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Lesjak V, Pirnat M. Diffuse Myocardial Calcifications Caused by Leptospirosis. Cureus 2023; 15:e45345. [PMID: 37849598 PMCID: PMC10577803 DOI: 10.7759/cureus.45345] [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] [Accepted: 09/15/2023] [Indexed: 10/19/2023] Open
Abstract
Severe leptospirosis is defined by multiple organ failure. Cardiac involvement is an uncommon complication in patients with leptospirosis, and the pathophysiology of it is not well understood. Diffuse myocardial calcifications connected with sepsis are infrequent, and their effect on heart function is hard to predict. They can lead to conduction disorders and arrhythmias, thereby causing sudden death. Myocardial calcifications are usually revealed incidentally by radiological investigations such as computed tomography (CT) scan in patients with or after sepsis and are commonly unidentified in practice because most cases progress gradually. This case report involves a 51-year-old male who presented to the emergency department with sepsis. The patient was diagnosed with leptospirosis, causing septic cardiomyopathy and diffuse calcifications of the myocardium of the left ventricle. This case highlights the importance of multimodality imaging and a multidisciplinary approach to diagnoses since early recognition and treatment are essential. Follow-up of such patients is necessary to monitor the systolic function of the left ventricle and cardiac arrhythmia.
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Affiliation(s)
- Vesna Lesjak
- Radiology, University Medical Centre Maribor, Maribor, SVN
| | - Maja Pirnat
- Radiology, University Medical Centre Maribor, Maribor, SVN
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2
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Jesrani G, Gupta S, Gaba S, Gupta M. Electrocardiographic abnormalities in prevalent infections in tropical regions: A scoping review. JOURNAL OF ACUTE DISEASE 2022. [DOI: 10.4103/2221-6189.342660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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3
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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.
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4
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Iglezias SD, Abreu PAE, Kanamura C, Magaldi AJ, Seguro AC, Brito TD. Immunohistochemical detection of Lp25 and LipL32 proteins in skeletal and cardiac muscles of fatal human leptospirosis. Rev Inst Med Trop Sao Paulo 2020; 62:e85. [PMID: 33174979 PMCID: PMC7653813 DOI: 10.1590/s1678-9946202062085] [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: 06/22/2020] [Accepted: 10/13/2020] [Indexed: 11/22/2022] Open
Abstract
Leptospirosis is an acute infection caused by pathogenic species of the genus Leptospira, which affects humans and animals in all world. In severe forms of the disease, kidneys, liver and lungs are the main affected organs, resulting in acute kidney injury, jaundice and pulmonary hemorrhage. Previous post-mortem studies have shown that lesions are not limited to these organs. Cardiac and striated muscle injuries have already been reported, but the pathophysiology of cardiac and skeletal lesions in leptospirosis is not fully understood. It has been suggested that the tissue damage observed in leptospirosis could be directly mediated by leptospires or by their toxic cellular components. LipL32 and Lp25 are leptospira membrane proteins with unknown functions, that are present only in pathogenic strains of Leptospira spp. Both proteins induce skeletal muscle lesions similar to those observed when normal guinea pigs are inoculated with leptospires. Through immunohistochemistry, this study showed the presence of LipL32 and Lp25 proteins on muscle cell membranes and in the underlying cytoplasm of skeletal muscles, as well as focal lesions in cardiac tissues of fatal cases of leptospirosis. Altogether, these results reinforce that both proteins can be important factors in the pathogenesis of leptospirosis.
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Affiliation(s)
| | | | - Cristina Kanamura
- Instituto Adolfo Lutz, Laboratório de Patologia, São Paulo, São Paulo, Brazil
| | - Antonio José Magaldi
- Universidade de São Paulo, Hospital das Clínicas, Departamento de Nefrologia, Laboratório de Investigação Médica (LIM-12), São Paulo, São Paulo, Brazil
| | - Antonio Carlos Seguro
- Universidade de São Paulo, Hospital das Clínicas, Departamento de Nefrologia, Laboratório de Investigação Médica (LIM-12), São Paulo, São Paulo, Brazil
| | - Thales De Brito
- Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil.,in memoriam
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Vélez Páez JL, Tercero Martínez WM, López Rondón EF, Rueda Barragán FE, Guerrero Agila VS. Leptospirosis con Síndrome de Weil que debutan con apendicitis aguda. Reporte de un caso. BIONATURA 2020. [DOI: 10.21931/rb/2020.05.03.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
La leptospirosis es una zoonosis de distribución mundial. Su forma clínicamente más grave se denomina Síndrome de Weil, el cual se caracteriza por generar un impacto sistémico multiorgánico severo y frecuentemente fatal. Numerosos animales salvajes y domésticos constituyen el reservorio y se transforman en portadores asintomáticos, siendo fuente de infección hacia los humanos. El diagnóstico se basa en la sospecha clínica y epidemiológica, confirmándose con estudios serológicos. El tratamiento es sintomático, y con antibióticos dirigidos. A continuación, se presenta un caso de una leptospirosis que se presenta con apendicitis aguda con compromiso orgánico severo no consecuente con la patología abdominal inicial.
