Cases reported "Weil Disease"

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1/6. leptospirosis mimicking sepsis after orthopedic surgery: a case report.

    We report a case of leptospirosis that occurred after elective surgery involving tendon transfer and shoulder arthroscopy. The disease mimicked hospital infection after orthopedic surgery and was at first misdiagnosed as post-operative sepsis. The patient was 60 year old female that developed sepsis with hypotension, shock, bleeding, jaundice and renal insufficiency 4 hours after surgery. shock treatment procedures were performed and broad spectrum antibiotic therapy was used with coverage for bacteria acquired in hospitals. A careful investigation was carried out by the Hospital infection control Service in search of the possible source of the infection. After clinical evaluation by a specialist in infectious diseases, the hypothesis of leptospirosis was put forward based on clinical and epidemiological data. The hypothesis was later confirmed by the positive result of serological tests with the microagglutination method that yielded 1:800 and then 1:12,600 7 days later. This is the first reported case of leptospirosis manifest directly following surgery, mimicking postoperative sepsis.
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2/6. Weil's syndrome.

    A case of leptospirosis in an 18-year-old white male was reported. Weil's syndrome was characterized by intense jaundice, acute renal failure, skin ecchymoses and conjunctival suffusion, in addition to meningitis. The polymerase chain reaction for Leptospira was negative, while the titers of the antibody microagglutination test against L. grippotyphosa rose higher than fourfold (up to 1:1,600) in the same blood sample. Patient's treatment consisted of rehydration and supportive care of acute renal failure, besides antibiotic therapy. Penicillin administration started after 6 days of disease. Patient improved without clinical sequelae.
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3/6. leptospirosis in zoo workers associated with bears.

    leptospirosis due to leptospira interrogans serovar icterohaemorrhagiae was diagnosed in two zoo animal keepers. The implicated source of infection was bear cubs that had microscopic agglutination antibody titers to leptospires of the Icterohaemorrhagiae serogroup.
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4/6. Effective treatment with dihydrostreptomycin of naturally infected cows shedding Leptospira interrogans serovar hardjo subtype hardjobovis.

    The efficacy of dihydrostreptomycin in stopping the shedding of Leptospira hardjo subtype hardjobovis was studied in naturally infected cows. blood and urine samples were collected from dairy cows kept on a farm where the farmer had contracted L hardjobovis infection. A microscopic agglutination test and an ELISA were used to determine specific antibody responses in serum. polymerase chain reaction was used to detect bacterial shedding in urine. On the first sample collection date, 6 cows were seropositive, and 3 of those shed leptospires in the urine. These 3 cows were treated once with 25 mg of dihydrostreptomycin/kg of body weight. Within 1 week, the 3 cows stopped shedding leptospires. Six weeks later, 8 more lactating cows were found to be shedding leptospires. These cows were also treated once with dihydrostreptomycin, and they too stopped shedding leptospires within 1 week. From then on, the whole herd was examined weekly for a period of 2 months, and all cows Leptospira-positive by polymerase chain reaction were treated once with dihydrostreptomycin. Again, all cows stopped shedding leptospires in the urine within 1 week after treatment with dihydrostreptomycin. After a single treatment of the whole herd at the same time, new infections were not seen.
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5/6. leptospirosis patient with AIDS: the first case reported.

    A case of renal icterohemorrhagic leptospirosis involving a patient with acquired immunodeficiency syndrome (AIDS) is reported. Despite the low levels of CD4 T lymphocytes, the clinical course of leptospirosis was similar to that observed in non-immunodepressed patients, and no worsening of AIDS occurred due to the infection by the spirochete. Serologic conversion was observed in the microscopic agglutination test, with maximum titer of 1:3,200. The patient had positive urine cultures for Leptospira interrogans for two months, whereas blood cultures were negative.
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6/6. leptospirosis: twelve Turkish patients with the Weil syndrome.

    Twelve cases of leptospirosis followed by the Infectious Diseases Clinic of the Cukurova University Medical School, Adana, turkey, between January 1994 and November 1995 are reported. Included are their clinical manifestation, laboratory findings and serotype. Nine men and three women with an average age of 40.4 years were studied. Symptoms, clinical manifestations, laboratory findings and treatment of the disease are evaluated. All of the patients had fever and chills and the following symptoms: nausea and vomiting (91.6%), lower back pain and myalgia (58.3%), headache (50%), epistaxis (16.6%) and confusion (25%). The predominant clinical findings were jaundice (91.6%), hepatomegaly (41.6%), dyspnea (25%), conjunctival suffusion (33%), and nuchal rigidity (33%). diagnosis was based on dark-field examination of the blood, cerebrospinal fluid and urine specimens. Also, microscopic agglutination tests (MAT) were carried out for serodiagnosis. MAT showed L. interrogans serovar icterohaemorrhagiae in 11 cases and L. interrogans serovar grippomosocova in one case. There was cross reaction with L. biflexa patoc in all cases. Agglutinations were tested in the same specimens twice and confirmed in the microbiology Laboratory of the Etlik Veterinary research Institute in Ankara. All cases were treated with penicillin and doxycycline. In the end; 83.3% of the patients were cured and 16.6% died due to hepatorenal failure.
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