Fulminant Leptospirosis as a Cause of Multiorgan Failure
Fulminant Leptospirosis as a Cause of Multiorgan Failure
Introduction: Leptospirosis has recently come to international attention as a globally important re-emerging infectious disease. Our case is unusual given the season, location and setting in which leptospirosis occurred. According to the New York City Board of Health, there were only two other cases of leptospirosis in New York City in the year that our patient was diagnosed.
Case presentation: A 49-year-old healthy Chinese man presented to our hospital with sepsis and multiorgan failure. The patient did not respond to antibiotics and his multiorgan failure worsened. His workup did not show any significant findings except for a positive nasopharyngeal swab result for influenza A. Later the patient developed hemoptysis with evidence of bilateral infiltrates on radiography. His status mildly improved after he was started on steroids. Eventually, a microagglutination test confirmed the presence of antibodies against Leptospira icterohaemorrhagiae. The patient subsequently recovered after a course of intravenous antibiotics.
Conclusion: The case of fulminant leptospirosis presented here should serve to alert health care providers and the general public to the clinical importance of this severe, sometimes fatal, disease. Leptospirosis should be considered early in the diagnosis of any patient with acute, non-specific febrile illness with multiorgan system involvement or high fever in a returning traveler. In addition, not only should it be considered in tropical and rural areas between late summer to early fall, but also in any location or time if the risk factors are present.
Leptospirosis is a zoonosis of worldwide distribution caused by infection with Leptospira interrogans, a pathogenic spirochete. The most important reservoirs are rodents, predominantly rats. Urinary shedding of organisms from infected animals is the most significant source of Leptospira spp. The majority of patients manifest a mild, anicteric febrile illness, but a minority of patients develop a severe form with multiorgan involvement, called Weil's disease. Weil's disease is characterized by multisystem dysfunction and can present with high fever, significant jaundice, renal failure, hepatic necrosis, pulmonary involvement, cardiovascular collapse, neurologic changes and hemorrhagic diathesis.
Abstract and Introduction
Abstract
Introduction: Leptospirosis has recently come to international attention as a globally important re-emerging infectious disease. Our case is unusual given the season, location and setting in which leptospirosis occurred. According to the New York City Board of Health, there were only two other cases of leptospirosis in New York City in the year that our patient was diagnosed.
Case presentation: A 49-year-old healthy Chinese man presented to our hospital with sepsis and multiorgan failure. The patient did not respond to antibiotics and his multiorgan failure worsened. His workup did not show any significant findings except for a positive nasopharyngeal swab result for influenza A. Later the patient developed hemoptysis with evidence of bilateral infiltrates on radiography. His status mildly improved after he was started on steroids. Eventually, a microagglutination test confirmed the presence of antibodies against Leptospira icterohaemorrhagiae. The patient subsequently recovered after a course of intravenous antibiotics.
Conclusion: The case of fulminant leptospirosis presented here should serve to alert health care providers and the general public to the clinical importance of this severe, sometimes fatal, disease. Leptospirosis should be considered early in the diagnosis of any patient with acute, non-specific febrile illness with multiorgan system involvement or high fever in a returning traveler. In addition, not only should it be considered in tropical and rural areas between late summer to early fall, but also in any location or time if the risk factors are present.
Introduction
Leptospirosis is a zoonosis of worldwide distribution caused by infection with Leptospira interrogans, a pathogenic spirochete. The most important reservoirs are rodents, predominantly rats. Urinary shedding of organisms from infected animals is the most significant source of Leptospira spp. The majority of patients manifest a mild, anicteric febrile illness, but a minority of patients develop a severe form with multiorgan involvement, called Weil's disease. Weil's disease is characterized by multisystem dysfunction and can present with high fever, significant jaundice, renal failure, hepatic necrosis, pulmonary involvement, cardiovascular collapse, neurologic changes and hemorrhagic diathesis.
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