OCCUPATIONAL LEPTOSPIROSIS: FROM ACUTE NONSPECIFIC INFECTION TO THE SEVERE FORM OF WEIL SYNDROME – A CASE REPORT

Abstract

Leptospirosis is a zoonosis caused by the bacterium Leptospira spp. Rodents are the primary urban reservoirs, and humans are the accidental hosts, infected directly or indirectly through the urine of infected animals. Diagnosis is complex, based on clinical-epidemiological-laboratory data, and treatment involves antibiotic therapy.This paper reports a severe occupational case of leptospirosis progressing to Weil's Syndrome with a late diagnosis. A 31-year-old elevator maintenance worker from Nova Lima/MG, immunocompetent, initially presented symptoms such as arthralgia, epigastralgia, diffuse myalgia, calf pain, headache, fever, nausea, and hyporexia. Upon seeking medical attention, he exhibited conjunctival suffusion and epistaxis. Laboratory tests showed anemia and thrombocytopenia, leading to the suspicion of dengue. The patient sought medical care three times, but the initial hypothesis was maintained. After six days, with general worsening and jaundice, he was hospitalized with suspected leptospirosis with Weil's Syndrome—jaundice, acute renal failure (ARF), and hemorrhagic phenomenon—and possible exposure to rat urine. Laboratory tests revealed anemia (normocytic and normochromic), leukocytosis, neutrophilia, left shift, thrombocytopenia, elevated aminotransferases, creatine kinase, urea, alkaline phosphatase, gamma-GT, hyperbilirubinemia, hypokalemia, hypomagnesemia, and elevated C-reactive protein. Serologies for viral hepatitis, Chagas disease, and HIV (Human Immunodeficiency Virus) were negative, and Enzyme Linked Immunosorbent Assay (ELISA-IgM) for Leptospira spp. was indeterminate. Ultrasound indicated hepatic impairment and nephrolithiasis. With alarm signs, the patient was transferred to the Intensive Care Unit (ICU), received intravenous hydration, analgesics, antiemetics, ceftriaxone, and potassium and magnesium replacement. Subsequently, serology confirmed leptospirosis. After ten days, he was discharged with clinical improvement and stabilized creatinine levels. This case highlights the importance of a detailed medical history and attention to epidemiological factors for early diagnosis of leptospirosis, alerting healthcare professionals to the potential severity of the disease.