ABSTRACT
Leptospirosis, a zoonotic disease characterized by a spectrum of influenza-like symptoms, can manifest as severe cases so called Weil's disease. Early diagnosis and treatment are crucial to avoid the potentially fatal course of the disease. Within 24 hours of the initial administration of antibiotics, patients may experience the Jarisch-Herxheimer reaction (JHR), characterized by chills, fever, hypotension, and impaired consciousness. The Okinawa Prefecture, where our hospital is situated, boasts the highest incidence rate of leptospirosis among all regions in Japan. This reports our encounter with the initial leptospirosis case after a period of 16 years within the Okinawa Prefecture. This case exhibited JHR and required the utilization of noradrenaline (NA). Despite evidence indicating that JHR does not correlate with mortality, we contend that diagnosis of Weil's disease necessitates admission to an intensive care unit (ICU) and vigilant monitoring for JHR, as it may result in impairment of general condition and fatal outcome, as observed in our case.
Subject(s)
Leptospirosis , Weil Disease , Humans , Weil Disease/drug therapy , Leptospirosis/diagnosis , Leptospirosis/drug therapy , Anti-Bacterial Agents/adverse effects , Norepinephrine/therapeutic use , Japan/epidemiologyABSTRACT
Leptospirosis is a zoonotic disease of worldwide distribution caused by infection with Leptospira genus bacteria, a pathogenic spirochaete. We present the case of a 29-year-old man admitted to our hospital with fever and multiorgan failure. He provided poor information about his symptoms. No recent travel or occupational history was reported and his clinical presentation did not suggest any infectious foci. His relatives later disclosed that he had been homeless for 3 weeks in the context of behavioural changes, obtaining foodstuff from waste containers and water from rain puddles. In the setting of this epidemiology, his presentation of fever, jaundice, acute renal injury and thrombocytopaenia suggested leptospirosis. Prompt empirical antimicrobial coverage was started, alongside organ support therapy. The diagnosis was later confirmed through microscopical and molecular methods. The patient made a full recovery. Leptospirosis should be considered early in the diagnostic work-up of any patient with acute febrile illness with multiorgan system involvement, with the identification of risk factors being essential to treat early in development of the disease.
Subject(s)
Ceftriaxone/administration & dosage , Environmental Exposure , Leptospira interrogans/isolation & purification , Multiple Organ Failure , Thrombocytopenia , Weil Disease , Administration, Intravenous , Adult , Anti-Bacterial Agents/administration & dosage , Critical Care/methods , Diagnosis, Differential , Environmental Exposure/adverse effects , Environmental Exposure/analysis , Fluid Therapy/methods , Ill-Housed Persons , Humans , Kidney Function Tests , Liver Function Tests , Male , Multiple Organ Failure/diagnosis , Multiple Organ Failure/etiology , Thrombocytopenia/diagnosis , Thrombocytopenia/etiology , Treatment Outcome , Weil Disease/blood , Weil Disease/diagnosis , Weil Disease/drug therapy , Weil Disease/therapyABSTRACT
A 35-year-old male patient reached the emergency department after an episode of massive haemoptysis a few hours ago. Fever and dyspnea were mentioned to be present the last 5 days. His medical history included only malaria, successfully treated 2 years ago. Clinical examination revealed high fever, jaundice, cyanosis, tachypnea and bilateral rales on pulmonary auscultation. Laboratory investigation showed high erythrocyte sedimentation rate and C reactive protein, leucocytosis, anaemia, mild thrombocytopaenia, renal impairment, hyperbilirubinaemia and abnormal liver function tests; arterial blood gas analysis showed respiratory alkalosis with severe hypoxia. Thoracic X-ray revealed bilateral pulmonary infiltrates, whereas abdominal and heart ultrasound detected hepatomegaly and small pericardial infusion, respectively. The diagnosis of leptospirosis along with acute respiratory distress syndrome was confirmed by positive IgM Leptospira antibodies. Empirical treatment with triple antibiotic therapy and corticosteroids was applied. The patient was discharged after 1 week, without any symptoms and with almost normal laboratory tests.
Subject(s)
Hemoptysis/microbiology , Respiratory Distress Syndrome/microbiology , Weil Disease/diagnosis , Acute Disease , Adult , Agricultural Workers' Diseases/diagnosis , Agricultural Workers' Diseases/microbiology , Anti-Bacterial Agents/therapeutic use , Diagnosis, Differential , Drug Therapy, Combination , Humans , Male , Weil Disease/drug therapyABSTRACT
Weil syndrome is a fulminant form of leptospirosis, usually caused by spirochetal organism Leptospira interrogans. It is characterized by icterus, petechial rashes over the body, signs of renal failure and hepatic failure. Anaemia is a usual manifes- tation of Leptospira infection, but autoimmune haemolytic anaemia is rare. We report a patient with autoimmune haemolytic anaemia following Leptospira infection, which was responsive to high-dose steroid therapy.
