A catastrophic leptospirosis case with multisystemic involvement

Abstract

Leptospirosis is a systemic infection with varying degree of clinical manifestations from mild to fatal disease. Clinical suspicion is very important to identify leptospirosis. A field worker patient was admitted to our clinic with emerging acute hepatitis and renal failure accompanying conjunctivitis, autoimmune hemolytic anemia, thrombocytopenia, pneumonia and epididymorchitis. During the follow-up the patient was transmitted to intensive care unit, and hemodialysis with plasma exchange was performed. Usually mild disease is treated in outpatient clinics because severe organ failure is experienced rarely. Alternative treatments such as plasma exchange and corticosteroids may also provide benefits especially in patients who were unresponsive to classical therapies.

Keywords

• Leptospirosis,Acute Hepatitis,Plasmapheresis,Hemodialysis

Multisistemik tutulumlu katastrofik leptospirozis vakası

Öz

Leptospirozis, hafif ile ölümcül hastalığa kadar değişen derecede klinik bulgulara sahip sistemik bir enfeksiyondur. Teşhis konusundaki en önemli vizyonun klinik şüpheniz olduğu düşünülmektedir. Kliniğimize, konjontivit, otoimmün hemolitik anemi, trombositopeni, pnömoni ve epididimo-orşitin eşlik ettiği akut hepatit ve böbrek yetmezliği tablosuyla başvuran ; takibinde yoğun bakım ünitesine alınıp plazma değişimi ve hemodiyaliz ile takip edilen tarlada çalışan bir işçiyi sunduk. Leptospiroziste genellikle hafif hastalık ayaktan tedavi edilirken, ciddi organ yetmezliği nadiren görülür. Plazma değişimi ve kortikosteroidler gibi alternatif tedaviler, özellikle klasik tedavilere yanıtsız kabul edilen hastalarda fayda sağlayabilir.

Anahtar Kelimeler

• Leptospirozis,Akut hepatit,Plazmaferez,Hemodiyaliz

Kaynakça

1. 1. Bharti AR, Nally JE, Ricaldi JN, Matthias MA, Diaz MM, Lovett MA, et al. Leptospirosis: a zoonotic disease of global importance. Lancet Infect Dis. 2003;3:757–71.
2. 2. A Calvo-Cano 1, E Aldasoro, M F Ramírez, M J Martínez, A Requena-Méndez, J Gascon, Two cases of laboratory-confirmed leptospirosis in travellers returning to Spain from Thailand, September 2013. Euro Surveill. 2014; 19(2):pii=20675
3. 3. Amilasan AS, Ujiie M, Suzuki M, Salva E, Belo MC,Koizumi N , et al. Outbreak of Leptospirosis after Flood, the Philippines, 2009. Emerg Infect Dis. 2012;18(1):91–4.
4. 4. Koizumi N, Watanabe H. Current Knowledge of Leptospira and Leptospirosis. Modern Media. 2006;52(10):290–306.
5. 5. John JT. Emerging and reemerging bacterial pathogens in India. Indian J Med Res. 1996;103:4-18.
6. 6. Nobuyuki Mishima, Koichiro Tabuchi, Tomoaki Kuroda, Issaku Nakatani, Pheophet Lamaningao, Mari Miyake, Seiji Kanda, Nobuo Koizumi, Toshimasa Nishiyama. The First Case in Japan of Severe Human Leptospirosis Imported from Vietnam. Tropical Medicine and Health. 2013;4:171-6.
7. 7. Turner LH. Leptospirosis I. Trans R. Soc Trop Med Hyg. 1967;61:842–55.
8. 8. Chernukha YG, Shishkina ZS, Baryshev PM, Kokovin IL. The dynamics of IgM and IgG Antibodies in leptospiral infection in man. Zentralbl. Bakteriol.Mikrobiol. Hyg. 1976;236:336–43.

9. 9. Silva MV, Camargo ED, Batista LA et al. Behaviour of specific IgM, IgG and IgA class antibodies in human leptospirosis during the acute phase of the disease and during convalescence. J. Trop. Med. Hyg. 1995;98:268–72.
10. 10. Glynn K, Hartskeel R, Ko A, Meslin F. Leptospirosis. In:Heymann DL, editor. Control of communicable diseases manual. 19th ed. Washington, DC: American Public Health Asssociation; 2008. pp. 351–64.
11. 11. Mandell G, Bennett J, Dolin R. Mandell, Douglas and Bennett’s principles and practice of infectious diseases. 7th ed. Volume 2. Philadelphia, PA: Churchill Livingstone Elsevier; 2010.
12. 12. Siriwanij T, Suttinont C, Tantawichien T, Chusil S, Kanjanabuch T, Sitprija V. Haemodynamics in leptospirosis: Effects of plasmapheresis and continuous venovenous haemofiltration. Nephrology (Carlton). 2005;10:1-6.
13. 13. Vieira SR, Brauner JS. Leptospirosis as a cause of acute respiratory failure: Clinical features and outcome in 35 critical care patients. Braz J Infect Dis. 2002;6:135-9.
14. 14. Vale TC, Santos GC, Saturnino SF, Antunes Neto AS, Amâncio FF, Oliveira MA, Fernandes BF, Gomez RS, Andrade MV, Teixeira AL. Weil Syndrome A Rare Cause of Cerebral Venous Thrombosis. JAM Neurology. 2014;71(2):238-9.
15. 15. Sbai H, Mellouki I, El Bouazzaoui A, Boukatta B, Smail,Harrandou M, Khatouf M, Ibrahimi A, Melhouf A, Kanjaa N; Multivisceral organ failure related to leptospirosis in pregnant patient. Indian Journal of Critical Care Medicine. 2013:17:43-45.