Department of Emergency Medicine, Emory University School of Medicine, 531 Asbury Circle, Annex Building, Suite N340, Atlanta, GA 30322, USA.
Am J Emerg Med. 2013 Feb;31(2):449.e1-2. doi: 10.1016/j.ajem.2012.06.016. Epub 2012 Sep 11.
Leptospirosis is a common zoonotic infection worldwide and is recognized as an emerging public health problem. Although commonly thought of as a tropical disease, incidence in temperate climates is increasing, with recent outbreaks in the United States and Germany, among other countries. The disease presents with symptoms ranging from fever, headache, nausea, and vomiting to life-threatening multiorgan failure characterized by acute liver failure, nephritis, pulmonary hemorrhage, meningitis, and cardiac arrhythmia. We describe a case of an otherwise healthy 28-year-old man who had just returned from a 2-month trip to Southeast Asia. He presented to our emergency department twice after his return with the complaint of fever and malaise. Initially, he was treated with symptomatic measures and discharged home with malaria smears and blood cultures pending. On his final presentation before admission, he presented with severe fatigue, myalgia, acute renal failure, and marked thrombocytopenia. After several days, inpatient testing revealed the patient's leptospira antibody titer was markedly positive. Given the nonspecificity of patient symptoms, early diagnosis of leptospirosis can be challenging. Diagnostic uncertainty may lead to delay in recommended intravenous antibiotic treatment. We present a case of severe leptospirosis treated exclusively with supportive measures and intravenous corticosteroids.
钩端螺旋体病是一种常见的全球人畜共患病，被认为是一个新出现的公共卫生问题。尽管通常被认为是热带疾病，但在温带气候中的发病率正在增加，最近在美国和德国等国家爆发了该病。该病的症状从发热、头痛、恶心和呕吐到以急性肝功能衰竭、肾炎、肺出血、脑膜炎和心律失常为特征的危及生命的多器官衰竭不等。我们描述了一例来自东南亚旅行归来的健康 28 岁男性患者。他在旅行归来后两次因发热和不适到我院急诊科就诊。最初，他接受了对症治疗，出院时等待疟疾涂片和血培养结果。在他最后一次入院前就诊时，他出现严重的疲劳、肌痛、急性肾衰竭和明显的血小板减少。几天后，住院检查发现患者的钩端螺旋体抗体滴度明显阳性。鉴于患者症状的非特异性，早期诊断钩端螺旋体病可能具有挑战性。诊断的不确定性可能导致推荐的静脉内抗生素治疗延迟。我们介绍了一例严重钩端螺旋体病，仅用支持治疗和静脉内皮质类固醇治疗。
