Leptospirosis is a zoonotic disease transmitted by fresh water and mammalian vectors in predominantly tropical regions, with an incidence of 0.1-10 per 100,000 in temperate climates, 10 or more per 100,000 in tropical climates, and up to 100 or more per 100,000 during outbreaks. Its rate of transmission spikes in areas affected by natural disasters such as floods and heavy rainfall and, because it often presents with non-specific symptoms, it can be difficult to diagnose. The case fatality rate in severe leptospirosis from <5 -30% makes it a pathogen of clinical importance. This review aims to summarize the most recent literature on the subject and provide recommendations to providers who may encounter afflicted patients.
A 12-year-old boy with a recent history of sinusitis and acute otitis media presented to the emergency department with 3 weeks of upper neck pain and generalized weakness. He also reported headaches and occasional diplopia and vomited twice the day before presentation. The patient was afebrile, with normal vital signs. On examination, he was listless and found to have a left-sided ear effusion, left-sided total facial paralysis, left-sided hearing loss, mild left upper extremity weakness, and ataxia. Laboratory values were significant for an increased WBC count of 30.42 Â 10 3 /mL and a C-reactive protein level of 15.7 mg/L. For the diagnosis and teaching points, see page 528. To view the entire collection of Images in Emergency Medicine, visit www.annemergmed.com Figure. MRI of the brain showing left sided otomastoiditis (white arrow), subdural empyema (A), and adjacent cerebellar edema with left to right shift (B).
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