ABSTRACT
Leptospirosis is an anthropozoonose, an animal disease transmissible to humans, caused by a spirochete of the genus Leptospira that lives mainly among rodents but also in wetlands. It occurs worldwide, particularly in Asia, Latin America and Africa. In Europe, the incidence is small (except in France and Great Britain, where its frequency has increased in recent years) but the frequency may be underestimated. Some areas overseas are particularly affected. In France, the potential epidemic of leptospirosis is subject to climatic variations, justifying a constant monitoring of the disease provided by the National Reference Centre (CNR) of leptospires. Transmission to humans primarily occurs through contact with environments contaminated by the urine of infected animals. The disease can affect the liver and kidneys (hepatonephritis) as cytolysis, cholestasis and renal failure associated with fever. A coagulopathy usually accompanies the clinical table. Its diagnosis is difficult because of the clinical polymorphism. Early diagnosis of leptospirosis allows effective medical care, improving patient outcomes. This is currently based on gene amplification (PCR) or serology positive by the microscopic agglutination test (MAT), which is the reference method. Its evolution is usually favorable with appropriate antibiotic treatment (aminopenicillin). However 5-10% of symptomatic patients have a severe multisystem defaillance. Nearly a century after the discovery of the causative agent, this zoonosis remains a public health problem, zoonosis priority in terms of virulence, its reporting is mandatory in our country. We report the case of a severe form of hepatonephritis due to water contaminated with Leptospira observed in Northern France.
Subject(s)
Leptospira interrogans serovar icterohaemorrhagiae/isolation & purification , Occupational Diseases/microbiology , Weil Disease/microbiology , Acute Kidney Injury/etiology , Acute Kidney Injury/therapy , Adult , Amoxicillin-Potassium Clavulanate Combination/therapeutic use , Animal Husbandry , Animals , Anti-Bacterial Agents/therapeutic use , Bacteremia/diagnosis , Bacteremia/microbiology , Disease Progression , Doxycycline/therapeutic use , Fever/etiology , France/epidemiology , Humans , Immunologic Tests , Jaundice/etiology , Leptospira interrogans serovar icterohaemorrhagiae/pathogenicity , Male , Occupational Diseases/diagnosis , Occupational Diseases/drug therapy , Ofloxacin/therapeutic use , Rats , Renal Dialysis , Sheep , Species Specificity , Water Microbiology , Water Pollution , Weil Disease/diagnosis , Weil Disease/drug therapy , Weil Disease/epidemiology , Weil Disease/transmission , ZoonosesABSTRACT
The regulator of the emergency medical ambulance service is involved in the various steps of the initial management of severe head trauma patients: handling calls, basic life support, prehospital advance life support, transport and hospital admission. The management is rapid (helicopter transports) coherent and adapted (adherence to the guidelines for severe head injury), and considers of local difficulties (geographical, possibility of admission to trauma centres), with the aim of improving the outcome of severely head-injured patients.
