Complications Of Leptospirosis Research Articles

MANAGEMENT OF WEIL'S DISEASE WITH SEPSIS AND MULTIPLE ORGAN DYSFUNCTION SYNDROME

Leptospirosis is a common zoonotic disease with a wide range of clinical manifestations, specifically in tropical regions. Weil's disease is considered a severe form of leptospirosis seen in a minority of leptospirosis cases with considerable mortality. These patients typically developed multiple organ dysfunction (MOD) of acute kidney injury, jaundice, and ARDS. We reported a case of a 62-year-old male transferred to our intensive care unit due to sepsis, severe leptospirosis jaundice, acute respiratory distress, thrombocytopenia, and renal injury. The patient was successfully managed with appropriate antimicrobial treatment and other supportive management, including mechanical ventilation and renal replacement therapy. Moreover, leptospirosis should be considered in any location wherever risk factors are present, not just in epidemic and tropical areas. In this case, we pointed out that serious complications of leptospirosis, such as multiple organ dysfunction, may happen. In such cases, adopting an integrated multidisciplinary team approach is essential to prevent complications and reduce mortality.

Importance of KIM-1 and MCP-1 in Determining the Leptospirosis-Associated AKI: A Sri Lankan Study.

Background Acute kidney injury (AKI) is one of most prevalent and serious complications of leptospirosis, a prevalent zoonotic disease in tropical countries. Prompt diagnosis of the leptospirosis-associated AKI is a challenge as there are no proper diagnostic tools that can identify patients in the early stage. Kidney injury molecule-1 (KIM-1) and monocyte chemoattractant protein-1 (MCP-1) are widely used novel AKI biomarkers that are studied in various disease conditions with AKI, but not in leptospirosis. Thus, this study is aimed at seeking the importance of KIM-1 and MCP-1 in determining the leptospirosis-associated AKI. Methods Leptospirosis-suspected patients who were admitted to medical wards of two selected hospitals in the Western province of Sri Lanka were recruited. Leptospirosis was confirmed by three diagnostic tests: PCR, MAT, and culture, and the status of AKI was determined by Kidney Disease Improving Global Outcomes (KDIGO) criteria. Results Of 170 leptospirosis-suspected patients, 79 were leptospirosis confirmed, and among them, 24.05% of patients were diagnosed to have AKI according to KDIGO criteria. Median serum KIM-1 (p < 0.0001), urine KIM-1 (0.0053), serum MCP-1 (0.0080), and urine MCP-1 (0.0019) levels in those developing AKI were significantly higher than in patients not developing AKI. The biomarker levels associated with leptospirosis AKI had AUC-ROC of 0.8565, 0.7292, 0.7024, and 0.7282 for serum KIM-1, urine KIM-1, serum MCP-1, and urine MCP-1, respectively. Conclusion This study revealed serum KIM-1 as a promising marker for leptospirosis-associated AKI among the tested biomarkers. Thus, further validation is recommended with a larger study group.

POS-179 LEPTOSPIROSIS ASSOCIATED ACUTE KIDNEY INJURY: A FIVE-YEAR EXPERIENCE FROM A TERTIARY CARE CENTER IN SOUTH INDIA

Leptospirosis is the most widespread zoonotic disease in the world and one of the main tropical infection causing acute kidney injury (AKI). The coastline states of India are most endemic to leptospirosis. Acute kidney injury is one of the most serious complications of leptospirosis and mortality rates varies according to the clinical presentation and usually increases when kidney injury is present. Early recognition helps clinicians to act fast and prevent mortality due to renal failure in Leptospirosis.

