A case of a combined course of typhoid fever and leptospirosis

Abstract

Coinfections are becoming increasingly relevant and urgently require research. The development of international tourism has caused the rapid spread of infectious diseases from countries with unfavorable sanitary and hygienic conditions. This article analyzes the clinical case of a patient who recently returned from India and developed a combined course of typhoid fever and leptospirosis due to astrovirus infection and blastocystosis. The disease was characterized by symptoms of enteritis, low-grade fever, and mild intoxication. The patient repeatedly sought medical help. Diagnoses of “acute respiratory viral infection” and “intestinal infection of unknown etiology” were established. Symptomatic therapy was performed without a positive effect; fever and severe asthenic syndrome persisted. The patient was hospitalized on the 18th day of illness with moderate severity. Taking into account clinical, anamnestic, and epidemiological data and laboratory examination results, typhoid fever was diagnosed. A polymerase chain reaction (PCR) test identified astrovirus RNA in the stool, and Blastocystis hominis was detected during stool examination. Despite the ongoing pathogenetic and antibacterial therapy, considering the determination of the pathogen’s sensitivity to antibiotics, the patient’s condition worsened. On day 23 of the illness, jaundice, hemorrhagic syndrome, and signs of acute renal failure were noted. Through in-depth analysis of changes in the clinical and laboratory findings, considering epidemiological history data (stay in a region endemic for leptospirosis), leptospirosis was diagnosed and treated with antibacterial therapy. Complex intensive therapy using extracorporeal treatment methods helped prevent the development of unfavorable outcomes of combined pathology. This clinical case emphasizes that doctors must be wary of imported infections and conduct additional comprehensive investigations of suspected cases.