CASE PRESENTATION: A 30-year-old man was retrieved from the jungle with severe weight loss and abdominal symptoms. He succumbed to death despite 22 days of intensive medical treatment. An autopsy revealed a ruptured gangrenous ileal volvulus with peritonitis and subdiaphragmatic abscess. Further laboratory analysis detected systemic Candida tropicalis and intestinal gramnegative bacterial sepsis, systemic Zika virus viremia, leptospirosis complicating rhabdomyolysis and disseminated intravascular coagulopathy, Type I Herpes Simplex virus infection of the tongue and upper gastrointestinal tract. The cause of death was the ruptured ileal volvulus, complicated with upper gastrointestinal bleeding due to Herpes simplex virus esophagitis in a malnourished patient with resolving leptospirosis and underlying Zika virus co-infection.
CONCLUSION: Rare clinical scenarios of adult-onset intestinal volvulus with concomitant multiple infections precludes clinical diagnosis and early treatment, leading to devastating consequences of clinical outcome. The positive clinical and postmortem correlation is a good learning lesson in many disciplines of medicine and science.
CASE REPORT: We describe here an unusual case of leptospirosis complicated by haemolytic anaemia in a 70-year-old man with established kidney failure. He presented with an abrupt onset of shortness of breath, flushing and erythematous rash after completing haemodialysis. The patient's biochemistry test samples were however rejected twice as they were grossly haemolysed. The integrated auto-verification alert system implemented in the hospital's laboratory information system alerted the staff of the possibility of in vivo haemolysis.
DISCUSSION: The auto-verification alert system effectively distinguishes between in vitro and in vivo haemolysis and as such can be utilised as a diagnostic aid in patients with suspected intravascular haemolysis.
CASE PRESENTATION: A 30-year-old man was retrieved from the jungle with severe weight loss and abdominal symptoms. He succumbed to death despite 22 days of intensive medical treatment. An autopsy revealed a ruptured gangrenous ileal volvulus with peritonitis and subdiaphragmatic abscess. Further laboratory analysis detected systemic Candida tropicalis and intestinal gramnegative bacterial sepsis, systemic Zika virus viremia, leptospirosis complicating rhabdomyolysis and disseminated intravascular coagulopathy, Type I Herpes Simplex virus infection of the tongue and upper gastrointestinal tract. The cause of death was the ruptured ileal volvulus, complicated with upper gastrointestinal bleeding due to Herpes simplex virus esophagitis in a malnourished patient with resolving leptospirosis and underlying Zika virus co-infection.
CONCLUSION: Rare clinical scenarios of adult-onset intestinal volvulus with concomitant multiple infections precludes clinical diagnosis and early treatment, leading to devastating consequences of clinical outcome. The positive clinical and postmortem correlation is a good learning lesson in many disciplines of medicine and science.
Material and Methods: In December 2014, Kelantan was hit by an extensive flood. A total of 1,728 serum samples were collected from livestock from the state, comprised of 1,024 from cattle, 366 from goats and 338 from sheep, and they were tested using the microscopic agglutination test (MAT).
Results: Altogether, 203 (11.75%; 203/1728; 95% CI: 10.20%-13.30%) of the tested sera were found to be positive serologically. Cattle had the highest prevalence of 14.16% (145/1024), while goats and sheep had 11.20% (41/366) and 5.03% (17/338) respectively. The most frequent serovars detected were Hardjo-bovis (3.70%; 64/1728), Hebdomadis (2.08%; 36/1728) and Pomona (1.04%; 18/1728). There was a statistically significant association (P < 0.05) between livestock that were exposed to the flood and seropositivity.
Conclusion: This study showed that flood is a risk factor that can play a role in the epidemiology of leptospiral infection in livestock.
METHODS: Focus group discussions using the phenomenology approach was conducted involving 72 respondents in Selangor and Kelantan. Data were examined using content analysis.
RESULTS: Respondents perceived leptospirosis infection as severe due to its poor disease prognosis and complications. However, some rated it less severe when compared with other chronic diseases such as cancer and AIDS. Their perceptions were influenced by their knowledge about the disease, media portrayal and frequency of health campaigns by the government. All respondents believed they were not susceptible to the disease.
CONCLUSION: The low perceived susceptibility of leptospirosis infection is a matter of concern as it may contribute to respondents' lack of motivation towards preventing the disease. The study findings may provide the basis for health promotional activities designed to heighten public perceived threat towards leptospirosis infection and thereby improving preventive health behaviors for avoiding leptospirosis.