Weil's disease presenting as atypical pneumonia.

Leptospirosis is a disease caused by spp. Leptospira, also known as Weil's disease if it manifests with jaundice. It can be associated with respiratory, renal, hepatic and haematological complications and most importantly carries a high mortality when untreated. We describe a case of a 53 year old man presenting with myalgia and fever in whom the diagnosis of leptospirosis was not initially considered. Following a deterioration in his condition a careful history revealed an apparent brief exposure to animal urine and subsequent grossly positive Leptospira serology. Treatment of his condition led to complete resolution after a brief stay on the intensive care unit. This case highlights the atypical nature of a presentation of Leptospirosis, its respiratory complications, and importance of serological testing in its diagnosis.

[Leptospirosis--disease with many faces]. / Leptospiroza--choroba o róznych obliczach.

Leptospirosis is a zoonotic disease of global reach caused by pathogenic spirochetes of the genus Leptospira. The disease has two periodic phases (septic and immune phase) and its clinical manifestations are diverse. Central nervous system involvement in leptospirosis most commonly occurs as aseptic meningitis, often asymptomatic, only with abnormal cerebrospinal fluid findings. Weil's syndrome is defined as liver damage with acute renal failure and bleeding diathesis, has a high mortality rate. A pulmonary form may occur as an acute respiratory distress syndrome. The reference standard assay is the microscopic agglutination test. A titer of at least 1:400 in the presence of symptoms confirms the diagnosis. The prognosis depends on a rapid identification and treatment with antibiotics. The paper presents selected cases of leptospirosis with its different clinical manifestations. The common feature was a severe illness and sometimes the need for cooperation of doctors of various specialities.

[CME: Zoonosis in Switzerland: Leptospirosis]. / CME: Zoonosen in der Schweiz: Leptospirose CME-Fragen.

CME: Zoonosis in Switzerland: Leptospirosis Abstract. Leptospirosis is worldwide a common zoonosis that also occurs in Switzerland. Frequently it presents as a self-limited, mild illness. The more severe presentation with jaundice and sever acute kidney injury (Weil's disease) is, however, associated with a high morbidity and mortality. In order to make the diagnosis, it is important to recognize the typical findings and perform the appropriate diagnostic workup. In this article, we discuss the clinical signs, diagnostic workup, therapy and prevention of leptospirosis and present the case of a 54-year-old patient with severe leptospirosis.

Leptospira interrogans and Leptospira peptidoglycans induce the release of tumor necrosis factor alpha from human monocytes.

Elevated plasma concentrations of the cytokine tumor necrosis factor alpha (TNF alpha) have been observed in patients affected by leptospirosis. In this study we found that a preparation of peptidoglycan of Leptospira interrogans, serovar copenhageni, was able to induce the release of TNF alpha from peripheral blood mononuclear cells. TNF alpha induction occurred in a dose dependent manner and was not affected by the endotoxin inhibitor polymixin B. This is the first report on induction of TNF alpha release by a peptidoglycan of spirochetes. Our findings are consistent with existing clinical data and provide a potential mechanism for TNF alpha production.

Leptospira interrogans serovars hardjo and pomona: causes of infections in dairy cows and humans in Florida.

Leptospirosis was diagnosed in 11 milkers on 3 dairy farms in a Florida county. Serologic test results identified Leptospira interrogans serovar hardjo as the infecting organism in milkers and cows on one farm, and hardjo was isolated from two cows. On the second farm, serovars hardjo and pomona were implicated serologically in the cows and milkers, and pomona was isolated from two milkers. On the third farm, hardjo infection was identified by serologic tests in one milker, and hardjo was isolated from another.This was the first isolation of hardjo from a human being reported in the United States. Leptospiral infection is an occupational hazard for dairy milkers in some areas of the United States. Thus, the authors recommend that preventive measures should be taken. These measures should include boots and other protective clothing and protection from urine spray for the eyes and nose.

Leptospirosis mimicking sepsis after orthopedic surgery: a case report.

We report a case of leptospirosis that occurred after elective surgery involving tendon transfer and shoulder arthroscopy. The disease mimicked hospital infection after orthopedic surgery and was at first misdiagnosed as post-operative sepsis. The patient was 60 year old female that developed sepsis with hypotension, shock, bleeding, jaundice and renal insufficiency 4 hours after surgery. Shock treatment procedures were performed and broad spectrum antibiotic therapy was used with coverage for bacteria acquired in hospitals. A careful investigation was carried out by the Hospital Infection Control Service in search of the possible source of the infection. After clinical evaluation by a specialist in infectious diseases, the hypothesis of leptospirosis was put forward based on clinical and epidemiological data. The hypothesis was later confirmed by the positive result of serological tests with the microagglutination method that yielded 1:800 and then 1:12,600 7 days later. This is the first reported case of leptospirosis manifest directly following surgery, mimicking postoperative sepsis.

