Leptospirosis: predictores de mala evolución clínica en pacientes hospitalizados, 25 años de experiencia / Leptospirosis: predictors of poor outcomes in hospitalized patients, 25 years of experience

Introducción: La leptospirosis es una zoonosis que cons-tituye un problema emergente de salud pública. La insufi-ciencia renal, plaquetopenia y compromiso respiratorio se describen como predictores de mortalidad.Objetivos: Describir características clínicas, radiológicas y de laboratorio de individuos hospitalizados por leptos-pirosis y evaluar los predictores de mala evolución clínica (MEC).Materiales y métodos: Estudio de cohorte de inclusión ambispectiva de pacientes con leptospirosis internados en un hospital de la ciudad de Santa Fe entre 1997 y 2022. Se definió MEC como la admisión a Unidad de Cuidados Intensivos (UCI), requerimiento de asistencia respiratoria mecánica (ARM) y/o muerte. Se utilizaron las pruebas de Chi2, test T de Student o la U de Mann-Whitney, según co-rrespondiera. Se construyó una regresión logística binaria con las variables con p<0,05.Resultados: 101 pacientes, 87,1% (n=88) hombres, media-na de edad de 29 (RIC 20-44) años. La fiebre fue el síntoma más frecuente [83,2% (n=84)], seguido del compromiso di-gestivo [62,4% (n=63)]. Las alteraciones de laboratorio más frecuentes fueron: eritrosedimentación elevada [91,9% (n=79)] y leucocitosis [61% (n=61)]. Se observó MEC en el 25,7% (n=26). El 25,7% (n=26) fue admitido en UCI, el 13,9% (n=14) requirió ARM y el 5% (n=5) falleció. La presencia de plaquetopenia (OR=13,3, IC95% 2-80), las alteraciones en la radiografía de tórax (OR=33,5, IC95% 5-225) y la ausencia de cefalea (OR=6,8, IC95% 1-32) fueron predictores inde-pendientes de MEC.Conclusiones: En concordancia con la bibliografía, la afec-tación pulmonar y plaquetopenia son factores de riesgo para la mala evolución clínica. En nuestra serie, la cefalea constituyó un síntoma protector

Introduction: Leptospirosis is an emerging zoonotic di-sease that poses a public health problem. Renal failu-re, thrombocytopenia, and respiratory involvement have been described as predictors of mortality.Objectives: To describe the clinical, radiological, and la-boratory characteristics of hospitalized individuals with leptospirosis and evaluate predictors of poor clinical outcomes (PCO).Materials and methods: A prospective cohort study was conducted including patients with leptospirosis admit-ted to a hospital in the city of Santa Fe between 1997 and 2022. PCO was defined as admission to the Intensive Care Unit (ICU), requirement for mechanical respiratory assistance (MRA), and/or death. The chi-square test, Student>s t-test, or Mann-Whitney U test were used as appropriate. A binary logistic regression was performed with variables having p<0.05.Results: Out of the 101 patients included, 87.1% (n=88) were male, with a median age of 29 (IQR 20-44) years. Fever was the most common symptom [83.2% (n=84)], followed by digestive involvement [62.4% (n=63)]. The most frequent laboratory abnormalities were elevated erythrocyte sedimentation rate [91.9% (n=79)] and leuko-cytosis [61% (n=61)]. PCO was observed in 25.7% (n=26) of patients, with 25.7% (n=26) admitted to the ICU, 13.9% (n=14) requiring MRA, and 5% (n=5) resulting in death. The presence of thrombocytopenia (OR=13.3, 95% CI 2-80), abnormalities in chest X-rays (OR=33.5, 95% CI 5-225), and absence of headache (OR=6.8, 95% CI 1-32) were predictors of PCO. Conclusions: Consistent with the literature, pulmonary involvement and thrombocytopenia are independent risk factors for poor clinical outcomes. In our series, the pre-sence of headache was a protective symptom

Monitoring Weil–Felix test in epidemic retinitis

Purpose: The objective was to study the positivity of the Weil–Felix test (WFT) in epidemic retinitis (ER) during the course of the disease. Methods: This is a retrospective, observational case series of patients diagnosed with ER and presented to a tertiary eye care hospital in south India. Patients with positive WFT at the presentation, and who underwent a follow?up WFT during or after the resolution of ER were studied from September 2019 to March 2022. Patient’s demographics, timings of clinical presentation and resolution, and investigation details with a special focus on WFT positivity and its duration were noted. Results: Sixteen patients were studied. Patients presented after 5 weeks of the fever (range: 2?12 weeks, median: 4). After 1?2 months, WFT was still positive in eight patients (50%). Only in one patient titers increased after 1 month, while in others, the titers decreased (n = 11) or remained the same (n = 4). Repeated tests in those patients (n = 6) after 3?4 months turned negative. Resolution of ER was seen at 1.35 months (range: 1?3 months) after the presentation. The mean duration for WFT to turn negative was 2 months from the presentation (range: 1?4 months) or 3.2 months of the fever (range: 1.5?6 months). Conclusion: In contrast to the reported physician’s observation of increasing titers of WFT after rickettsial fever, ophthalmologists may observe decreasing WFT titers in ER. The clinical resolution of ER may precede the normalization of WFT. Follow?up WFT titers should be studied in larger series in confirmed cases of rickettsial?ER to validate the affordable and readily available WFT in India

