Multivisceral organ failure related to leptospirosis in pregnant patient

Sbai, Hicham; Mellouki, I.; Abderahim, El Bouazzaoui; Boukatta, Brahim; Labib, Smael; Mustapha, Harrandou; Khatouf, Mohammed; Adil, Ibrahimi Sidi; Melhouf, A.; Kanjaa, Nabil

doi:10.4103/0972-5229.112143

Cited by 10 publications

(15 citation statements)

References 9 publications

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“…Conjunctival suffusion is common and can be a useful clinical sign in early recognition. 2 Our patient had vomiting, dry cough, watery stools for a few days and hemoptysis, vaginal spotting, and breathing difficulty on the day of admission. She did not give a history of fever.…”

Section: Discussionmentioning

confidence: 71%

“…Leptospirosis has a 5 to 40% mortality rate in severe disease. 2,3,4 Thrombocytopenia suggests severe disease and the subsequent risk of severe bleeding. 2,6 Wagenaar et al 6 have reported patients with leptospirosis may develop a spectrum of clinical effects due to infection-associated activation of the coagulation cascade.…”

Section: Discussionmentioning

confidence: 99%

“…Leptospirosis is a re-emerging zoonotic disease in Sri Lanka. 1 Severe leptospirosis is rarely described in pregnancy 2,3 and there is a scarcity of data regarding its effect on the pregnant patients . 3 Acute lung injury has been recognized as the commonest fatal complication of leptospirosis in certain studies.…”

Section: Introductionmentioning

confidence: 99%

“…4 Severe leptospirosis in pregnancy may be confused with hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome and acute fatty liver of pregnancy (AFLP) especially when the patient present in the 3rd trimester. 2,3 Unusual presentations may delay the diagnosis and subsequently the proper management. Therefore, a high degree of clinical suspicion is vital.…”

Section: Introductionmentioning

confidence: 99%

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Fulminant Leptospirosis Leading to Shock Lung & Severe Coagulopathy in a Pregnant Patient: A Case Report and Review of the Literature

Tharanga¹,

Pilapitiya

Senanayake

2020

J. Ruhunu Clin. Soc.

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Background: Leptospirosis is a zoonotic disease with high prevalence in Sri Lanka predominantly in paddy cultivating areas. Severe leptospirosis is rarely described in pregnancy and there is a scarcity of data regarding its effect on pregnant patients. Acute lung injury has been recognized as the commonest fatal complication of leptospirosis. We report a case of delayed presentation of fulminant leptospirosis in a pregnant patient complicated with acute respiratory distress syndrome (ARDS) and severe coagulopathy resulting in death despite the optimum medical care.Case Presentation: A-31-year-old woman in the twelfth-week of pregnancy admitted with a subacute history of frequent vomiting, dry cough, watery stools, vaginal spotting, hemoptysis, and progressive shortness of breath. She had tachycardia, hypotension, and acute severe respiratory distress with high-grade fever on admission. Her inflammatory markers were high with evidence of severe coagulopathy. With worsening clinical and biochemical parameters despite intensive medical intervention, patient had a fatal outcome. The autopsy revealed shock lung with multiple intra-alveolar hemorrhages. The serum Leptospira microscopic agglutination test (MAT) was positive confirming the fulminant leptospirosis.Conclusion: Prolongrespiratory symptoms; positive lung signs with acute respiratory distress can mimic the clinical picture of atypical pneumonia. Delayed presentation of ARDS limits the management options whilst increasing the risk of fatality. A high degree of suspicion is needed to diagnose leptospirosis in pregnancy.

