Case of fulminant leptospirosis in a renal transplant patient.

We present a case of fulminant leptospirosis that was acquired in the suburban area by a 48-year-old male renal transplant recipient. He developed acute renal and hepatic failure with profound jaundice. Spirochetes were identified on liver biopsy. Weil's disease was suspected, and the diagnosis was further supported by a positive serum Leptospira interrogans icterohaemorrhagiae antibody titer. Unfortunately, he suffered from recurrent lower gastrointestinal bleeding, had a prolonged hospital course, and eventually succumbed to overwhelming sepsis. This case is the third report to our knowledge of leptospirosis in a renal transplant recipient in the English literature.

The incidence of ehrlichial and rickettsial infection in patients with unexplained fever and recent history of tick bite in central North Carolina.

We examined the clinical and laboratory findings of a consecutive series of patients from central North Carolina presenting with fever and a history of tick bite within the preceding 14 days. Evidence of a tick-transmitted pathogen was detected in 16 of 35 patients enrolled over a 2-year period. Nine patients were infected with Ehrlichia chaffeensis, and 6 were infected with a spotted fever group rickettsia; 1 patient had evidence of coinfection with E. chaffeensis and a spotted fever group rickettsia. Four patients had detectable antibodies against the human granulocytic ehrlichiosis agent; however, only 2 had a 4-fold antibody titer rise without detectable antibodies against E. chaffeensis. The other 2 were thought to have cross-reacting antibodies to E. chaffeensis. We conclude that ehrlichial infections may be as common as spotted fever group rickettsial infections in febrile patients from central North Carolina with a recent history of tick bite.

Patterns of substance abuse in schizophrenia: nature and significance.

Recent literature suggests that the increasingly prevalent problem of substance abuse may have important implications for the symptoms and course of schizophrenia. To further examine the impact of substance abuse on this disorder, the clinical and research charts of 67 schizophrenic patients admitted to the Schizophrenia Program of the University of Michigan between 1987 and 1990 were reviewed and data on symptomatology, history of substance use, age at onset and first hospitalization, and family psychiatric history were gleaned. This information was analyzed with respect to clinical, demographic, and outcome variables with the following findings: (i) female subjects abused substances at a much lower rate (20%) than male subjects (48%); (ii) substance-abusing patients with schizophrenia had lower pre- and post-treatment Hamilton Rating Scale of Depression scores, poorer post-discharge treatment compliance, and were younger at first hospitalization than were non-abusing patients; (iii) the most often abused substance was cannabis (28%) followed closely by alcohol (21%), with cocaine, hallucinogens, and stimulants all abused by significantly fewer patients; (iv) rates of family history of schizophrenia were similar in substance-abusing and non-substance-abusing schizophrenic patients. These data suggest that substance abuse may not be etiologically related to schizophrenia but influences the onset, course, and symptomatology of schizophrenia.