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Background Weil’s disease is an infection caused by Leptospira bacteria. Leptospirosis may cause arrhythmias, such as atrial fibrillation and ST-T segment changes. We report a rare case of total atrioventricular block induced by leptospirosis. Early diagnosis and prompt management present particular challenges. Case report A 43-year-old Asian woman was referred from internal medicine to cardiology owing to an electrocardiogram abnormality. She complained of worsening chest discomfort 3 days earlier, accompanied by fever, nausea, and intermittent headaches. The patient appeared lethargic and jaundiced; blood pressure was 81/43 mmHg, heart rate was 41 bpm, respiratory rate was 20 times/minute, and temperature was 38.2 °C. The electrocardiogram showed a total atrioventricular block with a junctional escape rhythm of 45 bpm. Laboratory tests revealed increased renal and liver function, thrombocytopenia (98,000/µL), and positive immunoglobulin G and M anti- Leptospira . The patient was diagnosed with Weil’s disease (Faine’s score 32) and total atrioventricular block. The initial management involved fitting the patient with a transcutaneous pacemaker and giving dopamine 5 mcg/kgBW/minute, titrated to a target systolic blood pressure of > 90 mmHg. The patient was also scheduled to undergo temporary transvenous pacing. However, the patient died of suspected cardiogenic shock due to a deterioration in clinical condition. Conclusion Leptospirosis can cause rare but fatal arrhythmias, as seen in this case of fulminant leptospirosis with total atrioventricular block. Clinicians should be vigilant and consider this potential complication in similar cases.

Leptospirosis, a spirochetal zoonosis, is frequently unrecognized due to its manifestation as an undifferentiated fever. It is an emerging infectious disease that has changed from an occupational disease of veterinarians, farmers, butchers, and other animal handlers to a cause of epidemics in poor and decayed urban communities in developing countries. Humans are infected when mucous membranes or abraded skin come into direct contact with the urine of infected animals, especially rats and dogs. Mortality from severe leptospirosis is high, even when optimal treatment is provided. The diagnosis of leptospirosis is based on clinical findings, history of direct or indirect exposure to infected animals in endemic areas, and positive serological tests. It should be considered in the differential diagnosis of patients with febrile illnesses associated with pneumonitis and respiratory failure, especially when hemoptysis is present. Severe pulmonary involvement in leptospirosis consists primarily of hemorrhagic pneumonitis. In advanced cases, adult respiratory distress syndrome and massive pulmonary hemorrhage may occur. Chest radiographs show bilateral alveolar infiltrates and/or resemble viral pneumonia, bronchopneumonia, tuberculosis, adult respiratory distress syndrome, and other causes of pulmonary hemorrhage such as Goodpasture syndrome. High-resolution computed tomography scans may show nodular infiltrates, areas of consolidation, ground-glass attenuation, and crazy-paving patterns. Bronchoalveolar lavage and autopsy studies have suggested that ground-glass opacities and air-space consolidations are secondary to pulmonary hemorrhage. Although not specific, the presence of these computed tomography findings in a febrile patient with an appropriate history should suggest a diagnosis of leptospirosis.

Background There were few reports in the literature of Weil’s disease with multiple organ failures, especially in children living in dengue endemic areas. Case presentation A 12-year-old child was admitted to Tangerang district hospital with a provisional diagnosis of dengue infection. On the third day of hospitalization, dengue diagnostic tests were negative. As fever still remained and was followed by jaundice, decreasing hemoglobin, increasing bilirubin with abnormal value of liver enzymes; other causes of disease were investigated. Leptospirosis was confirmed by rapid IgM test (SD ® ) for leptospira; and micro-agglutination test which indicated Leptospira serogroup bataviae infection. The patient developed Weil’s disease during the course of illness. Renal function was back to normal on the 21st day of hospitalization, while hemoglobin and bilirubin returned to normal three weeks after discharged. Conclusions Our report highlights the importance of considering leptospirosis as a differential diagnosis in children with acute febrile illness; even when the signs and symptoms for the more common diagnoses such as dengue or typhoid fever were pathognomonic. A normal leukocyte count with neutrophilia and negative dengue NS1, dengue IgM, and Salmonella typhi IgM on admission should raise suspicion of leptospirosis, and prompt diagnostic assays for leptospirosis should be conducted.

