Abstract Leptospirosis is an endemic zoonotic disease caused by the spirochete Leptospira with potentially fatal consequences. Symptoms can range from mild flu-like illness to pulmonary, renal, and cardiovascular failure. Transmission most commonly occurs via exposure to the urine of infected animals. Transmission via animal bites has only been described in limited case reports. Treatment includes antibiotic administration, which may result in an acute inflammatory response termed a Jarisch-Herxheimer reaction (JHR). JHR reactions have classically been described with the treatment of spirochetes with penicillin. We present a case of Leptospirosis transmission via animal bite with a subsequent severe JHR after administration of piperacillin-tazobactam. A 21-year-old male with a history of hypothyroidism and rat bite to his finger, two weeks prior, presented with myalgias, fatigue and diarrhea and was admitted to the hospital for treatment of sepsis from a potential community-acquired pneumonia. He was initially treated empirically with vancomycin and piperacillin-tazobactam. Approximately two hours after the administration of piperacillin-tazobactam the patient became profoundly hypotense and required transfer to the intensive care unit. Over the next 12 hours his clinical course continued to deteriorate with the development of encephalopathy, seizures, and a stress-induced cardiomyopathy. Empiric treatment for meningitis with ampicillin and dexamethasone was started and doxycycline was given for any potential tick-borne illnesses. After consultation with infectious disease and approximately 24-hours after admission his therapy was narrowed to a seven-day course of ceftriaxone for treatment of a presumed spirochetal infection. The diagnosis of Leptospirosis was confirmed via polymerase chain reaction (PCR) testing for Leptospira DNA 17 days later. Leptospirosis spread via animal bite represents a underrecognized described mode of transmission with seven case reports found in the literature. Documentation of JHR with the use of piperacillin-tazobactam are scarce, despite its common use, representing a potentially significant underrecognized impact of JHR on patients with Leptospirosis. This abstract is funded by: None
Gunderson et al. (Fri,) studied this question.