The diagnosis of leptospirosis complicated by pulmonary tuberculosis complemented by metagenomic next-generation sequencing: A case report

Abstract

Leptospirosis is a zoonotic infection caused by the pathogenic Leptospira. Leptospirosis is transmitted mainly through contact with contaminated rivers, lakes, or animals carrying Leptospira. Human leptospirosis has a wide range of non-specific clinical manifestations ranging from fever, hypotension, and myalgia to multi-organ dysfunction, which severely hampers the timely clinical diagnosis and treatment of leptospirosis. Therefore, there is an urgent clinical need for an efficient strategy/method that can be used for the accurate diagnosis of leptospirosis, especially in critically ill patients. Here, we report a case of a 75-year-old male patient with clinical presentation of fever, cough, and diarrhea. Initial laboratory tests and a computed tomography (CT) scan of the chest suggested only tuberculosis. The patient was finally diagnosed with pulmonary tuberculosis (PTB) combined with leptospirosis by sputum Xpert MTB RIF, epidemiological investigations, and delayed serological testing. Furthermore, through metagenomic next-generation sequencing (mNGS) of clinical samples of cerebrospinal fluid (CSF), urine, plasma and sputum, the causative pathogens were identified as Mycobacterium tuberculosis complex and Leptospira spp. With specific treatment for both leptospirosis and tuberculosis, and associated supportive care (e.g., hemodialysis), the patient showed a good prognosis. This case report suggests that mNGS can generate a useful complement to conventional pathogenic diagnostic methods through more detailed etiological screening (i.e., at the level of species or species complex).

Pulmonary tuberculosis complicated by extensive and multiple ground-glass opacity diagnosed by metagenomic next-generation sequencing in a patient with normal immune function: A case report

“…mNGS can quickly identify multiple pathogens with unbiased, wide coverage, high e ciency, as well as assumption and minimize missed diagnosis [2,3] . There have been many reports of Mycobacterium tuberculosis infection being diagnosed through mNGS [15,16] . In addition, the retrospective study showed that the sensitivity of mNGS in tuberculosis diagnosis was 46%, signi cantly higher than that of the culture method [17] .…”

Unraveling the leptospirosis epidemic: tales from the Philippine outbreak – a short communication

“…These disasters increase the risk of water sources and the environment becoming contaminated with Leptospira bacteria. Secondly, poor sanitation and hygiene practices, especially in urban areas, contribute to the spread of the disease 16 . Additionally, there is a lack of awareness and understanding about leptospirosis among the general population, health workers, and policymakers, which hampers effective prevention and control efforts.…”