ABSTRACT
We report the clinical history of a paperless migrant living in Belgium who contracted Weil's disease. This historical term refers to the severe form of leptospirosis, an ever more frequent tropical disease in Europe due to the growing globalization background. However, leptospirosis remains underdiagnosed. Actually, common clinical forms are neglected in outpatient medicine and the performance of available diagnostic tests is limited, especially when they are performed in severe, potentially life-threatening forms. In these cases of sepsis or even septic shock, the antibiotic treatment is most often empirical although fortunately adapted thanks to the large sensitivity of the spirochete.
Nous rapportons l'histoire clinique d'un sans-papier séjournant en Belgique atteint de maladie de Weil. Ce terme historique désigne la forme sévère de la leptospirose, une maladie tropicale dont l'incidence augmente en Europe, sur fond de mondialisation en essor. La leptospirose reste toutefois sous-diagnostiquée. En effet, les formes cliniques courantes sont négligées en médecine ambulatoire et la performance des tests diagnostiques disponibles est limitée, lorsqu'ils sont demandés face aux formes sévères, potentiellement mortelles. Dans ces cas de sepsis, voire de choc septique, le traitement antibiotique est donc le plus souvent empirique, tout en demeurant, heureusement, adapté de par la multisensibilité du spirochète.
Subject(s)
Leptospirosis , Transients and Migrants , Weil Disease , Belgium , Europe , Humans , Leptospirosis/diagnosis , Weil Disease/diagnosisSubject(s)
Methanol/poisoning , Adult , Critical Care , Ethanol/administration & dosage , Female , Humans , Infusions, Parenteral , Male , Middle Aged , Suicide, AttemptedABSTRACT
In hypertension, mainly low renin subjects, a plasma Na-K ATPase inhibitor has yet been demonstrated. Moreover, it has been established that the concentration of this activity may be modulated by variations of the sodium and water balance. In the present study, such an activity and its role has been searched in the plasma of young healthy normotensive population. Its potential natriuretic property has also been tested. Twenty male subjects, younger than 30, volunteered 3 very different sodium diets: normal (+/- 170 mM/d), very low (-20 mM/d) and very high sodium intake (+340 mM/d). At the end of each period, some clinical and biological parameters have been studied: blood pressure, weight, vascular resistances and reactivity to norepinephrine, 24 h natriuresis, and plasma renin activity. Furthermore, the plasma natriuretic activity has been tested after filtration of the plasma across different Amicon filters to measure the effect of plasma extracts from 500 to 10,000 daltons (LMW) on fractional sodium excretion (FENa) after injection of such extracts in vivo in rat renal artery. For detection of a plasma Na-K ATPase inhibitor activity, 1/5 th diluted fresh plasma and LMW extracts have been incubated with purified rabbit renal Na-K ATPase enzyme and compared with the activity of this enzyme without such an incubation of plasma. We have observed that when the amount of sodium in the diet is higher, weight, systolic blood pressure, and vascular reactivity to norepinephrine increase. In the same condition, there are greater natriuretic activity in the LMW extracts and Na-K ATPase inhibitor activity in fresh plasma and LMW extracts of the normotensive people.(ABSTRACT TRUNCATED AT 250 WORDS)
