Polyneuritis and Rare Sequelae of Leptospirosis Contracted While on an Urban Clean-Up Mission in Detroit : A Case Report of Weils Disease and Literature Review

Abstract

Leptospirosis is a common zoonosis, an infectious disease that infects both humans and animals, which is caused by spirochete bacteria from genus Leptospira. Approximately 30% of children in urban Detroit and 16% of adults in Baltimore demonstrated serologic evidence of previous leptospirosis infections. The Detroit study showed correlation between degree of rat infestation and seropositivity rates. This finding suggests rats are major vectors for human leptospirosis in mainland United States. The leptospires from infected animals survive best in fresh water, damp alkaline soil, vegetation, and mud with temperatures higher than 22 C. Although leptospirosis is a well documented clinical condition, the sequelae of polyneuritis has not yet been reported to our knowledge. The following case is an example of such an occurrence. A 49-year-old Caucasian female presented to the emergency department with flu-like symptoms after volunteering in an urban Detroit neighborhood clean-up project. She admitted to picking up wood from stagnant water without wearing personal protective equipment. The primary differential diagnosis being Weils disease from leptospirosis and was proven positive with serologic testing via the Center for Disease Control. A computed tomography (CT) abdomen and pelvis demonstrated lymphadenopathy throughout the abdomen and near the spinal column. She was treated with ceftriaxone and doxycycline for 12 days but developed chronic neuralgia and polyneuritis. Leptospires are known to cause vasculitis. This patient developed polyneuritis either from direct invasion of the nerves from leptospires or compromised blood supply to the nerves. In addition to antibiotics, patients with severe cases of leptospirosis also require supportive therapy and careful management of renal, hepatic, hematologic, and central nervous system complications. If renal failure ensues, early initiation of hemodialysis or peritoneal dialysis may reduce mortality. Rapid identification of symptoms and a high clinical suspicion are paramount because early intervention can save their life.




J Med Cases. 2019;10(6):183-187
doi: https://doi.org/10.14740/jmc3320