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Affiliation(s)
- Jorge Luis Vélez Páez
- Especialista en Medicina Critica. Cuidados Intensivos Adultos, Hospital Pablo Arturo Suárez. Quito, Ecuador
| | | | - Edgar Fernando López Rondón
- Especialista en Cardilogía y Ecocardiografía. Área Clínica de Cardiología, Hospital Pablo Arturo Suárez. Quito, Ecuador
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6
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Smith S, Liu YH, Carter A, Kennedy BJ, Dermedgoglou A, Poulgrain SS, Paavola MP, Minto TL, Luc M, Hanson J. Severe leptospirosis in tropical Australia: Optimising intensive care unit management to reduce mortality. PLoS Negl Trop Dis 2019; 13:e0007929. [PMID: 31790405 PMCID: PMC6907868 DOI: 10.1371/journal.pntd.0007929] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/12/2019] [Accepted: 11/15/2019] [Indexed: 12/13/2022] Open
Abstract
Background Severe leptospirosis can have a case-fatality rate of over 50%, even with intensive care unit (ICU) support. Multiple strategies–including protective ventilation and early renal replacement therapy (RRT)–have been recommended to improve outcomes. However, management guidelines vary widely around the world and there is no consensus on the optimal approach. Methodology/Principal findings All cases of leptospirosis admitted to the ICU of Cairns Hospital in tropical Australia between 1998 and 2018 were retrospectively reviewed. The patients’ demographics, presentation, management and clinical course were examined. The 55 patients’ median (interquartile range (IQR)) age was 47 (32–62) years and their median (IQR) APACHE III score was 67 (48–105). All 55 received appropriate antibiotic therapy, 45 (82%) within the first 6 hours. Acute kidney injury was present in 48/55 (87%), 18/55 (33%) required RRT, although this was usually not administered until traditional criteria for initiation were met. Moderate to severe acute respiratory distress syndrome developed in 37/55 (67%), 32/55 (58%) had pulmonary haemorrhage, and mechanical ventilation was required in 27/55 (49%). Vasopressor support was necessary in 34/55 (62%). Corticosteroids were prescribed in 20/55 (36%). The median (IQR) fluid balance in the initial three days of ICU care was +1493 (175–3567) ml. Only 2/55 (4%) died, both were elderly men with multiple comorbidities. Conclusion In patients with severe leptospirosis in tropical Australia, prompt ICU support that includes early antibiotics, protective ventilation strategies, conservative fluid resuscitation, traditional thresholds for RRT initiation and corticosteroid therapy is associated with a very low case-fatality rate. Prospective studies are required to establish the relative contributions of each of these interventions to optimal patient outcomes. Severe leptospirosis continues to carry a high mortality. To improve outcomes, several countries have developed national guidelines for the management of severe disease. However, there is substantial variation in these guidelines despite the fact that severe leptospirosis has a very similar presentation around the world. In tropical Australia, the case-fatality rate of severe leptospirosis is only 4%. This retrospective study reviewed 55 patients with leptospirosis requiring support in an Australian Intensive Care Unit (ICU) in an effort to identify the management strategies that might explain these excellent outcomes. The low case-fatality rate was associated with prompt multimodal ICU support that included early antibiotics, protective ventilation strategies, conservative fluid resuscitation, traditional thresholds for renal replacement therapy initiation and corticosteroid therapy. However prospective, multinational studies–which include the resource-poor settings that bear the greatest burden of disease–are necessary to define which of these interventions have the greatest therapeutic value.
