[CME: Zoonosis in Switzerland: Leptospirosis]. / CME: Zoonosen in der Schweiz: Leptospirose CME-Fragen.

CME: Zoonosis in Switzerland: Leptospirosis Abstract. Leptospirosis is worldwide a common zoonosis that also occurs in Switzerland. Frequently it presents as a self-limited, mild illness. The more severe presentation with jaundice and sever acute kidney injury (Weil's disease) is, however, associated with a high morbidity and mortality. In order to make the diagnosis, it is important to recognize the typical findings and perform the appropriate diagnostic workup. In this article, we discuss the clinical signs, diagnostic workup, therapy and prevention of leptospirosis and present the case of a 54-year-old patient with severe leptospirosis.

Weil's disease presenting as atypical pneumonia.

Leptospirosis is a disease caused by spp. Leptospira, also known as Weil's disease if it manifests with jaundice. It can be associated with respiratory, renal, hepatic and haematological complications and most importantly carries a high mortality when untreated. We describe a case of a 53 year old man presenting with myalgia and fever in whom the diagnosis of leptospirosis was not initially considered. Following a deterioration in his condition a careful history revealed an apparent brief exposure to animal urine and subsequent grossly positive Leptospira serology. Treatment of his condition led to complete resolution after a brief stay on the intensive care unit. This case highlights the atypical nature of a presentation of Leptospirosis, its respiratory complications, and importance of serological testing in its diagnosis.

[Leptospirosis--disease with many faces]. / Leptospiroza--choroba o róznych obliczach.

Leptospirosis is a zoonotic disease of global reach caused by pathogenic spirochetes of the genus Leptospira. The disease has two periodic phases (septic and immune phase) and its clinical manifestations are diverse. Central nervous system involvement in leptospirosis most commonly occurs as aseptic meningitis, often asymptomatic, only with abnormal cerebrospinal fluid findings. Weil's syndrome is defined as liver damage with acute renal failure and bleeding diathesis, has a high mortality rate. A pulmonary form may occur as an acute respiratory distress syndrome. The reference standard assay is the microscopic agglutination test. A titer of at least 1:400 in the presence of symptoms confirms the diagnosis. The prognosis depends on a rapid identification and treatment with antibiotics. The paper presents selected cases of leptospirosis with its different clinical manifestations. The common feature was a severe illness and sometimes the need for cooperation of doctors of various specialities.

Leptospirosis mimicking sepsis after orthopedic surgery: a case report.

We report a case of leptospirosis that occurred after elective surgery involving tendon transfer and shoulder arthroscopy. The disease mimicked hospital infection after orthopedic surgery and was at first misdiagnosed as post-operative sepsis. The patient was 60 year old female that developed sepsis with hypotension, shock, bleeding, jaundice and renal insufficiency 4 hours after surgery. Shock treatment procedures were performed and broad spectrum antibiotic therapy was used with coverage for bacteria acquired in hospitals. A careful investigation was carried out by the Hospital Infection Control Service in search of the possible source of the infection. After clinical evaluation by a specialist in infectious diseases, the hypothesis of leptospirosis was put forward based on clinical and epidemiological data. The hypothesis was later confirmed by the positive result of serological tests with the microagglutination method that yielded 1:800 and then 1:12,600 7 days later. This is the first reported case of leptospirosis manifest directly following surgery, mimicking postoperative sepsis.

Enfermedad de Weil

Presentamos el caso de una mujer de 29 años, de un sector subnormal de Neiva con un cuadro de fiebre, dolores musculares, ictericia, hemorragia de vías digestivas, sin compromiso hemodinámico y falla renal aguda. La M.A.T. fue positiva para 4 serovars con títulos mayores de 1/800 diluciones. Este es uno de los pocos casos informados en la literatura, causada por múltiples serovars.

[The importance of myoglobin in the pathogenesis of leptospirosis]. / Znachenie mioglobina v patogeneze leptospiroza.

Measurements were made of serum and urine myoglobin in 48 patients with leptospiral jaundice (LJ) and 56 patients with various acute infections. At the height of LJ blood myoglobin level reached 28.96 +/- 4.3 micrograms/l (normal concentration 0.315 +/- 0.002 microgram/l). Compared to acute pneumonia, acute viral hepatitis, tonsillitis, erysipelas, diphtheria, health values, the ratio of serum myoglobin to urine myoglobin in leptospirosis made up 45.25 against 5.4, 4.8, 6.8, 3.7, 1.8 and 1.3, respectively. A relationship was found between concentrations of myoglobin, bilirubin, creatinine in the blood and leptospirosis severity. Elevation of serum myoglobin as a manifestation of specific myositis is pathognomic for leptospirosis and contributes to the onset of acute renal failure and disturbance of bilirubin metabolism. Quantitation of blood myoglobin may be helpful as an additional test for leptospirosis severity.

