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LEPTOSPIROSIS (Weil’s disease): A case report. O.Triantafyllou¹ G.Xaralampidis¹ E.Sogka¹ K.Karakousis¹ K.Krapis¹ K.Karamitsos¹ 1 Department of Internal.

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Presentation on theme: "LEPTOSPIROSIS (Weil’s disease): A case report. O.Triantafyllou¹ G.Xaralampidis¹ E.Sogka¹ K.Karakousis¹ K.Krapis¹ K.Karamitsos¹ 1 Department of Internal."— Presentation transcript:

1 LEPTOSPIROSIS (Weil’s disease): A case report. O.Triantafyllou¹ G.Xaralampidis¹ E.Sogka¹ K.Karakousis¹ K.Krapis¹ K.Karamitsos¹ 1 Department of Internal Medicine, General Hospital of Larissa. Larissa, Greece Introduction : Leptospirosis is a zoonosis of worldwide distribution caused by infection with a pathogenic spirochete called Leptospira interrogans (fig.1). Most important reservoirs are rodents. Leptospiral infection in humans causes a range of symptoms, from a mild anicteric form to a severe form with multiorgan involvement called Weil’s disease. It is caracterized by multisystem disfunction and manifests with high fever, jaundice,renal failure,hepatic necrosis, pulmonary involvment, cardiovasvular collapse,neurological changes and hemorrhagic diathesis. Fig1. Bacteria Leptospira 1

2 CASE REPORT IDENTIFICATON: 40 year-old man, farmer,smoker 10pys. Past history : appendectomy 30 years ago CAUSE OF ATTENDANCE AT HOSPITAL: Continuous fever up to 40 °C and non productive cough for two days INITIAL APPROACH Physical examination: Vital signs : T= 39,5°C BP=120/70 mmHg SPΟ2=98% HR=90/min. Cardiovascular : +S1, S2. No m/r/g.ECG=SR. Pulmonary : Clear to auscultation bilaterally. Abdominal : Abdomen soft and non-tender, with no organomegaly. Lymph nodes : No lymphadenopathy. Neurological :Without patologicaly findings. Blood analysis (table 1) Elevated SGOT, SGPT. Trombocytopenia. Elevated CPK. Imaging studies Normal chest x-ray (fig 2) and abdominal ultrasound (fig 3). Fig 2: chest x-ray Fig3:abdominal ultrasound 2

3 EVOLUTION Worsening of his clinical condition was recorded 48hours later. The patient developed jaundice and direct hyperbilirubinemia (table 1 ). Later, on the third day of hospitalization, he developed automatic epistaxis and aggravation of pulmonary function. Chest radiograph revealed bilateral infiltrates in costophrenic angles (fig. 4) LABORATORY TESTS ADMISSION 48 h HCT (%) /Hb (mg/dl)39.2 /13.738.8 /13.8 WBC (per mm³)87005890 NEUT%94.162.3 PLT (per mm³)9700030000 INR1.021.0 UREA (mg/dl)3339 CREATININE (mg/dl)1.030.99 Να+/ Κ+ (mmol/L)131/3.8141/3.3 AST/ALT (IU/L)129/126128/96 TOTAL BILIRUBIN (mg/dl)0.783.6 DIRECT BILIRUBIN (mg/dl)0.372.9 CPK335278 3 Table 1 :Laboratory tests Fig.4 : X-ray chest on 3 day

4 DIAGNOSIS On the 5 th day of hospital stay, the laboratory findings confirmed the presence of antibodies against Leptospira (*’). This result in association with the clinical condition of the patient lead us to diagnose : WEIL’S DISEASE, ICTEROHEMORRHAGIC LEPTOSPIROSIS (*’) : Αbs Leptospira ΙgM=+(86,66) IgG=+(36,94) DIFFERENTIAL DIAGNOSIS Αtypical bacterial infection Viral hepatitis Brucellosis Tubercolosis Vasculitis Hyperthyroidism Drugs Leptospirosis– Weil’s disease (*) (*) The patient refers, rodents presenting into his warehouse PROCECURES Blood,urine cultures Serology :HAV –HBV- HCV –HIV- EBP- CMV- HSV- VCA -TOXO. Tumor markers. Hormone test –ΤSH. Brucella agglutination tests wright, wright -coombs. Mantoux tuberculin skin test Serology test for Abs leptospira. Azithromycin and ceftriaxone started Platelets transfusion 4

5 THERAPY Antibiotic therapy : Ceftriaxone + Doxycicline (7days) (table 2) Table 2: Suggested therapeutic measures. FOLLOW UP Our patient recovered after treatment with antibiotics.The laboratory tests at the end of the therapy revealed normal range for platelets. The rest biochemical parameters come back to normal after 10 days of therapy ANATOMIC SITE/DIAGNOSIS/ MODIFYING CIRCUMSTANCES ETIOLOGIES (usual) PRIMARYALTERNATIVE ADJUNCT DIAGNOSTIC OR THERAPEUTIC MEASURES AND COMMENTS Leptospirosis (CID 36:1507 & 1514, 2003; LnID 3:757,2003) Leptospira – in urine of domestic livestock dogs, small rodents Severe illness: Pen G 1.5 million units IV q6h or ceftriaxone 1 gm q24h. Duration: 7 days Mild illness: (Doxy 100 mg IV/po q12h or AMP 0.5-1 gm IV q6h) x 7 days Severity varies. Two-stage mild anicteric illness to severe icteric disease (Weil’s disease) with renal failure and myocarditis. Rx: Azithro 1gm once, then 500 mg daily x 2 days: non-inferior to, and fewer side effects than, doxy in standard dose (AAC 51:3259, 2007). Jarisch-Herxheimer reaction can occur post-Pen therapy. SUGGESTED REGIMENTS 5

6 CONCLUSION The case presented here wants to remind the importance of consider leptospirosis in the diagnosis of any patient with acute non specific febrile illness with hepatic impairment end multiorgan involvement, not only in an endemic area but in any location if the risk factors are present. Leptospirosis’ clinical manifestations can range from a sub clinical infection to a severe multiorgan disease.Weil’s disease is the most severe form and has a mortality rate of 5% to10%. Recognition of Weil’s disease is especially important because antimicrobial agents can reduce its severity and duration as well as lead to a favorable outcome of this potential lethal condition REFERENCES Maroun et al: Fulminant Leptospirosis (Weil’s disease ) in an urban setting as an overlooked cause of multiorgan failure :a case report.Journal of Medical case report. 2011 5:7 Forbes AE, Zochowski WJ, Dubrey SW, Sivaprakasam V (July 2012). "Leptospirosis and Weil's disease in the UK". QJM : Monthly Journal of the Association of Physicians 105 (12): 1151–62 "LWasiński B, Dutkiewicz J (2013). ‘’leptospirosis—current risk factors connected with human activity and the environment“. Ann Agric Environ Med 20 (2): 239–44. PMID 23772568 The Sanford guide to Antimicrobical therapy 2013.cid36:1507n& 1514,2003: LnID 3:757,2003 M.Moroni, R.Esposito. Malattie Infettive:.infezioni del fegato e delle vie biliari Harrison internal medicine 165;1057 Picardeau M (January 2013). "Diagnosis and epidemiology of leptospirosis". Médecine Et Maladies Infectieuses 43 (1): 1–9. 6

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