A 50 y.o. male comes to the ED from the airport with a high fever. He had been in the Caribbean on vacation and was swimming in the ocean on Eleuthera.
He has mild jaundice and muscle aches
Our pt had leptospirosis. He had been swimming with feral pigs on the Disney island, Eutheria in the Bahamas
Leptospirosis is a common bacterial illness of pigs and feral swine throughout the world. It is caused by a gram negative bacteria found in pig urine. In areas where tourists swim with feral pigs as in Eutheria cases have been reported in humans where it can enter the body through mucous membranes or broken skin.
Symptoms occur anywhere from 2 days to 2 weeks after infection. A biphasic disease often presents with the first septic phase ending after about 7 days and the second phase starting in which antibodies are formed causing meningitis in some individuals. Of those infected only 10% develop severe disease. Vomiting, diarrhea and abdominal pain may develop. The classic form of severe leptospirosis is known as Weil’s disease with liver damage , kidney disease and bleeding.
Leptospira was first found in 1970 in California among sea lions. There are yearly seasonal outbreaks in sea lions . Horses, cows, dogs, sheep and goats are also susceptible. Interestingly, in animals the bacteria can be commensual, causing no disease in the animal but living in the proximal tubule and being continuously shed in urine.
Non marine environments can also be contaminated with leptospira especially in slow moving water like lakes or ponds Hawaii reports on average 40 cases per year caused by rodent and mongoose urine draining into ponds after heavy rains. A large outbreak was documented at Lake Springfield in Springfield Illinois when 100 swimmers came down with the disease after a triathlon in 1998. This was traced to raccoon urine.
FUN FACT
Leptospira is not the only disease associated with pigs. A case was reported of cellulitis.
He co leg pain blood cultures grew out Shewanella . While Shewanell is mainly associated with warm salt water, Denmark leads the world in the number of cases, possibly due to the warming of the Baltic Sea. This patient was treated with cefepime.
Picture of cellulitis with Shewanella species is a Marine species known to infect humans. He was treated with cefepime.
cellulitis from shewnella
Morgan J, Bornstein S, Karpati A, et al. Outbreak of leptospirosis among triathalon participants and community residents in Springield Illinois, 1998. Clin Infect Dis. 2002 Jun 15;34(12):1593-9.
Yu K, Huang Z, Xiao Y, Wang D. Shewanella infection in humans:epidemiology, clinical features and pathogenicity. Virulence 2022 Sep 5;13(1):1515-1532 .
Dretier A, Jacob J, Rouphael N. swimming with the pigs:a case of severe soft tissue infection during a Caribbean vacation. Case Rep Infect Dis. 20188 Oct 24;4092609 doi:19,1144/218/4082609.’
Eye image from Daniel Ostermayer