title: Atypical leptospirosis: an overlooked cause of aseptic meningitis.
abstract: BACKGROUND
  Leptospirosis, probably the most common zoonosis in the world, is caused by pathogenic Leptospira species. Clinical presentations range from nonspecific fevers to fulminant diseases such as Weil's syndrome. Neurological forms of leptospirosis (neuroleptospirosis) are usually underestimated, and many cases of leptospirosis are overlooked because of the lack of specificity of signs and symptoms. Diagnosis confirmation is difficult because of the challenges associated with isolating the organism and positive serologic testing. A comprehensive understanding of the clinical presentation of leptospirosis and risk factors for exposure to leptospirae are required for early diagnosis, in order to initiate appropriate treatment immediately.
  
  
  METHODS
  Here we present one male patient with anicteric leptospirosis that manifested as neuroleptospirosis with aseptic meningitis, although he did not have impaired kidney function or thrombocytopenia. He recovered well after an early investigation and treatment for leptospirosis based on suspected relevant risk factors and clinical manifestations.
  
  
  CONCLUSIONS
  To facilitate optimal use of antibiotic treatments and prevent lethal complications of leptospirosis, we report this case of leptospirosis, which highlights the importance of knowing the occupational history and environmental exposures of patients living in leptospirosis-endemic areas and presenting meningeal signs.
authors.affiliation: Department of Neurology, Wan Fang Medical Center, Taipei Medical University, No. 111, Section. 3, Shing Long Road, Taipei, 11696, Taiwan.
authors.forename: Ning
authors.initials: N
authors.lastname: Wang
authors.affiliation: Department of Neurology, Wan Fang Medical Center, Taipei Medical University, No. 111, Section. 3, Shing Long Road, Taipei, 11696, Taiwan.
authors.forename: Yu-Hsuan
authors.initials: YH
authors.lastname: Han
authors.affiliation: Department of Neurology, Wan Fang Medical Center, Taipei Medical University, No. 111, Section. 3, Shing Long Road, Taipei, 11696, Taiwan.
authors.forename: Jia-Ying
authors.initials: JY
authors.lastname: Sung
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Wan Fang Medical Center, Taipei Medical University, No. 111, Section. 3, Shing Long Road, Taipei, 11696, Taiwan.
authors.forename: Wen-Sen
authors.initials: WS
authors.lastname: Lee
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Wan Fang Medical Center, Taipei Medical University, No. 111, Section. 3, Shing Long Road, Taipei, 11696, Taiwan. 93023@w.tmu.edu.tw.
authors.forename: Tsong-Yih
authors.initials: TY
authors.lastname: Ou
mesh_terms: D000328:Adult; D006801:Humans; D007922:Leptospirosis / Q000150:complications* / Q000188:drug therapy; D008297:Male; D008582:Meningitis, Aseptic / Q000188:drug therapy / Q000209:etiology*
keywords: Aseptic meningitis; Leptospira; Leptospirosis; Neuroleptospirosis; Zoonosis