common in tropical areas, especially in island ecosystems. Because islands are relatively small, isolated, and have limited health and diagnostic facilities, the disease burden is often underestimated. In this systematic review, we aimed to describe the extent of leptospirosis in the Pacific Islands, including the diversity of pathogens and animal reservoirs. We identified 148 studies from 21 Pacific islands that described Leptospira infection in humans or animals. In hospitalized febrile patients, leptospirosis was a common cause of the acute febrile illness, but accurate diagnosis was challenging and often delayed because symptoms overlapped with many other infectious diseases, and access to laboratory diagnosis was limited. A wide variety of animal hosts of Leptospira were identified, with rodents, cattle, pigs and dogs reported as important hosts; however, their relative importance in human infection remains unclear. Our review demonstrates that the epidemiology of leptospirosis varies across the Pacific Islands, but information about risk factors and transmission routes is currently limited. We recommend more integrated studies, using an eco-epidemiological approach that includes human, veterinary and environmental factors, and interactions between factors at different ecological scales.
Collapse
Affiliation(s)
- Vanina Guernier
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
- Global Leptospirosis Environmental Action Network (GLEAN), World Health Organization, Geneva, Switzerland
- * E-mail:
| | - Cyrille Goarant
- Global Leptospirosis Environmental Action Network (GLEAN), World Health Organization, Geneva, Switzerland
- Institut Pasteur in New Caledonia, Institut Pasteur International Network, Nouméa, New Caledonia
| | - Jackie Benschop
- Global Leptospirosis Environmental Action Network (GLEAN), World Health Organization, Geneva, Switzerland
- School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - Colleen L. Lau
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
- Global Leptospirosis Environmental Action Network (GLEAN), World Health Organization, Geneva, Switzerland
- Research School of Population Health, The Australian National University, Canberra, Australia
| |
Collapse
|
39
|
Sukmark T, Lumlertgul N, Peerapornratana S, Khositrangsikun K, Tungsanga K, Sitprija V, Srisawat N. Thai-Lepto-on-admission probability (THAI-LEPTO) score as an early tool for initial diagnosis of leptospirosis: Result from Thai-Lepto AKI study group. PLoS Negl Trop Dis 2018; 12:e0006319. [PMID: 29554124 PMCID: PMC5875898 DOI: 10.1371/journal.pntd.0006319] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 03/29/2018] [Accepted: 02/15/2018] [Indexed: 11/18/2022] Open
Abstract
Background Leptospirosis is one of the most important zoonosis in the tropics. Currently, specific laboratory diagnostic test for leptospirosis such as polymerase chain reaction (PCR) or direct culture cannot be applied at the primary care setting especially in the resource- limited countries. Therefore, clinical presentation and laboratory examination are still the primary diagnostic tools for leptospirosis. Objectives To detect clinical factors for predicting leptospirosis in suspected cases, and to create a clinical prediction score (THAI-LEPTO) that is practical and easy to use in general practice while awaiting laboratory results. Materials and methods We performed a prospective multicenter study with a development and a validation cohort of patients presenting with clinical suspicion of leptospirosis as per the WHO clinical criteria. The development cohort was conducted at 11 centers in 8 provinces around Thailand. The validation cohort was conducted at 4 centers in 1 province from the Northeastern part of Thailand. Leptospirosis confirmed cases were defined if any one of the tests were positive: microscopic agglutination test, direct culture, or PCR technique. Multivariable logistic regression was used to identify predictors of leptospirosis. The clinical prediction score was derived from the regression coefficients (original) or from the odds ratio values (simplified). We used receiver operating characteristic (ROC) curve analysis to evaluate the diagnostic ability of our score and to find the optimal cutoff values of the score. We used a validation cohort to evaluate the accuracy of our methods. Results In the development cohort, we enrolled 221 leptospirosis suspected cases and analyzed 211. Among those, 105 (50%) were leptospirosis confirmed cases. In logistic regression adjusted for age, gender, day of fever, and one clinical factor at a time, leptospirosis group had more hypotension OR = 2.76 (95% CI 1.07–7.10), jaundice OR = 3.40 (95%CI 1.48–8.44), muscle pain OR = 2.12 (95%CI 1.06–4.26), acute kidney injury (AKI) OR = 2.90 (95%CI 1.31–6.15), low hemoglobin OR = 3.48 (95%CI 1.72–7.04), and hypokalemia with hyponatremia OR = 3.56 (95%CI 1.17–10.84) than non-leptospirosis group. The abovementioned factors along with neutrophilia and pulmonary opacity were used in the development of the score. The simplified score with 7 variables was the summation of the odds ratio values as follows: hypotension 3, jaundice 2, muscle pain 2, AKI 1.5, low hemoglobin 3, hypokalemia with hyponatremia 3, and neutrophilia 