Leptospira interrogans and Leptospira peptidoglycans induce the release of tumor necrosis factor alpha from human monocytes.

Elevated plasma concentrations of the cytokine tumor necrosis factor alpha (TNF alpha) have been observed in patients affected by leptospirosis. In this study we found that a preparation of peptidoglycan of Leptospira interrogans, serovar copenhageni, was able to induce the release of TNF alpha from peripheral blood mononuclear cells. TNF alpha induction occurred in a dose dependent manner and was not affected by the endotoxin inhibitor polymixin B. This is the first report on induction of TNF alpha release by a peptidoglycan of spirochetes. Our findings are consistent with existing clinical data and provide a potential mechanism for TNF alpha production.

Understanding of Weil's disease among canoeists.

Although the risks of contracting Weil's disease in the UK are small, it can be a serious illness. Recently the disease has attracted public interest. This interest has prompted confusion and anxiety among recreational water user groups such as canoeists who had not previously seen themselves as being particularly at risk. In this paper, the experience of symptoms associated with Weil's disease among canoeists, their understanding and perceptions of the disease, and their compliance with preventive advice on the British Canoe Union (BCU) warning card, have been studied. Gaps in understanding and of adherence to preventive advice were identified. Accordingly, it was concluded that health education for canoeists could be improved. Consideration is being given by the BCU to the value of preparing a canoeist instructors' training pack.

[The mechanisms maintaining epidemic foci of leptospirosis]. / Mekhanizmy podderzhaniia épidemicheskikh ochagov leptospirozov.

24,419 samples of blood serum, collected in the Azerbaijan SSR among different professional groups of the population, have been tested for leptospirosis. The comparison of the results with those obtained in the natural foci of leptospirosis and in the foci of this infection appearing as a consequence of human activities has made it possible to come to the conclusion that the epidemic foci of leptospirosis are maintained due to the existence of foci among cattle. The cases of contamination among persons professionally linked with large cattle breeding complexes have been found to exceed those among persons working at farms of a nonindustrial type.

Concurrent icterohaemorrhagic leptospirosis and septicemic salmonellosis acquired during urban disaster

Adult male after swimming in flood water in an urban area presented icterohaemorrhagic leptospirosis and septicemic salmonellosis. Severe clinical signs were characterized by fever, septicemia, jaundice, vomiting, haemorrhagic diarrhea and acute kidney failure. Peritoneal dialysis and treatment with penicillin and chloramphenicol were applied. Diagnosis was made on clinical, epidemiological and laboratorial basis. There was anticorpic seroconversion specific for L icterochaemorrhagiae. Hemocultures were positive for Salmonella with antigenica structure 4,5,12:i:-, a possible monophasic variant of S. typhimurium, 05 + (4,5,12:i:1,2). The patient survived. Attention is called to the cumulative risks for diseases acquired on exposure on exposure to floods, such as this double occurrence of diseases, both of animal origin. In view of clinical signs of comparable pathogenic and epidemic expression, investigation should be directed towards laboratorial tests for concurrent diseases

Skin reaction to lipids from avirulent strain Shibaura of Leptospira interrogans serovar copenhageni.

Sonically disrupted cells from avirulent strain Shibaura of Leptospira interrogans serovar copenhageni induced a skin reaction characterized by infiltration of polymorphonuclear leukocytes (PMN) associated with some edema in guinea pigs. To determine the substance inducing infiltration of PMN, lipids of avirulent strain Shibaura were extracted with chloroform--methanol--water after washing with acetone. The lipids comprised 28% of the dry weight of the cell. When the lipids were further separated into water--methanol and chloroform fractions, the most severe PMN infiltration of all samples was seen in the skin inoculated with extract recovered from the chloroform fraction. Neutral and polar lipids were detected after thin-layer chromatography of the chloroform extract. Neutral lipids were detected as free fatty acids (FFA). Fatty acids contained in polar lipids were mainly palmitic acid and palmitoleic acid, whereas FFA comprised 66.5% oleic acid. Skin reactions consisting of marked edema with mild infiltration of PMN were elicited by FFA. There was no obvious difference between a commercially available FFA mixture and the FFA from avirulent strain Shibaura. These observations suggest that FFA may play some role in the pathogenesis of leptospirosis.

