Clinical Scorecard: Leptospirosis as a recurring indicator of climate change and urban health inequities

At a Glance

Key Highlights

• More than one million leptospirosis cases occur worldwide each year; approximately 5–10% develop severe multisystem disease.
• Severe disease may include jaundice and acute kidney injury; reported mortality is approximately 5–15%.
• In New York City, locally acquired cases increased from an average of about 3 annually during 2001–2020 to 24 confirmed cases in 2023.
• In urban settings with established reservoirs, heavy precipitation, flooding, and insufficient drainage may move Leptospira from contaminated urine and feces into standing water; warmer, wetter conditions may prolong environmental survival.
• The source describes disproportionate risk among people experiencing homelessness and concentration of cases in high-poverty neighborhoods where rodent burden overlaps with socioeconomic disadvantage.

Guideline-Based Recommendations

Diagnosis

• In the reported case, leptospirosis remained high in the differential given the epidemiologic setting, despite no recognized bite or direct animal contact.
• PCR identified Leptospira DNA four days after the second admission.
• The reported case included fever, myalgias, jaundice, renal dysfunction, thrombocytopenia, and elevated creatine phosphokinase.

Management

• The reported patient received empiric broad-spectrum antibiotics for presumed sepsis, intravenous fluids, and electrolyte repletion; doxycycline was started after PCR identification.

Monitoring & Follow-up

• During clinical improvement in the reported case, liver enzymes, bilirubin, renal function, and platelet count progressively normalized.
• Close outpatient follow-up was planned after discharge in the reported case.

Risks

• Severe leptospirosis can include jaundice, acute kidney injury, and neurologic, ocular, hematologic, or gastrointestinal complications.
• The article reports approximately 5–15% mortality in severe disease.
• The source describes rodent reservoirs, flooding, heavy precipitation, insufficient drainage, and socioeconomic conditions including housing instability as relevant urban risk factors.

Patient & Prescribing Data

The case involved a 42-year-old man experiencing homelessness with alcohol use disorder, PCR-confirmed severe leptospirosis, hepatorenal dysfunction, rhabdomyolysis, and thrombocytopenia.

He received empiric broad-spectrum antibiotics, intravenous fluids, and electrolyte repletion; doxycycline was started after PCR confirmation. His clinical status and laboratory abnormalities improved, and he was discharged in stable condition with planned close outpatient follow-up.

Clinical Best Practices

• The case illustrates considering leptospirosis in a compatible illness and epidemiologically relevant setting, including an urban setting.
• The case history included shelter residence and sleeping in an area where rats might have been present; the patient denied recognized bites or direct contact.
• The reported severe case had renal, hepatic, hematologic, electrolyte, and muscle-enzyme abnormalities.
• The case report describes doxycycline after PCR confirmation, with intravenous fluids and electrolyte repletion.

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