Hemorragia alveolar en síndrome febril tropical: reporte de caso de leptospirosis con compromiso pulmonar / Alveolar hemorrhage in febril-tropical syndrome: case report of leptospirosis with lung commitment

Resumen La leptospirosis en una enfermedad infecciosa importante en el diagnóstico diferencial de un paciente con síndrome ictérico hemorrágico, especialmente en países de ubicación tropical como Colombia. A continuación, se presenta el caso de un paciente masculino de 21 años, con cuadro clínico agudo caracterizado por presencia de fiebre y elevación de bilirrubinas, asociado a diarrea y trombocitopenia. Inicialmente se hizo diagnóstico presuntivo de dengue, sin embargo, durante su evolución presentó hemorragia y dificultad respiratoria asociada a secreción hemática con necesidad de intubación endotraqueal, por lo que se solicitó serologia IgM seriada de leptospira pensando en esta entidad como diagnóstico diferencial luego de indagar antecedentes epidemiológicos, la cual tuvo reporte positivo. Es importante conocer este tipo de casos debido a la presentación de compromiso pulmonar como una manifestación rara pero altamente asociada a mortalidad. Finalmente, con manejo de soporte y antibiótico adecuado se obtuvo una buena evolución clínica de este paciente.

Abstract Leptospirosis is a relevant infectious disease when there is a patient with an ictero-hemorrhagic syndrome, especially in tropical countries such as Colombia. The following is the case of a 21-year-old male patient, with an acute clinical picture given by fever, elevated bilirubin, associated with diarrhea and thrombocytopenia. Initially, a presumptive diagnosis of dengue was made. However, during his evolution, he presented hemorrhage and respiratory distress with a hematic secretion that required endotracheal intubation. After inquiring about the epidemiological data, leptospirosis was considered a differential diagnosis. Serial serology for leptospira IgM was requested and was positive. It is essential to know this type of case due to pulmonary affections as a rare manifestation but highly associated with mortality. Finally, with adequate antibiotic and supportive management, a good clinical evolution of this patient was obtained.

A clinico-epidemiological profile of scrub typhus cases admitted in a tertiary hospital in South India

Scrub typhus (ST) is a consistently underreported disease. The disease is spreading to newer areas, and an understanding of disease epidemiology is needed in the local Indian and current context. This study describes the demographic characteristics, monthly distribution, clinical and laboratory presentations, and treatment outcome of the ST cases recently identified. Case sheets of 15 ST patients diagnosed from January 2019 to December 2020 were analyzed. The majority of the patients were male. Eighty percent of the patients were from rural or suburban areas. Higher admission was observed from September to December. Fever (100%), skin rash (73.3%), body ache (53.3%), and vomiting (53.3%) were the most common clinical features. The onset of fever till the appearance of skin rash was 3 ± 1.2 days. The mean day from onset of symptoms till diagnosis was 6.8 ± 3.9 days. Eschar was found in only two patients. Nine (60%) patients already had complications at the time of admission. Most patients presented a laboratory picture of thrombocytopenia, neutrophilic leukocytosis, and anemia. Complications such as septic shock, acute kidney injury, and hepatic involvement were observed. All responded to doxycycline within 48 h. No fatalities were observed. Early clinical suspicion of ST among those with high fever, skin rash and thrombocytopenia, and transaminitis showed positive clinical outcome.

Leptospirosis severa en el puerperio: informe de un caso / Severe leptospirosis in puerperium: a case report

Resumen ANTECEDENTES: La leptospirosis es una infección bacteriana que puede aparecer durante el embarazo o puerperio; su manifestación más grave es el síndrome de Weil, que puede provocar la muerte por choque séptico, insuficiencia multiorgánica y complicaciones hemorrágicas severas. CASO CLÍNICO: Paciente de 26 años, procedente de la provincia de Supe (Lima, Perú), en etapa puerperal, a quien se practicó cesárea cuatro días antes en una institución ajena al hospital. Acudió al hospital debido a la aparición de ictericia generalizada, fiebre de 39 °C, hepatoesplenomegalia, anasarca y síndrome de disfunción multiorgánica. Mediante la prueba de ELISA e IgM (subtipos Hursbridge 1/200 e Icterohaemorrhagiae 1/400) se estableció el diagnosticó de leptospirosis. En el noveno día se inició tratamiento con ceftriaxona. Cuatro semanas después tuvo mejoría clínica y fue dada de alta del hospital en condición estable. CONCLUSIONES: El diagnóstico de leptospirosis es incierto durante el embarazo, incluso un 10% de las pacientes afectadas podrían agravar su situación. Es importante vigilar el bienestar del feto y decidir la finalización del embarazo por la mejor vía, según las condiciones de la madre y el feto.

