Subject(s)
Humans , Male , Adolescent , Weil Disease/complications , Weil Disease/diagnosis , Weil Disease/drug therapy , Weil Disease/diagnostic imaging , Shock, Septic/diagnosis , Zoonoses/epidemiology , Diagnosis, Differential , Fever/diagnosis , Leptospira interrogans/isolation & purification , Anti-Bacterial Agents/therapeutic useABSTRACT
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.
Subject(s)
Humans , Male , Middle Aged , Weil Disease/diagnosis , Liver Failure, Acute/microbiology , Gastrointestinal Hemorrhage/microbiology , Weil Disease/complications , Liver Failure, Acute/diagnosis , Fatal Outcome , Gastrointestinal Hemorrhage/diagnosisABSTRACT
OBJECTIVE: This study was conducted to investigate factors associated with thrombocytopenia in a large cohort of patients with leptospirosis in an endemic area. METHODS: This retrospective study included 374 consecutive patients with leptospirosis who were admitted to tertiary hospitals in Fortaleza, Brazil. All patients had a diagnosis of severe leptospirosis (Weil's disease). Acute kidney injury was defined according to the RIFLE criteria. Thrombocytopenia was defined as a platelet count <100,000/mm3. RESULTS: A total of 374 patients were included, with a mean age of 36.1±15.5 years, and 83.4% were male. Thrombocytopenia was present at the time of hospital admission in 200 cases (53.5%), and it developed during the hospital stay in 150 cases (40.3%). The patients with thrombocytopenia had higher frequencies of dehydration (53% vs. 35.3%, p = 0.001), epistaxis (5.7% vs. 0.8%, p = 0.033), hematemesis (13% vs. 4.6%, p = 0.006), myalgia (91.5% vs. 84.5%, p = 0.038), hematuria (54.8% vs. 37.6%, p = 0.011), metabolic acidosis (18% vs. 9.2%, p = 0.016) and hypoalbuminemia (17.8% vs. 7.5%, p = 0.005). The independent risk factors associated with thrombocytopenia during the hospital stay were lengthy disease (OR: 1.2, p = 0.001) and acute kidney injury (OR: 6.6, p = 0.004). Mortality was not associated with thrombocytopenia at admission (12.5% vs. 12.6%, p = 1.000) or during the hospital stay (12.6% vs. 11.3%, p = 0.748). CONCLUSIONS: Thrombocytopenia is a frequent complication in leptospirosis, and this condition was present in more than half of patients at the time of hospital admission. Lengthy disease and acute kidney injury are risk factors for thrombocytopenia. There was no significant association between thrombocytopenia and mortality. .
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Child , Female , Humans , Male , Middle Aged , Young Adult , Thrombocytopenia/etiology , Weil Disease/complications , Acute Kidney Injury/complications , Brazil , Cause of Death , Hospital Mortality , Hospitalization , Retrospective Studies , Risk Factors , Sex Distribution , Tertiary Care Centers , Weil Disease/mortalityABSTRACT
A case of fulminant leptospirosis is presented, manifesting as rapid progression from acute undifferentiated febrile illness to refractory shock, jaundice, renal failure and massive pulmonary hemorrhage. The patient received aggressive intensive care unit support including prolonged intubation and ventilation. This case emphasizes that acute leptospirosis may well not be characterized by the classic scenario of a biphasic illness, but rather by a fulminant, monophasic illness.
Subject(s)
Humans , Male , Adult , Hemorrhage/etiology , Leptospira interrogans/isolation & purification , Lung Diseases/etiology , Shock/etiology , Weil Disease/complications , Severity of Illness IndexABSTRACT
Two patients who lived in Buenos Aires suburbs died from leptospirosis in July 2000 and March 2001. They developed a nonspecific febrile illness followed by hemorrhagic pneumonia and respiratory distress in absence of typical manifestations such as jaundice, nephropathy, thrombocitopenia or hemorrhages in other organs. In the house and surroundings of one patient rodents were captured and three strains of leptospira, serogroup Icterohaemorrhagiae were isolated. Laboratory guinea pigs were inoculated and they were sacrificed as soon as respiratory symptoms appeared. Necropsy showed primary lung injury, which was similar to the histopathological lesions found in one of the patients. Neither jaundice, nor renal damage was found. Pericardiac hemorrhages were considered as a possible cause of cardiopulmonary collapse. This clinical form has not been reported previously in this region, where conditions are indeed suitable for the human illness to appear.
