Suspected leptospiral meningitis in adults: report of four cases and review of the literature.
Bibliographic record
Abstract
BACKGROUND: Leptospirosis is a widespread zoonotic disease characterised by headache and fever. These symptoms are often suggestive of meningitis, but only a proportion of patients have leptospiral meningitis. METHODS: We report episodes of leptospiral meningitis in patients admitted to a tertiary referral centre in the Netherlands, in whom lumbar puncture was performed, and conducted a literature search of adult cases of leptospiral meningitis to describe clinical characteristics and outcome. RESULTS: Between 2011 and 2014, 19 patients with leptospirosis were identified. Seven underwent a lumbar puncture for suspected meningitis (37%), of which six had been in contact with fresh water in a tropical area. Four patients with suspected meningitis (57%) had cerebrospinal fluid pleocytosis indicative of leptospiral meningitis and presented with headache, fever and neck stiffness. In a review of the literature we identified 366 patients with leptospiral meningitis with a median age of 33 years (range 17-77). Risk factors for leptospirosis were identified in 32 of 33 patients. Typical cerebrospinal fluid abnormalities consisted of a mildly elevated leukocyte count (median 206 leukocytes/mm3, range 6-2072) with a lymphocytic predominance (median 95%). Outcome was generally favourable, with a mortality rate of 3% and neurological sequelae in 5% of the survivors. CONCLUSION: Leptospirosis in the Netherlands has a low incidence. In the case of suspected meningitis and a history of visiting tropical areas or direct or indirect contact with animal urine, leptospiral meningitis should be considered. Cerebrospinal fluid examination is vital for the differential diagnosis of leptospirosis. Outcome is generally favourable in patients with leptospiral meningitis treated with antibiotics.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".