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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Leptospirosis is a widespread spirochetal zoonosis caused by the members of the genus Leptospira. The natural history of human leptospiral infection varies widely. The infection can cause a subclinical illness, or may be mistaken for influenza. In individuals who become ill, leptospirosis typically presents as one of two clinically recognizable syndromes. The first syndrome is the mild anicteric form, which rarely results in death, while the second syndrome fulminant icteric form, known as Weil's syndrome, has an associated 10% mortality. The anicteric form comprises two disease stages, namely the septicemic phase and the immune phase. In fever work up, leptospirosis is usually not the first considered pathogen of sepsis, unless jaundice and ARF are present. This study investigated two patients with leptospirosis presenting with conscious disturbance and oligoric acute renal failure individually. In the second patient, persistent hypokalemia and metabolic alkalosis developed during recovery from acute renal failure. Several tubular function tests were performed to define the renal tubular lesion in this patient, revealing a defect on the thick ascending limb. This study also reviews previous studies on leptospirosis including its epidemiology, pathogenesis, clinical presentation, diagnosis, treatment, and prognosis.
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PMID:Reversible thick ascending limb dysfunction and aseptic meningitis syndrome: early manifestation in two leptospirosis patients. 1291 Nov 69

Leptospirosis is a systemic infection usually producing fever with hepatorenal involvement, meningoencephalitis, and hemorrhage. In this article, we present three children between 10 and 13 years of age with leptospirosis. The purpose of this paper is to emphasize that leptospirosis is a problem in our country with farmers/cattle and that leptospirosis should be considered in certain ill children. The main symptoms were headache, fever, fatigue, abdominal pain and unconsciousness. Two patients had hepatic and renal involvement. The other had hepatic, pulmonary and probably pericardial involvement. In all children spirochetes were demonstrated in blood and urine smears by dark-field microscopy and they were also isolated from urine and blood cultures by using Flecher medium. All patients were treated with penicillin; however, one subsequently required additional antibiotics due to Klebsiella pneumoniae septicemia. While one patient was discharged in a good health, the others were taken to their home by parents without completing treatment. In conclusion, we would like to emphasize that leptospirosis is still a public health problem in our region (Eastern Turkey) in where the majority of population are farmers and raise domestic animals such as cattle in rural areas. Additionally, leptospirosis should be considered in children admitted with headache, unconsciousness, fever and abdominal pain.
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PMID:Report of three children with leptospirosis in rural area of the east of Turkey. 1460 61

Concurrent melioidosis, leptospirosis, and scrub typhus after rural activities is rarely reported. A 19-year-old previously healthy man had fever onset after 2 weeks of military training. Pneumonia became evident on the fifth day of fever under intravenous penicillin and oral minocycline therapy. Acute respiratory failure developed the next day with shock and acute renal and liver function deterioration, which resulted in death. Blood cultures on the third and fifth days grew Burkholderia pseudomallei. Serology revealed leptospirosis and scrub typhus. The emergence of melioidosis in Taiwan and this death without antibiotic treatment for melioidosis alert us that B. pseudomallei should be included as a possible pathogen of pneumonia and sepsis, especially after rural activities.
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PMID:Fatal septicemic melioidosis in a young military person possibly co-infected with Leptospira interrogans and Orientia tsutsugamushi. 1590 73

One of the important causes of acute febrile illness in a country where malaria, typhoid and dengue are also not uncommon, leptospirosis, a zoonotic disease spread by rodents, is endemic in Tamil Nadu, Kerala and Andamans; and is now being increasingly reported from other parts of India, perhaps with better facility to diagnose the disease. Disease of profound importance in view of its grave outcome, in its icteric form (Weil's disease), may have a mortality of as high as 40%. Worst prognosticator is the presence of multi-organ failure (MOF), as in any other septicemia. Andaman hemorrhagic fever (AHF), a type peculiar to Andamans, is now being described elsewhere in the country also. IgM ELISA, Dot-ELISA, dip-stick method and slide agglutination test (SAT) are newer screening methods for diagnosis of leptospirosis, but are only genus-specific. Identifying specific serovar is possible by Micro-agglutination test (MAT) and culture method only. Anicteric type of disease, however, is easily treatable with penicillin and has a good prognosis. Oral doxycycline can be used for prophylaxis during the risk of exposure.
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PMID:Leptospirosis--an overview. 1694 24

Obscure fever is not an uncommon problem in Thailand. We studied 25 children with obscure fever admitted to Srinagarind (university) Hospital in Northeast Thailand. The etiology was identified in 52% of the cases: dengue (40%), leptospirosis (8%), and micrococcus septicemia (4%). Two cases with primary dengue infection developed dengue shock syndrome. The case with leptospirosis developed infection-associated, hemophagocytic syndrome. We found no cases of Japanese encephalitis, scrub typhus or murine typhus.
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PMID:Etiology of obscure fever in children at a university hospital in northeast Thailand. 1643 52

