Wild boars as possible source of hemorrhagic leptospirosis in Berlin, Germany

Abstract

Leptospirosis is a reemerging anthropozoonosis in developing and developed countries [1, 2], and Leptospira spp are endemic to a multitude of domestic and wild animals that shed the infectious pathogen in their urine [1]. Humans usually become infected through contact with urinecontaminated water or soil. Wild boars (Sus scrofa) are well known as animal hosts for Leptospira spp. Leptospires of the Pomona-serogroup, which are predominantly recognized as the infecting serogroup in domestic swine, have frequently been detected in wild boars in European and other countries [3, 4]. The population of this game species has significantly increased throughout Europe over the past decades [5]. As a consequence, migration to urban areas and close contact between wild boars and humans are more frequently observed. In September 2003, a 39-year-old male presented to the emergency unit with a 2-day history of watery diarrhea, fever and abdominal pain. There was no history of traveling abroad, but the patient remembered he had eaten raw eggs about 12 h prior to the onset of diarrhea. Physical examination on hospitalization revealed an acutely ill male with a temperature of 39.8°C, severe tachycardia (120 beats/min), and hypotension (90/60 mmHg). An initial chest radiograph was normal. Infectious gastroenteritis was suspected and the patient received intravenous fluids. On hospital day 3, his condition rapidly deteriorated. In a state of protracted shock, he developed clinical and laboratory signs of pancreatitis, cholecystitis, and hepatitis. Extensive microbiological, parasitological, and serological examinations revealed no causative pathogen and several blood cultures remained sterile. Despite an empiric antibiotic treatment with ciprofloxacin and clarithromycin and infusion therapy, the patient became hemodynamically unstable and had to be transferred to the intensive care unit. The following day, the patient became increasingly breathless and hypoxemic and required intubation. His chest radiograph revealed an adult respiratory distress syndrome pattern, while bronchoscopy showed a sanguineous lavage fluid, suggesting alveolar hemorrhage (Fig. 1). Under intubation, forced diuresis, and an antibiotic regimen including imipenem, ciprofloxacin and clarithromycin, the patient’s condition stabilized. Upon further questioning, his relatives recalled he had cleaned a pond in his garden 2 weeks before the onset of disease. During this work, he waded through the muddy water for several hours and contracted a number of small wounds on his calves. At that time, the pond was frequently used by wild boars as a drinking trough and for wallowing. Contact with other animals was negated. Leptospirosis was suspected, and three consecutive serum samples were submitted to the Eur J Clin Microbiol Infect Dis (2006) 25:544–546 DOI 10.1007/s10096-006-0174-3