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A Case of Leptospirosis Encountered in a Non-endemic Region (Hokkaido Prefecture)
1)Department of Pediatrics, Sapporo Tokushukai Hospital, 2)Unit of Veterinary Bacteriology, Rakuno Gakuen University
Takashi OGASAWARA1), Toshiaki OKA1), Mitsuo NARITA1), Miho OSHIMA1) & Ryo MURATA2)
(Received October 10, 2017)
(Accepted November 25, 2017)
Key words: Leptospira Copenhageni, microscopic agglutination test

Fifteen to 42 cases of leptospirosis have been reported each year in Japan, mostly from Okinawa prefecture, and no case has been found in Hokkaido prefecture. We report herein on a case of leptospirosis encountered in a non-epidemic region (Hokkaido prefecture). A 14-year-old male presenting with persistent fever, headache, conjunctival injection and rash was admitted to our hospital on the 8th day of illness. He also complained of bilateral calf muscle pain and general malaise. We initially suspected him of having Kawasaki disease and administered intravenous immunoglobulin (2 g/kg/dose) with oral aspirin (2,000 mg/day) on the day of admission, but the symptoms did not resolve. We asked him his history again, and it was revealed that he had a hamster die on the same day of his admission. Considering leptospirosis, we started oral doxycycline (200 mg/day) on the 13th day of illness and his symptoms rapidly improved following the treatment. We tested with PCR (for flaB gene), bacterial culture (with EMJH broth) and the microscopic agglutination test (MAT) for Leptospira on the 13th day of illness but the result of all tests was negative. Oral doxycycline was continued for 14 days. He was discharged from our hospital on the 22nd day of illness. We performed an MAT again on the 63rd day of illness and the test was positive for the Leptospira interogans serovar Copenhageni. In our case, the source of Leptospira was not clearly demonstrated because we could not examine the dead hamster microbiologically, but we assume the possibility of transmission from the hamster. In conclusion, it is important that, in patients who complain of fever and bilateral calf muscle pain following contact with rodents, leptospirosis must be considered even if they had not visited region where Leptospira in endemic.

[ Kansenshogaku Zasshi 92: 144-147, 2018 ]

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