Neuroleptospirosis con pericarditis y colestasis intrahepática (Síndrome de Weil) / Neuroleptospirosis with Pericarditis and Intrahepatic Cholestasis (Weil syndrome)

Introducción: El síndrome de Weil es una forma grave de la infección bacteriana causada por la bacteria Leptospira, conocida como leptospirosis. Este se caracteriza por la disfunción de múltiples órganos, entre ellos, hígado, riñón, músculos, serosas o el sistema neurológico, en este caso denominado neuroleptospirosis, genera una mortalidad muy elevada cuando no se brinda diagnóstico y tratamiento adecuado. Objetivo: Describir las manifestaciones clínicas, paraclínicos complementarios y tratamiento de un paciente con síndrome de Weil, una condición poco frecuente. Caso clínico: Paciente de 23 años quien consulta en el contexto de síndrome febril agudo asociado con neuritis óptica, dolor torácico y paraclínicos que evidenciaron afectación hepática y cardíaca. Se confirma el diagnóstico de síndrome de Weil dado por neuroleptospirosis, pericarditis y colestasis intrahepática. Conclusiones: mediante un caso clínico de síndrome de Weil, se describe la afectación multisistémica de complicaciones asociadas con leptospirosis, con manifestaciones poco habituales como neuroleptospirosis, pericarditis y colestasis intrahepática(AU)

Introduction: Weil syndrome is a serious form of the bacterial infection caused by the Leptospira bacterium; this is known as leptospirosis. This is characterized by multiple organ dysfunction; for example, the liver, kidney, muscles, of serous type, or the neurological system, in this case called neuroleptospirosis, which produces a very high mortality when adequate diagnosis and treatment are not provided. Objective: To describe the clinical manifestations, complementary paraclinic practice and treatment of a patient with Weil syndrome, as a rare condition. Clinical case: 23-year-old patient who presents with acute febrile syndrome associated with optic neuritis, chest pain, and paraclinical symptoms obviously consistent liver and cardiac involvement. The diagnosis of Weil syndrome is confirmed, specifically defined by neuroleptospirosis, pericarditis, and intrahepatic cholestasis. Conclusions: Through a clinical case of Weil syndrome, the multisystem involvement of complications associated with leptospirosis is described, along with its unusual manifestations, such as neuroleptospirosis, pericarditis, and intrahepatic cholestasis(AU)

Leptospirosis in French Historical Medical Literature: Weil's Disease or Kelsch's Disease?

Early names for leptospirosis often indicate occupational or environmental exposure. Leptospirosis is hard to identify in the tropical setting because of co-circulating diseases. This is not the case in the temperate setting, such as Europe, where the few historical differential diagnoses were malaria, typhoid, and viral hepatitis. Leptospirosis presumably caused community epidemics in Europe before 1900 and military epidemiologists carefully documented outbreaks in "constrained settings." Achille Kelsch (1841-1911) synthesized available military data and epidemiological perspectives to define "epidemic jaundice" as a nosological continuum, caused by an infectious agent found in muds and water. He viewed Weil's disease as being only one form of that now well-identified disease continuum. The causative pathogen and epidemiological determinants were identified years later. The role of soils and muds as intermediate reservoirs, as suggested by Kelsch, deserves further investigation.

Highly Pathogenic Leptospira Found in Urban Brown Rats (Rattus norvegicus) in the Largest Cities of Sweden.

Leptospirosis is an emerging zoonosis of global concern; however, its contemporary occurrence in Sweden, a European country partly located north of the Arctic Circle, is poorly known. Four out of 30 brown rats, captured within urban districts in Sweden, were found to be positive for antibodies to Leptospira interrogans serovar Icterohaemorrhagiae. This serovar causes Weil's disease in humans, a severe infection with jaundice, renal failure, and hemorrhage. Our study is the first finding of this highly pathogenic serovar in Swedish rats since the 1930s.

Molecular Typing of Pathogenic Leptospira Serogroup Icterohaemorrhagiae Strains Circulating in China during the Past 50 Years.

