Leptospirosis in a Japanese urban area: A case report and literature review

Shimizu, Yukiko; Sakamoto, Naoya; Ainoda, Yusuke; Hikone, Mayu; Kobayashi, Kenichiro; Iwabuchi, Sentaro; Koizumi, Nobuo; Ohnishi, Koji

doi:10.1016/j.jiac.2013.10.012

Cited by 5 publications

(5 citation statements)

References 23 publications

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“…En humanos la leptospirosis clínica se manifiesta con fiebre abrupta, dolor de cabeza, enrojecimiento conjuntival, fotofobia, ictericia, náuseas y vómito (Lin et al, 2008;Shimizu et al, 2014). Los signos clínicos pueden ser totalmente variables y están asociados con el serovar adaptado al hospedero, por ejemplo el serovar hardjo es el más frecuente en bovinos en Norte América, el cual resulta en la presentación de la enfermedad, sin embargo, otros serovares pueden estar asociados con la infeccion por leptospirosis incluyendo icterohaemorrhagiae, bratislava, pomona, canicola ygrippotyphosa.…”

Section: Introductionunclassified

Determinación de Leptospira spp. en humanos y bovinos pertenecientes al municipio de Toca, Boyacá

Pulido-Medellín

Díaz-Anaya

Forero

2017

vetzo

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Section: Introductionunclassified

Determinación de Leptospira spp. en humanos y bovinos pertenecientes al municipio de Toca, Boyacá

Pulido-Medellín

Díaz-Anaya

Forero

2017

vetzo

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“…Reportedly, the annual incidence of leptospirosis is very low (0.01–0.03 per 100 000 people) 5. Additionally, for leptospirosis cases reported in Japan, the mean duration of disease was approximately 6 days from symptom onset to treatment initiation 4. Specifically, leptospirosis was not included in the initial differential diagnosis in our patient because this case occurred in Nagano, a prefecture of Japan with no reported case of leptospirosis between 2007 and 2016 6.…”

Section: Discussionmentioning

confidence: 87%

“…A prompt and accurate diagnosis of leptospirosis is crucial to reduce mortality in patients with a severe infection. Additionally, an inaccurate or delayed diagnosis of leptospirosis can easily occur in specific cases such as in those originating in endemic or epidemic area of other infectious diseases and non-endemic areas of leptospirosis 2–4. Here, we report the case of a patient with a delayed diagnosis of severe leptospirosis and a positive serological test for spotted fever rickettsiosis.…”

Section: Introductionmentioning

confidence: 95%

Severe leptospirosis in a patient with positive serological test for spotted fever rickettsiosis

Harada¹,

Hayashi

2019

BMJ Case Rep

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Here, we report a case of a 64-year-old man with severe leptospirosis infected in an area in Japan that is non-endemic to leptospirosis. Initially, findings of high-grade fever, mild generalised arthralgia, rashes on the trunk, mild thrombocytopenia, elevated liver enzymes and renal dysfunction led to the suspicion of rickettsiosis, which was an endemic infectious disease in the area. Subsequently, leptospirosis was also considered after carefully reviewing patient history, which revealed that he may have been exposed to mice urine. Finally, leptospirosis was diagnosed after the serum indicated a positive PCR for leptospirosis. Furthermore, due to serum antibody positivity for Rickettsia japonica, false-positivity or coinfection of spotted fever rickettsiosis was suspected. Despite the delayed diagnosis, the patient recovered with antibiotic treatment. Thus, to prevent diagnostic errors, leptospirosis should be potentially considered with high suspicion in patients with acute undifferentiated fever, even in non-endemic areas of leptospirosis.

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“…This case report is the first, to the best of our knowledge, about leptospirosis in a homeless patient in an urban area of Tokyo. Major causes of infection in previous reports were occupational hazards or continuous contacts with rats inside the patients’ own houses [ 14 ]. Leptospirosis in the present case was probably caused by exposure to urine from rats inhabiting the parks and streets of Tokyo.…”

Section: Discussionmentioning

confidence: 99%

Leptospirosis infection in a homeless patient in December in Tokyo: a case report

2015

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IntroductionWe report a case of severe leptospirosis that occurred during winter in Tokyo, the capital of Japan. Leptospirosis is endemic in tropical regions and extremely rare in the urban areas of Japan. Only six new cases were reported in Tokyo in 2014. Most leptospirosis cases reported in urban areas of Japan were a result of occupational hazards, and there is no previous report of leptospirosis in a homeless patient in Tokyo. We believe this report could provide a widened perspective about the clinical presentation and epidemiology of leptospirosis in Japan.Case presentationOur patient was a 73-year-old Asian man. He had been homeless for over 10 years, with exposure to rodents and their excrement in parks and on the streets. He presented with fever and severe inflammatory response, satisfying the diagnostic criteria for systemic inflammatory response syndrome. Laboratory findings showed multiple-organ dysfunction, including renal failure, liver failure with increased total bilirubin level, and coagulopathy with decreased platelets. We suspected leptospirosis on the basis of these clinical findings. The diagnosis was also confirmed by polymerase chain reaction first, and paired antibody titers on day 9, in the recovery period, showed positive results for three species.ConclusionsOur patient’s case suggests that even patients without a history of traveling abroad or exposure to freshwater can develop leptospirosis in winter in urban areas in Japan. If a patient has symptoms like fever, calf pain and MOF; as a differential diagnosis we should rule outthe Leptospirosis. From the perspective of sensitivity, specificity, and clinical convenience, polymerase chain reaction could be the preferred diagnostic tool of choice.

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Leptospirosis in a Japanese urban area: A case report and literature review

Cited by 5 publications

References 23 publications

Determinación de Leptospira spp. en humanos y bovinos pertenecientes al municipio de Toca, Boyacá

Determinación de Leptospira spp. en humanos y bovinos pertenecientes al municipio de Toca, Boyacá

Severe leptospirosis in a patient with positive serological test for spotted fever rickettsiosis

Leptospirosis infection in a homeless patient in December in Tokyo: a case report

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