Elsevier

Human Pathology

Volume 32, Issue 7, July 2001, Pages 750-752
Human Pathology

Case Studies
Leptospirosis mimicking acute cholecystitis among athletes participating in a triathlon,☆☆

https://doi.org/10.1053/hupa.2001.25599Get rights and content

Abstract

Leptospirosis, a disease acquired by exposure to contaminated water, is characterized by fever accompanied by various symptoms, including abdominal pain. An acute febrile illness occurred in athletes who participated in an Illinois triathlon in which the swimming event took place in a freshwater lake. Of 876 athletes, 120 sought medical care and 22 were hospitalized. Two of the athletes had their gallbladders removed because of abdominal pain and clinical suspicion of acute cholecystitis. We applied an immunohistochemical test for leptospirosis to these gallbladders and demonstrated bacterial antigens staining (granular and filamentous patterns) around blood vessels of the serosa and muscle layer. Rare intact bacteria were seen in 1 case. These results show that leptospirosis can mimic the clinical symptoms of acute cholecystitis. If a cholecystectomy is performed in febrile patients with suspicious environmental or animal exposure, pathologic studies for leptospirosis on formalin-fixed, paraffin-embedded tissues may be of great value. HUM PATHOL 32:750-752. This is a US government work. There are no restrictions on its use.

Section snippets

Materials and methods

Four-micron sections of the gallbladder tissues were placed on Fisher Plus slides (Fisher Scientific Co, Pittsburgh, PA). Sections were deparaffinized, rehydrated, and digested in 0.1 mg/mL Proteinase K (Boehringer Mannheim Biochemicals, Indianapolis, IN) in 0.6 mol/L Tris (pH 7.5)/0.1% CaCl2 for 15 minutes. After washing, a mixture of reference rabbit polyclonal antisera reactive with 16 leptospiral strains (Centers for Disease Control and Prevention, Atlanta, GA)6 was allowed to incubate for

Results

A 29-year-old woman and a 60-year-old man who participated in the Illinois triathlon presented to emergency departments in their respective hometowns (Illinois and Nebraska) because of fever and abdominal pain. Cholescystectomy was performed because of clinical suspicion of acute cholecystitis. Postoperative recovery was uneventful for both patients. At the time of surgery, the outbreak investigation had not yet started, and samples for serologic tests had not been obtained. A serum sample

Discussion

In this study, we made the pathologic diagnosis of leptospirosis by demonstrating granular and filamentous IHC staining in sections from 2 gallbladders. Pathologic and IHC studies can be particularly useful when the only diagnostic specimens available are formalin-fixed, paraffin-embedded tissues. Interpretation of IHC assays can be difficult in cases in which no intact bacteria and only granular and filamentous staining are seen. Of the 2 cases presented here, only 1 had intact bacteria. For

Acknowledgements

The authors thank the physicians, laboratorians, and public health officials in the Nebraska and Illinois State Health Departments, Centers for Disease Control and Prevention, the Pathology Center in Nebraska, and Central Dupage Hospital in Illinois for their help gathering information and handling specimens. They especially thank Tara Ferebee-Harris and Tim Morken for their technical assistance.

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Address correspondence and reprint requests to Jeannette Guarner, MD, Centers for Disease Control and Prevention, Mailstop G32, 1600 Clifton Rd, NE, Atlanta, GA 30333.

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