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Affiliation(s)
- Simon Smith
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia
| | - Yu-Hsuan Liu
- Department of Intensive Care, Cairns Hospital, Cairns, Queensland, Australia
| | - Angus Carter
- Department of Intensive Care, Cairns Hospital, Cairns, Queensland, Australia
- James Cook University, Cairns Campus, Cairns, Queensland, Australia
| | - Brendan J. Kennedy
- Infectious Diseases Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Communicable Disease Control Branch, Adelaide, South Australia, Australia
| | | | | | | | - Tarryn L. Minto
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia
| | - Michael Luc
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia
| | - Josh Hanson
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia
- The Kirby Institute, University of New South Wales, Sydney, Australia
- * E-mail:
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Khoo CY, Ng CT, Zheng S, Teo LY. An unusual case of fulminant leptospiral myocarditis: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2019; 3:1-5. [PMID: 32259013 PMCID: PMC7108787 DOI: 10.1093/ehjcr/ytz180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 05/20/2019] [Accepted: 09/25/2019] [Indexed: 12/21/2022]
Abstract
Background Fulminant myocarditis secondary to leptospirosis is rare and associated with poor outcomes. Case summary We describe a 60-year-old gentleman with fulminant leptospiral myocarditis and profound cardiogenic shock requiring veno-arterial extracorporeal membrane oxygenator (VA-ECMO) support. He was given high-dose pulse steroids early on post-VA-ECMO implantation and achieved full recovery. To our knowledge, this is the first reported case of leptospiral myocarditis with multiorgan dysfunction successfully managed by VA-ECMO and high-dose pulse steroids. Discussion This case report highlights the potential benefits of steroids in the management of leptospiral myocarditis which requires further validation. Early aggressive supportive management with ECMO should be considered in patients with fulminant leptospiral myocarditis.
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Affiliation(s)
- Chun Yuan Khoo
- Department of Cardiology, National Heart Centre, 5 Hospital Drive, Singapore 169609, Singapore
| | - Choon Ta Ng
- Department of Cardiology, National Heart Centre, 5 Hospital Drive, Singapore 169609, Singapore
| | - Shuwei Zheng
- Department of Infectious Diseases, Singapore General Hospital, Singapore 169608, Singapore
| | - Loon Yee Teo
- Department of Cardiology, National Heart Centre, 5 Hospital Drive, Singapore 169609, Singapore
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8
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Jayathilaka PGNS, Mendis ASV, Perera MHMTS, Damsiri HMT, Gunaratne AVC, Agampodi SB. An outbreak of leptospirosis with predominant cardiac involvement: a case series. BMC Infect Dis 2019; 19:265. [PMID: 30885170 PMCID: PMC6423826 DOI: 10.1186/s12879-019-3905-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 03/14/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Severe leptospirosis is known to cause multi organ dysfunction including cardiac involvement. In the clinical setting with limited resources, high degree of suspicion is needed to diagnose cardiac involvement including myocarditis. Although myocarditis is not reported as a common complication due to lack of diagnostic facilities, there are evidence to support myocarditis is more prevalent in post mortem studies of patients died due to leptospirosis. We present a case series of severe leptospirosis with cardiac involvement observed during a period of one month at Colombo-North Teaching Hospital, Sri Lanka. CASE PRESENTATION We report here five patients with severe leptospirosis complicated with cardiac involvement, admitted to a single medical ward, Colombo-North Teaching Hospital, Sri Lanka during a one-month period. Out of six suspected leptospirosis patients admitted during that period, five in a raw developed severe leptospirosis with cardiac involvement. In this case series, four patients were confirmed serologically or quantitative PCR and one patient had possible leptospirosis. All patients developed shock during their course of illness. Two patients developed rapid atrial fibrillation. One patient had dynamic T wave changes in ECG and the other two had sinus tachycardia. Two patients had evidence of myocarditis in 2D echocardiogram, whereas other two patients had nonspecific findings and one patient had normal 2D echocardiogram. All five patients had elevated cardiac troponin I titre and it was normalized with the recovery. All five patients developed acute kidney injury. Four patients needed inotropic/vasopressor support to maintain mean arterial pressure and one patient recovered from shock with fluid resuscitation. All patients were recovered from their illness and repeat 2D echocardiograms after recovery did not show residual complications. One patient had serologically proven dengue co-infection with leptospirosis. CONCLUSIONS Myocarditis and cardiac involvement in leptospirosis may be overlooked due to non-specific clinical findings and co-existing multi-organ dysfunction. Atypical presentation of this case series may be due to micro-geographic variation and unusual outbreak of leptospirosis. Co-infection of dengue with leptospirosis should be considered in managing patients especially in endemic areas.
