Manifestations Of Leptospirosis Research Articles

Estimation of economic losses due to leptospirosis in dairy cattle

There are few studies that effectively quantify the economic losses resulting from problems caused by leptospirosis in naturally infected dairy cattle. Given this gap, the objective of this study was to propose and apply a method to quantify the economic losses resulting from productive and reproductive problems in a commercial dairy herd naturally infected by Leptospira spp. For this study, the zootechnical and economic indicators at a property with Jersey cattle were analyzed during the period from 2014 to 2017. The leptospirosis outbreak occurred in 2014, and the therapeutic approach was carried out between 2015 and 2017, with the latter considered the year of control of the outbreak. The adopted integrated control strategy consisted of dividing the herd according to the serological results obtained through the microscopic agglutination test, the treatment of reagents with streptomycin, and vaccination against leptospirosis of non-reagent heifers and cows. The method used to evaluate the economic indicators of the property was the calculation of the gross margin by taking into account the implicit and explicit cost parameters associated with the manifestation of leptospirosis. The prevalence rate of leptospirosis decreased from 49.4 % in 2015 to 21.6 % in 2017. There was a reduction in the abortion rate (from 40.00 % in 2014 to 9.00 % in 2017), in the stillborn rate (from 2.63 % in 2014 to 1.69 % in 2017) and an increase in the calving rate (from 65.00 % in 2014 to 86.00 % in 2017). In addition, there were increases in the number of lactating cows (from 38 in 2014–57 in 2017) and the mean times of lactation duration, which increased from 275 days in 2014–295 days in 2017. As a result, the average annual production of milk increased from 164,655 liters in 2014–248,521 liters in 2017. In 2014, when treatment hadn’t yet started, the gross margin per liter of milk sold, considering implicit and explicit costs, was US$0.00. In 2015 and 2016, US$0.27 and US$0.30 were obtained, respectively, for this variable. In 2017, with the disease under control on the property, the gross margin per liter of milk reached US$0.36. The gross margin per liter of milk sold was higher in the period when the disease was controlled, showing losses of up to 84 % of the gross margin during the outbreak. Immediate treatment of positive cows and preventive measures had a significant impact on improving the productive and economic efficiency of the property.

An Insight Into Various Manifestations of Leptospirosis: A Unique Case Series From a State in Eastern India.

Leptospirosis presents with highly variable clinical manifestations affecting different organ systems in different individuals. The presentation ranges from an asymptomatic or mild disease to a severe disease associated with multiorgan failure and higher mortality. Leptospirosis is highly underreported due to a lack of diagnostic modalities and less suspicion among clinicians. We present this single-center retrospective case series of 12 cases, which include various common and uncommon scenarios by which the disease can present and can be missed due to lack of suspicion. The study contains individual patient characteristics including demographic, laboratory, clinical, and treatment data. The association between these variables and mortality was analyzed using p-values and results were described. A p-value of<0.05 was considered statistically significant. A total of 12 cases were included in the study. The male-to-female ratio was 3:1. The mean age was higher (37.75±9.81 years) in cases who died than those who recovered (34.25±14.09). Factors like history of alcoholism, presence of chronic liver disease (CLD), jaundice, acute renal failure, requirement of dialysis, and requirement of intensive care were significantly associated with increased risk of death (odds ratio >1, p-value <0.05). The most common symptom of presentation was fever in 11 (91.66%) cases. Jaundice and renal failure were significantly associated with death (odds ratio 1.2, p-value 0.04). The requirement of intensive care treatment (odds ratio 2.1, p-value 0.05) and dialysis (odds ratio 39.66, p-value 0.03) were also significantly associated with death. The percentage of death was lower in the group of patients who received combination antibiotic therapy. Leptospirosis has varied presentations in different individuals and the diagnosis can be missed due to lack of specific signs and symptoms. Severe diseases involving multiple organs and preexisting comorbidities are associated with higher mortality rates. Timely diagnosis and treatment are necessary to reduce mortality and increase survival.

Эпизоотологический мониторинг лептоспироза лошадей в Омской области

Leptospirosis is one of the urgent problems of veterinary medicine and causes significant material damage to livestock, threatening human health and life. The paper presents the results of a study of the epizootic situation of the manifestation of leptospirosis among horses in the Omsk region for the period 2016-2020 and identifies unfavorable points for this disease. It was found that areas unfavorable for leptospirosis are mainly located in the forest-steppe zone of the Omsk region (Maryanovsky, Azovsky, Omsk, Moskalensky, Tyukalinsky, Is-ilkulsky, Lyubinsky, Kormilovsky) or on the border with the steppe zone (Tavrichesky and Azov). For the development of an epizootic of leptospirosis, there are pronounced prerequisites in the form of various reservoirs and free-living small mammals. The most intense epizootic situation is in the Maryanovsky district, where leptospirosis in horses is annually recorded.