Determining the Value of Angiopoietin-2 Biomarker in Predicting Complications of Leptospirosis

Background: Leptospirosis is a common zoonosis disease that is potentially life-threatening all around the world. Angiopoietin-2 can be used as an indicator to determine the severity of the disease in critically ill patients. Objectives: This study aimed to determine the value of angiopoietin-2 biomarker in predicting leptospirosis complications. Methods: In this prospective observational study, 90 participants, including 45 patients with leptospirosis and 45 participants in the control group, are studied. Three to five days after the onset of symptoms before starting treatment with antibiotics, 5 mL venous blood was taken to measuring the angiopoietin-2 level by enzyme-linked immunosorbent assay (ELISA). Results: In this study, 75 men (83.3%) and 15 women (16.7%) with an age distribution of 23 to 75 years participated. A total of 74 (82.3%) patients were employed in the agriculture sector, while 59 (65.6%) lived in rural areas. There was a significant relationship between patients with severe forms of leptospirosis and levels of angiopoietin-2 (P-value &lt; 0.01). Also, there was a significant relationship between angiopoietin-2 biomarker level and markers of disease severity such as anemia (P-value &lt; 0.01), oliguria (P-value &lt; 0.01), severe thrombocytopenia (P-value &lt; 0.01), length of stay (P-value &lt; 0.01), and CRP more than 2+ (P-value &lt; 0.001). Conclusions: This study demonstrated that angiopoietin-2 biomarker can be used in screening disease severity and predicting complications of leptospirosis.

Renal Failure Due to Human Leptospirosis; An Overview

: Leptospirosis is endemic in tropical and subtropical countries in South-East Asia. Patients are typically young and the disease influences a broad spectrum of mammals, and might lead to the wide variety conditions ranging from acute to chronic. One of the most important complications of leptospirosis is AKI. It is the most important zoonotic diseases caused by contact with either infected water or urine and can be transmitted to new hosts. Manifestation of leptospirosis varies from asymptomatic state in chronic form to symptomatic state, which encompasses fever, renal failure, icterus, and pulmonary hemorrhage in acute forms. Furthermore, AKI in leptospirosis, has many etiologies, and encompasses direct nephrotoxic action of the leptospira, hyperbillirubinemia, rhabdomyolysis, and hypervolemia (this means that this bacteria affects the tuft of the glumrol and also results in prerenal azotemia by the mechanism of hypovolemia). Case fatality rate of acute kidney injury due to leptospirosis is approximately 22%. This review is an attempt to summarize and discuss the current knowledge in the area of epidemiology and pathology of leptospirosis, with the latest therapeutic approach.

Sociodemographic and clinical characteristics of patients infected with Leptospira spp. treated at four hospitals in Medellín, Colombia, 2008-2013

Leptospirosis remains a significant health problem in tropical regions including Latin America, where its presentation is 100 times higher than that observed in other regions of the world. Mortality reaches 10% in severe cases. Its diagnosis is challenging because clinical manifestations during the initial phase are non-specific and because of limited availability of diagnostic tests. To describe the demographic and clinical characteristics and the outcomes in hospitalized patients with leptospirosis. This retrospective study included patients treated at four institutions in Medellín between January, 2009, and December, 2013, with a compatible clinical picture and a positive IgM for Leptospira spp. We included 119 patients, 80% male, and 58% of rural origin. The mean duration of symptoms was 9.6 days (SD=9.6). Eighty nine per cent of patients had fever; 62%, jaundice; 74%, myalgia; 46%, diarrhea; 41%, hepatomegaly; 13%, splenomegaly, and 13%, conjunctival injection. Fifty four per cent of patients had impaired renal function; 32%, pulmonary compromise, and 13%, liver failure. Sixteen per cent required admission to the ICU; 12%, mechanical ventilation, and 11%, vasopressor therapy.Weil's syndrome occurred in 38.6% and 5% died. The average hospital stay was 11 days (SD=9.6). In this population, the clinical manifestations and complications of leptospirosis were similar to those reported in the literature. We observed a relatively low overall mortality in relation to global statistics.

Acute kidney injury in leptospirosis: the Kidney Disease Improving Global Outcomes (KDIGO) criteria and mortality .

