Background. Leptospirosis is a spirochetal zoonosis with complex clinical features including renal and liver failure. Case report. We report the case of a Swiss fisherman presenting with leptospirosis. After initial improvement, refractory septic shock and severe liver and kidney failure developed. The expected mortality was estimated at 90% with clinical scores. The patient underwent plasma exchanges and high-volume hemofiltration (HVHF) with complete recovery of hepatic and kidney functions. Discussion. Plasma exchanges and HVHF may confer survival benefit on patients with severe leptospirosis, refractory septic shock, and multiple-organ failure.

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Background Patients on maintenance hemodialysis are at high risk for serious complications from COVID-19 infection including death. We present an overview of the local experience with dialysis units management and reorganization, local epidemiology and outcomes during the COVID-19 outbreak in Geneva, Switzerland.Methods All SARS-CoV-2 positive outpatients on maintenance dialysis were transferred from their usual dialysis facility to the Geneva University Hospitals dialysis unit to avoid creation of new clusters of transmission. Within this unit, appropriate mitigation measures were enforced as suggested by the institutional team for prevention and control of infectious diseases.Results From February 25 to May 18, 2020, 19 of 246 patients on maintenance dialysis were tested positive for SARS-CoV-2, representing an incidence rate of 97.6 cases per 100,000 person-days. Eighteen patients were on maintenance hemodialysis and one on peritoneal dialysis. Twelve of these infections were detected during the first two weeks after mitigation strategies were enforced. Most common symptoms were fever (89%), cough (84%) and fatigue (68%). Two patients required orotracheal intubation. Six patients on maintenance hemodialysis who had previously tested positive for SARS-CoV-2, all of them male, died (32%). Five deaths were COVID-19 related and one death was due to dialysis withdrawal at the patient’s request. Conclusion Strict mitigation measures seemed to be effective to control infection spread among patients on maintenance dialysis. COVID-19 infection is associated with a high fatality rate. Large scale epidemiological studies are needed to assess the efficacy of preventive measures in decreasing infection and mortality rate within the dialysis population.

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