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Brain & Heart Cardiac involvement in leptospirosis

characterized by antibody production and the excretion The diagnosis is confirmed by a positive PCR result of
of leptospires in the urine. During the leptospiremic blood or urine or by a positive serology result. Rarely, a
15
phase, the pathogen can be isolated from the blood and diagnosis is made by a positive culture of blood or urine.
cerebrospinal fluid (CSF). Conversely, in the immune Negative test results do not rule out the diagnosis because of
phase, it cannot be isolated from the blood or CSF owing the suboptimal sensitivity of leptospirosis tests. Molecular
to the presence of IgM-type antibodies, but it can still be tests, such as PCR, offer a rapid and accurate diagnosis,
19
isolated from the kidneys, urine, and aqueous humor. especially in the early stages of illness (i.e., the 1 week).
st
A single positive PCR result is diagnostic for leptospirosis.
Leptospirosis can manifest in two clinical forms: icteric
or anicteric. The anicteric form typically begins with a Although the organism may be intermittently detected
in urine during the 1 week of illness, it is more reliably
st
sudden onset of fever and may include symptoms such identified after that period. PCR tests typically have a
20
as chills, myalgia, abdominal pain, conjunctivitis, and sensitivity of 40% – 60% and a specificity above 95% in
occasionally, a skin rash. Severe headaches and aseptic blood samples. 19
meningitis can also occur. This form is usually self-limiting
and accounts for about 90% of cases. In contrast, the 4. Conclusion
icteric form can range from severe illness with multiorgan
dysfunction to a life-threatening condition. 1,2,16 Leptospirosis is a relatively underdiagnosed infectious
disease, despite its frequent occurrence, and cardiac
Cardiac involvement in leptospirosis may cause involvement is even less frequently reported. This could
symptoms such as shortness of breath, chest pain, be due to insufficient documentation of the frequency
palpitations, tachycardia, hypotension, EKG abnormalities, and extent of cardiac involvement in leptospirosis.
arrhythmias, ST/T changes, conduction abnormalities, Diagnostic challenges arise when clinical symptoms
and ECHO wall motion abnormalities. Furthermore, it suggest cardiac involvement, particularly in patients
can lead to conditions such as endocarditis, myocarditis, with a septic presentation where no clear source of
pericarditis, and cardiogenic shock. EKG or clinical infection is found. A comprehensive epidemiological
evidence of cardiac involvement is often associated with a history is essential in these cases. This case highlights
poor prognosis. 17 the importance of recognizing cardiac involvement in
In our case, the patient presented with hypotension leptospirosis.
that was managed with inotropic support while in septic Acknowledgments
shock. After 48 h of monitoring in the intensive care unit,
liver dysfunction also emerged. The patient did not show None.
clear EKG abnormalities, but laboratory tests revealed
elevated levels of cardiac biomarkers, including troponin, Funding
CK, CK-MB, and HSTI. ECHO revealed hypokinesia in None.
the anteroseptal wall of the left ventricle. Although the
initial cardiological assessment suggested acute coronary Conflict of interest
syndrome, clinical follow-up and a positive Leptospira The authors declare they have no competing interests.
PCR result confirmed myocardial involvement due to
leptospirosis. In the literature, myocardial involvement Author contributions
has been documented through case studies and case Conceptualization: Ayşe Sağmak Tartar, Mehmet Ali Aşan
series. 17,18
Investigation: Ayşe Sağmak Tartar, Mehmet Ali Aşan,
LV dysfunction is usually not detected in clinical Murat Harman
follow-ups of leptospirosis, leading to frequent oversight Writing–original draft: Ayşe Sağmak Tartar, Mehmet Ali
of cardiac involvement. In our case, ECHO revealed Aşan, Murat Harman
18
hypokinesia in the LV anteroseptal wall, and elevated CK, Writing–review & editing: Ayşe Sağmak Tartar, Türkkan
CK-MB, and HSTI levels were supportive of myocardial Öztürk Kaygusuz
involvement in leptospirosis.
Myocarditis is a fatal condition. Patients showing clinical Ethics approval and consent to participate
and laboratory findings suggestive of cardiac involvement Consent was obtained from the patient.
in leptospirosis should be evaluated for myocarditis using
imaging techniques such as ECHO and cardiac magnetic Consent for publication
resonance imaging. Consent was obtained from the patient.

Volume 2 Issue 4 (2024) 4 doi: 10.36922/bh.3496