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Objective: To investigate the prediction ability of vascular injury biomarkers for haemodialysis requirement in patients with severe leptospirosis., Methods: Prospective study with severe leptospirosis patients hospitalised in Fortaleza, Brazil. Blood samples were collected hospital admission to quantify vascular injury biomarkers: syndecan-1, ICAM-1, VCAM-1, angiopoietin-2 and FGF-23. Two groups were evaluated according to haemodialysis requirement during hospital stay., Results: Twenty-seven patients were included, with a mean age of 39 ± 18 years. 88.9% were males. 53.8% needed haemodialysis and presented higher levels on hospital admission of syndecan-1 (572 [300-811] vs. 263 [106-421] ng/ml; p = 0.03), angiopoietin-2 (1.52 [0.72-2.72] vs. 0.63 [0.4-1.38] ng/ml; p = 0.01), and FGF-23 (291 [56-2031] vs. 10 [10-806] pg/ml; p = 0.021). Syndecan-1 showed significant correlation with creatinine (r = 0.546; p = 0.05) and total bilirubin levels (r = 0.534; p = 0.013) on hospital admission. Angiopoietin-2 showed significant correlation with creatinine levels (r = 0.513; p = 0.009) on hospital admission and with number of haemodialysis sessions (r = 0.406; p = 0.049). No significant correlation was found with FGF-23. Regarding prognostic performance, combined syndecan-1 and angiopoietin-2 levels had a better ability to predict haemodialysis need in patients with severe leptospirosis (AUC-ROC = 0.744 [95% CI: 0.545-0.943] p = 0.035)., Conclusion: Syndecan-1 and angiopoietin-2 were associated with haemodialysis need in patients with severe leptospirosis and may be useful to improve therapeutic approach and reduce mortality., (© 2022 John Wiley & Sons Ltd.)

Leptospirosis presents in a biphasic manner: an early leptospiraemic phase and a late immune phase. In its severe form, it presents with multi-organ failure, also known as Weil's disease. Stevens-Johnson syndrome (SJS) is an autoimmune hypersensitive reaction leading to diffuse fluid filled vesicle formation with detachment of skin and mucous membrane. Though SJS is triggered by different infections and drugs, its association with leptospirosis is not frequently reported. Here we present such a case.

Weil syndrome is a fulminant form of leptospirosis, usually caused by spirochetal organism Leptospira interrogans. It is characterized by icterus, petechial rashes over the body, signs of renal failure and hepatic failure. Anaemia is a usual manifes- tation of Leptospira infection, but autoimmune haemolytic anaemia is rare. We report a patient with autoimmune haemolytic anaemia following Leptospira infection, which was responsive to high-dose steroid therapy., Competing Interests: None

Leptospirosis disease is caused by the spirochete Leptospira. It is a worldwide distribution zoonosis, with predominance in the tropics. In Spain, it is not frequent but some cases have been noticed especially in humid areas surrounded by rivers, lakes or ponds, such as Catalonia, Andalucia or the Valencian Community. It is transmitted by a variety of animals such as cows or rats, that are infected either by direct contact with these animals or their urine, or indirectly by consuming or being in contact with water contaminated by their urine. The clinical manifestations are very variable, being asymptomatic or not very symptomatic in most of the patients. Unusually, leptospirosis presents with a first phase with fever, myalgias, liver injury or different organs hemorrhage, followed by a second phase with the presence of jaundice due to hepatic failure. Weil's disease is a kind of severe leptospirosis characterized by hepatic failure with jaundice and acute renal failure, associated with high mortality rates.The diagnosis is based on serological techniques and DNA detection by PCR. The treatment consists of life support measures and antibiotic therapy. A patient with Weil's disease and leptospirosis digestive bleeding is presented, with a fulminant clinical course. In order to achieve an early diagnosis, the need to keep this entity in mind must be emphasized, especially in favorable epidemiological environments as the one of this patient.