Subject(s)
Anemia, Hemolytic, Autoimmune/immunology , Antibodies, Bacterial/immunology , Immunoglobulin M/immunology , Leptospira interrogans/immunology , Weil Disease/complications , Anemia, Hemolytic, Autoimmune/blood , Anemia, Hemolytic, Autoimmune/diagnosis , Anemia, Hemolytic, Autoimmune/drug therapy , Anti-Bacterial Agents/therapeutic use , Antibodies, Bacterial/blood , Drug Therapy, Combination/methods , Glucocorticoids/administration & dosage , Hemoglobins/analysis , Humans , Immunoglobulin M/blood , Leptospira interrogans/isolation & purification , Male , Middle Aged , Treatment Outcome , Weil Disease/diagnosis , Weil Disease/drug therapy , Weil Disease/microbiologySubject(s)
Humans , Male , Adolescent , Weil Disease/complications , Weil Disease/diagnosis , Weil Disease/drug therapy , Weil Disease/diagnostic imaging , Shock, Septic/diagnosis , Zoonoses/epidemiology , Diagnosis, Differential , Fever/diagnosis , Leptospira interrogans/isolation & purification , Anti-Bacterial Agents/therapeutic useSubject(s)
Hepatitis/etiology , Leptospira interrogans/isolation & purification , Weil Disease/complications , Acute Disease , Acute Kidney Injury/etiology , Adult , Alcohol Drinking/adverse effects , Anti-Bacterial Agents/therapeutic use , Atrial Fibrillation/etiology , Blood Transfusion , Cocaine-Related Disorders/complications , Combined Modality Therapy , Emergencies , Fatal Outcome , Hepatic Encephalopathy/etiology , Hepatitis/microbiology , Humans , Male , Weil Disease/drug therapy , Weil Disease/microbiology , Weil Disease/therapyABSTRACT
We present a case of Weil's disease complicated by a Jarisch-Herxheimer reaction (JHR) after initiation of antibiotics while in the emergency department requiring invasive monitoring and vasopressor support. The case is followed by a brief review of the JHR which is rarely observed with treatment of leptospirosis. A healthy 28-year-old female who recently returned from the Caribbean presented to the emergency department with flu-like symptoms. The patient appeared jaundiced with conjunctival suffusion and was ultimately treated with the appropriate antibiotics for leptospirosis in the ED. She decompensated subsequently, requiring supplemental oxygen, central and arterial line placement, and vasopressor support with norepinephrine. Although rarely encountered and not well reported throughout the literature, initiation of antibiotics can cause a JHR reaction given that Leptospira interrogans is a spirochete. This JHR may be self-limited and of short duration, or it can be prolonged and severe, requiring invasive therapies such as central line placement for vasopressor support and intubation. It is suggested that patients started on antibiotics for leptospirosis/Weil's disease should be monitored in the emergency department for a short duration prior to discharge or transfer to a regular medical floor for observation given the possibility for decompensation.
Subject(s)
Anti-Bacterial Agents/adverse effects , Jaundice/microbiology , Leptospira interrogans/isolation & purification , Norepinephrine/administration & dosage , Vasoconstrictor Agents/administration & dosage , Weil Disease/diagnosis , Adult , Anti-Bacterial Agents/administration & dosage , Drug-Related Side Effects and Adverse Reactions/diagnosis , Female , Humans , Jaundice/etiology , Risk Factors , Travel , Treatment Outcome , Weil Disease/drug therapy , Weil Disease/physiopathologyABSTRACT
BACKGROUND Unexplained renal insufficiency combined with hepatic failure is a common problem encountered by clinicians. As with many disease processes involving multi-organ systems, reversible causes are usually not readily identifiable, and for many patients their health deteriorates rapidly. We present a rare cause of acute renal failure and hyperbilirubinemia occurring simultaneously, with leptospirosis presenting as Weil's disease. CASE REPORT A 53-year-old male presented to our clinic with complaints of anuria over the past two days. His symptoms started with dark urine, severe cramps in the thighs, and chills. The patient was a visitor to the United States from Guyana. Positive physical examination findings included mild tachycardia and hypotension, scleral icterus, and tenderness over abdomen, costovertebral angles, and thighs. The patient had a high white blood cell count, thrombocytopenia, renal/hepatic insufficiency, and an urinary tract infection (UTI). The patient was initially treated under the suspicion of acute kidney injury secondary to rhabdomyolysis and pyelonephritis. The patient continued to deteriorate with decreasing platelet counts, worsening renal function, hyperbilirubinemia, and respiratory distress, with no improvement with hemodialysis. Broad-spectrum antibiotics were administered, including doxycycline, due to a high suspicion of leptospirosis. The patient's condition drastically improved after initiation of doxycycline. On subsequent days, the patient's Leptospira antibody results were available, showing titers of more than 1:3200. Hemodialysis was discontinued as the patient started producing urine with improved kidney function. CONCLUSIONS As world travel becomes more economically feasible, we will continue to encounter foreign endemic diseases. Leptospirosis presenting as Weil's disease is a common cause of renal and hyperbilirubinemia in endemic areas. Often, as was the case for our patient where the time from presentation to acute respiratory distress syndrome (ARDS) was 72 hours, the diagnosis evolves over the course of several days. Antibody testing often takes time and delays in treatment can cause rapid clinical deterioration. In such cases, we recommend beginning empiric treatment before confirmation of laboratory tests.