Acute kidney injury (AKI) is one of the most serious complications of leptospirosis. In recent years, studies have evaluated this complication using the risk, injury, failure, loss, and end-stage kidney disease and the acute kidney injury network classification systems. More recently, the kidney disease improving global outcomes (KDIGO) criteria have been developed to increase accuracy in detecting AKI. The aim of the present study was to determine the prevalence and factors associated with AKI and mortality in patients with leptospirosis, using KDIGO criteria. We conducted a retrospective analysis of patients with clinical and epidemiological diagnosis of leptospirosis between January 2007 and December 2011. AKI was defined and classified according to KDIGO guidelines. Independent risk factors for AKI and death were evaluated using logistic regression. Of the 205 patients included, only 10 patients (4.8%) exhibited Weil's syndrome. AKI occurred in 182 patients (88.7%), 33 (16.1%) of whom were classified as KDIGO 1, 36 (17.6%) as KDIGO 2, and 113 (55.1%) as KDIGO 3. There was an independent correlation between AKI and the incidence of hyperbilirubinemia and leukocytosis. KDIGO 3 and the need for mechanical ventilation were independently correlated with mortality. We observed a high prevalence of AKI using KDIGO criteria, even in patients with milder forms of leptospirosis. Hyperbilirubinemia and leukocytosis were independent risk factors for AKI. KDIGO 3 was independently associated with mortality. .

Neutrophil Gelatinase Associated Lipocalin (NGAL) in Leptospirosis Acute Kidney Injury: A Multicenter Study in Thailand.

AKI is one of the most serious complications of leptospirosis, an important zoonosis in the tropics. Recently, NGAL, one of the novel AKI biomarkers, is extensively studied in various specific settings such as sepsis, cardiac surgery, and radiocontrast nephropathy. In this multicenter study, we aimed to study the role of NGAL as an early marker and an outcome predictor of leptospirosis associated AKI. Patients who presented with clinical suspiciousness of leptospirosis were prospectively enrolled in 9 centers from August 2012 to November 2014. The first day of enrollment was the first day of clinical suspicious leptospirosis. Blood and urine samples were serially collected on the first three days and day 7 after enrollment. We used three standard techniques (microscopic agglutination test, direct culture, and PCR technique) to confirm the diagnosis of leptospirosis. KDIGO criteria were used for AKI diagnosis. Recovery was defined as alive and not requiring dialysis during hospitalization or maintaining maximum KDIGO stage at hospital discharge. Of the 221 recruited cases, 113 cases were leptospirosis confirmed cases. Thirty seven percent developed AKI. Median uNGAL and pNGAL levels in those developing AKI were significantly higher than in patients not developing AKI [253.8 (631.4) vs 24.1 (49.6) ng/ml, p < 0.001] and [1,030 (802.5) vs 192.0 (209.0) ng/ml, p < 0.001], respectively. uNGAL and pNGAL levels associated with AKI had AUC-ROC of 0.91, and 0.92, respectively. Both of urine NGAL and pNGAL level between AKI-recovery group and AKI-non recovery were comparable. From this multicenter study, uNGAL and pNGAL provided the promising result to be a marker for leptospirosis associated AKI. However, both of them did not show the potential role to be the predictor of renal recovery in this specific setting.

Pericarditis as a Rare Complication of Severe Leptospirosis

Leptospirosis is a disease with a large geographical spreading. The clinical picture varies from undiagnosed, flulike syndrome to multiorgan involvement forms. Involvement of pericardium during leptospirosis is a rare event but not unknown. Objective: Our aim is to describe a severe case of leptospirosis (Weil's diseases) with prominent liver involvement, complicated with exudative pericarditis. Materials and Methods: A male patient, working as a mechanic, presents with fever, conjunctival suffusion, jaundice, pronounced myalgia and anuria for more than two days. Based on the clinical evidence, laboratory results showing multiorgan involvement and the epidemiological data, the patient was suspected for leptospirosis. Results: Referring to the above mentioned data, the patient was serologically tested with ELISA for leptospirosis, which resulted positive for IgM and IgG in two blood samples. Conclusion: Severe clinical presentations of leptospirosis are not rare and cardiac involvements are not to, but remain underreported in most of the cases. Through this case report, we want to share our experience with our colleague and at the same time we want to bring into attention the rare complications of leptospirosis, such as pericarditis in our case.

