Case 154. Leptospirosis (71 y-o F)
　 　 　 　 　
　 　 Autopsied kidney of a housewife, presenting headache, muscle pain, jaundice and oliguric hematuria 　 　
　 　 　 　 　
　 　
Key words : Leptospira interrogans, Weil's disease, nephritis
 　 　
　 　 　 　 　
　 　
zoonosis
 　 　
　 　 　
　
　 　 　
The renal interstitium reveals mild lymphoplasmacytic infiltration (HE). The histologic change appears to be mild, when compared with the serious clinical manifestations. 　 Warthin-Starry's silver demonstrates infection of finely spiral microbes in the renal interstitium, confirming the diagnosis of leptospirosis or Weil's disease (oil immersion).
　 　 　
　
　 　 　
Hepatic lesion in the same case
Mild portal infiltration of lymphoid cells and distorted liver cell cords with intercellular edema are observed (HE).　Hepatocytes are not necrotic. Similar to the situation in the kidney, the histologic change is relatively mild when compared with the serious clinical manifestation.		 　 Striated muscle lesion in the same case
Rhabdomyolysis is focally observed (HE).　Muscle pain (particularly, pressure pain in the calf muscle) is characteristic of leptospirosis.
　 　 　
　
　 　 　
Meningeal lesion in the same case
Minimal lymphoid infiltation is seen in the subarachnoid space (HE).　Distinction from aseptic meningitis is needed.		 　 Reference case 154A
Warthin-Starry's silver for the urine sediment in case of leptospirosis (67 y-o M).　A few coiled argyrophilic microbes are seen on the urothelial cell.
　 　 　
　
　 　 　
Reference case 154A
Leptospira interrogans in blood cultured in Korthof's medium (Giemsa).　Leptospira is resistant to be stained with Giemsa's solution.		 　 Reference case 154A
Scanning electron micrograph of Leptospira interrogans.　Regular spiral structure of 0.5 mm periodicity is characteristic of cultured vLeptospira interrogans. Compare with the morphology of Borrelia burgdorferi in case 167.
　 　 　
　 　
　 　 　
Reference case 154B
Borrelia recurrentis in the blood in an African patient of relapsing fever (Giemsa).　Spiral microbes are easily identified in the blood in an early stage of relapsing fever. Borrelia species is relatively easy to be stained with Giemsa.