Leptospirosis continues to be a zoonotic infectious disease with a complicated diagnosis.
Leptospira is a spiral bacterium that causes leptospirosis. Photo: Shutterstock.
Leptospirosis (LS) is considered the most common zoonotic disease globally and continues to be an underrecognized and underdiagnosed condition.
The Centers for Disease Control and Prevention (CDC) estimate 100 to 150 cases of LS each year in the United States, with about 50% of those cases occurring in Puerto Rico.
In the country, around 15 to 100 suspected cases of LS are specifically registered between the period of 2000 and 2009, with 59 cases and 1 death reported in 2010. Doctors in previous interviews with the Journal of Medicine and Public Health (MSP) have reiterated that the disease on the island
it is underestimated due to the lack of widespread diagnostic tests, environmental surveillance programs to monitor the incidence of cases in animals, and actual circulating serovars, among other factors.
The condition is once again gaining notoriety in Puerto Rico as a result of a reported case of a 43-year-old man with a medical history of schizophrenia who presented at a hospital in the country after experiencing a week of intermittent fever, myalgia, and weakness. general.
It is indicated in the report that the patient had been found in a swampy area, a place where rodents live. Among the most notable symptoms, it was indicated that the man presented diffuse jaundice and mild abdominal tenderness.
Among the laboratories performed, parameters associated with a bacterial infection were noted and an abdominopelvic computed tomography scan revealed accumulation of peripancreatic fat, which raised suspicion for a diagnosis of pancreatitis, the authors report.
Once the patient was transferred to the intensive care unit, he developed several episodes of hematemesis, leading to hemodynamic instability and severe respiratory problems. Due to respiratory failure, endotracheal intubation was performed.
The patient was diagnosed on the basis of his symptoms with LS and was started on broad-spectrum parenteral antibiotics. Despite 72 hours of antibiotic treatment, the patient’s clinical condition deteriorated and he required high doses of norepinephrine and vasopressin.
However, due to the patient’s clinical progression, the doctors decided to start continuous renal replacement therapy (CRRT) by hemodialysis, which is used in critically ill patients with acute kidney injury (AKI).
Within 24 hours of starting CRRT, the patient’s clinical status improved dramatically, including his respiratory function, and he was able to be extubated. Days later, the diagnosis of LS was confirmed by testing, and in addition, renal function improved and he was discharged 12 days later.
When a patient with LS faces acute complications of renal function, it is called Weil’s syndrome (icteric leptospirosis), which includes symptoms such as jaundice and, in general, azotemia, anemia, altered consciousness, and continuous fever. According to the literature, it carries a mortality rate of 10%.
Therefore, it is essential that doctors recognize the disease in time, and that new treatment modalities could benefit these patients who present the same clinical picture as the one detailed in the publication.
Furthermore, they contend that early initiation of CRRT has been shown to greatly reduce the mortality associated with Weil’s disease.
A recent systematic review of 80 studies from 34 countries on LS morbidity and mortality revealed that the global incidence and mortality is around 1.03 million cases and 58,900 deaths each year.
Nearly half of the reported deaths were adult males ages 20 to 49.
Access the case here.