Recreational ‘mud fever’: Leptospira interrogans induced diffuse alveolar hemorrhage and severe acute respiratory distress syndrome in a U.S. Navy seaman following ‘mud-run’ in Hawaii

Abstract

A 23-year-old man with a viral-like prodrome developed sudden severe dyspnea and was found to have renal failure, anemia, shock, and diffuse alveolar hemorrhage with acute respiratory distress syndrome, requiring emergent endotracheal intubation and extracorporeal membrane oxygenation (ECMO). Travel and exposure history from peripheral sources revealed that the patient had participated in a ‘mud-run’ in Hawaii two weeks prior to symptom onset. The patient was subsequently diagnosed with leptospirosis and treated with ceftriaxone and doxycycline. He was discharged on hospital day 13 with full recovery. Leptospirosis is associated with exposure to water, soil, or other matter contaminated with urine of carrier animals. It has been associated with a multitude of activities over time; most recently recreational water-based activities including ‘mud-runs’ in endemic areas have been added to the list of routes of exposure. This case underscores the importance of obtaining a thorough epidemiological exposure and travel history and being aware of areas of endemicity for life-threatening infections. Additionally, to our knowledge this is the second case of a patient in the United States treated with ECMO for leptospirosis induced pulmonary hemorrhage.

Leptospirosis with pulmonary haemorrhage and multiple organ failure: a case report and literature review

“…It can detect Leptospira DNA in specimens quickly and accurately during the early stage of the infection. 21,22 Fifteen other reports [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] have described different diagnostic methods for severe leptospirosis requiring extracorporeal membrane oxygenation. As shown in Table 2, PCR, the MAT, ELISA, and NGS can be used to diagnose severe leptospirosis early.…”

Pica (Allotriophagy): An Underestimated Risk Factor for Severe Leptospirosis (Weil’s Diseases)? Report of a Leptospira Septic Shock Successfully Managed with ECMO

“…ECMO support in severe leptospirosis was previously described as an effective treatment for reducing patient mortality. Twelve recent case reports describe the use of a V-V ECMO in patients with leptospirosis complicated by ARDS and hemorrhagic pneumonia; only one patient died [ 6 , 18 , 19 , 20 ]. Two case reports described the use of V-A ECMO in two patients affected by complicated leptospirosis with (1) right ventricular overload and myocarditis and (2) cardiogenic shock and pulseless electrical activity, respectively.…”

Evidence of Leptospiral Presence in the Cumberland Gap Region

“…In Europe, more than half of human leptospirosis cases reported occupational or recreational exposure to water [36,37]. While the infectious dose of leptospires in humans is unknown, multiple incidents of infection acquired via recreational water exposure suggest that a low dose is sufficient to cause infection [38,39].…”