Cognitive impairment following leptospirosis encephalitis: case report and literature review
Notice bibliographique
Résumé
Case presentation: A 67-year-old woman was admitted to the hospital after episodes of epileptic seizures and mental confusion. She reported anxiety, disorientation, and headaches for the past 15 days. On initial examination, she was confused, drowsy, with signs of meningeal irritation. The cranial nerves were preserved. No alteration in strength or reflexes were found. Glasgow score was 13. A cranial MRI revealed extensive areas of T2/FLAIR hypersignal, severe microangiopathy, and pial enhancement by contrast in the right temporo-parieto-occipital region, in addition to positive Ig M serology for leptospirosis. She was treated with ampicillin and sulbactam. On the 3rd day of admission, there was a worsening of consciousness level, recurrent epileptic seizures, hyponatremia, and worsening renal function, leading to orotracheal intubation and mechanical ventilation for status epilepticus treatment. After 30 days hospitalized, she showed clinical and neurological improvement and was discharged with phenytoin and levetiracetam medication. Prior to hospitalization, she used lithium and sertraline to treat her bipolar affective disorder (BAD) diagnosed in her youth. After discharge, she began to presente cognitive complaints. During the neurologist consultation, the Montreal Cognitive Assessment (MoCA) test was 18 out of 30 points. The diagnostic hypothesis was multifactorial cognitive impairment secondary to deterioration of BAD associated with sequelae of leptospirosis encephalitis and vascular lesions. Discussion: Encephalitis is an acute inflammation of the central nervous system (CNS), specifically of the brain parenchyma, often caused by viruses such as influenza, herpes simplex, arboviruses, and in endemic areas like Brazil, dengue, Zika and Chikungunya viruses can also be pathogenic agents. Less commonly, bacterial pathogens such as Leptospira species can lead to this clinical manifestation. Leptospirosis is a zoonosis of significant global concern, prevalent in tropical climates and associated with lower economic levels. The disease is transmitted through contact of an open wound with the urine of the transmitting animal and can manifest in various clinical forms, although neurological presentation is uncommon (about 10-15% of Leptospirosis cases). The CNS can be affected by this zoonosis either through direct infection of the brain parenchyma or secondarily through hepatorenal involvement. This CNS involvement may manifest as meningitis or encephalitis. Final comments: Therefore, due to encephalitis being a medical emergency and this manifestation of Leptospirosis being considered rare, many physicians may not consider this possibility and may mismanage the patient or even miss the appropriate time to start treatment to prevent more severe sequelae. It is essential that, especially in the most prevalent areas of this significant zoonosis, this clinical manifestation must be adequately investigated and treated promptly.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,005 | 0,005 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,002 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».