Junctional rhythm: A rare sign in leptospirosis

Abstract

Leptospirosis is an important re-emerging infectious disease. Leptospirosis has been estimated to affect tens of millions of humans annually with a case fatality rate ranging from 5% to 25%; however, it is underreported due to the lack of clinical suspicion and barriers to diagnostic capacity. A 33-year-old healthy male presented with a history of fever of 2-day duration. His examination revealed icterus. His workup did not show any significant findings except for a mild transaminitis and a rise in serum creatinine by 0.5 mg/dl. Later, the patient developed bradycardia. An ELISA test for Leptospira antibodies was positive. The patient recovered after a course of intravenous antibiotics. Leptospirosis should be considered early in the diagnosis of any patient who presents with acute, nonspecific febrile illness with multiorgan involvement. Our case had an atypical presentation with involvement of the cardiovascular system in the form of junctional rhythm.

Leptospirosis in a patient with cardiac manifestation: A case report study and literature review

“…Which, according to the study of Assimakopoulos SF, et al., is uncommonly seen in patients. In this study, they presented a patient diagnosed with leptospirosis who developed sinus bradyarrhythmia during hospitalization 2,6 . In the study conducted by Mathew et al., encompassing 105 leptospirosis patients, various acute ECG changes were observed.…”

“…In this study, they presented a patient diagnosed with leptospirosis who developed sinus bradyarrhythmia during hospitalization. 2,6 In the study conducted by Mathew et al, encompassing 105 leptospirosis patients, various acute ECG changes were observed. These were include sinus tachycardia (34.2%), sinus bradycardia (16.2%), ST-segment elevation (13.2%), atrial fibrillation (AF) (6.31%), ST-segment depression (5.66%), first-degree atrioventricular (A-V) block (4.76%), left bundle branch block (LBBB) (4.76%), incomplete right bundle branch block (RBBB) (4.76%), atrial and ventricular ectopic beats (2.83%), T-wave inversions (2.83%), junctional rhythm (1.90%), low voltage QRS (1.90%), and abnormal QRS-T angle (1.90%).…”

“…Complications of leptospirosis encompass a range of serious conditions including renal failure, hepatitis, thrombocytopenia, pulmonary hemorrhage, acute respiratory distress syndrome, myocarditis, neuroleptospirosis, ocular issues, meningitis, hypotension, and hypokalemic paralysis. 2,4 As stated in studies, the most common electrocardiographic anomalies observed in leptospirosis are atrial fibrillation or first-degree atrioventricular block, which is followed by atrial flutter, second-degree atrioventricular block, bundle-branch blocks, junctional rhythm, ST-segment deviations either downwards or upwards, Twave reversal primarily in the anterior or lateral leads, prolonged corrected QT-intervals, premature ventricular contractions, and ventricular tachycardia. 5 Nonetheless, instances of severe bradycardia complicating leptospirosis have been infrequently reported thus far.…”

“…Leptospirosis, a significant zoonotic illness caused by Leptospira species, is transmitted through direct contact with the pathogen or contaminated water sources 1 . According to the World Health Organization (WHO), leptospirosis incidence varies from 0.01 to 1 case per 100,000 individuals in non‐endemic temperate regions from 10 to 100 cases per 100,000 in endemic tropical areas 2 . The bacteria primarily infect a range of animals, particularly rodents, and human infections typically occur through accidental contact with contaminated water or soil carrying the urine of infected animals 1 .…”

“…The majority of cases manifest as relatively mild, characterized by abrupt onset of symptoms such as fever, headache, nausea, vomiting, abdominal pain, conjunctival suffusion, and myalgia. Complications of leptospirosis encompass a range of serious conditions including renal failure, hepatitis, thrombocytopenia, pulmonary hemorrhage, acute respiratory distress syndrome, myocarditis, neuroleptospirosis, ocular issues, meningitis, hypotension, and hypokalemic paralysis 2,4 …”