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Bagula H, Banderker I, Moosa MS. A young adult with leptospirosis associated acute inflammatory demyelinating polyneuropathy. S Afr J Infect Dis 2023; 38:569. [PMID: 38223434 PMCID: PMC10784276 DOI: 10.4102/sajid.v38i1.569] [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: 08/23/2023] [Accepted: 11/03/2023] [Indexed: 01/16/2024] Open
Abstract
Leptospirosis is a zoonotic disease that commonly affects the liver and kidney. It can rarely affect the neurological system with aseptic meningitis being the commonest neurological presentation. We present the case of a patient with leptospirosis complicated by acute inflammatory demyelinating polyneuropathy. Contribution To our knowledge, this is the first reported case of acute inflammatory demyelinating polyneuropathy as a complication of leptospirosis in South Africa.
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Affiliation(s)
- Herman Bagula
- Department of Internal Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Ismail Banderker
- Department of Internal Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Muhammed S. Moosa
- Department of Internal Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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2
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Xucla-Ferrarons T, Turon-Sans J, Caballero-Avila M, Cortes-Vicente E, Rojas-Garcia R. Leptospirosis-induced acute acquired inflammatory neuropathy. J Peripher Nerv Syst 2023; 28:125-129. [PMID: 36567442 DOI: 10.1111/jns.12525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 12/27/2022]
Abstract
Leptospirosis is a zoonotic infection that can present with neurological manifestations. Although uncommon, it may affect the peripheral nervous system in the form of polyradiculoneuropathy. We report the case of a 30-year-old male who developed flaccid tetraparesis and multiple cranial neuropathies on the fourteenth day of admission to the intensive care unit for fever and multi-organ failure. We also review the existing literature about peripheral nerve damage in leptospirosis and present our hypothesis on the possible pathogenic mechanisms. Electrophysiological findings were consistent with acute demyelinating polyradiculoneuropathy and extensive blood tests were positive for leptospiral IgM and IgG antibodies. Treatment with plasmapheresis was begun, followed by intravenous immunoglobulin (IVIg), and the patient improved slowly. Our work adds to the evidence of leptospirosis infection as a cause of acute demyelinating polyneuropathy. The possibility that leptospirosis-polyradiculoneuropathy may be caused by an immune pathogenesis emphasizes the importance of identifying this entity because immunomodulatory therapy could play a vital role in the recovery process.
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Affiliation(s)
- Tomas Xucla-Ferrarons
- Department of Neurology, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Spain
| | - Janina Turon-Sans
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Caballero-Avila
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elena Cortes-Vicente
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ricard Rojas-Garcia
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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3
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Primary Neuroleptospirosis. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2017. [DOI: 10.1097/ipc.0000000000000529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tucci V, Moukaddam N, Meadows J, Shah S, Galwankar SC, Kapur GB. The Forgotten Plague: Psychiatric Manifestations of Ebola, Zika, and Emerging Infectious Diseases. J Glob Infect Dis 2017; 9:151-156. [PMID: 29302150 PMCID: PMC5750439 DOI: 10.4103/jgid.jgid_66_17] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The media and public health generally focus on the biological and physical ramifications of epidemics. Mental health issues that coincide with emerging diseases and epidemics are rarely examined and sometimes, even eschewed due to cultural considerations. Psychiatric manifestations of various infectious diseases, especially with a focus on Ebola Virus disease (EVD) and Zika Virus, are discussed in this commentary to illustrate the continued need of care after the resolution of the actual illness. Various infectious diseases have associations with mental illness, such as an increased risk of obsessive-compulsive disorders and Tourette syndrome in children with Group B streptococcal infection. Current EVD literature does not demonstrate a strong association of mental illness symptoms or diseases but there is a necessity of care that extends beyond the illness. Patients and their families experience depression, anxiety, trauma, suicidal ideation, panic and other manifestations. Zika virus has been associated neuronal injury, genetic alteration that affects fetal development and detrimental maternal mental health symptoms are being documented. While funding calls from the international community are present, there are no specific epidemiological data or fiscal estimates solely for mental health during or after infectious diseases epidemics or disasters that support health care providers and strengthen policies and procedures for responding to such situations. Therefore, those on the frontlines of epidemics including emergency physicians, primary care providers and infectious disease specialists should serve communicate this need and advocate for sustained and increased funding for mental health programs to heighten public awareness regarding acute psychiatric events during infectious diseases outbreaks and offer treatment and support when necessary.
