Leptospirosis Zoonotic Infection in a Veterinary Technician in North County

If a Pet has Leptospirosis, But No One Tests for it: Does it Really Have Lepto?

One Clinic’s Experience with Lepto and the Zoonotic Infection of a Technician
On June 4, 2011, a pet sitter dropped off one of my client’s dogs, a 12 year old Greyhound named Baron, who was not eating, vomiting, weak, trembling and shaking.  The clients were in New York, on their way to a cruise in Europe, and Baron had been sick for a few days.
On presentation, Baron was dehydrated and had an irregular heart rhythm with tachycardia and weak and asynchronous pulses.  His back legs were sliding out on him and he was trembling.  I suspected heart disease among other things due to his history and got permission for blood tests and xrays, ECG etc.
The blood tests came back and Baron had a BUN >180, CR >20.0, Ca = 11.6 and Phos >20.0, K >8.5, and an ALT = 148 ( normal range 10-118).
We started treating Baron for Acute Renal Failure and I decided to run a lepto panel because the ALT was a little high (and I had just been to a CE conference about Lepto).  Although I did not really think this was lepto in a 12 year greyhound that lives in the suburban sprawl of Vista, I decided to cover my bases.  We started Baron on Antibiotics to cover for Lepto and I warned all the staff to wear gloves when handling him.
Unfortunately, Baron deteriorated quickly over the next 24 – 48 hours and we decided to euthanize him.  He had developed anuria, pettechiation, respiratory signs and became almost comatose.  
A few days later we got his test results back from the lab.  Baron had never been vaccinated for Lepto, or at least not in the past ten years.   He was positive for L. Pomona at 1:3200 and L. Autumnalis at 1:800.  Negative for 4 other serovars.  The PCR was negative. The autumnalis was thought to be a cross reaction to the pomona according to the lab.  
Every employee, including a pregnant employee, was instructed to start antibiotic therapy right away according to his or her doctor’s instructions.   The clients and the pet sitter could not be reached for the next two weeks despite multiple attempts.
About a week or two later, my head nurse became ill with flu like symptoms and what she thought was a kidney infection.   She was diabetic and had kidney infections before.  Her doctor ran some tests and started her on antibiotics.  The doctor called her back in for IV fluids when her tests came back after discovering her renal values were high.  She was placed on outpatient IV Fluids for the day due to suspected Kidney infection.  The next day she told him about the case of Lepto we had in the hospital and they tested her for multiple serovars.  Lepto organisms were seen in her urine and her tests were positive for Leptospirosis.  Apparently, she had handled the dog when he was euthanized, she had not worn gloves but washed her hands later.   She never started a prophylactic course of antibiotics because she did not think she could catch it since she washed her hands and did not touch her mouth.  We were all unaware at the time that the organism can cross into the bloodstream through cuts, cuticles, broken skin etc.  
My technician was out of work for about 2-3 weeks.  During that time, as her body cleared the infection, she experienced severe respiratory symptoms and whole body bruising and pettechiation.  Although it concerned us, her doctors did not seem too worried about it saying it was classic for Lepto and would get better.
In the late 90’s, clients were very concerned about vaccines and vaccine reactions.  As a response to this concern we stopped including Lepto in our vaccine protocols.  Afterall, we hadn’t seen Lepto and the lepto in the old vaccines was not the most common serovar around.   So I half jokingly told my clients that we will stop vaccinating for it and eventually we will start to see it again and then we will restart vaccinating for it again.   Well it appears that time has come.  
We now include the four way Lepto in all our Distemper combo vaccines and only remove it when a dog is known allergic to it.  If an indoor dog that sleeps on the couch and only goes outside in their backyard can come down with Lepto, then any pet can.   If we had not run the test for Leptospirosis, I worry that my technician may not have been diagnosed so quickly and could have suffered serious consequences as a result. After seeing the effects on my technician, it is not worth it to me to expose myself or my staff to this disease while handling pets.  As a result, I now include Lepto in every vaccine combo.   
Ironically, the owner of the dog is a public health nurse.  She understood the severity of the zoonotic potential and fortunately she and her family were out of town when Baron probably contracted the illness.   Upon questioning it was discovered that Raccoons do visit the yard on occasion leading us to believe that he contracted the illness from exposure in his yard to infected urine.
This past week, we euthanized a 1 year old dog from Escondido, previously unvaccinated to Lepto,  that had a three day history of vomiting, lethargy and anorexia.  His lab results indicated a BUN >180 and Cr >13.5, Phos = 18.0, ALT = 127, Amylase 2481, HCT = 25.79, RBC = 3.77, Hgb=9.0.  His Lepto titers were negative except for L. canicola which was positive at 1:200.  Although not confirmatory, it was believed to be highly supportive of Leptospirosis infection.  A convalescing titer in 2-3 weeks would be needed to confirm the diagnosis.  The PCR test was negative.  All staff are starting antibiotics as a precaution.    
If you have any questions on this case, please feel free to contact Dr. Jenny Schiebert at Shadowridge Veterinary Hospital at 760-727-7900

Dr. Jenny Schiebert