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Human leptospirosis — a review of 50 cases

Leptospirose beim Menschen. Übersicht über 50 Fälle

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Summary

Epidemiological and clinical aspects of 50 consecutive patients, 47 adults and three children, hospitalized between 1977 and 1987 for human leptospirosis, were reviewed. 45 (90%) of the patients were from rural regions. 32 (64%) cases occurred in individuals at occupational risk for the infection. 35 (70%) cases were registered in the warm season. The source of infection was known in 34 (68%) cases. Weil's disease was diagnosed in 31 (62%) patients, aseptic meningitis in 12 (24%) and acute unexplained fever in seven (14%). Haemodialysis was required for 11 (35%) patients with Weil's disease. Three (6%) patients died. Cause of death was massive gastrointestinal haemorrhage in two and renal failure in one.Leptospira icterohaemorrhagiae was responsible for 39 (78%) cases,Leptospira canicola for six (12%),Leptospira grippotyphosa for two (4%), andLeptospira australis, Leptospira ballum andLeptospira sejroe, for one case each. A muscle biopsy was performed in six patients and a renal biopsy in three. Focal necrotic muscular changes, with mild mononuclear infiltrate, were found. Pigmented casts in distal convoluted tubules, mild interstitial inflammatory infiltrate and mesangial enlargement of some glomeruli were observed in kidney biopsies. A good knowledge of the protean clinical manifestations of leptospirosis and an accurate laboratory study are required for a correct diagnosis.

Zusammenfassung

Bei 50 Patienten, 47 Erwachsenen und drei Kindern, die zwischen 1977 und 1987 wegen Leptospirose stationär behandelt wurden, wurden epidemiologische und klinische Daten ausgewertet. 45 der Fälle (90%) stammten aus einer ländlichen Gegend. Bei 32 Patienten (64%) bestand ein berufliches Infektionsrisiko. 35 Fälle (70%) traten in der warmen Jahreszeit auf. In 34 Fällen (68%) konnte eine Infektionsquelle ermittelt werden. Bei 31 Patienten (62%) wurde ein Morbus weil diagnostiziert, bei 12 (24%) eine Meningitis und bei sieben (14%) Fieber unbekannter Ursache. 11 Patienten mit Morbus Weil (35%) mußten dialysiert werden. Drei Patienten (6%) verstarben. Die Todesursache war in zwei Fällen eine massive gastrointestinale Blutung und in einem Nierenversagen. Die Infektion wurde in 39 Fällen (78%) durchLeptospira icterohaemorrhagiae, in sechs Fällen (12%) durchLeptospira canicola, in zwei Fällen (4%) durchLeptospira grippotyphosa und in je einem Fall durchLeptospira australis, Leptospira ballum undLeptospira sejroe verursacht. Bei sechs Patienten wurde eine Muskelbiopsie und bei drei Patienten eine Nierenbiopsie entnommen. In den Muskelbiopsien fanden sich nekrotische Veränderungen mit leichter mononukleärer Infiltration, in den Nierenbiopsien Pigmentniederschläge in den distalen Tubuli contorti, eine leichte entzündliche interstitielle Infiltration, und mesangiale Verbreiterung in einigen Glomeruli. Für eine korrekte diagnostische Abklärung ist es nötig, die wechselnden klinischen Manifestationsformen der Leptospirose zu kennen und eine sorgfältige Labordiagnostik durchzuführen.

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Authors and Affiliations

  1. Department of Infectious Diseases, School of Medicine, Hospital S. João, P-4200, Porto

    H. Lecour M.D. & M. Miranda M.D.

  2. Departments of Internal Medicine I and Nephrology, School of Medicine, Hospital S. João, P-4200, Porto

    C. Magro M.D.

  3. Department of Pathology, School of Medicine, Hospital S. João, P-4200, Porto

    V. Gonçalves M.D.

  4. Department of Bacteriology, National Health Institute, Lisboa, Portugal

    Alice Rocha (Pharm, D.)

Authors
  1. H. Lecour M.D.
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  2. M. Miranda M.D.
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  3. C. Magro M.D.
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  4. V. Gonçalves M.D.
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  5. Alice Rocha
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Additional information

A review with the first 45 cases was presented as a poster at the Third European Congress of Microbiology, Den Haag, 11–14 May 1987.

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Lecour, H., Miranda, M., Magro, C. et al. Human leptospirosis — a review of 50 cases. Infection 17, 8–12 (1989). https://doi.org/10.1007/BF01643489

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  • DOI: https://doi.org/10.1007/BF01643489

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