1
|
Ji J, Wang W, Xiang S, Wei X, Pang G, Shi H, Dong J, Pang J. Diagnosis of leptospira by metagenomics next-generation sequencing with extracorporeal membrane oxygenation support: a case report. BMC Infect Dis 2023; 23:788. [PMID: 37957556 PMCID: PMC10644436 DOI: 10.1186/s12879-023-08793-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 11/06/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Leptospirosis is an infectious disease caused by pathogenic Leptospira spp., which could result in severe illnesses. Indirect contact with these pathogens is more common. Individuals could contract this disease through contact with contaminated water or during floods. In this case, we present the details of a 40-year-old male pig farmer who suffered from severe pulmonary hemorrhagic leptospirosis and multiple organ failure. The diagnosis of leptospirosis was confirmed through metagenomics next-generation sequencing (mNGS) while the patient received extracorporeal membrane oxygenation (ECMO) support, and antibiotic treatment was adjusted accordingly. The patient underwent comprehensive treatment and rehabilitation in the intensive care unit. CONCLUSION This case illustrates the importance of early diagnosis and treatment of leptospirosis. While obtaining the epidemiological history, second-generation metagenomics sequencing was utilized to confirm the etiology. The prompt initiation of ECMO therapy provided a crucial window of opportunity for addressing the underlying cause. This case report offers valuable insights for diagnosing patients with similar symptoms.
Collapse
Affiliation(s)
- Jianyu Ji
- Research Center of Communicable and Severe Diseases, Department of Intensive Care Unit, Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
- Guangxi Health Commission Key Laboratory of Diagnosis and Treatment of Acute Respiratory Distress Syndrome, Guangxi Academy of Medical Sciences, Nanning, Guangxi, China
- Guangxi Clinical Research Center Construction Project for Critical Treatment of Major Communicable Diseases, Guangxi Academy of Medical Sciences, Nanning, Guangxi, China
| | - Wei Wang
- Research Center of Communicable and Severe Diseases, Department of Intensive Care Unit, Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
- Guangxi Health Commission Key Laboratory of Diagnosis and Treatment of Acute Respiratory Distress Syndrome, Guangxi Academy of Medical Sciences, Nanning, Guangxi, China
- Guangxi Clinical Research Center Construction Project for Critical Treatment of Major Communicable Diseases, Guangxi Academy of Medical Sciences, Nanning, Guangxi, China
| | - Shulin Xiang
- Research Center of Communicable and Severe Diseases, Department of Intensive Care Unit, Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
- Guangxi Health Commission Key Laboratory of Diagnosis and Treatment of Acute Respiratory Distress Syndrome, Guangxi Academy of Medical Sciences, Nanning, Guangxi, China
- Guangxi Clinical Research Center Construction Project for Critical Treatment of Major Communicable Diseases, Guangxi Academy of Medical Sciences, Nanning, Guangxi, China
| | - Xiutian Wei
- Research Center of Communicable and Severe Diseases, Department of Intensive Care Unit, Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
- Guangxi Health Commission Key Laboratory of Diagnosis and Treatment of Acute Respiratory Distress Syndrome, Guangxi Academy of Medical Sciences, Nanning, Guangxi, China
- Guangxi Clinical Research Center Construction Project for Critical Treatment of Major Communicable Diseases, Guangxi Academy of Medical Sciences, Nanning, Guangxi, China
| | - Guangbao Pang
- Research Center of Communicable and Severe Diseases, Department of Intensive Care Unit, Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
- Guangxi Health Commission Key Laboratory of Diagnosis and Treatment of Acute Respiratory Distress Syndrome, Guangxi Academy of Medical Sciences, Nanning, Guangxi, China
- Guangxi Clinical Research Center Construction Project for Critical Treatment of Major Communicable Diseases, Guangxi Academy of Medical Sciences, Nanning, Guangxi, China
| | - Huirong Shi
- Research Center of Communicable and Severe Diseases, Department of Intensive Care Unit, Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
- Guangxi Health Commission Key Laboratory of Diagnosis and Treatment of Acute Respiratory Distress Syndrome, Guangxi Academy of Medical Sciences, Nanning, Guangxi, China
- Guangxi Clinical Research Center Construction Project for Critical Treatment of Major Communicable Diseases, Guangxi Academy of Medical Sciences, Nanning, Guangxi, China
| | - Jinda Dong
- Department of blood transfusion, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Jing Pang
- Research Center of Communicable and Severe Diseases, Department of Intensive Care Unit, Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China.
