1- Unidade de Infecciologia, Área de Pediatria Médica, Hospital de Dona Estefânia, Centro Hospitalar Lisboa Central EPE, Lisboa
2 - Unidade de Cuidados Intensivos, Área de Pediatria Médica, Centro Hospitalar Lisboa Central EPE, Lisboa
- 2015 Excellence in Pediatrics Conference, Londres, 10-12 de Dezembro de 2015 (Poster)
Introduction: Leptospirosis is a zoonosis characterized by a broad spectrum of clinical findings and occasionally could develop circulatory collapse and shock. At least 90% of all patients are anicteric and they frequently escape definitive diagnosis because jaundice and azotemia are absent.
Case report: A 14-year-old teenage boy who lives in city was admitted with high-grade fever (40ºC) with 7 days of evolution. On examination no rash was found neither any sign of tache noir. He was pale, had poor peripheral perfusion, tachycardia (FC-140/min), hypotension (60/30mmHg) and oliguria (0.7ml/Kg/h). He was admitted in intensive care unit with circulatory collapse under ionotropic supports and supplementary oxygen and the initial therapy included ceftriaxone, doxycycline and ciprofloxacin. Laboratory-test showed hemoglobin 11.9 g/dL, an almost prominent neutrophilia (87.5%) with leukocytosis (1300/uL), CRP 119mg/dL, GOT 80U/L, GPT 150U/L and albumin 2.7, other exams were normal. The abdominal ultrasound showed hepatosplenomegaly, ascites, bilateral pleural effusion, pericardic effusion and a mild mitral insufficiency. The ophthalmologic evaluation documented episcleritis, having been treated with topic dexamethasone and neomycin. Blood culture, rickettsias, bartonella and enterovirus were negatives. On urine direct test was documented forms of leptospira and positive real time PCR. The patient had a progressive improvement on his clinical condition and completed 14 days under ceftriaxone. The review of the clinical history showed contact with dogs, cats and rats. An infection disease notification was made and the public health delegate was called to intervene.
Conclusion: Leptospirosis it can be an underdiagnosed infection in our country. The doctor has to have a high clinical suspicion to do the de diagnosis.
Palavras Chave: Leptospirosis, septic shock.