title: Early diagnosis of leptospirosis.
abstract: 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.
authors.affiliation: Croatian National Institute of Public Health , Zagreb.
authors.forename: Andrea
authors.initials: A
authors.lastname: Babic-Erceg
authors.affiliation: Croatian National Institute of Public Health , Zagreb.
authors.forename: Diana
authors.initials: D
authors.lastname: Karlovic-Martinkovic
authors.affiliation: University Hospital for Infectious Diseases Dr. Fran Mihaljevic , Zagreb, Croatia.
authors.forename: Marija
authors.initials: M
authors.lastname: Santini
authors.affiliation: Croatian National Institute of Public Health , Zagreb.
authors.forename: Zdenka
authors.initials: Z
authors.lastname: Persic
authors.affiliation: Croatian National Institute of Public Health , Zagreb.
authors.forename: Tatjana
authors.initials: T
authors.lastname: Vilibic-Cavlek
keywords: leptospirosis; microscopic agglutination test; polymerase chain reaction