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Affiliation(s)
| | | | | | | | | | - Suneth Buddhika Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
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9
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Mathew A, Shanks M, Punnoose E, Fischer L, Koshy G, Potluri R, Bainey KR. Cardiac involvement in critically ill patients with leptospirosis: A prospective study using myocardial deformation imaging. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2018; 9:975-983. [PMID: 30407069 DOI: 10.1177/2048872618809319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Myocardial inflammation often complicates leptospirosis, a re-emerging global zoonosis. Leptospirosis associated myocardial dysfunction is equivocal and the pattern of cardiac involvement may not differ from that of sepsis associated myocarditis. METHODS We prospectively compared cardiac involvement in 113 intensive care unit patients with severe leptospirosis to 31 patients with sepsis syndrome using a comprehensive assessment comprising of clinical presentation, electrocardiography, two-dimensional echocardiography (with global longitudinal strain calculation), and cardiac biomarker evaluation. Binomial logistic regression was performed to identify independent predictors of left ventricular systolic dysfunction in leptospirosis. RESULTS Compared to sepsis syndrome, leptospirosis patients were younger, had higher body mass index measurements and were more likely to be smokers. Electrocardiography abnormalities were common and similar in both groups. Myocardial systolic dysfunction was common in both groups (leptospirosis: 55.86% vs sepsis syndrome: 51.61%, p=0.675) with subclinical left ventricular systolic dysfunction (characterized by abnormal global longitudinal strain and normal left ventricular ejection fraction) being most frequent followed by isolated right ventricular systolic dysfunction, isolated left ventricular systolic dysfunction, and bi-ventricular systolic dysfunction (leptospirosis: 31.43%, 18.42%, 13.16%, 10.53%, respectively; sepsis syndrome: 22.22%, 12.00%, 12.00%, 8.00%, respectively (p>0.05 for each comparator)). Leptospirosis patients had a trend towards greater troponin-T elevation (61.0% vs 40.0%, p=0.057). ST-segment elevation and elevated troponin were independent predictors of reduced left ventricular ejection fraction in leptospirosis. CONCLUSIONS Cardiac involvement in leptospirosis appears to be similar to that of sepsis syndrome, with myocardial systolic dysfunction being common. As such, clinical vigilance pertaining to cardiac status is paramount in these high-risk patients.
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Affiliation(s)
- Anoop Mathew
- Division of Cardiology, Malankara Orthodox Syrian Church (MOSC) Medical College Hospital, India.,Division of Cardiology, University of Alberta, Canada
| | - Miriam Shanks
- Division of Cardiology, University of Alberta, Canada
| | - Eapen Punnoose
- Division of Cardiology, Malankara Orthodox Syrian Church (MOSC) Medical College Hospital, India
| | - Louie Fischer
- Division of Cardiology, Malankara Orthodox Syrian Church (MOSC) Medical College Hospital, India
| | - George Koshy
- Department of Medicine, Malankara Orthodox Syrian Church (MOSC) Medical College Hospital, India
| | - Rahul Potluri
- Division of Cardiology, University of Alberta, Canada
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10
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Zuin M, Rigatelli G, Roncon L. Severe Heart Dysfunction Caused by Leptospiral Myocarditis. Am J Trop Med Hyg 2018; 99:1108-1109. [PMID: 30404682 PMCID: PMC6221234 DOI: 10.4269/ajtmh.18-0377] [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: 11/07/2022] Open
Affiliation(s)
- Marco Zuin
- Department of Cardiology, Rovigo General Hospital, Rovigo, Italy
- Section of Internal and Cardiopulmonary Medicine, Department of Medical Science, University of Ferrara, Ferrara, Italy
| | - Gianluca Rigatelli
- Department of Interventional Cardiology, Rovigo General Hospital, Rovigo, Italy
| | - Loris Roncon
- Department of Cardiology, Rovigo General Hospital, Rovigo, Italy
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11
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Forbat E, Rouhani MJ, Pavitt C, Patel S, Handslip R, Ledot S. Leptospirosis presenting as severe cardiogenic shock: A case report. J Intensive Care Soc 2018; 19:351-353. [DOI: 10.1177/1751143718754993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Leptospirosis is a rare infectious illness caused by the Spirochaete Leptospira. It has a wide-varying spectrum of presentation. We present a rare case of severe cardiogenic shock secondary to leptospirosis, in the absence of its common clinical features. Case presentation A 36-year-old woman presented to our unit with severe cardiogenic shock and subsequent multi-organ failure. Her clinical course was characterised by ongoing pyrexia of unknown origin with concurrent cardiac failure. She was initially managed with broad-spectrum antibiotics and inotropes. Percutaneous cardiac biopsy excluded major causes of myocarditis. On day 21 after presentation, she was found to be IgM-positive for leptospirosis. Conclusions This is a rare case of severe cardiogenic shock secondary to leptospirosis infection. The case also highlights the importance of obtaining a thorough social history when assessing a patient with an unusual presentation, as clues can often be missed.
