Low serum total nitrite and nitrate levels in severe leptospirosis

BMC Infectious Diseases

Senaka Rajapakse¹  Shiroma Handunnetti⁴  H Janaka De Silva²  Pranitha Somaratne³  Thamal Vithanage¹  Chaturaka Rodrigo¹  Thilini Kalugalage⁴ 

[1]Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka

[2]Department of Medicine, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka

[3]Medical Research Institute, Colombo, Sri Lanka

[4]Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo, Colombo, Sri Lanka

关键词: Creatinine;    Severity;    Nitrite;    Nitrate;    Nitric oxide;    Leptospirosis;   

Others  :  1148506
DOI  :  10.1186/1471-2334-13-206

 received in 2012-11-26, accepted in 2013-05-01,  发布年份 2013

【 摘 要 】

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 (NO^x) in serum are considered surrogate markers for nitric oxide. NO_x are excreted through the kidneys, and elimination is diminished in renal impairment. We assessed the correlation of NO_x 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 of leptospirosis 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. NO_x levels were measured using a modified Griess reaction.

Results

Forty patients were confirmed as having leptospirosis and 26 of them had severe disease. NO_x levels were significantly higher in confirmed leptospirosis patients compared to healthy controls, MAT equivocal patients and non-leptospirosis fever patients (p<0.001). NO_x concentrations were also significantly higher in patients with severe compared to mild leptospirosis (p<0.001). Once NO_x levels were corrected for renal function, by using the ratio NO_x/creatinine, NO_x 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.

【 授权许可】

   
2013 Kalugalage et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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