ro13-9904 and Leptospirosis

Leptospirosis is a zoonotic illness caused by pathogenic spirochetes of the genus Leptospira. The disease spectrum ranges from a mild influenza-like presentation to a more serious Weil's syndrome. Leptospirosis rarely presents as a primary neurological syndrome. We report two cases of Leptospira borgpetersenii serovar Tarasssovi presenting as aseptic meningitis in Sri Lanka.. We describe case reports of two patients presenting as symptomatic aseptic meningitis due to neuroleptospirosis. Both patients had significant neurological involvement at presentation in the absence of common clinical features of leptospirosis. These patients were initially managed as bacterial or viral meningitis and leptospirosis was suspected due to a history of exposure to contaminated water. Subsequently, they were diagnosed to have neuroleptospirosis by positive Leptospira serology and both patients gained full recovery.. Our report highlights the importance of considering leptospirosis as a differential diagnosis in patients with aseptic meningitis in endemic settings. Obtaining a detailed occupational and recreational history is helpful in diagnosing neuroleptospirosis promptly. We report the association of Leptospira borgpetersenii serovar (sv.) Tarassovi (strain bakeri) in causing aseptic meningitis, which has not been reported to the best of our knowledge.

Topics: Acyclovir; Adult; Animals; Anti-Bacterial Agents; Anti-Inflammatory Agents; Antiviral Agents; Ceftriaxone; Dexamethasone; Diagnosis, Differential; Drinking Water; Humans; Leptospira; Leptospirosis; Male; Meningitis, Aseptic; Serogroup; Sri Lanka; Treatment Outcome

In this report, two cases of leptospirosis admitted to our clinic in the same periods, have been presented. The first patient was a 29 years old male farmer, and the other was a 44 years old male prisoner. Both of them were from Middle Anatolian Region with the similar clinical findings (subfebrile fever, gastrointestinal complaints, ichterus in sclera, leucocytosis, and increased levels of liver enzymes, urea and creatine). The diagnosis was based on the antibody positivities against Leptospira with microscopic agglutination test which performed in the Etlik Central Veterinary Control and Research Institute. The first case was positive for L. grippotyphosa, and the second was positive for L. australis serovar bratislava at the titers of 1/800. Both of the patients were given empirical antibiotic treatment (ceftriaxone 2 x 1 gr, and ampicillin-sulbactam 4 x 1 gr, respectively), and discharged with complete healing. These cases led us to review the other leptospirosis cases in our country.

Topics: Adult; Agglutination Tests; Ampicillin; Anti-Bacterial Agents; Antibodies, Bacterial; Ceftriaxone; Humans; Leptospira; Leptospira interrogans serovar australis; Leptospirosis; Male; Sulbactam

The optimal treatment of severe and late leptospirosis, and even the need for antibiotic treatment in such clinical settings, remains a subject of debate. Twenty-two patients with severe late leptospirosis were treated with intravenous ceftriaxone 2g daily. Twenty-one patients recovered and one patient passed away due to respiratory complications of the disease. The adverse effect profile and the convenience of the regimen were superior to penicillin regimens reported in other clinical trials. Ceftriaxone may be a reasonable alternative in severe leptospirosis as an efficient, convenient and safe regimen. Large multicentre studies may further define the optimal interventions in severe leptospirosis as well as possible variations in the pathogenic and clinical parameters of respiratory leptospirosis.

Topics: Adult; Aged; Anti-Bacterial Agents; Ceftriaxone; Female; Humans; Leptospirosis; Male; Middle Aged

A prospective, open-label, randomized trial at Khon Kaen Hospital (Thailand) was conducted from July 2000 through December 2001 to compare the clinical efficacies of ceftriaxone and sodium penicillin G for the treatment of severe leptospirosis. A total of 173 patients with severe leptospirosis were randomly assigned to be treated with either intravenous ceftriaxone (1 g daily for 7 days; n=87) or intravenous sodium penicillin G (1.5 million U every 6 h for 7 days; n=86). The primary outcome was time to fever resolution. Survival analysis demonstrated that the median duration of fever was 3 days for both groups. Ten patients (5 in each group) died of leptospirosis infection. There were no statistically significant differences in the duration of organ dysfunction. Ceftriaxone and sodium penicillin G were equally effective for the treatment of severe leptospirosis. Once-daily administration and the extended spectrum of ceftriaxone against bacteria provide additional benefits over intravenous penicillin.

Topics: Adult; Ceftriaxone; Cephalosporins; Female; Humans; Leptospirosis; Male; Middle Aged; Penicillin G; Penicillins; Prospective Studies; Thailand; Treatment Outcome

Leptospirosis is a common zoonotic disease, especially in agricultural countries. Neurological manifestations of leptospirosis (neuroleptospirosis) have been reported in a study with a small number of patients. Here we report seven consecutive patients with neuroleptospirosis admitted to a neurology ward. All seven patients had a meningoencephalitis-like presentation. Leptospirosis was confirmed by polymerase chain reaction. None of the patients had systemic involvement. All patients responded significantly to intravenous ceftriaxone and oral doxycycline, recovering completely. Diagnosis of neuroleptospirosis should always be considered in patients with acute meningoencephalitis along with bacterial and viral encephalitis. Prognosis is good with early diagnosis and appropriate treatment.

Topics: Ceftriaxone; Humans; India; Leptospirosis; Meningoencephalitis; Neurology

The clinical manifestations of leptospirosis range from mild to life-threatening and can impact on multiple organ systems. A wide array of neurological manifestations of leptospirosis have been reported, although the pathophysiology of neuroleptospirosis remains incompletely understood. We present a case of leptospirosis complicated by bilateral sensorineural deafness, with nodular meningitis demonstrated in the internal auditory meatus on magnetic resonance imaging. The patient was treated with doxycycline, ceftriaxone, systemic and topical steroids, and hyperbaric oxygen therapy, with modest, but incomplete, improvement.

