• encephalitis
• intensive care unit
• leptospirosis
• multiple organ failure
• myocarditis

• Humans
• Male
• Leptospirosis/mortality
• Leptospirosis/epidemiology
• Female
• Critical Illness/mortality
• Retrospective Studies
• Middle Aged
• Intensive Care Units
• Adult
• Multiple Organ Failure/mortality
• Guadeloupe/epidemiology
• Aged
• Cluster Analysis

• Diagnosis
• Diagnostic
• Environmental exposure
• Exposition environnementale
• Leptospirose
• Leptospirosis
• Maladie professionnelle
• Occupational disease
• Spirochaetales

• Animals
• Humans
• Leptospirosis/diagnosis
• Zoonoses
• Communicable Diseases
• Hospitalization
• Intensive Care Units

• diffuse myocardial calcifications
• leptospira
• leptospirosis
• multi-parametric mri
• sepsis

Leptospirosis is an ubiquitous zoonosis with significant morbidity and mortality. Approximately 10 percent of human infections evolve into a severe form, with a sepsis-like disease, multiorgan failure, and significant mortality rate. The cornerstone of treatment of severe disease is antibiotic therapy, with the aims of preventing complications, reducing the duration of disease, and ultimately reducing mortality. The initiation of antibiotic chemotherapy can precipitate a febrile inflammatory reaction, also known as a Jarisch–Herxheimer reaction. We present a case report of a patient with severe leptospirosis, complicated by multiorgan failure with severe circulatory failure of distributive and cardiogenic etiology, possibly as a consequence of the Jarisch–Herxheimer reaction. The patient was treated with antimicrobial therapy and other supportive measures along with high-dose corticosteroid therapy, long-term mechanical ventilation, high-dose vasopressor therapy, and continuous veno-venous hemodiafiltration with extracorporeal cytokine removal.With this case, we would like to report on a patient presenting with two neglected diseases in our part of Europe, who was treated with novel therapeutic strategies.

• Leptospirosis
• Myocarditis
• Pseudoacute abdomen
• Renal failure
• Weil’s disease

• Abdominal Pain/diagnosis
• Abdominal Pain/etiology
• Dyspnea/diagnosis
• Dyspnea/etiology
• Humans
• Leptospirosis
• Male
• Middle Aged
• Multiple Organ Failure/diagnosis

• Medical University of Graz

Leptospirosis is a zoonosis caused by pathogenic Leptospira, and synanthropic and wildlife species of rodents are an important source of infection; however, much of the information about the progression of the infection was obtained from lab murine models. The aim of this study was to assess infection status and risk factors by pathogenic Leptospira in synanthropic and wild rodent species and describe histopathological lesions in several organs from naturally infected animals. In this study, 121 rodents from three synanthropic species and two wild species were trapped within dairy farms in Southern Chile, where the bacteria were present. Liver, heart, kidney, and lungs from trapped animals were analyzed by different techniques to detect if the lesions present were produced by the bacteria. A large proportion of animals were identified as infected that were not detected by the microscopic agglutination test. There is a lower risk of infection in the fall compared to the rest of the seasons, and the synanthropic species has a lower risk of infection in comparison with wildlife species. Immunohistochemistry and quantitative real-time lipL32 polymerase chain reaction contributed to identifying the presence of pathogenic Leptospira in related histological lesions and 50% more infections than serology.

Leptospirosis is caused by pathogenic Leptospira, and synanthropic and wildlife species of rodents are an important source of infection; however, much of the information about infection progression was obtained from murine models. The aim of this study was to assess infection status and risk factors associated with pathogenic Leptospira in synanthropic and wild rodent species and describe histopathological lesions in several organs from naturally infected animals. In a cross-sectional study, 121 rodents from three synanthropic species and two wild species were trapped in dairy farms in Southern Chile. Liver, heart, kidney, and lungs from trapped animals were fixed in formalin and stained with hematoxylin–eosin. Tissues with lesions consistent with Leptospira infection were tested by immunohistochemistry (IHC) and real-time polymerase chain reaction (qPCR) using the LipL32 antigen. Risk factors were assessed by a conditional mixed-logistic regression model. More than half (56.7%) of the negative reactors to the microscopic agglutination test were identified as infected either by IHC/qPCR. A lower risk of infection compared to the rest of the seasons was found in the fall, and the synanthropic species have a lower risk of infection in comparison with the wildlife species. IHC and qPCR contributed to the identification of pathogenic Leptospira in related histological lesions and 50% more infections than serology.

• infection status
• leptospirosis
• rodents

• cardiovascular medicine
• infectious diseases

Severe leptospirosis can have a case-fatality rate of over 50%, even with intensive care unit (ICU) support. Multiple strategies–including protective ventilation and early renal replacement therapy (RRT)–have been recommended to improve outcomes. However, management guidelines vary widely around the world and there is no consensus on the optimal approach.

All cases of leptospirosis admitted to the ICU of Cairns Hospital in tropical Australia between 1998 and 2018 were retrospectively reviewed. The patients’ demographics, presentation, management and clinical course were examined. The 55 patients’ median (interquartile range (IQR)) age was 47 (32–62) years and their median (IQR) APACHE III score was 67 (48–105). All 55 received appropriate antibiotic therapy, 45 (82%) within the first 6 hours. Acute kidney injury was present in 48/55 (87%), 18/55 (33%) required RRT, although this was usually not administered until traditional criteria for initiation were met. Moderate to severe acute respiratory distress syndrome developed in 37/55 (67%), 32/55 (58%) had pulmonary haemorrhage, and mechanical ventilation was required in 27/55 (49%). Vasopressor support was necessary in 34/55 (62%). Corticosteroids were prescribed in 20/55 (36%). The median (IQR) fluid balance in the initial three days of ICU care was +1493 (175–3567) ml. Only 2/55 (4%) died, both were elderly men with multiple comorbidities.

