Jpn. J. Infect. Dis., 54, 2001

Laboratory and Epidemiology Commumications

A Fatal Case ofWeil's Disease in Miyagi Prefecture
Kazuo Akiyama, You Ueki, Youko Okimura, Ikuo Goto and Hiroyuki Shiraishi*Miyagi Prefectural Institute of Public Health and Envir10nment,
Saiwaicho 4‑ 7‑2, Miyagino‑ku, Sendai 983‑0836
Communicated by Kazuo Kato

(Accepted September 10, 2001)

LeptosplrOSis is characterized by acute infection with fTever,blood pressure was 60‑70 mmHg, and he had di侃cultybreath‑Jaundice, and hemo血age. The causative agent is released丘.om

ing･ He was sent to? general city‑hospital･ Clinical examination

the urine of fleld mice and infects human through contact withrevealed high protelnuria, high bilimbinemia, and severe liver

skin. The infection is endemic in various parts ofdle WOrld ( 1 ,2),

dysfunction, which characteristics are typical of leptosirosis･

including Japan (3,4). In the past 3 years, leptospirosis has

Increased white blood cell count, and decreased red bloodincreased in Yamagata and Niigata Prefectures (unpublishedcell, platelet, and hemoglobin counts were noted･ There wasdata). In Miyagi Prefecture, leptospirosis cases have remained

a hemo汀hage in the lung, and resplratOr COntrOl and bloodfew (3).

transfusion were started. The patient's condition deteriorated,

A 45‑year old farmer living in the northem region OfMiyagl

and he died by multiple organ failure on October 4.

Prefecture visited a clinic close to his home with fever, head‑

Antibody titers agalnSt Leptospira copenhageni, L･ache, and loss of appetite which started on September 27 ofautumnalis, L. hebdomadis, and L. australis were measured

I 999. He worsened, experienclng Jaundice and kidney failure,by the microscopic agglutination test (1‑3). The leptospira

and went to another hospital on October 1. His condition

microorganisms Were Cultured in modified Korthof's medium

deteriorated further, and, 2 days later, he was in shock, his

at 30oC for 5 days, and leptosplra SuSPenSions adjusted to*Corresponding author: Fax: +8ト22‑256‑3362, E‑mail: mpslrais

tion test. Agglutinated leptosplra microorganisms weredetected by PCR amplification of the leptospira gene (5)･

108 live microorganisms per ml were used for the agglutina‑@satum.plala. orjp
156

Jpn. J. Infect. Dis., 54, 2001
1n the blood specimens of October 4, a leptosplra agent

REFERENCES

was detected by microscopy. ln the blood and cerebrosplnal

fluid ofOctober 4, the leptosplra genOme Was detected by PCR.

1. 戸aine, S. (eds.)(1982): Guidelines fわr the control or

The difference in antibody titers against L. copenhageni

leptosplrOSis. WHO offset pubhcation, no･ 67･ WHO,between the Octわber 2 and October 4 specimens was fburfbld･Geneva.
2. Mackenzie, 良. 良., Reiley, C. G., Alexander, A. D.,

The causative agent was thus conclusively diagnosed a§上.

BruCkner, E. A., Diercks, F. H. and Beye, H. K. (1966):

copenhageni.

reported in 1959, 407 patients in 1961, and 17 patients ln

An outbreak of leptosplrOSis among U･S･ Any troops
in the Canal Zone. Am. J. Trop. Med. Hyg･, 15, 57‑63･
3. Akiyama, K., Shiraishi, H., Yamamoto, H. and Ishida,1975 (3). The cases decreased dramatically, and most recentN. (1 990): Epidemiological analyses of leptospirosis inpatient was recorded in 1987 (the last decreased case wa.s in

Miyagi Prefecture through 30 years. Proceedings of the1983). This decrease was probably brought about by vacclna‑

LeptosplrOSis Research Conference. In Kobayashi, Y･,tion and wider use of fan machinery. It should be noted that(ed.), the 75th Anniversary of the Discovery of the Causal

the leptosplra infection rate in captured wild rats in the 1 960s

0rganism orWeil's Disease by lnada and ldo･ Hokusen‑

LeptosplrOSis was endemic until the 1 970s in the northem

region of Miyagi Prefecture; 822 patients (35 died) werewas similar to that in the 1990s in Miyagi Prefecture (3). lnsha, Tbkyo.

4. Yanagihara, Y and Masuzawa, T. (1995): Leptospirosis･
J. Med. Tech., 39, 102911037 (in Japanese).
5. Merien, F., Amouriaux, P., Perolat, P., Baranton, G. andaddition, since the revision of vaccination law in 1 995, fewer
and fTewer farmers have been receivlng the leptosplra Vaccina‑tion. Issulng WamlngS about persistent leptosplra in wild ratsGirons, I･ S･ (1992): Polynterase chain reaction for detec‑tion of Leptospira spp. ln Clinical samples･ J･ Clin･and encouraglng leptosplra Vaccination among moderate tohighrisk groups should be recommended.

Microbio1., 30, 2219‑2224.

157