Abstract BACKGROUND: Leptospirosis is a rare infectious complication that could manifest during pregnancy or puerperium. The most severe form, the Weil syndrome, has elevated mortality due to septic shock, multiple organ failure and severe bleeding complications. CLINICAL CASE: A 26-year-old female underwent cesarean section due to high risk of loss of fetal well-being at an outside hospital. On the 4th day postpartum, she was referred to our center febrile (38-39 ° C), with generalized jaundice, anasarca and hepatosplenomegaly, with further deterioration into multiorgan dysfunction syndrome. Elisa IgM was positive for Leptospirosis, specifically for the subtypes Hursbridge 1/200 and Icterohaemorrhagiae 1/400. On the ninth day after admission, ceftriaxone was started. Four weeks later, she had clinical improvement and was discharged in stable condition. CONCLUSIONS: The diagnosis of leptospirosis infection is uncertain during pregnancy and up to 10% of affected patients could have complications. It is important to monitoring the fetal well being and determine the proper time of pregnancy termination by the best route of delivery if there are maternal or fetal indications.

Terapia de reemplazo renal continua. Presentación de un caso / Continuous renal replacement therapy. Case report

RESUMEN La insuficiencia renal aguda es definida como la pérdida de función del riñón ocasionada por diversas causas, entre ellas infección e ingesta de fármacos. Esta entidad tiene alta morbilidad y mortalidad en las unidades de cuidados críticos. El tratamiento de la misma va desde la propia protección renal hasta la sustitución artificial de las funciones del riñón lesionado. En la actualidad la terapia de reemplazo renal continua se ha utilizado como soporte renal, y ofrece mayor estabilidad clínica a los pacientes más inestables. En esta revisión se comentan conceptos, indicaciones y los más recientes estudios que validan el uso de esta terapéutica, así como el método de programación que se utilizó en un paciente con diagnóstico de una leptospirosis icterohemorrágica (síndrome de Weil), que estuvo en shock séptico con disfunción multiorgánica, donde se empleó esta terapia con resultados satisfactorios (AU).

ABSTRACT Acute kidney failure is defined as the loss of kidney function caused by various causes, including infection and drug intake. This entity has high morbidity and mortality in critical care units. Treatment ranges from renal protection to artificial replacement of the functions of the injured kidney. Currently, continuous renal replacement therapy has been used as renal support, and offers greater clinical stability to the most unstable patients. In this review, authors discuss concepts, indications and the most recent studies that validate the use of this therapeutic, as well as the programming method that was used in a patient with diagnosis of icteric-hemorrhagic leptospirosis (Weil syndrome), who was in septic shock with multiorgan dysfunction, where this therapy was used with satisfactory results (AU).

Brote de 4 casos leptospirosis de un grupo familiar en zona rural tropical de Colombia: un reporte de caso / Outbreak of 4 leptospirosis cases in a family group in tropical rural zone of Colombia: a case report

La leptospirosis es una zoonosis con manifestaciones clínicas causadas por espiroquetas patógenas del género Leptospira spp. Su curso puede ser desde enfermedad leve hasta un síndrome ictero-hemorrágico severo denominado enfermedad de Weil. Se estudió un brote epidemiológico constituido por una serie de cuatro casos de leptospirosis de severidad moderada a severa, ocurridos en una zona rural de clima tropical en los llanos orientales de Colombia, a 450 metros sobre el nivel del mar en una familia visitante en Puerto Lleras, Meta, Colombia. Probablemente secundario al consumo de aguas contaminadas por orina de roedores. Las pacientes fueron ingresadas bajo la sospecha de un síndrome ictérico de origen infeccioso con un falso positivo para antígeno de superficie de hepatitis B. Dos pacientes desarrollaron síndrome de Weil asociado a microangiopatía trombótica por lo que requirieron manejo en unidad de cuidados intensivos (UCI) sin embargo, una de ellas fallece y las otras dos pacientes desarrollan signos y síntomas moderados evidenciando un curso variable de la enfermedad. En nuestro país existe una sobre notificación de síndromes febriles, ictéricos e icterohemorragicos de diferentes etiologías y difícil diagnóstico por lo que la leptospirosis tiende a ser confundida o ignorada como diferencial en muchos casos.

Leptospirosis is a zoonosis with clinical manifestations caused by pathogenic spirochetes of the genus Leptospira spp. Its course can range from mild illness to a severe jaundice-hemorrhagic syndrome called Weil's disease. An epidemiological outbreak consisting of a series of four cases of leptospirosis of moderate to severe severity, which occurred in a rural area with a tropical climate in the eastern plains of Colombia, at 450 meters above sea level, was studied in a visiting family in Puerto Lleras, Meta, Colombia. Probably secondary to the consumption of water contaminated by rodent urine. The patients were admitted on suspicion of an infectious jaundice syndrome with a false positive for hepatitis B surface antigen. Two patients developed Weil's syndrome associated with thrombotic microangiopathy, requiring ICU management, however, one of them died and the other two patients develop moderate signs and symptoms showing a variable course of the disease. In our country there is an overreporting of febrile, jaundice and jaundice syndromes of different etiologies and difficult diagnosis, so that leptospirosis tends to be confused or ignored as differential in many cases.