Massive hemoptysis in patients with severe leptospirosis is often resistant to conventional therapies and can rapidly become fatal. Desmopressin is a fast-acting blood-saving agent used in various hereditary and acquired clotting disorders. We used desmopressin infusions to treat massive pulmonary hemorrhage in six leptospirosis patients with respiratory failure, shock, and multiple organ dysfunction. Hemoptysis ceased rapidly in every case, and five patients finally recovered. Two additional patients with less severe hemoptysis were also successfully treated.

Leptospirosis is rarely reported in children. It is easily treated with antibiotics but can be fatal if treatment is delayed. A 12-year-old girl was diagnosed with Weil syndrome, a severe form of leptospirosis, 10 days after returning from Mainland China. She presented with fever, hypotension, jaundice, and acute renal failure. She had used well water for bathing and swum in freshwater.

Pneumonia that is unresponsive to appropriate antibiotic therapy suggests an infection due to more unusual or resistant organisms. In this report, a child with unilateral pneumonia, pleural effusion, and anti-I cold hemagglutinin antibodies is presented. The usual causes of this clinical picture were suspected and treated, but the child did not improve. Features of her history suggested a more unusual etiology, and a diagnosis of leptospirosis was made. A brief discussion of leptospiral disease in children is provided.

To assess the impact of Leptospira interrogans serovar hardjo infection on the reproductive performance of nine dairy herds with evidence of infection, forty years' fertility data were analysed relative to the year of first diagnosis. Fifty per cent of various fertility variables had their lowest values only in the year of diagnosis. Culling rates were highest during the year of diagnosis in five of the herds, and were above 22 per cent in five of nine (55.6 per cent) of the diagnosis years considered compared with seven (22.6 per cent ) of the 31 non-diagnosis years. An assessment of the fertility status of the herds by means of a formula which incorporated the first service conception rate, the number of services per conception for cows conceiving, the calving to conception interval and the culling rate, revealed low reproductive performance during the year of diagnosis in six of the nine herds. Abortion rates were highest in four of the herds during the year of diagnosis, and these included the herds in which the fertility status was not lowest. It was concluded that L interrogans serovar hardjo affected reproduction adversely by causing both abortions and low fertility, but that the effect was temporary.

Information is lacking on the prevalence and severity of cardiac and striated muscle injury in late leptospirosis, and it is unclear whether patients with one type of myositis are at increased risk of developing another. Therefore, 38 patients with severe, late Weil's disease were evaluated for heart and skeletal muscle involvement: 37% had myositisand 39% had abnormal electrocardiograms( ECGs). First-degree atrioventricular heart blockand changes suggestiveof acute pericarditis were the most common ECG findings. Two patients had transient pericardial friction rubs, but neither pericardial effusion, shock, nor congestive heart failure occurred. Cardiac involvement was not associated with skeletal muscle injury (P = .35), although both manifestations were correlated with severity of disease. Thus, ECG changes and myositis were prominent features of late Weil's disease but cardiac morbidity was not.

Human leptospirosis, one of the main urban endemics/epidemics in Brazil, has dramatically grown in the last three decades, especially after floods caused by summer rains. This presentation describes recent changes in the clinical patterns of this pathology in our region, expressed by the emergence of massive haemoptysis and acute respiratory distress syndrome, or both conditions associated. The evident changes in the respiratory structures emerged as a serious life threat and death mechanisms, becoming the main cause of death in leptospirosis among us because of their high incidence. This new face of the disease demands a revision of current concepts about its seriousness and raises speculations about the pathogenesis of such alterations.