title: Travel-related leptospirosis in Japan: a report on a series of five imported cases diagnosed at the National Center for Global Health and Medicine.
abstract: Leptospirosis is one of the most common travel-related infections. We report 5 cases of travel-related leptospirosis who presented at our clinic between January 2008 and December 2013. Patients were included in the study if they presented with a clinical profile that was compatible with the disease within 21 days of their return from traveling, which were laboratory-diagnosed as leptospirosis by blood culture, rise in antibody titers in paired sera using the microscopic agglutination test (MAT), and/or DNA detection using flaB-nested PCR. Five leptospirosis cases were evaluated, all of which contracted the disease after exposure to fresh water in Southeast Asian countries. All of the cases had fevers, headaches, conjunctival injections, and relative bradycardia. The pertinent laboratory findings included elevated C-reactive protein levels, elevated creatinine levels, and sterile pyuria. All 5 cases had serum MAT titers that increased by ≥ 4 times in the interval between specimens taken during the acute phase and those taken during the convalescence phase, and leptospiral DNA was detected in plasma and/or urine specimens in 4 cases. Leptospira interrogans was isolated from one patient's blood sample. Patients were treated with penicillin G, minocycline, or doxycycline. One case was cured without antibiotics. A diagnosis of leptospirosis should be considered for febrile travelers who return from Southeast Asian countries to Japan after being exposed to freshwater while traveling.
authors.affiliation: Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan. Electronic address: sonare.since1192@gmail.com.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kutsuna
authors.affiliation: Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Kato
authors.affiliation: Department of Bacteriology, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan.
authors.forename: Nobuo
authors.initials: N
authors.lastname: Koizumi
authors.affiliation: Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Yamamoto
authors.affiliation: Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Fujiya
authors.affiliation: Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan.
authors.forename: Momoko
authors.initials: M
authors.lastname: Mawatari
authors.affiliation: Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan.
authors.forename: Nozomi
authors.initials: N
authors.lastname: Takeshita
authors.affiliation: Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan.
authors.forename: Kayoko
authors.initials: K
authors.lastname: Hayakawa
authors.affiliation: Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan.
authors.forename: Shuzo
authors.initials: S
authors.lastname: Kanagawa
authors.affiliation: Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan.
authors.forename: Norio
authors.initials: N
authors.lastname: Ohmagari
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000907:Antibodies, Bacterial / Q000097:blood; D000942:Antigens, Bacterial / Q000235:genetics; D004269:DNA, Bacterial / Q000235:genetics; D005408:Flagellin / Q000235:genetics; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007919:Leptospira / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D007922:Leptospirosis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D010400:Penicillin G / Q000627:therapeutic use; D016133:Polymerase Chain Reaction; D014195:Travel; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000907:Antibodies, Bacterial; D000942:Antigens, Bacterial; D004269:DNA, Bacterial; C545586:FlaB1 protein, Leptospira interrogans; D005408:Flagellin; D010400:Penicillin G
keywords: Freshwater; Leptospira; Leptospirosis; Returned travelers; Zoonosis