Hemorragia alveolar pulmonar como presentación poco frecuente de infección por Leptospira spp: una enfermedad ocupacional del personal militar en zonas tropicales / Pulmonary alveolar hemorrhage as an unusual presentation of Leptospira spp: an occupational-disease of military personnel in tropical zones

Resumen La leptospirosis es una de las zoonosis endémicas más importantes en el mundo con un aumento de la incidencia en los últimos años. En el personal militar podría ser catalogada como una enfermedad ocupacional dado sus actividades específicas en áreas rurales. Su presentación clínica es variable siendo en la mayoría de los casos una enfermedad febril autolimitada. De acuerdo con diversos factores dependientes del patógeno y del hospedero pueden presentarse manifestaciones severas de la enfermedad dentro de la cual destaca el compromiso pulmonar con una alta tasa de mortalidad. Existe evidencia del uso de esteroide sistémico como parte del tratamiento de esta complicación. Presentamos el caso de un paciente joven, militar, que debuta con síndrome de hemorragia alveolar difusa secundario a leptospirosis y presenta una excelente respuesta al tratamiento con altas dosis de metilprednisolona, con una discusión del proceso diagnóstico y aspectos fisiopatológicos de esta condición.

Leptospirosis is one of the most important endemic zoonoses in the world with an increase in incidence in recent years. In military personnel it could be classified as an occupational disease given their specific activities in rural areas. Its clinical presentation is variable being in most cases a self-limited febrile disease. According to various factors dependent on the pathogen and the host, severe manifestations of the disease may occur within which the pulmonary involvement with a high mortality rate stands out. There is evidence of systemic steroid use as part of the treatment of this complication. We present a case of a young, military patient who debuts with diffuse alveolar hemorrhage syndrome secondary to leptospirosis and presents an excellent response to treatment with high doses of methylprednisolone, with a discussion of the diagnostic process and pathophysiological aspects of this condition.

Neuroleptospirosis con pericarditis y colestasis intrahepática (Síndrome de Weil) / Neuroleptospirosis with Pericarditis and Intrahepatic Cholestasis (Weil syndrome)

Introducción: El síndrome de Weil es una forma grave de la infección bacteriana causada por la bacteria Leptospira, conocida como leptospirosis. Este se caracteriza por la disfunción de múltiples órganos, entre ellos, hígado, riñón, músculos, serosas o el sistema neurológico, en este caso denominado neuroleptospirosis, genera una mortalidad muy elevada cuando no se brinda diagnóstico y tratamiento adecuado. Objetivo: Describir las manifestaciones clínicas, paraclínicos complementarios y tratamiento de un paciente con síndrome de Weil, una condición poco frecuente. Caso clínico: Paciente de 23 años quien consulta en el contexto de síndrome febril agudo asociado con neuritis óptica, dolor torácico y paraclínicos que evidenciaron afectación hepática y cardíaca. Se confirma el diagnóstico de síndrome de Weil dado por neuroleptospirosis, pericarditis y colestasis intrahepática. Conclusiones: mediante un caso clínico de síndrome de Weil, se describe la afectación multisistémica de complicaciones asociadas con leptospirosis, con manifestaciones poco habituales como neuroleptospirosis, pericarditis y colestasis intrahepática(AU)

Introduction: Weil syndrome is a serious form of the bacterial infection caused by the Leptospira bacterium; this is known as leptospirosis. This is characterized by multiple organ dysfunction; for example, the liver, kidney, muscles, of serous type, or the neurological system, in this case called neuroleptospirosis, which produces a very high mortality when adequate diagnosis and treatment are not provided. Objective: To describe the clinical manifestations, complementary paraclinic practice and treatment of a patient with Weil syndrome, as a rare condition. Clinical case: 23-year-old patient who presents with acute febrile syndrome associated with optic neuritis, chest pain, and paraclinical symptoms obviously consistent liver and cardiac involvement. The diagnosis of Weil syndrome is confirmed, specifically defined by neuroleptospirosis, pericarditis, and intrahepatic cholestasis. Conclusions: Through a clinical case of Weil syndrome, the multisystem involvement of complications associated with leptospirosis is described, along with its unusual manifestations, such as neuroleptospirosis, pericarditis, and intrahepatic cholestasis(AU)

Clinicopathological profile of rickettsial fever in tertiary healthcare centre: a prospective case study

