Myocarditis causing severe heart failure - an unusual early manifestation of leptospirosis: a case report

BACKGROUND: Leptospirosis is the most widespread zoonosis in the world. Cardiac involvement is a frequent complication of leptospirosis although significant left ventricular dysfunction is rare. We report a case of fatal leptospira myocarditis leading to cardiogenic shock on the second day of illness. This early occurrence of myocarditis is not previously reported. CASE PRESENTATION: A 36-yr-old previously healthy Sri Lankan male who takes care of a horse presented to the medical casualty ward with a one day history of fever, arthralgia and severe myalgia. He developed hypotension on the second day of illness. Electrocardiogram showed sinus tachycardia with ST segment depression in lateral leads which evolved in to rapid atrial fibrillation in the subsequent days. 2D echocardiogram showed dilated cardiac chambers with severe global hypokinesia and an ejection fraction of 20%. His renal and liver functions were within normal limits. He developed multi organ dysfunction syndrome and refractory shock, later in the course of illness. Leptospirosis was confirmed by positive leptospira IgM and negative IgG. Patient died on the fifth day of illness despite optimal medical treatment with intravenous penicillin, meropenem, levofloxacin, inotropes and supportive care in the intensive care unit. CONCLUSIONS: We describe a rare and unusual early complication of leptospirosis which has not been reported before. It is important to bear in mind that leptospirosis could present as myocarditis during the early phase of illness

Clinical and Epidemiological Characteristics and Outcome of Patients With Covid-19 in Sri Lanka; An Observational Study

Abstract Background Clinical manifestations of coronavirus disease 2019 (COVID19) can vary from asymptomatic to profusely symptomatic due to many factors. Having data on the clinical characteristics of the affected patients is important for the screening and diagnosis of COVID-19. Main objective of this study is to evaluate the clinical and epidemiological characteristics and outcomes of patients with COVID-19 admitted to six treatment centres in Sri Lanka. Methods For the specific epidemic situation of COVID-19, we chose to conduct a descriptive retrospective study from six treatment centres in the country between March 10, 2020 and May 30, 2020. Results The study included 431 laboratory confirmed patients with COVID-19. Of them, 335 (78.2%) were males and their mean age was 37 years. Most patients (373: 86.5%) had had close contact with COVID-19 positive patients. The majority were asymptomatic (243: 56.3%) and of the symptomatic patients, the most common symptom was sore throat (81, 19%), followed by cough (72, 17%), headache (72, 17%), fever (50, 12%), and nasal discharge (36, 8%). Eight patients required either high dependency care or intensive unit care two of them succumbed to the illness (0.5%). Hydroxychloroquine (HCQ) was used as a treatment in 248 patients and they had a significantly longer (17.6 days) duration of hospital stays compared those who were not treated (13.6 days) with HCQ. When the HCQ was not used as a treatment, asymptomatic individuals had significantly shorter durations of hospital (11.1 days) stays compared to symptomatic individuals (14.3 days). Conclusions The majority of patients remained asymptomatic during the course of illness. The most common symptom was sore throat, seen in one fifth of patients, followed by cough, and headache. Our study also indicated the possibility of reduced viral clearance and hence longer duration of hospital stays with HCQ.</jats:p