A death of a pregnant mother following Leptospirosis

Introduction Although leptospirosis is known to occur in Sri Lanka, its incidence has increased during the recent past. Because of the protean manifestations of leptospirosis it is sometimes misdiagnosed and underreported. Case report A 30 year old pregnant mother (POA 32 weeks) was transferred from a peripheral hospital with signs of icterus and vomiting for 3 days. She was treated by the Obstetrician as having HELLP syndrome. Hematological studies showed elevated liver enzymes and altered clotting profile. After an emergency caesarian section, she developed profuse haemorrhage and a subtotal hysterectomy was done. Although bleeding was arrested, her condition gradually deteriorated. She died in the ICU one week later. Autopsy findings: Yellow discolouration of conjunctiva and nail beds, and marked yellow stained pleural effusion and ascites were seen. Lungs were congested and heavy. Heart appeared flabby and yellow in colour. Kidneys were soft and enlarged with congested cortex. Cortico-medullary junction was well demarcated. Liver was enlarged and yellow. Histopathology revealed extensive pulmonary haemorrhages and focal hepatic necrosis. The serology report was positive for Leptospira (titer – 1600) Conclusions This death warrants the need of constant use of our knowledge in General Medicine, together with our specific knowledge which is confined to a particular specialty. The serology report confirmed the autopsy diagnosis. Therefore, the need to carry out all the relevant specific investigations is highlighted here. Medico-Legal Journal of Sri Lanka 2013; 1(3) : 20-22

Leptospirosis among the self-supporting convicts of Andaman Island during the 1920s--the first report on pulmonary haemorrhage in leptospirosis?

Several researchers had carried out investigations on the possibility of existence of Weil's disease in Andaman Islands during early 20th century. The first report of a series of confirmed cases of leptospirosis that occurred during1929 was published in 1931. There were several reports during 1995 to 2009 that described detailed account of leptospirosis including various clinical syndromes. The possibility of pulmonary involvement in leptospirosis being a manifestation historically overlooked rather than newly emerged during the past two decades is examined in this review in the context of Andaman Islands. Two case series of leptospirosis, one occurred in 1929 and the other in 1996-1997 were reviewed with special emphasis on pulmonary involvement and haemorrhagic manifestations. The similarities and differences in the clinical profile of patients of the two case series were analysed. The review shows that respiratory system involvement and pulmonary haemorrhage as evidenced by presence of haemoptysis as a complication of leptospirosis was occurring during 1920s in Andaman Islands. The incidence of pulmonary involvement, however, rose from 9.4 per cent during 1929 to 52 per cent in 1996-1997. The case fatality ratio in patients with pulmonary involvement, which was 50 per cent during 1929 and 42.9 per cent during 1996-1997, was higher than that in cases without pulmonary involvement. Fever, conjunctival congestion, jaundice, vomiting, diarrhoea, hepatomagaly, haemoptysis, haematemesis and subconjunctival haemorrhage were common in both series. The case series in Andaman Islands in 1929 was probably the first report of pulmonary haemorrhage as a manifestation of leptospirosis. The increase in the incidence of pulmonary involvement in leptospirosis in the recent past is probably due to the increase in the density and diversityof its animal vectors, the broadening of the range of circulating serovars and the interactions between the vector and the agent. An increased virulence of Leptospira through gene acquisition and loss on an evolutionary time scale and the resulting change in the gene content, gene order and gene expression cannot be ruled out.

An Unusual Presentation of Leptospirosis: A Case Report

Leptospirosis is a life-threatening zoonotic disease of global distribution. It has variable presentation ranging from mild febrile illness to life-threatening complications like acute renal failure, acute hepatic failure, pulmonary hemorrhages and cardiac arrhythmias. Cardiac manifestations of leptospirosis are not uncommon but are underdiagnosed. Cardiac manifestations may vary from minor rhythm abnormalities to fatal ventricular arrhythmias. We report an unusual presentation of leptospirosis in a patient who presented to the Emergency Department with epigastric pain and congestive cardiac failure with rhythm disturbances and selective myocardial involvement mimicking as Non ST elevation Inferior wall myocardial infarction (NSTEMI). The Cardiac manifestations of Leptospirosis need meticulous intensive care management as the mortality rate is very high in this subset of patients. Index suspicion and early treatment remains the mainstay of this life threatening zoonotic disease.