Background: Rickettsia are obligate intracellular proteobacteria spread by eukaryotic vectors like ticks, mites, fleas and lice. Rickettsial infections are generally incapacitating and difficult to diagnose; Case fatality rates up to 45 percent is seen in cases with multiple organ dysfunction. The disease continues to be under diagnosed and treated. Objective of this study was to study the clinicopathological profile and outcome of children admitted with rickettsial fever. To study the correlation between Rathi-Goodman-Aghai score and Weil-Felix test. To study the response of rickettsial fever to Doxycycline.''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''Methods: This study is a prospective observational study conducted from December 2017 to April 2019 at a tertiary health care center in South India, involving patients admitted between 2 months to 18 years of age with a diagnosis of Rickettsial fever. Clinical data and investigations were collected and analysed. The response to doxycycline was recorded.'''''''''''''''''''''''''''''''''''''''''''''''' '''''''''Results: Total of 49 patients were enrolled in the study. Most common age group affected was between 1 to 5 years accounting for 32.7% of the cases. 78% of the patients hailed from rural background. Most common presentation being fever, present in 100% of the cases. 81.6% of patients had significant Rathi-Goodman-Aghai score of >14. Weil felix showed significant titres (1:80) in 97.9% out of which serology suggestive of scrub typhus was found in 79.6% patients. There was no statistical significance between rickettsial score and Weil-Felix test (p value= 0.736). 26.5% of the cases required respiratory support and 2% cases required dialysis. 10.2% cases succumbed and 89.8% cases improved.Conclusions: Rickettsial infection is re-emerging with propensity for life threatening complications. There is no statistical significant correlation between Rickettsial score and Weil Felix test. Early treatment has better outcome.

Clinical presentations and predictors of mortality for leptospirosis - A study from suburban area in Malaysia

@#Introduction: Malaysia is endemic for leptospirosis with increasing incidence recorded over the years. Perak has recorded one of the highest incidence and mortality of leptospirosis since 2004. Methods: This is a retrospective study of confirmed leptospirosis cases in Larut, Matang and Selama (LMS) district in Perak reported in 2016. The demographic, clinical presentation, laboratory result and clinical outcomes data were analysed and presented. Results: Forty-two patients with confirmed diagnosis of leptospirosis were included into the study. Majority of patients were males and Malays. The case fatality rate was 14.3%. Patients with leptospirosis present with variable clinical presentations and are commonly seen with coinfection. Patients 70-year-old and older, have clinical presentations suggestive of organ dysfunction and require intensive care are associated with higher mortality. Conclusion: Leptospirosis is endemic in LMS district of Perak with high incidence and case fatality rate. The clinical presentation of leptospirosis is variable. Co-infection of leptospirosis with other acute febrile illness is common. Patients presenting with symptoms and signs of organ dysfunctions or require intensive care are associated with an increased odds of death.

Caracterización clínica de la leptospirosis grave en un hospital de alta complejidad de Cali, Colombia, 2010-2016 / Clinical characterization of patients with severe leptospirosis in a tertiary hospital in Cali, Colombia, 2010-2016

Resumen Introducción. La leptospirosis es una infección bacteriana endémica en Colombia. Su curso clínico puede ser variable y, en ocasiones, fatal. Hay pocos estudios en el país sobre los casos graves de esta enfermedad. Objetivo. Describir las características demográficas y clínicas de los pacientes con diagnóstico de leptospirosis grave hospitalizados en salas generales o atendidos en la unidad de cuidados intensivos de un hospital de cuarto nivel. Materiales y métodos. Se llevó a cabo un estudio observacional descriptivo de los pacientes adultos y niños con diagnóstico serológico de leptospirosis entre el 2010 y el 2016. Resultados. Se analizaron las historias clínicas de 87 pacientes, 74 % de los cuales correspondía a hombres y, el 84 %, a mayores de 18 años. El 35 % tenía alguna comorbilidad y la hipertensión arterial sistémica (16 %) y la diabetes mellitus (9 %) fueron las más comunes. Los síntomas más frecuentes fueron: fiebre, náuseas, astenia, mialgias, artralgias y dolor abdominal. El 34 % requirió atención en la unidad de cuidados intensivos, con una mediana de estancia de 5 días. El 61 % requirió hospitalización en sala general, con una mediana de estancia de 6 días. Todos los casos recibieron tratamiento antibiótico con ceftriaxona o doxiciclina. La tasa de letalidad fue del 1,1 % (n=1). Conclusiones. La infección por Leptospira spp. tiene el riesgo de diagnosticarse de manera tardía por su presentación clínica inespecífica, lo que implica considerar un gran número de diagnósticos diferenciales. La atención temprana de los pacientes con cuadros graves de esta enfermedad en la unidad de cuidados intensivos, puede evitar una mayor incidencia de complicaciones y disminuir la mortalidad.