Experimental infection of lactating goats with Leptospira interrogans serovars pomona and hardjo.

Pathogenesis of Leptospira interrogans serovars pomona and hardjo was evaluated in 14 lactating goats. Although mild clinical signs of leptospiral infection characterized by pyrexia and reduction in milk yield appeared in some animals, a consistent clinical pattern was not observed in the inoculated animals. The pomona serovar was isolated from the kidney of 1 of the 4 goats inoculated with serovar pomona. The hardjo serovar (strain UI 750) was isolated in the rabbit serum-supplemented bovine albumin polysorbate-80 liquid medium only from the mammary gland of 1 of 4 goats at 13 days after inoculation with serovar hardjo. The positive culture was detected after an 8-month incubation period.

Experimental infection of pregnant and lactating goats with Leptospira interrogans serovars hardjo and szwajizak.

Pathogenesis of 2 Leptospira serovars, hardjo and szwajizak, was studied in pregnant and lactating goats. Although clinical signs of leptospiral infection were minimal, cultural isolations were made from the mammary gland of 2 goats and the kidney of 1 goat inoculated with serovar hardjo (C846). The isolations were made only on solid bovine albumin polysorbate-80 medium supplemented either with rabbit serum or sodium pyruvate. Cultural isolations of serovar szwajizak were made from kidney, liver, brain, urine, and mammary gland samples of 1 goat and the liver and kidney samples of its kids. These isolations were made in only the solid bovine albumin polysorbate-80 medium which had been supplemented with normal goat serum.

[Glycoproteins from Leptospira interrogans serogroup icterohaemorrhagiae: distribution in the liver and kidney of experimentally infected guinea pigs]. / Glicolipoproteína de Leptospira interrogans sorogrupo icterohaemorrhagiae: distribuição em fígado e rim de cobaias experimentalmente infectadas.

Tissue damage in leptospirosis has been ascribed to direct effect of the microorganisms and/or their virulence, including products synthetized by leptospires or released during their lysis. This study aimed at chemical extraction of the glycolipoprotein (GLP) from virulent leptospires, production of a rabbit anti-GLP and analysis of its distribution in liver and kidney of inoculated guinea-pigs, sacrificed sequentially from the 1st to 6th day of infection, covering the whole, spectrum of acute leptospirosis. The comparison of GLP expression to local injuries aimed at new pathogenetic data. GLP was detected in liver and kidney in 2 out of 6 guinea-pigs on the 5th day and in all 6 animals on the 6th day of infection. Granular forms were seen in the cytoplasm of macrophages, free in interstitium or adhered to endothelial and parenchymal cell membranes, especially in the most damaged sites. These findings lead us to the hypothesis of GLP as a toxic factor resulting from leptospiral lysis by macrophages. Although it was not proved as a promoter of initial lesions, it seems to be related to the enhancement of tissue damage late in the course of the disease.

Isolation of Leptospira interrogans serovar muenchen from a sow with a history of abortion.

The isolation of Leptospira interrogans serovar muenchen from a sow which aborted in the first third of pregnancy is described. Isolation was achieved only in media containing a rabbit serum additive and identification was determined by cross-agglutination absorption. A high degree of cross-reactivity was found with reference antisera of the Australis serogroup. Serovar muenchen has not previously been reported in animals and may be responsible for a proportion of the titres to antigens of the Australis serogroup that have recently been reported in pigs in England.

Leptospirosis--an occupational disease of soldiers.

Two cases of leptospirosis are described in soldiers who fell into a river together. One developed Weil's disease due to icterohaemorrhagiae serogroup and the other "Mud-Fever" due to grippotyphosa serogroup. The organisms were initially cultured in standard blood culture media. There were six cases of leptospirosis in BAOR in the 10 years to 1980 giving an incidence 10 times greater than in the civil population of UK and West Germany. Leptospirosis is an occupational disease of soldiers in BAOR and the health risks of fresh water immersion should be publicised.

[Etiological structure and clinical epidemiological characteristics of Leptospira infection in Rostov Province based on data from therapeutic institutions from 1960 to 1983]. / Etiologicheskaia struktura i kliniko-épidemiologicheskaia kharakteri stika leptospiroznoi infektsii v Rostovskoi oblasti po materialam nekotorykh lechebnykh uchrezhdenii za 1960--1983 gg.

Changes in communal conditions, in economy, as well as in ecology and fauna, which took place in Rostov Province during the last decade (1973-1983) determined shifts in the etiological structure of Leptospira infection and in its course. The study revealed an increase in morbidity caused by L. icterohaemorrhagiae (up to 61%) and L. hebdomadis (up to 22%) with a simultaneous decrease in the isolation rate of L. grippotyphosa and L. pomona (up to 2-3%). In most cases (77%) the diseases caused by leptospires of different serogroups were found to take an icteric course accompanied by the development of hepatorenal insufficiency (46%). The similarity of clinical manifestations in different etiological forms of Leptospira infection was determined by common pathogenetic and pathophysiological features characteristic of the development of the leptospiral infectious process.