- Guangxi Health Commission Key Laboratory of Diagnosis and Treatment of Acute Respiratory Distress Syndrome, Guangxi Academy of Medical Sciences, Nanning, Guangxi, China.
- Guangxi Clinical Research Center Construction Project for Critical Treatment of Major Communicable Diseases, Guangxi Academy of Medical Sciences, Nanning, Guangxi, China.
| |
Collapse
|
2
|
Chang TMS. The role of artificial cells in the fight against COVID-19: deliver vaccine, hemoperfusion removes toxic cytokines, nanobiotherapeutics lower free radicals and pCO 2 and replenish blood supply. ARTIFICIAL CELLS, NANOMEDICINE, AND BIOTECHNOLOGY 2022; 50:240-251. [DOI: 10.1080/21691401.2022.2126491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Thomas Ming Swi Chang
- Departments of Physiology, Medicine and Biomedical Engineering, Faculty of Medicine and Biomedical Sciences, McGill University, Montreal, Canada
| |
Collapse
|
3
|
Sen S, Goyal A, Lokhande V. Extracorporeal Membrane Oxygenation in Severe Pulmonary Forms of Leptospirosis: A Report of Two Cases. Indian J Crit Care Med 2022; 26:966-969. [PMID: 36042754 PMCID: PMC9363801 DOI: 10.5005/jp-journals-10071-24286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Suvadeep Sen
- Department of Critical Care, Apollo Hospitals, Mumbai, Maharashtra, India
| | - Alaukik Goyal
- Department of Critical Care, Apollo Hospitals, Mumbai, Maharashtra, India
- Alaukik Goyal, Department of Critical Care, Apollo Hospitals, Mumbai, Maharashtra, India, Phone: +91 8530410945, e-mail:
| | - Vaishali Lokhande
- Department of Internal Medicine, Apollo Hospitals, Mumbai, Maharashtra, India
| |
Collapse
|
4
|
Pica (Allotriophagy): An Underestimated Risk Factor for Severe Leptospirosis (Weil's Diseases)? Report of a Leptospira Septic Shock Successfully Managed with ECMO. Infect Dis Rep 2021; 13:619-626. [PMID: 34287302 PMCID: PMC8293114 DOI: 10.3390/idr13030058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/28/2021] [Accepted: 07/02/2021] [Indexed: 01/18/2023] Open
Abstract
Leptospirosis is a zoonosis caused by infection with pathogenic strains of the bacterium Leptospira. The disease can be complicated by pulmonary hemorrhages and acute respiratory distress syndrome, with the mortality rate increasing to 51–100%. We report the case of a 37-year-old man who was admitted to the emergency department with a 6-day history of fever, weakness, vomiting and diarrhea, followed by jaundice. On admission, he presented leukocytosis, thrombocytopenia and acute liver and kidney injuries. His clinical course was critical, as it was immediately complicated by sepsis and severe respiratory failure, requiring haemodialysis, mechanical ventilation and broad-spectrum antibiotic therapy. In the following days, a veno-venous extracorporeal membrane oxygenation (VV-ECMO) was started due to a dramatic deterioration in respiratory function; 20 h later, it was switched to veno-arterial ECMO because of refractory cardiogenic shock. Hantavirus or Leptospira infection etiology was suspected, so penicillin G and methylprednisolone were initiated as an empirical therapy and subsequently confirmed after a laboratory diagnosis of leptospirosis. Although the clinical course was further complicated by hemorrhagic pneumonia, a gradual, full recovery occurred, and the patient was discharged from the hospital. After excluding other sources of contact with Leptospira-infected material, an unsuspected abnormal eating behavior was identified as the most probable cause of the patient’s Leptospira infection.