Abstract Introduction: Leptospirosis is an endemic bacterial infection in Colombia. Its clinical course can be variable and occasionally fatal. There are few studies in the country about severe cases of leptospirosis. Objectives: To describe the demographic and clinical characteristics of patients with a diagnosis of leptospirosis, and their management in a high complexity hospital. Materials and methods: This was a descriptive retrospective study of patients with a serologic diagnosis of leptospirosis between 2010 and 2016. Results: We analyzed 87 patients, 74% of them were men, and 84% were older than 18 years; 35% had a comorbidity, the most common being arterial hypertension (16%) and diabetes mellitus (9%). The most frequent symptoms were fever, nausea, fatigue, myalgia, arthralgia, and abdominal pain. The majority of patients required hospitalization in general wards (61%), with a median stay of six days; 34% required management in the intensive care unit, with a median stay of five days. Mortality was 1.1% (n=1). All patients received treatment with either ceftriaxone or doxycycline. Conclusions: There is a risk of leptospira infections having a late diagnosis given their unspecific clinical presentation, which generates a high number of differential diagnoses. The early management in the intensive care unit could decrease the incidence of complications and the mortality of patients with leptospirosis.

Ocular manifestations of Rickettsia conorii in South India

Purpose: Among the major groups of rickettsiosis, the commonly reported diseases in India are: (a) Typhus group induced—scrub typhus, murine flea-borne typhus; (b) Spotted fever group induced—Indian tick typhus; and (c) Q fever. Though many scrub typhus outbreaks have been reported from India, only one outbreak of spotted fever—serologically proven Indian tick typhus (Rickettsia conorii)—has been reported. We report for the first time ocular manifestations of serologically proven R. conorii infection in a cluster of patients. Methods: In this retrospective study, case records patients with serologically proven Indian tick typhus (Rickettsia conorii) were reviewed for clinical manifestations and treatment outcomes. Results: In the months of February to April 2016, a cluster of 12 patients (23 eyes) visited us with defective vision. Examination showed multifocal retinitis; mostly bilateral; patients had a history of fever approximately 4 weeks prior to onset of symptoms. After excluding other causes of multifocal retinitis, a diagnosis of rickettsial retinitis was made after Weil–Felix test (WFT) was significantly positive, and enzyme-linked immunosorbent assay was positive for R. conorii. Course of the disease, visual outcome, and investigations are discussed. Doxycycline along with oral corticosteroids was effective in treating the condition. Conclusion: Systematic fundus examination should be part of the routine evaluation of any patient who presents with fever and/or skin rash living in or returning from a specific endemic area. Clinical clues to diagnosing ocular rickettsiosis could be multifocal retinitis predominantly involving the posterior pole and macular involvement in the form of serous macular detachment or macular hard exudates. A positive WFT still serves as a useful and cheap diagnostic tool for laboratory diagnosis of rickettsial disease. Doxycycline along with oral corticosteroids was effective in treating the condition.

Afectación pancreática en infección por leptospirosis / Pancreatic involvement in leptospirosis infection

La leptospirosis en fase ictérica o enfermedad de Weil es una vasculitis zoonótica endémica de la Costa ecuatoriana. Sin embargo, la pancreatitis aguda como parte de esta entidad es una complicación rara vez documentada. En este reporte de caso se presenta a un adulto varón de 63 años con signos de falla multiorgánica y amilasa con rápido ascenso inicial. La leptospirosis no fue tomada como primera opción diagnóstica. El paciente fue tratado debido a un cuadro de SDRA como un shock séptico de foco pulmonar, con falla renal aguda que requirió hemodiálisis, permaneciendo en UCI con antibioticoterapia empírica. El objetivo de este caso es remarcar que la leptospirosis debe siempre estar considerada en el diagnóstico diferencial de ictericia y pancreatitis, sobre todo en nuestro medio.

The icteric presentation of Leptospirosis, also known as Weil's disease, is a zoonotic vasculitis endemic to Ecuador's coastal region. However, reports of pancreatic affection due to this entity are rarely documented. We chose to present the case of a 63 years old male with signs of catastrophic organic failure, associated with a rapid increase in serum amylase concentrations. Due to this presentation, Leptospirosis was not held as the primary culprit of the disease, and was treated at the ICU as septic shock of pulmonary origin with ARDS associated with acute kidney injury that required hemodialysis. Thus this case aims to highlight the importance of Leptospirosis as an important differential diagnosis in any patient hailing from a tropical region with jaundice and pancreatitis.

Resultados funcionales a corto plazo de la osteotomía de Weil en pacientes con metatarsalgia propulsiva / Short-term results of Weil's osteotomy in patients with propulsive metatarsalgia

Resumen: Introducción: La metatarsalgia es el motivo de consulta más frecuente en patología ortopédica del pie. La clave de su tratamiento radica en la correcta determinación del síntoma, que son alteraciones biológicas, morfológicas y mecánicas responsables del dolor. La osteotomía de Weil es comúnmente utilizada para múltiples patologías del antepié, incluyendo las metatarsalgias. Material y métodos: Se estudiaron pacientes intervenidos por síndrome de insuficiencia del primer rayo y deformidades asociadas productoras de metatarsalgia mecánica. El seguimiento mínimo fue de seis meses. Se entrevistó a todos los individuos con un cuestionario estandarizado basado en la AOFAS, una encuesta para saber su grado de satisfacción acerca de la cirugía. Resultados: Se obtuvieron 12 sujetos femeninos con un promedio de 51 años de edad en el período entre Marzo y Septiembre de 2013. Siete pies derechos, cinco izquierdos. Los valores de AOFAS mejoraron sólo en seis, se obtuvo un resultado excelente; cinco los calificaron como buenos y seis como no satisfactorio. Conclusiones: En una serie muy pequeña, se identificaron complicaciones postquirúrgicas cuando el acortamiento del metatarsiano es mayor a cuatro milímetros, con la aparición de rigidez (dedo flotante).