Leptospirosis complicated with meningoencephalitis and pancreatitis -a case report

In severe leptospirosis multi organ involvement is common. Pancreatitis and meningo encephalitis are two uncommon manifestations of leptospirosis. Our patient presented with fever, jaundice, altered sensorium and subsequently developed severe pain abdomen. He was finally diagnosed as having icteic leptospirosis complicated with pancreatitis and meningoencephalitis. Simultaneous presence of these two complications in a patient of leptospirosis probably not been documented before.

Role of High‐Dose Corticosteroid for the Treatment of Leptospirosis‐Induced Pulmonary Hemorrhage

Leptospirosis is a zoonotic disease of worldwide distribution caused by spirochetes of the genus Leptospira. Leptospirosis is a common disease, highly prevalent in human populations but most often unidentified. The International Leptospirosis Society estimates that disease incidence ranges are 0.1 to 1.0 per 100 000 in temperate climates and 10 to 100 per 100 000 in humid tropics.1 In India, outbreaks have been increasingly reported since 1980s, especially from the states of Gujarat, Kerala, Karnataka, Maharashtra, Orissa, and Tamil Nadu.2 Outbreaks mostly occur as a result of heavy rainfall and consequent flooding, usually during monsoons.3 The clinical manifestation of leptospirosis varies from inapparent infection to fulminant fatal disease. Pulmonary complications for patients with leptospirosis are also relatively common, reported in 17% to 70% of patients in several large studies.4 Although these manifestations are usually mild, recent studies suggest that pulmonary involvement is frequently the most dramatic feature of leptospiral infection. Accordingly, severe pulmonary manifestations of leptospirosis are becoming more prevalent, with pulmonary hemorrhage being the most predominant cause of death in leptospirosis. The hemorrhagic potential of leptospirosis was first reported by Weil in 1886.5 The intense intra-alveolar hemorrhages seem to be unique for leptospirosis. Previous literature on diffuse alveolar hemorrhage heavily emphasizes the causal role of vasculitides.6 Use of steroids is rarely reported in leptospirosis-associated pulmonary hemorrhages. Here, we report a case of leptospirosis with pulmonary hemorrhage that was successfully treated with a high intravenous dose of methylprednisolone.

Severe Leptospirosis Similar to Pandemic (H1N1) 2009, Florida and Missouri, USA

Severe Leptospirosis Similar to Pandemic (H1N1) 2009, Florida and Missouri, USA

Neuroretinitis as an Unusual Manifestation of Leptospirosis: A Case Report

Leptospirosis is a zoonotic infection caused by spirochetes leptospira. It presents with both ocular and systemic manifestations. Neuroretinitis has been reported in the few cases of leptospirosis. We present a case of leptospirosis with unilatertal neuroretinitis presenting with sudden loss of vision, optic disc edema and macular star. Leptospirosis was confirmed by serological test and the disease responded optimally to specific therapy.

Ocular zoonoses

Ocular zoonoses are relatively uncommon causes of ocular inflammation. Among the 175 well-described zoonotic diseases, approximately 30 are known to cause human ocular infections. In this article, we review the most prevalent ocular zoonoses indigenous to North America or Europe. The infections cause toxoplasmosis, toxocariasis, Lyme disease, cat-scratch disease and leptospirosis. Diagnoses of toxoplasma posterior uveitis and ocular toxocariasis are principally based on ophthalmologic findings. Laboratory tests, including antibody titers in ocular fluids, help to support diagnosis when ocular manifestations are atypical. A new trend in toxoplasmosis treatment is to replace sulfadiazine with azithromycin. Trimethoprim/sulfamethoxazole (cotrimoxazole) has proven efficacy in reducing recurrences of toxoplasmic retinochoroiditis. Ocular manifestations of Lyme disease are protean, but the most common are intermediate uveitis and retinal vasculitis. Parinaud oculoglandular syndrome and neuroretinitis with macular stellate exudates are highly suggestive of Bartonella henselae infection (bartonellosis). Diagnoses of the ocular manifestations of leptospirosis and Lyme disease are mainly based on positive histories of animal exposure, nonophthalmologic findings and laboratory investigations. Nongranulomatous uveitis, hypopion, vitritis, membranous veil-like opacities, disk edema and retinal periphlebitis are characteristic features of leptospirosis uveitis. Recent studies showed that PCR tests for bacteria in ocular specimens help in diagnosis (e.g., of infectious uveitis).

