[Leptospirosis and hemorrhagic fever with renal syndrome in northwestern Croatia].

UNLABELLED: Leptospirosis is a worldwide spread zoonosis, therefore being also present in northwest Croatia. It has been recently discovered that hemorrhagic fever with renal syndrome (HFRS) is present throughout Croatia, not just in the previously well known epidemic foci. Because of the similar clinical presentation and epidemiology of the two diseases, it is important to know the exact etiology of the current disease. The aim of this study was to determine the presentation of HFRS in northwest Croatia and possible coinfection in patients with leptospirosis. PATIENTS AND METHODS: During the 1988-2000 period, 42 patients with leptospirosis from northwest Croatia were analyzed. Leptospiral infection was confirmed in all 42 patients by microagglutination test. Serology for hantaviruses was done by ELISA test in a few patients with leptospirosis and severe renal failure.
RESULTS: In the majority of patients (37/42: 88%) acute renal failure was mild or moderate, with creatinine values below 500 mol/l. However, 12% of the patients developed severe acute renal failure, with creatinine values over 500 mol/l. The main therapeutic regime in all patients with leptospiral infection included body fluid replacement (electrolyte and glucose infusions) and antibiotic therapy. In patients with severe acute renal failure, it was necessary to introduce hemodialysis treatment. There was no fatal outcome in our patients. Over the last few years, antibody titers to hantaviruses were assessed by ELISA testing in five patients with leptospiral infection and severe form of acute renal failure, confirming HFRS persistence in northwest Croatia Testing for specific antibodies to hantaviruses has been suggested in all patients with leptospirosis and in whole Croatia, especially in northwest Croatia.