Subject(s)
Acute Kidney Injury/microbiology , Hyperbilirubinemia/microbiology , Weil Disease/complications , Humans , Male , Middle Aged , Weil Disease/diagnosis , Weil Disease/drug therapySubject(s)
Hemagglutination Tests , Weil Disease/diagnosis , Adolescent , Anti-Bacterial Agents/therapeutic use , Denmark , Diagnosis, Differential , Fever/etiology , Hemagglutination Tests/methods , Humans , Italy , Male , Travel , Treatment Outcome , Weil Disease/blood , Weil Disease/complications , Weil Disease/drug therapy , Weil Disease/immunologyABSTRACT
UNLABELLED: HISTORY AND DIAGNOSIS: A 30-year-old patient was hospitalised with fever and jaundice. No long-term medication was taken. The patient worked as a plumber in refurbishment projects. He presented with headaches, myalgia and arthralgia of varying location and a fever of 38.9â °C. Skin and sclerae were visibly jaundiced. His cardiovascular system was normal. Further routine examination did not reveal any additional signs. INVESTIGATIONS: Having ruled out an acute gallbladder infection or mechanical obstruction of the bile ducts by abdominal ultrasound, an infectious etiology appeared likely, alongside possible toxicological and immunological reasons. Clinical history and diagnosis led to an urgent suspicion of leptospirosis which was confirmed by IgM titer rise within five days in ELISA. TREATMENT AND COURSE: The patient was treated immediately with ceftriaxone. During his stay in the hospital, his fever, jaundice and subjective symptoms subsided. Initial pathological markers also showed a significant trend towards reversion to normal levels. The patient was discharged from the hospital without any symptoms after 16 days. CONCLUSION: Leptospirosis is a significant differential diagnosis in patients with fever, jaundice, headaches and myalgia. Clinical history can provide vital clues for diagnosing this illness. Individuals that are prone to be exposed to water contaminated with rodent urine are at heightened risk of developing the disease. Climatic conditions such as heavy rainfalls or flooding also appear to increase the risk of infection.
Subject(s)
Construction Industry , Occupational Diseases/diagnosis , Occupational Diseases/etiology , Weil Disease/diagnosis , Weil Disease/transmission , Adult , Antibodies, Bacterial/blood , Biopsy , Ceftriaxone/therapeutic use , Diagnosis, Differential , Enzyme-Linked Immunosorbent Assay , Humans , Immunoglobulin M/blood , Liver/pathology , Male , Medical History Taking , Risk Factors , Weil Disease/drug therapy , Weil Disease/pathologyABSTRACT
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
In this report, we describe a case of Weil disease. Chest x-ray and computed tomography (CT) findings showed temporary deterioration 1 day after the initiation of antibiotic treatment, and high-resolution CT findings with the patient's physical findings made us suspect pulmonary alveolar hemorrhage (PAH). We believed that the PAH had been induced by Weil disease and subsequently caused Jarisch-Herxheimer reaction. We confirmed the patient's contact history with mice, and symptoms improved immediately after starting appropriate treatments. Leptospirosis is a relatively rare cause of PAH. Therefore, the possibility of this disease should be included in the differential diagnosis, especially when high-resolution CT findings indicate PAH, and the imaging findings deteriorate rapidly after antibiotic therapy.