Topics: Ceftriaxone; Hearing Loss, Bilateral; Hearing Loss, Sensorineural; Humans; Hyperbaric Oxygenation; Leptospirosis

Topics: Anti-Bacterial Agents; Azithromycin; Blood Culture; Ceftriaxone; Drug Therapy, Combination; Humans; Leptospira; Leptospirosis; Male; Middle Aged; Shock, Septic

Neurological manifestations of leptospirosis without severe multiorgan involvement are a rare clinical entity. Despite the increasing prevalence of the disease in many tropical countries, its protean clinical presentations make its timely diagnosis challenging. We report the case of a 44-year-old Filipino man presenting with fever, myalgia, behavioural changes and altered sensorium. Neurological examination did not show any focal neurological deficits or clear signs of meningoencephalitis. Lumbar tap, cranial CT scan and cranial MRI were inconclusive. The diagnosis of leptospirosis with acute encephalitis relied heavily on the patient's clinical clues, appropriate exposure history and patterns in ancillary laboratory tests. Empiric antibiotic therapy with ceftriaxone was initiated. Seroconversion and fourfold increase in serological antibody titres by leptospirosis microagglutination test later confirmed the diagnosis. The patient was successfully treated, and all neurological complications were reversed.

Topics: Adult; Anti-Bacterial Agents; Behavioral Symptoms; Ceftriaxone; Humans; Leptospira; Leptospirosis; Male

Leptospirosis is a reemerging zoonosis with a worldwide distribution and a wide range of clinical manifestations. We report a case of leptospirosis meningitis in a previously healthy woman infected by her pet mouse.. A 27-year-old Caucasian woman with pet mice presented to our institute with a 1 week history of fever, headache, myalgia, vomiting, diarrhea, and dark urine. Her admission examination revealed neck stiffness, conjunctivitis, and icteric sclera. Her liver enzymes, bilirubin, white blood cell count, and C-reactive protein were elevated. Her cerebrospinal fluid showed an elevated white blood cell count. Polymerase chain reactions using her cerebrospinal fluid, blood, and urine showed negative results for leptospirosis, but the result of her microagglutination test was positive for Leptospira interrogans serovar sejroe with a more than threefold increase in paired sera. The patient was treated with ceftriaxone for 1 week, and her condition steadily improved.. This case report raises awareness of pet rodents as sources of leptospirosis. Leptospirosis meningitis should be considered in patients with meningeal symptoms and pet rodents.

Topics: Adult; Animals; Anti-Bacterial Agents; Ceftriaxone; Female; Humans; Leptospira interrogans; Leptospirosis; Meningitis, Bacterial; Mice; Pets; Rodent Diseases; Zoonoses

Topics: Adolescent; Anti-Bacterial Agents; Arrhythmias, Cardiac; Ceftriaxone; Child; Child, Preschool; Female; Heart Block; Hospitals, Pediatric; Humans; Leptospirosis; Male; Osteomyelitis; Shock, Septic; Singapore; Tertiary Care Centers

Leptospirosis is one of the leading global zoonotic causes of morbidity and mortality. It is induced by a pathogenic spirochete of the genus Leptospira. The icteric form of leptospirosis is characterized by pronounced hyperbilirubinemia and associated with significantly increased mortality. Conventional static liver function tests insufficiently assess hepatic damage and have limited prognostic value. Dynamic tests, such as indocyanine green plasma (ICG) clearance, more adequately reflect hepatic functional status. In this case report we describe the ICG plasma disappearance rates (ICG-PDR) in a patient with leptospirosis and massive hyperbilirubinemia, expanding our knowledge of liver dysfunction in icteric leptospirosis.. A 21-year-old Caucasian man presented with acute-onset jaundice, myalgia, fever and headaches. Laboratory tests upon admission revealed, most notably, acute kidney failure and hyperbilirubinemia of 17 mg/dl with mild elevation of aminotransferases. In the course of the following 4 days, total serum bilirubin increased to 54 mg/dl. The clinical outcome was favorable with intravenous ceftriaxone and doxycycline. Presumptive diagnosis of leptospirosis was later confirmed by PCR-based amplification of leptospiral DNA in the blood. ICG-PDR values, bilirubin as well as aminotransferases were recorded throughout hospitalization and a 3-month follow-up period. Initially dramatically reduced ICG-PDR (2.0%/min, normal range: 18-25%/min) rapidly normalized within 10 days, while bilirubin remained elevated up to week 7. Mild elevation of serum alanine aminotransferase was at its peak of 124 U/l by day 12 and reached close to normal levels by week 7 upon admission.. Markedly diminished ICG-PDR values presented in this case report suggest severe liver function impairment in the acute phase of icteric leptospirosis. Prolonged elevation of serum bilirubin may not adequately reflect recovery of liver injury in this disease. ICG clearance appears to be a promising marker for the detection of hepatic dysfunction and recovery in icteric leptospirosis in addition to the static tests.