BACKGROUND: Leptospirosis is one of the most important neglected tropical infectious diseases worldwide. Icterohaemorrhagiae has been throughout recent history, and still is, the predominant serogroup of this pathogen in China. However, very little in detail is known about the serovars or genotypes of this serogroup. METHODOLOGY/PRINCIPAL FINDINGS: In this study, 120 epidemic strains from five geographically diverse regions in China collected over a 50 year period (1958~2008), and 8 international reference strains characterized by 16S rRNA sequencing and MLST analysis. 115, 11 and 2 strains were identified as L. interrogans, L. borgpetersenii, and L. kirschneri, respectively. 17 different STs were identified including 69 ST1 strains, 18 ST17, 18 ST128, 9 ST143 and 2 ST209. The remaining 12 strains belonged to 12 different STs. eBURST analysis demonstrated that, among the clonal complexes isolated (CCs), CC1 accounted for 73.3% (88/120) strains representing three STs: ST1, ST128 and ST98. ST1 was the most likely ancestral strain of this CC, followed by singleton CC17 (17/120) and CC143 (11/120). Further analysis of adding 116 serogroup Icterohaemorrhagiae strains in the MLST database and studies previously described using global eBURST analysis and MST dendrogram revealed relatively similar ST clustering patterns with five main CCs and 8 singletons among these 244 strains. CC17 was found to be the most prevalent clone of pathogenic Leptospira circulating worldwide. This is the first time, to our knowledge, that ST1 and ST17 strains were distributed among 4 distinct serovars, indicating a highly complicated relationship between serovars and STs. CONCLUSIONS/SIGNIFICANCE: Our studies demonstrated a high level of genetic diversity in the serogroup Icterohaemorrhagiae strains. Distinct from ST17 or ST37 circulating elsewhere, ST1 included in CC1, has over the past 50 years or so, proven to be the most prevalent ST of pathogenic leptospires isolated in China. Moreover, the complicated relationship between STs and serovars indicates an urgent need to develop an improved scheme for Leptospira serotyping.

Leptospirosis in South-western Spain.

INTRODUCTION: Leptospirosis is a zoonosis of worldwide distribution and tropical predominance. Its incidence could be underestimated in template regions. We describe the manifestations of leptospirosis in an area of Southwestern Spain. PATIENTS AND METHODS: Eighty-six cases of leptospirosis (April 1997-April 2013) were retrospectively analyzed. The diagnosis was based in clinical and serological (Leptospira IgM ELISA) judgement. Epidemiological, clinical, laboratory, and prognostic dates were recorded. RESULTS: The mean age was 43.1 ± 13.8 years (84.9% males). The mean annual incidence was 1.99/100.000. There were activities of risk in 94%: 82.5% contact with animals (57.4% pigs, 38.1% dogs, 31.7% cows, 22.2% sheeps), and 31.7% contact with pooled water. The most frequent symptoms were fever (94.1%), arthromyalgias (60.7%), and cephalalgia (53.3%). The main laboratory alterations were hypertransaminemia (48%), renal insufficiency (26.3%), and thrombocytopenia (16.9%). A lymphocytic meningitis was associated in 11 cases (12.5%) and a picture of Weil's disease was observed in 13 patients (15.1%). The patients with meningitis were younger (31.2 ± 9.2 versus 44.8 ± 15.2, p=0.004). The patients with Weil's disease were older (53.5 ± 15.8 versus 41.2 ± 14.5, p=0.007). Fifty seven patients were hospitalized (66.3%) and 6 patients died (7.0%). Factors independently associated with mortality were age >60 years (odds ratio [OR] 45.0, confidence interval 95% [CI95%] 4.7-434.6) and diagnosis of Weil's disease (OR 15.8, CI95% 2.5-98.7). CONCLUSIONS: In our experience, leptospirosis have a not despicable incidence and tends to show fever and arthromyalgias in men with risk activities. Leptospirosis should be included in the differential diagnosis of lymphocytic meningitis. Mortality is associated with older age.

[Fever and jaundice... and if it was a leptospirosis. About a case of L. interrogans icterohaemorrhagiae in Northern France]. / Ictère fébrile et si c'était une leptospirose. À propos d'un cas de L. interrogans Icterohaemorrhagiae dans le Nord de la France.

