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Vysochanska VV, Babych MS, Kohutych AI, Halamba AA. A case of leptospirosis in transcarpathia complicated with Jarisch-Herxheimer reaction. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2024; 77:608-612. [PMID: 38691808 DOI: 10.36740/wlek202403134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
A case report of Jarisch-Herxheimer (JHR) reaction on a 10th day of Leptospirosis caused by Leptospira Pomona. JHR occurs as a complication of an antibiotic treatment of various spirochetes and may lead to respiratory distress syndrome, renal failure, hepatic insufficiency, and multiple organ failure. This case represents a skin and cardio-vascular form of JHR with no lung involvement. The patient was treated with benzylpenicillin and low dexamethasone doses for 5th day of the disease with a shift to ceftriaxone and high doses of methylprednisolone. The fastest diagnosis of a sporadic zoonotic disease, early start of antibiotic therapy, and adequate doses of corticosteroids are key to the successful treatment of leptospirosis.
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Affiliation(s)
- Vlasta V Vysochanska
- UZHHOROD NATIONAL UNIVERSITY, UZHHOROD, UKRAINE; REGIONAL CLINICAL INFECTIOUS DISEASES HOSPITAL, UZHHOROD, UKRAINE
| | | | - Anton I Kohutych
- UZHHOROD NATIONAL UNIVERSITY, UZHHOROD, UKRAINE; REGIONAL CLINICAL INFECTIOUS DISEASES HOSPITAL, UZHHOROD, UKRAINE
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Chiko Y, Shiokawa K, Namihira I, Itagaki K, Maruyama K, Tachibana Y, Ryu Y, Sakai T. Report of Weil's disease with a fatal course triggered by Jarisch-Herxheimer reaction. J Infect Chemother 2023:S1341-321X(23)00100-9. [PMID: 37075979 DOI: 10.1016/j.jiac.2023.04.009] [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: 02/01/2023] [Revised: 03/16/2023] [Accepted: 04/15/2023] [Indexed: 04/21/2023]
Abstract
Leptospirosis, a zoonotic disease characterized by a spectrum of influenza-like symptoms, can manifest as severe cases so called Weil's disease. Early diagnosis and treatment are crucial to avoid the potentially fatal course of the disease. Within 24 hours of the initial administration of antibiotics, patients may experience the Jarisch-Herxheimer reaction (JHR), characterized by chills, fever, hypotension, and impaired consciousness. The Okinawa Prefecture, where our hospital is situated, boasts the highest incidence rate of leptospirosis among all regions in Japan. This reports our encounter with the initial leptospirosis case after a period of 16 years within the Okinawa Prefecture. This case exhibited JHR and required the utilization of noradrenaline (NA). Despite evidence indicating that JHR does not correlate with mortality, we contend that diagnosis of Weil's disease necessitates admission to an intensive care unit (ICU) and vigilant monitoring for JHR, as it may result in impairment of general condition and fatal outcome, as observed in our case.
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Affiliation(s)
- Yuki Chiko
- Department of General Medicine, Okinawa Prefectural Yaeyama Hospital, Ishigaki, Japan.
| | - Kinue Shiokawa
- Department of General Medicine, Okinawa Prefectural Yaeyama Hospital, Ishigaki, Japan
| | - Ikumi Namihira
- Department of General Medicine, Okinawa Prefectural Yaeyama Hospital, Ishigaki, Japan
| | - Kensuke Itagaki
- Department of General Medicine, Okinawa Prefectural Yaeyama Hospital, Ishigaki, Japan
| | - Kengo Maruyama
- Department of General Medicine, Okinawa Prefectural Yaeyama Hospital, Ishigaki, Japan
| | - Yuki Tachibana
- Department of General Medicine, Okinawa Prefectural Yaeyama Hospital, Ishigaki, Japan
| | - Yoshinori Ryu
- Department of General Medicine, Okinawa Prefectural Yaeyama Hospital, Ishigaki, Japan
| | - Tatsuya Sakai
- Department of General Medicine, Okinawa Prefectural Yaeyama Hospital, Ishigaki, Japan
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Shi J, Wu W, Wu K, Ni C, He G, Zheng S, Cheng F, Yi Y, Ren R, Jiang X. The diagnosis of leptospirosis complicated by pulmonary tuberculosis complemented by metagenomic next-generation sequencing: A case report. Front Cell Infect Microbiol 2022; 12:922996. [PMID: 36268227 PMCID: PMC9577070 DOI: 10.3389/fcimb.2022.922996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 09/15/2022] [Indexed: 11/20/2022] Open
Abstract
Leptospirosis is a zoonotic infection caused by the pathogenic Leptospira. Leptospirosis is transmitted mainly through contact with contaminated rivers, lakes, or animals carrying Leptospira. Human leptospirosis has a wide range of non-specific clinical manifestations ranging from fever, hypotension, and myalgia to multi-organ dysfunction, which severely hampers the timely clinical diagnosis and treatment of leptospirosis. Therefore, there is an urgent clinical need for an efficient strategy/method that can be used for the accurate diagnosis of leptospirosis, especially in critically ill patients. Here, we report a case of a 75-year-old male patient with clinical presentation of fever, cough, and diarrhea. Initial laboratory tests and a computed tomography (CT) scan of the chest suggested only tuberculosis. The patient was finally diagnosed with pulmonary tuberculosis (PTB) combined with leptospirosis by sputum Xpert MTB RIF, epidemiological investigations, and delayed serological testing. Furthermore, through metagenomic next-generation sequencing (mNGS) of clinical samples of cerebrospinal fluid (CSF), urine, plasma and sputum, the causative pathogens were identified as Mycobacterium tuberculosis complex and Leptospira spp. With specific treatment for both leptospirosis and tuberculosis, and associated supportive care (e.g., hemodialysis), the patient showed a good prognosis. This case report suggests that mNGS can generate a useful complement to conventional pathogenic diagnostic methods through more detailed etiological screening (i.e., at the level of species or species complex).
