Saturday, September 22, 2018

PRO/AH/EDR> Leptospirosis - Austria: (WI) ex Costa Rica, contam. fresh water expos. susp.

LEPTOSPIROSIS - AUSTRIA: (VIENNA) ex COSTA RICA, CONTAMINATED FRESH
WATER EXPOSURE SUSPECTED
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Date: Wed 19 Sep 2018
From: Marton Szell <docmarton@gmx.at> [edited]


We report a case of leptospirosis in a 26-year-old Austrian backpacker
returning from Costa Rica. The infection occurred most likely at a
waterfall near the village of Montezuma on the Pacific coast of Costa
Rica. This waterfall is a popular place especially with backpackers;
therefore, other tourists could be affected, too.

The patient returned on 28 Aug 2018 after traveling for 5 weeks in
Panama and Costa Rica. He had a high fever and a feeling of overall
weakness 2 days before his return to Austria. He consulted a local
doctor who ruled out dengue fever (point-of-care test) because of a
high blood leukocyte count; the doctor prescribed a 5-day course of
oral ciprofloxacin as an antibiotic treatment. No other tests were
performed.

After the patient's return to Austria, his general condition improved
and his body temperature returned to normal. The fever reappeared 9
days after the initial onset of the disease, and the patient
complained of severe headache and flulike symptoms. His family doctor
initiated a broad diagnostic checkup. In the end, only leptospirosis
serology yielded positive [results].

We carried out a complete blood check. All parameters, except slightly
elevated liver enzymes, [were] normal. We repeated tests for
leptospirosis: [Leptospiral] DNA in blood and urine was undetectable
and serology showed normal IgG, but a 4-fold increase of IgM
antibodies (enzyme immunoassay) confirmed the diagnosis.

Our patient could recall having contact with fresh water 7 to 10 days
before the onset of fever. He took a bath in a waterfall near
Montezuma on the Nicoya peninsula of Costa Rica. The patient had no
contact with animals.

Because of the patient's remaining symptoms (slightly elevated body
temperature and general weakness), we prescribed a 7-day course of
oral doxycycline therapy. With this treatment, all symptoms have
disappeared.

--
Communicated by:
Dr. Marton Szell
Infectious Diseases Consultant
Dr. Verena Sperl
Infectious Diseases Resident
Emergency Department
Danube Hospital
Vienna, Austria
<marton.szell@wienkav.at>

[Leptospirosis is caused by exposure to _Leptospira_ bacteria in fresh
(not salty) water, wet soil, or vegetation that has been contaminated
by urine of animals chronically infected with one of the several
hundred serovars of the spirochete _Leptospira interrogans_. Rodents,
dogs, cattle, and pigs are the usual reservoirs for this organism.

Leptospirosis is an occupational hazard for people who work outdoors
or with animals; for example, workers in wet agricultural settings
(such as rice field workers), ranchers, slaughterhouse workers,
trappers, loggers, sewer workers, veterinarians, fishery workers,
dairy farmers, or military personnel.

Leptospirosis is also a risk during recreational activities such as
camping, fresh water swimming, canoeing, kayaking, rafting, golfing,
and trail biking that involve exposure to water in lakes, rivers, or
ponds contaminated by urine from leptospire-infected animals, as well
as a risk from household exposure to infected pet animals or rodents.
- Mod.ML

HealthMap/ProMED maps available at:
Austria: <http://healthmap.org/promed/p/109>
Costa Rica: <http://healthmap.org/promed/p/17>]

[See Also:
Leptospirosis - Israel (06): (HZ) recreation, streams, bovine
vaccination http://promedmail.org/post/20180827.5989589
Leptospirosis - Israel (05): (HZ) recreation, streams, MOH update
http://promedmail.org/post/20180819.5974231
Leptospirosis - Israel (04): (HZ) recreation, streams, animal
reservoir http://promedmail.org/post/20180818.5973544
Leptospirosis - Israel (03): (HZ) streams, German tourist, early
patient http://promedmail.org/post/20180817.5970939
Leptospirosis - Israel (02): (HZ) recreation, streams, background
http://promedmail.org/post/20180815.5968110
Leptospirosis - Israel: (HZ) recreation, streams, alert
http://promedmail.org/post/20180815.5966453
Leptospirosis - France: (AC): fatal, swimmer, triathletic training
http://promedmail.org/post/20180531.5829928
2014
----
Leptospirosis - Japan (02): ex Palau, swimming
http://promedmail.org/post/20141112.2949702
Leptospirosis - Malaysia: (NS) national park
http://promedmail.org/post/20141014.2862048
2012
----
Leptospirosis - Belgium: (LX) boy scouts, muskrat
http://promedmail.org/post/20120926.1310750
Leptospirosis - Netherlands ex Dominican Republic, 2011
http://promedmail.org/post/20120331.1086285
2011
----
Leptospirosis - France: (SV) swimmers
http://promedmail.org/post/20110707.2054
2010
----
Leptospirosis, fatal - Malaysia (02): (KH)
http://promedmail.org/post/20100824.2971
Leptospirosis, farm workers, travelers - Australia: (QL) alert
http://promedmail.org/post/20100219.0571
2004
----
Leptospirosis, hikers - China (Hong Kong)
http://promedmail.org/post/20040928.2684]
.................................................ml/rd/lm
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