Leptospirosis is an anthropozoonose, an animal disease transmissible to humans, caused by a spirochete of the genus Leptospira that lives mainly among rodents but also in wetlands. It occurs worldwide, particularly in Asia, Latin America and Africa. In Europe, the incidence is small (except in France and Great Britain, where its frequency has increased in recent years) but the frequency may be underestimated. Some areas overseas are particularly affected. In France, the potential epidemic of leptospirosis is subject to climatic variations, justifying a constant monitoring of the disease provided by the National Reference Centre (CNR) of leptospires. Transmission to humans primarily occurs through contact with environments contaminated by the urine of infected animals. The disease can affect the liver and kidneys (hepatonephritis) as cytolysis, cholestasis and renal failure associated with fever. A coagulopathy usually accompanies the clinical table. Its diagnosis is difficult because of the clinical polymorphism. Early diagnosis of leptospirosis allows effective medical care, improving patient outcomes. This is currently based on gene amplification (PCR) or serology positive by the microscopic agglutination test (MAT), which is the reference method. Its evolution is usually favorable with appropriate antibiotic treatment (aminopenicillin). However 5-10% of symptomatic patients have a severe multisystem defaillance. Nearly a century after the discovery of the causative agent, this zoonosis remains a public health problem, zoonosis priority in terms of virulence, its reporting is mandatory in our country. We report the case of a severe form of hepatonephritis due to water contaminated with Leptospira observed in Northern France.

Leptospirosis and Weil's disease in the UK.

The recent high-profile death of a British Olympic rower from leptospirosis has raised awareness to this uncommon but potentially fatal disease. The re-emergence of the disease abroad is well documented in the literature, but less is known about cases in the UK. The increase in participation in water sports, foreign travel and often a combination of the two, has increased the exposure of tourists subsequently returning to the UK from areas of high prevalence. Leptospirosis is a zoonotic infection. The bacteria are shed in the urine of animals to the environment from where humans are infected by incidental hosts. There is a wide spectrum of severity of symptoms, from a self-limiting febrile illness to fatal pulmonary haemorrhage, renal or liver failure. It is thought that cases remain unrecognized every year in the UK, largely due to the mild nature of symptoms and the wide differential for febrile illness and partly due to lack of awareness among clinicians. This review examines the epidemiology of leptospirosis in the UK, over the period 2006-10, the clinical features, diagnostic techniques and treatment.

Comparative analysis of severe pediatric and adult leptospirosis in Sao Paulo, Brazil.

Although leptospirosis may be fatal in childhood, the experience of many clinicians working in disease-endemic areas is that classic Weil's disease and death are less common among pediatric patients. The aim of the study was to ascertain disease spectrum and outcome differences in severe pediatric and adult leptospirosis in a large at-risk population. Epidemiologic, clinical, and laboratory data were obtained on hospitalized cases from São Paulo during 2004-2006. A total of 42 case-patients < 18 years of age and 328 case-patients ≥ 18 years of age were tested during the study. Compared with children, adults had higher rates of jaundice (P = 0.01), elevated serum bilirubin levels (P < 0.01), oliguria (P = 0.02), and elevated creatinine levels (P = 0.01) but not for thrombocytopenia or pulmonary involvement. The overall case-fatality rate was 27% (adult) versus 5% (pediatric) (P < 0.01). Severe pediatric leptospirosis may be less likely to show all classic features of Weil's disease and may be less fatal than in adults.

Different patterns in a cohort of patients with severe leptospirosis (Weil syndrome): effects of an educational program in an endemic area.

The aim of this study is to investigate the changes in clinical pattern and therapeutic measures in leptospirosis-associated acute kidney injury; a retrospective study with 318 patients in Brazil. Patients were divided according to the time of admission: 1985-1996 (group I) and 1997-2010 (group II). Patients were younger in group I (36 ± 13 versus 41 ± 16 years, P = 0.005) and the numbers of oliguria increased (21% versus 41% in group II, P = 0.014). Higher frequency of lung manifestations was observed in group II (P < 0.0001). Although increased severity, there was a significant reduction in mortality (20% in group I versus 12% in group II, P = 0.03). Mortality was associated with advanced age, low diastolic blood pressure, oliguria, arrhythmia, and peritoneal dialysis, besides a trend to better mortality with penicillin administration. Leptospirosis is occurring in an older population, with a higher number of oliguria and lung manifestations. However, mortality is decreasing and can be the result of changes in treatment.

