Penicillin Therapy in Icteric Leptospirosis

Edwards, Charles N.; Nicholson, G. D.; Hassell, Trevor; Everard, C. O. R.; Callender, Joy

doi:10.4269/ajtmh.1988.39.388

Cited by 83 publications

(68 citation statements)

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“…Antibiotic therapy in leptospirosis is widely believed to provide the greatest benefit when initiated in the early phase of the disease 1,4,13 whereas its efficacy when administered during severe, late-stage disease remains controversial. 14,15 Therefore, early diagnosis and timely administration of antibiotic therapy are required to reduce leptospirosis mortality during urban epidemics.…”

Section: Introductionmentioning

confidence: 99%

Referral pattern of leptospirosis cases during a large urban epidemic of dengue.

Flannery¹,

Pereira²,

de³

et al. 2001

The American Journal of Tropical Medicine and Hygiene

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Abstract. During heavy seasonal rainfall in 1996, concurrent epidemics of dengue and leptospirosis occurred in an urban center in northeastern Brazil. We interviewed 110 cases of leptospirosis hospitalized a median of seven days after the onset of illness to evaluate the impact of the dengue epidemic on the triage of suspected leptospirosis from ambulatory clinics to the infectious disease reference hospital. Within the first three days of illness, 46 (42%) cases sought their first medical evaluation, and 28 (61% of 46) received a diagnosis of dengue. Dengue diagnoses were associated with a median of five days delay in referral to the infectious disease hospital. Patients who reported initial diagnoses of dengue were more likely than other patients to have required admission to the intensive care unit (odds ratio [OR] ϭ 2.7, 95% confidence interval [CI] ϭ 0.8-9.5) and to have died during hospitalization (OR ϭ 5.1, 95% CI ϭ 0.8-55.0). These findings indicate that diagnostic confusion between the early symptoms of leptospirosis and dengue may have contributed to the high mortality observed during the leptospirosis epidemic.

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Section: Introductionmentioning

confidence: 99%

Referral pattern of leptospirosis cases during a large urban epidemic of dengue.

Flannery¹,

Pereira²,

de³

et al. 2001

The American Journal of Tropical Medicine and Hygiene

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“…Yet population-based studies indicate that the relationship between infecting serovar and clinical manifestations of the disease remains far from clear; purportedly virulent serovars can cause mild disease and vice versa (3,(7)(8)(9). It is not clear that antibiotic treatment of leptospirosis leads to improved outcome; clinical studies conflict (10,11). Therefore, just as in relapsing fever caused by spirochetes of the genus Borrelia (12), it is of substantial importance to delineate mechanisms by which Leptospira activate the immune system so as to point out novel ways to approach the treatment of this possibly fatal illness.…”

mentioning

confidence: 99%

Leptospira interrogansActivation of Human Peripheral Blood Mononuclear Cells: Preferential Expansion of TCRγδ+ T Cells vs TCRαβ+ T Cells

Klimpel

Matthias

Vinetz

2003

The Journal of Immunology

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Innate and adaptive immune responses induced by leptospirosis have not been well characterized. In this study we show that in vitro exposure of naive human PBMC to Leptospira interrogans results in cell proliferation and the production of IFN-γ, IL-12, and TNF-α. Cell proliferation was highest when using high numbers of Leptospira. Optimal cell proliferation occurred at 6–8 days, and the majority of cells contained in these cultures were γ/δ T cells. These cultures showed a 10- to 50-fold expansion of γ/δ T cells compared with the initial cellular input. Additionally, these cultures contained elevated numbers of NK cells. In contrast, exposure of PBMC to low numbers of Leptospira failed to induce γδ T cell or NK cell expansion, but induced significant αβ T cell expansion. Vγ9/Vδ2 were expressed on all γ/δ T cells expanded by exposure of PBMC to Leptospira. Leptospira stimulation of purified TCRγδ+ T cells, obtained from 8-day cultures of Leptorspira-stimulated PBMC, induced high levels of IFN-γ production, but no cell proliferation, suggesting that such stimulation of γδ T cells did not depend on specialized accessory cells or Ag processing. Finally, in patients with acute leptospirosis, there was a significant (4- to 5-fold) increase in the number of peripheral blood TCRγδ+ T cells. These results indicate that Leptospira can activate γδ T cells and αβ T cells and will guide further investigations into the roles of these T cell populations in host defense and/or the pathology of leptospirosis.

