A case of primary neuroleptospirosis

A Fatal Case of Presumptive Diagnosis of Leptospirosis Involving the Central Nervous System

Leptospirosis is a reemerging zooanthroponosis with a worldwide distribution, though it has a higher incidence in areas with tropical climate. A characteristic finding of the disease is its wide spectrum of symptoms and organ involvement, as it can appear either with very mild flu-like manifestations or with multiorgan failure, affecting the central nervous system (CNS) with a concomitant hepatorenal dysfunction (Weil's syndrome) and significant high mortality rate. We report herein a fatal case of a 25 years old female, previously healthy, with impaired neurological status. She had high fever and severe multiorgan failure. The clinical data and the epidemiological factors were not conclusive for the diagnosis, and the first serology test from the cerebrospinal fluid (CSF) and sera samples were negative. When the repetition of the blood test showed elevated IgM antibodies, Leptospirosis was the presumptive diagnosis. Although CNS involvement is rare, the diagnosis should be considered when there is an elevated risk of exposure. The diagnostic protocol should encompass direct evidence of the bacterium and indirect measurement of antibodies. Timely detection and management are imperative to forestall complications and fatality associated with the disease.

A rare case of anti-DPPX encephalitis combined with neuroleptospirosis

BACKGROUND

Neuroleptospirosis and anti-dipeptidyl-peptidase-like protein 6 (DPPX) encephalitis are both very rare and have only been reported in the form of respective case reports. There are no reports of anti-DPPX encephalitis combined with neuroleptospirosis in the literature. We reported the first case of neuroleptospirosis combined with elevated DPPX antibodies in serum and cerebrospinal fluid (CSF).

CASE PRESENTATION

A previously healthy 53-year-old Chinese male farmer with a history of drinking raw stream water and flood sewage exposure was brought to the hospital due to an acute onset of neuropsychiatric symptoms. No fever or meningeal irritation signs were detected on physical examination. Routine laboratory investigations, including infection indicators, leukocyte and protein in CSF, electroencephalogram and gadolinium-enhanced magnetic resonance imaging of the brain, all revealed normal. While metagenomic next-generation sequencing (mNGS) identified the DNA genome of Leptospira interrogans in the CSF. Anti-DPPX antibody was detected both in blood and in CSF. A diagnosis of neuroleptospirosis combined with autoimmune encephalitis associated with DPPX-Ab was eventually made. He resolved completely after adequate amount of penicillin combined with immunotherapy.

CONCLUSION

We highlight that in patients with acute or subacute behavioral changes, even in the absence of fever, if the most recent freshwater exposure is clear, physicians should pay attention to leptospirosis. Due to the low sensitivity of routine microscopy, culture, polymerase chain reaction and antibody testing, mNGS may have more advantages in diagnosing neuroleptospirosis. As autoimmune encephalitis can be triggered by various infections, neuroleptospirosis may be one of the causes of autoimmune encephalitis. Since neuronal antibody measurements themselves are not that common in neuroleptospirosis, future studies are needed to determine whether the detection of anti-DPPX antibodies is a rare event in leptospirosis. Early identification of autoimmune encephalitis and timely administration of immunotherapy may lead to a better outcome.

Neuro-leptospirosis - A batty diagnostic enigma

Leptospirosis is an important, worldwide zoonotic, with a high incidence in warm-climate and tropical countries. Leptospirosis has a broad spectrum of manifestations, from a non-specific febrile illness to severe disease with multi-organ involvement. Transmission typically occurs following exposure to urine from infected animals, in particular domesticated animals such as rodents and cattle. Leptospira species have been identified in bats, however bat-human transmission is uncertain, and bat-associated leptospirosis in humans is seldom reported. We report a unique case of severe neuro-leptospirosis resulting from bat exposure with an unusual manifestation of a non-traumatic subarachnoid haemorrhage, and the diagnostic challenges it presented.

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

Background

Leptospirosis is a zoonotic illness caused by pathogenic spirochetes of the genus Leptospira. The disease spectrum ranges from a mild influenza-like presentation to a more serious Weil’s syndrome. Leptospirosis rarely presents as a primary neurological syndrome. We report two cases of Leptospira borgpetersenii serovar Tarasssovi presenting as aseptic meningitis in Sri Lanka.

Case presentation

We describe case reports of two patients presenting as symptomatic aseptic meningitis due to neuroleptospirosis. Both patients had significant neurological involvement at presentation in the absence of common clinical features of leptospirosis. These patients were initially managed as bacterial or viral meningitis and leptospirosis was suspected due to a history of exposure to contaminated water. Subsequently, they were diagnosed to have neuroleptospirosis by positive Leptospira serology and both patients gained full recovery.