[A case of severe leptospirosis infection (Weil's disease) in Tokyo].

We report a case of severe leptospirosis infection (Weil's disease) in Tokyo. A 54-year-old man admitted on September 14, 2006, for a 5-day inability to walk due to severe progressive bilateral leg pain, shoulder pain, and fever exhibited jaundice, conjunctival suffusion, hypoxia, and grasping pain in the bilateral leg muscles. Laboratory findings showed severe liver damage, renal failure, leukocytosis, anemia, thrombocytopenia, elevated CRP, hyponatremia, and hypokalemia. Chest X-ray imaging showed interstitial infiltrates in the bilateral lung fields. After cefepime was initiated, he developed chills, fever, and hypotension due to Jarisch-Herxheimer reaction, necessitating respiratory support. Pulmonary hemorrhaging was also found. On hospital day 2, a urine polymerase chain reaction test for leptospira proved positive for the same base sequence as part of the leptospira gene. A microscopic agglutination test showed elevated antibody titers against Leptospira interrogans. Based on a diagnosis of leptospirosis, the man was treated with 2g per day of ceftriaxione for 2 weeks and recovered fully. The leptospira strain was isolated from rodents captured at his home, and we identified the same base sequence as from his urine sample. Reports shows, leptospirosis in Japan have decreased recently, but, as this case can still be seen even in Tokyo, and diagnosticians should maintain an awareness of possible significance in patients with typical findings for this disease.

Leptospirosis: clinical presentation and correlation with serovars.

A total of 2400 patients with pyrexia of unknown origin and or suspected leptospirosis were included in this study. Dark field microscopy detected Leptospira in 690 cases, Leptospira serological Investigations proved positive in 570 out of these 690 patients. Among them 212 had the classical icteric and the other 358 had anicteric type of presentation. Notably eptospira interrogans serovar ictero haemorrhagiae infection was encountered in 212 patients. In 30 patients, who had multi organ dysfunction which included renal failure, hepatic dysfunction or meningitis was due to Leptospira interrogans Serovar cannicola. Coexsistense of leptospirosis and hepatitis B virus infection were noted in 15 patients. Antibody to Leptospira interrogans was demonstrated by Micro agglutination test (MAT) in addition to dark field microscopy positivity in these cases. Similarly HIV antibody was demonstrated in 30 of the 330 anicteric patients. 554 out of 570 cases responded to intra venous penicillin (216), and oral Doxycycline (182) and Augmentin (156), and the remaining 16 patients succumbed to death.

Influence of leptospirosis on reproductive performance of sows in Brazil.

The purpose of this study was to investigate the association between seropositivity for the most frequent Leptospira serovars and reproductive losses in sows in Brazil. Serum samples from 351 sows from 18 herds (in the state of Rio de Janeiro, Brazil) with low reproductive efficiency were tested (microscopic agglutination) for antibodies against serovars of Leptospira. Antibodies were detected in serum samples of 66.1% of all sows, most frequently serovar icterohaemorrhagiae (43.1%), followed by pomona (18.1%) and tarassovi (9.9%). Seroreactivity to icterohaemorrhagiae and pomona were associated (P<0.05) with impaired reproductive performance (and substantial economic loss). Seroreactivity for pomona was associated (P<0.05) with stillborn piglets and mummified fetuses, whereas seroreactivity to icterohaemorrhagiae was associated (P<0.05) with the number of piglets born dead.

[Longitudinal epidemiology of leptospirosis in the Czech Republic (1963-2003)]. / Dlouhodobá epidemiologie leptospirózy (1963-2003) v Ceské Republice.