Topics: Alanine Transaminase; Ceftriaxone; Coloring Agents; Doxycycline; Humans; Hyperbilirubinemia; Indocyanine Green; Leptospirosis; Liver Diseases; Liver Function Tests; Male; Young Adult

Tropical infections form 20-30% of ICU admissions in tropical countries. Diarrheal diseases, malaria, dengue, typhoid, rickettsial diseases and leptospirosis are common causes of critical illness. Overlapping clinical features makes initial diagnosis challenging. A systematic approach involving (1) history of specific continent or country of travel, (2) exposure to specific environments (forests or farms, water sports, consumption of exotic foods), (3) incubation period, and (4) pattern of organ involvement and subtle differences in manifestations help in differential diagnosis and choice of initial empiric therapy. Fever, rash, hypotension, thrombocytopenia and mild derangement of liver function tests is seen in a majority of patients. Organ failure may lead to shock, respiratory distress, renal failure, hepatitis, coma, seizures, cardiac arrhythmias or hemorrhage. Diagnosis in some conditions is made by peripheral blood smear examination, antigen detection or detection of microbial nucleic acid by PCR. Tests that detect specific IgM antibody become positive only in the second week of illness. Initial therapy is often empiric; a combination of intravenous artesunate, ceftriaxone and either doxycycline or azithromycin would cover a majority of the treatable syndromes. Additional antiviral or antiprotozoal medications are required for some specific syndromes. Involving a physician specializing in tropical or travel medicine is helpful.

Topics: Artesunate; Azithromycin; Ceftriaxone; Child; Communicable Diseases; Critical Care; Dengue; Diagnosis, Differential; Doxycycline; Exanthema; Female; Fever; Geography; Humans; Intensive Care Units; Leptospirosis; Malaria; Male; Nervous System Diseases; Pregnancy; Shock, Hemorrhagic; Syndrome; Travel; Tropical Medicine; Typhoid Fever

Topics: Adult; Anti-Bacterial Agents; Antibodies, Bacterial; Ceftriaxone; DNA, Bacterial; Endemic Diseases; Enzyme-Linked Immunosorbent Assay; Heart; Humans; India; Leptospira; Leptospirosis; Male; Myocarditis; Polymerase Chain Reaction; Radiography; Tachycardia, Sinus; Thorax; Travel-Related Illness; Treatment Outcome

We report a one-health investigation of three cases of leptospirosis on a dairy farm with unvaccinated cattle in New Zealand. The cases are discussed in the context of diagnostics, risk factors, persistence of symptoms and outbreak mitigation measures.. Clinical and laboratory records from the human cases were reviewed and serological and molecular investigations were conducted into the Leptospira status of cattle and pigs on the farm.. Cases presented early in their illness and all three were confirmed within seven days of onset of symptoms by urine PCR and within 18 days by convalescent MAT (two Hardjo, one Pomona). Cattle and pigs had serological evidence of recent infection with Hardjo/Pomona and Pomona/Copenhageni respectively. Pigs were slaughtered and cattle were vaccinated. Post-exposure prophylaxis was given to staff in-contact with the milking herd until the herd had antibiotic treatment at drying-off (approximately four months after the initial case).. The utility of PCR testing for Leptospira DNA as both an early and rapid test for leptospirosis was demonstrated. Two of three cases reported persistence of symptoms at least six months after the acute episode and one of these remains unable to work. Risk mitigation measures such as post-exposure prophylaxis, animal vaccination, heightened clinical suspicion of leptospirosis and recognition of context specific risk factors (eg, effluent spreading) demonstrate the value of medical and veterinary experts working together.

Topics: Animals; Anti-Bacterial Agents; Antibodies, Bacterial; Cattle; Ceftriaxone; Doxycycline; Farms; Female; Humans; Leptospira; Leptospirosis; Male; New Zealand; Risk Factors; Swine; Vaccination

We describe a case of intermediate leptospirosis resulting from Leptospira licerasiae infection in a traveler returning to Japan from Brazil. Intermediate leptospirosis should be included in the differential diagnosis for travelers with fever returning from South America. This case highlights the need for strategies that detect pathogenic and intermediate Leptospira species.

Topics: Adult; Anti-Bacterial Agents; Antibodies, Bacterial; Brazil; Ceftriaxone; Humans; Japan; Leptospira; Leptospirosis; Male; Travel

The aim of this study is to investigate predictive factors for intensive care unit (ICU) admission among patients with severe leptospirosis.. This is a retrospective study with all patients with severe leptospirosis admitted to a tertiary hospital. Patients were divided in ICU and ward groups. Demographical, clinical and laboratory data of the groups were compared as well as acute kidney injury (AKI) severity, according to the RIFLE criteria (R = Risk, I = Injury, F = Failure, L = Loss, E = End-stage kidney disease).. A total of 206 patients were included, 83 admitted to ICU and 123 to ward. Mean age was 36 ± 15.8 years, with 85.9% males. Patients in ICU group were older (38.8 ± 15.7 vs. 34.16 ± 15.9 years, p = 0.037), had a shorter hospital stay (4.13 ± 3.1 vs. 9.5 ± 5.2 days, p = 0.0001), lower levels of hematocrit (29.6 ± 6.4 vs. 33.1 ± 8.6%, p = 0.003), hemoglobin (10.2 ± 2.4 vs. 11.6 ± 1.9 g/dL, p < 0.0001), and platelets (94,427 ± 86,743 vs. 128,896 ± 137,017/mm(3), p = 0.035), as well as higher levels of bilirubin (15.0 ± 12.2 vs. 8.6 ± 9.5 mg/dL, p = 0.001). ICU group also had a higher frequency of severe AKI (RIFLE-"Failure": 73.2% vs. 54.2%, p < 0.0001) and a higher prevalence of dialysis requirement (57.3% vs. 27.6%, p < 0.0001). Mortality was higher among ICU patients (23.5% vs. 5.7%, p < 0.0001). Independent predictors for ICU admission were tachypnea (p = 0.027, OR = 13, CI = 1.3-132), hypotension (p = 0.009, OR = 5.27, CI = 1.5-18) and AKI (p = 0.029, OR = 14, CI = 1.3-150). Ceftriaxone use was a protective factor (p = 0.001, OR = 0.13, CI = 0.04-0.4).. Independent risk factors for ICU admission in leptospirosis include tachypnea, hypotension and AKI. Ceftriaxone was a protective factor for ICU admission, suggesting that its use may prevent severe forms of the disease.