Glicolipoproteína de Leptospira interrogans sorogrupo icterohaemorrhagiae: distribuiçäo em fígado e rim de cobaias experimentalmente infectadas / Glycoproteins from Leptospira interrogans serogroup icterohaemorrhagiae: distribution in the liver and kidney of experimentally infected guinea pigs

Acredtita-se que as lesöes teciduais na leptospirose possam decorrer da açäo direta das leptospiras, de toxinas sintetizadas ou liberadas durante sua lise. O presente estudo visou a extraçäo química da glicolipoproteína (GLP) da aleptospira, a produçäo de anti-soro anti-GLP e a avaliaçäo de sua distribuiçäo em cortes de fígado e rim de cobaias inoculadas e sacrificadas em estudo sequencial diário até o 6§ dia de infecçäo, correspondente ao pico da doença. Procurou-se também correlacionar a expressäo tecidual da GLP com o grau de lesöes locais, em busca de novos subsídios para a compreensäo da patogenia da leptospiros. A GLP foi detectada em fígado e rim de 2 dentre 6 cobaias no 5§ dia e em todas as 6 no 6§ dia de infecçäo, sob a forma de grânulos no citoplasma de macrófagos, livres no interstício ou acolados à membrana de células endoteliais e parenquimatosas, especialmente nas regiöes mais lesadas. A cronologia do aparecimento da GLP e sua distribuiçäo sugerem tratar-se de produto de lise de leptospiras fagocitadas por macrófagos e que esta substância, conquanto näo comprovada como iniciadora das lesöes, asocia-se a seu agravamento nas etapas mais avançadas da leptospirose

[Glycoproteins from Leptospira interrogans serogroup icterohaemorrhagiae: distribution in the liver and kidney of experimentally infected guinea pigs]. / Glicolipoproteína de Leptospira interrogans sorogrupo icterohaemorrhagiae: distribuição em fígado e rim de cobaias experimentalmente infectadas.

Tissue damage in leptospirosis has been ascribed to direct effect of the microorganisms and/or their virulence, including products synthetized by leptospires or released during their lysis. This study aimed at chemical extraction of the glycolipoprotein (GLP) from virulent leptospires, production of a rabbit anti-GLP and analysis of its distribution in liver and kidney of inoculated guinea-pigs, sacrificed sequentially from the 1st to 6th day of infection, covering the whole, spectrum of acute leptospirosis. The comparison of GLP expression to local injuries aimed at new pathogenetic data. GLP was detected in liver and kidney in 2 out of 6 guinea-pigs on the 5th day and in all 6 animals on the 6th day of infection. Granular forms were seen in the cytoplasm of macrophages, free in interstitium or adhered to endothelial and parenchymal cell membranes, especially in the most damaged sites. These findings lead us to the hypothesis of GLP as a toxic factor resulting from leptospiral lysis by macrophages. Although it was not proved as a promoter of initial lesions, it seems to be related to the enhancement of tissue damage late in the course of the disease.

[Etiological structure and clinical epidemiological characteristics of Leptospira infection in Rostov Province based on data from therapeutic institutions from 1960 to 1983]. / Etiologicheskaia struktura i kliniko-épidemiologicheskaia kharakteri stika leptospiroznoi infektsii v Rostovskoi oblasti po materialam nekotorykh lechebnykh uchrezhdenii za 1960--1983 gg.

Changes in communal conditions, in economy, as well as in ecology and fauna, which took place in Rostov Province during the last decade (1973-1983) determined shifts in the etiological structure of Leptospira infection and in its course. The study revealed an increase in morbidity caused by L. icterohaemorrhagiae (up to 61%) and L. hebdomadis (up to 22%) with a simultaneous decrease in the isolation rate of L. grippotyphosa and L. pomona (up to 2-3%). In most cases (77%) the diseases caused by leptospires of different serogroups were found to take an icteric course accompanied by the development of hepatorenal insufficiency (46%). The similarity of clinical manifestations in different etiological forms of Leptospira infection was determined by common pathogenetic and pathophysiological features characteristic of the development of the leptospiral infectious process.