Treatment of severe leptospirosis with therapeutic plasma exchange in a pediatric patient

Abstract

Leptospirosis is a common zoonotic disease caused by spirochetes of the genusLeptospira. Although it is mostly a tropical disease, some case reports havebeen published from temperate regions of the world. The disease presentswith a wide spectrum; from asymptomatic self limited disease to a fatalillness characterized by multi-organ involvement.An 8-year-old girl presented with a 5-day history of fever, myalgia, fatigue,vomiting and diarrhea. She developed anuria, hypotension and becameunconscious one day after admission and was referred to our pediatric intensivecare unit for further evaluation and treatment. Initial physical examinationrevealed fever, jaundice, diffuse petecchiae on whole body, hepatomegaly andsevere hypotension. Laboratory investigations showed elevated liver enzymesand bilirubin levels, elevated creatinine and creatine kinase levels andtrombocytopenia. The diagnosis of Leptospirosis was detected by rapid IgMtest and confirmed by microscopic agglutination test later. She was treatedwith mechanical ventilation, wide spectrum antibiotics, positive inotropicagents and penicillin G plus two days of continuous renal replacementtherapy and five sessions of therapeutic plasma exchange performed daily.She recovered completely and was transferred to the pediatric ward on the14th day of hospitalization.The exact role of therapeutic plasma exchange has not been well documentedyet, it seems to have benefical effects on clinical and laboratory findings andsurvival as we observed in our patient and learned from experiences in adultpatients presented as case reports.