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LEPTOSPIROSIS AFTER RECREATIONAL EXPOSURE TO WATER IN THE YAEYAMA ISLANDS, JAPAN

Leptospirosis is a global zoonotic disease with a variety of clinical manifestations. We report an outbreak of leptospirosis in the Yaeyama Islands, Japan, in the summer of 1999 associated with heavy rainfall. Fourteen people were diagnosed with leptospirosis and required hospitalization. All cases were found to have exposure to contaminated soil or water. A history of recreational activities involving water sports was more frequent (71%) than occupational risk factors related to agriculture or construction (29%). Fever was the primary symptom in all cases, followed by chills (93%), headache (86%), myalgias (57%) and conjunctival suffusion (57%). All cases were successfully treated with antimicrobial therapy except one patient who improved spontaneously. Jarisch-Herxheimer reactions were seen in six cases (43%). The increasing incidence of leptospirosis related to recreational sports is an important public health problem in resort areas. A high-index of suspicion, early treatment, and prevention are crucial in this latently endemic area.

Received March 3, 2005. Accepted for publication April 2, 2005.

Acknowledgments: The authors thank Drs. Kyoko Maesato, Masamoto Nakamura, Kasen Kobashigawa, Daisuke Asou, Hitoshi Tamaki, Kousei Yoshimine, Seishou Niimura, Masaki Imamura, Osamu Ikehara, and Nozomi Kidokoro for providing us clinical information and Masaji Nakamura for providing microbiological data. The American Committee on Clinical Tropical Medicine and Travellers’ Health (ACCTMTH) assisted with publication expenses.

^* Address correspondence to Masashi Narita, University of Pittsburgh Presbyterian Shadyside Internal Medicine Residency Program, 5230 Centre Avenue, Pittsburgh, PA 15232. E-mail: naritam{at}upmc.edu

Authors’ addresses: Masashi Narita, University of Pittsburgh Presbyterian Shadyside Internal Medicine Residency Program, 5230 Centre Avenue, Pittsburgh, PA 15232, Telephone: 412-623-2465, Fax: 412-623-3592, E-mail: naritam{at}upmc.edu. Shigeki Fujitani, University of Pittsburgh Critical Care Medicine, 3550 Terrace Street, 655 Scaife Hall, Pittsburgh, PA 15261, Telephone: 412-647-6249, Fax: 412-647-8060, E-mail: shigekifujitani{at}hotmail.com. David A. Haake, Associate Professor of Medicine in Residence, The David Geffen School of Medicine at UCLA, Infectious Diseases Section, 111F, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., Los Angeles, CA 90073, Telephone: 310-268-3814, Fax: 310-268-4928, E-mail: dhaake{at}ucla.edu. David L. Paterson, Associate Professor, Infectious Disease Department, University of Pittsburgh, Falk Medical Building, Suite 3-A, 3601 Fifth Avenue, Pittsburgh, PA 15213, Telephone: 412-648-6401, Fax: 412-648-6399, E-mail: Patersond{at}msx.dept-med.pitt.edu.

Reprint requests: Masashi Narita, University of Pittsburgh Presbyterian Shadyside Internal Medicine Residency Program, 5230 Centre Avenue, Pittsburgh, PA 15232, Telephone: 412-623-2465, Fax: 412-623-3592, E-mail: naritam{at}upmc.edu.

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