1. The score showed the highest discriminatory power with area under the curve (AUC) 0.82 (95%CI 0.67–0.97) on fever day 3–4. In the validation cohort we enrolled 96 leptospirosis suspected cases and analyzed 92. Of those, 69 (75%) were leptospirosis confirmed cases. The performance of the simplified score with 7 variables at a cutoff of 4 was AUC 0.78 (95%CI 0.68–0.89); sensitivity 73.5; specificity 73.7; positive predictive value 87.8; negative predictive value 58.3. Conclusions THAI-LEPTO score is a newly developed diagnostic tool for early presumptive diagnosis of leptospirosis in patients presenting with severe clinical suspicion of the disease. The score can easily be applied at the point of care while awaiting confirmatory laboratory results. Each predictor used has been supported by evidence of clinical and pathophysiological correlation. Leptospirosis is an important zoonosis in the tropics. However, there is still a major barrier of early diagnosis of leptospirosis due to a lack of specific and sensitive testing. Moreover, in resource-limited countries with small budgets, a simple and cheap diagnostic test is essential for the diagnosis of leptospirosis. The THAI-LEPTO score has been developed and validated based on the relevant clinical history and related laboratory test. This score will help the physician in early diagnosis and prompt treatment leptospirosis as a point of care test. Finally, we aim that this scoring system can be one of the key parts of diagnostic algorithm and improve leptospirosis patients’ outcome.
Collapse
Affiliation(s)
| | - Nuttha Lumlertgul
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Sadudee Peerapornratana
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Center for Critical Care Nephrology, The CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | | | - Kriang Tungsanga
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Visith Sitprija
- Queen Saovabha Memorial Institute, Thai Red Cross, Bangkok, Thailand
| | - Nattachai Srisawat
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Center for Critical Care Nephrology, The CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
- * E-mail:
| | | |
Collapse
|
40
|
Tomari K, Toyokawa T, Takahashi T, Kakita T, Okano S, Kyan H, Tonegawa N, Okawa T, Matsuoka T, Matsumora T. Childhood leptospirosis in an industrialized country: Population-based study in Okinawa, Japan. PLoS Negl Trop Dis 2018. [PMID: 29518084 PMCID: PMC5860792 DOI: 10.1371/journal.pntd.0006294] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Leptospirosis is considered underdiagnosed because of its nonspecific presentation and lack of proper understanding of its epidemiology. Early diagnosis and treatment are crucial. However, few data are available on confirmed leptospirosis cases in children in industrialized countries. We therefore aimed to describe epidemiologic and clinical characteristics of laboratory-confirmed childhood leptospirosis in Okinawa, Japan. We reviewed the national surveillance data of pediatric leptospirosis in Okinawa, Japan from January 2003 through December 2015. The database included all of laboratory-confirmed leptospirosis diagnosed at the only central laboratory for leptospirosis in the region. There were 44 children (0–20 years of age) with laboratory-confirmed leptospirosis. Of these, 90% were male, 91% were 10–20 years of age, and 96% of cases occurred in August and September. The number of laboratory-confirmed patients ranged from 0 to 11 per year (mean: 3.3 per year), and the estimated annual rate was 1.0 per 100,000 pediatric populations. In all cases, the presumed infection route was recreational exposure to river water. Commonly observed manifestations include fever (95%), myalgia (52%), and conjunctival suffusion (52%). Childhood leptospirosis in Okinawa, Japan occurred predominantly in teenage boys after freshwater exposure in summer, and most patients had characteristic conjunctival suffusion. Cohort studies would be helpful to better understand more detailed clinical manifestations in association with prognosis. Leptospirosis is a bacterial disease that affects humans and animals. It is caused by Leptospira. Leptospira is a spiral-shaped Gram-negative spirochete with internal flagella, which enters the host through mucosa and broken skin. Leptospirosis is a worldwide zoonosis, but it is considered underdiagnosed because of its nonspecific presentation and lack of proper understanding of its epidemiology, especially in children. In human, it can cause a wide range of symptoms in acute phase include fever, chills, headache, muscle aches, vomiting, and diarrhea. Some of these symptoms can be observed in other febrile diseases such as typhoid fever, rickettsiosis, Kawasaki disease, and adenovirus infections. Although Leptospirosis can be deadly in severe, untreated cases, few data are available on leptospirosis in children, industrialized countries, and confirmed cases. This study conducted a population-based study to describe epidemiologic and clinical characteristics of childhood leptospirosis in a leptospirosis-endemic area in an industrialized country, Okinawa, Japan. This new knowledge may contribute to a better overall understanding of the Leptospirosis in children.