[The mechanisms maintaining epidemic foci of leptospirosis]. / Mekhanizmy podderzhaniia épidemicheskikh ochagov leptospirozov.

24,419 samples of blood serum, collected in the Azerbaijan SSR among different professional groups of the population, have been tested for leptospirosis. The comparison of the results with those obtained in the natural foci of leptospirosis and in the foci of this infection appearing as a consequence of human activities has made it possible to come to the conclusion that the epidemic foci of leptospirosis are maintained due to the existence of foci among cattle. The cases of contamination among persons professionally linked with large cattle breeding complexes have been found to exceed those among persons working at farms of a nonindustrial type.

[The importance of myoglobin in the pathogenesis of leptospirosis]. / Znachenie mioglobina v patogeneze leptospiroza.

Measurements were made of serum and urine myoglobin in 48 patients with leptospiral jaundice (LJ) and 56 patients with various acute infections. At the height of LJ blood myoglobin level reached 28.96 +/- 4.3 micrograms/l (normal concentration 0.315 +/- 0.002 microgram/l). Compared to acute pneumonia, acute viral hepatitis, tonsillitis, erysipelas, diphtheria, health values, the ratio of serum myoglobin to urine myoglobin in leptospirosis made up 45.25 against 5.4, 4.8, 6.8, 3.7, 1.8 and 1.3, respectively. A relationship was found between concentrations of myoglobin, bilirubin, creatinine in the blood and leptospirosis severity. Elevation of serum myoglobin as a manifestation of specific myositis is pathognomic for leptospirosis and contributes to the onset of acute renal failure and disturbance of bilirubin metabolism. Quantitation of blood myoglobin may be helpful as an additional test for leptospirosis severity.

[A type strain or a neotype strain of Leptospira]. / Zur Frage eines Typstammes beziehungsweise Neotypstammes für die Leptospiren.

A deep review of the scientific literature concerning the history of the two oldest icterohaemorrhagiae strains is given in order to promote a decision about the legitimate neotype strain on the genus Leptospira. The strain RGA was found to meet completely the requirements for a Neotype culture given by the International Code of Nomenclature of Bacteria. Its origin from a patient with Weil's disease through guinea pig passages in 1915 is well documented and its culture is unequivocally described by Ungermann in 1916. The strain was maintained in pure culture. Since more than 60 years the strain is used for comparative investigations in classification studies in all laboratories performing such tests. At contrary the history of strain Ictero I is very incomplete. The strain was claimed by Yamamoto to be one of the strain isolated by Inada and Ido in 1915 originally designated as Yamasaki. However, the statement the maintenance of these strains because of loss of virulence was discontinued, is repeatedly mentioned in some old publications of the authors. Moreover it is reported that the strain Ictero I because of contamination with a fungus was recultivated after a passage through a splenectomized mouse, i.e. the strain was not maintained in a pure culture. Beside this it is hardly understandable why has the strain not been submitted to other laboratories before 1965. The strain Ictero I was found to contain an additional thermolabile antigen not present in RGA. At present it is impossible to decide whether this property was already present in the original culture or developed only later, eventually after its mouse passage. Summarizing all these facts, it must be stated that the strain Ictero I cannot be considered to meet all the necessary requirements of its recognition as neotype culture of the Genus Leptospira.

Skin reaction to lipids from avirulent strain Shibaura of Leptospira interrogans serovar copenhageni.

Sonically disrupted cells from avirulent strain Shibaura of Leptospira interrogans serovar copenhageni induced a skin reaction characterized by infiltration of polymorphonuclear leukocytes (PMN) associated with some edema in guinea pigs. To determine the substance inducing infiltration of PMN, lipids of avirulent strain Shibaura were extracted with chloroform--methanol--water after washing with acetone. The lipids comprised 28% of the dry weight of the cell. When the lipids were further separated into water--methanol and chloroform fractions, the most severe PMN infiltration of all samples was seen in the skin inoculated with extract recovered from the chloroform fraction. Neutral and polar lipids were detected after thin-layer chromatography of the chloroform extract. Neutral lipids were detected as free fatty acids (FFA). Fatty acids contained in polar lipids were mainly palmitic acid and palmitoleic acid, whereas FFA comprised 66.5% oleic acid. Skin reactions consisting of marked edema with mild infiltration of PMN were elicited by FFA. There was no obvious difference between a commercially available FFA mixture and the FFA from avirulent strain Shibaura. These observations suggest that FFA may play some role in the pathogenesis of leptospirosis.