Leptospirosis is a globally distributed zoonosis of major public health importance and is associated with severe disease manifestations such as acute renal failure and pulmonary haemorrhage syndrome. However, the extent to which the pathogenesis of leptospirosis mimics sepsis caused by Gram-negative bacteria remains unknown. The aim of this study was to evaluate serum levels of nitric oxide (NO) in patients diagnosed with severe leptospirosis. Sera from 35 confirmed cases of severe leptospirosis and 13 healthy subjects were analysed. Patients with severe leptospirosis had significantly higher NO levels compared to healthy individuals (30.82+/-10.90 microM versus 3.86+/-1.34 microM, P < 0.001), indicating that this immune mediator plays a role in the underlying systemic inflammatory response.
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PMID:High serum nitric oxide levels in patients with severe leptospirosis. 1719 20

Leptospirosis is a zoonosis of worldwide distribution, spread by the urine of infected animals. It is a major public health problem, especially in developing countries, where circumstances for transmission are most favourable. The clinical picture varies from mild disease to a severe illness with haemostatic derangements and multiorgan failure eventually leading to death. Although the haemorrhagic complications of severe disease are serious, the pathophysiology is scarcely elucidated. The complex mechanisms involved in inflammation-induced coagulation activation are extensively studied in various infectious diseases, i.e. Gram-negative sepsis. Tissue factor-mediated coagulation activation, impairment of anticoagulant and fibrinolytic pathways in close concert with the cytokine network are thought to be important. But for human leptospirosis, data are limited. Because of the growing interest in this field, the impact of leptospirosis, and the availability of new therapeutic strategies, we reviewed the evidence regarding the role of coagulation in leptospirosis and provide suggestions for future research.
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PMID:What role do coagulation disorders play in the pathogenesis of leptospirosis? 1720 55

Co-infection with falciparum malaria and leptospirosis is uncommon. The aim of this study is to report a case of severe sepsis secondary to dual infection with falciparum malaria and leptospirosis. The literature is also reviewed on the clinical course of such co-infections, and the possible mechanisms and treatment of patients with life-threatening malaria and leptospirosis with activated protein C. The patient was a 25-year old male admitted in the Respiratory Intensive Care Unit (RICU) with fever, haemolysis, acute renal failure, hepatitis, acute lung injury (ALI) and altered sensorium. A syndromic evaluation was done and investigations revealed falciparum parasitaemia. He was treated with parenteral artesunate, ceftriaxone and doxycycline, and adjunctive therapies as for severe sepsis. Infusion of activated protein C was started 20 hours after onset of organ dysfunction, and intensive haemodialysis was instituted. Over the next four days the patient became afebrile with progressive resolution of ALI, renal failure and hepatitis. His Leptospira serology (requested as part of the evaluation) was reported positive on day 5. Dual infections are common and under-recognized in the tropics. Failure to treat potential co-infections may lead to poor outcomes. Acute lung injury in falciparum malaria has high mortality rates and therapy as for severe sepsis may improve survival. Adjunctive therapies, including activated protein C, cannot replace source eradication.
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PMID:Severe sepsis due to severe falciparum malaria and leptospirosis co-infection treated with activated protein C. 1742 47

Acute kidney injury (AKI) has become increasingly prevalent in both developed and developing countries, and is associated with severe morbidity and mortality, especially in children. Uncertainty regarding the true incidence of AKI limits awareness of the problem, thereby reducing political visibility of the disorder and hampering efforts to prevent its occurrence. In developed countries, AKI occurs predominantly in urban intensive care units and is associated with multiorgan failure and sepsis, high mortality, and occurrence in older populations. While cases of AKI in urban areas of the developing world have similar characteristics to those in the developed world, AKI in rural regions commonly develops in response to a single disease and specific conditions (e.g. gastroenteritis) or infections (e.g. severe malaria, leptospirosis, or hemolytic-uremic syndrome) and in younger otherwise healthy individuals. Many causes of AKI in rural settings, such as diarrhea, poisoning, malaria, or septic abortion, can be prevented by interventions at the individual, community, and regional levels. Treatment with dialysis is often unavailable or too costly in developing regions, so there must be community-wide efforts to eradicate causes of AKI, expedite diagnosis, and aggressively manage prerenal conditions and specific infections. We have reviewed recent literature on AKI, identified differences and similarities in the condition between developed and developing areas, analyzed the practical implications of the identified differences, and made evidence-based recommendations for study and management.
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PMID:The contrasting characteristics of acute kidney injury in developed and developing countries. 1821 80

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.
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PMID:Case of fulminant leptospirosis in a renal transplant patient. 1955 75


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