Weil's disease with multiple organ dysfunction, community-acquired pneumonia and septic shock: The role of rapid diagnosis and management.

Leptospirosis is an uncommon infectious illness - a spirochetal zoonosis - caused by Leptospira species and the primary cause of human leptospirosis is exposure to the urine of infected rodents. Clinical manifestations of human leptospirosis are diverse, ranging from asymptomatic infection to severe life-threatening with multiorgan dysfunction. The severe condition is known as Weil's disease, which is characterized by feverish illness with jaundice, acute kidney damage, and bleeding. The aim of this case report was to present a Weil's disease which occurred simultaneously with a community-acquired pneumonia (CAP) resulting in serious complications. A 41-year-old man with Weil's disease, as well as CAP caused by Streptococcus pneumoniae, and septic shock was presented. The patient was treated accordingly after establishing the diagnosis through history taking, physical examination, and laboratory tests. In this instance, the score for diagnosing leptospirosis based on Modified Faine's Criteria was calculated resulting possible diagnoses; and therefore, therapeutic management was initiated. Despite presenting with severe symptoms, the patient recovered completely after receiving antibiotics and supportive care. This study highlights that when a patient has Weil's disease and a CAP infection, which could cause unfavorable consequence, a prompt diagnosis and proper treatment could result satisfied patient recovery.

[Endometriosis and fertilization in vitro. Apropos of 40 cycles]. / Endométriose et fécondation in vitro. A propos de 40 cycles.

The physiopathology and the role of endometriosis in infertility is still unclear. The use of in vitro fertilization (IVF) could be a good model for the understanding of etio-pathology and treatment when fecundity is desired. We compare results of IVF procedure in patients with endometriosis after ovulation induction with clomiphene-HMG (group 1) and Gn-Rh analog's short administration using regimen and HMG (group 2). Forty cycles have been conducted for 18 patients. Mean duration of infertility is 6.9 years and mean age of patients is 34.8 years. We observed no difference in terms of results of ovulation induction in Gr 1 or in Gr 2 compared with IVF patients without endometriosis and after the same treatment regimen, except a non significant decrease in the number of recovered oocytes. As for IVF patients without endometriosis, the use of Gn Rh analogs permits an improvement of results in terms of suppression of spontaneous premature LH surge, and increase of number of follicles and cleaved embryos. The fertilization and cleavage rates are not affected by the presence of endometriosis when compared to IVF patients without endometriosis. The number of recovered oocytes decreases with the severity of endometriosis (RAFS classification), but the pregnancy rate is not affected. Overall Third trimester pregnancy rate is 12.5% per induction cycle and 21.7% per embryo transfer. We may conclude that the presence of endometriosis does not affect the quality of the oocyte and is not a cause of exclusion in an IVF program.