Recreational ‘mud fever’: Leptospira interrogans induced diffuse alveolar hemorrhage and severe acute respiratory distress syndrome in a U.S. Navy seaman following ‘mud-run’ in Hawaii

Schmalzle, Sarah A; Tabatabai, Ali; Mazzeffi, Michael; Matta, Ann; Hollis, Allison; Zubrow, Marc; Rajagopal, Keshava; Thom, Kerri; Scalea, Thomas

Leptospirosis occurs in humans following contact of mucous membranes or abraded skin with the spirochete Leptospira interrogans, excreted in the urine of infected animals. Cases of leptospirosis can occur worldwide but are classically associated with tropical and subtropical regions [5] . Of the states in the USA, Hawaii has the highest endemicity [6] and was the initial clue to the diagnosis in this case. Exposure to contaminated water, soil, and other matter places several populations at risk-rural animal or vegetable farmers, slaughterhouse workers, flood victims, soldiers, and urban sanitation workers or children exposed to rat urine in garbage or alleyways. Based on the various presentations and patterns of exposure, the human form of this disease has gone by many names: Weil's syndrome, hemorrhagic jaundice, swineherd's disease, Fort Bragg fever, swamp fever, mud fever, autumn fever, field fever, rice-field fever, cane-cutter's fever, and canicola fever [5] . Improved sanitation and mechanization of agriculture decreased rates of this disease, with epidemic leptospirosis disappearing in the 1960s. Global climate change has now been implicated in its reemergence beyond classic geographic boundaries [7] [8] [9] . The epidemiology is changing in another way alsooutbreaks associated with recreational water sports have been increasingly documented [10] [11] [12] . Chemoprophylaxis for participation in water sports has been suggested by some but remains controversial [2, 12] .