Leptospirosis is a zoonosis caused by the spirochete Leptospira interrogans . Most cases of leptospirosis are mild to moderate, and self-limited. The course of disease, however, may be complicated by multiorgan dysfunction such as in Weil's disease. We present a case of Weil's disease with pancreatitis in a young Caucasian man residing in Hawai'i. Although leptospirosis is common in Hawai'i, few patients present with pancreatitis. This report of leptospirosis-induced pancreatitis should help raise awareness of clinicians to assess for pancreatitis when evaluating a patient with leptospirosis and acute abdominal pain.

Background: There were few reports in the literature of Weil's disease with multiple organ failures, especially in children living in dengue endemic areas., Case Presentation: A 12-year-old child was admitted to Tangerang district hospital with a provisional diagnosis of dengue infection. On the third day of hospitalization, dengue diagnostic tests were negative. As fever still remained and was followed by jaundice, decreasing hemoglobin, increasing bilirubin with abnormal value of liver enzymes; other causes of disease were investigated. Leptospirosis was confirmed by rapid IgM test (SD(®)) for leptospira; and micro-agglutination test which indicated Leptospira serogroup bataviae infection. The patient developed Weil's disease during the course of illness. Renal function was back to normal on the 21st day of hospitalization, while hemoglobin and bilirubin returned to normal three weeks after discharged., Conclusions: Our report highlights the importance of considering leptospirosis as a differential diagnosis in children with acute febrile illness; even when the signs and symptoms for the more common diagnoses such as dengue or typhoid fever were pathognomonic. A normal leukocyte count with neutrophilia and negative dengue NS1, dengue IgM, and Salmonella typhi IgM on admission should raise suspicion of leptospirosis, and prompt diagnostic assays for leptospirosis should be conducted.

BACKGROUND Unexplained renal insufficiency combined with hepatic failure is a common problem encountered by clinicians. As with many disease processes involving multi-organ systems, reversible causes are usually not readily identifiable, and for many patients their health deteriorates rapidly. We present a rare cause of acute renal failure and hyperbilirubinemia occurring simultaneously, with leptospirosis presenting as Weil's disease. CASE REPORT A 53-year-old male presented to our clinic with complaints of anuria over the past two days. His symptoms started with dark urine, severe cramps in the thighs, and chills. The patient was a visitor to the United States from Guyana. Positive physical examination findings included mild tachycardia and hypotension, scleral icterus, and tenderness over abdomen, costovertebral angles, and thighs. The patient had a high white blood cell count, thrombocytopenia, renal/hepatic insufficiency, and an urinary tract infection (UTI). The patient was initially treated under the suspicion of acute kidney injury secondary to rhabdomyolysis and pyelonephritis. The patient continued to deteriorate with decreasing platelet counts, worsening renal function, hyperbilirubinemia, and respiratory distress, with no improvement with hemodialysis. Broad-spectrum antibiotics were administered, including doxycycline, due to a high suspicion of leptospirosis. The patient's condition drastically improved after initiation of doxycycline. On subsequent days, the patient's Leptospira antibody results were available, showing titers of more than 1:3200. Hemodialysis was discontinued as the patient started producing urine with improved kidney function. CONCLUSIONS As world travel becomes more economically feasible, we will continue to encounter foreign endemic diseases. Leptospirosis presenting as Weil's disease is a common cause of renal and hyperbilirubinemia in endemic areas. Often, as was the case for our patient where the time from presentation to acute respiratory distress syndrome (ARDS) was 72 hours, the diagnosis evolves over the course of several days. Antibody testing often takes time and delays in treatment can cause rapid clinical deterioration. In such cases, we recommend beginning empiric treatment before confirmation of laboratory tests.

