Tohoku J. Exp. Med., 2015 May, 236(1)

Leptospirosis in the Tohoku Region: Re-emerging Infectious Disease

HIROKI SAITOH,¹ NOBUO KOIZUMI,² JUNJI SETO,³ SATOSHI AJITSU,⁴ AKIO FUJII,⁵ SATOSHI TAKASAKI,⁶ SHU YAMAKAGE,⁶ SATOSHI AOKI,⁷ KEISUKE NAKAYAMA,⁷ YUGO ASHINO,^1,8 HAORILE CHAGAN-YASUTAN,^1,8 HIDEYASU KIYOMOTO⁹ and TOSHIO HATTORI^1,8

¹Division of Emerging Infectious Diseases, Department of Internal Medicine, Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan
²Department of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan
³Department of Microbiology, Yamagata Prefectural Institute of Public Health, Yamagata, Yamagata, Japan
⁴Department of Internal Medicine, Okitama Public General Hospital, Higashiokitama, Yamagata, Japan
⁵Department of Internal Medicine, Shinjo Tokushukai Hospital, Shinjyo, Yamagata, Japan
⁶Department of Internal Medicine, Yamagata Prefectural Central Hospital, Yamagata, Yamagata, Japan
⁷Division of Nephrology, Endocrinology and Vascular Medicine, Department of Internal Medicine, Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan
⁸Laboratory of Disaster-Related Infectious Disease, International Research Institute of Disaster Science, Tohoku University, Sendai, Miyagi, Japan
⁹Division of Integrated Nephrology and Telemedicine, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Miyagi, Japan

Leptospirosis is a zoonotic and disaster-related infectious disease. It is mainly endemic in subtropical or tropical countries and has not been reported since 2009 in the Tohoku region (northern Japan), including the Yamagata and Miyagi Prefectures. However, we experienced four patients with leptospirosis in the Tohoku region from 2012 to 2014; three patients (#1-3) live in the agricultural areas of the Yamagata Prefecture and one patient (#4) was a visitor to the Miyagi Prefecture. Patient 1 (81-year-old female) is a villager, with a rat bite, while Patient 2 (77-year-old male) and Patient 3 (84-year-old female) are farmers and were infected probably during agriculture work. Patient 4 (40-year-old male US citizen) was infected while traveling in Thailand. They had chief complaint of fever, headache, and myalgia and showed manifestations of hyperbilirubinemia (mean, 4.35 mg/dL), thrombocytopenia and acute kidney injury (AKI). All patients were diagnosed by polymerase chain reaction using blood and/or urine samples and a microscopic agglutination test for the anti-Leptospira antibody. All the patients were treated with infused antibiotics, including minocycline. The patients underwent hemodialysis due to severe AKI (mean serum creatinine, 4.44 mg/dL), except for Patient 2 with the normal serum creatinine level (1.12 mg/dL). All the patients recovered and were discharged. The presence of the three patients in the Yamagata Prefecture implies that leptospirosis does re-emerge in the Tohoku region. Therefore, careful survey of the pathogen is necessary for febrile patients with AKI who engage in agriculture or have a recent history of travelling in subtropical or tropical countries.

keywords —— Keywords: disaster; global warming; hemodialysis; leptospirosis; outbreak

© 2015 Tohoku University Medical Press

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Tohoku J. Exp. Med., 2015, 236, 33-37

Correspondence: Toshio Hattori, Laboratory of Disaster-Related Infectious Disease, International Research Institute of Disaster Science, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan.

e-mail: hatoriaoi@gmail.com