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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EAlthough the primary treatment for typical leptospirosis is antimicrobial therapy in the form of penicillin and doxycycline, assessment of left ventricular (LV) systolic function should also be performed in patients with this condition. Findings of new LV dysfunction (ejection fraction \u0026lt;50%) may provide evidence of associated myocarditis, which is an important finding.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInflammatory Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EBacterial Infections\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology \u0026amp; Cardiovascular Medicine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInflammatory Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EBacterial Infections\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EAlthough the primary treatment for typical leptospirosis is antimicrobial therapy in the form of penicillin and doxycycline, assessment of left ventricular (LV) systolic function should also be performed in patients with this condition. Findings of new LV dysfunction (ejection fraction \u0026lt;50%) may provide evidence of associated myocarditis, which is an important finding. In addition, when patients such as farmers or others working closely with animals, present with unexplained myocarditis, the differential diagnosis should include leptospirosis according to Dabor Resiere, MD, Central University Hospital, Fort de France, Martinique.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003ELeptospirosis is an endemic disease in the Caribbean caused by Leptospira, a motile bacterium [Bharti AR et al. \u003Cem\u003ELancet Infect Dis\u003C\/em\u003E 2003] spread predominantly during rainy seasons as well as in the urine of infected animals such as dogs. In its virulent forms, leptospirosis may lead to liver failure, renal failure, severe pulmonary hemorrhage, myocarditis, and death. In 2012, the Dominican Republic\u0027s Minister of Agriculture died of leptospirosis. Even today, 5% to 10% of patients with leptospirosis in the Caribbean may die from the disease.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003ESome patients may present with flu-like symptoms, but others patients may be relatively asymptomatic or have insidious symptoms making the onset difficult to discern. When patients present with fewer than 8 days of symptomatology, Dr. Resiere recommends a polymerase chain reaction (PCR) test for diagnosis; this has been available in Martinique since 2006.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EIf leptospirosis is diagnosed, physicians should evaluate for new LV systolic dysfunction (ejection fraction \u0026lt;50%) as the complication of myocarditis can be devastating. In patients presenting with cardiogenic shock, mortality approaches 40%. Practioners evaluating patients with leptospirosis should also have a high degree of suspicion for meningitis, encephalitis, and other neurological manifestations, which occur in 5% to 10% of patients.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003ETreatment of leptospirosis includes not only antibiotics but supportive therapy (eg, including fluid and electrolyte regulation) and monitoring for new complications.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003ETo evaluate cases of leptospirosis in a single institution, Dr. Resiere and colleagues conducted a retrospective analysis, looking at data from 82 patients admitted to University Hospital in Martinique, 29% of whom were admitted prior to the institution of PCR tests for diagnosis, from 2001 to 2006, and 63% of whom were admitted between 2006 and 2010. Of 32 patients admitted to the intensive care unit for leptospirosis, the most frequent abnormal vital sign was tachycardia. He also noted that \u0026lt;10 of the 20 patients admitted to the hospital with this diagnosis after 2006 required intensive care [Mehdaoui H et al. \u003Cem\u003ECritical Care\u003C\/em\u003E 2012].\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EGreater awareness could vastly reduce the mortality associated with leptospirosis in the Caribbean improving the timing of diagnosis and early institution of care. Physicians should carefully consider leptospirosis in those presenting with symptoms. For those with symptoms \u0026lt;8 days, the physician should perform a PCR test for the early diagnosis of leptospirosis, if available. In cases where leptospirosis has been confirmed, the physician should not merely prescribe antibiotic and supportive therapy, but should evaluate for cardiac involvement as myocarditis is associated with high mortality rate and requires specialized care.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2013 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/13\/14\/11.2.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nznnq1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}