Weil's disease, the most severe form of leptospirosis, is characterized by jaundice, haemorrhage and renal failure. The mechanisms of jaundice caused by pathogenic Leptospira remain unclear. We therefore aimed to elucidate the mechanisms by integrating histopathological changes with serum biochemical abnormalities during the development of jaundice in a hamster model of Weil's disease. In this work, we obtained three-dimensional images of infected hamster livers using scanning electron microscope together with freeze-cracking and cross-cutting methods for sample preparation. The images displayed the corkscrew-shaped bacteria, which infiltrated the Disse's space, migrated between hepatocytes, detached the intercellular junctions and disrupted the bile canaliculi. Destruction of bile canaliculi coincided with the elevation of conjugated bilirubin, aspartate transaminase and alkaline phosphatase levels in serum, whereas serum alanine transaminase and γ-glutamyl transpeptidase levels increased slightly, but not significantly. We also found in ex vivo experiments that pathogenic, but not non-pathogenic leptospires, tend to adhere to the perijunctional region of hepatocyte couplets isolated from hamsters and initiate invasion of the intercellular junction within 1 h after co-incubation. Our results suggest that pathogenic leptospires invade the intercellular junctions of host hepatocytes, and this invasion contributes in the disruption of the junction. Subsequently, bile leaks from bile canaliculi and jaundice occurs immediately. Our findings revealed not only a novel pathogenicity of leptospires, but also a novel mechanism of jaundice induced by bacterial infection., (© 2014 The Authors. International Journal of Experimental Pathology © 2014 International Journal of Experimental Pathology.)

Objective: This study was conducted to investigate factors associated with thrombocytopenia in a large cohort of patients with leptospirosis in an endemic area., Methods: This retrospective study included 374 consecutive patients with leptospirosis who were admitted to tertiary hospitals in Fortaleza, Brazil. All patients had a diagnosis of severe leptospirosis (Weil's disease). Acute kidney injury was defined according to the RIFLE criteria. Thrombocytopenia was defined as a platelet count <100,000/mm3., Results: A total of 374 patients were included, with a mean age of 36.1 ± 15.5 years, and 83.4% were male. Thrombocytopenia was present at the time of hospital admission in 200 cases (53.5%), and it developed during the hospital stay in 150 cases (40.3%). The patients with thrombocytopenia had higher frequencies of dehydration (53% vs. 35.3%, p=0.001), epistaxis (5.7% vs. 0.8%, p=0.033), hematemesis (13% vs. 4.6%, p=0.006), myalgia (91.5% vs. 84.5%, p=0.038), hematuria (54.8% vs. 37.6%, p=0.011), metabolic acidosis (18% vs. 9.2%, p=0.016) and hypoalbuminemia (17.8% vs. 7.5%, p=0.005). The independent risk factors associated with thrombocytopenia during the hospital stay were lengthy disease (OR: 1.2, p=0.001) and acute kidney injury (OR: 6.6, p=0.004). Mortality was not associated with thrombocytopenia at admission (12.5% vs. 12.6%, p=1.000) or during the hospital stay (12.6% vs. 11.3%, p=0.748)., Conclusions: Thrombocytopenia is a frequent complication in leptospirosis, and this condition was present in more than half of patients at the time of hospital admission. Lengthy disease and acute kidney injury are risk factors for thrombocytopenia. There was no significant association between thrombocytopenia and mortality.

Leptospirosis is a re-emerging zoonosis caused by spirochetes from the genus Leptospira and is typically associated with rural settings. Transmission occurs via contact with urine from infected animals; incubation period ranges from 4 days to 4 weeks. The clinical spectrum of leptospirosis may be mild and self-limited or severe with jaundice, renal failure, and bleeding manifestations (icterohaemorrhagic leptospirosis, so called Weil's disease). Mortality in severe forms remains high even when optimal treatment is provided. Early clinical suspicion and laboratory confirmation of leptospirosis is essential since delays in diagnosis may increase mortality. Alcohol-related toxicity and alcoholic hepatitis are common pathological processes, which can occasionally produce clinical syndromes similar to leptospirosis. There are few reports regarding the clinical course of leptospirosis in chronic alcoholics. Here, we describe two patients with Weil's disease, in whom alcohol abuse caused therapeutic difficulties. One of the cases was with lethal outcome.

Leptospirosis is a spirochetal zoonosis with a worldwide distribution affecting both animals and humans. These are infected only occasionally by direct contact with infected animals or through contaminated water and soil. Generally, this disease is commonly found in tropical regions. Infected patients usually present with non-specific features. In fact, the clinical manifestations of leptospirosis are variable, ranging from occult infection to Weil's disease with fatal complications. Often the disease remains underdiagnosed due to the broad spectrum of signs and symptoms. Here we are reporting a case of a woman with an ictero-haemorraghic leptospirosis complicated by acute renal failure and pulmonary involvement that received intensive care unit support including intubation and ventilation and promptly resolved with appropriate therapy.