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Affiliation(s)
- E Forbat
- Adult Intensive Care Unit, Royal Brompton Hospital, London, UK
| | - MJ Rouhani
- Adult Intensive Care Unit, Royal Brompton Hospital, London, UK
| | - C Pavitt
- Adult Intensive Care Unit, Royal Brompton Hospital, London, UK
| | - S Patel
- Adult Intensive Care Unit, Royal Brompton Hospital, London, UK
| | - R Handslip
- Adult Intensive Care Unit, Royal Brompton Hospital, London, UK
| | - S Ledot
- Adult Intensive Care Unit, Royal Brompton Hospital, London, UK
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12
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Spiri AM, Rodriguez-Campos S, Matos JM, Glaus TM, Riond B, Reusch CE, Hofmann-Lehmann R, Willi B. Clinical, serological and echocardiographic examination of healthy field dogs before and after vaccination with a commercial tetravalent leptospirosis vaccine. BMC Vet Res 2017; 13:138. [PMID: 28545521 PMCID: PMC5445508 DOI: 10.1186/s12917-017-1056-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 05/11/2017] [Indexed: 01/08/2023] Open
Abstract
Background Leptospirosis is a re-emerging bacterial zoonosis caused by spirochetes of the genus Leptospira. Severe disease has been reported in dogs in Europe despite vaccination with bivalent Leptospira vaccines. Recently, a tetravalent canine Leptospira vaccine (Nobivac® L4) was licenced in Europe. The goal of this study was to investigate clinical signs, microscopic agglutination test (MAT) titres, haematology, blood biochemistry, cardiac (c) Troponin I levels and echocardiography before and after vaccination with this tetravalent vaccine. Forty-eight healthy dogs were prospectively enrolled and vaccinated twice, 3–4 weeks apart (T0 and T1). Before vaccination (T0) and 16–31 days after the second vaccination (T2), MAT (n = 48), haematology (n = 48), blood biochemistry (n = 36) and cTroponin I measurements (n = 29) were performed, and MAT was repeated 347–413 days after the second vaccination (T3, n = 44). Echocardiography was performed before the first and second vaccination (T0 and T1, n = 24). Results Mild and transient clinical signs within 5 days following the first and second vaccination occurred in 23% and 10% of the dogs, respectively. Before the first vaccination (T0), all dogs showed negative MAT titres for the tested serovars except for Canicola (50% with titres 100–400). At T2, positive MAT titres to the serovars Canicola (100%), Australis (89%), Grippotyphosa (86%), Bratislava (60%), Autumnalis (58%), Copenhageni (42%), Pomona (12%), Pyrogenes (8%) and Icterohaemorrhagiae (2%) were found. Median to high titres (≥ 400) were most common to the serovar Canicola (92%) and less common to the serovars Australis (41%), Grippotyphosa (21%), Bratislava (12%), Autumnalis (4%), Pyrogenes (4%) and Pomona (2%). At T3, positive MAT titres (titre range: 100–400) were found in 2–18% of the dogs to serovars of the vaccine serogroups and in 2–18% of the dogs to the non-vaccine serovars Pomona, Autumnalis, Pyrogenes and Ballum. Haematology, blood biochemistry, cTroponin I levels and echocardiography results did not change significantly following vaccination. Conclusions Clinical signs following vaccination with Nobivac® L4 were transient and mild in all cases. Seroconversion differed considerably among individual dogs and among the vaccine serogroups. Electronic supplementary material The online version of this article (doi:10.1186/s12917-017-1056-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andrea M Spiri
- Clinical Laboratory, Vetsuisse Faculty, University of Zurich, Winterthurerstr. 260, 8057, Zurich, Switzerland.,Center for Clinical Studies, Vetsuisse Faculty, University of Zurich, Winterthurerstr. 260, 8057, Zurich, Switzerland
| | - Sabrina Rodriguez-Campos
- Institute of Veterinary Bacteriology, Vetsuisse Faculty, University of Bern, Länggassstr. 122, 3001 Bern, Switzerland
| | - José M Matos
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Winterthurerstr. 260, 8057, Zurich, Switzerland
| | - Tony M Glaus
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Winterthurerstr. 260, 8057, Zurich, Switzerland
| | - Barbara Riond
- Clinical Laboratory, Vetsuisse Faculty, University of Zurich, Winterthurerstr. 260, 8057, Zurich, Switzerland
| | - Claudia E Reusch
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Winterthurerstr. 260, 8057, Zurich, Switzerland
| | - Regina Hofmann-Lehmann
- Clinical Laboratory, Vetsuisse Faculty, University of Zurich, Winterthurerstr. 260, 8057, Zurich, Switzerland.,Center for Clinical Studies, Vetsuisse Faculty, University of Zurich, Winterthurerstr. 260, 8057, Zurich, Switzerland
| | - Barbara Willi
- Clinical Laboratory, Vetsuisse Faculty, University of Zurich, Winterthurerstr. 260, 8057, Zurich, Switzerland. .,Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Winterthurerstr. 260, 8057, Zurich, Switzerland.
