Een 57-jarige man met hoge koorts, hevige spierpijn, trombocytopenie, icterus en acute nierinsufficiëntie: diagnostische sleutels tot een vergeten, maar opkomende ziekte

Abstract

A 57-year-old man with a high fever, severe muscle aches, thrombocytopenia, icterus and acute renal failure: diagnostic keys to a forgotten but emerging disease Leptospirosis is a well-known disease in (sub)tropical regions, but in these areas it is often forgotten and unrecognised. In recent years, however, there has been an increasing incidence in these regions, mainly due to recreational exposure. Leptospirosis is a zoonosis. The rat is the main reservoir. Transmission of leptospires usually occurs via exposure of skin and mucous membranes to an environment contaminated by rat urine. The disease has a biphasic course with an initial phase of bacteremia followed by a fierce immune response provoked by vasculitis. The clinical presentation is variable, but in the vast majority of the cases the condition presents as a non-specific flu-like syndrome characterised by pronounced myalgia. A typically fulminant disease course with severe acute renal failure, haemorrhagic rash, submucosal and subcutaneous haemorrhage, icterus and thrombocytopenia is rather rare but has a significant mortality despite the current intensive care. The final diagnosis is most often confirmed by the detection of antibodies against leptospirosis. PCR tests are also available. Mild forms are often self-limiting, therefore antibiotic treatment is not always necessary. In case of a fulminant course of the disease, hospitalisation for maximum supportive care and antibiotic therapy is primordial. In this article, the pathogenesis, clinical presentation, diagnosis and treatment of leptospirosis are discussed based on a clinical case.