In this report, we describe a case of Weil disease. Chest x-ray and computed tomography (CT) findings showed temporary deterioration 1 day after the initiation of antibiotic treatment, and high-resolution CT findings with the patient's physical findings made us suspect pulmonary alveolar hemorrhage (PAH). We believed that the PAH had been induced by Weil disease and subsequently caused Jarisch-Herxheimer reaction. We confirmed the patient's contact history with mice, and symptoms improved immediately after starting appropriate treatments. Leptospirosis is a relatively rare cause of PAH. Therefore, the possibility of this disease should be included in the differential diagnosis, especially when high-resolution CT findings indicate PAH, and the imaging findings deteriorate rapidly after antibiotic therapy.

Leptospirosis, a spirochetal zoonosis, is frequently unrecognized due to its manifestation as an undifferentiated fever. It is an emerging infectious disease that has changed from an occupational disease of veterinarians, farmers, butchers, and other animal handlers to a cause of epidemics in poor and decayed urban communities in developing countries. Humans are infected when mucous membranes or abraded skin come into direct contact with the urine of infected animals, especially rats and dogs. Mortality from severe leptospirosis is high, even when optimal treatment is provided. The diagnosis of leptospirosis is based on clinical findings, history of direct or indirect exposure to infected animals in endemic areas, and positive serological tests. It should be considered in the differential diagnosis of patients with febrile illnesses associated with pneumonitis and respiratory failure, especially when hemoptysis is present. Severe pulmonary involvement in leptospirosis consists primarily of hemorrhagic pneumonitis. In advanced cases, adult respiratory distress syndrome and massive pulmonary hemorrhage may occur. Chest radiographs show bilateral alveolar infiltrates and/or resemble viral pneumonia, bronchopneumonia, tuberculosis, adult respiratory distress syndrome, and other causes of pulmonary hemorrhage such as Goodpasture syndrome. High-resolution computed tomography scans may show nodular infiltrates, areas of consolidation, ground-glass attenuation, and crazy-paving patterns. Bronchoalveolar lavage and autopsy studies have suggested that ground-glass opacities and air-space consolidations are secondary to pulmonary hemorrhage. Although not specific, the presence of these computed tomography findings in a febrile patient with an appropriate history should suggest a diagnosis of leptospirosis.

Context: Leptospirosis is an emerging zoonosis world wide; it is being reported in many areas of south-east Asia now. A recent surge in the number of patients with leptospirosis has been noted in the Sub-Himalayan region of North India which was uncommon. We present here a case series of 13 patients who were positive for leptospirosis either by IgM Elisa or PCR method., Aims: To study the profile of leptospirosis in a sub-Himalayan state of North India i.e. Himachal Pradesh., Settings and Design: This was a retrospective study of leptospira positive patients who were admitted in IGMC, Shimla. The study was conducted in Indira Gandhi Medical College, Shimla situated at a moderate altitude in North India., Methods and Material: All patients presenting in Medical College Hospital during three months from 1st August to 31st October who tested IgM positive or borderline or PCR positive for leptospirosis were taken into the study. Their presenting complaints, examination findings and lab findings were recorded and analyzed based on the Faine's criteria and modified Faine's criteria. Patients with clinical features of Leptospirosis and who tested positive for IgM Leptospirosis were taken as IgM lepto can be falsely positive., Results: Out of total 13 patients there were 3 males and 10 females, age range was from 24 to 78 yrs and mean was 44 yrs. Predominant complaints were fever, jaundice, myalgia, and headache. All had contact with animals or contaminated environment. LFT's were deranged in 12 and renal functions were deranged in all. Ten had positive results for IgM against leptospira while 2 had borderline positive result. One patient was positive by PCR method using G1, G2 primers. Ten patients had Weil's syndrome and this was the main presentation of leptospirosis in our group, one had acute respiratory distress syndrome (ARDS) and needed ventilator. There were no deaths. All responded to injectable ceftriaxone and oral doxycycline. Applying Faine's criteria only 7 were positive, but using modified Faine's criteria all 13 were positive for leptospirosis., Conclusions: Leptospirosis was unexpectedly found to be positive in many of our patients who were having pyrexia during the monsoons. A recent surge has been noted in the number of cases with leptospirosis in this state. The possibility of co-infection especially with scrub typhus must be considered in cases with atypical presentation and severe illness. Most of the patients were from rural background with poor hygienic conditions. There was no mortality and main complication was Weil's syndrome in 77 percent.