Topics: Acute Kidney Injury; Adult; Anti-Bacterial Agents; Ceftriaxone; Cross-Sectional Studies; Female; Humans; Hypotension; Intensive Care Units; Length of Stay; Leptospirosis; Male; Middle Aged; Odds Ratio; Retrospective Studies; Risk Factors; Severity of Illness Index; Survival Rate

Undifferentiated febrile illness in a returning soldier is a common problem encountered by serving medical officers. A 32-year-old soldier presented to Birmingham Heartlands Hospital with fever and acute kidney injury after return from Borneo. Leptospirosis was suspected and empirical antibiotics were started before subsequent confirmation by serology and PCR. Leptospirosis is common in South-East Asia, and troops exercising in jungle areas, and in the UK, are at risk. Advice, including inpatient management when appropriate, is available from the UK Role 4 Military Infectious Diseases and Tropical Medicine Service.

Topics: Acute Kidney Injury; Adult; Anti-Bacterial Agents; Borneo; Ceftriaxone; Diarrhea; DNA, Bacterial; Doxycycline; Fever; Humans; Immunoglobulin M; Leptospira; Leptospirosis; Male; Military Personnel; Myalgia; Polymerase Chain Reaction; Serologic Tests; Travel; United Kingdom

Leptospirosis involves nervous system in around 10-15% of the cases, the commonest presentation being aseptic meningitis. Most of the clinical features of neuroleptospirosis are due to capillary endothelial damage and vasculitis. Ataxia is an extremely uncommon manifestation of Leptospirosis occuring in <5% of cases.. A 28 year old female from North India presented with a short febrile illness followed by an acute onset cerebellar ataxia, anemia, thrombocytopenia and transaminitis. Leptospira serology showed high titres of IgM (ELISA) and MAT (microscopic agglutination test titre >1:800) . She was treated with intravenous ceftriaxone for 14 days following which she showed marked recovery.. The clinical features of neuroleptospirosis are varied, most of them resulting from endothelial damage and vasculitis. Immune mediated phenomenon with no structural damage is another possible mechanism leading to cerebellar ataxia. Cerebellar ataxia due to common tropical infections should be ruled out in the appropriate setting, as early institution of treatment can abate neurological morbidity. The case report highlights the importance of identifying a reversible cause of cerebellar ataixa due to a tropical infection, possibly due to a immune mediated phenomenon, and would be of interest to both internists and neurologists.

Topics: Adult; Agglutination Tests; Anti-Bacterial Agents; Antibodies, Bacterial; Brain; Ceftriaxone; Cerebellar Ataxia; Enzyme-Linked Immunosorbent Assay; Female; Humans; Immunoglobulin M; Leptospira; Leptospirosis; Magnetic Resonance Imaging

Topics: Anti-Bacterial Agents; Ceftriaxone; Diabetes Mellitus, Type 2; Humans; Leptospirosis; Magnetic Resonance Imaging; Male; Middle Aged; Myocarditis; Pancreatitis

Short-course (less than 7 days) antibiotic treatments have been rarely assessed in the management of leptospirosis. We analyzed the charts of patients hospitalized with confirmed and probable leptospirosis in a teaching hospital between 1994 and 2012. Of 89 patients with confirmed or probable leptospirosis, 21 patients (11 confirmed, 10 probable - 14 uncomplicated and 7 severe forms) admitted between 2001 and 2012 received ceftriaxone (1-2 g daily) for less than 7 days. Apyrexia was obtained within 2 days of treatment in all patients and no relapse was observed. These data support the hypothesis that short-course treatments of 3-6 days with ceftriaxone (1-2 g per day) may be an option in the treatment of uncomplicated and severe forms of leptospirosis responding quickly to therapy. This hypothesis deserves being confirmed in further clinical studies.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Ceftriaxone; Child; Female; France; Humans; Leptospira; Leptospirosis; Male; Middle Aged; Retrospective Studies; Young Adult

An increasing number of travelers from western countries visit tropical regions, questioning western physicians on the prophylaxis, the diagnosis and the therapeutic management of patients with travel-associated infection. In July 2014, a French couple stayed for an adventure-travel in Columbia without malaria prophylaxis. A week after their return the woman presented with fever, myalgia, and retro-orbital pain. Three days later, her husband presented similar symptoms. In both patients, testing for malaria, arboviruses and blood cultures remained negative. An empirical treatment with doxycycline and ceftriaxone was initiated for both patients. Serum collected from the female patient yielded positive IgM for leptospirosis but was negative for her husband. Positive Real-Time PCR were observed in blood and urine from both patients, confirming leptospirosis. Three lessons are noteworthy from this case report. First, after exclusion of malaria, as enteric fever, leptospirosis and rickettsial infection are the most prevalent travel-associated infections, empirical treatment with doxycycline and third generation cephalosporin should be considered. In addition, the diagnosis of leptospirosis requires both serology and PCR performed in both urine and blood samples. Finally, prophylaxis using doxycycline, also effective against leptospirosis, rickettsial infections or travellers' diarrhea should be recommended for adventure travelers in malaria endemic areas.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Colombia; Diagnosis, Differential; Doxycycline; Female; Fever; France; Humans; Leptospirosis; Malaria; Male; Rickettsia Infections; Travel; Treatment Outcome; Typhoid Fever

Topics: Anti-Bacterial Agents; Ceftriaxone; Fever; Humans; Hypotension; Leptospirosis; Male; Middle Aged; Travel