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“…Algunos estudios sugieren que, en pacientes con enfermedad grave, la administración temprana de antibióticos se asocia con una reducción en la duración de la enfermedad y en las tasas de mortalidad (36)(37)(38). Por el contrario, en una revisión sistemática de la literatura científica no se demostraron los beneficios del tratamiento antibiótico en la reducción de la mortalidad (39).…”

Section: Discussionunclassified

Sociodemographic and clinical characteristics of patients infected with Leptospira spp. treated at four hospitals in Medellín, Colombia, 2008-2013

et al. 2017

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Valderrama: concepción y escritura del proyecto de investigación en su fase inicial Laura Castañeda y Sara Penagos: consolidación de la información en bases de datos Todos los autores participaron en la revisión de las historias clínicas en cada una de las instituciones participantes, en la recolección de la información necesaria para completar los formularios, en el análisis de los resultados y en la escritura del artículo final. Introducción. La leptospirosis continúa siendo un problema significativo de salud en regiones tropicales, incluidos los países de Latinoamérica, donde es 100 veces más frecuente que en otras regiones del mundo. En los cuadros graves de la enfermedad, su mortalidad alcanza el 10 %. Su diagnóstico es un reto debido a que las manifestaciones clínicas en la fase inicial son inespecíficas y a la poca disponibilidad de pruebas diagnósticas. Objetivo. Describir las características sociodemográficas y clínicas, y el desenlace de la enfermedad en pacientes hospitalizados con leptospirosis. Materiales y métodos. Es un estudio retrospectivo que incluyó pacientes atendidos en cuatro instituciones de Medellín, entre enero de 2009 y diciembre de 2013, con un cuadro clínico sugestivo e IgM positiva para Leptospira spp. Resultados. Se incluyeron 119 pacientes, 80 % hombres y 58 % de procedencia rural. La duración promedio de los síntomas fue de 9,6 días (DE=9,6). El 89 % de los pacientes presentó fiebre; el 62 %, ictericia; el 74 %, mialgias; el 46 %, diarrea; el 41 %, hepatomegalia; el 13 %, esplenomegalia, y 13 %, enrojecimiento de los ojos. En 54 % de los pacientes hubo deterioro de la función renal, en 32 %, compromiso pulmonar y, en 13 %, falla hepática. El 16 % de los pacientes requirió atención en la unidad de cuidados intensivos, el 12 %, asistencia respiratoria mecánica, y el 11 %, administración de vasopresores. En 38,6 % de ellos la enfermedad cursó con síndrome de Weil y el 5 % falleció. La duración promedio de la hospitalización fue de 11 días (DE=9,6). Conclusiones. La leptospirosis en esta población tuvo manifestaciones clínicas y complicaciones similares a las reportadas en la literatura científica. Se observó una mortalidad general relativamente baja comparada con las estadísticas mundiales.

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Penicillin Therapy in Icteric Leptospirosis

Cited by 83 publications

References 0 publications

Referral pattern of leptospirosis cases during a large urban epidemic of dengue.

Referral pattern of leptospirosis cases during a large urban epidemic of dengue.

Leptospira interrogansActivation of Human Peripheral Blood Mononuclear Cells: Preferential Expansion of TCRγδ+ T Cells vs TCRαβ+ T Cells

Sociodemographic and clinical characteristics of patients infected with Leptospira spp. treated at four hospitals in Medellín, Colombia, 2008-2013

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