The incidence of leptospirosis, or Weil's disease, in developed countries, particularly in temperate regions, has been dramatically decreasing due to recent improvements in the hygienic environment. In these areas, physicians rarely face this disease and inclusion as a differential diagnosis of acute renal failure seems increasingly uncommon. However, we encountered two cases of severe leptospirosis requiring hemodialysis in central Tokyo. Both cases showed hyperbilirubinemia, thrombocytopenia and mental disturbance in addition to acute renal failure. Severe leptospirosis remains associated with high mortality rates, and early clinical suspicion and laboratory confirmation of the disease are crucial. Detailed history-taking suggested that leptospirosis was caused by transmission from rats in both cases. Rodents inhabit most land areas, implying that the disease can occur all over the world, even in huge metropoles such as Tokyo. These two cases indicate the need for awareness of leptospirosis among physicians working even in urban areas of developed countries.

Leptospirosis is recognized as a globally re-emerging zoonosis. Interstitial nephritis is the principal feature of the disease. Leptospirosis-induced acute kidney injury typically is nonoliguric and includes hypokalemia. Tubular function alterations precede a decrease in the glomerular filtration rate, which could explain the high frequency of hypokalemia. Studies in human beings and animals have shown increased urinary fractional excretion of potassium and sodium, as well as an increased potassium/sodium ratio, suggesting increased distal potassium secretion caused by increased distal sodium delivery consequent to functional impairment of proximal sodium reabsorption. Confirming these findings, Western blot studies have shown lower renal expression of the sodium/hydrogen exchanger isoform 3 and of aquaporin 2, together with higher renal expression of the Na-K-2Cl cotransporter NKCC2, in infected animals. The severe form (Weil's disease) manifests as diffuse alveolar hemorrhage, pulmonary edema, acute respiratory distress syndrome, or a combination of these features, accompanied by acute kidney injury and can be highly lethal. Antibiotic treatment is efficient in the early and late/severe phases. For critically ill leptospirosis patients, the following are recommended: daily hemodialysis, low daily net fluid intake (because of the risk for pulmonary hemorrhage), and lung-protective strategies (low tidal volumes and high positive end-expiratory pressures after recruitment maneuvers).

Clinical and laboratory diagnosis of severe leptospirosis (Weil's disease) may be difficult when other pathological processes that may cause similar clinical syndromes or affect immune response to infections coexist. In addition, the optimal management of the disease remains to be defined. We report on a case of Weil's disease, in which concurrent chronic hepatitis B virus infection and alcohol abuse caused diagnostic and therapeutic difficulties.

We present the case of a 19-year-old male, admitted in the Ophthalmology Clinic for Macular Chorioretinitis, hemorrhagic form. Laboratory findings shown high titres of icterus-hemorrhages leptospirosis.

The purpose of this study was to investigate the association between seropositivity for the most frequent Leptospira serovars and reproductive losses in sows in Brazil. Serum samples from 351 sows from 18 herds (in the state of Rio de Janeiro, Brazil) with low reproductive efficiency were tested (microscopic agglutination) for antibodies against serovars of Leptospira. Antibodies were detected in serum samples of 66.1% of all sows, most frequently serovar icterohaemorrhagiae (43.1%), followed by pomona (18.1%) and tarassovi (9.9%). Seroreactivity to icterohaemorrhagiae and pomona were associated (P<0.05) with impaired reproductive performance (and substantial economic loss). Seroreactivity for pomona was associated (P<0.05) with stillborn piglets and mummified fetuses, whereas seroreactivity to icterohaemorrhagiae was associated (P<0.05) with the number of piglets born dead.

