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  Table of Contents    
LETTER TO EDITOR  
Year : 2011  |  Volume : 54  |  Issue : 2  |  Page : 426-427
Leptospirosis-induced still birth and postpartum sepsis


1 Department of Microbiology, Sri Venkateswara Institute of Medical Sciences, Tirupati- 517 507, India
2 Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati- 517 507, India

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Date of Web Publication27-May-2011
 

How to cite this article:
Sharma KK, Madhvilatha P, Kalawat U, Sivakumar V. Leptospirosis-induced still birth and postpartum sepsis. Indian J Pathol Microbiol 2011;54:426-7

How to cite this URL:
Sharma KK, Madhvilatha P, Kalawat U, Sivakumar V. Leptospirosis-induced still birth and postpartum sepsis. Indian J Pathol Microbiol [serial online] 2011 [cited 2019 Dec 12];54:426-7. Available from: http://www.ijpmonline.org/text.asp?2011/54/2/426/81617

This article was presented at the VI Meeting of International Leptospirosis Society, Cochin, India in September 2006.


Sir,

Stillbirths have been reported in association with virtually all types of infections, including bacterial, viral, and parasitic. Leptospirosis, although uncommon, has also been associated with transplacental transmission of infection and stillbirth. [1]

A 21-year-old, 34-week pregnant woman delivered a 1.91 kg weight stillbirth male child.

She had severe anemia, jaundice, and encephalopathy and was referred to our hospital for further management. On clinical examination, the patient was afebrile, conscious, and oriented with rapid and feeble pulse. Her blood pressure was 70/0 (diastolic pressure nonrecordable). There was pallor and pedal edema. Mild tenderness was noted in suprapubic region. Complete hemogram and blood biochemistry revealed hemoglobin to be 4.4 gm%, platelet count 0.48 lakhs/mm 3 , blood urea 28 mg/dl, serum creatinine 1.0 mg/dl, total serum bilirubin 9.9 mg/dl, and conjugate bilirubin 4.6 mg/dl. Other biochemical, radiologic, and echocardiographic parameters were normal. Dark field microscopy (DFM) of blood for leptospires was positive. Considering the positivity of blood for DFM, two drops of the patient's blood was inoculated into one tube each of Ellinghausen-McCullough-Johnson-Harrison (EMJH) culture media and EMJH selective media with 5-fluoro uracil (50 μg /ml) at bed side. Growth in culture media was established by DFM.

Leptospirosis was confirmed by fourfold rise of the microscopic agglutination test (MAT) titer, which increased from an initial titer of 1:80 with L. copenhagenii to 1:640 with the second sample collected 14 days apart. All other tests for bacteria, viruses, fungi, and parasites were negative.

Conventional antimicrobial agents, such as cefaperazone /sulbactum and metronidazole, were given and two units of packed cell, 2 units of whole blood, and 4 units of fresh frozen plasma were transfused. The patient recovered from shock after three days of medical management in intensive care unit. Mild jaundice persisted and patient was discharged with proper medical advice. After 6 months of follow-up, she is free from jaundice and is doing well.

The abortive effect of leptospirosis is well known in animals but is rare in humans. The cytotoxic impact of leptospires combined with hemorrhage and pyrexia can be a primary cause of fetal mortality. If the fetus remains viable, it can sometimes display developmental abnormality. Several studies, such as a study by Cramer and Wadulla [2] and also from Japan, [3] have indicated abortion as a complication of human leptospirosis.

The case presented here showed all the manifestations of leptospirosis and was culture positive, which is considered the gold standard. So miscarriage, postpartum sepsis, and jaundice could have been induced by leptospirosis. Therefore, one must remember that leptospirosis is an easily treated infection and its complications can be avoided by early diagnosis and timely administration of simple antibiotic therapy as also suggested by studies conducted by Gaspari et al [4] and Chedraui et al. [5]

High index of clinical suspicion and increased awareness regarding the possibility of leptospirosis in a pregnant woman living in endemic regions is of utmost importance for early detection and treatment of the disease in mother and its prevention of transmission to the fetus. However, to prove conclusively abortion as a complication of leptospirosis, well-planned prospective studies are required.

 
   References Top

1.Robert L, Goldenberg MD, Cortney TB. The infectious origin of still birth. Am J Obstet Gynecol 2003; 18:861-73.   Back to cited text no. 1
    
2.Cramer H, Wadulla H. Abortus bei Leptospirosis canicola. Arch Gynak 1950; 177:167-77.   Back to cited text no. 2
    
3.Coughlan JD, Bain AD. Leptospirosis in human pregnancy followed by death of fetus. Br Med J 1969;1:228-30.  Back to cited text no. 3
    
4.Chedraui PA, San Miguel G. A case of leptospirosis and pregnancy. Arch Gynecol Obstet 2003;269:53-4.   Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Gaspari R, Annetta MG, Cavalier F, Pallavicini F, Grillo R, Conti G, et al. Unusual presentation of leptospirosis in the late stage of pregnancy. Minerva Anestesiol 2007;73:429-32.  Back to cited text no. 5
    

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Correspondence Address:
Krishna K Sharma
Department of Microbiology, Venkateswara Institute of Medical Sciences, Tirupati- 517 507, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.81617

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This article has been cited by
1 Atypical manifestations of leptospirosis
S. Rajapakse,C. Rodrigo,K. Balaji,S. D. Fernando
Transactions of the Royal Society of Tropical Medicine and Hygiene. 2015;
[Pubmed] | [DOI]



 

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