Dehkordi Arash Ghani, Al-Tamary Salah Rabea Salah, Al-Tamary Ashraf Rabea Salah, Al-Tamary Hamza Rabea Salah, Albarari Shams Samih Ahmad, Assad Alaaldin Mohammad Zeyad, Hamdan Ghena Mohammad Othman, Mikadze Ia
Department of Infectious Diseases, Tbilisi State Medical University, Tbilisi, Georgia.
Case Rep Infect Dis. 2024 Nov 20;2024:1414417. doi: 10.1155/2024/1414417. eCollection 2024.
Pathogenic species are the source of leptospirosis, a common zoonotic infection that can cause a wide range of clinical manifestations, from minor flu-like symptoms to severe multiorgan failure. We present two peculiar cases of leptospirosis; they highlight the need for clinical awareness to improve patient outcomes and further knowledge of leptospirosis epidemiology and therapy by illuminating the difficulties in diagnosis and treatment. The first case involved a 30-year-old male presented with jaundice. Although he had no history of chronic illnesses, an exhaustive investigation was warranted due to his recent travel history and occupational contact. Laboratory tests revealed significantly increased levels of AST and ALT and positive IgM serology. Remarkably, the patient refuted the traditional theory of leptospirosis transmission by denying direct animal interaction. After starting therapy with dexamethasone initially and adding doxycycline later, the patient's condition significantly improved; his jaundice resolved and his liver enzyme levels returned to normal. An outpatient follow-up after discharge was advised to assess liver and kidney function. The second case involved an 87-year-old woman with a fever, weakness and hypertension. Investigations revealed hepatosplenomegaly, raising the possibility of hypersplenism. She reported exposure to animals, particularly her dogs in her urban house. Surprisingly, her AST and ALT levels were normal. Lab tests also revealed thrombocytopoenia with normal APTT and prolonged PT. Serological tests indicated positive IgM. Along with intravenous infusions, the patient's treatment plan comprised dexamethasone, enalapril and ceftriaxone to treat inflammation, hypertension and bacterial infection, respectively. Following a 20-day hospital stay, the patient's laboratory results and symptoms improved, leading to her discharge. Continuous follow-up recommended to monitor her recovery and prevent recurrence. These case studies emphasise the significance of taking leptospirosis into account when treating patients who do not have normal exposure histories yet present with unusual symptoms.
致病菌种是钩端螺旋体病的源头，钩端螺旋体病是一种常见的人畜共患感染病，可引发广泛的临床表现，从轻微的流感样症状到严重的多器官功能衰竭。我们呈现两例钩端螺旋体病的特殊病例；它们凸显了临床意识的必要性，即通过阐明诊断和治疗中的困难，来改善患者预后，并进一步了解钩端螺旋体病的流行病学和治疗方法。第一例病例是一名30岁男性，出现黄疸症状。尽管他没有慢性病病史，但鉴于他近期的旅行史和职业接触情况，仍有必要进行详尽的调查。实验室检查显示，谷草转氨酶（AST）和谷丙转氨酶（ALT）水平显著升高，IgM血清学检测呈阳性。值得注意的是，该患者否认有直接的动物接触，这与传统的钩端螺旋体病传播理论相悖。最初使用地塞米松进行治疗，随后加用强力霉素，患者的病情显著改善；黄疸消退，肝酶水平恢复正常。建议出院后进行门诊随访，以评估肝肾功能。第二例病例是一名87岁女性，伴有发热、虚弱和高血压症状。检查发现肝脾肿大，提示可能存在脾功能亢进。她报告接触过动物，尤其是她在城市家中饲养的狗。令人惊讶的是，她的AST和ALT水平正常。实验室检查还显示血小板减少，活化部分凝血活酶时间（APTT）正常，凝血酶原时间（PT）延长。血清学检测显示IgM呈阳性。患者的治疗方案包括静脉输液，同时使用地塞米松、依那普利和头孢曲松，分别用于治疗炎症、高血压和细菌感染。经过20天的住院治疗，患者的实验室检查结果和症状有所改善，随后出院。建议持续随访，以监测她的康复情况并预防复发。这些病例研究强调，在治疗没有正常接触史但出现异常症状的患者时，考虑钩端螺旋体病的重要性。
