Unusual clinical manifestations of leptospirosis.

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. Leptospirosis in early pregnancy may lead to fetal loss. There are a few reports of leptospirosis in HIV-infected individuals but no generalisation can be made due to paucity of data. 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.

Sero surveillance of leptospirosis among sewer workers in Pune.

Leptospirosis is an important occupational disease affecting people coming in contact with animals and their discharges. The occurrence of infection in ones workplaces is linked to the environment to which the worker is exposed and the adaptability of the organism in that working environment. Rodents usually abound in underground sewers and are carriers of leptospira. The urine of rodents and other animals present in that area is likely to contaminate these sewers. Leptospira are excreted in the urine of infected animals. Thus sewer workers are at a potential risk of leptospirosis. The prevalence of leptospirosis in these workers could thus indirectly predict the presence of the disease in animals in a particular geographical niche. Total seventy-eight sewer workers from 5 different municipal wards in Pune were examined to find out the evidence of past infection with leptospira using microagglutination test (MAT). The prevalence rate was found to be 16.6%. The serovars to which antibodies were detected include autumnalis (38.4%), pyrogenes (23.0%), canicola (15.3%) and pomona (15.3%). Evidence of leptospiral infection was found to be maximum in sewer workers in the areas of the city that were infested with rodents and stray animals.

Pneumonia due to an unusual serotype of Salmonella.

Salmonella species is a rare cause of infection in the respiratory tract. Pleuropulmonary infection with these organisms are however associated with high mortality. We report a case where serotype Worthington was isolated from a patient of acute pneumonia.

Enteric fever due to Salmonella Weltevreden in a four-year-old child.

A four-year old child was admitted with signs and symptoms suggestive of enteric fever. Blood culture and serial stool cultures were undertaken. Weltevreden, a rare Salmonella serotype was isolated from the stool samples. The isolate was sensitive to ampicillin, cefotaxime, gentamicin, chloramphenicol and ciprofloxacin.

Isolation of Salmonella enterica serotype Worthington from a splenic abscess in a patient with chronic myeloid leukemia

Splenic abscesses are caused by Staphylococcus aureus, Streptococcus and bacteria belonging to the family Enterobacteriaceae. We report a case of splenic abscess caused by an unusual serotype of Salmonella. A 55 year old man was admitted with complaints of fever and abdominal pain. On the basis of clinical findings and laboratory reports, a diagnosis of chronic myeloid leukemia was made. Ultrasonography of the abdomen revealed a single large cystic lesion in the spleen. Percutaneous drainage of the abscess was carried out. Salmonella enterica serotype Worthington was isolated from a pus sample taken from the abscess. The isolate was resistant to ampicillin, gentamicin, cefotaxime, chloramphenicol and tetracycline, and sensitive to amikacin and norfloxacin. Serotype Worthington is an emerging pathogen. This is the first report of isolation of this serotype from a splenic abscess. In seriously ill patients, such infections should be treated with a combination of antibiotics to circumvent problems with multidrug resistance.

Evaluation of clinical criteria for the diagnosis of leptospirosis.

OBJECTIVES: Leptospirosis has a wide range of clinical presentation and therefore, clinical suspicion of the infection is often difficult. The objective of this study is to find out the usefulness of the clinical and epidemiological criteria in the diagnosis of leptospirosis and its comparison with microagglutination test (MAT). METHODS: A total of 118 patients with undiagnosed fever of more than seven days duration were included in the study. Their clinical presentation was scored on the basis of a clinical criteria. Sera of the patients were tested for antibodies against leptospira with the help of microagglutination test using a battery of antigens. The usefulness of the criteria was evaluated and compared with microagglutination test. RESULTS: A total of 44 out of 118 (37.28%) patients could be provisionally diagnosed as cases of leptospirosis on the basis of the clinical criteria. Eighteen of these 44 (40.9%) patients had serological evidence of leptospirosis. The criteria had a sensitivity of 81.81%, specificity of 72.91%, a positive predictive value of 40.9% and a negative predictive value of 94.59% when compared with microagglutination test. CONCLUSIONS: The criteria had a moderate sensitivity and specificity. Considering the non-specific signs and symptoms of this infection, the positive predictive value is significantly high. The criteria has a high negative predictive value and this would help the clinicians exclude the diagnosis of leptospirosis with precision.

Common infecting leptospiral serovars in and around Pune, Maharashtra.

Leptospirosis is a disease with protean manifestations. The present study was conducted in Pune to examine the possibility of leptospiral infection among a group of patients with fever of undetermined origin and to identify the common infecting serovars. Serological evidence of leptospirosis was found in 22 of the 118 (18.6%) patients with the help of microagglutination test (MAT) using a battery of 9 antigens. The serovars responsible for infection included autumnalis in eight cases, copenhageni in six, pomona in three, grippotyphosa in two and australis, batavia and canicola in one case each. Thus, there appears to be a focus of leptospirosis in and around Pune with autumnalis and copenhagni as the common infecting serovars.

Contaminated antiseptics--an unnecessary hospital hazard.

A total of 284 antiseptic solutions were studied to check for their sterility. The overall antiseptic contamination rate was 15.14%. 14.85% of freshly prepared antiseptics were contaminated. Here, the problem could be attributed to inadequate precautions while preparing the antiseptics. 15.3% of the in-use antiseptics were contaminated. This could be due to improper handling. Non-fermenters (45.45%), Pseudomonas aeruginosa (30.30%) and Klebsiella spp. (22.72%) were the commonest organisms recovered from the antiseptics. In 44.44% of patients, the isolates obtained from the catheterised urine in the same wards matched with the isolates from antiseptics of that ward. Antiseptic solutions have to be regularly monitored. If they are found to be contaminated, they should be discarded immediately and replaced by fresh sterile antiseptics otherwise instead of preventing infection, antiseptics will become a source of hospital-acquired infection.

Infective endocarditis due to an unusual serotype of Salmonella.

Salmonellae are a rare cause of infective endocarditis. We report a case in which Salmonella enterica serotype Worthington was isolated from a case of endocarditis. The isolate was resistant to ampicillin, gentamicin, amikacin and chloramphenicol and sensitive to ciprofloxacin and cefotaxime.