After higher rates of occupational or leisure diseases recorded in the Czech Republic in the second half of the last century it was found that the last climatic changes and catastrophic floods of 1997 and 2002 were followed by outbreaks of leptospirosis as the only re-emerging postflood infection. While in tropics and subtropics the monsoon season is typically followed by highly increased rates of leptospirosis in humans, even, with fatal outcomes, this phenomenon remained unknown under the climatic conditions of the Czech Republic where human leptospirosis has been reported rather sporadically, mostly in natural foci of infection, and its incidence rate is usually about 0.3% per 100,000 population. Nevertheless, after the unexpected vast floods of 1997 and 2002 that also afflicted natural foci of leptospirosis, the rates of reported and serologically confirmed cases of leptospirosis in the Czech Republic were three times as high as usual with the specific morbidity reaching 0.9 case per 100,000 population. In 1997, as many as 7156 persons were tested for leptospirosis in the Czech Republic: the disease was diagnosed and reported in 94 patients and in 2002, 92 out of 4999 persons tested were diagnosed with leptospirosis. Two thirds of these cases were from inundation areas, half of them being directly associated with floods (exposure to residual water, flood mud in cellars, etc.). Four case of Weil disease reported in 1997 were fatal. As many as 41 deaths from Weil disease have been reported in the Czech Republic since 1963 when the disease became reportable.

[Seropositivity to leptospiras in sera from patients suspected of viral hepatitis negative to serological markers]. / Seropositividad a leptospiras en sueros de pacientes sospechosos de hepatitis viral negativos a marcadores serológicos.

The prevalence of leptospirosis found in icteric patients negative to serological markers for hepatitis was described. 15.99 % of them were positive patients. It was observed a predominance of serovars canicola, pomona and icterohaemorrhagiae.

Human and canine leptospirosis: serological data of São Paulo City, Brazil, 2000 to 2003.

Sera from humans and dogs were tested by microscopic agglutination test. Icterohaemorrhagiae was the predominant serogroup in both groups, associated with the infestation of Rattus norvegicus.

Leptospira interrogans serovar Valbuzzi: a cause of severe pulmonary haemorrhages in the Andaman Islands.

Outbreaks of leptospirosis that present with predominant pulmonary signs and symptoms have been occurring in the Andaman Islands since the late 1980s. Before this, pulmonary haemorrhage had not been observed as a common complication of leptospirosis in India. During an outbreak on North Andaman in 1997, four leptospire isolates were obtained from blood of a fatal case and three other patients who recovered. These isolates were characterized using serological and molecular techniques. Cross-agglutination absorption tests and microscopic agglutination tests using mAbs were used for serological characterization. Genetic typing was done using DNA sequencing of PCR products. Serologically, the isolates were closely related to strain Valbuzzi serovar Valbuzzi of serogroup Grippotyphosa. The sequences of PCR products from these isolates were compared with those of 45 strains belonging to seven species. The isolates showed 97.5-100 % sequence similarity to reference strains belonging to Leptospira interrogans, indicating that the isolates belong to L. interrogans. Serogroups Icterohaemorrhagiae and Australis have been incriminated as the cause of pulmonary haemorrhage in China, Korea and Australia. The four isolates characterized in the present study were obtained from patients with similar symptoms. However, they belonged to serovar Valbuzzi of serogroup Grippotyphosa, indicating that serogroups other than Icterohaemorrhagiae and Australis can also cause pulmonary haemorrhage.

Clinical profile of leptospirosis in South gujarat.

BACKGROUND: South Gujarat has been witnessing increasing incidence of leptospirosis for the last few years. AIM: To study the clinical profile of leptospirosis in South Gujarat. SETTINGS AND DESIGN: Prospective study during July-September 2000 at the New Civil Hospital, Surat, Gujarat. PATIENTS AND METHODS: All the consecutive cases with clinical suspicion of leptospirosis were screened for lgM antileptospira antibody on the first and the fourteenth day. A four fold or greater increase in agglutinin antibody titre on paired samples was considered diagnostic. If the patient died before the fourteenth day then initial titre greater than 1:15 was considered diagnostic. RESULTS: Total number of patients referred to the hospital were fifty, of which thirty-eight [33 males, with age 14-50 (30 +/- 10.51)] were diagnosed as having leptospirosis. Most common organs involved were liver (27, 71.05%) and kidney (24, 63.15%). Cardio-vascular (12, 31.5%), pulmonary (10, 26.35%), neurological (2, 5.26%) and haematological (8, 21%) involvements were less common. Six patients died because of pulmonary involvement in the form of alveolar haemorrhage, while one died because of cardiac involvement. CONCLUSION: Liver and kidney were the most commonly involved organs in severe leptospirosis. Pulmonary involvement, though uncommon, led to high mortality.