Renal involvement in convalescents after icterohemorrhagic leptospirosis

Icterohemorrhagic spirochetosis convalescents develop slowly regressing renal dysfunctions most frequent of which are chronic renal failure, pyelonephritis and tubulointersticial nephritis, arterial hypertension. Renal disorders may be due to immunopathological reactions followed by activation of bacterial microflora. Damage from commissures at the sites of prior hemorrhage is also possible. In bovine leptospirosis renal damage is not so severe but it tends to progression. So, renal affection in leptospirosis is a specific pathology observed in any clinical form of the disease and demands surveillance in the regions of local focuses.     

Outcome and tendency of late convalescence in icterohemorrhagic leptospirosis

To elucidate the time of onset and duration of complications of icterohemorrhagic leptospirosis (IL), a clinical course of early and late convalescence was analysed in 170 patients who were followed up for 1.5-9 years. It was found that affection of hepatobiliary, urinary, cardiovascular and nervous systems persisted for a year after the acute disease in 65.3, 67.6, 31.8 and 13.5% patients, respectively. The organ of vision was affected for 1 year in 7.1% patients. A total of 86% patients retained the above disorders in early convalescence (for a year). In early convalescence the author observed development of such diseases as chronic hepatitis, a latent stage of chronic renal failure, myocardiac myocardiodystrophy. Nervous and ocular complications manifested both in early and late convalescence (4-18 months). The complications combined in 66.0% cases, renal dysfunction + hepatic dysfunction being most frequent. Endogenic infection foci activated within 6 months after IL. In 19.4% patients, the pathological process prolonged up to 1.5 years. In 5.3% patients it can last for several years. It is concluded that IL patients should be followed up for 1.5 years, combined pattern of organ affection typical for IL should be taken into account.     

Comparative clinical and immunological parameters in convalescence of patients with icterohemorrhagic leptospirosis

AIM: To investigate clinico-immunological parallels of convalescent period in leptospiral jaundice (LJ). MATERIAL AND METHODS: Clinical and immunological indices were studied in 121 LJ convalescents (97.6% males, age 17-45 years). RESULTS: Acute leptospirosis period was characterized with polymorphic clinical picture impeding precise diagnosis and threatening with such complications as bacterial shock, acute renal failure, acute renal-hepatic failure, DIC-syndrome, respiratory distress. Convalescents for a long time exhibited polyorganic pathology, developed sepsis. In late convalescence one could observe affections of the heart, liver, kidneys, bones, nervous system, eyes. This can be explained by disorders in immunity, especially structural immunodeficiency, and commissures at the sites of hemorrhages. CONCLUSION: Polyorganic pathology in leptospirosis convalescents arises because of immunity disorders which are not associated with the disease form. In late convalescence severe complications may accompany leptospiral jaundice.     

Secondary leptospirosis

The author describes cases of secondary leptospirosis. Secondary infection with leptospiras occurred in patients with concomitant pathology. In connection with occupational activity or life-style the patients got infected from Rattus norvegicus.     

Human leptospirosis.

Human leptospirosis is a subject of increasing interest. Although this disease was frequently associated with individuals whose occupation or geographic location placed them in close proximity to wild animals or farm animals, recent cases have been particularly prevalent in young children and adolescents in urban and suburban America. Many of the recent cases have been acquired from household pets, particularly from dogs or hamsters. In particular, healthy dogs who have been immunized with leptospiral organisms, thereby creating a significant risk for their owners. This article will review the pathophysiology, clincal manifestations, laboratory diagnosis, treatment, and prevention of leptospirosis in the modern era, with particular emphasis on a more complete understanding of the epidemiology of this disorder.     

Diagnosis of acute leptospirosis

Leptospirosis is a globally important zoonotic disease and an important public health problem in developing countries. Early diagnosis is essential because antibiotic treatment is most effective when initiated early in the course of the disease. Culture and the microscopic agglutination test are gold standard methods for leptospirosis diagnosis; however, they are not useful for early diagnosis. Current whole cell-based rapid serological tests have low sensitivity for early phase leptospirosis and may have low specificity in highly endemic areas. PCR is demonstrably useful for early diagnosis, but it is unavailable in most developing countries. Thus, diagnostic methods that not only have higher sensitivity and accuracy for early phase leptospirosis but are also widely applicable in developing countries remain to be developed. The availability of genome sequences and genetic tools of Leptospira spp. will accelerate our understanding of Leptospira pathogenesis and provide insights into the development of more efficient and accurate diagnostic tests for acute-phase leptospirosis.     

Treatment of terminal restlessness: a review of the evidence

Terminal restlessness is an important issue in the management of symptoms at the end of life with between 25% and 88% of dying patients exhibiting this condition. (1-5) The purpose of this review was to examine the empiric evidence about the pharmacological treatment for terminal restlessness. All available literature, in all languages, from 1966-2002 including randomized trials, concurrent observations, retrospective chart reviews, single case studies, clinical practice guidelines, expert consensus, single expert opinion articles, and editorials were reviewed as "best available evidence." Of the 72 articles reviewed, 14 met the criteria and were chosen for analysis. Despite the majority of authors recommending neuroleptic medications as a first or second line pharmacological treatment of restlessness, a number of studies demonstrated the effectiveness of other medications such as benzodiazepines (notably midazolam and lorazepam), or phenothiazines, either alone or in combinations. There is insufficient evidence to suggest that a single medication or class of medications is appropriate for terminal restlessness. There is a clear need for additional trials of neuroleptics, benzodiazepines, barbiturates, and combination protocols to determine which protocols are the most effective and have the least side effects.     

Respiratory failure in leptospirosis

We report on four cases of leptospirosis with pulmonary manifestations as their presenting features. With adequate supportive therapy the prognosis is good. Leptospirosis should be considered in the differential diagnosis of pulmonary haemorrhage.