Subject(s)
Humans , Animals , Male , Female , Adult , Rats , Respiratory Insufficiency/microbiology , Weil Disease/complications , Hemorrhage/microbiology , Lung Diseases/microbiology , Argentina , Weil Disease/pathology , Fatal Outcome , Hemorrhage/pathology , Lung Diseases/pathologyABSTRACT
An outbreak of acute febrile illness with haemorrhagic manifestations and pulmonary involvement occurred in Diglipur of North Andaman during October-November 1993. Investigations were carried out to see whether leptospires were responsible for this outbreak. Serum samples were collected from suspected cases and tested for presence of antibodies to leptospires by microscopic agglutination test (MAT) using a battery of 19 antigens representing 16 serogroups. 66.7 per cent of the specimens showed significant titres of antibodies against leptospires, 18 of 23 paired sera (78.3%) showed sero-conversion or four-fold rise in antibody titres. The commonest serovar involved was Leptospira grippotyphosa followed by L. canicola and L. JEZ bratislava. In 7 patients L. grippotyphosa was the sole serovar against which antibodies were detected. Clinical and epidemiological observations of this outbreak were similar with that of earlier seasonal outbreaks of acute febrile illness with haemorrhagic manifestations occurring in the same area, indicating that the past outbreaks may also have been due to leptospires. This is the first report of pulmonary leptospirosis from India.
Subject(s)
Disease Outbreaks , Humans , India/epidemiology , Lung Diseases/etiology , Weil Disease/complicationsABSTRACT
A leptospirose humana, uma das principais endemias dos centros urbanos no Brasil, vem crescendo de forma dramática nas três últimas décadas, com prevalência após enchentes causadas pelas chuvas de veräo. Säo descritas as recentes modificaçöes de seus padröes clínicos em nossa regiäo, constituídas pelo surgimento de hemoptise/s maciça/s e da síndrome de angústia respiratória do adulto, ou de ambas associadamente. Essas evidentes mudanças situadas nas estruturas respiratórias depontaram como séria ameaça à vida e como mecanismos de morte, passando a representar entre nós, por sua grande freqüência, a principal causa de óbito na leptospirose. A nova face da doença impöe revisäo dos conceitos sobre sua gravidade e especulaçäo sobre a patogenia dessas alteraçöes. A evoluçäo fatal dos seis pacientes descritos, dois deles sem icterícia e sem insuficiência renal, mostra a grandeza do desafio
Subject(s)
Adult , Middle Aged , Humans , Male , Female , Weil Disease/pathology , Hemoptysis/pathology , Leptospirosis/pathology , Respiratory Distress Syndrome/pathology , Brazil/epidemiology , Cause of Death , Weil Disease/complications , Weil Disease/mortality , Fatal Outcome , Hemoptysis/etiology , Hemoptysis/mortality , Leptospirosis/complications , Leptospirosis/mortality , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/mortalityABSTRACT
Correlacionan-se as principais manifestaçöes clínicas encontradas na forma úctero-hemorrágica da leptospirose com seus achados anatomopatológicos em autópsias e biópsias, consubstanciados em vasta experiência nas três últimas décadas na cidade do Rio de Janeiro. O mecanismo patogênico básico das lesöes é analisado como decorrente de dano celular direto pela estrutura da leptospira e de seus produtos de degradaçäo, por via de alteraçöes vasculares propiciadoras de hipoxia tecidual. O quadro clínico e laboratorial de icterícia com insuficiência renal correlaciona-se com aspectos histopatológicos de hepatite colestática centrolobular e de necrose tubular aguda com nefrite intesticial. As mialgias, presentes na quase totalidade dos casos, säo justificadas pelo quadro histológico de miosite alterativa com lesöes multifocais em aproximadamente 80 por cento dos 88 espécimes estudados em material de biópsias musculares. As manifestaçöes cardiovasculares, pulmonares, digestivas e neuropsiquiátricas derivam de miocardite, pneumonite e de lesöes associadas a fenômenos congestivos e hemorrágicos
Subject(s)
Humans , Male , Female , Acute Kidney Injury/etiology , Weil Disease/complications , Hepatitis/etiology , Leptospira interrogans/pathogenicity , Myositis/etiology , Brazil , Weil Disease/pathology , Liver/pathology , Kidney Tubular Necrosis, Acute/pathology , Kidney/pathology , Leptospira/classification , Nephritis, Interstitial/pathologyABSTRACT
Em 23 pacientes com leptospirose apresentando comprometimento pulmonar, internados no Hospital Universitário Antônio Pedro da UFF, Niterói, hemoptise e hemoptóicos foram observados em 21.7 por cento e 30, 4 por cento, respectivamente. Gasometria arterial revelou hipoxemia e hipocapnia na maioria dos casos. Radiografia de tórax em 15 pacientes mostrou comprometimento alveolar em 60 por cento, comprometimento intersticial-reticular em 6 por cento, padräo misto (alveolar e intersticial) em 20 por cento e ausências de alteraçöes radiológicas em 14 por cento. A necrópsia de 13 pacientes mostrou edema, congestäo e hemorragia nos pulmöes em 100 por cento dos casos. A hemorragia foi focal em 46 por cento e difusa em 54 por cento dos casos. Houve formaçäo de membrana hialina em 30 por cento e trombos de fibrina em 46 por cento dos pulmöes estudados, o que estabelece o diagnóstico da coagulaçäo intravascular e a ocorrência da síndrome de angústia respiratória na leptospirose