1921
Volume 93, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

Leptospirosis is a potentially severe illness in returned travelers. Patients often present with fever, headache, and neck pain, which may lead to a workup for meningitis including the acquisition of cerebrospinal fluid (CSF). Although DNA has been detected in CSF by polymerase chain reaction (PCR), little data exist regarding the utility of testing CSF in addition to serum or plasma obtained on presentation. In this report, we present two cases of leptospirosis in returned travelers presenting with fever and headache. Our first patient had neutrophilic meningitis, and was detectable only in CSF obtained on admission. The second patient had a normal CSF profile, but was detected in CSF at a bacterial load 5- to 10-fold higher than that in plasma. CSF is an important specimen for the diagnosis of by molecular methods and may yield an actionable diagnosis in the absence of leptospiremia.

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2015-08-05
2017-11-23
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References

  1. Levett PN, , 2001. Leptospirosis. Clin Microbiol Rev 14: 296326.[Crossref]
  2. Clapper M, Myers GB, , 1943. Clinical manifestations of Weil's disease with particular reference to meningitis. Arch Intern Med 72: 1830.[Crossref]
  3. Cargill WH, Jr Beeson PB, , 1947. The value of spinal fluid examination as a diagnostic procedure in Weil's disease. Ann Intern Med 27: 396400.[Crossref]
  4. van Crevel R, Speelman P, Gravekamp C, Terpstra WJ, , 1994. Leptospirosis in travelers. Clin Infect Dis 19: 132134.[Crossref]
  5. Traxler RM, Callinan LS, Holman RC, Steiner C, Guerra MA, , 2014. Leptospirosis-associated hospitalizations, United States, 1998–2009. Emerg Infect Dis 20: 12731279.[Crossref]
  6. Bajani MD, Ashford DA, Bragg SL, Woods CW, Aye T, Spiegel RA, Plikaytis BD, Perkins BA, Phelan M, Levett PN, Weyant RS, , 2003. Evaluation of four commercially available rapid serologic tests for diagnosis of leptospirosis. J Clin Microbiol 41: 803809.[Crossref]
  7. Picardeau M, Bertherat E, Jancloes M, Skouloudis AN, Durski K, Hartskeerl RA, , 2014. Rapid tests for diagnosis of leptospirosis: current tools and emerging technologies. Diagn Microbiol Infect Dis 78: 18.[Crossref]
  8. Limmathurotsakul D, Turner EL, Wuthiekanun V, Thaipadungpanit J, Suputtamongkol Y, Chierakul W, Smythe LD, Day NP, Cooper B, Peacock SJ, , 2012. Fool's gold: why imperfect reference tests are undermining the evaluation of novel diagnostics: a reevaluation of 5 diagnostic tests for leptospirosis. Clin Infect Dis 55: 322331.[Crossref]
  9. Merien F, Baranton G, Perolat P, , 1995. Comparison of polymerase chain reaction with microagglutination test and culture for diagnosis of leptospirosis. J Infect Dis 172: 281285.[Crossref]
  10. Dittrich S, Rattanavong S, Lee SJ, Panyanivong P, Craig SB, Tulsiani SM, Blacksell SD, Dance DA, Dubot-Peres A, Sengduangphachanh A, Phoumin P, Paris DH, Newton PN, , 2015. Orientia, Rickettsia, and Leptospira pathogens as causes of CNS infections in Laos: a prospective study. Lancet Glob Health 3: e104e112.[Crossref]
  11. Romero EC, Billerbeck AE, Lando VS, Camargo ED, Souza CC, Yasuda PH, , 1998. Detection of Leptospira DNA in patients with aseptic meningitis by PCR. J Clin Microbiol 36: 14531455.
  12. Romero EC, Blanco RM, Yasuda PH, , 2010. Aseptic meningitis caused by Leptospira spp diagnosed by polymerase chain reaction. Mem Inst Oswaldo Cruz 105: 988992.[Crossref]
  13. Vinetz JM, Glass GE, Flexner CE, Mueller P, Kaslow DC, , 1996. Sporadic urban leptospirosis. Ann Intern Med 125: 794798.[Crossref]
  14. Waggoner JJ, Abeynayake J, Balassiano I, Lefterova M, Sahoo MK, Liu Y, Vital-Brazil JM, Gresh L, Balmaseda A, Harris E, Banaei N, Pinsky BA, , 2014. Multiplex nucleic acid amplification test for the diagnosis of dengue, malaria, and leptospirosis. J Clin Microbiol 52: 20112018.[Crossref]
  15. Waggoner JJ, Balassiano I, Abeynayake J, Sahoo MK, Mohamed-Hadley A, Liu Y, Vital-Brazil JM, Pinsky BA, , 2014. Sensitive real-time PCR detection of pathogenic Leptospira spp. and a comparison of nucleic acid amplification methods for the diagnosis of leptospirosis. PLoS One 9: e112356.[Crossref]
  16. Wilson MR, Naccache SN, Samayoa E, Biagtan M, Bashir H, Yu G, Salamat SM, Somasekar S, Federman S, Miller S, Sokolic R, Garabedian E, Candotti F, Buckley RH, Reed KD, Meyer TL, Seroogy CM, Galloway R, Henderson SL, Gern JE, DeRisi JL, Chiu CY, , 2014. Actionable diagnosis of neuroleptospirosis by next-generation sequencing. N Engl J Med 370: 24082417.[Crossref]
  17. Thaipadungpanit J, Chierakul W, Wuthiekanun V, Limmathurotsakul D, Amornchai P, Boonslip S, Smythe LD, Limpaiboon R, Hoffmaster AR, Day NP, Peacock SJ, , 2011. Diagnostic accuracy of real-time PCR assays targeting 16S rRNA and lipL32 genes for human leptospirosis in Thailand: a case-control study. PLoS One 6: e16236.[Crossref]
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  • Received : 03 Mar 2015
  • Accepted : 21 Apr 2015

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