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Short Report
Bacterial infections
Leptospirosis is a pandemic zoonosis largely distributed in tropical areas, where warm climate conditions are favourable for Leptospira sp. maintenance in the environment. Feral and domestic animals can be directly affected by specific serovars, but simultaneously functioning as life-long reservoirs for other pathogenic serovars. Humans contract the disease by direct or indirect contact with infected urine of reservoir animals [1, 2]. Because leptospires can survive for long periods in the environment, notably through biofilm formation [3], abraded skin or mucous membranes may serve as port of entry for dissemination in the body [1]. Humans are mainly accidental hosts. Clinical manifestations span from subclinical or mild to severe symptoms, the latter associated with high mortality rate [1].
Rarely, and in high disease transmission settings, humans might develop into carrier state [4]. Recreational water activities and flooding have been described as the main source of infection in various case reports [5, 6]. In Europe, sporadic cases associated with outdoor activities (prolonged exposure to contaminated water) have been described [7]. We report upon an outbreak of human leptospirosis in Belgium in scouts attending a summer camp along the banks of the Semois river and the subsequent environmental investigations of one wildlife rodent population residing alongside the river.
The cases. On 17 August 2012, within an interval of a few hours, three boy scouts presented to the emergency department 7 days after returning from a scout camp (1-10 August 2012) on the banks of the Semois river in the Belgian Ardennes. Scout no. 1, aged 13 years, presented generally ill with clinical signs of viral meningitis associated with myalgia, anorexia and headache, and complained of irritated eyes and a painful throat with a dry cough. Clinical examination revealed bilateral conjunctivitis, neck stiffness, photophobia, pharyngitis and fever. A lumbar puncture indicated lymphocytic meningitis (predominance of 72% lymphocytes) with elevated protein concentration. Blood analyses revealed slightly increased creatinine and C-reactive protein (CRP) levels (Table 1). Common causes of viral meningitis were excluded (Table 1) as were Borrelia burgdorferi, Mycoplasma pneumoniae and West Nile virus infection because of a recent holiday in Tuscany, Italy after the scout camp. Scout no. 2, aged 14 years, presented with diffuse myalgia, general malaise,...