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13
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Schuller S, Francey T, Hartmann K, Hugonnard M, Kohn B, Nally JE, Sykes J. European consensus statement on leptospirosis in dogs and cats. J Small Anim Pract 2015; 56:159-79. [PMID: 25754092 DOI: 10.1111/jsap.12328] [Citation(s) in RCA: 151] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 10/31/2014] [Accepted: 11/28/2014] [Indexed: 02/03/2023]
Abstract
Leptospirosis is a zoonotic disease with a worldwide distribution affecting most mammalian species. Clinical leptospirosis is common in dogs but appears to be rare in cats. Both dogs and cats, however, can shed leptospires in the urine. This is problematic as it can lead to exposure of humans. The control of leptospirosis, therefore, is important not only from an animal but also from a public health perspective. The aim of this consensus statement is to raise awareness of leptospirosis and to outline the current knowledge on the epidemiology, clinical features, diagnostic tools, prevention and treatment measures relevant to canine and feline leptospirosis in Europe.
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Affiliation(s)
- S Schuller
- Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, 3012 Bern, Switzerland
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14
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Rajapakse S, Rodrigo C, Balaji K, Fernando SD. Atypical manifestations of leptospirosis. Trans R Soc Trop Med Hyg 2015; 109:294-302. [PMID: 25813883 DOI: 10.1093/trstmh/trv026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 02/11/2015] [Indexed: 12/23/2022] Open
Abstract
Leptospirosis is an illness with a wide spectrum of clinical manifestations and severe illness affects nearly all organ systems. Serious and potentially life-threatening clinical manifestations of acute leptospirosis are caused by both direct tissue invasion by spirochaetes and by the host immune responses. In its severe form, leptospirosis can cause multi-organ dysfunction and death in a matter of days. Therefore it is critical to suspect and recognize the disease early, in order to initiate timely treatment. While the classical presentation of the disease is easily recognized by experienced clinicians practising in endemic regions, rarer manifestations can be easily missed. In this systematic review, we summarize the atypical manifestations reported in literature in patients with confirmed leptospirosis. Awareness of these unusual manifestations would hopefully guide clinicians towards early diagnosis.
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Affiliation(s)
- Senaka Rajapakse
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Chaturaka Rodrigo
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Krishan Balaji
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Sri Lanka
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Myocarditis causing severe heart failure--an unusual early manifestation of leptospirosis: a case report. BMC Res Notes 2015; 8:80. [PMID: 25884600 PMCID: PMC4371810 DOI: 10.1186/s13104-015-1031-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 02/23/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Leptospirosis is the most widespread zoonosis in the world. Cardiac involvement is a frequent complication of leptospirosis although significant left ventricular dysfunction is rare. We report a case of fatal leptospira myocarditis leading to cardiogenic shock on the second day of illness. This early occurrence of myocarditis is not previously reported. CASE PRESENTATION A 36-yr-old previously healthy Sri Lankan male who takes care of a horse presented to the medical casualty ward with a one day history of fever, arthralgia and severe myalgia. He developed hypotension on the second day of illness. Electrocardiogram showed sinus tachycardia with ST segment depression in lateral leads which evolved in to rapid atrial fibrillation in the subsequent days. 2D echocardiogram showed dilated cardiac chambers with severe global hypokinesia and an ejection fraction of 20%. His renal and liver functions were within normal limits. He developed multi organ dysfunction syndrome and refractory shock, later in the course of illness. Leptospirosis was confirmed by positive leptospira IgM and negative IgG. Patient died on the fifth day of illness despite optimal medical treatment with intravenous penicillin, meropenem, levofloxacin, inotropes and supportive care in the intensive care unit. CONCLUSIONS We describe a rare and unusual early complication of leptospirosis which has not been reported before. It is important to bear in mind that leptospirosis could present as myocarditis during the early phase of illness.
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Cheng YT, Liang KW, Liu TJ, Pan MJ, Wang KY, Lin WW. Dynamic Compression of the Left Coronary Artery by a Left Ventricular Pseudoaneurysm after Myocarditis. ACTA CARDIOLOGICA SINICA 2014; 30:582-5. [PMID: 27122839 DOI: 10.6515/acs20140114a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
UNLABELLED A 69-year-old man with a recent diagnosis of suspected leptospirosis infection-related myocarditis presented with antecedent arthralgia, myalgia, fever, intermittent anterior chest pain, yellowish sclera, yellowish skin and shortness of breath. His symptoms improved after antibiotic treatment with penicillin for 14 days. However, recurrent chest pain and progressive dyspnea upon exertion developed 2 months later. A newly developed left ventricular outflow tract pseudoaneurysm was identified by cardiac sonography and multi-detector computed tomography of the heart. A subsequent coronary arteriogram demonstrated an left ventricular (LV) pseudoaneurysm causing compression to both the left circumflex coronary artery and the left anterior descending coronary artery with significant stenosis. To the best of our knowledge, this is the first reported case of a LV pseudoaneurysm developing after a clinical course of suspected leptospirosis-related myocardit is causing dynamic compression of the left coronary artery. KEY WORDS Dynamic compression of coronary artery; Left ventricular pseudoaneurysm; Leptospirosis; Myocarditis.
