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Weil disease is a rare and severe outcome of infection with leptospires. We report the radiographic appearance of this disease in a patient with hepatic, renal, and pulmonary involvement. Imaging findings added significantly to an early correct diagnosis and, thus, to immediate and successful therapy in this critically ill patient.
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A method for estimating the leptospiricidal activity of therapeutic antiserum for Weil's disease was improved by using the intracutaneous method in guinea pigs. The neutralization curves between the leptospiral suspensions for challenge and the antisera were shown to be linear over a wide range of the dosis of the pathogen. Although the reproducibility of the neutralization experiments was high, a significant divergence was observed among the slopes in various test samples. However, the trouble due to such a discrepancy in the slope may practically be reduced if such an antiserum preparation that has a regression coefficient close to the mean of those of various neutralization lines constructed by many different products is adopted as the reference. A practical method for the potency test was suggested.
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A 77-year-old man developed a fever up to 38.4 degrees C, with diarrhoea, acute renal failure (creatinine up to 8.7 mg/dl; urea up to 308 mg/dl) and marked jaundice (total bilirubin up to 24.3 mg/dl). In addition there was thrombocytopenia, conjunctivitis and epistaxis, as well as cerebral symptoms with somnolence and general slowing up. At first he was thought to have cholangitis resulting from previously diagnosed gall-stones, and he was therefore treated with ampicillin, 2 g two times daily, and metronidazole, 0.5 g two times daily. The fewer regressed, but the renal failure required haemodialysis and haemofiltration under strict fluid control. Endoscopy excluded obstructive jaundice, but a suspicion of inflammatory liver disease or possibly cirrhosis was raised in the differential diagnosis. Serology revealed an increased titre for Leptospira interrogans var. sejroe (1:200, later 1:1600). Liver biopsy finding was compatible with the diagnosis of leptospirosis. Because of the high inflammatory activity in the liver, 2 mega units of penicillin G were administered three times daily for six days. Gradually the renal functions and jaundice improved and, on discharge on the 36th day, the patient was again in generally good health, although creatinine and bilirubin values were still slightly elevated (1.7 mg/dl each).
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
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Two patients with leptospirosis (Weil's disease), with acute respiratory failure necessitating mechanical ventilation, are described. Adult respiratory distress syndrome (ARDS) in one patient and profuse pulmonary bleeding in the other were the respective causes of respiratory failure. One patient died after developing the multiple organ dysfunction syndrome (MODS), the other patient recovered completely. Respiratory failure is an uncommon complication of leptospirosis and is due to severe pulmonary bleeding and/or ARDS.