東京23 区内で感染した重症レプトスピラ症（ワイル病）の1 症例

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  • A Case of Severe Leptospirosis Infection (Weilʼs Disease) in Tokyo
  • 症例 東京23区内で感染した重症レプトスピラ症(ワイル病)の1症例
  • ショウレイ トウキョウ 23 クナイ デ カンセン シタ ジュウショウ レプトスピラショウ ワイルビョウ ノ 1 ショウレイ

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We report a case of severe leptospirosis infection (Weilʼs disease) in Tokyo. A 54-year-old man admitted on September 14, 2006, for a 5-day inability to walk due to severe progressive bilateral leg pain, shoulder pain, and fever exhibited jaundice, conjunctival suffusion, hypoxia, andgraspingpaininthebilateralleg muscles. Laboratory findings showed severe liver damage, renal failure, leukocytosis, anemia, thrombocytopenia, elevated CRP, hyponatremia, and hypokalemia. Chest X-ray imaging showed interstitial infiltrates in the bilateral lung fields. After cefepime was initiated, he developed chills, fever, and hypotension due to Jarisch-Herxheimer reaction, necessitating respiratory support. Pulmonary hemorrhaging was also found. On hospital day 2, a urine polymerase chain reaction test for leptospira proved positive for the same base sequence as part of the leptospira gene. A microscopic agglutination test showed elevated antibody titers against Leptospira interrogans. Based on a diagnosis of leptospirosis, the man was treated with 2g per day of ceftriaxione for 2 weeks and recovered fully. The leptospira strain was isolated from rodents captured at his home, and we identified the same base sequence as from his urine sample. Reports shows, leptospirosis in Japan have decreased recently, but, as this case can still be seen even in Tokyo, and diagnosticians should maintain an awareness of possible significance in patients with typical findings for this disease.

収録刊行物

  • 感染症学雑誌

    感染症学雑誌 84 (1), 59-64, 2010

    一般社団法人 日本感染症学会

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