Leptospirosis with Pulmonary Hemorrhage, Caused by a New Strain of Serovar Lai: Langkawi.

This article presents a case illustrating that the less adventurous tourist may also become infected with leptospirosis. The clinical presentation of leptospirosis can vary from a nonspecific febrile illness to a complicated, potentially fatal, disease after an incubation period of 2 to 30 days. An acute leptospiremic phase may be followed by an immune phase. Symptoms usually start with a sudden onset of fever, chills, headache, and myalgia. Peripheral conjunctival infection suffusion is often seen. Jaundice is reported in 0% to 93% of large confirmed case series, and is typically orange-yellow, caused by reversible hepatocellular dysfunction. Renal failure is common in complicated disease. Severe leptospirosis with hepatorenal complications and hemorrhages is often referred to as Weil's syndrome. The histopathologic hallmark of leptospirosis is capillary vasculitis. Oliguria is caused by tubular necrosis, and this clinical finding signals a poor prognosis. Interstitial nephritis may also occur. The lungs are not affected, but PH is being reported increasingly all over the world, and several serovars have been implicated. Severe disease with PH may occur without jaundice. Rhabdomyolysis and myocarditis are rare.