- Email: [email protected]
Lymphopenia in hospitalised cases of leptospirosis
Correspondence 857
5. Linden PK, Kusne S, Coley K, Fontes P, Kramer DJ, Paterson D. Use of parenteral colistin for the treatment of serious infection due to antimicrobial-resistant Pseudomonas aeruginosa. Clin Infect Dis 2003; 37: e154–e160. 6. Levin AS, Barone AA, Penco J et al. Intravenous colistin as therapy for nosocomial infections caused by multidrugresistant Pseudomonas aeruginosa and Acinetobacter baumannii. Clin Infect Dis 1999; 28: 1008–1011. 7. Livermore DM. The need for new antibiotics. Clin Microbiol Infect 2004; 10(suppl 4): 1–9. 8. Oie S, Uematsu T, Sawa A et al. In vitro effects of combinations of antipseudomonal agents against seven strains of multidrug-resistant Pseudomonas aeruginosa. J Antimicrob Chemother 2003; 52: 911–914. 9. Giamarellos-Bourboulis EJ, Kentepozidis N, Antonopoulou A, Plachouras D, Tsaganos T, Giamarellou H. Postantibiotic effect of antimicrobial combinations on multidrug-resistant Pseudomonas aeruginosa. Diagn Microbiol Infect Dis 2005; 51: 113–117. 10. Giamarellos-Bourboulis EJ, Sambatakou H, Galani I, Giamarellou H. In vitro interaction of colistin and rifampin on multidrug-resistant Pseudomonas aeruginosa. J Chemother 2003; 15: 235–238. 11. Alou L, Aguilar L, Sevillano D et al. Is there a pharmacodynamic need for the use of continuous versus intermittent infusion with ceftazidime against Pseudomonas aeruginosa? An in vitro pharmacodynamic model. J Antimicrob Chemother 2005; 55: 209–213. 12. Giamarellos-Bourboulis EJ, Adamis T, Laoutaris G et al. Immunomodulatory clarithromycin treatment of experimental sepsis and acute pyelonephritis caused by multidrug-resistant Pseudomonas aeruginosa. Antimicrob Agents Chemother 2004; 48: 93–99. 13. Gillis RJ, Iglewski BH. Azithromycin retards Pseudomonas aeruginosa biofilm formation. J Clin Microbiol 2004; 42: 5842–5845.
10.1111/j.1469-0691.2005.01247.x
Lymphopenia in hospitalised cases of leptospirosis The article published in Clinical Microbiology and Infection by Jaure´guiberry et al. [1] presented an interesting description of the clinical findings for 34 patients hospitalised with leptospirosis in a hospital from the Pontchaillou area of France. The most striking finding was the high frequency of lymphopenia (< 1000 lymphocytes ⁄ mm3), which was observed for 85% of the leptospirosis patients analysed. By performing a MedLine search, we verified that this finding had not been reported previously in the literature. Jaure´guiberry et al. raised the possibility that this high frequency of lymphopenia could be specific to leptospirosis in the Pontchaillou area, but more definite
conclusions could not be drawn because of a lack of published studies from other regions in which this issue was addressed. In response, we re-analysed our data for 253 leptospirosis patients enrolled in a clinical trial [2] conducted in an infectious disease hospital in the city of Salvador, Brazil. The percentage of patients (17%) with lymphocyte counts < 1000 ⁄ mm3 at admission was much lower than the figure (85%) reported by Jaure´guiberry et al. Interestingly, our patients with lymphopenia had a significantly lower mean platelet count than patients with higher leukocyte counts (133 089 ± 55 203 ⁄ mm3 vs. 162 626 ± 95 956 ⁄ mm3; p 0.014). As the frequency of icteric patients was much higher in our study than in the Pontchaillou study (94.1% vs. 34.3%), we also assessed whether this finding could explain the difference in lymphopenia between the studies. However, no significant difference (p 0.910) was observed between the mean lymphocyte counts of patients with and without jaundice (2196 ± 1384 ⁄ mm3) (2226 ± 1469 ⁄ mm3). It should be noted that, while the