Peripheral nerve palsy in a case of leptospirosis

We describe an unusual case of leptospirosis in a 54-year-old man presenting peripheral nerve palsy. The diagnosis of leptospirosis was confirmed by ELISA IgM and the microscopic agglutination test. Electrophysiological studies showed that no response could be obtained from the right fibular nerve. At 7 months after the initiation of treatment, additional electrophysiological studies and a neurological examination showed, respectively, a chronic axonal lesion of right fibular nerve with signs of re-innervation and a nearly complete clinical recovery. We feel that this case may serve to remind clinicians that peripheral nerve palsy is a potential clinical feature of leptospirosis.     

河南省不同流域稻田型钩端螺旋体病流行特征的比较分析

目的 :分析比较河南省不同流域稻田型钩端螺旋体病流行特征的异同 ,为制订相应的预防措施提供依据。方法 :主要采用现况研究、病原分离、血清学检验等方法。结果 :淮河流域及黄河流域稻田型钩体病存在 :( 1)流行形式的差异 :淮河流域流行形式较单一 ,为稻田型 ;而黄河流域则较复杂 ,有稻田型、雨水 -稻田型、洪水 -稻田型。 ( 2 )疫区环境的不同 :淮河流域疫区主要在丘陵地带 ,较为固定 ;黄河流域疫区主要在平原 ,流行地区逐年扩大。 ( 3)流行菌群皆以黄疸出血群为主 ,宿主动物为鼠类 ,主要是黑线姬鼠。 ( 4)淮河流域存在钩体病的经济疫源地 ,现又证明存在自然疫源地 ;而黄河北岸的疫区为单纯自然疫源地。结论 :由于地理环境、气候条件等不同 ,两地的稻田型钩体病既有许多共同点 ,也有不同之处 ,故应采取相应的防治措施。     

钩端螺旋体多抗原肽的构建及免疫性分析

目的 构建问号钩端螺旋体(简称钩体)主要外膜蛋白OmpL1、LipL21和LipL32优势抗原表位的串联基因及其表达系统,了解该重组蛋白的免疫活性.方法 采用噬菌体M13KE表面展示技术结合Western blot分析,鉴定了OmpLl、LipL21和LipL32的优势抗原表位,人工合成优势抗原表位串联基因并构建其原核表达系统.SDS-PAGE检测重组蛋白的表达情况;Western blot及ELISA鉴定重组蛋白的免疫活性.结果 该合成基因在原核表达系统中得到了有效表达,且表达产物主要以可溶性形式存在.Western blot和ELISA结果 显示该重组蛋白能与兔抗钩体全菌抗体及不同血清群的钩体病人血清中的抗体产生免疫反应.结论 本研究成功构建了钩体多表位串联基因及其表达系统,所表达目的 蛋白具有良好的免疫活性,且对不同血清群型抗体之间均有免疫原活性.     

钩端螺旋体病豚鼠模型肾小球超微结构的病理改变

作者用扫描电镜、透射电镜和冷冻复型技术观察钩体病豚鼠模型的肾小球超微结构,发现病变集中在滤过膜,主要表现为滤过膜结构破坏导致肾小球出血,足细胞形态异常,表面有大量钩体粘附。     

冰冻复型电镜技术对豚鼠钩端螺旋体病肺弥漫性出血肺微血管的研究

冰冻复型电镜技术用于钩端螺旋体病肺弥漫性出血动物模型的肺微血管研究是一种新尝试。本文结果表明,肺微血管始终无结构上的破损和断裂,却以内皮细胞膜镶嵌蛋白的数量和分布异常、内皮细胞出现大量细胞孔道和内皮连接开启为特征,并与肺弥漫性出血的发展密切相关,结果揭示漏出性出血(Dia-pedesis)与肺微血管内皮细胞的细胞膜超微病变存在着内在联系。     