Collapse
Affiliation(s)
- Kouki Tomari
- Department of General Pediatrics, Okinawa Prefectural Nanbu Medical Center & Children’s Medical Center, Okinawa, Japan
- * E-mail:
| | - Takao Toyokawa
- Department of Infectious Disease, Okinawa Prefectural Nanbu Medical Center & Children’s Medical Center, Okinawa, Japan
| | - Takuto Takahashi
- Department of Pediatrics, SUNY Downstate Medical Center, Brooklyn, NY, United States of America
| | - Tetsuya Kakita
- Medical Microbiology and Zoology Section, Okinawa Prefectural Institute of Health and Environment, Okinawa, Japan
| | - Sho Okano
- Medical Microbiology and Zoology Section, Okinawa Prefectural Institute of Health and Environment, Okinawa, Japan
| | - Hisako Kyan
- Medical Microbiology and Zoology Section, Okinawa Prefectural Institute of Health and Environment, Okinawa, Japan
| | - Naoya Tonegawa
- Department of General Pediatrics, Okinawa Prefectural Nanbu Medical Center & Children’s Medical Center, Okinawa, Japan
| | - Teppei Okawa
- Department of General Pediatrics, Okinawa Prefectural Nanbu Medical Center & Children’s Medical Center, Okinawa, Japan
| | - Takashi Matsuoka
- Department of General Pediatrics, Okinawa Prefectural Nanbu Medical Center & Children’s Medical Center, Okinawa, Japan
| | - Tsutomu Matsumora
- Department of General Pediatrics, Okinawa Prefectural Nanbu Medical Center & Children’s Medical Center, Okinawa, Japan
| |
Collapse
|
41
|
Gorbea H, Garcia-Rivera EJ, Torres H, Lorenzi OD, Rivera A, Galloway RL, Sharp TM. Leptospirosis Cases Infected with Uncommon Serogroups, Puerto Rico, 2013-2015. Am J Trop Med Hyg 2018; 98:258-261. [PMID: 29141761 PMCID: PMC5928731 DOI: 10.4269/ajtmh.17-0538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Leptospirosis is an emerging bacterial zoonosis that is endemic but underrecognized throughout the tropics. Through prospective surveillance for acute febrile illness (AFI) among patients who presented to the emergency department of a hospital located in an urban region of Puerto Rico, four patients with laboratory-confirmed leptospirosis were identified. All patients had signs and symptoms of AFI, including fever, headache, and dehydration. Three patients had leukocytosis with thrombocytopenia and were admitted to the hospital. One hospitalized patient presented with jaundice, icteric sclera, and hematuria and developed rhabdomyolysis, whereas another patient with pulmonary edema was admitted to the intensive care unit. Microscopic agglutination titers among the four patients were highest against serogroups Icterohaemorrhagiae (serovar Mankarso), Australis (serovar Bratislava), Bataviae (serovar Bataviae), and Canicola (serovar Canicola). These case reports demonstrate that infection with these apparently uncommon serogroups can result in illness ranging from mild to life-threatening.
