Fulminant Leptospirosis (Weil's disease) in an urban setting as an overlooked cause of multiorgan failure: a case report

Abstract

IntroductionLeptospirosis 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 presentationA 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.ConclusionThe 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.

Efficacy of cefepime, ertapenem and norfloxacin against leptospirosis and for the clearance of pathogens in a hamster model

“…Diarrhea was not found in hamsters treated with cefepime in our experiment. In addition, the use of cefepime for human leptospirosis was also reported [26,27]. Our data support the efficiency of cefepime on improving survival in vivo and alleviating tissue injury.…”

Leptospirosis with Acute Liver Injury

“…Nearly 90% of cases are considered mild, and oral doxycycline or amoxicillin may be used. For severe cases, parenteral high-dose penicillin G or ceftriaxone is recommended (8). …”

Efficacy of the Rabbit Polyclonal Anti-leptospira Antibody against Homotype or Heterotype Leptospira Infection in Hamster

“…However, the excellent efficiency of the antibiotic is beyond doubt. For example, cefepime was reported for use in human leptospirosis [34,35]. Therefore, polyclonal antibody treatment and antibiotic therapy can be used together to treat leptospirosis.…”