Uncommon manifestation of leptospirosis: a diagnostic challenge

Abstract

Leptospirosis is a zoonotic disease commonly affecting the tropical countries. It may have protean clinical manifestations including hepatorenal dysfunction, myocarditis, pulmonary haemorrhage, meningitis, optic neuritis and rhabdomyolysis. Neurological manifestation of leptospirosis without the classical hepatorenal dysfunction is a rare entity. This complication of leptospirosis can present with diverse central and peripheral neurological presentations. The overlapping clinical manifestations with many common tropical pathogens often pose diagnostic dilemma and delay in definitive therapy may lead to adverse clinical consequences. We report a case of a 19-year-old man with no prior comorbidities presenting with high-grade fever and altered sensorium. He was diagnosed to be a probable case of leptospirosis, based on all available test results and by fulfilment of parameters under modified Faine’s criteria. The patient was successfully managed and discharged in stable condition.

Aseptic meningitis as the initial presentation of Leptospira borgpetersenii serovar Tarassovi: two case reports and a literature review

“…Neurological manifestations can be seen in about 10–15% of patients with leptospirosis although signs of meningeal irritation occur in 80% of neuroleptospirosis cases [ 8 ]. According to Panicker et al [ 1 ], 40 patients admitted to a general medical ward over a 3-year period with acute neurological disease were found to have leptospirosis.…”

“…Shermanii 2 Panicker, Mammachan and Jayakumar, 2001 [ 1 ] Primary neuroleptospirosis Fever, headache, and neck stiffness common serotypes implicated are Caninola, Icterohaemorragiae, and Pamona 3 Özdemir et al, 2008 [ 10 ] An discriminated aseptic meningitis case between rickettsia and leptospiral meningitis Fever, chills, rigors, headache, and disorientation Leptospira biflexa sv. Patoc 4 Bhatt et al, 2018 [ 8 ] Uncommon manifestation of leptospirosis: A diagnostic challenge Fever, diffuse dull-aching headache with generalized body aches and malaise. Worsening of sensorium in form of decreased responsiveness to commands, decreased verbal output and inability to move his limbs.…”

“…During the immune phase of infection, immune complexes may lead to raised CSF opening pressure, lymphocytic pleocytosis (less than 500 × 10 6 /l), raised proteins (up to 0.4-3 g/l) and normal glucose levels [ 1 , 9 ]. Anti- Leptospira antibodies may be detected in CSF during this phase [ 8 ]. Highly sensitive molecular diagnostics also have been used to detect small amount of leptospiral DNA in CSF, enabling early detection and prompt treatment [ 7 , 16 ].…”

“…Both these patients were diagnosed with Leptospira meningitis according to clinical symptoms and a positive serum MAT. Modified Faine’s criteria (see Additional file 1 ) is a scoring system introduced by World Health Organization (WHO) to diagnose leptospirosis in resource poor settings [ 8 ]. It is based on the clinical history (part A), epidemiological history (part B) supported by laboratory parameters (part C).…”

Behavioural change: a rare presentation of leptospirosis

“…A retrospective cross-sectional study in India found that among those presenting with acute neurological disease subsequently found to have leptospirosis, neurological manifestations usually manifest with signs and symptoms of aseptic meningitis, and are more commonly seen in the anicteric forms of leptospirosis 8. Encephalitis, transverse myelitis or Guillain-Barre syndrome, cerebellitis, or intracranial bleed may also occur in leptospirosis but are seldom seen 9. Radiological findings are variable.…”