Leptospirosis III

Lh, Turner

doi:10.1016/0035-9203(70)90087-8

Cited by 125 publications

(23 citation statements)

References 32 publications

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“…5). For detailed descriptions of historical methods see the following publications (Faine et al 1999; Galton 1962; Levett 2001; Sulzer and Jones 1978; Turner 1968, 1970; Wolff 1954). …”

Section: Diagnosismentioning

confidence: 99%

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Leptospirosis in Humans

Haake

Levett

2014

Current Topics in Microbiology and Immunology

779

974

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Leptospirosis is a widespread and potentially fatal zoonosis that is endemic in many tropical regions and causes large epidemics after heavy rainfall and flooding. Infection results from direct or indirect exposure to infected reservoir host animals that carry the pathogen in their renal tubules and shed pathogenic leptospires in their urine. Although many wild and domestic animals can serve as reservoir hosts, the brown rat (Rattus norvegicus) is the most important source of human infections. Individuals living in urban slum environments characterized by inadequate sanitation and poor housing are at high risk of rat exposure and leptospirosis. The global burden of leptospirosis is expected to rise with demographic shifts that favor increases in the number of urban poor in tropical regions subject to worsening storms and urban flooding due to climate change. Data emerging from prospective surveillance studies suggest that most human leptospiral infections in endemic areas are mild or asymptomatic. Development of more severe outcomes likely depends on three factors: epidemiological conditions, host susceptibility, and pathogen virulence (Fig. 1). Mortality increases with age, particularly in patients older than 60 years of age. High levels of bacteremia are associated with poor clinical outcomes and, based on animal model and in vitro studies, are related in part to poor recognition of leptospiral LPS by human TLR4. Patients with severe leptospirosis experience a cytokine storm characterized by high levels of IL-6, TNF-alpha, and IL-10. Patients with the HLA DQ6 allele are at higher risk of disease, suggesting a role for lymphocyte stimulation by a leptospiral superantigen. Leptospirosis typically presents as a nonspecific, acute febrile illness characterized by fever, myalgia, and headache and may be confused with other entities such as influenza and dengue fever. Newer diagnostic methods facilitate early diagnosis and antibiotic treatment. Patients progressing to multisystem organ failure have widespread hematogenous dissemination of pathogens. Nonoliguric (high output) renal dysfunction should be supported with fluids and electrolytes. When oliguric renal failure occurs, prompt initiation of dialysis can be life saving. Elevated bilirubin levels are due to hepatocellular damage and disruption of intercellular junctions between hepatocytes, resulting in leaking of bilirubin out of bile caniliculi. Hemorrhagic complications are common and are associated with coagulation abnormalities. Severe pulmonary hemorrhage syndrome due to extensive alveolar hemorrhage has a fatality rate of >50 %. Readers are referred to earlier, excellent summaries related to this subject (Adler and de la Peña-Moctezuma 2010; Bharti et al. 2003; Hartskeerl et al. 2011; Ko et al. 2009; Levett 2001; McBride et al. 2005).

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“…5). For detailed descriptions of historical methods see the following publications (Faine et al 1999; Galton 1962; Levett 2001; Sulzer and Jones 1978; Turner 1968, 1970; Wolff 1954). …”

Section: Diagnosismentioning

confidence: 99%

“…Blood cultures should be taken as soon as possible after the patient’s presentation. One or two drops of blood are inoculated into 5–10 ml semisolid or liquid medium at the bedside (Turner 1970). Multiple cultures yield higher recovery rates, but this is rarely possible.…”

Section: Diagnosismentioning

confidence: 99%

Leptospirosis in Humans

Haake

Levett

2014

Current Topics in Microbiology and Immunology

779

974

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“…The difficulty in differentiating leptospires from 'pseudo-leptospires' in blood cultures has been stressed by several authors (Davis et al, 1969;Turner, 1970;Cruickshanik et al, 1973;Alexander, 1974). In addition to the spiral structure of such artefacts, the Brownian movement in them can also lead to a mistaken impression (Turner, 1970). Because of this possibility of misdiagnosis, Alexander (1974) recommended that direct dark-ground examination of blood for leptospires should not be undertaken as a single diagnostic procedure.…”

Section: Discussionmentioning

confidence: 99%

“…This could happen in a routine laboratory with limited experience of leptospires. The difficulty in differentiating leptospires from 'pseudo-leptospires' in blood cultures has been stressed by several authors (Davis et al, 1969;Turner, 1970;Cruickshanik et al, 1973;Alexander, 1974). In addition to the spiral structure of such artefacts, the Brownian movement in them can also lead to a mistaken impression (Turner, 1970).…”

Section: Discussionmentioning

confidence: 99%

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Pseudo-leptospires in blood culture.

Rahman¹,

Macis²

1979

J Clin Pathol

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SUMMARY Spiral filaments seen in the blood cultures of two patients with fever and jaundice were initially thought to be leptospires; these were later proved to be artefacts. An investigation was carried out to exclude the possibility of laboratory contamination of the culture media and to find out how these objects were produced. The significance of the findings is discussed in relation to the possibility of a mistaken diagnosis in routine laboratories which have a limited experience of leptospires.Two patients with fever, headache, and jaundice were admitted to two hospitals of this district within a period of six months. The first patient was a male sewer worker and the second was a female laboratory assistant who was responsible for feeding rats. Blood culture and other tests, including those for Australia antigen, urea level, microscopy and cultures of urine and faeces, and blood counts, failed to establish a diagnosis in either patient. However, fluid from blood culture bottles of both patients, when examined under dark-ground microscopy, showed spiral objects having sluggish and sinuous movement. These were thought to be leptospires as their appearances were similar to those given in a standard textbook (Cruickshank et al., 1973), although none had hooked ends and none showed active motility. The Leptospirosis Reference Laboratory in London did not confirm our findings, and the serological tests for leptospirosis were negative. Both patients recovered within a few days without any specific treatment. Investigations were made to discover the significance and source of the spiral objects seen in the blood culture bottles in our laboratory and to exclude the possibility of contamination of the media.Material and methods (a) Ten blood culture bottles prepared in this laboratory (KM) were incubated at 370C without any addition of blood. Drops of the broth were removed andexamined under the dark-ground microscope on the 1st, 3rd, 7th, and 14th days of incubation for the presence of the spiral objects.(b) Ten blood culture bottles (KM) were inoculated with blood from hospital patients with known Received for publication 24 April 1979 conditions other than leptospirosis (for example, postoperative pyrexia, bacterial endocarditis, etc). These were then incubated and examined as in (a).(c) Two blood culture bottles (KM) were inoculated with blood from two normal healthy volunteers. These were incubated and examined as in (a).(d) Five blood culture bottles were obtained from a neighbouring hospital laboratory (NG). These were inoculated with patients' blood, as in (b), and then examined as in (a).(e) Five specimens of blood containing an anticoagulant (EDTA) were obtained from the haematology laboratory of this hospital. These were incubated at 370C without the addition of any culture medium. They were then examined in the same way as above.The KM blood culture bottles contained brain heart infusion, liquoid 0-05 %, and glucose 0-5 %, and the NG bottles contained tryptone soya broth and liquoid 0 05 %.The dark-gr...

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Leptospirosis in New England

Andrew¹

1977

JAMA

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Leptospirosis III

Cited by 125 publications

References 32 publications

Leptospirosis in Humans

Leptospirosis in Humans

Pseudo-leptospires in blood culture.

Leptospirosis in New England

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