应用纯化重组外膜脂蛋白LipL32检测钩端螺旋体病抗体

目的 建立以纯化重组外膜脂蛋白LipL32为基础的钩端螺旋体(钩体)病抗体的检测方法 .方法 以摹因重组技术获取重组钩体外膜脂蛋白LipL32,以该蛋白为抗原,分别使用间接法和夹心法ELISA应用于不同人和鼠血清的检测,检测结果 与钩体显微镜凝集试验(MAT)进行比较,同时人血清的检测结果 还与进口试剂盒比较.结果 纯化的重组蛋白检测9例钩体确诊病例双份血清标本,三种ELISA法的检出率与MAT无明显差别.检测45份MAT阳性标本,间接法ELISA敏感性为71.11%(32/45),夹心法ELISA为80.00%(36/45),而进口 ELISA阳性13份,占28.89%(13/45),25份可疑占55.56%(25/45).特异性检测,MAT阴性血清69份,间接和夹心法ELISA特异度均为97.10%(67/69),其中检测门诊体检血清43份,间接和夹心法ELISA均为阴性,进口ELISA检测14份,也为阴性.检测非钩体发热病例血清标本16份,间接和夹心法ELISA共检出2份阳性,进口ELISA则是1份阳性,12份可疑.检测梅毒螺旋体质控阳性血清10份,四种方法 均为阴性.重组蛋白检测鼠血清标本274份,夹心法ELISA的敏感性为86.75%(131/151),特异性为99.19%(122/123),符合率为92.34%(253/274),与MAT检测结果 相符.结论 重组LipL32蛋白具有结合活性,可应用于钩体血清抗体的检测,其中夹心法ELISA对鼠血清钩体抗体的检测显示较好的敏感性和特异性,适用于钩体病现场血清流行病学大样本调查.     

黔南州钩端螺旋体病疫区空间划分与宿主动物分布关系的探讨

目的探讨黔南州钩体病疫区与宿主动物之间的关系,为防制与预测提供依据。方法应用描述、血清、地理等流行病学方法,对流行特征及疫区形成因素进行分析。结果黑线姬鼠为主要带菌宿主,带菌率7.36%,占受检鼠类所分离菌总数的95.84%;宿主动物的地理区域性与病例聚散分布存在密切的关系。结论按照农耕方式、宿主动物区划以及病例分布建立不同类型的疫区模式。     

Acute pancreatitis caused by leptospirosis： Report of two cases

Two cases of acute pancreatitis with leptospirosis are reported in this article. Case 1: A 68-year-old woman, presented initially with abdominal pain, nausea, vomiting, and jaundice. She was in poor general condition, and had acute abdominal signs and symptoms on physical examination. Emergency laparotomy was performed, acute pancreatitis and leptospirosis were diagnosed on the basis of surgical findings and serological tests. The patient died on postoperative d 6. Case 2: A 62-year-old man, presented with fever, jaundice, nausea, vomiting, and malaise. Acute pancreatitis associated with leptospirosis was diagnosed, according to abdominal CT scanning and serological tests. The patient recovered fully with antibiotic treatment and nutritional support within 19 d.     

Massive rhabdomyolysis and multiple organ dysfunction syndrome caused by leptospirosis

We report a case of leptospiral infection in a 63-year-old man who acquired the infection while swimming in canals and streams in Hawaii. The patient's course was atypical in that he was anicteric and had no evidence of meningitis when he presented with fever, rapidly progressive and severe rhabdomyolysis, thrombocytopenia, acute renal failure, and respiratory distress syndrome. Although he recovered after a protracted illness, he required major life support, including mechanical ventilation and hemodialysis. Initial antimicrobial therapy was designed to cover major bacterial and atypical pathogens, including leptospires. An in-depth work-up for causes of this catastrophic illness confirmed acute leptospirosis. Although rare, leptospirosis is a potentially lethal infection classically associated with hepatitis, azotemia, and meningitis. Most patients experience self-limited illness, with fever, myalgias, and malaise followed by an immune-mediated aseptic meningitis. A small proportion develop shock and multiple organ dysfunction. Whereas myalgias are ubiquitous in leptospiral infection, and most patients show mildly elevated muscle enzymes, life-threatening rhabdomyolysis is rare. This atypical case is reported to urge clinicians to consider leptospirosis in the evaluation of a patient with cryptogenic sepsis who develops multiple organ dysfunction associated with rhabdomyolysis. Appropriate antimicrobial therapy, with penicillin or doxycycline, can be life-saving. Received: 24 November 1999 Final revision received: 15 February 2000 Accepted: 7 March 2000