title: Leptospirosis in the Tohoku region: re-emerging infectious disease.
abstract: Leptospirosis is a zoonotic and disaster-related infectious disease. It is mainly endemic in subtropical or tropical countries and has not been reported since 2009 in the Tohoku region (northern Japan), including the Yamagata and Miyagi Prefectures. However, we experienced four patients with leptospirosis in the Tohoku region from 2012 to 2014; three patients (#1-3) live in the agricultural areas of the Yamagata Prefecture and one patient (#4) was a visitor to the Miyagi Prefecture. Patient 1 (81-year-old female) is a villager, with a rat bite, while Patient 2 (77-year-old male) and Patient 3 (84-year-old female) are farmers and were infected probably during agriculture work. Patient 4 (40-year-old male US citizen) was infected while traveling in Thailand. They had chief complaint of fever, headache, and myalgia and showed manifestations of hyperbilirubinemia (mean, 4.35 mg/dL), thrombocytopenia and acute kidney injury (AKI). All patients were diagnosed by polymerase chain reaction using blood and/or urine samples and a microscopic agglutination test for the anti-Leptospira antibody. All the patients were treated with infused antibiotics, including minocycline. The patients underwent hemodialysis due to severe AKI (mean serum creatinine, 4.44 mg/dL), except for Patient 2 with the normal serum creatinine level (1.12 mg/dL). All the patients recovered and were discharged. The presence of the three patients in the Yamagata Prefecture implies that leptospirosis does re-emerge in the Tohoku region. Therefore, careful survey of the pathogen is necessary for febrile patients with AKI who engage in agriculture or have a recent history of travelling in subtropical or tropical countries.
authors.affiliation: Division of Emerging Infectious Diseases, Department of Internal Medicine, Graduate School of Medicine, Tohoku University.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Saitoh
authors.forename: Nobuo
authors.initials: N
authors.lastname: Koizumi
authors.forename: Junji
authors.initials: J
authors.lastname: Seto
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ajitsu
authors.forename: Akio
authors.initials: A
authors.lastname: Fujii
authors.forename: Satoshi
authors.initials: S
authors.lastname: Takasaki
authors.forename: Shu
authors.initials: S
authors.lastname: Yamakage
authors.forename: Satoshi
authors.initials: S
authors.lastname: Aoki
authors.forename: Keisuke
authors.initials: K
authors.lastname: Nakayama
authors.forename: Yugo
authors.initials: Y
authors.lastname: Ashino
authors.forename: Haorile
authors.initials: H
authors.lastname: Chagan-Yasutan
authors.forename: Hideyasu
authors.initials: H
authors.lastname: Kiyomoto
authors.forename: Toshio
authors.initials: T
authors.lastname: Hattori
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D001733:Bites and Stings; D003141:Communicable Diseases / Q000453:epidemiology*; D018450:Disease Progression; D005260:Female; D006386:Hemagglutination Tests; D006760:Hospitalization; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007922:Leptospirosis / Q000097:blood / Q000453:epidemiology*; D008297:Male; D051381:Rats