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Affiliation(s)
- Yu-Tsung Cheng
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung
| | - Kae-Woei Liang
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung; ; Institute of Clinical Medicine, Cardiovascular Research Center and Department of Medicine, National Yang-Ming University School of Medicine, Taipei
| | - Tsun-Jui Liu
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung; ; Institute of Clinical Medicine, Cardiovascular Research Center and Department of Medicine, National Yang-Ming University School of Medicine, Taipei
| | - Ming-Jeng Pan
- Institute of Life Sciences, Central Taiwan University of Science and Technology
| | - Kuo-Yang Wang
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung; ; Institute of Clinical Medicine, Cardiovascular Research Center and Department of Medicine, National Yang-Ming University School of Medicine, Taipei; ; Department of Medicine, Chung-Shan Medical University School of Medicine
| | - Wei-Win Lin
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung; ; Department of Life Science, Tunghai University, Taichung, Taiwan
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18
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Voon V, Saiva L, Prendiville B, Brennan D, Dodd J, McCreery C. Leptospiral myocarditis--a rare assault on myocardium. Int J Cardiol 2013; 172:e76-8. [PMID: 24411208 DOI: 10.1016/j.ijcard.2013.12.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 12/21/2013] [Indexed: 11/19/2022]
Affiliation(s)
- Victor Voon
- St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
| | - Lavanya Saiva
- St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | | | - David Brennan
- St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Jonathan Dodd
- St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
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19
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Gancheva GI. Leptospirosis in elderly patients. Braz J Infect Dis 2013; 17:592-5. [PMID: 23830052 PMCID: PMC9425124 DOI: 10.1016/j.bjid.2013.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 01/11/2013] [Accepted: 01/28/2013] [Indexed: 11/28/2022] Open
Abstract
Leptospirosis is a re-emerging zoonosis with broad clinical spectrum and high mortality in severe forms. The aim of this study was to analyze clinical manifestations, laboratory findings, epidemiological data, and management in elderly patients with leptospirosis. Toward that end, we performed a descriptive analysis of 15 leptospirosis elderly cases (age 60–78 years) treated at the Clinic of Infectious Diseases of University Hospital – Pleven (1976–2012). Patients were serologically confirmed by microscopic agglutination test. Twelve cases (80%) presented with the severe form of leptospirosis. Co-morbidity (hypertonic diseases, chronic pulmonary diseases, chronic alcohol abuse, and diabetes) was registered in 13 cases. All cases had fever, oliguria, conjunctival suffusions, hepatosplenomegaly. Jaundice (14/93%), hemorrhagic diathesis (13/87%), vomiting (11/73%), abdominal pain (10/67%), myalgia (7/47%) and hypotension (7/47%) also were observed. Renal dysfunction was expressed by increased blood urea nitrogen (mean 38.1 ± 24.1 mmol/L) and serum creatinine (mean 347.6 ± 179.8 μmol/L). Hepatic dysfunction was expressed by increased total serum bilirubin level (mean 274.6 ± 210.7 μmol/L) and slightly elevated aminotransferases (ASAT mean 125.8 ± 61.6 IU/L; ALAT mean 131.3 ± 126.5 IU/L). Five cases (33%) had a lethal outcome. In conclusion, leptospirosis in elderly patients is associated with severe course and higher risk for death, and requires prompt intensive treatment.
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Affiliation(s)
- Galya Ivanova Gancheva
- Department of Infectious Diseases, Epidemiology, Parasitology and Tropical Medicine, Medical University, Pleven, Bulgaria.