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Affiliation(s)
- Veronica Tucci
- Department of Emergency Medicine, Merit Health Wesley, Hattiesburg, MS, USA
| | - Nidal Moukaddam
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Jonathan Meadows
- Department of Research, Undergraduate Medical Education, Touro College of Osteopathic Medicine, New York, USA
| | - Suhal Shah
- Department of Research, Undergraduate Medical Education, Touro College of Osteopathic Medicine, New York, USA
| | - Sagar C Galwankar
- Department of Emergency Medicine, University of Florida, Jacksonville, Florida, USA
| | - G Bobby Kapur
- Department of Emergency Medicine, Jackson Memorial Hospital, Miami, Florida, USA
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Castaño A, Volcy M, García FA, Uribe CS, Bigal ME, Restrepo M. Headache in Symptomatic Intracranial Hypertension Secondary to Leptospirosis: A Case Report. Cephalalgia 2016; 25:309-11. [PMID: 15773829 DOI: 10.1111/j.1468-2982.2004.00841.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A Castaño
- Universidad de Antioquia, Hospital Universitario San Vicente de Paúl, Medellín, Colombia.
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Mahesh M, Shivanagappa M, Venkatesh CR. Bilateral Abducent Palsy in Leptospirosis- An Eye Opener to a Rare Neuro Ocular Manifestation: A Case Report. IRANIAN JOURNAL OF MEDICAL SCIENCES 2015; 40:544-7. [PMID: 26538786 PMCID: PMC4628148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Leptospirosis, a disease of great significance in tropical countries, presents commonly as a biphasic illness with acute febrile episode in the first phase followed by a brief afebrile period and then by the second phase of fever with or without jaundice and renal failure. However, it has varied manifestations and unusual clinical features ascribed to immunological phenomena can occur due to the additional involvement of pulmonary, cardiovascular, and neurological systems. Among the various neurological features, aseptic meningitis is the most common myeloradiculopathy, myelopathy, cerebellar dysfunction, transverse myelitis, Guillain-Barre syndrome, optic neuritis, peripheral neuropathy hare also described. Cranial neuropathy involving facial nerve is a rare, but known neurological manifestation. Sixth nerve palsy in neuroleptospirosis has so far not been reported. We hereby present the occurrence of bilateral abducent nerve palsy in a patient with leptospirosis.
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Affiliation(s)
- Mahadevaiah Mahesh
- Associate Professor of Medicine, Department of General Medicine, JSS Medical College, Mysore, Karnataka State, India,Correspondence: Mahadevaiah Mahesh, MBBS, MD; No 106 Brigade Solitaire Apartments, 147/17-18 Alanahally Layout, Mysore City 570 028, Karnataka State, India Tel: +91 98451 14166
| | - Mamatha Shivanagappa
- Assistant Professor of OBG, Department of Obstetrics and Gynecology, Medical College, Mysore, Karnataka State, India
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Wang LS, Wang CCJ, Huang SH, Chao H, Lin SH, Chang JH, Ho YH. Leptospirosis with transient paraparesis and thrombocytopenia: a case report. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2011; 45:75-8. [PMID: 22153760 DOI: 10.1016/j.jmii.2011.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2010] [Revised: 03/17/2010] [Accepted: 05/11/2010] [Indexed: 11/24/2022]
Abstract
Leptospirosis is the most widespread zoonosis in the world. We present an unusual case of leptospirosis in a 44-year-old man with severe thrombocytopenia and transient paraparesis. The diagnosis of leptospirosis was confirmed by blood nested polymerase chain reaction, seroconversion of Leptospira IgM and the microscopic agglutination test. Nerve conduction studies were suggestive of early polyneuropathy involving the right peroneal nerve and bilateral sural nerves. Peripheral nerve palsy is a potential clinical feature of leptospirosis.
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Affiliation(s)
- Lih-shinn Wang
- Department of Infectious Diseases, Buddhist Tzu Chi General Hospital, Taiwan, ROC.
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Patil VC, Patil HV, Sakaria A, Tryambake S. An unusual case of Weil's syndrome with paraparesis. Indian J Crit Care Med 2011; 15:130-3. [PMID: 21814381 PMCID: PMC3145300 DOI: 10.4103/0972-5229.83014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Leptospirosis is an important emerging zoonosis with a worldwide distribution that is characterized by a broad spectrum of clinical manifestations ranging from inapparent infection to fulminant disease. Leptospirosis has protean clinical manifestations. The classical presentation of the disease is an acute biphasic febrile illness with or without jaundice. Unusual clinical manifestations may result from involvement of pulmonary, cardiovascular, neural, gastrointestinal, ocular and other systems. Immunological phenomena secondary to antigenic mimicry may also be an important component of many clinical features and may be responsible for reactive arthritis. The presentation of paraparesis in combination with Weil's syndrome is rare. Few cases were reported with leptospirosis and paraparesis in India and abroad. It is important to bear in mind that leptospiral illness may be a significant component in cases of dual infections or in simultaneous infections with more than two pathogens. Here we are reporting a case of Weil's syndrome with paraparesis in 28-year-old male patient who was critically ill due to severe hepatorenal dysfunction and hyperkalemia.
