Aseptic meningitis as the initial presentation of Leptospira borgpetersenii serovar Tarassovi: two case reports and a literature review

• Published in: BMC infectious diseases 2021-05, Vol.21 (1), p.488-6, Article 488
• Main Authors: Bandara, A G N M K, Kalaivarny, G, Perera, Nilanka, Indrakumar, J
• Format: Article
• Language: English
• Subjects: Acyclovir - therapeutic use; Adult; Animals; Anti-Bacterial Agents - therapeutic use; Anti-Inflammatory Agents - therapeutic use; Antiviral Agents - therapeutic use; Aseptic meningitis; Blood pressure; Case Report; Case reports; Case studies; Ceftriaxone - therapeutic use; Dexamethasone - therapeutic use; Diagnosis; Diagnosis, Differential; Differential diagnosis; Drinking Water - microbiology; Encephalitis; Fever; Glasgow Coma Scale; Glucose; Guillain-Barre syndrome; Headaches; Humans; Illnesses; Infections; Influenza; Laboratories; Leptospira; Leptospira - genetics; Leptospira - isolation & purification; Leptospira borgpetersenii Serovar Tarassovi; Leptospirosis; Leptospirosis - diagnosis; Leptospirosis - drug therapy; Literature reviews; Male; Meningitis; Meningitis, Aseptic - diagnosis; Meningitis, Aseptic - drug therapy; Nervous system; Neuroleptospirosis; Neutrophils; Patients; Proteins; Rafting; Risk exposure; Serogroup; Serology; Spirochetes; Sri Lanka; Treatment Outcome; Urine; Vomiting; Water pollution; Zoonoses
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-021-06200-w

Leptospirosis is a zoonotic illness caused by pathogenic spirochetes of the genus Leptospira. The disease spectrum ranges from a mild influenza-like presentation to a more serious Weil's syndrome. Leptospirosis rarely presents as a primary neurological syndrome. We report two cases of Leptospira borgpetersenii serovar Tarasssovi presenting as aseptic meningitis in Sri Lanka. We describe case reports of two patients presenting as symptomatic aseptic meningitis due to neuroleptospirosis. Both patients had significant neurological involvement at presentation in the absence of common clinical features of leptospirosis. These patients were initially managed as bacterial or viral meningitis and leptospirosis was suspected due to a history of exposure to contaminated water. Subsequently, they were diagnosed to have neuroleptospirosis by positive Leptospira serology and both patients gained full recovery. Our report highlights the importance of considering leptospirosis as a differential diagnosis in patients with aseptic meningitis in endemic settings. Obtaining a detailed occupational and recreational history is helpful in diagnosing neuroleptospirosis promptly. We report the association of Leptospira borgpetersenii serovar (sv.) Tarassovi (strain bakeri) in causing aseptic meningitis, which has not been reported to the best of our knowledge.