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