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Affiliation(s)
- Virendra C Patil
- Department of Medicine, Krishna Institute of Medical Sciences University, Karad, Dist. Satara (Maharashtra State), India
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Silva AP, Burg LB, Schadeck Locatelli JF, Manes J, Crispim M. Leptospirosis presenting as ascending progressive leg weakness and complicating with acute pancreatitis. Braz J Infect Dis 2011. [DOI: 10.1016/s1413-8670(11)70236-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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10
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Lepur D, Himbele J, Klinar I, Vranjican Z, Barsic B. Anti-ganglioside antibodies-mediated leptospiral meningomyeloencephalopolyneuritis. ACTA ACUST UNITED AC 2007; 39:472-5. [PMID: 17464876 DOI: 10.1080/00365540601034816] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A case of leptospirosis complicated with meningo-myelo-encephalo-polyneuritis and nephrotic syndrome is presented. Anti-ganglioside antibodies were detected for the first time in a patient with neurological complications of leptospirosis. Possible pathogenic mechanisms and treatment options of these rare manifestations are discussed.
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Affiliation(s)
- Dragan Lepur
- Department of Neuroinfections and Intensive Care Medicine, University Hospital for Infectious Diseases 'Dr. Fran Mihaljevic', Mirogojska, Zagreb. Croatia.
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11
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Semiz UB, Turhan V, Basoglu C, Oner O, Ebrinc S, Cetin M. Leptospirosis presenting with mania and psychosis: four consecutive cases seen in a military hospital in Turkey. Int J Psychiatry Med 2006; 35:299-305. [PMID: 16480244 DOI: 10.2190/0kux-je1j-hv6k-3r9j] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To present the clinical features and the treatment alternatives of manic and psychotic symptoms in patients with leptospirosis. METHODS Clinical observation and diagnosis of four cases with leptospirosis presenting with psychiatric symptoms. RESULTS Leptospirosis diagnoses were established by recovery of the organism from culture, macroagglutination tests, and dark field microscopy in all cases. Leptospira ELISA-Ig M was also positive in all cases. Microagglutination tests were positive in case 1 and case 2. All of the cases were also screened for other possible medical, infectious, and neurological disorders that could account for their clinical symptoms. Patients were treated with a combination of antibiotics, antipsychotics and mood stabilizers. CONCLUSIONS The presence of manic and psychotic symptoms with fever and high transaminase and/or CPK levels in high risk occupational groups during rainy periods should alert the physician to the possibility of leptospirosis. The psychiatric symptoms are sensitive to anti-psychotics and mood stabilizers but not to antimicrobial treatment, suggesting that the psychiatric picture may not be related to direct invasion of the central nervous system by the infectious agent.
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Affiliation(s)
- Umit B Semiz
- GATA Haydarpasa Training Hospital, Istanbul, Turkey
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Abstract
Leptospirosis is an important zoonosis of worldwide distribution. It is uncommon for leptospirosis to present as a primary neurological disease. In this study of patients who presented with an acute neurological disease, and who were subsequently found to have leptospirosis, aseptic meningitis was the commonest manifestation. The other presentations were myeloradiculopathy, myelopathy, Guillain-Barré syndrome-like presentation, meningoencephalitis, intracerebral bleed, cerebellar dysfunction, iridocyclitis, and tremor/rigidity. Treatment consists of antibiotics, crystalline penicillin being the drug of choice, which reduces the course of illness if given early. The role of steroids is controversial. The prognosis after primary neuroleptospirosis is generally good but altered sensorium and seizures herald a worse prognosis.
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Affiliation(s)
- J N Panicker
- Department of Medicine, Medical College, Thiruvananthapuram, Kerala, India.
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13
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Occupational Dermatoses and Infections. Fam Med 1994. [DOI: 10.1007/978-1-4757-4005-9_43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Bezerra HM, Ataíde Júnior L, Hinrichsen SL, Travassos FM, Travassos PT, Silva MJ, Silva MB. [Involvement of the nervous system in leptospirosis. I. Evaluation of neurologic aspects]. ARQUIVOS DE NEURO-PSIQUIATRIA 1993; 51:457-63. [PMID: 8147745 DOI: 10.1590/s0004-282x1993000400006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
From January 1st up to September 30th 1990, 77 patients with leptospirosis confirmed by laboratory studies were admitted at the Infectious and Parasitic Diseases Service of the Hospital das Clínicas of the Universidade Federal de Pernambuco. Clinical manifestations had sudden onset with presence of fever, headache, chills and muscle pains. Plurisystemic involvement was observed both in the icteric and in the non-icteric patients. The neurological exam was abnormal in 70 of the patients (90.91%). Neurological findings were essentially variable. Though in a transitory form, they allowed the observation of the following clinical forms: meningoencephalitis and polyneuritis in association, meningoencephalitis, polyneuritis, and subarachnoid hemorrhage.
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Affiliation(s)
- H M Bezerra
- Serviço de Doenças Infecciosas e Parasitárias do Hospital, Universidade Federal de Pernambuco (SDIP/UFPE), Brasil
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Hancox RJ, Karalus N, Singh V. Mononeuritis multiplex in leptospirosis. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1991; 23:395-6. [PMID: 1882206 DOI: 10.3109/00365549109024332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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