Collapse
Affiliation(s)
- Hector Gorbea
- University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | | | - Hilda Torres
- University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Olga D Lorenzi
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Aidsa Rivera
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Renee L Galloway
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tyler M Sharp
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| |
Collapse
|
42
|
Efficacy of a New Recrystallized Enrofloxacin Hydrochloride-Dihydrate against Leptospirosis in a Hamster Model. Antimicrob Agents Chemother 2017; 61:AAC.01285-17. [PMID: 28874381 DOI: 10.1128/aac.01285-17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 08/29/2017] [Indexed: 12/28/2022] Open
Abstract
A trial on Syrian hamsters (Mesocricetus auratus) infected with Leptospira interrogans serovar Canicola was established to compare treatment efficacies of daily intramuscular (i.m.) injections of either 10 mg/kg of 5% enrofloxacin (Baytril [BE]; Bayer Animal Health, Mexico) or the same dose of enrofloxacin hydrochloride-dihydrate (enro-C). Hamsters were experimentally infected via the oral submucosa with 400 microorganisms/animal, in a sequential time schedule aligned to the initial treatment day, and were treated in groups as follows: a group treated with 5% enrofloxacin daily for 7 days after 24 h of infection (group BE24); a group treated as described for group BE24 but with enro-C (enro-C24); a group also treated with 5% enrofloxacin but starting at 72 h after infection (BE74); a group treated as described for group BE74 but with injection of enro-C (enro-C74). An untreated-uninfected control group (group CG-) and an infected-untreated control group (group CG+) were assembled (n = 18 in all groups). Weights and temperatures of the hamsters were monitored daily for 28 days. After hamsters were euthanatized or following death, necropsy, histopathology, macroscopic agglutination tests (MAT), bacterial culture, and PCR were performed. The mortality rates were 38.8% in group BE24 and 100% in group BE74 No mortality was observed in group enro-C24, and 11.1% mortality was recorded in group enro-C74 The mortality rates in groups CG+ and CG- were 100% and zero, respectively. Combined necropsy and histopathologic findings revealed signs of septicemia and organ damage in groups BE24, BE72, and CG+ Groups enro-C24 and CG- showed no lesions. Moderated lesions were registered in 3 hamsters in group enro-C72 MAT results were positive in 83.3% of BE24 hamsters (83.3%) and 100% of BE72 and CG+ hamsters; MAT results were positive in 16.7% in group Enro-C24 and 38.9% in group enro-C72 Only 4/18 were PCR positive in group enro-C72 and only 1 in group enro-C24 (P < 0.05). It can be concluded that enro-C may be a viable option to treat leptospirosis in hamsters and that this may be the case in other species.
Collapse
|
43
|
Mišić-Majerus L, Habuš J, Štritof Z, Bujić N, Mađarić V, Kolaric-Sviben G, Vince S, Peršić Z, Turk N. Epidemiological and clinical features of leptospirosis in a highly endemic area over three time periods. Trop Med Int Health 2017; 22:1405-1413. [PMID: 28857412 DOI: 10.1111/tmi.12967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To present the features of human leptospirosis over three time periods (1970-1975; 2000-2005; 2010-2015), to compare the collected data and to determine whether the incidence, seasonal and spatial distribution, prevalence of presumptive infective serogroups and clinical features have changed over the last 50 years. METHODS Epidemiological and clinical data obtained from patients hospitalised and treated in a well-known endemic focus of leptospirosis, Koprivnica-Križevci County in Croatia, were analysed. RESULTS We observed a steady decline in the overall incidence of leptospirosis and a change in the patient age distribution, with the age ratio changing in favour of middle-aged and older patients. Although leptospirosis was most frequently diagnosed in August in all time periods, the number of cases increased in autumn. The most prevalent serogroup during the first and the second time period was Icterohaemorrhagiae, while in the third time period, the serogroup Australis prevailed. We also noted an increase in the number of severe clinical manifestations. CONCLUSIONS This retrospective research demonstrates a continuous decline in the incidence of human leptospirosis in Croatia. The pattern of disease has changed from predominantly mild clinical forms observed in children to more severe clinical forms observed in middle-aged to older patients, especially those working in agriculture. Additional epidemiological changes included an increase in the number of cases during the autumn months and changes in prevailing serogroups. Statistical analysis revealed a significant relationship between the severity of the clinical picture, patient age and presumed sources of infection.