We report a case of severe leptospirosis that occurred during winter in Tokyo, the capital of Japan. Leptospirosis is endemic in tropical regions and extremely rare in the urban areas of Japan. Only six new cases were reported in Tokyo in 2014. Most leptospirosis cases reported in urban areas of Japan were a result of occupational hazards, and there is no previous report of leptospirosis in a homeless patient in Tokyo. We believe this report could provide a widened perspective about the clinical presentation and epidemiology of leptospirosis in Japan.. Our patient was a 73-year-old Asian man. He had been homeless for over 10 years, with exposure to rodents and their excrement in parks and on the streets. He presented with fever and severe inflammatory response, satisfying the diagnostic criteria for systemic inflammatory response syndrome. Laboratory findings showed multiple-organ dysfunction, including renal failure, liver failure with increased total bilirubin level, and coagulopathy with decreased platelets. We suspected leptospirosis on the basis of these clinical findings. The diagnosis was also confirmed by polymerase chain reaction first, and paired antibody titers on day 9, in the recovery period, showed positive results for three species.. Our patient's case suggests that even patients without a history of traveling abroad or exposure to freshwater can develop leptospirosis in winter in urban areas in Japan. If a patient has symptoms like fever, calf pain and MOF; as a differential diagnosis we should rule outthe Leptospirosis. From the perspective of sensitivity, specificity, and clinical convenience, polymerase chain reaction could be the preferred diagnostic tool of choice.

Topics: Aged; Anti-Bacterial Agents; Ceftriaxone; Humans; Ill-Housed Persons; Leptospirosis; Male; Polymerase Chain Reaction; Systemic Inflammatory Response Syndrome; Tokyo

Leptospirosis is not a major disease in urban areas of Japan. We describe a 49-year-old man with leptospirosis, who lived in an urban area and had no history of living in endemic area of leptospirosis. As he worked at a fish market infested with rats, he was suspected of having contracted leptospirosis and received antimicrobial agent treatment. Serum and urinary tests confirmed the diagnosis of leptospirosis. Although it took six days from the onset until treatment initiation, the patient improved in response to receiving ceftriaxone for seven days. Analyzing past reports of Japanese patients with leptospirosis who had no history of overseas travel, we identified 90 patients with courses similar to that of our patient, and the period from onset to treatment initiation was about six days on average (described in 46 cases). Health care providers as well as patients need to recognize that even people with no history of being in an endemic area of leptospirosis may still be at risk of developing this disease depending on occupations and activities.

Topics: Anti-Bacterial Agents; Ceftriaxone; Humans; Japan; Leptospirosis; Male; Middle Aged

We report the case of a 33-year-old primigravida who presented at 37 weeks of gestation with symptoms suggestive of acute fatty liver of pregnancy, but was later diagnosed with leptospirosis (i.e. Weil’s disease or syndrome) on serological testing. Cardiotocography showed fetal distress, and an emergency Caesarean section was performed. A healthy neonate with no evidence of congenital leptospirosis was delivered. The patient was treated with intravenous ceftriaxone and discharged well 13 days after admission. Herein, we discuss the patient’s clinical presentation and the cardiotocography changes observed in leptospiral infection, and review the current literature.

Topics: Adult; Cardiotocography; Ceftriaxone; Cesarean Section; Diagnosis, Differential; Fatty Liver; Female; Fetal Distress; Humans; Leptospira; Leptospirosis; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Treatment Outcome; Ultrasonography

Topics: Anti-Bacterial Agents; Ceftriaxone; Doxycycline; Female; Humans; Leptospirosis; Male

We report the patient data in 77 cases of leptospirosis confirmed by PCR and/or serology (micro-agglutination), observed between 1994 and 2008 at the Besançon teaching hospital. Our aim was to compare the epidemiological, clinical, biological, and therapeutic characteristics of leptospirosis in the Franche-Comté region, to those reported in other regions.. The median age was 42years and 95% were male patients. Leptospirosis acquisition was likely related to aquatic leisure activities (50.6%), professional exposure (28.6%), building maintenance works (11.7%), or unknown (9.1%). Forty-eight cases were uncomplicated and 29 were severe presentations of leptospirosis. Among severe cases, eight patients had to be managed in an intensive care unit, and one patient died. L. grippotyphosa and L. icterohaemorrhagiae were the main serogroups involved. Age above 50years and serogroup L. icterohaemorrhagiae were positively associated with clinical severity. The outcome was favorable for 15 patients treated with ceftriaxone for less than 7days.. We recommended conducting clinical trials aiming at validating short courses of ceftriaxone to treat leptospirosis.

Topics: Adolescent; Adult; Aged; Amoxicillin; Animals; Anti-Bacterial Agents; Ceftriaxone; Child; Environmental Exposure; Female; France; Hospitals, Teaching; Humans; Leptospira interrogans; Leptospirosis; Male; Middle Aged; Occupational Diseases; Retrospective Studies; Symptom Assessment; Travel; Water Microbiology; Young Adult; Zoonoses

Topics: Agglutination Tests; Anti-Bacterial Agents; Ceftriaxone; Child, Preschool; Diagnosis, Differential; Drug Therapy, Combination; Enzyme-Linked Immunosorbent Assay; Glucocorticoids; Humans; Immunoglobulin M; Leptospira; Leptospirosis; Lymphohistiocytosis, Hemophagocytic; Male

Topics: ADAM Proteins; ADAMTS13 Protein; Anti-Bacterial Agents; Ceftriaxone; Diagnosis, Differential; Humans; Leptospirosis; Male; Middle Aged; Purpura, Thrombotic Thrombocytopenic

Leptospirosis is a zoonotic disease with protean manifestations. A 35-year-old male presented with pneumonia after the Typhoon Morakot. Skin rash, conjunctival suffusion, and subconjunctival hemorrhage led us to the diagnosis of leptospirosis and the microscopic agglutination test confirmed the diagnosis. This patient well demonstrated the picture of conjunctival suffusion and reminded us of the alertness of leptospirosis after a typhoon.

