Cognitive impairment following leptospirosis encephalitis: case report and literature review
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.005 | 0.005 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
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 source (direct Gemma or distilled Codex), 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".