Wang et al. BMC Res Notes (2016) 9:154 DOI 10.1186/s13104-016-1964-z CASE REPORT Atypical leptospirosis: an overlooked cause of aseptic meningitis Ning Wang 1 , Yu‑Hsuan Han 1 , Jia‑Ying Sung 1 , Wen‑Sen Lee 2 and Tsong‑Yih Ou 2* Abstract Background: Leptospirosis, probably the most common zoonosis in the world, is caused by pathogenic Leptospira species. Clinical presentations range from nonspecific fevers to fulminant diseases such as Weil’s syndrome. Neuro‑ logical forms of leptospirosis (neuroleptospirosis) are usually underestimated, and many cases of leptospirosis are overlooked because of the lack of specificity of signs and symptoms. Diagnosis confirmation is difficult because of the challenges associated with isolating the organism and positive serologic testing. A comprehensive understanding of the clinical presentation of leptospirosis and risk factors for exposure to leptospirae are required for early diagnosis, in order to initiate appropriate treatment immediately. Case presentation: Here we present one male patient with anicteric leptospirosis that manifested as neuroleptospi‑ rosis with aseptic meningitis, although he did not have impaired kidney function or thrombocytopenia. He recovered well after an early investigation and treatment for leptospirosis based on suspected relevant risk factors and clinical manifestations. Conclusion: To facilitate optimal use of antibiotic treatments and prevent lethal complications of leptospirosis, we report this case of leptospirosis, which highlights the importance of knowing the occupational history and environ‑ mental exposures of patients living in leptospirosis‑endemic areas and presenting meningeal signs. Keywords: Leptospirosis, Leptospira, Aseptic meningitis, Neuroleptospirosis, Zoonosis © 2016 Wang et al. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/ publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Background Leptospirosis is an acute febrile zoonotic disease caused by infection with pathogenic spirochetes of the genus Leptospira. It is transmitted to humans principally via environmental water contaminated with the urine of wild and domestic mammals that are chronically colonized by Leptospira [1]. e leptospires dwell in the renal tubules of their animal hosts, including almost all known species of rodents, marsupials and other mammals, which are common carriers and excretors of leptospires [2]. Risk of infection is associated with occupational and recreational activities, as well as household environments where there is close contact with animals. e clinical presentations are diverse, ranging from undifferentiated fever to fatal disease. Anicteric leptospirosis is the most common manifestation, occurring in 80 % of cases [3]. Its diagno- sis relies upon a strong suspicion of this disease based on various nonspecific clinical presentations. is world- wide disease has been found to occur predominantly in wet tropical and subtropical regions [4, 5], including Tai- wan. Here, we describe a male patient with leptospirosis, who presented with aseptic meningitis but without jaun- dice, impaired kidney function or thrombocytopenia. e patient was prudently investigated and treated based on his relevant exposure history and clinical manifestations. Case report e 37-year-old male patient was a cook working in a restaurant close to a waste recycling station and a pond for recreational shrimp fishing. e patient was generally healthy and had suffered no major illnesses until 1 week before hospitalization. At that time, in late November 2012 (autumn), he presented with a low grade fever, Open Access BMC Research Notes *Correspondence: [email protected] 2 Division of Infectious Diseases, Department of Internal Medicine, Wan Fang Medical Center, Taipei Medical University, No. 111, Section. 3, Shing Long Road, Taipei 11696, Taiwan Full list of author information is available at the end of the article
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