Collapse
Affiliation(s)
- Ljiljana Mišić-Majerus
- Division of Infectious Diseases Dr. Tomislav Bardek General Hospital, Koprivnica, Croatia
| | - Josipa Habuš
- National Reference Laboratory for Leptospirosis, University of Zagreb, Zagreb, Croatia
| | - Zrinka Štritof
- National Reference Laboratory for Leptospirosis, University of Zagreb, Zagreb, Croatia
| | - Nevenka Bujić
- Division of Infectious Diseases Dr. Tomislav Bardek General Hospital, Koprivnica, Croatia
| | - Vesna Mađarić
- Division of Infectious Diseases Dr. Tomislav Bardek General Hospital, Koprivnica, Croatia
| | - Gordana Kolaric-Sviben
- Division of Infectious Diseases Dr. Tomislav Bardek General Hospital, Koprivnica, Croatia
| | - Silvijo Vince
- Reproduction and Obstetric Clinic, University of Zagreb, Zagreb, Croatia
| | - Zdenka Peršić
- Croatian National Reference Laboratory for Human Leptospirosis, Croatian Institute of Public Health, Zagreb, Croatia
| | - Nenad Turk
- National Reference Laboratory for Leptospirosis, University of Zagreb, Zagreb, Croatia
| |
Collapse
|
44
|
Neaterour P, Rivera A, Galloway RL, Negrón MG, Rivera-Garcia B, Sharp TM. Fatal Leptospira spp./Zika Virus Coinfection-Puerto Rico, 2016. Am J Trop Med Hyg 2017; 97:1085-1087. [PMID: 28722594 PMCID: PMC5637617 DOI: 10.4269/ajtmh.17-0250] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Coinfection with pathogens that cause acute febrile illness (AFI) can complicate patient diagnosis and management. This report describes a fatal case of Leptospira spp./Zika virus (ZIKV) coinfection in Puerto Rico. The patient presented with a 5-day history of AFI; reported behavioral risk factors for leptospirosis; was diagnosed with possible leptospirosis, dengue, chikungunya, or ZIKV disease; and received appropriate treatment for leptospirosis and dengue. Following a 3-day hospitalization, the patient died due to acute gastrointestinal hemorrhage, and kidney and liver failure. Serologic diagnostic testing for leptospirosis and ZIKV disease was negative; however, molecular diagnostic testing performed postmortem was positive for detection of Leptospira spp. and ZIKV nucleic acid. This case demonstrates the need for continued clinical awareness of leptospirosis in areas experiencing outbreaks of pathogens that cause AFI and the need for evaluation of coinfection with AFI-causing pathogens as a risk factor for increased severity of disease.
Collapse
Affiliation(s)
- Paige Neaterour
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Aidsa Rivera
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Renee L Galloway
- Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Tyler M Sharp
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| |
Collapse
|
45
|
Klein M, Argemi X, Kepka S. Céphalées fébriles aux urgences : un cas de leptospirose. ANNALES FRANCAISES DE MEDECINE D URGENCE 2017. [DOI: 10.1007/s13341-017-0747-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
46
|
Trimble A, Moffat V, Collins AM. Pulmonary infections in the returned traveller. Pneumonia (Nathan) 2017; 9:1. [PMID: 28702303 PMCID: PMC5471882 DOI: 10.1186/s41479-017-0026-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 10/16/2016] [Indexed: 01/14/2023] Open
Abstract
Pulmonary infections in the returned traveller are a common presentation. A wide variety of infections may present with pulmonary symptoms. It is important for clinicians to differentiate the cause of these symptoms. The risk of contracting certain travel-related pulmonary diseases depends on travel destination, length of stay, activities undertaken and co-morbidities. Some pathogens are found worldwide, whilst others are related to specific locations. This review article will discuss the approach to diagnosing and treating pulmonary infections in the returned traveller.