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Fulminant Leptospirosis Leading to Shock Lung & Severe Coagulopathy in a Pregnant Patient: A Case Report and Review of the Literature

Tharanga¹,

Pilapitiya

Senanayake

2020

J. Ruhunu Clin. Soc.

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“…Human infections can occur by direct contact with urine or tissue of an infected animal, especially rodents or indirectly through contaminated water, soil, or vegetation [1]. Leptospirosis ranges in severity from a mild illness suggesting a viral infection to a multisystemic syndrome.…”

Section: Discussionmentioning

confidence: 99%

Leptospirosis in Pregnancy: A Rare Condition Mimicking HELLP Syndrome

Tong

Mathur

2018

J Med Cases

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We report a case of leptospirosis in pregnancy. A 37-year-old woman of para 1, normal vaginal delivery (NVD) presented at 33 weeks with 3 days of jaundice and diarrhea and no history of fever, abdominal pain, itch or pale stools. Her pregnancy was uneventful except for gestational diabetes. On examination she had jaundice otherwise unremarkable. Investigations revealed proteinuria, hemolysis, low platelets, raised transaminases and bilirubin. Working diagnosis was of atypical hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome owing to absence of hypertension. She progressed into labour 1 day later after preterm premature rupture of membranes (PPROM), had thick meconium and pathological cardiotocography (CTG). She delivered a baby weighing 1,736 g and normal Apgar scores. Arterial cord pH was 7.275, lactate 3.04, base excess of -8.8 and venous pH was 7.316, lactate 2.93, BE -10.6. Leptospirosis EIA IgM antibody was positive and placenta histology showed focus increased perivillous fibrinoid deposits with acute intervillositis and meconium staining. Baby showed no signs of congenital leptospirosis and was discharged on day 15 of life. Patient's symptoms resolved within 2 weeks and her biochemistry normalized within 1 month. Owning to unusual presentation and rarity, leptospirosis in pregnancy is often misdiagnosed and underreported. It mimics HELLP syndrome, viral hepatitis, obstetric cholestasis and acute fatty liver of pregnancy. It has severe implications of early miscarriages, stillbirths and neonatal leptospirosis requiring high index of suspicion, need for increased awareness, early diagnosis and treatment.

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Foetal outcome of Leptospira and Rickettsial infections during pregnancy: a systematic review

Sengupta,

Mandal

et al. 2024

Transactions of the Royal Society of Tropical Medicine and Hygiene

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Background Leptospirosis and rickettsial infections are bacterial zoonoses prevalent in different geographical locations and presents with overlapping symptoms. Objective To identify foetal outcomes in pregnant women diagnosed with rickettsial infections, including scrub typhus and leptospirosis, along with their associated factors. Methods A comprehensive search was conducted in MEDLINE/PubMed, Scopus, CENTRAL (Cochrane), Web of Science, PsycINFO, Academic Search Premier, CINAHL, and Embase using defined search terms. Studies involving pregnant women with diagnosed leptospirosis and rickettsial infections, including scrub typhus, were selected. Two independent reviewers screened titles and abstracts using the Rayyan Web interface. Data extraction was performed in Microsoft Excel, with Zotero for reference management. Study quality was assessed using Joanna Briggs Institute Critical Appraisal tools. Data synthesis included narrative analysis. Results Fifty-four studies were included: 22 on scrub typhus, 14 on rickettsial infection, 16 on leptospirosis, and 2 on all three infections. Of 176 scrub typhus cases, 53 resulted in foetal loss and 3 in neonatal death. Among 38 rickettsial infection cases, 4 had foetal loss. Out of 63 leptospirosis cases, 13 experienced foetal loss. Six maternal deaths occurred due to scrub typhus and one due to Rocky Mountain spotted fever. Conclusion Leptospirosis and rickettsial infections, including scrub typhus, are important causes of pregnancy loss. Further research is needed to better understand and mitigate these risks in pregnant women.

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Multivisceral organ failure related to leptospirosis in pregnant patient

Cited by 10 publications

References 9 publications

Fulminant Leptospirosis Leading to Shock Lung & Severe Coagulopathy in a Pregnant Patient: A Case Report and Review of the Literature

Fulminant Leptospirosis Leading to Shock Lung & Severe Coagulopathy in a Pregnant Patient: A Case Report and Review of the Literature

Leptospirosis in Pregnancy: A Rare Condition Mimicking HELLP Syndrome

Foetal outcome of Leptospira and Rickettsial infections during pregnancy: a systematic review

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