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Leptospirosis Cases Infected with Uncommon Serogroups, Puerto Rico, 2013-2015
Hector Gorbea1, Enid J Garcia-Rivera1, Hilda Torres1
1University of Puerto Rico School of Medicine, San Juan, Puerto Rico.
Abstract:
Leptospirosis is an emerging bacterial zoonosis that is endemic but underrecognized throughout the tropics. Through prospective surveillance for acute febrile illness (AFI) among patients who presented to the emergency department of a hospital located in an urban region of Puerto Rico, four patients with laboratory-confirmed leptospirosis were identified. All patients had signs and symptoms of AFI, including fever, headache, and dehydration. Three patients had leukocytosis with thrombocytopenia and were admitted to the hospital. One hospitalized patient presented with jaundice, icteric sclera, and hematuria and developed rhabdomyolysis, whereas another patient with pulmonary edema was admitted to the intensive care unit. Microscopic agglutination titers among the four patients were highest against serogroups Icterohaemorrhagiae (serovar Mankarso), Australis (serovar Bratislava), Bataviae (serovar Bataviae), and Canicola (serovar Canicola). These case reports demonstrate that infection with these apparently uncommon serogroups can result in illness ranging from mild to life-threatening.
Insights
Leptospirosis, a tropical bacterial zoonosis, was identified in four patients with acute febrile illness in Puerto Rico. These cases highlight the potential for severe illness from uncommon serogroups, underscoring the need for increased recognition.
Area of Science:
- Tropical Medicine
- Infectious Diseases
- Bacteriology
Background:
- Leptospirosis is an underrecognized bacterial zoonosis prevalent in tropical regions.
- Early identification and management are crucial for improving patient outcomes.
Observation:
- Prospective surveillance for acute febrile illness (AFI) was conducted in an urban hospital in Puerto Rico.
- Four patients with laboratory-confirmed leptospirosis were identified among AFI cases.
- Clinical presentations ranged from mild AFI symptoms to severe conditions like rhabdomyolysis and pulmonary edema.
Findings:
- Microscopic agglutination tests revealed highest titers against Leptospira serogroups Icterohaemorrhagiae, Australis, Bataviae, and Canicola.
- Three patients exhibited leukocytosis with thrombocytopenia, requiring hospitalization.
- One patient developed jaundice, hematuria, and rhabdomyolysis; another required intensive care for pulmonary edema.
Implications:
- These case reports underscore that uncommon Leptospira serogroups can cause a spectrum of illness, from mild to life-threatening.
- Increased awareness and diagnostic vigilance for leptospirosis are necessary in tropical urban settings.
- Further research into the epidemiology of these serogroups in Puerto Rico is warranted.
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