Collapse
Affiliation(s)
- Ashleigh Trimble
- Crosshouse Hospital, Kilmarnock Road, Crosshouse, KA2 0BE UK
- Respiratory Infection Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA UK
| | - V. Moffat
- Aintree Hospital, Longmoor Lane, Liverpool, L9 7AL UK
| | - A. M. Collins
- Respiratory Infection Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA UK
- Respiratory Research Group, Royal Liverpool and Broadgreen University Hospital Trust, Prescot Street, Liverpool, L7 8XP UK
| |
Collapse
|
47
|
Sociodemographic and clinical characteristics of patients infected with Leptospira spp. treated at four hospitals in Medellín, Colombia, 2008-2013. BIOMEDICA 2017; 37:62-67. [DOI: 10.7705/biomedica.v37i1.3280] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/31/2016] [Indexed: 11/21/2022]
Abstract
Introducción. La leptospirosis continúa siendo un problema significativo de salud en regiones tropicales, incluidos los países de Latinoamérica, donde es 100 veces más frecuente que en otras regiones del mundo. En los cuadros graves de la enfermedad, su mortalidad alcanza el 10 %. Su diagnóstico es un reto debido a que las manifestaciones clínicas en la fase inicial son inespecíficas y a la poca disponibilidad de pruebas diagnósticas.Objetivo. Describir las características sociodemográficas y clínicas, y el desenlace de la enfermedad en pacientes hospitalizados con leptospirosis.Materiales y métodos. Es un estudio retrospectivo que incluyó pacientes atendidos en cuatro instituciones de Medellín, entre enero de 2009 y diciembre de 2013, con un cuadro clínico sugestivo e IgM positiva para Leptospira spp.Resultados. Se incluyeron 119 pacientes, 80 % hombres y 58 % de procedencia rural. La duración promedio de los síntomas fue de 9,6 días (DE=9,6). El 89 % de los pacientes presentó fiebre; el 62 %, ictericia; el 74 %, mialgias; el 46 %, diarrea; el 41 %, hepatomegalia; el 13 %, esplenomegalia, y 13 %, enrojecimiento de los ojos. En 54 % de los pacientes hubo deterioro de la función renal, en 32 %, compromiso pulmonar y, en 13 %, falla hepática. El 16 % de los pacientes requirió atención en la unidad de cuidados intensivos, el 12 %, asistencia respiratoria mecánica, y el 11 %, administración de vasopresores. En 38,6 % de ellos la enfermedad cursó con síndrome de Weil y el 5 % falleció. La duración promedio de la hospitalización fue de 11 días (DE=9,6).Conclusiones. La leptospirosis en esta población tuvo manifestaciones clínicas y complicaciones similares a las reportadas en la literatura científica. Se observó una mortalidad general relativamente baja comparada con las estadísticas mundiales.
Collapse
|
48
|
Chaudhry R, Saigal K, Bahadur T, Kant K, Chourasia B, Gupta N. Varied presentations of leptospirosis: experience from a tertiary care hospital in north India. Trop Doct 2017; 47:128-132. [PMID: 28092222 DOI: 10.1177/0049475516687431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Leptospirosis has been recognised as an emerging global public health problem. The aim of our study was to explore the epidemiological and clinical pattern of disease occurrence in suspected cases and to search for any existing co-infections. Ours was a retrospective study in patients with acute febrile illness in north India over a period of three years (April 2011 to June 2014). Serological diagnosis of leptospirosis was made using the PanBio IgM ELISA kit. Using modified Faine's criteria, presumptive and possible diagnosis was made in 57% and 34% cases, respectively. Most of the affected population was resident in north and central India. Nineteen patients showed co-infection with other common pathogens prevailing locally. There is a need to increase awareness and understand the local sero-epidemiological pattern of leptospirosis so that timely preventive and curative action may be taken by healthcare authorities.