Seroepidemiology and serological follow-up of anti-leptospiral IgG in children in Southern Vietnam

A follow-up study was conducted with 23 months interval to investigate the seroepidemiology and persistence of Leptospira IgG antibodies among healthy children in Binh Thuan province, Southern Vietnam. Sera from 262 children (7–13 years of age) were collected and analysed with a commercially available enzyme-linked immunosorbent assay (ELISA) for Leptospira IgG. Seroconversion was observed in 10.4% (22 of 211, 95% CI: 5.6–26.7) of the children, of whom 18 (8.5%) had probably and four (1.9%) had certainly been exposed to Leptospira. Based on the reduction of sero-negatives of 1.9% among children who have been certainly exposed, the annual seroconversion rate, a measure of the incidence rate of Leptospira infections, corresponds to 0.99% (95% CI: 0.39–2.52). In 61% (31 of 51, 95% CI: 47.1–73.0) of the children with past-infection, Leptospira IgG antibodies remain detectable after 2 years. Data from this study indicate that IgG antibody responses against Leptospira may persist at least for 2 years in children without manifestations of leptospirosis. Results of study uncover the true incidence of leptospirosis infection, the dynamics of waxing and waning antibody concentrations and points at a larger burden of clinically non-significant Leptospira infections in Southern Vietnam. This also indicates background reactivity for serological testing and thus serological result of a single serum sample must be carefully interpreted.

Sex Differences in Clinical Leptospirosis in Germany: 1997-2005

Although the majority of patients with reported leptospirosis are male, several seroepidemiologic studies demonstrated that leptospirosis seroprevalences are at least identical between both sexes. To study the effect of sex on the severity--and possibly, recognition--of leptospirosis, we conducted a sex-specific analysis of the clinical manifestations of the disease among patients with reported leptospirosis in Germany during 1997-2005. Data on demographic characteristics, symptoms, place of infection and place of residence when infection occurred, possible exposure risks, infecting serovars, and mortality were evaluated for patients with laboratory-confirmed leptospirosis reported in Germany during 1997-2005. Mantel-Haenszel odds ratios (OR(MH)), adjusted for age, were used to determine the association between sex and the frequency of reported symptoms. Among 338 patients with leptospirosis (263 male patients and 75 female patients) reported in Germany during 1997-2005, male patients were more likely than female patients to be hospitalized (OR, 2.6; P<.01) and to exhibit symptoms of severe leptospirosis with jaundice (OR(MH), 3.7; P<.01), renal impairment (OR(MH), 3.4; P<.01), and hemorrhage (OR(MH), 7.8; P<.05). These sex-related differences were not associated with differences in exposure risks, presumptive infecting serogroups, or health-seeking behavior. Our results indicate that male sex is associated with a higher severity of clinical leptospirosis. Reports on male predominance in leptospirosis may thus reflect sex-related variability in the incidence of severe disease, rather than different infection rates. In clinical practice, sex differences in the manifestation of leptospirosis may cause systematic underinvestigation and undertreatment of the disease in female patients.

Acute Renal Failure: A Common Manifestation of Leptospirosis

Leptospirosis is an infectious disease caused by pathogenic leptospires and may vary in degree from an asymptomatic infection to severe and fatal illness. Sixteen patients (all males; aged 40 ± 17 years) with leptospirosis were admitted to Şişli Etfal Training and Research Hospital between July 1998 and August 2003 and were retrospectively reviewed. Age, gender, occupation, clinical presentation, laboratory features, seasonal distribution of the disease, diagnostical approach, and prognostic factors were evaluated. Eleven patients were cured with no complication; four patients died of hepatic and/or renal failure. Eight patients presented with acute renal failure; seven of them needed dialytic support. One patient developed chronic renal failure and had to undergo regular hemodialysis. All deceased patients (aged 61 ± 7 years) were anuric at admission and their serum bilirubin changed between 39–44 mg/dL (mean 41.3 ± 2.2 mg/dL). Cured patients ranged in age from 14–62 years (34 ± 14 years) and their serum bilirubin levels ranged from 9–35 mg/dL (23.1 ± 11.4 mg/dL). Crystalline penicillin G 12 million U/day was administered to all patients. Six patients also received hepatic coma treatment. This study emphasizes that leptospirosis presenting with renal failure is a severe disease, and mortality is frequently related to delays in diagnosis due to lack of clinical understanding. The association of acute renal failure and jaundice should lead the clinician to suspect leptospirosis. We concluded that old age, oliguria/anuria, high serum bilirubin levels (> 36 mg/dL), and high serum potassium levels might be risk factors that increase mortality in leptospirosis.

