A case report of Leptospirosis with positive cerebrospinal fluid targeted next-generation sequencing

Leptospirosis is a global zoonotic disease caused by pathogenic Leptospira species, predominantly Leptospira interrogans. Transmission to humans typically occurs via mucosal or percutaneous exposure to water contaminated by the urine of reservoir hosts, such as rodents and livestock. We report a case of a 67-year-old male admitted with a 2-day history of fever and a 1-day history of altered mental status, complicated by jaundice and hepatorenal failure. A definitive diagnosis of leptospirosis (icterohemorrhagic phenotype) was established by correlating the patient's clinical manifestations and history of occupational exposure in rice paddies with the detection of Leptospira species via cerebrospinal fluid (CSF) targeted next-generation sequencing (tNGS).After treatment with meropenem, corticosteroids to prevent the Jarisch-Herxheimer reaction, and therapy to protect the liver and reduce jaundice, the patient's organ function and mental status improved.This case suggests that for febrile patients with epidemiological exposure, neurological symptoms, and multi-organ involvement, early use of CSF tNGS can improve the diagnosis of leptospirosis, providing a critical basis for early and precise treatment.