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Central nervous system leptospirosis in the Philippines
G Watt1, C Manaloto, C G Hayes
1U.S. Naval Medical Research Unit No. 2, Manila, Philippines.
Abstract:
One hundred hospitalized patients in Manila, Philippines with aseptic meningoencephalitis were screened for leptospirosis. On the basis of a microscopic agglutination titer of 1:1,600 or greater, the diagnosis was made in five cases, yet in no instance had leptospirosis been included in the differential diagnosis on admission to the hospital. Four of the five patients first noted neurologic symptoms during the second week of illness; two patients presented with encephalitis, two with meningitis and the fifth with hemiparesis. No case was complicated by renal dysfunction or jaundice. By the time of discharge from the hospital, two patients had recovered completely and the other three had markedly improved. Our data show that leptospirosis is an important but overlooked cause of aseptic meningoencephalitis in the Philippines. This is probably also the case in other parts of the tropics where Leptospira interrogans infection remains a significant public health problem.
Insights
Leptospirosis is an overlooked cause of aseptic meningoencephalitis in hospitalized patients in the Philippines. Early diagnosis and treatment are crucial for better patient outcomes in tropical regions.
Area of Science:
- Infectious Diseases
- Neurology
- Public Health
Background:
- Aseptic meningoencephalitis presents a diagnostic challenge in tropical regions.
- Leptospirosis is a significant public health concern in the tropics, caused by Leptospira interrogans.
Purpose of the Study:
- To investigate the prevalence of leptospirosis as a cause of aseptic meningoencephalitis in hospitalized patients in Manila, Philippines.
- To highlight the importance of including leptospirosis in the differential diagnosis for aseptic meningoencephalitis.
Main Methods:
- Screening of 100 hospitalized patients diagnosed with aseptic meningoencephalitis.
- Diagnosis of leptospirosis based on a microscopic agglutination titer of 1:1,600 or greater.
Main Results:
- Leptospirosis was diagnosed in 5 out of 100 patients (5%).
- Leptospirosis was not initially considered in the differential diagnosis for any of these patients.
- Neurologic symptoms, including encephalitis, meningitis, and hemiparesis, appeared in the second week of illness. No cases involved renal dysfunction or jaundice.
- Two patients recovered fully, and three showed marked improvement by hospital discharge.
Conclusions:
- Leptospirosis is an important, yet frequently overlooked, cause of aseptic meningoencephalitis in the Philippines.
- This finding is likely applicable to other tropical areas where Leptospira interrogans infections are prevalent.
- Increased awareness and inclusion of leptospirosis in differential diagnoses are recommended for aseptic meningoencephalitis cases in endemic regions.