Conclusion

Our report highlights the importance of considering leptospirosis as a differential diagnosis in patients with aseptic meningitis in endemic settings. Obtaining a detailed occupational and recreational history is helpful in diagnosing neuroleptospirosis promptly. We report the association of Leptospira borgpetersenii serovar (sv.) Tarassovi (strain bakeri) in causing aseptic meningitis, which has not been reported to the best of our knowledge.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-021-06200-w.

Three Leptospira Strains From Western Indian Ocean Wildlife Show Highly Distinct Virulence Phenotypes Through Hamster Experimental Infection

Leptospirosis is one of the most widespread zoonoses worldwide, with highest incidence reported on tropical islands. Recent investigations carried out in a One-Health framework have revealed a wide diversity of pathogenic Leptospira lineages on the different islands of Western Indian Ocean carried out by a large diversity of mammal reservoirs, including domestic and wild fauna. Using golden Syrian hamsters as a model of acute infection, we studied the virulence of Leptospira interrogans, L. mayottensis, and L. borgpetersenii isolates obtained from rats, tenrecs, and bats, respectively. Hamsters were inoculated with 2.10⁸ bacterial cells and monitored for 1 month. The L. interrogans isolate proved to be the most pathogenic while L. mayottensis and L. borgpetersenii isolates induced no clinical symptoms in the infected hamsters. High leptospiral DNA amounts were also detected in the urine and organs of hamsters infected with the L. interrogans isolate while L. mayottensis and L. borgpetersenii isolates mostly failed to disseminate into the organism. In addition, histological damage was more pronounced in the kidneys and lungs of hamsters infected with the L. interrogans isolate. Altogether, these data support that Leptospira strains shed by mammals endemic to this insular ecosystem (L. mayottensis and L. borgpetersenii isolates) are less pathogenic than the L. interrogans rat-borne isolate. These results may provide a relevant framework for understanding the contrasting epidemiology of human leptospirosis observed among Western Indian Ocean islands.

Estimating the burden of leptospirosis in Sri Lanka; a systematic review

Background

Although the assessment of disease burden should be a priority for allocating resources, leptospirosis is grossly underestimated despite its true burden in Sri Lanka. This study aimed to assess the morbidity and mortality of leptospirosis based on routine surveillance data, hospital reported data and scientific publications from Sri Lanka.

Method

A systematic review was carried out, and Pub Med, MEDLINE®, BIOSIS Previews, Zoological Record, Web of Science Core Collection, Current Contents Connect, KCI-Korean Journal Database, BIOSIS Citation Index, Data Citation Index, SciELO Citation Index and Google Scholar databases were searched. Quarterly epidemiological bulletin (QEB), indoor morbidity & mortality returns (IMMR) and hand searches of local literature were performed in local libraries. Forty-two relevant full texts, 32 QEBs, and 8 IMMR were included in the full text review. Adjustments were made for under diagnosis, underreporting and chance variability.

Results

The estimated annual caseload of leptospirosis in Sri Lanka from 2008 to 2015, was 10,423, and the cumulative annual incidence of leptospirosis that required hospitalization was 52.1 (95% CI 51.7–52.6) per 100,000 people. The estimated number of annual deaths due to leptospirosis was approximately 730 (95% CI 542–980), with an estimated pooled case fatality ratio of 7.0% (95% CI 5.2–9.4). The most common organs involved were the kidney, liver and heart, with median rates of 48.7, 30, and 14.2%, respectively.

Conclusion

Our systematic review shows gross underestimation of the true leptospirosis burden in the national statistics of Sri Lanka, and the hospitalization rates estimated in our study were compatible with the total burden estimate of 300·6 (95% CI 96·54–604·23) per 100,000 people published previously.

Electronic supplementary material

The online version of this article (10.1186/s12879-018-3655-y) contains supplementary material, which is available to authorized users.

First Reported Case of Neuroleptospirosis Complicated With Anton's Syndrome

Leptospirosis is a spirochetal zoonotic disease with a wide clinical spectrum, often underdiagnosed especially when presented as an acute neurological manifestation. We report a case of a 24-year-old man with serologically positive leptospirosis, who presented with altered sensorium, seizures and subsequently developed cortical blindness. His brain MRI revealed bilateral occipital and later parietal lobe cerebritis.