Predictors of the development of myocarditis or acute renal failure in patients with leptospirosis: An observational study

BackgroundLeptospirosis has a varied clinical presentation with complications like myocarditis and acute renal failure. There are many predictors of severity and mortality including clinical and laboratory parameters. Early detection and treatment can reduce complications. Therefore recognizing the early predictors of the complications of leptospirosis is important in patient management. This study was aimed at determining the clinical and laboratory predictors of myocarditis or acute renal failure.MethodsThis was a prospective descriptive study carried out in the Teaching Hospital, Kandy, from 1st July 2007 to 31st July 2008. Patients with clinical features compatible with leptospirosis case definition were confirmed using the Microscopic Agglutination Test (MAT). Clinical features and laboratory measures done on admission were recorded. Patients were observed for the development of acute renal failure or myocarditis. Chi-square statistics, Fisher's exact test and Mann-Whitney U test were used to compare patients with and without complications. A logistic regression model was used to select final predictor variables.ResultsSixty two confirmed leptospirosis patients were included in the study. Seven patients (11.3%) developed acute renal failure and five (8.1%) developed myocarditis while three (4.8%) had both acute renal failure and myocarditis. Conjunctival suffusion - 40 (64.5%), muscle tenderness - 28 (45.1%), oliguria - 20 (32.2%), jaundice - 12 (19.3%), hepatomegaly - 10 (16.1%), arrhythmias (irregular radial pulse) - 8 (12.9%), chest pain - 6 (9.7%), bleeding - 5 (8.1%), and shortness of breath (SOB) 4 (6.4%) were the common clinical features present among the patients. Out of these, only oliguria {odds ratio (OR) = 4.14 and 95% confidence interval (CI) 1.003-17.261}, jaundice (OR = 5.13 and 95% CI 1.149-28.003), and arrhythmias (OR = 5.774 and 95% CI 1.001-34.692), were predictors of myocarditis or acute renal failure and none of the laboratory measures could predict the two complications.ConclusionsThis study shows that out of clinical and laboratory variables, only oliguria, jaundice and arrhythmia are strong predictors of development of acute renal failure or myocarditis in patients with leptospirosis presented to Teaching Hospital of Kandy, Sri Lanka.

Facial palsy associated with leptospirosis

The authors report a rare case of facial palsy associated with leptospirosis. A 60-year-old man was admitted to ICU with severe leptospirosis. On the eighth day of hospitalisation, he developed left peripheral facial palsy with a favourable course in response to corticosteroids. Several types of neurological complications of leptospirosis have been reported: encephalitis, myelitis, stroke, cerebral arteritis, mononeuritis, polyradiculoneuropathy, and cranial nerve palsy. Peripheral facial palsy is a rare complication of leptospirosis. This case illustrates the possible association between leptospirosis and facial palsy.

Assessing cost effectiveness of empirical and prophylactic therapy for managing leptospirosis outbreaks

This study evaluates the utility and cost effectiveness of empirical and prophylactic antibiotic treatment of leptospirosis compared with conventional management. We developed decision trees comparing empirical antibiotic treatment (within 4-7 days of symptom onset) or prophylaxis to conventional antibiotic treatment (initiated 7 days post-onset). Costs were calculated using both US and Barbados pricing. Empirical treatment provided slightly lower probability of survival, while prophylactic treatment resulted in slightly higher survival rates. Antibiotic treatment initiated after 4-7 symptomatic days was ineffective in preventing serious health outcomes, but cost less with the exception of azithromycin (US pricing). Empirical treatment in Barbados cost less than conventional treatment. Prophylaxis reduced rare serious health outcomes and resulted in significant cost savings for the United States and Barbados. Prophylactic therapy for high-risk individuals or prompt diagnosis and early treatment (before 4 days of symptoms) appear to be cost-effective approaches to prevent severe complications of leptospirosis.