Abstract: Introduction: Metatarsalgia is the most common reason for consultation in orthopedic pathology of the foot. The key to its treatment lies in the correct determination of the symptoms, which are biological, morphological and mechanical alterations responsible for pain. Weil´s osteotomy is commonly used for multiple forefoot pathologies, including metatarsalgias. Material and methods: We included patients with first-line failure syndrome and associated mechanical metatarsalgia-producing deformities. The minimum follow-up was six months. All individuals were interviewed with a standardized questionnaire based on the AOFAS, a survey to know their degree of satisfaction about the surgery. Results: Twelve female subjects with a mean age of 51 years were recruited between March and September of 2013. Seven right feet, five left. The AOFAS values ​​improved only in six, in which an excellent result was obtained; five rated them as good and six as unsatisfactory. Conclusions: In a very small series, postoperative complications were observed when the shortening of the metatarsal was greater than four millimeters, with the appearance of stiffness (floating finger).

Hemorragia digestiva e insuficiencia hepática aguda por leptospirosis: una entidad que no debemos olvidar / Gastrointestinal bleeding and acute hepatic failure by leptospirosis: an entity that should not be forgotten

La leptospirosis es una enfermedad causada por la espiroqueta Leptospira. Se trata de una zoonosis de distribución mundial, con predominio en los trópicos. En España no es frecuente pero sí se observan casos en zonas más húmedas o con presencia de ríos, lagos o estanques, como son Cataluña, Andalucía o la Comunidad Valenciana, donde se relaciona con los arrozales. Los transmisores son múltiples animales como vacas o ratas, contagiándose el ser humano mediante contacto directo con estos animales o su orina, o bien de forma indirecta al consumir o estar en contacto con agua contaminada por la orina de éstos. Las manifestaciones clínicas son muy variables, siendo asintomática o poco sintomática en la mayoría de los pacientes. Aunque no ocurre siempre, la leptospirosis cursa con una primera fase con fiebre, mialgias, afectación renal o hemorragia de distintos órganos, seguida de una segunda fase con presencia de ictericia por afectación hepática. La enfermedad de Weil es una forma de leptospirosis grave caracterizada por afectación hepática con ictericia e insuficiencia renal aguda, asociada a una considerable mortalidad. El diagnóstico se basa en técnicas serológicas y detección de DNA mediante PCR. El tratamiento consta de medidas de soporte y antibioticoterapia. Presentamos un paciente con enfermedad de Weil y hemorragia digestiva por leptospirosis, con una evolución clínica fulminante, y hacemos hincapié en la necesidad de tener presente esta entidad, especialmente en ambientes epidemiológicos favorables como el de este paciente, con el fin de lograr un diagnóstico precoz.

Leptospirosis disease is caused by the spirochete Leptospira. It is a worldwide distribution zoonosis, with predominance in the tropics. In Spain, it is not frequent but some cases have been noticed especially in humid areas surrounded by rivers, lakes or ponds, such as Catalonia, Andalucia or the Valencian Community. It is transmitted by a variety of animals such as cows or rats, that are infected either by direct contact with these animals or their urine, or indirectly by consuming or being in contact with water contaminated by their urine. The clinical manifestations are very variable, being asymptomatic or not very symptomatic in most of the patients. Unusually, leptospirosis presents with a first phase with fever, myalgias, liver injury or different organs hemorrhage, followed by a second phase with the presence of jaundice due to hepatic failure. Weil's disease is a kind of severe leptospirosis characterized by hepatic failure with jaundice and acute renal failure, associated with high mortality rates. The diagnosis is based on serological techniques and DNA detection by PCR. The treatment consists of life support measures and antibiotic therapy. A patient with Weil's disease and leptospirosis digestive bleeding is presented, with a fulminant clinical course. In order to achieve an early diagnosis, the need to keep this entity in mind must be emphasized, especially in favorable epidemiological environments as the one of this patient.

