What role do coagulation disorders play in the pathogenesis of leptospirosis?

Wagenaar, Jiri F. P.; Goris, Marga G. A.; Adi, Mateus Sakundarno; Gasem, Muhammad Hussein; Mairuhu, Albert T.A.; Kruif, Martijn D. de; Cate, Hugo Ten; Hartskeerl, Rudy A.; Brandjes, D. P. M.; Gorp, Eric C. M. Van

doi:10.1111/j.1365-3156.2006.01792.x

Cited by 43 publications

(36 citation statements)

References 81 publications

(89 reference statements)

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“…Bleeding in leptospirosis may be the result of a defect in the primary hemostasis or a imbalance in secondary hemostasis by depletion of coagulation proteins because of enhanced coagulation or by activated fribrinolysis. 22 In a recent study, Chierakul et al measured plasma concentrations of fibrinogen, Ddimer, thrombin-antithrombin III complexes, and prothrombin fragment 1.2 and evaluated the disseminated intravascular coagulation score. The median concentrations of fibrinogen, D-dimer, thrombin-antithrombin III complexes, and prothrombin fragment 1.2 were significantly elevated in leptospirosis.…”

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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“…Bleeding manifestations have been attributed mainly to endothelial injury. Thrombocytopenia and, in few cases, disseminated intravascular coagulation can worsen the bleeding tendency [62]. Jaundice usually is present in almost all cases of leptospirosis.…”

Section: Pathophysiologymentioning

confidence: 99%

The kidney in leptospirosis

Abdulkader

Silva

2008

Pediatr Nephrol

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Leptospirosis is a worldwide zoonosis. Typically, patients are young men, although children can be affected. In children, this disease causes mainly alterations of sensorium. Acute renal failure and jaundice (Weil's syndrome) are less common in children than in adults. The main renal histological findings are acute interstitial nephritis and acute tubular necrosis. Acute renal failure is characterized by hypokalemia and nonoliguria. Many factors are involved in its physiopathology: hypotension, hypovolemia, rhabdomyolysis, hyperbilirubinemia, and, primarily, the direct action of leptospiral proteins. Antibiotic administration (especially early administration) reduces length of hospitalization and leptospiruria. For children, even late antibiotic treatment has been shown to reduce the extent of acute renal failure and thrombocytopenia. Although the best method of dialysis is not yet established, early and intensive dialysis can decrease mortality. Mortality in patients with acute renal failure is approximately 15-20% in association with the presence of oliguria, higher levels of creatinine, and older age. Functional recovery is fast and complete; however, abnormal urinary concentration can persist.

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“…However, thrombocytopenia in leptospirosis is transient and does not result from disseminated intravascular coagulation (DIC) [1]. Low platelet counts are common in leptospirosis, and human and experimental data have been inconsistent in supporting a role for an underlying DIC in predisposing to hemorrhagic manifestations in leptospirosis [30]. One potential explanation of thrombocytopenia in leptospirosis is that certain strains of Leptospira directly activate platelets [10].…”

Section: Discussionmentioning

confidence: 99%

Comparative Analysis of Pediatric and Adult Leptospirosis in Pleven Region, Bulgaria

Gancheva¹

2017

SJCM

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Abstract:Leptospirosis is worldwide re-emerging zoonosis with protean clinical manifestations. The more common mild, anicteric form is characterized by nonspecific symptoms such as fever, headache, chills, myalgia, nausea and abdominal pain. The severe, potentially fatal form (Weil's disease) typically presenting as triad of jaundice, acute renal failure (ARF), and hemorrhage is estimated to occur in 5-15% of all human infections with mortality rate up to 40%. Elder age is one of poor prognostic factors in leptospirosis. There are few studies about leptospirosis in children and no one comparative study of pediatric and adult leptospirosis in regions with temperate climate. Our aims were to describe retrospectively the disease spectrum and outcome differences in children and adults with leptospirosis over a period of 41 years and to compare severity in different age groups. The study material comprised the data from 105 consecutive leptospirosis cases from Central Northern Bulgaria treated in Clinic of Infectious Diseases at University Hospital -Pleven (1976-2016) (95 male, age 37±18 years, lethal outcome in 12.38%), followed by comparative analysis of group of children (age ≤17-years-old; N 1 =13) versus group of adults (age ≥18 years-old; N 2 =92). Results: Fever (100%), hepatomegaly (92%), conjunctival suffusions (88%), myalgia (87%), nausea and vomiting (84%), shivering (79%), splenomegaly (74%), headache (65%), jaundice (64%), oliguria (58%), tachycardia (55%), hypotension (50%), abdominal pain (41%), and hemorrhagic diathesis (37%) were the most characteristic manifestations in whole series. Only headache and meningitis had had a significantly higher prevalence in the group of children. Leucocytosis, blood urea nitrogen, serum creatinine, serum bilirubin, aminotransferases, gamma glutamyl tranferase (GGT) and serum amylase levels were significantly higher in group of adults. Potassium level, total protein and albumins were significantly lower in the same group. The distribution of cases in whole series according to severity was as follows: mild cases -27, moderate -44 cases and severe -34 cases. In group of children seven mild and six moderate cases had been observed versus 20 mild, 38 moderate and 34 severe cases in the group of adults. All thirteen deceased patients were adults. We concluded that in Pleven region, leptospirosis in children usually is mild and anicteric. The leptospiral meningitis is not unusual manifestation for pediatric leptospirosis. The major factors leading to death in adults with leptospirosis were lung edema and brain edema due to severe ARF.

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What role do coagulation disorders play in the pathogenesis of leptospirosis?

Cited by 43 publications

References 81 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

The kidney in leptospirosis

Comparative Analysis of Pediatric and Adult Leptospirosis in Pleven Region, Bulgaria

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