title: Leptospirosis presenting as honeymoon fever.
abstract: An increasing number of travelers from western countries visit tropical regions, questioning western physicians on the prophylaxis, the diagnosis and the therapeutic management of patients with travel-associated infection. In July 2014, a French couple stayed for an adventure-travel in Columbia without malaria prophylaxis. A week after their return the woman presented with fever, myalgia, and retro-orbital pain. Three days later, her husband presented similar symptoms. In both patients, testing for malaria, arboviruses and blood cultures remained negative. An empirical treatment with doxycycline and ceftriaxone was initiated for both patients. Serum collected from the female patient yielded positive IgM for leptospirosis but was negative for her husband. Positive Real-Time PCR were observed in blood and urine from both patients, confirming leptospirosis. Three lessons are noteworthy from this case report. First, after exclusion of malaria, as enteric fever, leptospirosis and rickettsial infection are the most prevalent travel-associated infections, empirical treatment with doxycycline and third generation cephalosporin should be considered. In addition, the diagnosis of leptospirosis requires both serology and PCR performed in both urine and blood samples. Finally, prophylaxis using doxycycline, also effective against leptospirosis, rickettsial infections or travellers' diarrhea should be recommended for adventure travelers in malaria endemic areas.
authors.affiliation: IHU Méditerranée Infection, Pôle des Maladies Infectieuses et Tropicales Clinique et Biologique, Service de Maladies Infectieuses et Tropicales, CHU Nord, Assistance Publique - Hôpitaux de Marseille, Chemin de Bourrelys, 13015 Marseille, France.
authors.forename: B
authors.initials: B
authors.lastname: de Sainte Marie
authors.affiliation: IHU Méditerranée Infection, Pôle des Maladies Infectieuses et Tropicales Clinique et Biologique, Service de Maladies Infectieuses et Tropicales, CHU Nord, Assistance Publique - Hôpitaux de Marseille, Chemin de Bourrelys, 13015 Marseille, France.
authors.forename: M
authors.initials: M
authors.lastname: Delord
authors.affiliation: IHU Méditerranée Infection, Pôle des Maladies Infectieuses et Tropicales Clinique et Biologique, Laboratoire de Bactériologie, CHU Timone, Assistance Publique - Hôpitaux de Marseille, Chemin de Bourrelys, 13015 Marseille, France; Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, INSERM 1095, 13005 Marseille, France.
authors.forename: G
authors.initials: G
authors.lastname: Dubourg
authors.affiliation: IHU Méditerranée Infection, Pôle des Maladies Infectieuses et Tropicales Clinique et Biologique, Service de Maladies Infectieuses et Tropicales, CHU Nord, Assistance Publique - Hôpitaux de Marseille, Chemin de Bourrelys, 13015 Marseille, France; Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, INSERM 1095, 13005 Marseille, France.
authors.forename: P
authors.initials: P
authors.lastname: Gautret
authors.affiliation: IHU Méditerranée Infection, Pôle des Maladies Infectieuses et Tropicales Clinique et Biologique, Service de Maladies Infectieuses et Tropicales, CHU Nord, Assistance Publique - Hôpitaux de Marseille, Chemin de Bourrelys, 13015 Marseille, France; Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, INSERM 1095, 13005 Marseille, France.
authors.forename: P
authors.initials: P
authors.lastname: Parola
authors.affiliation: IHU Méditerranée Infection, Pôle des Maladies Infectieuses et Tropicales Clinique et Biologique, Service de Maladies Infectieuses et Tropicales, CHU Nord, Assistance Publique - Hôpitaux de Marseille, Chemin de Bourrelys, 13015 Marseille, France; Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, INSERM 1095, 13005 Marseille, France.
authors.forename: P
authors.initials: P
authors.lastname: Brouqui
authors.affiliation: IHU Méditerranée Infection, Pôle des Maladies Infectieuses et Tropicales Clinique et Biologique, Service de Maladies Infectieuses et Tropicales, CHU Nord, Assistance Publique - Hôpitaux de Marseille, Chemin de Bourrelys, 13015 Marseille, France; Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, INSERM 1095, 13005 Marseille, France. Electronic address: jean-christophe.lagier@ap-hm.fr.
authors.forename: J C
authors.initials: JC
authors.lastname: Lagier
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002443:Ceftriaxone / Q000627:therapeutic use; D003105:Colombia; D003937:Diagnosis, Differential; D004318:Doxycycline / Q000627:therapeutic use; D005260:Female; D005334:Fever / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D005602:France; D006801:Humans; D007922:Leptospirosis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D008288:Malaria / Q000175:diagnosis; D008297:Male; D012282:Rickettsia Infections / Q000175:diagnosis; D014195:Travel; D016896:Treatment Outcome; D014435:Typhoid Fever / Q000175:diagnosis
chemical_list: D000900:Anti-Bacterial Agents; D002443:Ceftriaxone; D004318:Doxycycline
keywords: Colombia; Doxycycline; Leptospirosis; Prophylaxis; Travel-associated infection; White-water