Leptospirosis is one of the most common and important zoonotic infections worldwide. Leptospirosis generally presents with features of bacterial infection in acute phase followed by multi-organ complications and may be complicated by jaundice and renal failure, pulmonary hemorrhage, acute respiratory distress syndrome, myocarditis, rhabdomyolysis, Sweet's and uveitis. 1 Acute pancreatitis and myocarditis are very rare manifestations in leptospirosis. 2,3 In addition, vasculitis and gangrene are also uncommon complications. In this article, we present a rare case of acute renal failure and hyperbilirubinemia occurring simultaneously, severe vasculitis with peripheral gangrene of the lower extremities with leptospirosis. CASE REPORT A 45-year-old male patient was admitted to our clinic with a seven-day history of fever, myalgia, jaundice and reddish skin lesions. He also had anuria over the previous two days. On examination, the patient was mildly tachycardic (120/minute) with a blood pressure of 180/90 mmHg, pyrexia (38.4°C) and tachypnea (24/minute). Physical examination findings were icteric sclera, remarkable for jaundice and large tender hepatomegaly, cutaneous necrosis of the feet due to vasculitis (Figure 1). Abdominal organomegaly could not be assessed because the patient had severe rigidity and tenderness to palpation and percussion. There was no rebound ABSTRACT Leptospirosis is a zoonotic disease that occurs worldwide. Various clinical manifestations of leptospirosis can be seen. In this article, we present a case with acute renal failure, severe vasculitis and hyperbilirubinemia occurring simultaneously with leptospirosis. A 45-year-old male patient presented with fever, myalgia, jaundice and reddish skin lesions and anuria. Physical examination findings were icteric sclera, large tender hepatomegaly, and lower extremities' cutaneous necrosis due to vasculitis. Hemodialysis was started. Kidney biopsy revealed degenerative changes of proximal tubules, some of them containing bile casts. Microscopic agglutination test was positive and consistent with leptospirosis. Intravenous ampicillin and oral tetracycline were started. Methylprednisolone 60 mg per day was given for skin vasculitis. Hemodialysis therapy was discontinued. All clinical findings gradually regressed.
In this study, strains of feline immunodeficiency virus (FIV), designated TR-D, TR-Mo and TR-Mi, isolated from three cats in Turkey, were characterized. PCR products (859 bp) from the envelope (env) gene region were amplified and sequenced, and possible geographical differences in the env gene region of Turkish FIV strains are discussed. Phylogenetic analysis of two strains showed that FIV subtype B was present in Turkey. Phylogenetic analysis showed that one new Turkish FIV strain occupies a separate branch from known clusters (subtypes A to E) from the USA, Canada, Europe and Japan.
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