Renal involvement in leptospirosis: new insights into pathophysiology and treatment

Acute renal failure (ARF) is one of the most common complications of leptospirosis although the causal mechanisms are still unclear. Diverse mechanisms are implicated in leptospiral nephropathy and new data supports the role of peculiar ion transport defects. Besides antibiotic therapy, ARF management in leptospirosis requires dialytic therapy which is most efficient when started early. Dialysis is the standard supportive therapy even though recent evidence suggests clinical benefit from alternative treatments such as plasmapheresis and hemofiltration. Renal recovery is achieved soon after clinical improvement. The comprehension of the primary mechanisms of renal dysfunction will be helpful in the development of additional therapeutic tools for improving supportive therapy for leptospiral nephropathy. This review discusses new insights into mechanisms implicated in leptospiral ARF and recent advances in treatment.

Anti-ganglioside antibodies-mediated leptospiral meningomyeloencephalopolyneuritis

A case of leptospirosis complicated with meningo-myelo-encephalo-polyneuritis and nephrotic syndrome is presented. Anti-ganglioside antibodies were detected for the first time in a patient with neurological complications of leptospirosis. Possible pathogenic mechanisms and treatment options of these rare manifestations are discussed.

What role do coagulation disorders play in the pathogenesis of leptospirosis?

Leptospirosis is a zoonosis of worldwide distribution, spread by the urine of infected animals. It is a major public health problem, especially in developing countries, where circumstances for transmission are most favourable. The clinical picture varies from mild disease to a severe illness with haemostatic derangements and multiorgan failure eventually leading to death. Although the haemorrhagic complications of severe disease are serious, the pathophysiology is scarcely elucidated. The complex mechanisms involved in inflammation-induced coagulation activation are extensively studied in various infectious diseases, i.e. Gram-negative sepsis. Tissue factor-mediated coagulation activation, impairment of anticoagulant and fibrinolytic pathways in close concert with the cytokine network are thought to be important. But for human leptospirosis, data are limited. Because of the growing interest in this field, the impact of leptospirosis, and the availability of new therapeutic strategies, we reviewed the evidence regarding the role of coagulation in leptospirosis and provide suggestions for future research.

Leptospirosis in Istanbul, Turkey: A wide spectrum in clinical course and complications

Patients with high fever and multiorgan involvement were investigated for the determination of frequency, clinical course and complications of leptospirosis in Istanbul. Leptospirosis was determined in 22 cases among the 35 hospitalized patients that were pre-diagnosed as leptospirosis according to 'Probable Leptospirosis Diagnosis and Follow-up' form. Among the leptospirosis cases 19 were male and 16 were military staff. Mean age was 35.6 y. Dark field examination (DFE), latex agglutination test (LAG), ELISA IgM, leptospirosis culture (LC) and microscopic agglutination test (MAT) were performed to confirm the diagnoses. The most frequent initial symptoms and findings were fever, fatigue, headache, nausea-vomiting and increased muscle sensitivity. Jaundice was noted only in 2 cases. A 74-y-old female patient died after the recurrence of the disease with severe rhabdomyolysis and pulmonary failure. Sagittal sinus thrombosis, perimyocarditis and chronic renal failure were major complications in another 3 patients. ELISA IgM, LC, DFE, LAG and MAT tests were positive in 68, 72, 82, 100 and 100% of the patients, respectively. As a conclusion, diagnosis of leptospirosis is usually overlooked. Clinical awareness, use of probable leptospirosis diagnosis forms and the application of different laboratory methods in the diagnosis of suspected cases may offer the chance to diagnose the leptospirosis accurately.

