A Life-Threatening Case of Severe Leptospirosis in Wales, UK - Recognising Severe Disease in Non-endemic Settings

Sep 30, 2026

Leptospirosis is an uncommon infectious disease in the United Kingdom, typically linked to occupational exposure, yet severe presentations can occur in non-endemic settings. Clinician awareness is critical because cases may progress to jaundice and acute renal failure. The report summarizes a 54-year-old man with a two-week history of malaise, fevers, and oliguria initially treated as sepsis of unknown origin. Rapid deterioration required ITU admission for haemofiltration while investigations confirmed the diagnosis.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages5

Reading Time13 min

AccessFree to download

Introduction

Clinical features and transmission

Case Presentation

Presentation and initial management

ITU care and follow-up

Review began 11/28/2025 Review ended 12/05/2025 Published 12/10/2025 © Copyright 2025 Ahmed et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98918 Open Access Case Report A Life-Threatening Case of Severe Leptospirosis in Wales, UK: Recognising Severe Disease in Nonendemic Settings Hosham Ahmed 1, Anas Ishqair 2, Rehan Khalil 2 , Sala Fadelallah 2 1. Medicine, University Hospital of Wales, Cardiff, GBR 2. Internal Medicine, University Hospital of Wales, Cardiff, GBR Corresponding author: Hosham Ahmed, [hosham.a95@gmail.com](hosham.a95@gmail.com) Abstract Leptospirosis is an infectious disease that is uncommonly seen in the United Kingdom. It is typically associated with occupational exposure among sewage workers, farmers, veterinarians and abattoir employees. The illness is known by other terms such as seven-day fever, haemorrhagic fever and Weil’s disease. The prevalence of leptospirosis outside of the United Kingdom is well documented, however it remains relatively uncommon to be encountered in hospitals inside the UK. While the majority of cases encountered are mild, severe disease with jaundice and acute renal failure has been described, highlighting the importance of clinician awareness in non-endemic settings. We summarise the case of a 54-year-old male with a two-week history of malaise, fevers and oliguria who was initially treated for sepsis of unknown origin. The patient rapidly deteriorated and was admitted to ITU for haemofiltration whilst further investigations took place to establish a diagnosis. Categories: Internal Medicine, Infectious Disease Keywords: acute kidney injury, dialysis, leptospirosis, severe, uk-united kingdom Introduction This case aims to highlight the potential severe and even fatal consequences of leptospirosis so that clinicians should be able to identify risk factors and investigate promptly should the suspicion be there even in non-endemic environments. Leptospirosis is a zoonotic infection which is caused by the spirochaete Leptospira interrogans. The organism thrives in warm, humid environments, making leptospirosis far more prevalent in tropical and subtropical regions [1] . However, the phenomenon of the global spread of leptospirosis has been increasingly recognised: incidence trends show that temperate and high-income countries are no longer excluded from risk, with travel, migration and changing recreational exposures contributing to this shift [2] . Surveillance within the European Union/European Economic Area shows that notification rates of leptospirosis increased by approximately 5% per year over 2010-2021, illustrating a rising burden even intemperate regions [3] . Clinically leptospirosis has a biphasic presentation-an early phase and a second immune phase. The early leptospiraemic phase generally lasts around a week and may be mild or even subclinical. Individuals may only have flu-like symptoms during this stage. Subconjunctival haemorrhage/redness is also commonly seen. The second phase can lead to severe infection known as Weil’s disease; this gives rise to renal failure, hepatitis and even aseptic meningitis [4] . A diagnosis in temperate regions such as the UK can be challenging given the wide array of symptoms and overlap with other infectious diseases such as dengue, malaria and influenza virus [5] . Transmission occurs primarily through exposure to water or soil contaminated with the urine of infected animals, particularly rodents. Rates of transmission are affected by changes in climate as well as one 's environment; for example, we know the bacteria itself occupies warm conditions and tends tobe found in rivers, sewers and waterlogged soil. Laboratory confirmation remains key in establishing a diagnosis. It

FAQs

Why is severe leptospirosis important in non-endemic UK settings?

The article emphasizes that clinicians should recognize that leptospirosis can have severe or even fatal consequences even outside endemic regions, despite being uncommon in the UK.

What were the patient’s presenting symptoms and initial working diagnosis?

A 54-year-old man presented with nausea, fevers, myalgia, diarrhoea, and poor urine output. He was initially treated for sepsis of unknown origin due to haemodynamic instability.

How was severe disease managed, and what was the outcome?

The patient received broad-spectrum antibiotics and required ITU admission for haemofiltration and invasive monitoring. After improvement, he was weaned off vasopressors, transferred for further dialysis, then discharged with doxycycline and renal clinic follow-up.

Sep 30, 2026

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