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[Icterohemorrhagic leptospirosis with acute renal failure (author's transl)]
Abstract:
Icterohemorrhagic leptospirosis is a zoonosis which is relatively frequent in rural agricultural or cattle areas. In the severe forms of the disease renal affection is frequent, but the incidence of acute renal insufficiency is far lesser. Three cases of acute renal insufficiency in adult male patients secondary to an infection by Leptospira icterohaemorrhagiae are presented. Two of the patients resided in urban areas and only one of which presented professional risk. The clinical polymorphysm of the illness is confirmed, having observed not only the absence of fever but also that of jaundice. The former history of chronic alcoholism, present in two cases, determined diagnostic difficulties with acute alcoholic hepatitis. The serologic diagnosis is often positive only at the end of the second week, and the need to carry out a series of seroaglutinations is to be insisted upon. The types of renal impairment in leptospirosis are reviewed and the presence of acute renal insufficiency is stressed, including those patients with less severe forms of the disease, and especially those without Weil's syndrome. All of the patients had to be treated with dialysis, although two of them had a conserved diuresis after an initial brief period of oliguria.
Insights
Acute renal insufficiency can occur in leptospirosis, even in less severe cases without jaundice. Early diagnosis and serologic testing are crucial for effective treatment of this zoonotic disease.
Area of Science:
- Infectious Diseases
- Nephrology
- Zoonotic Diseases
Background:
- Icterohemorrhagic leptospirosis is a zoonotic disease common in agricultural settings.
- While renal involvement is frequent in severe leptospirosis, acute renal insufficiency is less common.
Observation:
- Presents three cases of acute renal insufficiency in adult males due to Leptospira icterohaemorrhagiae infection.
- Two patients lived in urban areas, and one had a professional risk.
- Clinical presentation varied, with absence of fever and jaundice in some cases.
- Chronic alcoholism in two patients complicated diagnosis, mimicking acute alcoholic hepatitis.
Findings:
- Highlights the clinical polymorphism of leptospirosis, including atypical presentations.
- Emphasizes the diagnostic challenge posed by co-existing conditions like alcoholism.
- Stresses the importance of serial seroagglutination tests for diagnosis, as serology may be positive late.
- Reviews renal impairment types in leptospirosis, underscoring acute renal insufficiency even in milder forms without Weil's syndrome.
Implications:
- Suggests that acute renal insufficiency should be considered in leptospirosis cases, irrespective of disease severity or presence of jaundice.
- Reinforces the need for prompt diagnostic workup, including serology, in suspected leptospirosis.
- All presented patients required dialysis, indicating the severity of renal compromise in these cases.