Collapse
|
5
|
Dong WH, Chen Z. Leptospirosis with pulmonary haemorrhage and multiple organ failure: a case report and literature review. J Int Med Res 2021; 49:3000605211019665. [PMID: 34044641 PMCID: PMC8165534 DOI: 10.1177/03000605211019665] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Pulmonary haemorrhage is an important complication of leptospirosis. We herein report an uncommon case of severe pulmonary haemorrhage and multiple organ failure caused by leptospirosis in a 49-year-old man who was previously healthy. He was a farm worker who was admitted to the hospital because of haemoptysis. He had worked in a paddy field 4 days prior to admission. Chest computed tomography revealed pulmonary haemorrhage, which rapidly deteriorated into haemorrhagic shock and multiple organ failure. Based on the patient’s possible history of contact with contaminated water and the DNA sequence of Leptospira detected in his bronchoalveolar lavage fluid, the patient was diagnosed with pulmonary haemorrhagic leptospirosis. Despite the administration of a fluid bolus, norepinephrine, broad-spectrum antibiotics, and haemostatics, and even with administration of a blood transfusion and extracorporeal life support, the pulmonary haemorrhage could not be controlled effectively. The patient eventually died of haemorrhagic shock. Leptospirosis can be a life-threatening disease despite aggressive treatment, even with extracorporeal life support. Next-generation sequencing can provide important diagnostic clues for patients with atypical leptospirotic symptoms.
Collapse
Affiliation(s)
- Wei-Hua Dong
- Department of Emergency, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, Jiangxi, China.,Medical Department of Nanchang University, Nanchang, Jiangxi, China
| | - Zhi Chen
- Department of Emergency, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, Jiangxi, China
| |
Collapse
|
6
|
Wang HJ, Chen GZ, Zhou CJ, Fu Y, Yao LN. Veno-venous extracorporeal membrane oxygenation successfully treated a case of severe pulmonary hemorrhage caused by leptospirosis. BMC Infect Dis 2020; 20:794. [PMID: 33109122 PMCID: PMC7588943 DOI: 10.1186/s12879-020-05518-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 10/16/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Pulmonary hemorrhage is an important complication of leptospirosis. Once acute respiratory distress syndrome (ARDS) occurs as a secondary condition, treatment is extremely difficult and the mortality rate is very high. CASE PRESENTATION The patient was a 49-year-old. He was admitted to the hospital because he had experienced a fever and cough for 4 days. Hemorrhage, respiratory failure, ARDS and other symptoms appeared soon after admission. Due to severe pulmonary hemorrhage secondary to ARDS, mechanical ventilation was performed through tracheal intubation. During intubation, the patient suffered cardiac arrest, and the patient's condition worsened. He was confirmed to have leptospirosis through second-generation sequencing of the alveolar lavage fluid. Finally, we successfully treated the patient with penicillin as an anti-infective medication and venous-venous extracorporeal membrane oxygenation (v-vECMO). To the best of our knowledge, this report is the first to describe the successful application of ECMO in mainland China. CONCLUSIONS Leptospirosis can induce serious but transient ARDS with a better prognosis than other causes of ARDS. Our patient was successfully treated with V-vECMO.
Collapse
Affiliation(s)
- H J Wang
- Department of Intensive Care Unit, the Affiliated People's Hospital of Ningbo University, 251 East Baizhang Road, Ningbo City, 315010, Zhejiang Province, P.R. China.
| | - G Z Chen
- Department of Intensive Care Unit, the Affiliated People's Hospital of Ningbo University, 251 East Baizhang Road, Ningbo City, 315010, Zhejiang Province, P.R. China
| | - C J Zhou
- Department of Intensive Care Unit, the Affiliated People's Hospital of Ningbo University, 251 East Baizhang Road, Ningbo City, 315010, Zhejiang Province, P.R. China
| | - Y Fu
- Department of Intensive Care Unit, the Affiliated People's Hospital of Ningbo University, 251 East Baizhang Road, Ningbo City, 315010, Zhejiang Province, P.R. China
| | - L N Yao
- Department of Intensive Care Unit, the Affiliated People's Hospital of Ningbo University, 251 East Baizhang Road, Ningbo City, 315010, Zhejiang Province, P.R. China
| |
Collapse
|