A case of a combined course of typhoid fever and leptospirosis

Abstract

These days co-infections are becoming increasingly relevant and urgent for research. The development of international tourism causes wide spreading of various infectious diseases from countries with unfavorable sanitary and hygienic conditions.
 The article analyses the clinical case of a patient who recently returned from India and who developed the combined course of typhoid fever and leptospirosis on the background of astrovirus infection and blastocystosis. The disease debuted with symptoms of enteritis, low-grade fever, and mild intoxication. The patient repeatedly sought medical help. Diagnoses of “Acute respiratory viral infection” and “Intestinal infection of unknown etiology” were established. Symptomatic therapy was carried out without a positive effect; fever and severe asthenic syndrome persisted. The patient was hospitalized on the 18th day of illness in a condition of moderate severity. Taking into account clinical, anamnestic, epidemiological data and laboratory examination results, typhoid fever was diagnosed. Using the polymerase chain reaction (PCR) method, Astrovirus RNA was detected in the stool, and Blastocystis hominis was detected during stool examination. Despite the ongoing pathogenetic and antibacterial therapy, considering the determination of the pathogen's sensitivity to antibiotics, the patient's condition worsened. On the 23rd day of illness, the appearance of jaundice, hemorrhagic syndrome, and signs of acute renal failure were noted. An in-depth analysis of changes in the clinical and laboratory aspects of the disease, considering epidemiological history data (stay in a region endemic for leptospirosis), made it possible to diagnose leptospirosis and carry out correction of antibacterial therapy. Carrying out complex intensive therapy with the use of extracorporeal treatment methods helped prevent the development of unfavorable outcomes of combined pathology.
 This clinical case illustrates the need for doctors to be wary of the problem of imported infections and to conduct additional comprehensive investigation for suspected cases.