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Molecular Detection of Leptospira in Two Returned Travelers: Higher Bacterial Load in Cerebrospinal Fluid Versus Serum or Plasma

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  • Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California; Division of Infectious Diseases, Sequoia Hospital, Redwood City, California; Department of Medicine, Stanford University School of Medicine, Stanford, California; Department of Pathology, Stanford University School of Medicine, Stanford, California

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 Leptospira 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 Leptospira was detectable only in CSF obtained on admission. The second patient had a normal CSF profile, but Leptospira 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 Leptospira by molecular methods and may yield an actionable diagnosis in the absence of leptospiremia.

Author Notes

* Address correspondence to Jesse J. Waggoner, Department of Medicine, Stanford University School of Medicine, 3373 Hillview Avenue, Room 220, Palo Alto, CA 94304. E-mail: waggo001@stanford.edu

Authors' addresses: Jesse J. Waggoner, Division of Infectious Diseases, Department of Medicine, Stanford University, Stanford, CA, and Division of Infectious Diseases, Sequoia Hospital, Redwood City, CA, E-mail: waggo001@stanford.edu. Elizabeth A. Soda, Division of Infectious Diseases, Sequoia Hospital, Redwood City, CA, E-mail: elizabeth.soda@gmail.com. Ryan Seibert, Department of Medicine, Stanford University, Stanford, CA, E-mail: rseibert@stanford.edu. Philip Grant and Benjamin A. Pinsky, Division of Infectious Diseases, Department of Medicine, Stanford University, Stanford, CA, E-mails: pmgrant@stanford.edu and bpinsky@stanford.edu.

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