Babic-Erceg Andrea, Karlovic-Martinkovic Diana, Santini Marija, Persic Zdenka, Vilibic-Cavlek Tatjana
Croatian National Institute of Public Health , Zagreb.
University Hospital for Infectious Diseases Dr. Fran Mihaljevic , Zagreb, Croatia.
Infect Dis Rep. 2014 Jun 24;6(2):5156. doi: 10.4081/idr.2014.5156. eCollection 2014 May 13.
A 25-years old man from Zagreb, Croatia, was admitted to the University Hospital for Infectious Diseases four days after the onset of symptoms such as fever, intense pain in the calves and anuria. The patient owned a rabbit and, before the onset of the disease, repaired some rubber pipes damaged by rodents. At admission, he had a severe clinical picture with fever, hypotension, jaundice, immobility, and pain in leg muscles. Treatment with ceftriaxone was initiated in combination with volume restitution. Renal failure soon ensued. Consequently continuous venovenous hemodiaphiltration therapy was performed. Due to acute respiratory distress syndrome, the patient was mechanically ventilated. The patient's condition gradually improved and he recovered fully from multi-organ failure. Diagnosis was confirmed by a microscopic agglutination test (MAT) covering 15 leptospira serovars and real-time polymerase-chain reaction (PCR). The first serum sample taken on day 6 tested negative for leptospira, while PCR showed positive results for leptospiral DNA. The second serum sample taken on day 13 tested positive for serovar Canicola serogroup Canicola, serovar Patoc, serovar Grippotyphosa serogroup Grippotyphosa and serovar Tarassovi serogroup Tarassovi (titre 4000, 4000, 1000 and 2000, respectively), while PCR was negative. This report highlights the benefits of combining MAT and PCR methods in early diagnosis of leptospirosis.
一名来自克罗地亚萨格勒布的25岁男子，在出现发热、小腿剧痛和无尿等症状四天后，被收治入大学传染病医院。该患者养了一只兔子，在疾病发作前，他修理了一些被啮齿动物损坏的橡胶管。入院时，他呈现出严重的临床症状，包括发热、低血压、黄疸、肢体活动障碍和腿部肌肉疼痛。开始使用头孢曲松治疗并补充液体。随后很快出现肾衰竭。因此，进行了持续静脉-静脉血液透析滤过治疗。由于急性呼吸窘迫综合征，患者接受了机械通气。患者的病情逐渐好转，最终从多器官功能衰竭中完全康复。通过覆盖15种钩端螺旋体血清型的显微镜凝集试验（MAT）和实时聚合酶链反应（PCR）确诊。第6天采集的第一份血清样本钩端螺旋体检测为阴性，而PCR显示钩端螺旋体DNA呈阳性。第13天采集的第二份血清样本，犬型钩端螺旋体血清群犬型、帕托克血清型、黄疸出血群黄疸出血血清型和塔拉索夫血清型塔拉索夫血清群检测呈阳性（滴度分别为4000、4000、1000和2000），而PCR为阴性。本报告强调了MAT和PCR方法联合用于钩端螺旋体病早期诊断的益处。