Topics: Adult; Ceftriaxone; Cyclonic Storms; Humans; Leptospirosis; Male; Penicillins; Pneumonia, Bacterial; Taiwan; Treatment Outcome

In October 2011, a case of leptospirosis was identified in a Dutch traveller returning from the Dominican Republic to the Netherlands. The 51-year-old man had aspired muddy water in the Chavón river on 29 September. Twenty days later he presented with fever, nausea, vomiting, diarrhoea, arthralgia, headache, conjunctival suffusion and icterus. Leptospira serovar Icterohaemorrhagiae or Australis infection was confirmed ten days later by laboratory testing.

Topics: Agglutination Tests; Anti-Bacterial Agents; Antibodies, Bacterial; Ceftriaxone; Dominican Republic; Doxycycline; Enzyme-Linked Immunosorbent Assay; Fever; Humans; Leptospira interrogans; Leptospirosis; Male; Middle Aged; Netherlands; Severity of Illness Index; Travel; Treatment Outcome

Topics: Anti-Bacterial Agents; Ceftriaxone; Humans; Hypokalemia; Kidney Diseases; Leptospirosis; Male; Middle Aged; Paralysis; Penicillins; Treatment Outcome

In leptospirosis, severe pulmonary hemorrhagic syndrome has replaced Weil's disease as the main cause of mortality, with rates of up to 75%. Four men, all farmers, were admitted to the intensive care unit between August 2009 and July 2010 with a diagnosis of acute respiratory distress syndrome. All patients presented with fever, hemoptysis, bilateral pulmonary infiltrates in chest radiographs, and thrombocytopenia and had compatible epidemiological history with leptospirosis; 3 patients had anemia, 3 had renal failure, 2 had increased creatine kinase, whereas bilirubin was slightly increased in only 1 patient. Leptospirosis was diagnosed serologically in all cases. Empirical therapy with ceftriaxone was administered immediately to all patients, while implementation of ARDSnet protective mechanical ventilation approach combined with an early goal-directed hemodynamic approach led to a relatively low mortality rate (25%). Acute Physiology and Chronic Health Evaluation II, Simplified Acute Physiology Score II and Sepsis-Related Organ Failure Assessment scoring systems were unable to predict the outcome of the patients with leptospirosis-associated severe pulmonary hemorrhagic syndrome.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Ceftriaxone; Hemorrhage; Humans; Leptospirosis; Lung; Lung Diseases; Male; Middle Aged; Radiography; Respiration, Artificial; Respiratory Distress Syndrome; Retrospective Studies

Topics: Anti-Bacterial Agents; Ceftriaxone; Drug Therapy, Combination; Fever; Humans; Leptospirosis; Male; Middle Aged; Muscle Rigidity; Penicillin G; Tachycardia

To investigate the prevalence of leptospirosis among patients from within and outside Kolkata, India, attending the Calcutta School of Tropical Medicine, for treatment during August 2002 to August 2008.. The leptospirosis cases were determined on the basis of clinical, epidemiological, and biochemical factors, and were tested for leptospiral antibodies using IgM ELISA. Serum samples with absorbance ratio ≥ 1.21 were interpreted as reactive.. The commonest presentation involved fever, headache and jaundice. The male-female ratio was 61:46. A total of 65(64.20%) cases had abnormal liver and renal functions respectively, and 57.1% had both the abnormalities. The highest incidence (75, 35.04%) was recorded in September-October followed by July-August (53, 24.77%). The reactive cases had absorbance ratios between 1.21 and 8.21, and 53 showed equivocal result, while IgM non reactivity were seen in 90 patients (absorbance ratios 0.10-0.90). The patients responded to treatment with parenteral antibiotics, penicillin, ceftriaxone and cefotaxime; follow up did not reveal case fatality.. The cardinal signs of leptospirosis help in making clinical diagnosis, but in any hyper-endemic situation any patient reporting with acute fever and signs of pulmonary, hepatic or renal involvement should be suspected to have leptospirosis and investigated accordingly. Increased awareness, and early diagnosis and treatment, can reduce mortality due to leptospirosis.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Antibodies, Bacterial; Cefotaxime; Ceftriaxone; Child; Climate; Drug Therapy, Combination; Enzyme-Linked Immunosorbent Assay; Female; Fever; Headache; Humans; Immunoglobulin M; Incidence; India; Infusions, Intravenous; Jaundice; Leptospira; Leptospirosis; Male; Middle Aged; Penicillins; Retrospective Studies; Risk Factors; Young Adult

Topics: Anti-Bacterial Agents; Ceftriaxone; Doxycycline; Female; Humans; Leptospirosis; Male

Topics: Agricultural Workers' Diseases; Anti-Bacterial Agents; Ascites; Ceftriaxone; Humans; Leptospirosis; Male; Middle Aged; Peritonitis; Treatment Outcome

Topics: Anti-Bacterial Agents; Anti-Inflammatory Agents; Antibodies, Monoclonal; Ceftriaxone; Crohn Disease; Gastrointestinal Agents; Humans; Infliximab; Leptospira interrogans serovar icterohaemorrhagiae; Leptospirosis; Male; Middle Aged; Quality of Life; Transaminases; Treatment Outcome

Leptospirosis, a disease of protean manifestations occurs sporadically throughout the year with a peak seasonal incidence during the rainy season. We hereby present a case that had clinical features of nephrotic syndrome with massive proteinuria. Leptospirosis was detected on ELISA testing. Patient was cured with antibiotics and diuretics.

