It can bind to thrombin that decreases the fibrin formation. Reduced fibrin formation increases the risk of bleeding. Leptospira also secretes sphingomyelinase and haemolysin that target red blood cells.Leptospira spreads rapidly to all organs through the bloodstream. They mainly affect the liver. They invade spaces between hepatocytes, causing apoptosis. The damaged hepatocytes and hepatocyte intercellular junctions cause leakage of bile into the bloodstream, causing elevated levels of bilirubin, resulting in jaundice. Congested liver sinusoids and perisinusoidal spaces have been reported. Meanwhile, in the lungs, petechiae or frank bleeding can be found at the alveolar septum and spaces between alveoli. Leptospira secretes toxins that cause mild to severe kidney failure or interstitial nephritis. The kidney failure can recover completely or lead to atrophy and fibrosis. Rarely, inflammation of the heart muscles, coronary arteries, and aorta are found. Diagnosis
Laboratory tests
For those who are infected, a complete blood count may show a high white cell count and a low platelet count. When a low haemoglobin count is present together with a low white cell count and thrombocytopenia, bone marrow suppression should be considered. Erythrocyte sedimentation rate and C-reactive protein may also be elevated.The kidneys are commonly involved in leptospirosis. Blood urea and creatinine levels will be elevated. Leptospirosis increases potassium excretion in urine, which leads to a low potassium level and a low sodium level in the blood. Urinalysis may reveal the presence of protein, white blood cells, and microscopic haematuria.
Fetal trimethadione syndrome (also known as paramethadione syndrome, German syndrome, tridione syndrome, among others) is a set of birth defects caused by the administration of the anticonvulsants trimethadione (also known as Tridione) or paramethadione to epileptic mothers during pregnancy.Fetal trimethadione syndrome is classified as a rare disease by the National Institute of Healths Office of Rare Diseases, meaning it affects less than 200,000 individuals in the United States.The fetal loss rate while using trimethadione has been reported to be as high as 87%. Presentation
Fetal trimethadione syndrome is characterized by the following major symptoms as a result of the teratogenic characteristics of trimethadione. Cranial and facial abnormalities which include; microcephaly, midfacial flattening, V-shaped eyebrows and a short nose
Cardiovascular abnormalities
Absent kidney and ureter
Meningocele, a birth defect of the spine
Omphalocele, a birth defect where portions of the abdominal contents project into the umbilical cord
A delay in mental and physical development

Diagnosis
Treatment
Surgery may help alleviate the effects of some physical defects, but prognosis is poor, especially for those with severe cardiovascular and cognitive problems. Speech and physical therapy, as well as special education is required for surviving children. References


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