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20
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Fernando T, Rodrigo C, Samarakoon L, Navinan MR, Dandeniya C, Constantine G, Rajapakse S. Electrocardiographic and echocardiographic manifestations of cardiac involvement in leptospirosis. Trans R Soc Trop Med Hyg 2013; 107:457-9. [DOI: 10.1093/trstmh/trt038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Silva FTM, Silva Junior GBD, Benevides AN, Daher EDF. Atrial flutter complicating severe leptospirosis: a case report. Rev Soc Bras Med Trop 2013; 46:246-8. [DOI: 10.1590/0037-8682-1739-2013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 01/21/2013] [Indexed: 11/22/2022] Open
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22
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Navinan MR, Rajapakse S. Cardiac involvement in leptospirosis. Trans R Soc Trop Med Hyg 2012; 106:515-20. [PMID: 22818758 DOI: 10.1016/j.trstmh.2012.06.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Revised: 05/31/2012] [Accepted: 06/18/2012] [Indexed: 01/29/2023] Open
Abstract
Leptospirosis is a neglected global disease with significant morbidity and mortality. Cardiac complications such as chest pain, arrhythmias, pulmonary oedema and refractory shock have been reported in patients with severe disease. However, the frequency and extent of cardiac involvement in leptospirosis, are under-reported and poorly understood. Multiple factors may contribute to clinical manifestations that suggest cardiac involvement, causing diagnostic confusion. A variety of electrocardiographic changes occur in leptospirosis, with atrial fibrillation, atrioventricular conduction blocks and non-specific ventricular repolarization abnormalities being the most common. Electrolyte abnormalities are likely to contribute to electrocardiographic changes; direct effects on Na(+)-K(+)-Cl(-) transporters in the renal tubules have been postulated. Echocardiographic evidence of myocardial dysfunction has not been adequately demonstrated. The diagnostic value of cardiac biomarkers is unknown. Histopathological changes in the myocardium have been clearly shown, with myocardial inflammation and vasculitis present in postmortem studies. Nonetheless, the pathophysiology of cardiac involvement in leptospirosis is poorly understood. Cardiac involvement, demonstrated electrocardiographically or clinically, tends to predict poor outcome. No specific therapies are available to prevent or treat cardiac involvement in leptospirosis; current management is based on correction of deranged homeostasis and supportive therapy. Evidence suggests that direct myocardial damage occurs in patients with severe leptospirosis, and further studies are recommended to elucidate its pathophysiology, clinical features and contribution to overall prognosis, and to identify appropriate diagnostic investigations and specific therapies.
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Dassanayake DLB, Wimalaratna H, Nandadewa D, Nugaliyadda A, Ratnatunga CN, Agampodi SB. Predictors of the development of myocarditis or acute renal failure in patients with leptospirosis: an observational study. BMC Infect Dis 2012; 12:4. [PMID: 22243770 PMCID: PMC3292442 DOI: 10.1186/1471-2334-12-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2011] [Accepted: 01/13/2012] [Indexed: 11/19/2022] Open
Abstract
Background Leptospirosis has a varied clinical presentation with complications like myocarditis and acute renal failure. There are many predictors of severity and mortality including clinical and laboratory parameters. Early detection and treatment can reduce complications. Therefore recognizing the early predictors of the complications of leptospirosis is important in patient management. This study was aimed at determining the clinical and laboratory predictors of myocarditis or acute renal failure. Methods This was a prospective descriptive study carried out in the Teaching Hospital, Kandy, from 1st July 2007 to 31st July 2008. Patients with clinical features compatible with leptospirosis case definition were confirmed using the Microscopic Agglutination Test (MAT). Clinical features and laboratory measures done on admission were recorded. Patients were observed for the development of acute renal failure or myocarditis. Chi-square statistics, Fisher's exact test and Mann-Whitney U test were used to compare patients with and without complications. A logistic regression model was used to select final predictor variables. Results Sixty two confirmed leptospirosis patients were included in the study. Seven patients (11.3%) developed acute renal failure and five (8.1%) developed myocarditis while three (4.8%) had both acute renal failure and myocarditis. Conjunctival suffusion - 40 (64.5%), muscle tenderness - 28 (45.1%), oliguria - 20 (32.2%), jaundice - 12 (19.3%), hepatomegaly - 10 (16.1%), arrhythmias (irregular radial pulse) - 8 (12.9%), chest pain - 6 (9.7%), bleeding - 5 (8.1%), and shortness of breath (SOB) 4 (6.4%) were the common clinical features present among the patients. Out of these, only oliguria {odds ratio (OR) = 4.14 and 95% confidence interval (CI) 1.003-17.261}, jaundice (OR = 5.13 and 95% CI 1.149-28.003), and arrhythmias (OR = 5.774 and 95% CI 1.001-34.692), were predictors of myocarditis or acute renal failure and none of the laboratory measures could predict the two complications. Conclusions This study shows that out of clinical and laboratory variables, only oliguria, jaundice and arrhythmia are strong predictors of development of acute renal failure or myocarditis in patients with leptospirosis presented to Teaching Hospital of Kandy, Sri Lanka.
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