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"Leptospirosis is a wide-spread zoonosis in the world, especially in the tropical countries. Ninety percent of cases are characterized by abrupt fever and have good prognosis, but in 10% of cases, exacerbation will occur and the mortality rate is about 10%. Leptospirosis may strike the entire organ, including gastrointestinal tract. Pancreatitis in leptospira is characterized by increased serum amylase levels, with mean values of five times normal. Early diagnosis and prompt treatment will engender good prognosis. Treatment of acute pancreatitis caused by leptospira is similar with other acute pancreatitis treatment caused by other agents. The pathophysiology of leptospira infection includes endotoxin, hemolysis and lipase."

"Menentukan penyebab kolestasis merupakan tantangan tersendiri, namun hal itu perlu mendapatkan perhatian khusus karena akan menentukan langkah selanjutnya. Leptospirosis, yang dapat bermanifestasi sebagai kolestasis, mempunyai gambaran klinis yang sangat bervariasi sehingga penegakkan diagnosis seringkali sulit. Pada makalah ini dilaporkan kasus laki-laki, usia 50 tahun dengan nyeri perut kanan atas dan kolestasis disertai gangguan fungsi ginjal, pneumonia dan gambaran EKG abnormal. Pemeriksaan serologi leptospira menunjukkan hasil IgM positif. Perlu dipertimbangkan pemeriksaan screening leptospirosis pada pasien dengan kolestasis terutama pasien dengan risiko tinggi terinfeksi leptospira.

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Discovering the etiology of cholestasis is challenging, but it requires particular rconsideration, because it will determine our next steps. While leptospirosis may cause cholestasis, leptospirosis has diverse clinical spectrum so that it is often difficult to establish the diagnosis. We reported a fifty-year-old man with right upper quadrant abdominal pain and cholestasis. In addition, we also found distorted renal function, pneumonia, and ECG abnormalities. The patient underwent serologic test for leptospiral infection and the IgM was positive. These findings showed the necessity for considering leptospirosis screening in patients with cholestasis especially those in higher risk group."

"Leptospirosis is a zoonotic disease cause by a microorganism? leptospira, with animals especially rats acting as the reservoir host. Humans are infected by direct contact with urine or tissues of the infected animals and indirectly by contaminated water, soil, and vegetation leptospira. Infection can result in acute renal failure, or liver damage and pancreas.In this case patient with the problem is leptospirosis, acute pancreatitis and acute renal failure. Serologic test resulted in positive leptospira with titer 400 for serovar Hardjo and titer 100 for serovar Bataviae."

"Recurrent acute pancreatitis is often caused by excessive alcohol intake and bile stones. Patients suffering from more than one episode of acute pancreatitis are diagnosed with recurrent acute pancreatitis. The etiology of recurrent acute pancreatitis is known in 70 to 90% of patients after evaluation incorporating history taking, physical examination, routine laboratory assessment, and transabdominal ultrasonography or CT scan. However, the etiology of 10 to 30% of patients with recurrent acute pancreatitis remains undetermined. Further more sensitive evaluation is often performed, such as ERCP, ultrasound endoscopy, or MRCP, in order to determine the cause for recurrent acute pancreatitis. These tests are usually able to diagnose microlithiasis, sphincter oddi dysfunction, or pancreatic division,3-4'5-6>7.Medina- Perez M, Garcia Ferris G, Caballow Gomes J, Hospital de la Merced, and Ossuna Sevilla reported a rare case on a 33-year old woman with recurrent acute pancreatitis related with an anatomical abnormality in the form of a duplicate duodenal ampulla with multiple stones2 Even though several researches were able to detect microlithiasis in less than 10% of all patients with recurrent acute pancreatitis, most of them found microlithiasis in approximately two thirds of the patients.3"

"Tuberculosis is a common infectious disease in our community. The management of this disease become more difficult and also the prognosis when there were an advanced complication and a high prevalence of multidrugs resistance. We report a -10-year-old female patient with pyopneaenatorax with history of discontinuing tuberculosis drugs before"

"Sampai dengan tahun 2013 dilaporkan ada 13 kasus leptospirosis di Kabupaten Banyumas.Terjadinya peningkatan kasus selama dua tahun terakhir perlu mendapat perhatian dari berbagai pihak agar kasus leptospirosis bisa segera ditangani. Tujuan penelitian ini adalah memetakan kasus leptospirosis dan menganalisis faktor risiko lingkungan dan perilaku yang memengaruhi leptospirosis. Penelitian ini menggunakan desain studi observasional kasus kontrol. Pengumpulan data dilakukan dengan wawancara, observasi, dan pengukuran. Analisis data menggunakan analisis spasial, analisis univariat, dan bivariat. Kasus adalah penderita leptospirosis berjumlah 13 orang dan kontrol adalah tetangga kasus yang tidak menderita leptospirosis berjumlah 52 orang. Hasil pemetaan menunjukkan kasus leptospirosis di Kabupaten Banyumas termasuk daerah aliran sungai dengan radius 600 meter ke sungai; seluruh kasus dekat dengan sawah (jarak < 1 km); sebagian besar memiliki vegetasi ≥ 3 jenis dan berada di daerah dengan curah hujan tinggi. Faktor lingkungan yang terbukti berhubungan dengan leptospirosis adalah kondisi jalan yang buruk sekitar rumah (OR = 4,90; CI 95% = 1,35 - 17,10). Faktor perilaku yang berhubungan dengan leptospirosis adalah kebiasaan mandi/mencuci di sungai (OR = 4,35; 95% CI = 1,21 - 15,60), riwayat peran serta dalam kegiatan sosial yang beresiko (OR = 12,00; 95% CI = 1,45 - 99,09) dan penggunaan alat pelindung diri (OR = 7,50; 95% CI = 1,00 - 62,18).

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There were 13 Leptospirosis cases in Banyumas in 2013. The increasing incidents in last 2 years should get an attention from all institutions. The study conducted was to map incidence of leptospirosis and analyze the environmental and behavior risk factors which associated leptospirosis case. This research was observational by case-control approach. The data was collected through interviews, observation and test. For analyzing the data, the researcher applied spatial analysis, univariate, and bivariate analysis. It was 13 leptospirosis cases and 52 people as the controls; they are the neighbors who are free from leptospirosis.The mapping showed that leptospirosis cases in Banyumas were along the riverin 600 meters radius, all cases with the distance of 0 - 1 km into the rice field, had vegetation ≥ 3 species and those were in areas with high rainfall intensity. Environmental risk factor associated with leptospirosis was a bad road conditions around the house (OR = 4,90; CI 95% = 1,35 - 17,10). Behavior risk factors werethe bathing/washing habit in the river (OR = 4,35; 95% CI = 1,21 - 15,60, a history of participation in social activities (OR = 12,00; 95% CI = 1,45 - 99,09)and the use of personal protective equipment (OR = 7,50; 95% CI = 1,00 - 62,18). "