Subject(s)
Occupational Diseases/diagnostic imaging , Tomography, X-Ray Computed , Weil Disease/diagnostic imaging , Adult , Animals , Anti-Bacterial Agents/adverse effects , Anti-Bacterial Agents/therapeutic use , Diagnosis, Differential , Hemoptysis/diagnostic imaging , Hemoptysis/etiology , Humans , Male , Mice , Occupational Diseases/complications , Occupational Diseases/drug therapy , Weil Disease/complications , Weil Disease/drug therapySubject(s)
Facial Paralysis/etiology , Leptospira interrogans serovar icterohaemorrhagiae/pathogenicity , Weil Disease/complications , Adolescent , Animals , Anti-Inflammatory Agents/therapeutic use , Antibodies, Bacterial/blood , Disease Vectors , Drug Therapy, Combination , Facial Paralysis/drug therapy , Facial Paralysis/microbiology , Humans , Immunoglobulin M/blood , Leptospira interrogans serovar icterohaemorrhagiae/immunology , Leptospira interrogans serovar icterohaemorrhagiae/isolation & purification , Male , Morocco , Penicillins/therapeutic use , Platelet Transfusion , Prednisolone/therapeutic use , Prisoners , Rats/microbiology , Thrombocytopenia/etiology , Thrombocytopenia/therapy , Tuberculosis, Pleural/complications , Weil Disease/diagnosis , Weil Disease/drug therapyABSTRACT
Leptospirosis in humans is a common zoonotic disease. It is often under-diagnosed, especially when associated with neurological features, resulting in significant morbidity and mortality. This subgroup of patients with neurological manifestations is often empirically treated for cerebral malaria, dengue fever, tuberculous meningitis, hepatic encephalopathy, viral encephalitis, etc. Hence it is important to be aware of uncommon manifestations of this disease. We report one such patient, which highlights the importance of considering leptospirosis as the diagnostic possibility with hepato-renal, pulmonary and nervous system involvement, particularly where diagnostic supports and resources are limited.
Subject(s)
Meningoencephalitis/diagnosis , Weil Disease/diagnosis , Acute Disease , Anti-Bacterial Agents/administration & dosage , Cough/etiology , Diagnosis, Differential , Doxycycline/administration & dosage , Headache/etiology , Hemoptysis/etiology , Humans , Kidney/physiopathology , Leptospira interrogans serovar icterohaemorrhagiae/drug effects , Liver/physiopathology , Male , Meningoencephalitis/pathology , Penicillins/administration & dosage , Seizures/etiology , Vomiting/etiology , Weil Disease/drug therapy , Weil Disease/microbiology , Weil Disease/physiopathology , Young AdultABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Weil Disease/diagnosis , Leptospira/isolation & purification , Weil Disease/drug therapy , Multiple Organ Failure/etiologySubject(s)
Acute Lung Injury/microbiology , Leptospira interrogans serovar icterohaemorrhagiae/isolation & purification , Rural Population , Volunteers , Weil Disease/complications , Weil Disease/diagnosis , Acute Lung Injury/diagnosis , Acute Lung Injury/drug therapy , Adult , Anti-Bacterial Agents/therapeutic use , Ceftriaxone/therapeutic use , Doxycycline/therapeutic use , Drug Therapy, Combination , Humans , Indonesia , Male , Treatment Outcome , Weil Disease/drug therapyABSTRACT
Clinical and laboratory diagnosis of severe leptospirosis (Weil's disease) may be difficult when other pathological processes that may cause similar clinical syndromes or affect immune response to infections coexist. In addition, the optimal management of the disease remains to be defined. We report on a case of Weil's disease, in which concurrent chronic hepatitis B virus infection and alcohol abuse caused diagnostic and therapeutic difficulties.
Subject(s)
Alcoholism/microbiology , Hepatitis B, Chronic/microbiology , Weil Disease/diagnosis , Acute Kidney Injury/etiology , Alcoholism/complications , Anti-Bacterial Agents/therapeutic use , Cefotaxime/therapeutic use , Hepatitis B, Chronic/complications , Humans , Immunocompromised Host , Liver Function Tests , Male , Middle Aged , Serologic Tests , Weil Disease/complications , Weil Disease/drug therapyABSTRACT
Leptospirosis which is caused by Leptospira species, may present with clinical features that vary from a mild flu-like illness to an acute life-threatening condition. Weil's disease, the most severe form of leptospirosis is characterized by multiorgan involvement including liver, kidney and lungs. In this report a severe Weil's disease was presented. A 43 years old male patient who had a history of swallowing water while swimming in the creek, was admitted to the hospital with the complaints of weakness, cough, bloody sputum, generalized jaundice and dark urine. Acute renal failure, bilateral lung infiltration, hyperbilirubinemia, leukocytosis and thrombocytopenia were detected, and the patient has undergone to hemodialysis. Ceftriaxone and ciprofloxacin treatment was applied to the patient after collection of blood, urine and sputum cultures and serum samples for serological tests. None of the cultures yielded pathogenic microorganisms. Microscopic agglutination test (MAT) was applied to two serum samples which were collected with 10 days interval. The first serum sample revealed antibody positivity at 1/200 titer against L. semeranga Patoc I, while the second serum revealed antibody positivity at 1/400 titer against both L. semeranga Patoc I and L. icterohaemorrhagiae Wijnberg. By the administration of antibiotic therapy and early supportive care the patient was cured completely. In conclusion Weil's disease should be taken into consideration in the patients with multiple organ involvements.