Jarisch-Herxheimer Reaction in Leptospirosis: A Reply to Leblebicioglu et al.

We fully agree with the suggestion of Leblebicioglu et al. that in the case we reported [1] meningitis could have been only a delayed manifestation of leptospirosis. However, the abrupt onset of the meningeal symptoms following the initiation of a beta-lactam agent was suggestive of a Jarisch-Herxheimer reaction. More data on the pathophysiology of the Jarisch-Herxheimer reaction would help us to analyze such observations more precisely. Reference

Schweinehüterkrankheit als Differentialdiagnose des akuten Nierenversagens

Leptospirosis is a worldwide infectious disease affecting both animals and humans. Leptospira pomona is well known as a pathogen of a mild form of leptospirosis (maladie des jeune porchers). A 51-year-old male farmer was referred to our hospital with high fever, hyperbilirubinemia and acute renal failure. Further laboratory tests revealed elevated inflammatory parameters, thrombocytopenia, signs of a mild hepatitis and involvement of pancreas. About 7 days before he had experienced muscle pain accompanied by headache and fever. Suspecting leptospirosis an intravenous therapy with penicillin was started. During the subsequent course of his illness a sixfold increase increase of antibody titer against leptospira pomona was documented within 3 weeks. Urine retention parameters decreased by intravenous fluid resuscitation in the intensive care unit, so that hemodialysis was not necessary. Platelets and bilirubin returned to normal. Atrial fibrillation as a sign of cardiac manifestation of leptospirosis changed spontaneously in a regular and permanent sinusrhythm. The patient was discharged home after 3 weeks in the hospital. Early diagnosis is most important for the prognosis of patients with severe form of leptospirosis. Leptospira pomona is a known pathogen of anicteric leptospirosis but in some cases is able to cause a severe form of leptospirosis with renal failure, jaundice and thrombocytopenia.

Fulminanter Verlauf einer Leptospirose mit multiplen Organmanifestationen

We describe a case of a 39-year-old male, who initially presented with severe muscle pain, fever, shortness of breath and tachycardia. He was admitted to hospital with suspected myocarditis. The next days he developed a generalized icterus and acute renal failure. Suspecting leptospirosis an intravenous therapy with penicillin was started. Due to pulmonary and circulatory insufficiency intensive care was necessary. In course the patient developed all known manifestations of leptospirosis including, cardiac arrhythmia and asystolia due to AV-block III degrees, recurrent atelectases of the lungs, hyperbilirubinemia, thrombocytopenia, hepatitis, pancreatitis, very severe rhabdomyolysis and polyradiculitis with areflexia and tetraplegia. Additionally, the patient had a transient hyperthyreosis, which has not been described in the literature so far. After 33 days the patient left the intensive care unit and was discharged out of hospital a fortnight later. 4 weeks later he was able to return to work. The only residuum of this illness is a partial paresis of his right quadriceps muscle.

Chest radiographc manifestation of leptospirosis

Chest radiographc manifestation of leptospirosis

Human leptospirosis--a review of 50 cases.

Epidemiological and clinical aspects of 50 consecutive patients, 47 adults and three children, hospitalized between 1977 and 1987 for human leptospirosis, were reviewed. 45 (90%) of the patients were from rural regions. 32 (64%) cases occurred in individuals at occupational risk for the infection. 35 (70%) cases were registered in the warm season. The source of infection was known in 34 (68%) cases. Weil's disease was diagnosed in 31 (62%) patients, aseptic meningitis in 12 (24%) and acute unexplained fever in seven (14%). Haemodialysis was required for 11 (35%) patients with Weil's disease. Three (6%) patients died. Cause of death was massive gastrointestinal haemorrhage in two and renal failure in one. Leptospira icterohaemorrhagiae was responsible for 39 (78%) cases, Leptospira canicola for six (12%), Leptospira grippotyphosa for two (4%), and Leptospira australis, Leptospira ballum and Leptospira sejroe, for one case each. A muscle biopsy was performed in six patients and a renal biopsy in three. Focal necrotic muscular changes, with mild mononuclear infiltrate, were found. Pigmented casts in distal convoluted tubules, mild interstitial inflammatory infiltrate and mesangial enlargement of some glomeruli were observed in kidney biopsies. A good knowledge of the protean clinical manifestations of leptospirosis and an accurate laboratory study are required for a correct diagnosis.