ABSTRACT
Leptospirosis is a potentially severe illness in returned travelers. Patients often present with fever, headache, and neck pain, which may lead to a workup for meningitis including the acquisition of cerebrospinal fluid (CSF). Although Leptospira DNA has been detected in CSF by polymerase chain reaction (PCR), little data exist regarding the utility of testing CSF in addition to serum or plasma obtained on presentation. In this report, we present two cases of leptospirosis in returned travelers presenting with fever and headache. Our first patient had neutrophilic meningitis, and Leptospira was detectable only in CSF obtained on admission. The second patient had a normal CSF profile, but Leptospira was detected in CSF at a bacterial load 5- to 10-fold higher than that in plasma. CSF is an important specimen for the diagnosis of Leptospira by molecular methods and may yield an actionable diagnosis in the absence of leptospiremia.
Subject(s)
Bacterial Load , DNA, Bacterial/blood , DNA, Bacterial/cerebrospinal fluid , Leptospirosis/blood , Leptospirosis/cerebrospinal fluid , Leptospirosis/diagnosis , Adult , Fever , Headache , Humans , Leptospira/isolation & purification , Male , Polymerase Chain Reaction , Young AdultSubject(s)
Cerebrospinal Fluid/microbiology , Communicable Diseases/microbiology , DNA, Bacterial/genetics , Leptospira/isolation & purification , Leptospirosis/microbiology , Metagenomics/methods , Adolescent , Communicable Diseases/cerebrospinal fluid , Humans , Leptospira/genetics , Leptospirosis/cerebrospinal fluid , Male , Sequence Analysis, DNA/methodsABSTRACT
To our knowledge, this is the first known case of a patient with leptospirosis and very elevated CSF, which caused hydrocephalus.
Subject(s)
Hydrocephalus/cerebrospinal fluid , Hydrocephalus/parasitology , Immunoglobulin M/cerebrospinal fluid , Leptospirosis/cerebrospinal fluid , Glasgow Coma Scale , Humans , Hydrocephalus/surgery , Leptospirosis/complications , Leptospirosis/surgery , Male , Middle Aged , Serologic Tests , VentriculostomyABSTRACT
Clinical and biological symptoms of neuroleptospirosis are misleading. We report a 62-year-old man, without any risk factor, suffering from febrile headache with a pseudotumoral cerebral spinal fluid due to neuroleptospirosis. Thereby, we present useful diagnostic assays and their practical interest.
Subject(s)
Leptospirosis/diagnosis , Diagnosis, Differential , Headache/microbiology , Humans , Leptospira/isolation & purification , Leptospirosis/cerebrospinal fluid , Leptospirosis/pathology , Lymphocytes/pathology , Male , Meningitis/microbiology , Middle Aged , Polymerase Chain Reaction , Pseudotumor Cerebri/cerebrospinal fluidABSTRACT
Leptospirosis is a disease with protean manifestations. We report a case of Guillain-Barre syndrome (GBS) in a pediatric patient following infection with Leptospira. Infecting Leptospira presumably belonged to serovar Copenhageni. The patient recovered completely. The possibility of GBS developing as a result of antecedent leptospiral infection should be kept in mind.
Subject(s)
Guillain-Barre Syndrome/diagnosis , Guillain-Barre Syndrome/microbiology , Leptospirosis/complications , Agglutination Tests/methods , Child , Child Health Services , Female , Fluorescent Antibody Technique, Indirect/methods , Humans , Leptospira/classification , Leptospira/isolation & purification , Leptospirosis/cerebrospinal fluid , Leptospirosis/diagnosis , Leptospirosis/urineABSTRACT
Samples of cerebrospinal fluid from 103 patients with aseptic meningitis were tested by PCR for detection of leptospires, and the results were compared with those of the microscopic agglutination test (MAT) and an enzyme-linked immunosorbent assay for detection of immunoglobulin M (ELISA-IgM). Of these samples, 39.80% were positive by PCR and 8.74 and 3.88% were positive by MAT and ELISA-IgM, respectively.
Subject(s)
Leptospira/isolation & purification , Leptospirosis/cerebrospinal fluid , Meningitis, Aseptic/cerebrospinal fluid , Adolescent , Adult , Age Distribution , Child , Child, Preschool , DNA, Bacterial/analysis , Enzyme-Linked Immunosorbent Assay , Female , Humans , Infant , Leptospirosis/complications , Male , Meningitis, Aseptic/complications , Meningitis, Aseptic/microbiology , Middle Aged , Polymerase Chain Reaction/methodsABSTRACT
14 cases that were admitted to the Hospital Universitario de Caracas, between 1.989 and 1.994, with a definitive diagnosis of Leptospirosis by microaglutination of live antigens were studied. Most of them hospitalized at the gastroenterology service. The serovar most frequently found was icterohemorragiae 11 cases. There was a predominium for the male gender 12/2 and the majority of patients belonged to the range of age between 31 and 40. The most common forms of presentations were: fever (14), jaundice (10) and myalgias (10) while the most relevant findings at physical examination were: jaundice (12), fever (11) and hepatomegaly (8). All patients had abnormal laboratory tests and among these, aminotransferases, bilirrubin, creatinin, CPK, platelets and urinary sediment were more frequently altered. Only half of the patients were diagnosed as Leptospirosis at the moment of admission. We conclude that even though Leptospirosis is an infectious disease distributed worldwide only few cases are hospitalized and differential diagnosis is difficult because of diversity of clinical presentations and lack of laboratory resources. It is important for gastroenterologists because most of complicated cases present as jaundiced patients.