Leptospirosis and its pulmonary complications

The aim of this study was to assess the incidence and factors associated with pulmonary complications of leptospirosis. In a retrospective study, patients with a definite diagnosis of leptospirosis following a 6-week period of severe flooding in Hadyai city, Thailand, were reviewed. Pulmonary complications of leptospirosis were defined as the occurrence of respiratory symptoms and an abnormal CXR. The clinical and laboratory test results for patients with and without pulmonary complications were compared. Among the 157 patients with leptospirosis, eight patients had pulmonary complications. Three patients had acute renal failure (ARF) and pulmonary oedema. One patient had ARF and adult respiratory distress syndrome (ARDS). Two patients had ARF, congestive heart failure and pulmonary oedema. One patient had congestive heart failure and pulmonary oedema. One patient had only ARF. Factors associated with pulmonary complications were delayed antibiotic treatment and thrombocytopenia (platelet count < 100 x 10(9)/L). Three patients developed adult respiratory distress syndrome and one died from respiratory failure. Pulmonary complications and death occur in a low percentage of patients with leptospirosis. Delayed antibiotic treatment and thrombocytopenia are risk factors for the development of pulmonary involvement in leptospirosis.

Leptospirosis: a case report of a patient with pulmonary haemorrhage successfully managed with extra corporeal membrane oxygenation

Leptospirosis is a zoonosis of worldwide significance. Pulmonary involvement is common but often mild and of little clinical significance. However, over the last two decades an increasing number of cases have been reported with pulmonary haemorrhage as a prominent feature [Carvalho CR, Bethlem EP. Pulmonary complications of leptospirosis. Clin Chest Med, 2002; 23(2):469–78]. These cases are particularly challenging to treat as they often have resistant hypoxaemia despite maximal invasive mechanical ventilation. Consequently, there is a high mortality rate. Here, we present a case of severe leptospirosis complicated by massive pulmonary haemorrhage which was successfully managed by extra corporeal membrane oxygenation (ECMO).

Leptospirosis Complicated by a Jarisch-Herxheimer Reaction and Adult Respiratory Distress Syndrome: Case Report

Leptospirosis, severe infection due to Leptospira interrogans, is a potentially lethal disease that causes multiple organ failure. In addition to hepatic, renal, and CNS involvement, which are classic complications of leptospirosis, the disease may also be complicated by adult respiratory distress syndrome. Treatment with penicillin may precipitate a severe Jarisch-Herxheimer reaction. The mechanisms of Leptospira-induced toxicity remain obscure. We report a near-fatal case of leptospirosis in a patient who developed a JHR and respiratory failure immediately after initiation of therapy.

Surgical complications of leptospirosis in children

During a 54-mo period ending June 1976, 25 presumed and 9 confirmed cases of leptospirosis were admitted for treatment. Six children required surgical procedures for complications developing during the acute phase of the illness. Acute acalculous cholecystitis or hydropic distention of the gallbladder was noted in all six patients. Abdominal pain, fever, jaundice, palpable right upper abdominal mass, and radiographic delineation of gallbladder enlargement indicated the presence of biliary tract abnormalities. Exploration, culture of bile, and cholecystostomy were carried out in all patients. Gallbladder bile grew leptospires in one patient. Liver biopsy in two patients revealed acute cholangitis. All patients recovered and examinations 4 mo-4.5 yr later revealed no symptoms, with normal oral cholecystograms in five children. One child in this group was found at exploration to have acute edematous pancreatitis. Another child developed progressive desquamation of the skin of all extremities with ultimate development of peripheral gangrene requiring amputations of portions of all four extremities. Recent experience shows that leptospirosis is not uncommon, that it is often encountered in urban and surburban environments, and that children are at risk for acquiring the disease, at times from immunized family pets. The vasculitis that affects all organ systems explains the diffuse nature of the disease and the potential for complications that require surgical intervention.