Date: Wed 12 Nov 2014
From: Takashi Matono <email@example.com> [edited]
A 32 year old Japanese male presented with fever and headache; he had participated in a waterfall and hiking tour of Ngardmau Falls, which is located in the state of Ngardmau, Babeldaob Island, Palau. They swam in the waterfall and a river swollen after typhoon flooding [Phanfone-fed] during the rainy season.
At the time of admission, his physical examination showed that his temperature was 40.0 C [104 F], [and he had an erythematous rash on his trunk and muscle pain in both legs]. The serum and urine polymerase chain reaction (PCR) for _Leptospira_ were negative on admission. His IgM antibody was negative at the initial visit; however, the diagnosis of leptospirosis was confirmed by an increased antibody titer after one week.
His girlfriend, a 28 year old Japanese female, also presented with fever, headache, conjunctival hyperemia, and muscle pain in both legs at the same time. She had bimodal fever, including an afebrile period of 24 hours. She was diagnosed with leptospirosis by PCR of her serum and urine at the initial visit.
Takashi Matono, MD
Disease Control and Prevention Center
National Center for Global Health and Medicine, Tokyo, Japan
Satoshi Kutsuna, MD, PhD;
Sunao Takeuchi MD;
Kei Yamamoto MD;
Yoshihiro Fujiya, MD;
Momoko Mawatari, MD;
Nozomi Takeshita, MD, PhD;
Kayoko Hayakawa, MD, PhD;
Yasuyuki Kato, MD, MPH;
Shuzo Kanagawa, MD; Norio Ohmagari, MD, MSc
[Leptospirosis is a zoonotic spirochetal infection that is distributed widely throughout the world. Although leptospirosis is commoner in tropical areas, it is also found in temperate areas. It is transmitted to humans by direct contact of abraded skin or mucous membranes with the urine of infected animals or by contact with wet soil, vegetation, or water that has been contaminated with infected animal urine. These animals are mostly asymptomatic but chronically infected with one of the several hundred serovars of the spirochete leptospira. Many species of wild and domestic animals (including rodents, dogs, cattle, and swine) are susceptible to chronic urinary infection with leptospira. In carrier animals with chronic renal infections, leptospiruria persists for long periods or for life, and leptospira bacteria shed in urine may survive in water or moist soil for weeks to months.
Outbreaks frequently follow heavy rainfalls, flooding with fresh water, and increasing rodent numbers. Leptospirosis is an occupational hazard for people who work outdoors or with animals, for example, farmers, sewer workers, veterinarians, dairy farmers, and rice and sugarcane field workers. It is a recreational hazard for those who participate in outdoor water sports such as swimming, rowing, or white-water rafting in contaminated lakes and rivers, as happened in the 2 Japanese tourists described above. Although vaccines are available for immunizing other animals against leptospirosis, no vaccine against leptospirosis is available for use in humans.
For a discussion of leptospirosis, see ProMED-mail post Leptospirosis - Philippines (03) 20111018.3118.
Palau is an island country that is part of the larger island group of Micronesia in the western Pacific Ocean. Palau's population of around 21 000 is spread across 250 islands forming the western chain of the Caroline Islands. The Imperial Japanese Navy conquered Palau during World War I, and the islands were later made a part of the Japanese-ruled South Pacific Mandate by the League of Nations. Palau was made a part of the United States-governed Trust Territory of the Pacific Islands after WW II in 1947 and gained full sovereignty in 1994 under a Compact of Free Association with the United States, which provides defense, funding, and access to social services (<http://en.wikipedia.org/wiki/Palau
Babeldaob is the largest island and contains 10 of Palau's 16 states (<http://en.wikipedia.org/wiki/Babeldaob
>). Ngardmau, with a population of 221 persons, is one of Palau's 16 states and is located on the west side of Babeldaob between the states of Ngaraard and Ngeremlengui. The capital Ngerulmud is located in Melekeok State on Babeldaob.
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