1921
Volume 97, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

Coinfection with pathogens that cause acute febrile illness (AFI) can complicate patient diagnosis and management. This report describes a fatal case of 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 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.

[open-access] 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.

Loading

Article metrics loading...

The graphs shown below represent data from March 2017
/content/journals/10.4269/ajtmh.17-0250
2017-06-26
2019-04-23
Loading full text...

Full text loading...

/deliver/fulltext/14761645/97/4/tpmd170250.html?itemId=/content/journals/10.4269/ajtmh.17-0250&mimeType=html&fmt=ahah

References

  1. Katz AR, Ansdell VE, Effler PV, Middleton CR, Sasaki DM, , 2001. Assessment of the clinical presentation and treatment of 353 cases of laboratory-confirmed leptospirosis in Hawaii, 1974–1998. Clin Infect Dis 33: 18341841.[Crossref] [Google Scholar]
  2. Amilasan AS, Ujiie M, Suzuki M, Salva E, Belo MC, Koizumi N, Yoshimatsu K, Schmidt WP, Marte S, Dimaano EM, Villarama JB, Ariyoshi K, , 2012. Outbreak of leptospirosis after flood, the Philippines, 2009. Emerg Infect Dis 18: 9194.[Crossref] [Google Scholar]
  3. Bharti AR, Nally JE, Ricaldi JN, Matthias MA, Diaz MM, Lovett MA, Levett PN, Gilman RH, Willig MR, Gotuzzo E, Vinetz JM, ; Peru-United States Leptospirosis Consortium, 2003. Leptospirosis: a zoonotic disease of global importance. Lancet Infect Dis 3: 757771.[Crossref] [Google Scholar]
  4. Daher EF, Lima RS, Silva Júnior GB, Silva EC, Karbage NN, Kataoka RS, Carvalho Júnior PC, Magalhães MM, Mota RM, Libório AB, , 2010. Clinical presentation of leptospirosis: a retrospective study of 201 patients in a metropolitan city of Brazil. Braz J Infect Dis 14: 3–10. [Google Scholar]
  5. Costa F, Hagan JE, Calcagno J, Kane M, Torgerson P, Martinez-Silveira MS, Stein C, Abela-Ridder B, Ko AI, , 2015. Global morbidity and mortality of leptospirosis: a systematic review. PLoS Negl Trop Dis 9: e0003898.[Crossref] [Google Scholar]
  6. Petersen LR, Jamieson DJ, Powers AM, Honein MA, , 2016. Zika virus. N Engl J Med 374: 15521563.[Crossref] [Google Scholar]
  7. Sharp TM, Muñoz-Jordán J, Perez-Padilla J, Bello-Pagán MI, Rivera A, Pastula DM, Salinas JL, Martinez Mendez JH, Méndez M, Powers AM, Waterman S, Rivera-García B, , 2016. Zika virus infection associated with severe thrombocytopenia. Clin Infect Dis 63: 11981201. [Google Scholar]
  8. Dirlikov E, Major CG, Mayshack M, Medina N, Matos D, Ryff KR, Torres-Aponte J, Alkis R, Munoz-Jordan J, Colon-Sanchez C, Salinas JL, Pastula DM, Garcia M, Segarra MO, Malave G, Thomas DL, Rodríguez-Vega GM, Luciano CA, Sejvar J, Sharp TM, Rivera-Garcia B, , 2016. Guillain-Barré syndrome during ongoing Zika virus transmission—Puerto Rico, January 1–July 31, 2016. MMWR Morb Mortal Wkly Rep 65: 910914.[Crossref] [Google Scholar]
  9. Lozier M, Adams L, Febo MF, Torres-Aponte J, Bello-Pagan M, Ryff KR, Munoz-Jordan J, Garcia M, Rivera A, Read JS, Waterman SH, Sharp TM, Rivera-Garcia B, , 2016. Incidence of Zika virus disease by age and sex—Puerto Rico, November 1, 2015—October 20, 2016. MMWR Morb Mortal Wkly Rep 65: 12191223.[Crossref] [Google Scholar]
