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Department of Medical
Microbiology, Aberdeen
Royal Infirmary,
Aberdeen, Scotland, UK
Correspondence:
Bal Abhijit M
E-mail: a.bal@abdn.ac.uk
PubMed ID
: 16333189
ABSTRACT
ABSTRACT
Leptospirosis has protean clinical manifestations. The classical presentation of the disease is an acute biphasic
febrile illness with or without jaundice. Unusual clinical manifestations may result from involvement of pulmonary,
cardiovascular, neural, gastrointestinal, ocular and other systems. Immunological phenomena secondary to
antigenic mimicry may also be an important component of many clinical features and may be responsible for
reactive arthritis. Leptospirosis in early pregnancy may lead to fetal loss. There are a few reports of leptospirosis
in HIV- infected individuals but no generalisation can be made due to paucity of data. It is important to bear in
mind that leptospiral illness may be a significant component in cases of dual infections or in simultaneous
infections with more than two pathogens.
KEY WORDS: Cardiac arrhythmia, Cholecystitis, Congenital infection, Guillain-Barre syndrome, Pancreatitis,
Pancytopenia, Pregnancy, Leptospirosis
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reported in literature.[49]
Musculoskeletal symptoms
Various musculoskeletal abnormalities have been reported in
patients with leptospiral infection. In a case reported by
Coursin and colleagues,[50] a 63-year-old man presented with
multiorgan dysfunction and rhabdomyolysis. Although myal
gia and mild elevation of muscle enzymes are common in lept
ospirosis, severe involvement of muscle tissue is rare. A fatal
case of rhabdomyolysis was reported by OLeary et al.[51] In
this report, acute infection with leptospira belonging to
serogroup Grippotyphosa was diagnosed on the basis of serol
ogy. Skeletal muscle involvement independently correlates with
the severity of disease.[52]
Hematological manifestations
Somers et al[53] reported a rare case of erythroid hypoplasia in a
case of leptospirosis. The patient presented with fever, jaun
dice, shortness of breath, and meningism. His haematologic
parameters showed normocytic normochromic anaemia,
reticulocytopenia, and thrombocytopenia. Severe erythroid
hypoplasia was observed on bone marrow examination. It is
possible that this complication results from a direct action of
toxic leptospiral products on the progenitor cells of the mar
row. Stefos and colleagues reported two cases of pancytopenia
following infection with leptospira.[54] Interestingly, neither
patient had a history of jaundice. According to Bishara and co
workers,[55] pancytopenia could occur in as many as 28% of pa
tients with leptospirosis. Most of the infections in their series
of cases were caused by leptospira belonging to serogroup
Icterohaemorrhagiae and it is possible that infection with this
serogroup is associated with hematologic abnormalities. Iso
lated thrombotic thrombocytopenia purpura has been reported
following infection with leptospires.[56]
Immunological manifestations
Rare immune-mediated manifestations of leptospirosis include
antiphospholipid syndrome[57] and reactive arthritis.[58] Such
manifestations are likely to be a result of an immunologic cross
reactivity. Antibodies generated in response to leptospiral in
fection may cross react with host antigens and could lead to
an inflammatory response. Finsterer et al[59] have reported an
interesting case of carpal tunnel syndrome in a pet-shop worker
who was later found to have a positive leptospiral IgG and IgM
serology. Symptoms improved on doxycycline therapy, although
the antibody levels remained elevated over the next three years.
Explaining the disappearance of symptoms is difficult espe
cially because the patient continued to have high antibody
titres and hence immunological cross reactivity could still have
taken place. The authors hypothesized that persistence of an
tibodies could be the result of re-exposure at workplace or a
long- term immunological response. However, this does not
necessarily explain the resolution of symptoms. A plausible
explanation is that immune-mediated illness is caused by an
tigen-antibody complexes rather than by cross-reactive anti
bodies. Doxycycline therapy, by eradicating the leptospires and
thereby removing the source of antigens, could prevent the
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