THE PATHOGENESIS OF LEPTOSPIRAL JAUNDICE

Abstract

An analysis of the data obtained from the study of 235 cases of leptospirosis would indicate that there is no evidence in support of hemolysis as a dominant factor in the genesis of icterus. No relation of cause and effect of anemia and jaundice was evident. Severe bilirubinemia appeared with unaltered red cell or hemoglobin values in the well hydrated patients. Even among the anicteric, anemia may be attributed to blood loss, either internal or external, a negative nitrogen balance, high fever, azotemia (most prominent among the icteric, but rather common among the anicteric), parasitic infestations with chronic blood loss, and, in some instances, frequent phlebotomies for numerous laboratory examinations. Laboratory evidence of hepatic dysfunction was recorded in both the anicteric and the icteric: abnormal cephalin flocculation, hyperbilirubinemia, urobilinogenuria, abnormal bromsulfalein test, and impairment in synthesis of the serum proteins and cholesterol esters. The most intense hepatic dysfunction occurred during the 2d week of illness, as evidenced by the maximal increases in bilirubin and the alterations in cholesterol esterification. The main factor governing the pathogenesis of icterus in leptospirosis is a decreased functional capacity of the liver.