Leptospirosis, a zoonotic disease characterized by a spectrum of influenza-like symptoms, can manifest as severe cases so called Weil's disease. Early diagnosis and treatment are crucial to avoid the potentially fatal course of the disease. Within 24 hours of the initial administration of antibiotics, patients may experience the Jarisch-Herxheimer reaction (JHR), characterized by chills, fever, hypotension, and impaired consciousness. The Okinawa Prefecture, where our hospital is situated, boasts the highest incidence rate of leptospirosis among all regions in Japan. This reports our encounter with the initial leptospirosis case after a period of 16 years within the Okinawa Prefecture.
This case exhibited JHR and required the utilization of noradrenaline (NA). Despite evidence indicating that JHR does not correlate with mortality, we contend that diagnosis of Weil's disease necessitates admission to an intensive care unit (ICU) and vigilant monitoring for JHR, as it may result in impairment of general condition and fatal outcome, as observed in our case.
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- Leptospirosis: clinical aspects.Clin Med. 2022; 22: 14-17
- Ueber einer eigenhuemliche, mit Milztumor, Icterus un Nephritis einhergehende, acute Infektionskrankheit.Deut Arch Klin Med. 1886; 39: 109
- Global morbidity and mortality of leptospirosis: a systematic review.PLoS Neglected Trop Dis. 2015; 9e0003898
- Laboratory diagnostic, epidemiological, and clinical characteristics of human leptospirosis in Okinawa Prefecture, Japan, 2003-2020.PLoS Neglected Trop Dis. 2021; 15e0009993
- The Jarisch-Herxheimer reaction after antibiotic treatment of spirochetal infections: a review of recent cases and our Understanding of Pathogenesis.Am J Trop Med Hyg. 2017; 96: 46-52
- Leptospirosis in humans.Curr Top Microbiol Immunol. 2015; 387: 65-97
- Natural defense by saliva and mucosa against oral infection by Leptospira.Can J Microbiol. 2014; 60: 383-389
- Leptospirosis diagnosis: competancy of various laboratory tests.J Clin Diagn Res. 2014 Jan; 8: 199-202
- Determination of susceptibilities of 26 Leptospira sp. serovars to 24 antimicrobial agents by a broth microdilution technique.Antimicrob Agents Chemother. 2004; 48: 4002-4005
- Ceftriaxone compared with sodium penicillin g for treatment of severe leptospirosis.Clin Infect Dis. 2003; 36: 1507-1513
- An open, randomized, controlled trial of penicillin, doxycycline, and cefotaxime for patients with severe leptospirosis.Clin Infect Dis. 2004; 39: 1417-1424
- Placebo-controlled trial of intravenous penicillin for severe and late leptospirosis.Lancet. 1988; 1: 433-435
- Jarisch-herxheimer reaction among patients with leptospirosis: incidence and risk factors.Am J Trop Med Hyg. 2017; 96: 791-794
- Clinical characteristics of laboratory-confirmed leptospirosis in Okinawa, Japan, 1974-2015: high incidence of Jarisch-Herxheimer reaction.Trans R Soc Trop Med Hyg. 2016; 110: 558-565
- The Jarisch-Herxheimer reaction in leptospirosis: a systematic review.PLoS One. 2013; 8e59266
Published online: April 21, 2023
Accepted: April 15, 2023
Received in revised form: March 16, 2023
Received: February 1, 2023
Publication stageIn Press Corrected Proof
© 2023 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.