  10. Sharp TM, Rivera García B, Pérez-Padilla J, Galloway RL, Guerra M, Ryff KR, Haberling D, Ramakrishnan S, Shadomy S, Blau D, Tomashek KM, Bower WA, , 2016. Early indicators of fatal leptospirosis during the 2010 epidemic in Puerto Rico. PLoS Negl Trop Dis 10 : e0004482. [Google Scholar]
  11. Sergio ADM, Figueroa EG, Saadia VM, Elizabeth S, Beatriz R, Víctor MAA, Espinosa JN, , 2012. Leptospirosis prevalence in patients with initial diagnosis of dengue. J Trop Med 2012: 519701. [Google Scholar]
  12. Ellis T, Imrie A, Katz KR, Effler PV, , 2008. Underrecognition of leptospirosis during a dengue fever outbreak in Hawaii, 2001–2002. Vector Borne Zoonotic Dis 8: 541547.[Crossref] [Google Scholar]
  13. Nhan TX, Bonnieux E, Rovery C, De Pina JJ, Musso D, , 2016. Fatal leptospirosis and chikungunya co-infection: do not forget leptospirosis during chikungunya outbreaks. IDCases 22: 1214.[Crossref] [Google Scholar]
  14. Biron A, Cazorla C, Amar J, Pfannstiel A, Dupont-Rouzeyrol M, Goarant C, , 2016. Zika virus infection as an unexpected finding in a Leptospirosis patient. JMM Case Rep 3 : e005033. [Google Scholar]
  15. Centers for Disease Control and Prevention, 2016. Trioplex Real-time RT-PCR Assay. Available at: http://www.fda.gov/downloads/MedicalDevices/Safety/EmergencySituations/UCM491592.pdf. Accessed February 8, 2017.
  16. Stoddard RA, Gee JE, Wilkins PP, McCaustland K, Hoffmaster AR, , 2009. Detection of pathogenic Leptospira spp. through TaqMan polymerase chain reaction targeting the LipL32 gene. Diagn Microbiol Infect Dis 64: 247255.[Crossref] [Google Scholar]
  17. Rajapakse S, Rodrigo C, Handunnetti SM, Deepika S, , 2015. Current immunological and molecular tools for leptospirosis: diagnostics, vaccine design, and biomarkers for predicting severity. Ann Clin Microbiol Antimicrob 14: 18.[Crossref] [Google Scholar]
  18. Agampodi SB, Dahanayaka NJ, Nockler K, Anne MS, Vinetz JM, , 2016. Redefining gold standard testing for diagnosing leptospirosis: further evidence from a well-characterized, flood-related outbreak in Sri Lanka. Am J Trop Med Hyg 95: 531536.[Crossref] [Google Scholar]
  19. Nabity SA, Ribeiro GS, Aquino CL, Takahashi D, Damião AO, Gonçalves AH, Miranda-Filho DB, Greenwald R, Esfandiari J, Lyashchenko KP, Reis MG, Medeiros MA, Ko AI, , 2012. Accuracy of a dual path platform (DPP) assay for the rapid point-of-care diagnosis of human leptospirosis. PLoS Negl Trop Dis 6: e1878.[Crossref] [Google Scholar]
  20. Cohen AL, McMorrow M, Walaza S, Cohen C, Tempia S, Alexander-Scott M, Widdowson MA, , 2015. Potential impact of co-infections and co-morbidities prevalent in Africa on influenza severity and frequency: a systematic review. PLoS One 10: e0128580.[Crossref] [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.17-0250
Loading
/content/journals/10.4269/ajtmh.17-0250
Loading

Data & Media loading...

  • Received : 27 Mar 2017
  • Accepted : 07 May 2017
  • Published online : 26 Jun 2017

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error