Reversal of renal tubule transporter downregulation during severe leptospirosis with antimicrobial therapy.

Tubular dysfunction is a hallmark of severe leptospirosis. Antimicrobial therapy is thought to interfere on renal involvement. We evaluated the expression of a proximal tubule type-3 Na+/H+ exchanger (NHE3) and a thick ascending limb Na+-K+-2Cl(-) cotransporter (NKCC2) in controls and treated hamsters. Animals infected by a serovar Copenhageni isolate, were treated or not with ampicillin (AMP) and/or N-acetylcysteine (NAC). Leptospiral antigen(s) and expression of renal transporters were evaluated by immunohistochemistry, and serum thiobarbituric acid (TBARS) was quantified. Infected hamsters had high amounts of detectable leptospiral antigen(s) in target tissues while renal expression of NHE3 and NKCC2 decreased. Ampicillin treatment was associated with minimal or no detection of leptospiral antigens, normal expression of NHE3 and NKCC2 transporters, and reduced levels of TBARS. NAC effect was restricted to lowering TBARS. Early and late AMP treatment rescued tubular defects in severe leptospirosis disease, and there was no evidence of benefit from antioxidant therapy.

Enfermedad de Weil

Presentamos el caso de una mujer de 29 años, de un sector subnormal de Neiva con un cuadro de fiebre, dolores musculares, ictericia, hemorragia de vías digestivas, sin compromiso hemodinámico y falla renal aguda. La M.A.T. fue positiva para 4 serovars con títulos mayores de 1/800 diluciones. Este es uno de los pocos casos informados en la literatura, causada por múltiples serovars.

Outcome of leptospirosis in children.

We conducted a retrospective analysis of 43 consecutive children (35 boys and 8 girls), 4-14 years of age and living in an urban area, who were hospitalized at the Instituto de Infectologia Emilio Ribas (Sao Paulo, Brazil) from January 1989 to December 1995 with an acute illness subsequently diagnosed as leptospirosis. Epidemiologic data indicated contact with contaminated water in most cases (88%). The patient sera reacted most strongly with Leptospira interrogans serovars copenhageni (45%) and icterohaemorrhagiae (32.7%). Jaundice was present in 70% of the patients, elevated transaminase levels in 56%, renal failure in 79%, meningitis in 23%, thrombocytopenia in 65%, and hemorrhagic manifestations in 11.6%. Three children had pulmonary hemorrhage with respiratory failure and one death occurred as a consequence of respiratory failure. We also observed that antimicrobial therapy reduced the extent of renal failure and thrombocytopenia. These data indicate that antibiotics benefit children with late, severe leptospirosis and that severe disease also occurs in children and should be considered in the differential diagnosis.

Penicillin therapy in icteric leptospirosis - abstract

The efficacy of antibiotic therapy in icteric (severe) human leptospirosis is unknown. We therefore undertook a prospective, randomized, controlled study of penicilin therapy in such patients. All admitted between October 1, 1983 and June 30, 1986 with a history compatible with leptospirosis, were randomized on admission to receive either 2 megaunits of crystalline pencillin intravenously every six hours for five days or intravenous fluids only. The diagnosis of leptospirosis was confirmed by a four-fold rise in titre or an initial titre> 1:1600 in the micoagglutination test, and/or by positive leptospira cultures. One hundred and fifty patients were initiated, and leptospirosis was confirmed in seventy-five of them. Seventy-one (94.7 percent) of these were jaundiced. One died before randomization, while four were allergic to penicillin. Thus, thirty-two patients were assigned to receive penicillin, and thirty-four to the control group. A comparison of the results of laboratory tests made on the day of admission revealed no signifcant differences between the two groups. There was no significant difference in time for defervescence, return of biochemical variables to normal, incidence of iritis, or mortality between the two groups. Three patients (8.8 percent) died in the control and one (3.1 percent) in the treatment group. The mortality rate was 5.1 percent for the study and 7 percent overall. Six patients had positive urine cultures in the controls while no cultures were obtained in the treated patients. Penicillin appears to have little effect in icteric leptospirosis (AU)