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<i>Leptospira</i> spp. are fastidious and slow-growing bacteria, making recovery difficult and diagnostic sensitivity in the clinical setting low. However, collection of <i>Leptospira</i> isolates is valuable for epidemiological and laboratory research. Severe leptospirosis cases may present as septic shock, and the differential diagnosis often includes bacterial septicemia, leading clinicians to collect blood cultures. Here, we report the successful isolation of pathogenic <i>Leptospira</i> spp. from blood culture bottles (targeting aerobic bacteria incubated at 37°C) from a 64-year-old man admitted with septic shock. The patient presented with 4 days of fever, severe hypotension, transient atrial fibrillation, jaundice, and oliguric renal failure. After admission, intravenous ceftriaxone plus azithromycin was given with fluid resuscitation, norepinephrine infusion, invasive mechanical ventilation, and renal replacement therapy. He was discharged from the hospital 16 days after admission. Using the blood sample obtained on admission, the diagnosis of leptospirosis was confirmed by multiplex real-time PCR (targeting bacterial 16S rRNA and <i>LipL</i>32 gene). We collected 200 μL from the blood culture bottle to inoculate a 5-mL Ellinghausen, McCullough, Johnson, and Harris media supplemented with 5% fetal bovine serum. After 2 weeks of incubation at 30°C, <i>Leptospira</i> strains were identified and confirmed by real-time PCR. Genotyping was undertaken using the multi-locus sequence typing (MLST) scheme#1. The isolate matched with ST50 isolates in the PUbMLST database. This case provides evidence that in tropical countries, severe leptospirosis should be considered in patients who present with symptoms of sepsis. Pathogenic <i>Leptospira</i> may be successfully isolated from aerobic blood cultures in routine clinical settings.

Original publication

DOI

10.4269/ajtmh.20-0204

Type

Journal

The American journal of tropical medicine and hygiene

Publication Date

11/2020

Volume

103

Pages

1834 - 1837

Addresses

Department of Immunology, Mahidol University, Bangkok, Thailand.

Keywords

Humans, Leptospira, Leptospirosis, Shock, Septic, Ceftriaxone, Azithromycin, Anti-Bacterial Agents, Drug Therapy, Combination, Middle Aged, Male, Blood Culture