A leptospirosis case returning from the Eco-Challenge on Borneo Island, Malaysia, September 2000
(IASR 2001;22:5-6)

Leptospirosis is a zoonotic disease caused by Leptospira interrogans. Following is a case report, in which information provided by the patient helped diagnosis.

The case was a 25-year-old male complaining of fever and headache. During August 16 to September 4, 2000, the patient and three teammates participated in the Eco-Challenge, a survival race held in Sabah State in Borneo Island, Malaysia. On September 7, he developed fever (38-39C) with chills. As his teammate had presented fever and was admitted in our hospital on September 8, the patient was also hospitalized the following day.

Upon admission, physical examinations revealed body temperature of 37.9C, and pulse rate of 90/minute (regular). Conjunctiva bulbae was hyperemic, but not anemic or icteric. Lymph node was not palpable, and skin eruption was not seen. There was no abnormal finding on chest, abdomen, and with neurological examinations. He had been vaccinated against tetanus, rabies, diphtheria, and hepatitis A, but he did not take malaria chemoprophylaxis. Blood chemistry revealed WBC, 13,100/ul (neutrophils 91%); Hb, 14.8g/dl; platelet, 190,000/ul; total bilirubin, 0.5mg/dl; GOT, 63IU/l; GPT, 66IU/l; LDH, 420IU/l; BUN, 12.5mg/dl; creatine, 0.9mg/dl; CRP, 17.8mg/dl. Plasmodium was negative on blood smears. Pathogenic bacterium was negative by stool culture.

As the patient provided information from the survival race organizer that the race participants developed leptospirosis, a serum sample collected on September 11 was forwarded to NIID. Both Leptospira antigen and antibodies were negative. Fever continued at 39C and leptospirosis was clinically diagnosed. Minocycline 200mg was administered intravenously from September 12, and fever subsided after September 14. Treatment with minocycline was given for a week, and the patient was discharged. Doxycycline 200mg/day was given orally for two weeks. On September 28 convalescent serum was submitted to NIID. Antibodies against Leptospira interrogans serovar hebdomadis were positive at 1:160, thus leptospirosis was confirmed.

Reported by: Mitsuo Sakamoto, Hiroko Sagara, Dept. of Infectious Diseases, Yokohama Municipal Citizen's Hospital; Nobuo Koizumi, Haruo Watanabe, Dept. of Bacteriology, NIID.

Correspondence:
E-mail: fumana@xc4.so-net.ne.jp
FAX: +81-45-331-1960

IASR editorial note: International Society of Travel Medicine (ISTM) has been conducting sentinel surveillance targeting travelers (Geo-Sentinel) using 26 travel clinics in the world. On September 11, 2000, Geo-Sentinel sites in London, New York, and Toronto notified ISTM that nine Eco-Challenge participants presented symptoms suggestive of leptospirosis. ISTM requested the society members by e-mail to disseminate the information to colleague physicians. ProMED released the similar message to the race participants to recommend medical consultation. The notice was circulated among mailing list members of the Japanese travel medicine experts (JOHAC Forum) and the Ministry of Health and Welfare.

A total of 78 teams from 26 countries participated in the race. Four members in a team competed in jungle trekking, canoeing, kayaking, rafting, scuba diving, mountain biking, cave exploring, etc. for 6-12 days. Local rivers were flooded since August 25.

As of September 15, 37 cases (hospitalized 12, confirmed 2) were found in US, whereas 4 cases in France (as of September 21, two were confirmed) and 9 cases in UK were reported.

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