Severe leptospirosis after rat bite: A case report

Case report: Leptospirosis with multi-organ failure complicated by massive upper gastrointestinal bleeding in a non-epidemic setting with successful management

Leptospirosis is a common zoonotic disease with a wide range of clinical manifestations, specifically in tropical regions. Weil's disease is considered a severe form of leptospirosis seen in a minority of leptospirosis cases with considerable mortality. These patients typically developed the triad of acute renal injury, jaundice, and hemorrhages. Herein, we reported a case of a 28-year-old male transferred to our intensive care unit due to severe leptospirosis with diffuse alveolar hemorrhage, cholestatic jaundice, acute respiratory distress, and renal injury. The patient was successfully managed with appropriate antimicrobial treatment and other supportive management, including mechanical ventilation, vasopressor, and corticosteroid therapy. Ten days after admission, the patient unexpectedly developed uncontrollable massive upper gastrointestinal bleeding, requiring immediate surgical interventions. Splenectomy, partial gastrectomy, along with gastro-esophageal anastomosis were performed. Following a prolonged hospitalization, the patient fully recovered and was discharged home with excellent clinical outcomes. This fulminant leptospirosis case described here should assist in informing medical professionals of the clinical significance of this serious, occasionally fatal illness. Moreover, leptospirosis should be considered in any location wherever risk factors are present, not just in epidemic and tropical areas. In this case, we pointed out that serious complications of leptospirosis, such as hemorrhage, may happen despite their rarity. In such cases, adopting an integrated multidisciplinary team approach is essential to prevent complications and reduce mortality.

Severe Leptospirosis: A Case Report

Leptospirosis is an infection caused by Leptospira. Leptospirosis causes disease in humans mainly in developing countries and also in countries with poor housing and sanitation, due to animals (mainly rats) that are potential sources of contamination. The clinical manifestations and the severity of leptospirosis are highly variable. We present the case of a 56-year-old female that was admitted to the emergency department with a three-week history of fever (38.4ºC), headache, dyspnea, and cough. There was a worsening of the patient's clinical status with respiratory failure and the necessity of admission to the intensive care unit for respiratory support with mechanical ventilation. The treatment was initiated with piperacillin and tazobactam, azithromycin, and steroids. There was a favorable evolution, and the patient was transferred to the internal medicine ward after 12 days with a suspected diagnosis of small vessel vasculitis and pneumonia. In the medical ward, after a careful anamnesis, leptospirosis was suspected and confirmed. The aim of this case report is to highlight the importance of a good anamnesis and the fact that an elaborate clinical history helps to consider new diagnostic hypotheses. Also intends to alert to the existence of leptospirosis in developed countries, a disease underdiagnosed in these countries.

Biofilm formation and social interaction of Leptospira in natural and artificial environments

In the recent decades, there has been increased interest in the study on social interactions of pathogenic bacteria and biofilm-forming microbes. Leptospira is a zoonotic pathogen that causes human leptospirosis. Biofilm formation by pathogenic and saprophytic Leptospira has been documented in various biotic and abiotic environments. Biofilm supports cell growth and protects them from a variety of environmental stress. Pathogenic bacterial biofilm might increase the virulence and pathogenesis. However, research on the social behaviour and biofilm production by Leptospira is limited. This review discusses the interplay between the different species in the biofilm formation of saprophytic and pathogenic Leptospira and potential future applications.

Rodent bites in a quadriplegic

Rodent bites are infrequently reported in the medical literature. A rodent bite usually occurs only to individuals with sensory impairment. Rodent saliva can introduce fatal bacterial infections (rat-bite fever, leptospirosis or scrub typhus). We report a case of rodent bite in a patient suffering from post-traumatic quadriplegia.