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    Home > Active Ingredient News > Infection > Different clinical prognosis! Comparative analysis of 2 cases of leptospirosis infection

    Different clinical prognosis! Comparative analysis of 2 cases of leptospirosis infection

    • Last Update: 2022-09-20
    • Source: Internet
    • Author: User
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    preface

    Leptospirosis (leptostomy) disease is a naturally pathogenic zoonotic disease whose host is mainly rodents (rodents


    Leptosomiasis is mainly distributed in the southeast and northwest regions in China, and there are also occasional cases


    Case after

    Case 1

    Patient A, male, a 37-year-old farmer, had no obvious precipitating fever of 38.


    Dynamic changes in important infection indicators after admission (see Figure 1), 16.


    Meropenem, moxifloxacin, anti-infective, endotracheal intubation, continuous renal replacement therapy, and platelet transfusions


    Clinicians immediately discontinued meropenem and switched to moxifloxacin combined with penicillin sodium needles for 1.


    Figure 1.


    Figure 2 Results of peripheral blood DNA sequencing of the pathogen's metagenomic

    Case 2

    Patient B, male, 55 years old, farmer, 13 days ago (2019-9-30) repeated "fever", self-measured body temperature of 38.


    2020-10-9Shotomy mNGS tips for patients doing it in the outer hospital: Enterobacter pussica and question mark leptospirosis, specific reports can not be obtained


    The dynamic changes of important infection indicators after admission (see Figure 3), WBC on the day of admission was 29.


    In order to further clarify the infectious factors, blood culture, urine culture, fat da waifei test, dengue virus NS1 antigen and respiratory tract RNA test were also tested, and the results were negative


    Figure 3 Dynamic change of common infection indicators

    Table 1.


    Case studies

    Clinical case studies

    What are the key factors influencing the prognosis of leptosomia?

    Through the comparative analysis of 2 cases with different clinical outcomes, it can be seen that the prognosis of hook body disease is related to three important factors:

    1) Is it detected early? The early symptoms of leptosomia are similar to the symptoms of "cold", in rural areas, it is often treated as a cold, delaying the disease, case 2 is 10 days after the onset of symptoms, case 1 is 4 days


    2) Do you have comorbidities? Case 2 has a history of hepatitis and, hook body infection induces hepatitis attacks, which eventually lead to systemic multi-organ failure, while Case 1 is a 37-year-old young man with no history of specific diseases and eventually recovers


    3) Is penicillin used early and in sufficient amounts? Case 1 was treated with a combination of 1.


    Inspection case studies

    How is leptosomia diagnosed early?

    Leptospirosis can be diagnosed by silver staining or dark-field microscopy, fluorescent antibody experiments or immunohistochemical experiments, microscopic agglutination tests, enzyme-linked immunosorbent assays, PCR methods, and metagenomic sequencing [4


    NGS is a pathogen identification method that has emerged in recent years, which does not require the cultivation of pathogens, nor does it rely on known nucleic acid sequence design primers, etc.
    , can be directly sequenced and identified by the specimen, can detect the microbial species and abundance information contained in the sample, monitoring covers more than 16,000 pathogens, including bacteria, fungi, viruses, parasites and other pathogenic microorganisms, the detection of unknown microorganisms has a very large advantage, The two cases in this study also ultimately relied on NGS technology to identify the main pathogenic bacteria
    .
    This shows that the use of NGS for early screening of unexplained infections in the future is a reference method
    .

    Knowledge development

    At present, the laboratory diagnosis of leptosomiasis still needs to rely on serological methods, such as cross-agglutination test and microscopic agglutination test, which have the disadvantages of long time, the need to maintain the live culture of the strain, and the ability to identify fewer serotypes
    。 With the development of molecular biology, genomics and bioinformatics, the use of 16SrRNA typing, pulsed field gel electrophoresis (PFGE), multi-site sequence typing (MLST), multi-site variable number tandem repeat sequence typing (MLVA), whole genome sequencing (WGST) and other molecular typing methods are increasing, and the use of these molecular typings is of great significance
    for the analysis of the genetic variation and propagation law of leptosomiasis.

    Case summary

    Hook disease mainly occurs in areas with poor rural health conditions, and local farmers do not have a strong sense of hygiene and are prone to such infectious diseases
    .
    After getting sick, the symptoms are not obvious, and local medical institutions also lack relevant clinical experience and testing methods, which can easily lead to delays
    in the disease.

    Such infectious diseases mainly rely on NGS testing in conditional hospitals, and the standardization of NGS testing still lacks corresponding consensus before the question, and it is also necessary to use traditional means to corroborate each other, but the pathogen information provided by NGS (especially difficult to cultivate pathogens) is rich, which is more suitable for the diagnosis of difficult infections, and NGS testing
    can be considered as soon as possible for unexplained fever in conditional areas.

    Expert reviews

    The incidence of leptopathy in Guangdong is relatively low, with the rapid development of China's economy, the incidence and mortality rate of hookworm disease in the country have become a downward trend
    .
    Preventing the occurrence of leptosomiasis is an understanding of the species composition, infection status and etiological characteristics of isolated strains in the local host animal.

    The study analyzed cases of infection with the same pathogen in two different clinical outcomes, and the comparative analysis was strong, which could clearly highlight the main factors affecting the prognosis of hook body disease, which was of great significance
    for the prevention of similar infections.
    (Di Yuwei, Chief Technician, Guangdong Provincial People's Hospital)

    【References】

    Xu Guoying, Zhu Hansong, Liu Weijun, et al.
    Epidemiological status of leptospirosis in Fujian Province from 2015 to 2020[J].
    Chinese Journal of Epidemiology,2022, 43(4):6.

    [2].
    Rajapakse S.
    Leptospirosis: clinical aspects.
    Clin Med (Lond).
    2022Jan; 22(1):14-17.

    Zhao Zhe,He Zhen,Long Yong.
    Epidemiological characteristics and prevention status of common rat-borne diseases in China[J].
    Chinese Sanitary Insecticides and Devices,2021, 27(6):4.

    [4].
    VasylievaN, Andreychyn M, Kravchuk Y,et al.
    Changes in leptospirosis etiologyin animals and humans.
    Ann Agric EnvironMed.
    2017;24(4):671-675.
    doi:10.
    26444/aaem/78031.

    Li Zhe,Xu Yinghua,Xin Xiaofang.
    Research progress on molecular typing of leptospiratorium in China[J].
    Disease Surveillance,2022, 37(4):512-516.

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