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

Laboratory and Epidemiology Communications

A Case of LeptosplrOSis Probably Caused by Drinking ContaminatedWe11‑Water after an Earthquake
Tomohiro Aoki*, Nobuo Koizumil and HaruO WatanabeI
Department ofInternal Medicine, Nichinan Municlbal Hospital,
Syoyama 511‑ 7, Nichinan‑cho, Hinogun, Tottori 689‑5211 and/Departmen i of Bacteriology, National lnstitu te of lnfectious Diseases,

Toyama 1‑23‑1, Shinjuku‑ku, Too,0 162‑d8640
Communicated by Haruo Watanabe(Accepted December 1 8, 2001)

LeptosplrOSis, a zoonotic disease caused by infection withg/dl, platelet count 47,000/LEI, total bilirubin O･8 mg/dl,

pathogenic Leptospira, is prevalent in developlng countries

aspartate aminotransferase (AST) 3 9 IU/dl, alanine aminotrans‑of the world, especially in Asia and Central and South America(1), though rare in Japa.n･ We here report a recent case offerase (ALT) 26 IU/dl, lactate dehydrogenase (LDH) I 76 1U/dl, blood urea.nitrogen (BUN) 12･8 mg/dl, creatinine O･69

leptosplrOSis in Japan, ln Which the subject was probably

mg/dl, C‑reactlVe Protein (CRP) 26 mg/dl, and hematuria (+)

infected by drinking contaminated well‑water after an earth‑and proteinuria positive. The laboratory findings, indicativeof innammation and thrombocytopenia, suggested a severequake.

A 48‑year‑Old man had a history of drinking water from a

infection. Cultures of sputum, blood, and urine were negative･

slightly muddy well aRer an earthquake in the Tbttori area on

Piperacillin sodium (3 g/day) was initially prescribed･ On

6 October 2000. He had a fever of380C on 10 October; hishospital day 3, however, conJunctival injection, headache, andcondition worsened, accompanied by chills, fatigue, andgastrocnemius paln Were aggravated and jaundice became

myalgia. He was admitted to a hospital on 13 October. His

prominent. At this polnt, leptosplrOSis was suspected, andminocycline (300 mg/day) was. given･ On hospital day 5,fever
dropped to 370C and the patient Was discharged from thehospital on 21 November 2000 (Fig. 1)･
Sera taken on 1 3 October and 16 November were examinedbody temperature was 39.5oC, and his heart rate 92/min. Bloodpressure was nomal. He had a conJunctival injection but noother abnomal丘ndings. White blood cell count was 1 1 ,000/〟l with 88% segmented neutrophils. Hemoglobin was 14･9

Mbocycbe POO叫dJLy)

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15.00013,000

11.00
?,000

7,00
kdy tebPehttLrt ( ℃)

40.0

39.0

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37.0

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10/Oct.

1112HospibJ

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6Fig, 1. Clinical course of the paticnt･*Corresponding author: Tel: +8 1 1859‑82‑1235, Fax: +811859182‑

1 34 1 , E‑mail: aoki 1 @town.nichinan.tottorijp

243

2072182291023

11

Jpn. J. Infect. Dis., 54, 2001
Table I. MicroscopIC agglutination tcstwith paired sera
Antigens Aggultination titcr in the sera onSpecies

Leptosptra in terrogans

Serovar1australis

30ctober< く く く 1 ‑1 2 1 ‑ ‑･1 2 1

in terf10ga nS

autumnalis

in terroga ns

batavi ac

in Eernogans

canicolain lerflOganS

copenh agen iin terflOga lZS

hebdomadi si c teroh acmorrhagiac

in terrogans

krcmastospyrOgen CS

borBPeEerse17 ii

JaVanica

kirschnert'

gri 打po typh osa

6November

1 ′b 1 ‑ 1 0 1 2 0 0 0 0 0 0 0 0 0 0 0>1くくilZ terY10gatZS

in terl'Oga nS

100000000000

for sero‑diagnosis of Leptospira infection by microscoplC

leptosplrOSis should not be ignored when physicians see

agglutination (2). Titer of antibody against L. interrogans

patients with fever of unknown ongln a洗er natural disasters.

serovar autumnalis in the serum or 16 November was 16‑

fold higher than that of 13 October (Table I).

This article appeared in the Infectious Agents Surveillance
Report, vol. 22, No. 7, p. 7, 2001 in Japanese.

Incidence of leptosplrOSis has dramatically decreased inJapan, and yearly reported cases are few.LeptosplrOSis in
our case was probably caused by drinking contaminated wel1‑

REFERENCES

water after an earthquake. Natural disasters may cause

1. Levett, P. N. (2001): Leptospirosis. Clin. Microbiol. Rev.,

contamination of drinking water by rat urine containing

Leptospira. ln tropICalreglOnS, Outbreaks of leptosplrOSis

14, 296‑326.

2. Faine, S., Adler, B., Bolin, C. and Perolat, P. (1999):

o洗en occur a鮎r heavy rain and flood (1). Our recent investi‑

Leptospira and LeptosplrOSis. p. I 80. 2nd ed. MediSci,
Me lboume.

gations revealed the presence or leptosplreS in urine or rats

trapped in urbanareas (unpublished data). The possibility of244