Leptospirosis onboard afloat unit: Case report of an underreported infectious disease

Rat-borne diseases including leptospirosis have been of historical importance in the military. With the risk of human-rat encounters onboard ships and vessels, encountering such an illness at sea is not rare for a primary care physician. Thus, it becomes important for those at the front, to be aware of its presentation and management. Leptospirosis must always be considered as a differential diagnosis of febrile patients, in an environment with positive risk factors. We present the case of a 30-year-old sailor managed and evacuated at sea, who presented with fever and abdominal pain. Our patient was found to have hypotension with oliguria and was administered fluid resuscitation along with broad-spectrum antibiotics while at sea, with a provisional diagnosis of acute pyelonephritis and differential diagnosis of leptospirosis. He was evacuated to a tertiary care center where he was evaluated and managed as anicteric leptospirosis. Our patient had an uneventful recovery. It is essential for primary health-care workers to have a high level of suspicion, to ensure the successful management of such atypical infections. Earliest initiation of empirical antibiotic therapy and symptomatic management along with fastest means of evacuation is suggested to ensure best outcome. The availability of rapid diagnostic tests at primary care centers is a must, to ensure early diagnosis and treatment. Although curable, prevention by rodent control and hygiene maintenance continues to be the most effective and economical methods to minimize the loss of workforce, morbidity, and mortality due to leptospirosis.