Topics: Adult; Ceftriaxone; Enzyme-Linked Immunosorbent Assay; Furosemide; Humans; Immunoglobulin M; Leptospira; Leptospirosis; Male; Nephrotic Syndrome; Proteinuria; Treatment Outcome

Leptospirosis is an emerging zoonosis world wide; it is being reported in many areas of south-east Asia now. A recent surge in the number of patients with leptospirosis has been noted in the Sub-Himalayan region of North India which was uncommon. We present here a case series of 13 patients who were positive for leptospirosis either by IgM Elisa or PCR method.. To study the profile of leptospirosis in a sub-Himalayan state of North India i.e. Himachal Pradesh.. This was a retrospective study of leptospira positive patients who were admitted in IGMC, Shimla. The study was conducted in Indira Gandhi Medical College, Shimla situated at a moderate altitude in North India.. All patients presenting in Medical College Hospital during three months from 1st August to 31st October who tested IgM positive or borderline or PCR positive for leptospirosis were taken into the study. Their presenting complaints, examination findings and lab findings were recorded and analyzed based on the Faine's criteria and modified Faine's criteria. Patients with clinical features of Leptospirosis and who tested positive for IgM Leptospirosis were taken as IgM lepto can be falsely positive.. Out of total 13 patients there were 3 males and 10 females, age range was from 24 to 78 yrs and mean was 44 yrs. Predominant complaints were fever, jaundice, myalgia, and headache. All had contact with animals or contaminated environment. LFT's were deranged in 12 and renal functions were deranged in all. Ten had positive results for IgM against leptospira while 2 had borderline positive result. One patient was positive by PCR method using G1, G2 primers. Ten patients had Weil's syndrome and this was the main presentation of leptospirosis in our group, one had acute respiratory distress syndrome (ARDS) and needed ventilator. There were no deaths. All responded to injectable ceftriaxone and oral doxycycline. Applying Faine's criteria only 7 were positive, but using modified Faine's criteria all 13 were positive for leptospirosis.. Leptospirosis was unexpectedly found to be positive in many of our patients who were having pyrexia during the monsoons. A recent surge has been noted in the number of cases with leptospirosis in this state. The possibility of co-infection especially with scrub typhus must be considered in cases with atypical presentation and severe illness. Most of the patients were from rural background with poor hygienic conditions. There was no mortality and main complication was Weil's syndrome in 77 percent.

Topics: Administration, Oral; Adult; Aged; Anti-Bacterial Agents; Ceftriaxone; Doxycycline; Enzyme-Linked Immunosorbent Assay; Female; Humans; Immunoglobulin M; India; Injections; Leptospirosis; Male; Middle Aged; Polymerase Chain Reaction; Retrospective Studies; Seasons; Weil Disease; Young Adult

Indira Gandhi Medical College, Shimla receives referred patients of pyrexia with multi-organ dysfunction during the monsoon season from all over the state of Himachal Pradesh. Most common etiologies of pyrexia are enteric fever, scrub typhus, malaria, viral, tubercular, and some patients of dengue fever from adjoining states. Leptospirosis has not yet been reported in sub-Himalayan state of Himachal Pradesh, India. We present here a case of leptospirosis presenting as ARDS, proven on IgM Elisa and confirmed by PCR. Leptospirosis is a new etiology in this region for patients presenting with pyrexia and ARDS.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Doxycycline; Enzyme-Linked Immunosorbent Assay; Fever; Humans; Incidental Findings; India; Leptospirosis; Male; Oxygen Inhalation Therapy; Polymerase Chain Reaction; Respiratory Distress Syndrome; Treatment Outcome

A 40-year-old teacher fell ill one week after returning from a two weeks back-packing trip to Thailand and Laos. He developed high fever, severe headache, myalgias and a conjunctivitis.. CRP and liver enzymes were elevated. The patient developed acute renal failure. Total leucocyte count was normal but the differential count showed an extreme left shift. Imaging procedures revealed hepato-splenomegaly and enlarged kidneys. TREATMENT, COURSE AND DIAGNOSIS: The patient was treated with moxifloxacin and ceftriaxon based on the initial suspicion of a severe infection potentially due to leptospirosis. This treatment led to a rapid improvement of the patient's condition and also of the laboratory findings. Leptospirosis could be confirmed by the seroconversion of specific antibodies to L. grippotyphosa 2 1/2 weeks after onset of complaints (initial serology negative).. In febrile travelers returning from Southeast Asia, leptospirosis has to be considered especially in case of severe headache, myalgias, elevated liver enzymes and renal failure and a history of close contact to potentially contaminated water (rivers, lakes). Diagnosis is confirmed by the detection of specific antibodies.

