Molecular Detection of Leptospira in Two Returned Travelers: Higher Bacterial Load in Cerebrospinal Fluid Versus Serum or Plasma
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Jesse J Waggoner1, Elizabeth A Soda2, Ryan Seibert2
1Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California; Division of Infectious Diseases, Sequoia Hospital, Redwood City, California; Department of Medicine, Stanford University School of Medicine, Stanford, California; Department of Pathology, Stanford University School of Medicine, Stanford, California waggo001@stanford.edu.
Abstract:
Leptospirosis is a potentially severe illness in returned travelers. Patients often present with fever, headache, and neck pain, which may lead to a workup for meningitis including the acquisition of cerebrospinal fluid (CSF). Although Leptospira DNA has been detected in CSF by polymerase chain reaction (PCR), little data exist regarding the utility of testing CSF in addition to serum or plasma obtained on presentation. In this report, we present two cases of leptospirosis in returned travelers presenting with fever and headache. Our first patient had neutrophilic meningitis, and Leptospira was detectable only in CSF obtained on admission. The second patient had a normal CSF profile, but Leptospira was detected in CSF at a bacterial load 5- to 10-fold higher than that in plasma. CSF is an important specimen for the diagnosis of Leptospira by molecular methods and may yield an actionable diagnosis in the absence of leptospiremia.
Insights
Cerebrospinal fluid (CSF) testing aids in diagnosing leptospirosis in returned travelers, even when blood tests are negative. This molecular diagnostic approach can detect Leptospira DNA in CSF, offering crucial insights for patient care.
Area of Science:
- Infectious Diseases
- Microbiology
- Travel Medicine
Background:
- Leptospirosis is a severe illness common in travelers returning from endemic areas.
- Clinical presentation often mimics meningitis, prompting cerebrospinal fluid (CSF) analysis.
- Limited data exist on the diagnostic value of CSF testing for Leptospira compared to serum/plasma.
Observation:
- Two returned travelers with fever and headache were diagnosed with leptospirosis.
- One patient presented with neutrophilic meningitis, with Leptospira DNA detectable only in CSF.
- The second patient had a normal CSF profile, yet showed higher Leptospira DNA levels in CSF than in plasma.
Findings:
- CSF polymerase chain reaction (PCR) is valuable for diagnosing leptospirosis.
- Leptospira DNA in CSF can be a key diagnostic marker, especially when blood tests are inconclusive.
- CSF analysis offers actionable diagnostic insights in cases of suspected leptospirosis.
Implications:
- CSF testing should be considered in the diagnostic workup of returned travelers with suspected leptospirosis.
- Molecular detection of Leptospira in CSF can improve diagnostic yield.
- This highlights the importance of CSF as a specimen for identifying infectious agents in returned travelers.