serovar Copenhageni has been the most frequent serovar isolated from patients hospitalised in Salvador, the serovar Grippotyphosa was the serovar isolated most frequently in the Pontchaillou hospital [1,3]. Interactions between host immune response and environmental factors, including the distribution of serovars, may provide explanations for the differences in the frequency of lymphopenia between patients hospitalised in Salvador and those hospitalised in the Pontchaillou area of France. The correlation between lymphocyte and platelet counts suggests that there are similarities in the factors that mediate the development of lymphopenia and plaquetopenia in leptospirosis patients. The prevalence of lymphopenia in patients with leptospirosis across regions, and the factors related to any variations, are important questions for future research. A. A. Lopes*, E. Costa and E. Sacramento Federal University of Bahia, Internal Medicine Department and Edgard Santos University Hospital, Clinical Epidemiology Unit, Salvador, BA, Brazil *E-mail: [email protected]
2005 Copyright by the European Society of Clinical Microbiology and Infectious Diseases, CMI, 11, 856–858
858 Clinical Microbiology and Infection, Volume 11 Number 10, October 2005
REFERENCES 1. Jaure´guiberry S, Roussel M, Brinchault-Rabin G et al. Clinical presentation of leptospirosis: a retrospective study of 34 patients admitted to a single institution in metropolitan France. Clin Microbiol Infect 2005; 11: 391– 394.
2. Costa E, Lopes AA, Sacramento E et al. Penicillin at the late stage of leptospirosis: a randomized controlled trial. Rev Inst Med Trop Sao Paulo 2003; 45: 141–145. 3. Ko AI, Galvao Reis M, Ribeiro Dourado CM, Johnson WD, Riley LW. Urban epidemic of severe leptospirosis in Brazil. Salvador Leptospirosis Study Group. Lancet 1999; 354: 820– 825.
2005 Copyright by the European Society of Clinical Microbiology and Infectious Diseases, CMI, 11, 856–858
5. Linden PK, Kusne S, Coley K, Fontes P, Kramer DJ, Paterson D. Use of parenteral colistin for the treatment of serious infection due to antimicrobial-resistant Pseudomonas aeruginosa. Clin Infect Dis 2003; 37: e154–e160. 6. Levin AS, Barone AA, Penco J et al. Intravenous colistin as therapy for nosocomial infections caused by multidrugresistant Pseudomonas aeruginosa and Acinetobacter baumannii. Clin Infect Dis 1999; 28: 1008–1011. 7. Livermore DM. The need for new antibiotics. Clin Microbiol Infect 2004; 10(suppl 4): 1–9. 8. Oie S, Uematsu T, Sawa A et al. In vitro effects of combinations of antipseudomonal agents against seven strains of multidrug-resistant Pseudomonas aeruginosa. J Antimicrob Chemother 2003; 52: 911–914. 9. Giamarellos-Bourboulis EJ, Kentepozidis N, Antonopoulou A, Plachouras D, Tsaganos T, Giamarellou H. Postantibiotic effect of antimicrobial combinations on multidrug-resistant Pseudomonas aeruginosa. Diagn Microbiol Infect Dis 2005; 51: 113–117. 10. Giamarellos-Bourboulis EJ, Sambatakou H, Galani I, Giamarellou H. In vitro interaction of colistin and rifampin on multidrug-resistant Pseudomonas aeruginosa. J Chemother 2003; 15: 235–238. 11. Alou L, Aguilar L, Sevillano D et al. Is there a pharmacodynamic need for the use of continuous versus intermittent infusion with ceftazidime against Pseudomonas aeruginosa? An in vitro pharmacodynamic model. J Antimicrob Chemother 2005; 55: 209–213. 12. Giamarellos-Bourboulis EJ, Adamis T, Laoutaris G et al. Immunomodulatory clarithromycin treatment of experimental sepsis and acute pyelonephritis caused by multidrug-resistant Pseudomonas aeruginosa. Antimicrob Agents Chemother 2004; 48: 93–99. 13. Gillis RJ, Iglewski BH. Azithromycin retards Pseudomonas aeruginosa biofilm formation. J Clin Microbiol 2004; 42: 5842–5845.
