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Low serum total nitrite and nitrate levels in severe leptospirosis

Show simple item record Kalugalage, T. en_US Rodrigo, C. en_US Vithanage, T. en_US Somaratne, P. en_US de Silva, H.J. en_US Handunnetti, S. en_US Rajapakse, S. en_US 2014-10-29T09:40:38Z en_US 2014-10-29T09:40:38Z en_US 2013 en_US
dc.identifier.citation BMC Infectious Diseases. 2013; 13: 206 en_US
dc.identifier.issn 1471-2334 (Electronic) en_US
dc.identifier.other 10.1186/1471-2334-13-206. en
dc.identifier.uri en_US
dc.description Indexed in MEDLINE en
dc.description.abstract BACKGROUND: The relationship between inducible nitric oxide synthatase activity and disease severity in leptospirosis is unclear. Nitric oxide is converted to nitrites and nitrates, thus nitrite and nitrate levels (NOx) in serum are considered surrogate markers for nitric oxide. NOx are excreted through the kidneys, and elimination is diminished in renal impairment. We assessed the correlation of NOx with disease severity in patients with leptospirosis, compared with healthy controls and non-leptospirosis fever patients. METHODS: All patients admitted over a two-month period to the National Hospital, Colombo, Sri Lanka with a clinical picture suggestive ofleptospirosis were included. Leptospirosis was confirmed by the microscopic agglutination test (titre ≥ 400). Severe leptospirosis was defined by the presence of two or more of the following criteria: jaundice (bilirubin> 51.3 μmol/l), oliguria (urine output < 400 ml/day), serum creatinine> 133 μmol/l or blood urea > 25.5 mmol/l, or the presence of organ dysfunction. Non-leptospirosis fever patients and healthy volunteers were used as control groups. NOx levels were measured using a modified Griess reaction. RESULTS: Forty patients were confirmed as having leptospirosis and 26 of them had severe disease. NOx levels were significantly higher in confirmed leptospirosis patients compared to healthy controls, MAT equivocal patients and non-leptospirosis fever patients (p<0.001). NOx concentrations were also significantly higher in patients with severe compared to mild leptospirosis (p<0.001). Once NOx levels were corrected for renal function, by using the ratio NOx/creatinine, NOx levels were actually significantly lower in patients with severe disease compared to other patients, and values were similar to those of healthy controls. CONCLUSIONS: We postulate that high NOx levels may be protective against severe leptospirosis, and that finding low NOx levels (when corrected for renal function) in patients with leptospirosis may predict the development of severe disease and organ dysfunction. © 2013 Kalugalage et al.; licensee BioMed Central Ltd. en_US
dc.publisher BioMed Central en_US
dc.source.uri en
dc.title Low serum total nitrite and nitrate levels in severe leptospirosis en_US
dc.type Article en_US
dc.identifier.department Medicine en_US

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