Severe Leptospirosis Observed in a Man Who Had Just Returned from Abroad

Yıl 2013, , 116 - 119, 01.01.2013

Galya Gancheva Milena Karcheva

https://doi.org/10.5152/balkanmedj.2012.085

Öz

Leptospirosis, a re-emerging zoonosis caused by pathogenic Leptospira, has a low incidence in Bulgaria. This paper reports a case of leptospirosis in Pleven, Bulgaria, in which the subject was infected after wading through irrigative canal in northern Greece. Two days later, he had a fever, myalgia and vomiting followed by jaundice, darkness of urine and oliguria. The patient was admitted to Clinic of Infectious Diseases at University Hospital-Pleven after returning to Bulgaria. The history and laboratory findings suggested icterohaemorrhagic leptospirosis. Penicillin G was prescribed and intensive supportive treatment was initiated. Dialysis was performed two hours after admission and was followed by poliuric stage of acute renal failure (peak urine output 16 600 mL/day). Microaglutination test (MAT) for sero-diagnosis was positive (L. hardjo 1:1600, L. icterohaemorrhagiae 1:800). The patient was discharged after sixteen days with improved renal and liver functions. In conclusion, The probability of leptospirosis should not be ignored in patients with fever after returning from abroad. The prompt dialysis and adequate treatment improve prognosis. Turkish Başlık: Yurtdışından Yeni Dönmüş Bir Adamda Gözlenen Ciddi Leptospiroz Anahtar Kelimeler: Leptospiroz, akut renal yetmezlik, diyaliz Leptospiroz, yeniden ortaya çıkan, patojenik Letpospira'nın neden olduğu bir zoonozdur, Bulgaristan'da düşük insidansa sahiptir. Bu yazıda Kuzey Yunanistan'da sulama kanalından geçtikten sonra enfekte olan bir kişide Bulgaristan, Plevne'de bir leptospiroz vakası rapor edilmektedir. İki gün sonra ateş, miyalji ve kusma; takiben sarılık, idrarda koyuluk ve oligüri vardı. Bulgaristan'a döndükten sonra hasta Plevne-Üniversite Hastanesi'nde Enfeksiyon Hastalıkları Kliniğine başvurdu. Öykü ve laboratuvar bulguları ikterohemorajik leptospiroz düşündürdü. Penisilin G reçete edildi ve yoğun destek tedavisi başlandı. Yatıştan iki saat sonra diyaliz yapıldı ve takiben akut renal yetmezlik poliüri evresi oldu (pik idrar çıkışı 16 600 mL/gün). Sero-tanı için mikroaglutinasyon test (MAT) pozitif idi (L. hardjo 1:1600, L. icterohaemorrhagiae 1:800). Hasta düzeltilmiş renal ve karaciğer fonksiyonları ile onaltı gün sonra taburcu edildi. Sonuç olarak, yurtdışından döndükten sonra ateşi olan hastalarda leptospiroz olasılığı göz ardı edilmemelidir. Acil diyaliz ve yeterli tedavi prognozu düzeltir.

Anahtar Kelimeler

Leptospirosis, acute renal failure, dialysis

Severe Leptospirosis Observed in a Man Who Had Just Returned from Abroad

Öz

Kaynakça

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