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Neuroleptospirosis: Aseptic Meningoencephalitis or Invasion into the Central Nervous System?
| Schiefecker AJ1*, Beer R1, Pfausler B1, Lackner P1, Broessner G1, Kofler M1, Richter S2, Allerberger F2, Muhr T3, Goris M4, Helbok R1 and Schmutzhard E1 | |
| 1Neurologic Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria | |
| 2AGES (Austrian Agency for Health and Food Safety), Moedling, Austria | |
| 3Department of Medicine, Landeskrankenhaus Graz West, Graz, Austria | |
| 4Royal Tropical Institute (KIT), KIT Biomedical Research, WHO/FAO/OIE and National Collaborating Centre for Reference and Research on Leptospirosis, Amsterdam, The Netherlands | |
| Corresponding Author : | Dr. Alois Josef Schiefecker, M.D. Neurologic Intensive Care Unit Department of Neurology Medical University of Innsbruck Innsbruck, Austria Tel: 82-2-958-8295 E-mail: alois.schiefecker@tirol-kliniken.at |
| Received: July 18, 2015 Accepted: August 19, 2015 Published: August 22, 2015 | |
| Citation: Schiefecker AJ, Beer R, Pfausler B, Lackner P, Broessner G, et al. (2015) Neuroleptospirosis: Aseptic Meningoencephalitis or Invasion into the Central Nervous System?. J Neuroinfect Dis S2:001. doi:10.4172/2314-7326.S2-001 | |
| Copyright: © 2015 Schiefecker AJ, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. | |
| Related article at Pubmed, Scholar Google | |
Abstract
Leptospirosis is a zoonotic disease of global importance with a mortality of up to 50% among patients requiring intensive care medicine. Meningitis or meningoencephalitis due to leptospires are considered to be an immunologically mediated disease and to occur mainly during the second phase of disease. Herein, we report a patient with severe meningo-encephalitis due to leptospirosis with evidence of direct bacterial invasion into the central nervous system (CNS). A 36-year-old otherwise healthy male farmer, without recent travel history, presented with recurrent fever, peaking >39°C, cough and conjunctivitis 10 days after high-pressure cleaning of a piggery without eye protection. Diagnostic work-up revealed meningoencephalitis due to Leptospira species (spp.). Serology (microscopic agglutination test) yielded elevated antibody titers (1:400) for Leptospira interrogans. Polymerase chain reaction (PCR) and electron micrograph of cerebrospinal fluid (CSF) demonstrated direct invasion of Leptospires into the CSF. Magnetic resonance imaging (MRI) of the brain and spine did not reveal any pathologic findings; electroencephalography (EEG) indicated right-hemispheric slowing. Due to severe abdominal pain, gastroscopy was performed. Histology showed signs of vasculitis. Conventional abdominal angiography demonstrated vasculitis resembling panarteriitis nodosa. Combined antibiotic and steroid therapy lead to clinical improvement.
Neuroleptospirosis is an important differential diagnosis of occupational meningoencephalitis in Central Europe. This case supports the hypothesis of direct invasion of leptospires into the CNS.
