Renal Replacement Therapy in a Patient Diagnosed With Pancreatitis Secondary to Severe Leptospirosis

Maria-Rios, Jose C; Marin-Garcia, Gerald L; Rodríguez-Cintrón, William

doi:10.12788/fp.0070

Cited by 4 publications

(8 citation statements)

References 14 publications

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“…In contrast, Herath et al reported a higher incidence at 66.67% in their case series 19. In most cases reported, AP was seen in patients with severe leptospirosis requiring dialysis, ventilatory support or vasopressor support 20–24. Our data showed a higher incidence of AP at 70.37%.…”

Section: Discussioncontrasting

confidence: 73%

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Incidence of acute pancreatitis among patients with leptospirosis requiring extracorporeal membrane oxygenation (ECMO): a descriptive study

Madrigal

Panlilio

Burog

et al. 2023

BMJ Open Gastroenterol

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BackgroundAcute pancreatitis (AP) is an infrequently reported manifestation of leptospirosis. It is more commonly seen in patients with acute respiratory distress syndrome. Despite novel modalities such as extracorporeal membrane oxygenation (ECMO), the mortality rate remains high and whether this is associated with the lung injury caused by the inflammation in AP remains unclear.Objectives and methodsA descriptive study was conducted at a tertiary hospital in the Philippines. Primary outcome was defined as the presence or absence of AP. Secondary outcomes were defined as 28-day mortality rate, length of hospital stay, ECMO days, renal replacement therapy (RRT) days, days on mechanical ventilation, presence of local complications of AP and development of nosocomial infections.ResultsA total of 27 patients were included in the study, and 88.89% (n=24) were men. The mean age for all patients was 33.59±10.22 years. Out of the 27 patients, 19 (70.37%) were diagnosed with AP. Among these 19 patients, one (5.26%) had necrotising pancreatitis and two (10.52%) developed local complications of pancreatitis. Six patients (31.58%) died among those who developed AP, while one (12.50%) died among those who did not. The duration of hospital stay, ECMO, RRT, mechanical ventilation and development of nosocomial infections was also higher in the group who presented with AP.ConclusionAP is an under-reported complication of leptospirosis. Our study demonstrated a higher mortality and morbidity in patients with leptospirosis who developed AP.

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Section: Discussioncontrasting

confidence: 73%

“…19 In most cases reported, AP was seen in patients with severe leptospirosis requiring dialysis, ventilatory support or vasopressor support. [20][21][22][23][24] Our data showed a higher incidence of AP at 70.37%. This higher incidence may be attributable to the underlying severity of leptospirosis in our population.…”

Section: Discussionmentioning

confidence: 86%

Incidence of acute pancreatitis among patients with leptospirosis requiring extracorporeal membrane oxygenation (ECMO): a descriptive study

Madrigal

Panlilio

Burog

et al. 2023

BMJ Open Gastroenterol

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“…Other clinical signs were abdominal tenderness (n = 15, 18.9%), conjunctival suffusion (n = 13, 16.4%), tachypnea (n = 10, 12.6%), and basal crepitation (n = 9, 11.3%) ( Table 1 ). 3 , 6 , 8 , 11 – 15 , 17 , 19 , 21 – 47 …”

Section: Resultsmentioning

confidence: 99%

“…The most common electrocardiographic findings noted were atrial fibrillation (n = 3, 3.7%), bradycardia (n = 3, 3.7%), and atrioventricular block (n = 1, 1.2%) ( Table 2 ). 3 , 6 , 8 , 11 – 15 , 17 , 19 , 21 – 47 …”

Section: Resultsmentioning

confidence: 99%

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Clinical characteristics and outcomes of patients with leptospirosis complicated with acute pancreatitis: a systematic review

Charles,

Jayarajah,

Subasinghe

2023

J Int Med Res

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Objectives Acute pancreatitis (AP) is a severe complication of leptospirosis. This review focuses on the current evidence of AP in patients with leptospirosis. Methods Data on clinical characteristics, biochemical parameters, diagnosis, complications, critical care, fluid management, operative management, and outcomes were analyzed. This study was registered in PROSPERO (CRD42022360802). Results We included 35 individual case reports and 4 case series involving 79 patients. Sex was reported for 48 (60.7%) patients; 38 (48.1%) were male and 10 (12.6%) were female. The patients’ mean age was 45.13 (15–83 years). Acute kidney injury, thrombocytopenia, hypotension, and liver injury were the most common complications reported. Complete recovery was reported for 36 (45.5%) patients. Biochemical and radiological recovery was reported for 10 (12.6%) and 9 (11.3%) patients, respectively. Death was reported in 18 (22.7%) patients. Conclusion A high degree of clinical suspicion and different modalities of investigations are essential in the diagnosis of AP in leptospirosis. AP can be easily missed in leptospirosis because both conditions share similar clinical presentations and complications. Because of the high prevalence of acute kidney injury, judicious fluid management and close monitoring are mandatory.

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Plasma Exchange as A Rescue Therapy in Weil’s Disease with Severe Hyperbilirubinemia, Acute Renal Failure, And Multidrug-Resistant Organism Co-Infection: A Rare Case in Critical Care Setting

Vania,

Hutagalung

2023

J. Biomed. Transl. Res.

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Background: Leptospirosis is a zoonotic infectious disease caused by spirochete Leptospira interrogans. Weil’s disease is a severe form of leptospirosis. In case of Weil's Disease which did not show improvement despite standard treatment with RRT and antibiotics, an additional therapeutic modality is needed as a rescue therapy in critical condition. Therapeutic plasma exchange (TPE) has been reported to showed positive outcomes in patient with sepsis and leptospirosis. However, TPE has not been widely used in treating severe leptospirosis. We report a case of Weil’s disease with severe hyperbilirubinemia, acute renal failure, and multidrug-resistant organism (MDRO) successfully treated with therapeutic plasma exchange (TPE) and intermittent renal replacement therapy (RRT).Case Presentation: A 25-year-old male developed Weil’s disease with severe hyperbilirubinemia and acute renal failure. The culture results showed that he was co-infected with multidrug-resistant organism. He failed to improve and fell into a septic shock while treated in the intensive care unit with empirical antibiotics and intermittent RRT. His serum bilirubin rises to 43.34mg/dL. Furthermore, he underwent single TPE and showed rapid clinical improvement with recovery of liver and renal function.Conclusion: Plasma exchange had a vital role in reducing serum bilirubin and removal of harmful substances. TPE as a rescue therapy can be used for further intensive care support in severe leptospirosis which has not shown improvement despite standard treatment with RRT and antibiotics.

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Renal Replacement Therapy in a Patient Diagnosed With Pancreatitis Secondary to Severe Leptospirosis

Abstract: In areas where the zoonotic disease leptospirosis is endemic, reduced morbidity and mortality is strongly linked to quick initiation of renal replacement therapy.Author affiliations are listed at the end of the article.

Cited by 4 publications

References 14 publications

Incidence of acute pancreatitis among patients with leptospirosis requiring extracorporeal membrane oxygenation (ECMO): a descriptive study

Incidence of acute pancreatitis among patients with leptospirosis requiring extracorporeal membrane oxygenation (ECMO): a descriptive study

Clinical characteristics and outcomes of patients with leptospirosis complicated with acute pancreatitis: a systematic review

Plasma Exchange as A Rescue Therapy in Weil’s Disease with Severe Hyperbilirubinemia, Acute Renal Failure, And Multidrug-Resistant Organism Co-Infection: A Rare Case in Critical Care Setting

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