1Leptospirosis Reference Laboratory, Bacteriology Unit, Infectious Disease Research Centre, Institute for Medical Research, Jalan Pahang, Kuala Lumpur, Malaysia.
2Department of Pathology, Selayang Hospital, Lebuhraya Selayang, Kepong, Batu Caves, Selangor, Malaysia.
Am J Trop Med Hyg. 2021 Jan;104(1):216-218. doi: 10.4269/ajtmh.20-0267.
Leptospirosis is an important zoonotic disease with worldwide distribution and nonspecific clinical manifestation. We report a case of fatal leptospirosis in a previously healthy woman with a causative agent. A young adult Indian woman was brought in dead to the forensic department. Ten days before, she developed fever, dizziness with headache, myalgia, diarrhea, and vomiting. Routine inquest and autopsy were performed on the deceased, revealing hemorrhagic lungs with extensive intra-alveolar hemorrhages, pale liver with dissociation and separation of hepatocyte plates, and edematous brain with histiocyte and lymphocyte infiltration in the parenchyma and meninges. Heart tissue depicts myocarditis and pericarditis inflammatory changes. Cerebrospinal fluid (CSF) was turbid in appearance with mildly elevated leukocytes, predominantly lymphocytes. Real-time PCR targeting lipL32 gene of pathogenic was detected in the blood, CSF, brain, kidney, heart, and liver. The genetic profile of the causative agent was ST149 (multi-locus sequence typing Scheme 3). This study illustrates the usefulness of PCR assay in postmortem diagnosis and addresses the need for further surveillance to identify the epidemiological link of the disease.
钩端螺旋体病是一种具有全球分布和非特异性临床表现的重要动物源性传染病。我们报告了一例以前健康的女性因钩端螺旋体病导致的致命病例。一位年轻的印度女性被带到法医部门时已经死亡。10 天前，她开始发烧、头晕伴头痛、肌痛、腹泻和呕吐。对死者进行了常规尸检和解剖，发现肺部出血，肺泡内广泛出血，肝脏苍白，肝细胞板分离，脑肿胀，实质和脑膜中有组织细胞和淋巴细胞浸润。心脏组织显示心肌炎和心包炎的炎症变化。脑脊液外观混浊，白细胞轻度升高，主要是淋巴细胞。在血液、脑脊液、大脑、肾脏、心脏和肝脏中检测到针对致病性的 lipL32 基因的实时 PCR。病原体的遗传特征为 ST149（多位点序列分型方案 3）。本研究说明了 PCR 检测在死后诊断中的有用性，并强调需要进一步监测以确定疾病的流行病学联系。
