Department of Internal Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal.
Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal.
JNMA J Nepal Med Assoc. 2022 Jan 15;60(245):83-85. doi: 10.31729/jnma.6240.
Leptospirosis, an underreported disease, is a highly prevalent spirochaetal zoonotic disease in both tropical and temperate climates. Symptoms can range from mild illness to potentially life-threatening infection. Laboratory tests are nonspecific. Microbiological confirmation is not widely available in endemic developing countries like Nepal. We need to rely on the serologic test, which has its own pitfalls in the initial days of illness. Here, we report a case of 56 years old female from the western region of Nepal who presented with fever, jaundice and anuria. She initially tested negative for leptospirosis but was later found to be positive in the second week of illness. Unlike the usual non-oliguric renal failure in leptospirosis, she presented with anuria requiring haemodialysis and subsequently had a good recovery with treatment. We highlight the importance of clinical suspicion and logical interpretation of serologic tests based on its timing from the onset of illness.
钩端螺旋体病是一种未被充分报告的疾病，在热带和温带气候中都是一种高度流行的螺旋体动物源性传染病。症状范围从轻度疾病到潜在的危及生命的感染。实验室检测是非特异性的。在尼泊尔等流行发展中国家，微生物学确认并不广泛。我们需要依靠血清学检测，但在疾病的初始阶段，该检测存在自身的缺陷。在此，我们报告了一位来自尼泊尔西部地区的 56 岁女性病例，她出现发热、黄疸和无尿。她最初的钩端螺旋体病检测结果为阴性，但在疾病的第二周被发现为阳性。与钩端螺旋体病中常见的非少尿性肾衰竭不同，她出现无尿需要血液透析，随后经过治疗后恢复良好。我们强调了基于疾病发病时间对临床疑似病例进行血清学检测，并进行逻辑解读的重要性。
