Enlarge / People kayaking and boating along a canal in The Hague, The Netherlands.
It was his yellow, bloody eyes that betrayed his illness. The previously healthy 18-year-old presented to an emergency room in the Netherlands after two days with fever, vomiting and diarrhea. His heart was beating fast and his abdomen was a bit tender.
The whites of his eyes were smeared with blood, a sign that blood vessels had ruptured on the surface of his eyes. Areas not bloody were jaundice yellow. Laboratory tests later showed that he had acute kidney injury as well as liver dysfunction. But an equally important clue to the cause of his acute illness was the mention that he had fallen down a canal three weeks earlier.
All in all, it was a textbook case, according to a recent report in the New England Journal of Medicine. The man had a rare but severe bout of leptospirosis, a bacterial infection characterized by fever, jaundice, kidney failure and bleeding. The source: a fall into a sewer likely contaminated with the urine of infected rodents.
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Leptospirosis is caused by the spiral-shaped bacterium Leptospira interrogans, which quietly infects a number of animals and colonizes the kidneys. The bacteria can be found harmlessly infecting pigs, horses, cows, dogs, a range of wild animals and even frogs. However, they are most dangerous to humans from the common brown rat, Rattus norvegicus.
The bacteria are excreted in the urine of an infected animal, and humans can become infected through direct contact or through contact with contaminated water and soil. The spiral-shaped invaders enter humans through cuts and mucous membranes such as the eyes. Once inside, they multiply in the bloodstream and can attack the liver and kidneys. Severe cases can lead to meningitis, organ failure, and acute respiratory distress.
L. interrogans is found worldwide but is primarily endemic to humid tropical and subtropical areas. The World Health Organization estimates that there are more than 500,000 cases of leptospirosis each year. According to the US Centers for Disease Control and Prevention, about 10 percent of cases are severe and about 5 to 15 percent of severe cases are fatal. Antibiotics such as doxycycline or penicillin are effective in clearing the infection.
In the young man’s case, a week’s hospitalization and intravenous antibiotics did the trick. At a three-week follow-up, all of his symptoms had disappeared.