An unusual case of leptospirosis is described in a 19-month-old male child presenting with meningitis and acute renal failure without jaundice. Some aspects concerning the pathogenesis and treatment of this potentially life-threatening disease are also discussed. Leptospirosis was diagnosed on the basis of history and serological tests.

Leptospirosis is rarely reported in children. It is easily treated with antibiotics but can be fatal if treatment is delayed. A 12-year-old girl was diagnosed with Weil syndrome, a severe form of leptospirosis, 10 days after returning from Mainland China. She presented with fever, hypotension, jaundice, and acute renal failure. She had used well water for bathing and swum in freshwater.

A case of fulminant leptospirosis is presented, manifesting as rapid progression from acute undifferentiated febrile illness to refractory shock, jaundice, renal failure and massive pulmonary hemorrhage. The patient received aggressive intensive care unit support including prolonged intubation and ventilation. This case emphasizes that acute leptospirosis may well not be characterized by the classic scenario of a biphasic illness, but rather by a fulminant, monophasic illness.

Weil's syndrome is known in a serious clinical form, but the development of immune haemolytic anaemia related to Leptospira in human beings is a very rare clinical presentation, and we encountered only 1 case report in a literature scan. In this paper we present a case of Weil's syndrome in which immune haemolytic anaemia findings, and haemolysis could only be controlled by intravenous immunoglobulin (IvIg) treatment.

We describe the successful medical treatment of invasive aspergillosis in a patient suffering from Weil's disease with a combined therapy based on amphotericin B lipid complex and voriconazole.

A 51-year-old man became jaundiced, after experiencing flu-like symptoms for a week. On admission anaemia, thrombocytopenia, and hepatic and renal function disorders were present. One month previously he had had sinusitis. Thrombotic thrombocytopenic purpura (TTP)/haemolitic-uraemic syndrome (HUS) was suspected, but the thrombocyte count rose spontaneously. The leukocytosis indicated an infectious cause of the symptoms and the jaundice appeared to originate from intrahepatic cholestasis. All symptoms could be traced to leptospirosis icterohaemorrhagica (known as 'Weil's disease'). The source was possibly the patient's fishpond. He recovered spontaneously and was also treated with antibiotics. Leptospirosis, a multi-organ disease is seen ever more infrequently as an occupational disease in stock farmers and increasingly frequently in people whose hobbies involved animals.

In the patient case (man, age 25) with suspected leptospirosis, indication for polymerase chain reaction (PCR) are supposed and procedures suitable for taking biological material are recommended. In the presented case of leptospirosis, serious conditions were accompanied by high fever, chills, hepatorenal failure, meningitis, pneumonia, increased bleeding time and further symptoms are described. Introduction of the molecular biological methods (PCR) enables to determine leptospiroses diagnosis even in the early phase of the disease, when the antibodies are not yet formed. Detection of DNA pathogenic leptospires in the PCR method is completed with serological examination by microagglutination-lysis (MAL) method for determination of the corresponding serovar that is important from therapeutic and epidemiological reasons.

Leptospirosis, the most common vasculitic zoonosis in the world, is characterized with jaundice and acute renal failure. However, pancreatitis is an uncommon complication of leptospirosis. In this report, an acute pancreatitis case due to Weil's disease has been presented. A 31-year-old female patient with high levels of glucose, blood urea nitrogen, creatinine, creatine kinase, bilirubin, amylase and lipase, has been diagnosed to have leptospirosis by the high positive result (1/800) of microscopic agglutination test against Leptospira interrogans serogroup icterohemorrhagiae. The patient has been treated with supportive and symptomatic therapy, and with penicillin G for leptospirosis. Following triple hemodialysis, all the blood biochemistry tests returned to normal on the tenth day of therapy. This case was reported to draw attention to Leptospira infections which should be considered in the differential diagnosis of patients with jaundice and pancreatitis.