Subject(s)
Leptospirosis/diagnosis , Adult , Diagnosis, Differential , Female , Humans , Jaundice/diagnosis , Leptospirosis/blood , Leptospirosis/cerebrospinal fluid , Leptospirosis/urine , Male , Middle Aged , Retrospective Studies , VenezuelaABSTRACT
From January 1st up to September 30th 1990, 77 patients with leptospirosis diagnosis confirmed by laboratory studies were admitted at the Infectious and Parasitic Disease Service of the Hospital das Clínicas of the Universidade Federal de Pernambuco. The neurological exam was abnormal in 70 of the patients (90.91%). The cerebrospinal fluid (CSF) examination was carried out on 67 (87%) of the patients; it was abnormal in 64 (95.52%) yielding hypercytosis in the majority of cases. There was no difference in the CSF behavior in report to the several neurological forms nor in relation to the icteric or non-icteric forms of the disease. Significant were the results for the microscopic agglutination tests for leptospirosis in the CSF.
Subject(s)
Central Nervous System Diseases/cerebrospinal fluid , Leptospirosis/cerebrospinal fluid , HumansABSTRACT
From January 1st up to September 30th 1990, 77 patients with leptospirosis were admitted at the Infectious and Parasitic Diseases Service of the Hospital das Clínicas of the Universidade Federal de Pernambuco. The majority (64) were male patients, and average age was 28 years old. Serovars icterohaemorrhagic and canicola were the most frequent. CSF examination was performed in 67 (87.0%) patients and it was abnormal in 64 (95.52%). Micro-agglutination test for leptospirosis with live antigens was performed in CSF, as well as immunological tests for syphilis, cysticercosis and schistosomiasis for differential diagnosis. Concerning the serovar identification, results of microagglutination test for leptospirosis in CSF were significant considering the similitude of responses when compared to those found for blood samples.
Subject(s)
Central Nervous System Diseases/diagnosis , Leptospirosis/diagnosis , Adolescent , Adult , Aged , Agglutination Tests , Antigens, Bacterial/analysis , Antigens, Bacterial/cerebrospinal fluid , Central Nervous System Diseases/cerebrospinal fluid , Diagnosis, Differential , Female , Humans , Leptospira/immunology , Leptospirosis/cerebrospinal fluid , Male , Middle AgedABSTRACT
Entre 1-janeiro e 30-setembro-1990 foram estudados 77 pacientes com diagnóstico de leptospirose, admitidos no SDIP/UFPE. O exame neurológico foi anormal em 70 (90,91 por cento) dos pacientes. O exame do LCR, foi realizado em 67 (87 por cento) dos pacientes, foi anormal em 64 (95,52 por cento), tendo como achado mais frequente a pleocitose. Näo houve diferença significativa no comportamento do LCR nas diversas formas clínicas neurológicas observadas, nem quando comparadas as formas ictéricas com as näo ictéricas. Bastante significativos foram os resultados da reaçäo de microaglutinaçäo para leptospirose no LCR
Subject(s)
Humans , Central Nervous System Diseases/cerebrospinal fluid , Leptospirosis/cerebrospinal fluidABSTRACT
Entre 1-janeiro e 30-setembro-1990 foram estudados 77 pacientes com diagnóstico de leptospirose: 64 (83,11 por cento) eram do sexo masculino e a média de idade, 28 anos. Os sorovars icterohemorrhagiae e canicola foram os mais frequentes. O exame do LCR, realizado em 67 (87,0 por cento) dos pacientes, foi anormal em 64 (95,52//). A reaçäo de microaglutinaçäo para leptospirose com antígenos vivos foi realizada no LCR, bem como reaçöes imunológicas para sífilis, cisticercose e esquistossomose para diagnóstico diferencial. Bastante signficativa foram os resultados da reaçäo de microaglutinaçäo para leptospirose no LCR, pela semelhança das respostas àquelas encontradas no sangue quanto à identificaçäo do sorovar
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Central Nervous System Diseases/diagnosis , Leptospirosis/diagnosis , Agglutination Tests , Antigens, Bacterial/analysis , Antigens, Bacterial/cerebrospinal fluid , Central Nervous System Diseases/cerebrospinal fluid , Leptospira/immunology , Leptospirosis/cerebrospinal fluidABSTRACT
Se analizó el cuadro clínico y la epidemiología de 36 casos del leptospirosis hospitalizados durante los meses de verano 1983-1984, los que se estudiaron por reacción de aglutinación microscópica usando 8 a 12 antígenos. No hubo relación entre el serotipo y la forma clínica. El cuadro clínico fue variado desde una evolución febril corta o otras con compromiso hepático renal y meningitis aséptica. Los serotipos más frecuentes fueron L. grippotyphosa, L. ballum, L. canícola y L. autumnalis lo que difiere de estudios anteriores hechos en este hospital. La evolución fue benigna en todos los casos. Para el mejor conocimiento de los diferentes cuadros clínicos que se producen en el curso de la infección por leptospiras, es necesario la comprobación por el laboratorio, mediante procedimientos que actualmente tienen un alto costo
Subject(s)
Leptospirosis/epidemiology , Leptospirosis/cerebrospinal fluid , Leptospirosis/complicationsSubject(s)
Leptospirosis , Adolescent , Adult , Animals , Diagnosis, Differential , Humans , Leptospirosis/cerebrospinal fluid , Leptospirosis/diagnosis , Leptospirosis/therapy , Male , Middle Aged , RatsABSTRACT
Two cases of leptospirosis with different clinical presentations are presented. The importance of recognizing mild, nonicteric and meningoencephalitic forms in order to identify vectors and contaminated areas and prevent further infections is emphasized. Cerebrospinal fluid (CSF) findings in reported cases of leptospirosis are reviewed and possible prognostic implications of CSF xanthrochromia, hypoglycorrhachia, persistent polymorphonuclear leukocytosis, and increased intracranial pressure are discussed.