Leptospirosis infantil en pacientes con síndrome febril en la Región de Urabá, Colombia / Childhood leptospirosis in patients with febrile syndrome in the Region of Urabá, Colombia

RESUMEN El objetivo del estudio fue describir los casos de leptospirosis infantil en cuatro municipios de la región de Urabá (Colombia) y factores relacionados con severidad de los cuadros clínicos. Se realizó un estudio transversal analítico retrospectivo de 74 pacientes menores de 17 años con síndrome febril por leptospirosis entre 2010 y 2012. El mayor número de casos correspondió a niños de áreas urbanas (57/74; 77%), entre 10 y 14 años (33/74; 44,5%). La respuesta por MAT más frecuente fue a los serogrupos Grippothyposa y Bratislava, asociados a reservorios silvestres y pecuarios respectivamente. Se encontró asociación entre la presencia de animales domésticos dentro de la vivienda (OR 2,73; IC95% 0,98-7,60; p=0,05) y la severidad de la enfermedad. El riesgo de leptospirosis infantil severa se relaciona con la tenencia de animales domésticos dentro de la vivienda.

ABSTRACT The aim of the study was to discover cases of childhood leptospirosis in four municipalities in the region of Urabá (Colombia) and the factors related to the severity of clinical manifestations. A retrospective cross-sectional study assessed 74 children aged younger than 17 years with febrile syndrome due to leptospirosis between 2010 and 2012. The majority of cases were in children from urban areas (57/74; 77%), between 10 and 14 years of age (33/74; 44.5%). The microscopic agglutination test (MAT) revealed that the most frequent serogroups were Grippotyphosa and Bratislava, which are associated with wildlife and livestock reservoirs, respectively. There was a association between the presence of household pets and the severity of the disease (odds ratio [OR] 2.73; 95% confidence interval [CI] = 0.98-7.60; p=0.05). The risk of severe childhood leptospirosis is linked to having household pets.

Cuadro ictérico hemorrágico grave causado por Leptospira interrogans serovar Icterohaemorrhagiae / Case of jaundiced severe bleeding caused by Leptospira interrogans serovar icterohaemorrhagiae

Resumen Se trata de un paciente con cuadro ictérico-hemorrágico grave causado por Leptospira interrogans quien presentó una hemorragia intracerebral, pulmonar y hepato-esplenomegalia. El estudio del daño tanto a nivel hepático como del bazo fueron hechos por tomografías axiales computarizadas, en tanto que el agente etiológico fue diagnosticado por la técnica de microaglutinación. El manejo terapéutico de la leptospirosis se realizó con penicilina, con buena evolución del paciente. Se presenta el caso de un cuadro ictérico hemorrágico estudiando los factores de riesgo, el desarrollo de la enfermedad y el manejo correcto del paciente contrastando la literatura.

Abstract We describe a patient with severe hemorrhagic- jaundiced-causedby Leptospira interrogans, who also presented an intracerebral hemorrhage, pulmonary and hepatosplenomegaly. The study of the liver and spleen damage were made by TC scans, while the etiologic agent was diagnosed by the microscopic agglutination technique. The therapeutic management of leptospirosis was performed with penicillin, with good outcomes. We present the case of a patient with jaundice and hemorrhage and his risk factors, similarly the development of disease and the proper patient management.

Predictors of mortality among pediatric patients with Leptospirosis: A multicenter retrospective study

Objective@#Leptospirosis in children is one of the most common diagnostic dilemmas, hence this study was performed to determine the clinical profile, outcome and risk factors associated with mortality in patients seen at tertiary government hospitals from January 2008 to December 2012. @*Methods@#A case-control retrospective study was done among admitted patients at UP-PGH, SLH, and RITM. Descriptive statistics and multiple logistic regressions were utilized. @*Results@#Among the 404 leptospirosis cases included in the study, 94% were male, with 43% belonging to 16-18-year-old age group (age range 3 to 18 years old). A higher occurrence was noted during the rainy season and in Manila. Clinical findings include fever, abdominal pain, calf tenderness, vomiting and conjunctival suffusion. Significant correlation was noted in patients with jaundice (p-value 0.014; OR 6.293, CI 1.449-27.335), dyspnea (p-value 0.004; OR 7.880, CI 1.967-31.561) and cardiac abnormality (p-value 0.042; OR 15.343, CI 1.106-212.853). Abnormal laboratory findings include neutrophilia, azotemia, creatinemia, anemia, elevated bilirubin levels and thrombocytopenia. Prolonged prothrombin time was associated with poor outcome (p-value 0.004, OR 23, CI 2.79-189.67). Penicillin was the drug of choice given to 96.8%. 94.6% of cases who had oliguric renal failure were conservatively converted to non-oliguric type. 5.4% underwent peritoneal dialysis and survived. Inotropes were used in 93% of non-survivors. The case fatality rate was 3.5% with the cause of death mostly due to Weil’s disease. The average hospital stay among survivors was 6.8+3.3 days as compared with 1.8+1.9 days in non survivors. Shorter hospital stay (p-value 0.00; OR 3.514, CI 2.115-5.839), as well as inotropic support (p-value 0.035; OR 62.511, CI 1.33-2949.134), were associated with poorer outcome, but these findings can be attributed to late presentation of cases at the hospital for admission. @*Conclusion@#A5 year review of patients with leptospirosis showed that jaundice, dyspnea, cardiac abnormality and prolonged prothrombin time were predictive of mortality.