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Affiliation(s)
- Jichan Shi
- Department of Infectious Disease, Wenzhou Central Hospital, The Dingli Clinical College of Wenzhou Medical University, Wenzhou, China
| | - Wenjie Wu
- Institute of Innovative Applications, MatriDx Biotechnology Co., Ltd, Hangzhou, China
| | - Kang Wu
- Institute of Innovative Applications, MatriDx Biotechnology Co., Ltd, Hangzhou, China
| | - Chaorong Ni
- Institute of Infectious Diseases, Center for Disease Control and Prevention, Wenzhou, China
| | - Guiqing He
- Department of Infectious Disease, Wenzhou Central Hospital, The Dingli Clinical College of Wenzhou Medical University, Wenzhou, China
| | - Shilin Zheng
- Department of Infectious Disease, Wenzhou Central Hospital, The Dingli Clinical College of Wenzhou Medical University, Wenzhou, China
| | - Fang Cheng
- Department of Infectious Disease, Wenzhou Central Hospital, The Dingli Clinical College of Wenzhou Medical University, Wenzhou, China
| | - Yaxing Yi
- Institute of Innovative Applications, MatriDx Biotechnology Co., Ltd, Hangzhou, China
| | - Ruotong Ren
- Institute of Innovative Applications, MatriDx Biotechnology Co., Ltd, Hangzhou, China
- Foshan Branch, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
- *Correspondence: Ruotong Ren, ; Xiangao Jiang,
| | - Xiangao Jiang
- Department of Infectious Disease, Wenzhou Central Hospital, The Dingli Clinical College of Wenzhou Medical University, Wenzhou, China
- *Correspondence: Ruotong Ren, ; Xiangao Jiang,
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Sato Y, Mizuyama M, Sato M, Minamoto T, Kimura R, Toma C. Environmental DNA metabarcoding to detect pathogenic Leptospira and associated organisms in leptospirosis-endemic areas of Japan. Sci Rep 2019; 9:6575. [PMID: 31024059 PMCID: PMC6484013 DOI: 10.1038/s41598-019-42978-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/11/2019] [Indexed: 02/06/2023] Open
Abstract
Leptospires, which cause the zoonotic disease leptospirosis, persist in soil and aqueous environments. Several factors, including rainfall, the presence of reservoir animals, and various abiotic and biotic components interact to influence leptospiral survival, persistence, and pathogenicity in the environment. However, how these factors modulate the risk of infection is poorly understood. Here we developed an approach using environmental DNA (eDNA) metabarcoding for detecting the microbiome, vertebrates, and pathogenic Leptospira in aquatic samples. Specifically, we combined 4 sets of primers to generate PCR products for high-throughput sequencing of multiple amplicons through next-generation sequencing. Using our method to analyze the eDNA of leptospirosis-endemic areas in northern Okinawa, Japan, we found that the microbiota in each river shifted over time. Operating taxonomic units corresponding to pathogenic L. alstonii, L. kmetyi, and L. interrogans were detected in association with 12 nonpathogenic bacterial species. In addition, the frequencies of 11 of these species correlated with the amount of rainfall. Furthermore, 10 vertebrate species, including Sus scrofa, Pteropus dasymallus, and Cynops ensicauda, showed high correlation with leptospiral eDNA detection. Our eDNA metabarcoding method is a powerful tool for understanding the environmental phase of Leptospira and predicting human infection risk.
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Affiliation(s)
- Yukuto Sato
- Center for Strategic Research Project, Organization for Research Promotion, University of the Ryukyus, 1 Senbaru, Nishihara, Okinawa, 903-0213, Japan.
| | - Masaru Mizuyama
- Department of Bacteriology, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan.,Graduate School of Engineering and Science, University of the Ryukyus, 1 Senbaru, Nishihara, Okinawa, 903-0213, Japan
| | - Megumi Sato
- Graduate School of Health Sciences, Niigata University, 2-746 Asahimachi-dori, Chuo-ku, Niigata, 951-8122, Japan
| | - Toshifumi Minamoto
- Graduate School of Human Development and Environment, Kobe University, 3-11 Tsurukabuto, Nada-ku, Kobe, 657-8501, Japan
| | - Ryosuke Kimura
- Department of Human Biology and Anatomy, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Claudia Toma
- Department of Bacteriology, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan.
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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.
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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
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