Date: Wed 19 Sep 2018
From: Marton Szell <firstname.lastname@example.org> [edited]
We report a case of leptospirosis in a 26-year-old Austrian backpacker returning from Costa Rica. The infection occurred most likely at a waterfall near the village of Montezuma on the Pacific coast of Costa Rica. This waterfall is a popular place especially with backpackers; therefore, other tourists could be affected, too.
The patient returned on 28 Aug 2018 after traveling for 5 weeks in Panama and Costa Rica. He had a high fever and a feeling of overall weakness 2 days before his return to Austria. He consulted a local doctor who ruled out dengue fever (point-of-care test) because of a high blood leukocyte count; the doctor prescribed a 5-day course of oral ciprofloxacin as an antibiotic treatment. No other tests were performed.
After the patient's return to Austria, his general condition improved and his body temperature returned to normal. The fever reappeared 9 days after the initial onset of the disease, and the patient complained of severe headache and flulike symptoms. His family doctor initiated a broad diagnostic check-up. In the end, only leptospirosis serology yielded positive [results].
We carried out a complete blood check. All parameters, except slightly elevated liver enzymes, [were] normal. We repeated tests for leptospirosis: [Leptospiral] DNA in blood and urine was undetectable and serology showed normal IgG, but a 4-fold increase of IgM antibodies (enzyme immunoassay) confirmed the diagnosis.
Our patient could recall having contact with fresh water 7 to 10 days before the onset of fever. He took a bath in a waterfall near Montezuma on the Nicoya peninsula of Costa Rica. The patient had no contact with animals. Because of the patient's remaining symptoms (slightly elevated body temperature and general weakness), we prescribed a 7-day course of oral doxycycline therapy. With this treatment, all symptoms have disappeared.
Dr. Marton Szell
Infectious Diseases Consultant
Dr. Verena Sperl
Infectious Diseases Resident
[Leptospirosis is caused by exposure to _Leptospira_ bacteria in fresh (not salty) water, wet soil, or vegetation that has been contaminated by urine of animals chronically infected with one of the several hundred serovars of the spirochete _Leptospira interrogans_. Rodents, dogs, cattle, and pigs are the usual reservoirs for this organism.
Leptospirosis is an occupational hazard for people who work outdoors or with animals; for example, workers in wet agricultural settings (such as rice field workers), ranchers, slaughterhouse workers, trappers, loggers, sewer workers, veterinarians, fishery workers, dairy farmers, or military personnel.
Leptospirosis is also a risk during recreational activities such as camping, fresh water swimming, canoeing, kayaking, rafting, golfing, and trail biking that involve exposure to water in lakes, rivers, or ponds contaminated by urine from leptospire-infected animals, as well as a risk from household exposure to infected pet animals or rodents. - ProMED Mod.ML]
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