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Volume 25, Number 5—May 2019
Dispatch

Severe Myasthenic Manifestation of Leptospirosis Associated with New Sequence Type of Leptospira interrogans

Matthias Tomschik1Comments to Author , Inga Koneczny1, Anna-Margarita Schötta, Sebastian Scharer, Merima Smajlhodzic, Paloma Fernandes Rosenegger, Martin Blüthner, Romana Höftberger, Fritz Zimprich, Gerold Stanek, and Mateusz Markowicz
Author affiliations: Medical University of Vienna, Vienna, Austria (M. Tomschik, I. Koneczny, A.-M. Schötta, S. Scharer, M. Smajlhodzic, P.F. Rosenegger, R. Höftberger, F. Zimprich, G. Stanek, M. Markowicz); Medizinisches Versorgungszentrum Labor PD Dr. Volkmann und Kollegen GbR, Karlsruhe, Germany (M. Blüthner)

Main Article

Figure 2

Timeline of medical history for patient with severe myasthenic manifestation of leptospirosis, including results of relevant neurologic and laboratory investigations. Decrement in repetitive stimulation denotes the maximum decrease in amplitude of the fourth or fifth compound muscle action potential waveform during supramaximal repetitive nerve stimulation at 3 Hz. A decrement >10% is regarded as pathologic (6). Leptospira ELISA cutoff values: IgG, <10 U/mL negative, 15 U/mL positive; IgM,

Figure 2. Timeline of medical history for patient with severe myasthenic manifestation of leptospirosis, including results of relevant neurologic and laboratory investigations. Decrement in repetitive stimulation denotes the maximum decrease in amplitude of the fourth or fifth compound muscle action potential waveform during supramaximal repetitive nerve stimulation at 3 Hz. A decrement >10% is regarded as pathologic (6). Leptospira ELISA cutoff values: IgG, <10 U/mL negative, 15 U/mL positive; IgM, <15 U/mL negative, >20 U/mL positive. CRP, C-reactive protein; LRP4, lipoprotein receptor-related protein 4.

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1These authors contributed equally to this article.

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