期刊论文详细信息
Journal of Medical Case Reports
Leptospirosis infection in a homeless patient in December in Tokyo: a case report
Tatsuki Uemura1  Akiyoshi Hagiwara1  You Me Kang1 
[1] Department of Emergency Medicine and Critical Care, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku 162-8655, Tokyo, Japan
关键词: Weil’s disease;    Tokyo;    Leptospirosis;    Homeless;    flaB;   
Others  :  1231242
DOI  :  10.1186/s13256-015-0687-4
 received in 2015-03-02, accepted in 2015-08-20,  发布年份 2015
PDF
【 摘 要 】

Introduction

We report a case of severe leptospirosis that occurred during winter in Tokyo, the capital of Japan. Leptospirosis is endemic in tropical regions and extremely rare in the urban areas of Japan. Only six new cases were reported in Tokyo in 2014. Most leptospirosis cases reported in urban areas of Japan were a result of occupational hazards, and there is no previous report of leptospirosis in a homeless patient in Tokyo. We believe this report could provide a widened perspective about the clinical presentation and epidemiology of leptospirosis in Japan.

Case presentation

Our patient was a 73-year-old Asian man. He had been homeless for over 10 years, with exposure to rodents and their excrement in parks and on the streets. He presented with fever and severe inflammatory response, satisfying the diagnostic criteria for systemic inflammatory response syndrome. Laboratory findings showed multiple-organ dysfunction, including renal failure, liver failure with increased total bilirubin level, and coagulopathy with decreased platelets. We suspected leptospirosis on the basis of these clinical findings. The diagnosis was also confirmed by polymerase chain reaction first, and paired antibody titers on day 9, in the recovery period, showed positive results for three species.

Conclusions

Our patient’s case suggests that even patients without a history of traveling abroad or exposure to freshwater can develop leptospirosis in winter in urban areas in Japan. If a patient has symptoms like fever, calf pain and MOF; as a differential diagnosis we should rule outthe Leptospirosis. From the perspective of sensitivity, specificity, and clinical convenience, polymerase chain reaction could be the preferred diagnostic tool of choice.

【 授权许可】

   
2015 Kang et al.

【 预 览 】
附件列表
Files Size Format View
20151109092040594.pdf 299KB PDF download
Fig. 1. 20KB Image download
【 图 表 】

Fig. 1.

【 参考文献 】
  • [1]Babudieri B. Animal reservoirs of leptospirosis. Ann N Y Acad Sci. 1958; 70(3):393-413.
  • [2]Musso D, La Scola B. Laboratory diagnosis of leptospirosis: a challenge. J Microbiol Immunol Infect. 2013; 46(4):245-52.
  • [3]Levett PN. Leptospirosis. Clin Microbiol Rev. 2001; 14(2):296-326.
  • [4]Dupont H, Dupont-Perdrizet D, Perie JL, Zehner-Hansen S, Jarrige B, Daijardin JB. Leptospirosis: prognostic factors associated with mortality. Clin Infect Dis. 1997; 25(3):720-4.
  • [5]Covic A, Goldsmith DJ, Gusbeth-Tatomir P, Seica A, Covic M. A retrospective 5-year study in Moldova of acute renal failure due to leptospirosis: 58 cases and a review of the literature. Nephrol Dial Transplant. 2003; 18(6):1128-34.
  • [6]Marotto PCF, Nascimento CM, Eluf-Neto J, Marotto MS, Andrade L, Sztajnbok J et al.. Acute lung injury in leptospirosis: clinical and laboratory features, outcome, and factors associated with mortality. Clin Infect Dis. 1999; 29(6):1561-3.
  • [7]Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA et al.. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest. 1992; 101(6):1644-55.
  • [8]Edwards CN, Nicholson GD, Hassell TA, Everard CO, Callender J. Thrombocytopenia in leptospirosis: the absence of evidence for disseminated intravascular coagulation. Am J Trop Med Hyg. 1986; 35(2):352-4.
  • [9]Suputtamongkol Y, Niwattayakul K, Suttinont C, Losuwanaluk K, Limpaiboon R, Chierakul W et al.. An open, randomized, controlled trial of penicillin, doxycycline, and cefotaxime for patients with severe leptospirosis. Clin Infect Dis. 2004; 39(10):1417-24.
  • [10]Panaphut T, Domrongkitchaiporn S, Vibhagool A, Thinkamrop B, Susaengrat W. Ceftriaxone compared with sodium penicillin G for treatment of severe leptospirosis. Clin Infect Dis. 2003; 36(12):1507-13.
  • [11]Saengjaruk P, Chaicumpa W, Watt G, Bunyaraksyotin G, Wuthiekanun V, Tapchaisri P et al.. Diagnosis of human leptospirosis by monoclonal antibody-based antigen detection in urine. J Clin Microbiol. 2002; 40(2):480-9.
  • [12]Cohen AL, Dowell SF, Nisalak A, Mammen MP, Petkanchanapong W, Fisk TL. Rapid diagnostic tests for dengue and leptospirosis: antibody detection is insensitive at presentation. Trop Med Int Health. 2007; 12(1):47-51.
  • [13]Tokyo Metropolitan Infectious Disease Surveillance Center. Infectious disease weekly report number 52. Tokyo Metropolitan Institute of Public Health. 7 January 2015. http://idsc.tokyo-eiken.go.jp/assets/weekly/2014/52e.pdf. Accessed 28 August 2015.
  • [14]Shimizu Y, Sakamoto N, Ainoda Y, Hikone M, Kobayashi K, Iwabuchi S et al.. Leptospirosis in a Japanese urban area: a case report and literature review. J Infect Chemother. 2014; 20(4):278-81.
  • [15]Villumsen S, Pedersen R, Krogfelt AK, Jensen SJ. Expanding the diagnostic use of PCR in leptospirosis: improved method for DNA extraction from blood cultures. PLoS One. 2010; 5(8):e12095.
  文献评价指标  
  下载次数:10次 浏览次数:15次