Zusammenfassung
Die Kombination aus initial hohem Fieber verbunden mit starkem Krankheitsgefühl, Splenomegalie, Transaminasenerhöhungen und akutem Nierenversagen muss auch in Deutschland differenzialdiagnostisch an eine Leptospirose denken lassen. Die Diagnose erfolgt im Regelfall serologisch über den Titerverlauf. Die renale Beteiligung ist häufig, mit allerdings im Regelfall guter Prognose, insbesondere bei fehlendem Ikterus. Eine Therapie mit Doxycyclin oder Penizillin kann Krankheitsdauer und Ausscheidung, evtl. auch die Nephritis verkürzen bzw. verhindern.
Abstract
When confronted by the combination of initial high fever associated with intense malaise, splenomegaly, elevated levels of transaminases, and acute renal failure, consideration must be given to the differential diagnosis of leptospirosis even in Germany. As a rule, the diagnosis is confirmed by serological testing based on the titer curve. Renal involvement is frequent, but usually has a good prognosis, especially if jaundice has not developed. Treatment with doxycycline or penicillin can shorten the disease course and exudation, possibly also the nephritis, or hinder it.
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Literatur
(1998) Update: leptospirosis and unexplained acute febrile illness among athletes participating in triathlons—Illinois and Wisconsin. MMWR Morb Mortal Wkly Rep 47: 673–676
Abb J (2002) Acute leptospirosis in a triathlete. Wilderness Environ Med 13: 45–47
Alves VA, Gayotto LC, Yasuda PH, Wakamatsu A, Kanamura CT, De Brito T (1991) Leptospiral antigens (L. interrogans serogroup ictero-haemorrhagiae) in the kidney of experimentally infected guinea pigs and their relation to the pathogenesis of the renal injury. Exp Pathol 42: 81–93
Brueck M, Grempels E, Braig G, Kramer W (2002) Leptospirosis as a differential diagnosis of acute renal failure. Med Klin 97: 614–618
Dupont H, Dupont-Perdrizet D, Perie JL, Zehner-Hansen S, Jarrige B, Daijardin JB (1997) Leptospirosis: prognostic factors associated with mortality. Clin Infect Dis 25: 720–724
Friedland JS, Warrell DA (1991) The Jarisch-Herxheimer reaction in leptospirosis: possible pathogenesis and review. Rev Infect Dis 13: 207–210
Lai KN, Aarons I, Woodroffe AJ, Clarkson AR (1982) Renal lesions in leptospirosis. Aust N Z J Med 12: 276–279
Levett PN (2001) Leptospirosis. Clin Microbiol Rev 14: 296–326
Levett PN (2003) Usefulness of serologic analysis as a predictor of the infecting serovar in patients with severe leptospirosis. Clin Infect Dis 36: 447–452
McClain J, Ballou W, Harrison S, Steinweg D (1984) Doxycycline therapy for leptospirosis. Ann Intern Med 100: 696–698
Stephan C, Hunfeld KP, Schonberg A, Ott MG, Hetzenecker M, Bitzer R, Just-Nubling G (2000) Leptospirose nach Betriebsausflug. Dtsch Med Wochenschr 125: 623–627
Sterling C, Thiermann A (1981) Urban rats as chronic carriers of leptospirosis: an ultrastructural investigation. Vet Pathol 18: 629–637
Watt G, Padre L, Tuazon M, Calubaquib C, Santiago E, Ranoa C, Laughlin L (1988) Placebo-controlled trial of intravenous penicillin for severe and late leptospirosis. Lancet 1: 433–435
Weil A (1886) Ueber eine eigentümliche, mit Milztumor, Icterus und Nephritis einhergehende akute Infektionskrankheit. Dtsch Arch Klin Med 39: 209–232
Yang CW, Wu MS, Pan MJ (2001) Leptospirosis renal disease. Nephrol Dial Transplant 16 (Suppl 5): 73–77
Danksagung
Die Autoren danken Herrn Professor H.-J. Gröne für die kritische Durchsicht des Manuskripts.
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Strutz, F., Scheel, A., Koziolek, M. et al. „Eigentümliche Infektion“ mit Fieber, Splenomegalie und akutem Nierenversagen bei einem 24-jährigen Forstwirtschaftsstudenten. Internist 44, 1575–1578 (2003). https://doi.org/10.1007/s00108-003-1090-6
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DOI: https://doi.org/10.1007/s00108-003-1090-6