10.1111/j.1469-0691.2005.01247.x
Lymphopenia in hospitalised cases of leptospirosis The article published in Clinical Microbiology and Infection by Jaure´guiberry et al. [1] presented an interesting description of the clinical findings for 34 patients hospitalised with leptospirosis in a hospital from the Pontchaillou area of France. The most striking finding was the high frequency of lymphopenia (< 1000 lymphocytes ⁄ mm3), which was observed for 85% of the leptospirosis patients analysed. By performing a MedLine search, we verified that this finding had not been reported previously in the literature. Jaure´guiberry et al. raised the possibility that this high frequency of lymphopenia could be specific to leptospirosis in the Pontchaillou area, but more definite
conclusions could not be drawn because of a lack of published studies from other regions in which this issue was addressed. In response, we re-analysed our data for 253 leptospirosis patients enrolled in a clinical trial [2] conducted in an infectious disease hospital in the city of Salvador, Brazil. The percentage of patients (17%) with lymphocyte counts < 1000 ⁄ mm3 at admission was much lower than the figure (85%) reported by Jaure´guiberry et al. Interestingly, our patients with lymphopenia had a significantly lower mean platelet count than patients with higher leukocyte counts (133 089 ± 55 203 ⁄ mm3 vs. 162 626 ± 95 956 ⁄ mm3; p 0.014). As the frequency of icteric patients was much higher in our study than in the Pontchaillou study (94.1% vs. 34.3%), we also assessed whether this finding could explain the difference in lymphopenia between the studies. However, no significant difference (p 0.910) was observed between the mean lymphocyte counts of patients with and without jaundice (2196 ± 1384 ⁄ mm3) (2226 ± 1469 ⁄ mm3). It should be noted that, while the serovar Copenhageni has been the most frequent serovar isolated from patients hospitalised in Salvador, the serovar Grippotyphosa was the serovar isolated most frequently in the Pontchaillou hospital [1,3]. Interactions between host immune response and environmental factors, including the distribution of serovars, may provide explanations for the differences in the frequency of lymphopenia between patients hospitalised in Salvador and those hospitalised in the Pontchaillou area of France. The correlation between lymphocyte and platelet counts suggests that there are similarities in the factors that mediate the development of lymphopenia and plaquetopenia in leptospirosis patients. The prevalence of lymphopenia in patients with leptospirosis across regions, and the factors related to any variations, are important questions for future research. A. A. Lopes*, E. Costa and E. Sacramento Federal University of Bahia, Internal Medicine Department and Edgard Santos University Hospital, Clinical Epidemiology Unit, Salvador, BA, Brazil *E-mail: [email protected]
2005 Copyright by the European Society of Clinical Microbiology and Infectious Diseases, CMI, 11, 856–858
858 Clinical Microbiology and Infection, Volume 11 Number 10, October 2005
REFERENCES 1. Jaure´guiberry S, Roussel M, Brinchault-Rabin G et al. Clinical presentation of leptospirosis: a retrospective study of 34 patients admitted to a single institution in metropolitan France. Clin Microbiol Infect 2005; 11: 391– 394.
2. Costa E, Lopes AA, Sacramento E et al. Penicillin at the late stage of leptospirosis: a randomized controlled trial. Rev Inst Med Trop Sao Paulo 2003; 45: 141–145. 3. Ko AI, Galvao Reis M, Ribeiro Dourado CM, Johnson WD, Riley LW. Urban epidemic of severe leptospirosis in Brazil. Salvador Leptospirosis Study Group. Lancet 1999; 354: 820– 825.
2005 Copyright by the European Society of Clinical Microbiology and Infectious Diseases, CMI, 11, 856–858