Leptospirosis in pregnancy: A lesson in subtlety

Area of Science:

• Infectious Diseases
• Maternal-Fetal Medicine
• Pathology

Background:

• Leptospirosis is a zoonotic disease caused by Leptospira spirochetes, typically presenting as a self-limited illness.
• Severe leptospirosis occurs in 10% of cases, with high fatality rates, predominantly affecting men.
• Leptospirosis in pregnant women is uncommon, posing unique diagnostic and management challenges.

Observation:

• A 28-year-old pregnant woman at 18 weeks gestation presented with collapse and died shortly after arrival.
• Initial examination and ultrasound revealed no abnormalities; post-mortem findings included hepatosplenomegaly, pulmonary congestion, and organ infarcts.
• Diagnosis was challenging, only confirmed post-mortem via histopathology and positive Leptospira IgM antibody and PCR tests.

Findings:

• Histopathology revealed pulmonary hemorrhages, edema, splenic infarcts, and acute tubular necrosis in the kidneys.
• Laboratory investigations confirmed Leptospira infection, despite the subtle and obscure clinical presentation.
• The case highlights the potential for leptospirosis to cause severe maternal-fetal mortality.

Implications:

• Leptospirosis can present insidiously, even in pregnant individuals, necessitating a high index of suspicion.
• Early and accurate diagnosis is critical for timely intervention and improved outcomes in maternal leptospirosis.
• This case underscores the importance of considering zoonotic infections in unexplained maternal and fetal demise.