Massive hemoptysis in patients with severe leptospirosis is often resistant to conventional therapies and can rapidly become fatal. Desmopressin is a fast-acting blood-saving agent used in various hereditary and acquired clotting disorders. We used desmopressin infusions to treat massive pulmonary hemorrhage in six leptospirosis patients with respiratory failure, shock, and multiple organ dysfunction. Hemoptysis ceased rapidly in every case, and five patients finally recovered. Two additional patients with less severe hemoptysis were also successfully treated.

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.

Leptospirosis is a common zoonosis seen worldwide, but it is rare in our locality (Hong Kong). Clinical manifestations of leptospirosis are variable and may range from subclinical infection to fever, jaundice, hemorrhagic tendency, and fulminant hepato-renal failure. Severe hyperbilirubinemia and acute renal failure have been associated with high mortality. We report our experience with a patient who developed severe Weil's syndrome with marked conjugated hyperbilirubinemia and oliguric acute renal failure. These complications persisted despite treatment with penicillin and hemodiafiltration. Plasma exchange was instituted in view of the severe hyperbilirubinemia (970 micromol/liter). This was followed by prompt clinical improvement, with recovery of liver and renal function. The beneficial effects of plasma exchange could be attributed to amelioration of the toxic effects of hyperbilirubinemia on hepatocyte and renal tubular cell function. We conclude that plasma exchange should be considered as an adjunctive therapy for patients with severe icteric leptospirosis complicated by acute renal failure who have not shown rapid clinical response to conventional treatment.

Two patients who lived in Buenos Aires suburbs died from leptospirosis in July 2000 and March 2001. They developed a nonspecific febrile illness followed by hemorrhagic pneumonia and respiratory distress in absence of typical manifestations such as jaundice, nephropathy, thrombocitopenia or hemorrhages in other organs. In the house and surroundings of one patient rodents were captured and three strains of leptospira, serogroup Icterohaemorrhagiae were isolated. Laboratory guinea pigs were inoculated and they were sacrificed as soon as respiratory symptoms appeared. Necropsy showed primary lung injury, which was similar to the histopathological lesions found in one of the patients. Neither jaundice, nor renal damage was found. Pericardiac hemorrhages were considered as a possible cause of cardiopulmonary collapse. This clinical form has not been reported previously in this region, where conditions are indeed suitable for the human illness to appear.

Blood samples from 46 patients with leptospirosis were analyzed on a Cobas Vega (ABX, France) device over the course of disease. Hemoglobin content, erythrocyte count, mean volume of erythrocytes, mean content and mean concentration of hemoglobin in an erythrocyte, anisocytosis index, reticulocyte count, and content of free hemoglobin (FH) were analyzed. Anemia (normocytic normochromic hyperregeneratory) is a typical manifestation of leptospirosis during the second week of disease. The leading pathogenetic mechanism of anemia associated with leptospirosis is erythrocyte hemolysis, whose intensity during the acute period depends on the severity of intoxication and extracorporeal methods of detoxication. Persistence of anemia during convalescent period is due to involvement of the kidneys (nephrotic nephritis).

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.

This material intends to present three clinical observations regarding the uveitis etiology, that is represented by the association of some etiological factors less known: Toxoplasma gondii, Listeria monocytogenes, Leptospira icterohaemorrhagiae. The uveitis described here have been severe in the fast evolution and with trends of reappearence. This work demonstrates that the strict etiological antibacteria and antiparasite therapy is not enough and only corticotherapy is able to fight against the accentuated inflammatory phenomena that go along with type of uveitis.

A study made in three autopsies suggested development during the second to third week of leptospirosis icterohaemorrhagica against the background of secondary immunodeficiency (due to severity of the underlying condition or induced by glucocortocoid and antibiotic therapy) Aspergillus affection of the heart that had significantly aggravated the clinical course of leptospirosis and appeared to be the immediate provoking cause of acute cardiovascular insufficiency with a fatal result to follow. Two cases demonstrated an isolated fungal infection of the myocardium. In one of these running a longer (20 days in duration) course there took place a hematogenic dissemination of the aspergilli present in the liver during the development of the metastatic focus in the myocardium. The observations done suggest that each case requires individual consideration as to part the fungus infection plays in the outcome of the pathological process depending upon its type and extension in the organ.

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.