Bao QH, Yu L, Ding JJ, Chen YJ, Wang JW, Pang JM, Jin Q. Severe community-acquired pneumonia caused by Leptospira interrogans: A case report and review of literature. World J Clin Cases 2021; 9(8): 1901-1908 [PMID: 33748240 DOI: 10.12998/wjcc.v9.i8.1901]
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Mar 16, 2021; 9(8): 1901-1908 Published online Mar 16, 2021. doi: 10.12998/wjcc.v9.i8.1901
Severe community-acquired pneumonia caused by Leptospira interrogans: A case report and review of literature
Qiu-Hong Bao, Li Yu, Jian-Jun Ding, Ying-Jun Chen, Jun-Wei Wang, Jian-Ming Pang, Qi Jin
Qiu-Hong Bao, Jian-Ming Pang, Department of Respiratory and Critical Medicine, Tiantai Hospital of Hangzhou Medical College, Tiantai 317200, Zhejiang Province, China
Li Yu, Ying-Jun Chen, Jun-Wei Wang, Department of Infectious Disease, Tiantai Hospital of Hangzhou Medical College, Tiantai 317200, Zhejiang Province, China
Jian-Jun Ding, Department of Critical Care Medicine, Tiantai Hospital of Hangzhou Medical College, Tiantai 317200, Zhejiang Province, China
Qi Jin, ICU Administration, Tiantai Hospital of Hangzhou Medical College, Taizhou 317200, Zhejiang Province, China
Author contributions: Bao QH and Jin Q contributed to conception and design, manuscript writing and final approval of the manuscript; Wang JW and Pang JM performed the research; Chen YJ provided financial support and manuscript writing; Ding JJ and Yu L analyzed the data and wrote the manuscript; all authors have read and approved the final manuscript.
Supported byBasic Public Welfare Research Scheme of Zhejiang Province, No. GF19H030001.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Received: October 15, 2020 Peer-review started: October 15, 2020 First decision: December 13, 2020 Revised: December 24, 2020 Accepted: January 28, 2021 Article in press: January 28, 2021 Published online: March 16, 2021 Processing time: 135 Days and 4.1 Hours
Abstract
BACKGROUND
Leptospira is an uncommon pathogen for adult severe community-acquired pneumonia and its nonspecific manifestations and limited diagnostic tests make it difficult to identify. Although conventional penicillin remains efficacious to treat leptospirosis, failure in early diagnosis and treatment can lead to progression into a deadly syndrome with multiple organ dysfunction. Next generation sequencing is of great value to understand cases with infection of unknown cause, which could help in the diagnosis of uncertain Leptospira infection.
CASE SUMMARY
We recently managed a patient with fever, cough and dyspnea on admission that progressed into persistent adult respiratory distress syndrome, hemoptysis and hematuria after admission. In this case, the rare Leptospira infection was clouded by the positive influenza tests at admission, delaying early Leptospira-targeted antibiotics administration. Next generation sequencing, a novel molecular diagnostic tool, provided a key hint to uncover the crucial pathogen, Leptospira interrogans, further supported by the possible occupational exposure history. Subsequent conventional penicillin and mechanical respiratory support were administrated to cure the patient successfully without any sequela.
CONCLUSION
Clinicians must pay attention to possible exposure history and keep uncommon Leptospira in mind when managing pneumonia with unknown causes.
Core Tip: Pneumonia caused by Leptospira interrogans is rare but life-threatening. In the early phase, the nonspecific symptoms of Leptospira pneumonia often lead clinicians to misdiagnosis as influenza or other illness. We herein report a 54-year-old man who presented with cough, fever and dyspnea and was misdiagnosed with influenza but was confirmed with Leptospira infection with the help of next generation sequencing. Possible exposure history and next generation sequencing during management of infections with unknown causes are important.