In patients with severe leptospirosis in tropical Australia, prompt ICU support that includes early antibiotics, protective ventilation strategies, conservative fluid resuscitation, traditional thresholds for RRT initiation and corticosteroid therapy is associated with a very low case-fatality rate. Prospective studies are required to establish the relative contributions of each of these interventions to optimal patient outcomes.

Severe leptospirosis continues to carry a high mortality. To improve outcomes, several countries have developed national guidelines for the management of severe disease. However, there is substantial variation in these guidelines despite the fact that severe leptospirosis has a very similar presentation around the world. In tropical Australia, the case-fatality rate of severe leptospirosis is only 4%. This retrospective study reviewed 55 patients with leptospirosis requiring support in an Australian Intensive Care Unit (ICU) in an effort to identify the management strategies that might explain these excellent outcomes. The low case-fatality rate was associated with prompt multimodal ICU support that included early antibiotics, protective ventilation strategies, conservative fluid resuscitation, traditional thresholds for renal replacement therapy initiation and corticosteroid therapy. However prospective, multinational studies–which include the resource-poor settings that bear the greatest burden of disease–are necessary to define which of these interventions have the greatest therapeutic value.

• Adult
• Australia
• Critical Care/methods
• Disease Management
• Female
• Hospitals
• Humans
• Leptospirosis/diagnosis
• Leptospirosis/mortality
• Leptospirosis/pathology
• Leptospirosis/therapy
• Male
• Middle Aged
• Retrospective Studies
• Survival Analysis
• Treatment Outcome
• Tropical Climate

• Leptospirosis
• acute kidney injury
• elderly
• mortality
• prognosis

Leptospirosis is an important re-emerging infectious disease. Leptospirosis has been estimated to affect tens of millions of humans annually with a case fatality rate ranging from 5% to 25%; however, it is underreported due to the lack of clinical suspicion and barriers to diagnostic capacity. A 33-year-old healthy male presented with a history of fever of 2-day duration. His examination revealed icterus. His workup did not show any significant findings except for a mild transaminitis and a rise in serum creatinine by 0.5 mg/dl. Later, the patient developed bradycardia. An ELISA test for Leptospira antibodies was positive. The patient recovered after a course of intravenous antibiotics. Leptospirosis should be considered early in the diagnosis of any patient who presents with acute, nonspecific febrile illness with multiorgan involvement. Our case had an atypical presentation with involvement of the cardiovascular system in the form of junctional rhythm.

• Leptospirosis
• echocardiography
• myocardial disease
• myocarditis
• strain echocardiography
• tricuspid regurgitation

• Adult
• Anti-Bacterial Agents/therapeutic use
• Antibodies, Bacterial/blood
• Ceftriaxone/therapeutic use
• DNA, Bacterial/urine
• Endemic Diseases
• Enzyme-Linked Immunosorbent Assay
• Heart/physiopathology
• Humans
• India
• Leptospira/genetics
• Leptospira/isolation & purification
• Leptospirosis/complications
• Leptospirosis/diagnosis
• Leptospirosis/drug therapy
• Male
• Myocarditis/diagnosis
• Myocarditis/microbiology
• Polymerase Chain Reaction
• Radiography
• Tachycardia, Sinus/diagnosis
• Tachycardia, Sinus/microbiology
• Thorax/drug effects
• Travel-Related Illness
• Treatment Outcome

• Epidemiology
• Leptospirosis
• Netherlands
• Travellers
• case series

• Acute kidney injury
• Changing patterns
• Laboratory findings
• Leptospirosis
• Mortality

Leptospirosis is a zoonotic disease with worldwide distribution and increasing prevalence. Infection is caused by the spirochete Leptospira, with common exposure being contaminated fresh water. Most infections are asymptomatic, but symptoms range from a mild, self-limiting, non-specific febrile illness to fulminant respiratory and renal failure with a high mortality rate. The combination of jaundice, renal failure, and hemorrhage is known as Weil’s disease and is the most characteristic pattern associated with severe leptospirosis. Clinical suspicion alone may be enough to warrant empiric antibiotic treatment in many cases. Serological methods are the most commonly used means of confirming a diagnosis of leptospirosis. The “gold standard” is the microscopic agglutination test. Typical treatment for mild causes is oral doxycycline, though azithromycin and oral penicillins are reasonable alternatives. Intravenous penicillin G has long been the standard of care for severe cases though limited studies show no benefit compared to third generation cephalosporins. We review the clinical presentation, diagnosis, treatment and prevention of leptospirosis.

• Leptospirosis
• Tropical diseases
• Infectious disease

• Leptospira
• leptospirosis
• recreational activities
• water-borne
• zoonosis

• Atypical manifestations
• Leptospirosis
• Weil's disease

• leptospirosis
• myocarditis
• facial nerve palsy
• sri lanka

• Anti-Bacterial Agents/therapeutic use
• Cefotaxime/therapeutic use
• Facial Paralysis/complications
• Facial Paralysis/drug therapy
• Facial Paralysis/microbiology
• Facial Paralysis/pathology
• Farmers
• Humans
• Leptospirosis/complications
• Leptospirosis/drug therapy
• Leptospirosis/microbiology
• Leptospirosis/pathology
• Male
• Middle Aged
• Myocarditis/complications
• Myocarditis/drug therapy
• Myocarditis/microbiology
• Myocarditis/pathology
• Penicillins/therapeutic use
• Prednisolone/therapeutic use
• Sri Lanka