Topics: Acute Kidney Injury; Adult; Anti-Bacterial Agents; Anti-Infective Agents; Asia, Southeastern; Aza Compounds; Ceftriaxone; Fever of Unknown Origin; Fluoroquinolones; Humans; Leptospirosis; Male; Moxifloxacin; Quinolines; Travel; Treatment Outcome

Although antimicrobial therapy of leptospirosis has been studied in a few randomized controlled clinical studies, those studies were limited to specific regions of the world and few have characterized infecting strains. A broth microdilution technique for the assessment of antibiotic susceptibility has been developed at Brooke Army Medical Center. In the present study, we assessed the susceptibilities of 13 Leptospira isolates (including recent clinical isolates) from Egypt, Thailand, Nicaragua, and Hawaii to 13 antimicrobial agents. Ampicillin, cefepime, azithromycin, and clarithromycin were found to have MICs below the lower limit of detection (0.016 microg/ml). Cefotaxime, ceftriaxone, imipenem-cilastatin, penicillin G, moxifloxacin, ciprofloxacin, and levofloxacin had MIC(90)s between 0.030 and 0.125 microg/ml. Doxycycline and tetracycline had the highest MIC(90)s: 2 and 4 microg/ml, respectively. Doxycycline and tetracycline were noted to have slightly higher MICs against isolates from Egypt than against strains from Thailand or Hawaii; otherwise, the susceptibility patterns were similar. There appears to be possible variability in susceptibility to some antimicrobial agents among strains, suggesting that more extensive testing to look for geographic variability should be pursued.

Topics: Ampicillin; Anti-Bacterial Agents; Azithromycin; Cefepime; Cefotaxime; Ceftriaxone; Cephalosporins; Ciprofloxacin; Egypt; Hawaii; Humans; Leptospira; Leptospirosis; Levofloxacin; Microbial Sensitivity Tests; Nicaragua; Ofloxacin; Tetracycline; Thailand

Topics: Adult; Anti-Bacterial Agents; Antibodies, Bacterial; Azithromycin; Bronchoscopy; Ceftriaxone; Drug Therapy, Combination; Floxacillin; Hemorrhage; Humans; Leptospira; Leptospirosis; Lung Diseases; Male; Pneumonia, Bacterial; Radiography, Thoracic

Leptospirosis is an acute generalized infectious disease, caused by spirochaetes, Leptospira interrogans. The severity of the disease ranges from an asymptomatic subclinical course to a fatal outcome. The three cases presented here were diagnosed serologically and had thrombocytopenia and acute renal failure as complication of anicteric leptospirosis. Our first case admitted with clinical presentation of pneumonia but clinical progress and laboratory findings made us to consider leptospirosis. The other two cases presented with aseptic meningitis were diagnosed as anicteric leptospirosis by the serological test results. One of the cases had fatal outcome but could not be strictly correlated with leptospirosis.

Topics: Acute Kidney Injury; Acyclovir; Adult; Aged; Agglutination Tests; Ampicillin; Anti-Bacterial Agents; Antibodies, Bacterial; Ceftriaxone; Clarithromycin; Doxycycline; Drug Therapy, Combination; Enoxaparin; Fatal Outcome; Female; Humans; Leptospira interrogans; Leptospirosis; Male; Middle Aged; Thrombocytopenia; Turkey

A 35-year-old man was admitted to our hospital with chills, headache, pain in the calves for five days and a bloody sputum. The day before he had returned from a 4-week trip to the north of Thailand. There he had participated in hiking trips and walked sometimes over wet fields with small skin injuries on his feet. The admission examination was uneventful except fever as high as 39 Celsius, particularly no rash, no conjunctivitis, no spleno- or hepatomegaly and no palpable lymph nodes could be noted.. An x-ray of the chest showed confluent opacities, a bronchoscopy revealed diffuse alveolar hemorrhagy. Blood chemistry showed elevated liver enzymes, elevated kidney retention parameters and an increased C-reactive protein. An extended microbiological diagnostic procedure showed elevated antibody titers for leptospira and a PCR detected leptospira-DNA, representing acute leptospirosis.. After initiation of an antibiotic regimen including ceftriaxone and erythromycine the fever resolved immediately and the general condition improved. The patient could be discharged after two weeks in a good physical condition.. The constellation of flu-like symptoms, hepatitis and nephritis, eventually escorted by bloody sputum, may suggest leptospirosis.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Diagnosis, Differential; Erythromycin; Germany; Humans; Leptospirosis; Male; Thailand; Travel

Topics: Acute Disease; Anti-Bacterial Agents; Ceftriaxone; Cost-Benefit Analysis; Health Care Costs; Humans; Leptospirosis; Penicillins

Concomitant leptospirosis and scrub typhus is rare. The spectrum of clinical severity for both scrub typhus and leptospirosis ranges from mild to fatal. Acute pancreatitis and cholecystitis are infrequent complications in adult patients with either leptospirosis or scrub typhus. We report a case of leptospirosis and scrub typhus coinfection in a 41-year-old man presenting with acute acalculous cholecystitis, pancreatitis and acute renal failure. Abdominal computed tomography revealed edematous change of the gallbladder without intrahepatic or pancreatic lesions. The patient was successfully treated with doxycycline and ceftriaxone, and supportive management.

Topics: Acalculous Cholecystitis; Adult; Anti-Bacterial Agents; Antibodies, Bacterial; Ceftriaxone; Cholecystitis, Acute; Doxycycline; Drug Therapy, Combination; Humans; Leptospira interrogans; Leptospirosis; Military Personnel; Orientia tsutsugamushi; Pancreatitis; Renal Insufficiency; Scrub Typhus; Tomography, X-Ray Computed

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Cephalosporins; Doxycycline; Humans; Leptospirosis; Male; Recreation; Travel

Meningeal involvement in leptospiral infection is quite common, usually mild and often overlooked. In contrast, cases of isolated involvement of the central nervous system, including aseptic meningitis, have been reported only rarely. A case of a patient with acute aseptic meningitis caused by Leptospira australis serovar bratislava is reported. This is believed to be the first report of aseptic meningitis due to Leptospira australis. This case indicates the need to consider human leptospirosis in the differential diagnosis of aseptic meningitis.

Topics: Adult; Agglutination Tests; Antibodies, Bacterial; Ceftriaxone; Diagnosis, Differential; Humans; Leptospira; Leptospirosis; Male; Meningitis, Aseptic