Collapse
Affiliation(s)
- Rama Chaudhry
- 1 Professor, Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Karnika Saigal
- 2 Ex Senior Resident, Department of Microbiology All India Institute of Medical Sciences, New Delhi, India
| | - Tej Bahadur
- 3 PhD Scholar, Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Kamla Kant
- 4 Senior Resident, Department of Microbiology All India Institute of Medical Sciences, New Delhi, India
| | - Bishwanath Chourasia
- 3 PhD Scholar, Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Nitin Gupta
- 5 Senior Resident, Infectious Disease Division, Department of Medicine and Microbiology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
49
|
Riefkohl A, Ramírez-Rubio O, Laws RL, McClean MD, Weiner DE, Kaufman JS, Galloway RL, Shadomy SV, Guerra M, Amador JJ, Sánchez JM, López-Pilarte D, Parikh CR, Leibler JH, Brooks DR. Leptospira seropositivity as a risk factor for Mesoamerican Nephropathy. INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2017; 23:1-10. [PMID: 28209095 PMCID: PMC6060841 DOI: 10.1080/10773525.2016.1275462] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 12/08/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Leptospirosis is postulated as a possible cause of Mesoamerican Nephropathy (MeN) in Central American workers. OBJECTIVES Investigate job-specific Leptospira seroprevalence and its association with kidney disease biomarkers. METHODS In 282 sugarcane workers, 47 sugarcane applicants and 160 workers in other industries, we measured anti-leptospiral antibodies, serum creatinine, and urinary injury biomarkers, including neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), and N-acetyl-D-glucosaminidase (NAG). RESULTS Leptospira seroprevalence differed among job categories and was highest among sugarcane cutters (59%). Seropositive sugarcane workers had higher NGAL concentrations (relative mean: 1.28; 95% CI: 0.94-1.75) compared to those who were seronegative, with similar findings among field and non-field workers. CONCLUSIONS Leptospira seroprevalence varied by job category. There was some indication that seropositivity was associated with elevated biomarker levels, but results were inconsistent. Additional studies may help establish whether Leptospira infection plays any role in MeN among Central American workers.
Collapse
Affiliation(s)
- Alejandro Riefkohl
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Oriana Ramírez-Rubio
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Preventive Medicine and Public Health Department, Universidad Autónoma de Madrid, Madrid, Spain
| | - Rebecca L. Laws
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Michael D. McClean
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Daniel E. Weiner
- Division of Nephrology, Department of Medicine, Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - James S. Kaufman
- Research Service, VA New York Harbor Healthcare System and New York University School of Medicine, New York, NY, USA
| | - Renee L. Galloway
- Bacterial Special Pathogens Branch, Division of High-Consequence Pathogens & Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sean V. Shadomy
- Bacterial Special Pathogens Branch, Division of High-Consequence Pathogens & Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marta Guerra
- Bacterial Special Pathogens Branch, Division of High-Consequence Pathogens & Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Juan José Amador
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - José Marcel Sánchez
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Damaris López-Pilarte
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Chirag R. Parikh
- Section of Nephrology, Department of Medicine, Yale University, New Haven, CT, USA
- Program of Applied Translational Research, Department of Medicine, Yale University, New Haven, CT, USA
| | - Jessica H. Leibler
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Daniel R. Brooks
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| |
Collapse
|
50
|
Lane AB, Dore MM. Leptospirosis: A clinical review of evidence based diagnosis, treatment and prevention. World J Clin Infect Dis 2016; 6:61-66. [DOI: 10.5495/wjcid.v6.i4.61] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 10/08/2016] [Accepted: 10/24/2016] [Indexed: 02/06/2023] Open
Abstract
Leptospirosis is a zoonotic disease with worldwide distribution and increasing prevalence. Infection is caused by the spirochete Leptospira, with common exposure being contaminated fresh water. Most infections are asymptomatic, but symptoms range from a mild, self-limiting, non-specific febrile illness to fulminant respiratory and renal failure with a high mortality rate. The combination of jaundice, renal failure, and hemorrhage is known as Weil’s disease and is the most characteristic pattern associated with severe leptospirosis. Clinical suspicion alone may be enough to warrant empiric antibiotic treatment in many cases. Serological methods are the most commonly used means of confirming a diagnosis of leptospirosis. The “gold standard” is the microscopic agglutination test. Typical treatment for mild causes is oral doxycycline, though azithromycin and oral penicillins are reasonable alternatives. Intravenous penicillin G has long been the standard of care for severe cases though limited studies show no benefit compared to third generation cephalosporins. We review the clinical presentation, diagnosis, treatment and prevention of leptospirosis.
Collapse
|