Reemerging leptospirosis, California

Abstract

Leptospirosis is a reemerging infectious disease in California. Leptospirosis is the most widespread zoonosis throughout the world, though it is infrequently diagnosed in the continental United States. From 1982 to 2001, most reported California cases occurred in previously healthy young adult white men after recreational exposures to contaminated freshwater. We report five recent cases of human leptospirosis acquired in California, including the first documented common-source outbreak of human leptospirosis acquired in this state, and describe the subsequent environmental investigation. Salient features in the California cases include high fever with uniform renal impairment and mild hepatitis. Because leptospirosis can progress rapidly if untreated, this reemerging infection deserves consideration in febrile patients with a history of recreational freshwater exposure, even in states with a low reported incidence of infection.

Figure 1

California state map showing case report exposures by county: Case 1, Butte County; cases 2–4, Tuolomne County; case 5, Santa Clara County.

Figure 2

A: Renal biopsy shows inflammatory cell infiltrate in the interstitium and focal denudation of tubular epithelial cells. Hematoxylin and Eosin; original magnifications x100. B: Immunostaining of fragmented leptospire (arrowhead) and granular form of bacterial antigens (arrows). Original magnifications x158.