Jamaican with life-threatening leptospirosis treated in Cayman Islands

Wednesday, December 06, 2017

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A Jamaican father of two young children, who had a severe form of leptospirosis, can now breathe a sigh of relief following the intervention of doctors at Health City Cayman Islands.

Clester Christie, a farmer who went to Grand Cayman for work, fell seriously ill a few days after his arrival.

It turned out that the 31-year-old had a life-threatening case of leptospirosis, a release from Health City Cayman Islands said yesterday.

According to the East End, Grand Cayman facility, fortunately for Christie, internal medicine and nephrology specialist at the Health Services Authority (HSA) Dr Nelson Iheonunekwu recognised that the Jamaican's vitals were falling fast and quickly referred him to Health City Cayman Islands.

The doctors at the facility reportedly confirmed the HSA's diagnosis that Christie was suffering from a complication of the zoonotic bacterial infection leptospirosis, called leptospirosis pulmonary hemorrhagic syndrome, which is a rare bacterial disease that forms blood clots in the lungs of the afflicted.

“He came here [and at] that time he was in a very critical stage. I would say his oxygen level, his saturation level was in the 50s, so if he stayed like that a few more hours he would have arrested... within half an hour we took him to the operating room,” Dr Binoy Chattuparambil, chief cardiac surgeon and senior cardiothoracic and vascular surgeon at Health City, is quoted as saying in the release.

The release said the Health City team hooked Christie up to an Extracorporeal Membrane Oxygenation (ECMO) machine via the venovenous route to support his lungs, marking the first time the doctors had used ECMO in this manner. For previous patients, ECMO had been used to support both the heart and lungs, the release said.

Dr Dhruva Kumar Krishnan, senior consultant in cardiac anaesthesiology and intensive care, explained that the venovenous ECMO support gives the lungs a rest.

“When the lungs [have] failed to do what [they are] supposed to do, we can rest the lungs by bringing the blood out from the body into the [machine and wash] out the carbon dioxide, [add] more oxygen to it and [bring] it back into the heart. So, this machine [helps] the lungs start to function normally,” he said.

Dr Chattuparambil said their bronchoscopy examination revealed that “both lungs were packed with blood clots, both sides... the lung... was... choked — so no blood was going inside”.

This then led Dr Dhruva to perform several bronchoscopies to remove multiple blood clots.

“He had a lot of clots in his lungs so we had to clear them all... at the same time we don't want fresh bleeding to happen. He slowly improved... but again he started deteriorating when we tried taking this machine off after a couple of days... We had to do repeated bronchoscopy procedures to remove the remaining clots... before he could get better,” Dr Dhruva said.

The release said seeing Christie on the road to recovery was doubly rewarding for the doctors who treated him.

“We are very happy for this man, who is doing well now,” said Dr Dhruva.

Christie was also very grateful for the care he received at Health City, the release said.

“If I never came here, I would have died. If I was in Jamaica, I would have died... they don't have the same equipment like they do [at] Health City to help me,” Christie is quoted as saying in the release.

Meanwhile medical intensivist at Health City Dr Mahantesh Patil said in his last 15 years of clinical experience, he had not seen such a severe form of leptospirosis.

“Mr Clester, I would say he is very lucky to [have been] on the island at the right time,” Dr Patil said.

The medical intensivist also noted that the mortality rate for patients in Christie's condition is “extremely high”.

“I would say as high as 70 per cent... despite all support and if you don't have a facility to do multi-organ support, I would say he had no chance to survive,“ the doctor said.

According to HSA's Dr Iheonunekwu, who referred him to Health City Cayman Islands, he was deeply moved when he saw his former patient after his recovery.

“I was amazed,” the doctor is quoted as saying. “In fact, some of the nurses in critical care who were taking care of him, who knew how gravely sick he was, were in tears when he actually came to pay us a visit... so we were really, really moved and we were very grateful to God that he made it.

“If only people knew what Health City does, they would appreciate what was done for him. Any other place — if it was in areas where ECMO was not available — he would have died... there is no doubt about that,” Dr Iheonunekwu said.

Dr Chattuparambil also noted the severity of Christie's condition when he arrived at Health City.

“We knew that if we didn't extend help, he was going to die,” he said, adding that the facility got its reward in seeing Christie reunited with his wife and children.

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