Leptospirosis Similar to Pandemic (H1N1) 2009 | CDC EID

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Volume 17, Number 6–June 2011
Letter
Severe Leptospirosis Similar to Pandemic (H1N1) 2009, Florida and Missouri, USA
Yi-Chun Lo,1 Kristina W. Kintziger,1 Henry J. Carson,1 Sarah L. Patrick, George Turabelidze, Danielle Stanek, Carina Blackmore, Daniel Lingamfelter, Mary H. Dudley, Sean V. Shadomy, Wun-Ju Shieh, Clifton P. Drew, Brigid C. Batten, and Sherif R. Zaki
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (Y.-C. Lo, S.V. Shadomy, W.-J. Shieh, C.P. Drew, B.C. Batten, S.R. Zaki); Missouri Department of Health and Senior Services, Jefferson City, Missouri, USA (Y.-C. Lo, S.L. Patrick, G. Turabelidze); Florida Department of Health, Tallahassee, Florida, USA (K.W. Kintziger, D. Stanek, C. Blackmore); and Jackson County Medical Examiner's Office, Kansas City, Missouri, USA (H.J. Carson, D. Lingamfelter, M.H. Dudley)

Suggested citation for this article

To the Editor: Leptospirosis is caused by pathogenic spirochetes of the genus Leptospira and transmitted through direct contact of skin or mucous membranes with urine or tissues of Leptospira-infected animals or through indirect contact with contaminated freshwater or soil. Leptospirosis shares common clinical signs with influenza, including fever, headache, myalgia, and sometimes cough and gastrointestinal symptoms. During 2009, acute complicated influenza-like illness (ILI) and rapid progressive pneumonia were often attributed to pandemic (H1N1) 2009; however, alternative final diagnoses were reported to be common (1). We report 3 cases of severe leptospirosis in Florida and Missouri with clinical signs similar to those of pandemic (H1N1) 2009.

Patient 1 was a 40-year-old Florida man who sought treatment at an emergency department after a 4-day history of fever, myalgia, calf pain, malaise, and headache in July 2009. ILI was diagnosed. Laboratory testing was not performed, and the patient was instructed to take ibuprofen. Three days later, jaundice developed. He was admitted to an intensive-care unit with a diagnosis of hepatitis and acute renal failure. The man raised horses, goats, and chickens on his farm and was frequently employed to control rat infestations at an auto parts store and warehouse. Leptospirosis was suspected. Doxycycline was administered, and the man recovered and was discharged on the eighth day of hospitalization. Leptospira-specific immunoglobulin M antibodies were detected by dot blot (ARUP Laboratories, Salt Lake City, Utah, USA) on the second of paired consecutive blood specimens.

Patient 2 was a 17-year-old Missouri woman with a history of obesity. She was hospitalized in August 2009 with a 5-day history of fever, myalgia, calf pain, malaise, headache, nausea, vomiting, dyspnea, and cough, complicated by acute renal failure. The diagnosis on admission was viral infection. On the third day of hospitalization, severe pneumonia and respiratory failure developed, and she was administered vancomycin, piperacillin/tazobactam, levofloxacin, and doxycycline. She died the same day. Ten days before illness onset, she had swum in a creek near her residence.

Patient 3 was a 59-year-old Florida man with a history of obesity and diabetes mellitus. He sought treatment at a clinic in September 2009 and reported a 5-day history of fever, myalgia, malaise, nausea, abdominal pain, and dyspnea. He was treated for gastritis. Two days later, he came to an emergency department and was admitted to the hospital with severe pneumonia and multiorgan failure; he died the next day. The man had frequently engaged in activities to control rat infestations on the farm where he raised chickens, pigs, and goats.


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Leptospirosis Similar to Pandemic (H1N1) 2009 | CDC EID


Suggested Citation for this Article
Lo Y-C, Kintziger KW, Carson HJ, Patrick SL, Turabelidze G, Stanek D, et al. Severe leptospirosis similar to pandemic (H1N1) 2009, Florida and Missouri, USA [letter]. Emerg Infect Dis [serial on the Internet]. 2011 Jun [date cited].
http://www.cdc.gov/EID/content/17/6/1145.htm

DOI: 10.3201/eid1706.100980



1These authors contributed equally to this article.


Comments to the Authors
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Yi-Chun Lo, Missouri Department of Health and Senior Services, 920 Wildwood, PO Box 570, Jefferson City, MO 65109, USA; email: igj7@cdc.gov