Acute Pancreatitis in Fatal Anicteric Leptospirosis

Spichler, Anne; Spichler, Ethel Stambovsky; Moock, Marcelo; Vinetz, Joseph M.; Leake, John A. D.

doi:10.4269/ajtmh.2007.76.886

Cited by 24 publications

(20 citation statements)

References 12 publications

(15 reference statements)

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“…2 Pancreatitis is described as an uncommon complication of leptospirosis, but there are a considerable number of reports in literature. [37][38][39][40] In the present study, the complications found were pulmonary bleeding (14%), tract intestinal bleeding (13%), atrial fibrillation (11.4%), pulmonary infection (6.0%), meningitis (1.0%) and pancreatitis (0.5%).…”

Section: Discussionmentioning

confidence: 99%

Clinical presentation of leptospirosis: a retrospective study of 201 patients in a metropolitan city of Brazil

Daher¹,

Lima²,

Júnior³

et al. 2010

Braz J Infect Dis

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INTRODUCTION: leptospirosis is a zoonosis of worldwide importance. The disease is endemic in Brazil. This study was conducted to describe the clinical and laboratory presentation of leptospirosis in a metropolitan city of Brazil. METHODS: this is a retrospective study including 201 consecutive patients with leptospirosis admitted to tertiary hospitals in Fortaleza, Brazil, between 1985 and 2006. All patients had clinical and epidemiological data suggestive of leptospirosis, and positive laboratorial test for leptospirosis (microscopic agglutination test, MAT, higher than 1:800). RESULTS: a total of 201 patients were included, with mean age of 38.9 ± 15.7 years; 79.1% were male. The mean length from onset of symptoms to admission was 7 ± 3 days. The main clinical signs and symptoms at admission were fever (96.5%), jaundice (94.5%), myalgia (92.5%), headache (74.6%), vomiting (71.6%) and dehydration (63.5%). Hemorrhagic manifestations were present in 35.8%. Acute kidney injury was found in 87% of the patients. Platelet count was less than 100,000/mm³ in 74.3%. Hematuria was found in 42.9%. Death occurred in 31 cases (15.4%). CONCLUSIONS: leptospirosis is a globally relevant disease with potential fatal outcome. Signs and symptoms suggestive of leptospirosis must be known by any physician in order to institute early adequate treatment to improve outcome. Early indication and daily hemodialysis seems to be beneficial in this group of patients

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Section: Discussionmentioning

confidence: 99%

Clinical presentation of leptospirosis: a retrospective study of 201 patients in a metropolitan city of Brazil

Daher¹,

Lima²,

Júnior³

et al. 2010

Braz J Infect Dis

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“…(27,36). Patients suffering from leptospirosis have a diverse array of clinical symptoms, such as meningitis (10), pneumonitis (12), hepatitis (1), nephritis (31), and pancreatitis (35), and death may result (5). It is known that zoonotic infections of humans with leptospires are a significant public health problem in developing countries (24).…”

Section: ؉ T Lymphocytes Derived From Lipl21-or Lipl32-immunized Balbmentioning

confidence: 99%

Identification of Immunodominant B- and T-Cell Combined Epitopes in Outer Membrane Lipoproteins LipL32 and LipL21 of Leptospira interrogans

Lin

Zhao

Qian

et al. 2010

Clin Vaccine Immunol

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Leptospirosis is a serious infectious disease caused by pathogenic Leptospira. B-and T-cell-mediated immune responses contribute to the mechanisms of Leptospira interrogans infection and immune intervention.LipL32 and LipL21 are the conserved outer membrane lipoproteins of L. interrogans and are considered vaccine candidates. In this study, we identified B-and T-cell combined epitopes within LipL32 and LipL21 to further develop a novel vaccine. By using a computer prediction algorithm, two B-and T-cell combined epitopes of LipL21 and four of LipL32 were predicted. All of the predicted epitopes were expressed in a phage display system. Four epitopes, LipL21 residues 97 to 112 and 176 to 184 (LipL21 97-112 and LipL21 176-184 , respectively) and LipL32 133-160 and LipL32 221-247 of LipL32 were selected as antigens by Western blotting and enzymelinked immunosorbent assay. These selected epitopes were also recognized by CD4 ؉ T lymphocytes derived from LipL21-or LipL32-immunized BALB/c (H-2 d ) mice and mainly polarized the immune response toward a Th1 phenotype. The identification of epitopes that have both B-and T-cell immune reactivities is of value for studying the immune mechanisms in response to leptospiral infection and for designing an effective vaccine for leptospirosis.Leptospirosis is a widespread zoonotic disease caused by pathogenic Leptospira spp. (27,36). Patients suffering from leptospirosis have a diverse array of clinical symptoms, such as meningitis (10), pneumonitis (12), hepatitis (1), nephritis (31), and pancreatitis (35), and death may result (5). It is known that zoonotic infections of humans with leptospires are a significant public health problem in developing countries (24).Currently, most vaccines against leptospirosis in animal models have been studied using heat-killed or formalin-killed leptospires, outer membrane proteins, and native or recombinant proteins from leptospires (13,21,23). In general, currently available vaccines made from either inactivated leptospires or their membrane components may elicit immunity but with the disadvantages of incomplete, short-term, limited serovar-specific effects and poor immunological memory (39). In addition, the increasing number of serovars also provides a challenge to developing an ideal vaccine with full protection against pathogenic leptospires.In response to leptospiral infection, the host launches vigorous humoral and cellular immune responses. Evidence indicates that leptospires can activate the immune system, but their immunological effects are still unclear. T lymphocytes play an important role in the recognition and subsequent elimination of tumors and intracellular pathogens. Recent studies have shown that heat-killed Leptospira interrogans induces CD4 ϩ T-cell and ␥/␦ T-cell responses and stimulates type I cytokine production (9, 26). These data suggest that the type I or cellmediated immune response is involved in the protective effect against leptospires.LipL32 and LipL21 are outer membrane proteins of leptospires. They play importa...

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“…The disease can occur in two forms: Anicteric leptospirosis [3] and severe leptospirosis called Weil's Syndrome.…”

Section: Discussionmentioning

confidence: 99%

Acute Necrotising Pancreatitis Associated with Leptospirosis—A Case Report

Jain

Mohan

2010

Indian J Surg

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Acute Pancreatitis in Fatal Anicteric Leptospirosis

Cited by 24 publications

References 12 publications

Clinical presentation of leptospirosis: a retrospective study of 201 patients in a metropolitan city of Brazil

Clinical presentation of leptospirosis: a retrospective study of 201 patients in a metropolitan city of Brazil

Identification of Immunodominant B- and T-Cell Combined Epitopes in Outer Membrane Lipoproteins LipL32 and LipL21 of Leptospira interrogans

Acute Necrotising Pancreatitis Associated with Leptospirosis—A Case Report

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