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      Fatal Leptospira spp./Zika Virus Coinfection—Puerto Rico, 2016

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          Abstract.

          Coinfection with pathogens that cause acute febrile illness (AFI) can complicate patient diagnosis and management. This report describes a fatal case of Leptospira spp./Zika virus (ZIKV) coinfection in Puerto Rico. The patient presented with a 5-day history of AFI; reported behavioral risk factors for leptospirosis; was diagnosed with possible leptospirosis, dengue, chikungunya, or ZIKV disease; and received appropriate treatment for leptospirosis and dengue. Following a 3-day hospitalization, the patient died due to acute gastrointestinal hemorrhage, and kidney and liver failure. Serologic diagnostic testing for leptospirosis and ZIKV disease was negative; however, molecular diagnostic testing performed postmortem was positive for detection of Leptospira spp. and ZIKV nucleic acid. This case demonstrates the need for continued clinical awareness of leptospirosis in areas experiencing outbreaks of pathogens that cause AFI and the need for evaluation of coinfection with AFI-causing pathogens as a risk factor for increased severity of disease.

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          Leptospirosis: a zoonotic disease of global importance.

          Michael Matthias, J. Nally, Fiona A Lovett … (2003)
          In the past decade, leptospirosis has emerged as a globally important infectious disease. It occurs in urban environments of industrialised and developing countries, as well as in rural regions worldwide. Mortality remains significant, related both to delays in diagnosis due to lack of infrastructure and adequate clinical suspicion, and to other poorly understood reasons that may include inherent pathogenicity of some leptospiral strains or genetically determined host immunopathological responses. Pulmonary haemorrhage is recognised increasingly as a major, often lethal, manifestation of leptospirosis, the pathogenesis of which remains unclear. The completion of the genome sequence of Leptospira interrogans serovar lai, and other continuing leptospiral genome sequencing projects, promise to guide future work on the disease. Mainstays of treatment are still tetracyclines and beta-lactam/cephalosporins. No vaccine is available. Prevention is largely dependent on sanitation measures that may be difficult to implement, especially in developing countries.
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            Outbreak of Leptospirosis after Flood, the Philippines, 2009

            Al-shere Amilasan, Mugen Ujiie, Motoi Suzuki … (2012)
            After a typhoon in September 2009, an outbreak of leptospirosis occurred in Metro Manila, the Philippines; 471 patients were hospitalized and 51 (10.8%) died. A hospital-based investigation found risk factors associated with fatal infection to be older age, hemoptysis, anuria, jaundice, and delayed treatment with antimicrobial drugs.
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              Assessment of the clinical presentation and treatment of 353 cases of laboratory-confirmed leptospirosis in Hawaii, 1974-1998.

              P Effler, Sérgio D. Sasaki, David A Katz … (2001)
              Leptospirosis is frequently misdiagnosed as a result of its protean and nonspecific presentation. Leptospirosis, a zoonosis with global distribution, commonly occurs in tropical and subtropical regions; most reported cases in the United States occur in Hawaii. All laboratory-confirmed leptospirosis cases in the State of Hawaii from 1974 through 1998 (n=353) were clinically evaluated. The most common presentation involved nonspecific signs or symptoms, including fever, myalgia, and headache. Jaundice occurred in 39% of cases; conjunctival suffusion was described in 28% of these cases. Initiation of antibiotics before the seventh day of symptoms was associated with a significantly shortened duration of illness. Because early recognition and initiation of antibiotic therapy are important, clinicians should familiarize themselves with the clinical presentation of leptospirosis, and when evaluating a patient with a febrile illness, they should obtain exposure and travel histories and entertain the possibility of leptospirosis in the differential diagnosis.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Am J Trop Med Hyg
                Journal ID (iso-abbrev): Am. J. Trop. Med. Hyg
                Journal ID (publisher-id): tpmd
                Title: The American Journal of Tropical Medicine and Hygiene
                Publisher: The American Society of Tropical Medicine and Hygiene
                ISSN (Print): 0002-9637
                ISSN (Electronic): 1476-1645
                Publication date (Print): 11 October 2017
                Publication date (Electronic): 26 June 2017
                Publication date PMC-release: 26 June 2017
                Volume: 97
                Issue: 4
                Pages: 1085-1087
                Affiliations
                [1 ]Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico;
                [2 ]Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia;
                [3 ]Puerto Rico Department of Health, San Juan, Puerto Rico
                Author notes
                [* ]Address correspondence to Tyler M. Sharp, Dengue Branch, Centers for Disease Control and Prevention, 1324 Calle Cañada, San Juan, Puerto Rico 00920. E-mail: tsharp@ 123456cdc.gov

                Authors’ addresses: Paige Neaterour, Aidsa Rivera, and Tyler M. Sharp, Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico, E-mails: paige-neaterour@ 123456ouhsc.edu , erj2@ 123456cdc.gov , and tsharp@ 123456cdc.gov . Renee L. Galloway, Bacterial Special Pathogens Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA, E-mail: zul0@ 123456cdc.gov . Myriam Garcia Negrón and Brenda Rivera-Garcia, Puerto Rico Department of Health, Medical Center Area, San Juan, Puerto Rico, E-mails: mgarcia@ 123456salud.pr.gov and wtm6@ 123456cdc.gov .

                Article
                Publisher ID: tpmd170250
                DOI: 10.4269/ajtmh.17-0250
                PMC ID: 5637617
                PubMed ID: 28722594
                SO-VID: ff55a171-c597-4c0e-a9a8-332a77f1415b
                Copyright © © The American Society of Tropical Medicine and Hygiene
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 27 March 2017
                Date accepted : 07 May 2017
                Page count
                Pages: 3
                Categories
                Subject: Articles

                ScienceOpen disciplines: Infectious disease & Microbiology
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology

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