Clinical Snapshot
Leptospirosis After a Trip to Bali
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An 18-year-old male developed high fever, chills, headache, and limb pain on his flight home from a trip to Bali. Clinical examination the following day revealed a discrete widespread rash on the trunk (Figure 1), eyes redness (Figure 2) and a fever of 39.7°C. Initially, CRP levels were only mildly elevated. However, after the patient’s fever rose to 41.3°C and he became increasingly drowsy on the following day, his CRP level increased to 185 mg/L. A rise in transaminases (GPT of up to 186 U/L) was also seen. Approximately 2 weeks earlier, while in northern Bali, the patient had bathed in waterfalls and jumped from 14-m-high cliffs. Shortly after disease onset, his 18-year-old travel companion, also male, became ill with the same symptoms following similar exposure (5-m jump). The two patients were successfully treated with ceftriaxone plus doxycylin and doxycyclin alone, respectively. Whole-blood PCR analysis confirmed leptospirosis in both cases (Leptospira interrogans DNA-positive, detectable in specialized laboratories), even before antibody detection. The key to rapid diagnosis and treatment of patients returning from vacation with fever is to ask about contact with fresh water in rivers/lakes in combination with concomitant skin injuries, mucous membrane contact, or water ingestion. Prompt initiation of antibiotic therapy is prognostically important since the efficacy of this treatment subsequently levels off as the immune phase starts and a cytokine storm and organ complications may develop.
Dr. med. Günther Slesak, Dr. med. Johannes Schäfer, Tropenklinik Paul-Lechler-Krankenhaus, Fachbereich Tropenmedizin, Tübingen, slesak@tropenklinik.de
Conflict of interest statement: The authors declare that no conflict of interest exists.
Translated from the original German by Christine Rye.
Cite this as: Slesak G, Schäfer J: Leptospirosis after a trip to Bali. Dtsch Arztebl Int 2025; 122: 460. DOI: 10.3238/arztebl.m2025.0103
