{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,3]],"date-time":"2026-01-03T06:51:30Z","timestamp":1767423090840,"version":"build-2065373602"},"reference-count":25,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2021,7,5]],"date-time":"2021-07-05T00:00:00Z","timestamp":1625443200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infectious Disease Reports"],"abstract":"<jats:p>Leptospirosis is a zoonosis caused by infection with pathogenic strains of the bacterium Leptospira. The disease can be complicated by pulmonary hemorrhages and acute respiratory distress syndrome, with the mortality rate increasing to 51\u2013100%. We report the case of a 37-year-old man who was admitted to the emergency department with a 6-day history of fever, weakness, vomiting and diarrhea, followed by jaundice. On admission, he presented leukocytosis, thrombocytopenia and acute liver and kidney injuries. His clinical course was critical, as it was immediately complicated by sepsis and severe respiratory failure, requiring haemodialysis, mechanical ventilation and broad-spectrum antibiotic therapy. In the following days, a veno-venous extracorporeal membrane oxygenation (VV-ECMO) was started due to a dramatic deterioration in respiratory function; 20 h later, it was switched to veno-arterial ECMO because of refractory cardiogenic shock. Hantavirus or Leptospira infection etiology was suspected, so penicillin G and methylprednisolone were initiated as an empirical therapy and subsequently confirmed after a laboratory diagnosis of leptospirosis. Although the clinical course was further complicated by hemorrhagic pneumonia, a gradual, full recovery occurred, and the patient was discharged from the hospital. After excluding other sources of contact with Leptospira-infected material, an unsuspected abnormal eating behavior was identified as the most probable cause of the patient\u2019s Leptospira infection.<\/jats:p>","DOI":"10.3390\/idr13030058","type":"journal-article","created":{"date-parts":[[2021,7,5]],"date-time":"2021-07-05T22:02:04Z","timestamp":1625522524000},"page":"619-626","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Pica (Allotriophagy): An Underestimated Risk Factor for Severe Leptospirosis (Weil\u2019s Diseases)? Report of a Leptospira Septic Shock Successfully Managed with ECMO"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9823-554X","authenticated-orcid":false,"given":"Adam","family":"Fabiani","sequence":"first","affiliation":[{"name":"Cardiothoracic-Vascular Department, Azienda Sanitaria Universitaria Integrata, Cattinara University Hospital, 34148 Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eugenia","family":"Dal Bo","sequence":"additional","affiliation":[{"name":"Cardiothoracic-Vascular Department, Azienda Sanitaria Universitaria Integrata, Cattinara University Hospital, 34148 Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6121-7009","authenticated-orcid":false,"given":"Stefano","family":"Di Bella","sequence":"additional","affiliation":[{"name":"Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Cattinara University Hospital, 34148 Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Gabrielli","sequence":"additional","affiliation":[{"name":"Cardiothoracic-Vascular Department, Azienda Sanitaria Universitaria Integrata, Cattinara University Hospital, 34148 Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandro","family":"Bologna","sequence":"additional","affiliation":[{"name":"Cardiothoracic-Vascular Department, Azienda Sanitaria Universitaria Integrata, Cattinara University Hospital, 34148 Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9781-4219","authenticated-orcid":false,"given":"Umberto","family":"Albert","sequence":"additional","affiliation":[{"name":"Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Cattinara University Hospital, 34148 Trieste, Italy"},{"name":"UCO Clinica Psichiatrica, Department of Mental Health, 34128 Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8319-635X","authenticated-orcid":false,"given":"Gianfranco","family":"Sanson","sequence":"additional","affiliation":[{"name":"Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Cattinara University Hospital, 34148 Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,7,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1099\/jmm.0.000899","article-title":"Leptospirosis","volume":"68","author":"Fry","year":"2019","journal-title":"J. Med. Microbiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.jcrc.2019.02.018","article-title":"Acute respiratory distress syndrome in leptospirosis","volume":"51","author":"Vandroux","year":"2019","journal-title":"J. Crit. Care"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Costa, F., Hagan, J., Calcagno, J., Kane, M., Torgerson, P., Martinez-Silveira, M.S., Stein, C., Abela-Ridder, B., and Ko, A.I. (2015). Global Morbidity and Mortality of Leptospirosis: A Systematic Review. PLOS Negl. Trop. Dis., 9.","DOI":"10.1371\/journal.pntd.0003898"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1016\/j.tmaid.2013.12.005","article-title":"An exotic case of leptospirosis imported into an endemic area","volume":"12","author":"Goarant","year":"2014","journal-title":"Travel Med. Infect. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"361","DOI":"10.3855\/jidc.8613","article-title":"Acute encephalitis as initial presentation of leptospirosis","volume":"11","author":"Puca","year":"2017","journal-title":"J. Infect. Dev. Ctries."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e229582","DOI":"10.1136\/bcr-2019-229582","article-title":"A case of leptospirosis with acute respiratory failure and acute kidney injury treated with simultaneous extracorporeal membrane oxygenation and haemoperfusion","volume":"12","author":"Chavez","year":"2019","journal-title":"BMJ Case Rep."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1097\/01.qco.0000178824.05715.2c","article-title":"Leptospirosis","volume":"18","author":"McBride","year":"2005","journal-title":"Curr. Opin. Infect. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1016\/S1473-3099(03)00830-2","article-title":"Leptospirosis: A zoonotic disease of global importance","volume":"3","author":"Bharti","year":"2003","journal-title":"Lancet Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1081\/JDI-200037154","article-title":"Acute Renal Failure: A Common Manifestation of Leptospirosis","volume":"26","author":"Cetin","year":"2004","journal-title":"Ren. Fail."},{"key":"ref_10","first-page":"189","article-title":"Ocular manifestations of leptospirosis","volume":"51","author":"Rathinam","year":"2005","journal-title":"J. Postgrad. Med."},{"key":"ref_11","unstructured":"Zulyadaini, E., and Fajri, A. (2021, June 21). ECG Changes in Leptospira Myocarditis: Case study. Available online: https:\/\/journal.ugm.ac.id\/jaci\/article\/download\/47851\/24913."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"463","DOI":"10.5603\/KP.2015.0106","article-title":"Brugada electrocardiography pattern caused by Taxus poisoning","volume":"73","author":"Bugajski","year":"2015","journal-title":"Kardiol. Pol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1836","DOI":"10.1161\/CIRCULATIONAHA.108.827147","article-title":"Images in cardiovascular medicine. Yew Causes Brugada ECG","volume":"119","author":"Veltmann","year":"2009","journal-title":"Circulation"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1136\/jcp.2009.069575","article-title":"Cardiac findings in leptospirosis","volume":"63","author":"Shah","year":"2010","journal-title":"J. Clin. Pathol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"404","DOI":"10.5114\/ait.2019.89952","article-title":"Yew poisoning\u2014Pathophysiology, clinical picture, management and perspective of fat emulsion utilization","volume":"51","author":"Rutkiewicz","year":"2019","journal-title":"Anaesthesiol. Intensive Ther."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1177\/1060028017754225","article-title":"Clinical Toxicology of Yew Poisoning","volume":"52","author":"Labossiere","year":"2018","journal-title":"Ann. Pharmacother."},{"key":"ref_17","first-page":"215","article-title":"Severe pulmonary manifestation of leptospirosis","volume":"70","author":"Helmerhorst","year":"2012","journal-title":"Neth. J. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1186\/s40560-020-00447-2","article-title":"Leptospirosis as an important differential of pulmonary haemorrhage on the intensive care unit: A case managed with VV-ECMO","volume":"8","author":"Barnacle","year":"2020","journal-title":"J. Intensive Care"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e00529","DOI":"10.1016\/j.idcr.2019.e00529","article-title":"Recreational \u2018mud fever\u2019: Leptospira interrogans induced diffuse alveolar hemorrhage and severe acute respiratory distress syndrome in a U.S. Navy seaman following \u2018mud-run\u2019 in Hawaii","volume":"15","author":"Schmalzle","year":"2019","journal-title":"IDCases"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Wang, H.J., Chen, G.Z., Zhou, C.J., Fu, Y., and Yao, L.N. (2020). Veno-venous extracorporeal membrane oxygenation successfully treated a case of severe pulmonary hemorrhage caused by leptospirosis. BMC Infect. Dis., 20.","DOI":"10.1186\/s12879-020-05518-1"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1597","DOI":"10.1213\/01.ANE.0000215121.67833.2F","article-title":"Veno-Arterial Extracorporeal Membrane Oxygenation in Acute Respiratory Distress Syndrome Caused by Leptospire Sepsis","volume":"102","author":"Kahn","year":"2006","journal-title":"Anesth. Analg."},{"key":"ref_22","first-page":"1","article-title":"An unusual case of fulminant leptospiral myocarditis: A case report","volume":"3","author":"Khoo","year":"2019","journal-title":"Eur. Heart J. Case Rep."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1093\/trstmh\/tru148","article-title":"High dose corticosteroids in severe leptospirosis: A systematic review","volume":"108","author":"Rodrigo","year":"2014","journal-title":"Trans. R. Soc. Trop. Med. Hyg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1007\/BF01730367","article-title":"Survey on the prevalence of leptospira infections in the Italian population","volume":"10","author":"Cacciapuoti","year":"1994","journal-title":"Eur. J. Epidemiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.cimid.2019.04.001","article-title":"Epidemiology of leptospirosis in North-Central Italy: Fifteen years of serological data (2002\u20132016)","volume":"65","author":"Bertelloni","year":"2019","journal-title":"Comp. Immunol. Microbiol. 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